Any attendings out there regret not doing a fellowship?

[propofabulous]

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Any attendings out there who have had a few years of experience really regret not doing a fellowship (whether due to difficulty getting a job, or missing out on doing a certain type of case, or feeling like you are not achieving your potential)? If so, which one do you regret not doing and why? Likewise, if you considered doing a fellowship but passed on it and are happy with your decision, I would love to hear your opinion as well. Thanks!

 

[turnupthegas]

Been out around 2.5 years. Was big on regional in residency and considered doing a fellowship (interviewed and received offers). Got pretty good and it as we had a lot of exposure in residency. After speaking with a few groups, pay wasn't going to change much if at all. My first job I was hired in academics as if I did the fellowship (block team) and paid as such. My current job is a partnership based on productivity. About half my class did one, the others did not. All got amazing jobs. Some of the people I work with don't want to do cardiac or peds anymore and trained at great places only after 3 years.

I will say if you want to stay in high brow academics - it may be helpful. If you want more than 50% of your case load to be peds/cardiac - Do it. ICU takes a pay cut. Pain is a different beast and has it's own issues. Do it if you love it. Opportunity cost is high (350-450k/lifestyle change).

 

[Mikkel]

I'm thankful every day that I didn't waste a year of my life doing a fellowship.

 

[caligas]

I'm thankful every day that I didn't waste a year of my life doing a fellowship.

same

 

[nycitygas]

I 100% regret doing a fellowship for a multitude of reasons.

 

[hununuh]

I 100% regret doing a fellowship for a multitude of reasons.

Which fellowship did you do?

 

[ProRealDoc]

I'm glad I did one as it has allowed me to command a higher salary than I ever imagined. I have not taken in-house call in 4 years and only stay past midnight finishing up a case 2-3 nights a year, all because of my fellowship. So for me, it was worth every dime. I have BladeMDA to thank for his sound advice.

 

[kidthor]

I did a peds fellowship and 100% do not regret it.

 

[kidthor]

I'm glad I did one as it has allowed me to command a higher salary that I ever imagined. I have not taken in-house call in 4 years and only stay past midnight finishing up a case 2-3 nights a year, all because of my fellowship. So for me, it was worth every dime. I have BladeMDA to thank for his sound advice.

Which fellowship is this?

 

[caligas]

Which fellowship did you do?

Advanced bed control.

 

[ProRealDoc]

Which fellowship is this?

Cardiac

 

[Mikkel]

I'm glad I did one as it has allowed me to command a higher salary that I ever imagined.

How much do you make?

Do you bill your units higher than non-fellowship trained anesthesiologists somehow? Are you doing more units?

 

[deleted171991]

Advanced bed control.

That's the residency. The fellowship is about inserting the TEE probe and showing the images to the surgeon, so s/he can tell you what to do next.

 

[ProRealDoc]

How much do you make? Send me your W-2s and tax filings and I'll send you mine.

Do you bill your units higher than non-fellowship trained anesthesiologists somehow? Are you doing more units?

I don't do my own billing so I really don't care.

 

[caligas]

That's the residency. The fellowship is about inserting the TEE probe and showing the images to the surgeon, so s/he can tell you what to do next.

haha. I used to work with a heart surgeon that grabbed the probe through the drapes to move it around.

 

[Mikkel]

I don't do my own billing so I really don't care, but I average $450-500k every year.

That's pretty decent pay. Good job finding that sweet gig. 👍

 

[deleted162650]

haha. I used to work with a heart surgeon that grabbed the probe through the drapes to move it around.

If I was working with him, every time I’d yell “Hey, that’s not the probe!”

 

[ProRealDoc]

That's pretty decent pay. Good job finding that sweet gig. 👍

Nice try!

 

[deleted171991]

If I was working with him, every time I’d yell “Hey, that’s not the probe!”

Pinocchio!

 

[dchz]

This is a very loaded question. And a lot of people try to one up each other on SDN, it's the nature of the beast. But let's examine this loaded question:

First, you have to ask people to specify which fellowship they did. I know for a fact i would regret a regional, OB, CCM, or pain fellowship. I'm not even out of fellowship yet and I know for a fact I'd quit mid fellowship if I had to go through what the regional guy does every day.

People also have a hard time being honest with themselves. Sure, some people got great jobs through connections that really didn't need fellowship. But how does that other guy that barely made it through residency with below average skills know anything besides his job?? How would he know what opportunities he would had if he refined his skills in fellowship? People don't know what people don't know.

Conversely, some people complain about stuff regardless of how good they've had it. What if one did a fellowship and is at a reasonable job, but doesn't know what ****ty job they would have had if they didn't do a fellowship? Sometimes people just don't know what they have in the bigger context.

Another reason why this is a loaded question: Some people go into fellowships with the wrong expectations. E.g. If you want to go into a fellowship because you think it would give you a better job and better pay. you're gonna be very disappointed if you did a CCM fellowship and actually have to take a pay cut to work CCM. That person would obviously regret doing the CCM fellowship. However, if another person wants to do CCM because he likes the pace, loves being the PA's bitch, and taking care of the critically ill brings him joy every day. That person would not regret doing the same exact fellowship.

 

[deleted171991]

Another reason why this is a loaded question: Some people go into fellowships with the wrong expectations. E.g. If you want to go into a fellowship because you think it would give you a better job and better pay. you're gonna be very disappointed if you did a CCM fellowship and actually have to take a pay cut to work CCM. That person would obviously regret doing the CCM fellowship. However, if another person wants to do CCM because he likes the pace, loves being the PA's bitch, and taking care of the critically ill brings him joy every day. That person would not regret doing the same exact fellowship.

Let's not mention the people who have only seen one model of practice, because they haven't had too many jobs, so they think everybody everywhere is the midlevels' bitch, as in anesthesia. 😉

I trained in a place with midlevels, and even as a fellow I was treated with way more respect than what I get from the average CRNA as an anesthesiology attending.

On topic, I don't recommend a CCM fellowship except for the truly passionate, who live and breathe critical care.

 

[Mikkel]

some people complain about stuff regardless of how good they've had it. What if one did a fellowship and is at a reasonable job, but doesn't know what ****ty job they would have had if they didn't do a fellowship? Sometimes people just don't know what they have in the bigger context.

My personal limited experience is that the best jobs around specifically do not require a fellowship.

1) Fellowship requirements usually involve practices which straight-salary employees, which means someone else is getting a slice of your revenue.

2) Fellowship requirements usually involve jobs in geographically-desirable locations, which means the labor market is in favor of the employer, which means employee terms will be less than favorable.

3) Fellowship requirement for some but not all positions in a group could have been enacted to underpay non-fellowship new hires (you don't have a fellowship? Your salary will be $50k less than a fellowship trained guy).

4) Fellowships and subsequent case focus can trap you in a group as you lose your generalist skills (100% peds guy trying to find a job in the same town but trying to do adults again after 10 years). Less job mobility and less negotiating strength.

 

[dchz]

My personal limited experience is that the best jobs around specifically do not require a fellowship.

1) Fellowship requirements usually involve practices which straight-salary employees, which means someone else is getting a slice of your revenue.

2) Fellowship requirements usually involve jobs in geographically-desirable locations, which means the labor market is in favor of the employer, which means employee terms will be less than favorable.

3) Fellowship requirement for some but not all positions in a group could have been enacted to underpay non-fellowship new hires (you don't have a fellowship? Your salary will be $50k less than a fellowship trained guy).

4) Fellowships and subsequent case focus can trap you in a group as you lose your generalist skills (100% peds guy trying to find a job in the same town but trying to do adults again after 10 years). Less job mobility and less negotiating strength.

I don't think you can make an argument of the bolded portion. Are you saying that they will not hire you for the job, other thing equal, if you had a fellowship? That makes no sense to me.

For the sake of the argument, would you let us know what part of the country you live in? what is the population of the city you live in?

1). This is not true. Having done a fellowship does not make you doomed to have someone take your revenue, nor do you have to be straight-salaried. How you equate the two is beyond me.

2). Yes. If you want to live where there are people. They usually require you be more trained to do certain type of cases (e.g. hearts. But on the other hand, i have never had anyone tell me I can't do blocks because i didn't have a regional fellowship). But doing a fellowship does not mean you have to live in those places. It means you're better at that sub specialty. Where u want to live does not dictated your fellowship nor vice versa.

3). This is only true if the group is desperate, e.g. extremely low supply of fellowship trained. Otherwise the door is closed to you if you don't have a fellowship. Also I have never heard of anyone letting me do chronic pain for $50k less per year w/o fellowship training.

4). This is true whether you have done a fellowship or not. Pigeonholing of any sort can give you skills atrophy. Again, neither a necessary nor a sufficient result of a fellowship.

 

[deleted171991]

I don't think you can make an argument of the bolded portion. Are you saying that they will not hire you for the job, other thing equal, if you had a fellowship? That makes no sense to me.

Absolutely, if they don't need that fellowship, and/or can't offer the type of job the candidate is trained for (especially true for recent grads). Examples:

- critical care anesthesiologist in a group that only does anesthesia
- pediatric anesthesiologist in a group that barely does kids
- cardiac anesthesiologist in a group that barely does hearts, if any
- pain doc in a group that doesn't have a pain clinic.

Et cetera, et cetera, et cetera. Try to think like a business person, and see who you would hire.

Versus the well-trained general anesthesiologist who will benefit from every subspecialty skill without anybody questioning his/her ulterior motives.

 

[Justice4all]

The opportunity cost with fellowship can't be argued against. I did two fellowships in pediatrics but i do not regret it. Maybe in 5 years or 10. Recommend not doing a fellowship because of midlevel encroachment or money. If not restricted by location, you can find a job that matches your wishes without a fellowship

 

[Dam272]

Absolutely, if they don't need that fellowship, and/or can't offer the type of job the candidate is trained for (especially true for recent grads). Examples:

- critical care anesthesiologist in a group that only does anesthesia
- pediatric anesthesiologist in a group that barely does kids
- cardiac anesthesiologist in a group that barely does hearts, if any
- pain doc in a group that doesn't have a pain clinic.

Et cetera, et cetera, et cetera. Try to think like a business person, and see who you would hire.

Versus the well-trained general anesthesiologist who will benefit from every subspecialty skill without anybody questioning his/her ulterior motives.

Applying for CCM this year. But being practical, not emotional, would not sacrifice QOL, “significant” pay cut, or location, just so that I can do CCM along with anesth. Though am hopeful

 

[deleted171991]

Applying for CCM this year. But being practical, not emotional, would not sacrifice QOL, “significant” pay cut, or location, just so that I can do CCM along with anesth. Though am hopeful

Then why are you applying? Because the chances of not sacrificing QOL, pay and/or location, to do both, are virtually nil.

 

[abolt18]

I've had a lot of concern recently about fellowship limiting my future in some ways.

I know I definitely want cardiac to be a part of my career, but not all day every day. I enjoy all other aspects of anesthesia (minus sick kids and NICU). I'd like to practice in an environment where I get to do CT a couple/few days a week, but still get to do healthy peds, OB, regional, etc. I enjoy all of those things and don't want to lose any part of them in the near future.

Couple weeks from submitting fellowship application. Can't help but feel a bit nervous and have to keep asking myself if it's the right choice for me. I appreciate this thread and the conversations.

 

[deleted171991]

I've had a lot of concern recently about fellowship limiting my future in some ways.

I know I definitely want cardiac to be a part of my career, but not all day every day. I enjoy all other aspects of anesthesia (minus sick kids and NICU). I'd like to practice in an environment where I get to do CT a couple/few days a week, but still get to do healthy peds, OB, regional, etc. I enjoy all of those things and don't want to lose any part of them in the near future.

Couple weeks from submitting fellowship application. Can't help but feel a bit nervous and have to keep asking myself if it's the right choice for me. I appreciate this thread and the conversations.

Do what you love and never look back. Do something you would do all day, every day. Otherwise, you could be in for a VERY long year of fellowship.

Let me tell you about my fellowship experience: every morning, I couldn't wait to get to work and learn some more. I swear!

 

[Mikkel]

I don't think you can make an argument of the bolded portion. Are you saying that they will not hire you for the job, other thing equal, if you had a fellowship? That makes no sense to me.

If I was in a group that was filled with generalists, and I had to choose between a pediatric anesthesiologist who's been doing only peds for 5 years and a fresh graduate, I would pick the fresh graduate.

If I was in a group that did only anesthesia, I would definitely not hire a CCM/pain fellowship trained person who expected to do CCM/pain regularly.

1). This is not true. Having done a fellowship does not make you doomed to have someone take your revenue, nor do you have to be straight-salaried. How you equate the two is beyond me.

A group that advertises "CCM fellowship required" for instance has a level of complexity and hierarchy that doesn't engender itself to a non-salary payment structure. You're already classifying people based on extrinsic factors, not on actual work output like a unit-based payment structure.

In other words, it's an academic-private fusion... these are typically unequal.

Would you expect to be paid more for equal work just because you spent an extra year doing something that the other person didn't? An academic group would say yes, true equal private group would say hell no.

2). Yes. If you want to live where there are people. They usually require you be more trained to do certain type of cases (e.g. hearts. But on the other hand, i have never had anyone tell me I can't do blocks because i didn't have a regional fellowship). But doing a fellowship does not mean you have to live in those places. It means you're better at that sub specialty. Where u want to live does not dictated your fellowship nor vice versa.

I meant to say that highly desirable geographic locations tend to require fellowships, but they'll also be unequal, favoring the old partners, because they have the upper hand in that labor market.

Those positions tend to pay less than geographically worse places.

3). This is only true if the group is desperate, e.g. extremely low supply of fellowship trained. Otherwise the door is closed to you if you don't have a fellowship. Also I have never heard of anyone letting me do chronic pain for $50k less per year w/o fellowship training.

If the door is closed because you don't have a fellowship, maybe it's better that you didn't take that job anyway (reasons above).


Regarding pain...
Either you can do chronic pain or you can't, whether by skills or by bylaws.

I know of plenty of non-fellowship trained anesthesiologists, who are recent graduates, who are now doing occasional pain days.

They bill on procedures, is blind to fellowship.

4). This is true whether you have done a fellowship or not. Pigeonholing of any sort can give you skills atrophy. Again, neither a necessary nor a sufficient result of a fellowship.

Having the fellowship advertises the fact that you might be skills deficient compared to a generalist. This could hurt your chances.

 

[MoMoGesiologist]

Then why are you applying? Because the chances of not sacrificing QOL, pay and/or location, to do both, are virtually nil.

Not always. My ICU fellowship got me a pay raise and the location I wanted

 

[Mikkel]

I've had a lot of concern recently about fellowship limiting my future in some ways.

I know I definitely want cardiac to be a part of my career, but not all day every day. I enjoy all other aspects of anesthesia (minus sick kids and NICU). I'd like to practice in an environment where I get to do CT a couple/few days a week, but still get to do healthy peds, OB, regional, etc. I enjoy all of those things and don't want to lose any part of them in the near future.

Couple weeks from submitting fellowship application. Can't help but feel a bit nervous and have to keep asking myself if it's the right choice for me. I appreciate this thread and the conversations.

Try to find a group that is open to non-fellowship guys who want to do basic cardiac.


If you have enough cases as a resident, enough echo numbers, and if the hospital bylaws don't exclude it, see if you can backdoor the cardiac. Fewer and fewer places let you do that, but it's worth investigating.

 

[Mikkel]

Not always. My ICU fellowship got me a pay raise and the location I wanted

What are you generating versus what's paid as salary?

Comparing apples and oranges.

 

[sevoflurane]

We have combo ICU/Anesthesia.
We wouldn’t take it on if it didn’t at least break even (associated stipend)

 

[Mikkel]

We have combo ICU/Anesthesia.
We wouldn’t take it on if it didn’t at least break even (associated stipend)

Why would you get a stipend? How many CCM guys? Are you the only group offering coverage?

 

[abolt18]

Do what you love and never look back. Do something you would do all day, every day. Otherwise, you could be in for a VERY long year of fellowship.

Let me tell you about my fellowship experience: every morning, I couldn't wait to get to work and learn some more. I swear!

That's the thing. I am just about that pumped every single day about ANESTHESIA. It's just extra pump when doing CT. I enjoy echo and want to become an expert in it (which I know will happen from personal drive rather than just fellowship serving it up on a platter.)

But loving these things doesn't mean I don't want to ALSO do the other parts of anesthesia. I do think I could be happy doing purely CT but I want to remain well-rounded and maintain the skills I'm developing in residency.

 

[sevoflurane]

Why would you get a stipend? How many CCM guys? Are you the only group offering coverage?

Negotiated stipend. Only aneathesia group providing ICU coverage. There is a pulm/cc group in town, but they don’t work at the hospital we staff.

 

[Mikkel]

That's the thing. I am just about that pumped every single day about ANESTHESIA. It's just extra pump when doing CT. I enjoy echo and want to become an expert in it (which I know will happen from personal drive rather than just fellowship serving it up on a platter.)

But loving these things doesn't mean I don't want to ALSO do the other parts of anesthesia. I do think I could be happy doing purely CT but I want to remain well-rounded and maintain the skills I'm developing in residency.

You might want to consider working for a few years and a generalist, and see how much you want to go back and do a fellowship.

Not many people go back, and that might be a good thing.

Maybe you'll find the right job without a fellowship, and you might be able to dabble in cardiac.

 

[abolt18]

Try to find a group that is open to non-fellowship guys who want to do basic cardiac.


If you have enough cases as a resident, enough echo numbers, and if the hospital bylaws don't exclude it, see if you can backdoor the cardiac. Fewer and fewer places let you do that, but it's worth investigating.

My concern is that if in 10 (or however many) years I want to move jobs and still want CT, it'll likely only be HARDER to find these places that let you do cardiac without a fellowship.

 

[abolt18]

You might want to consider working for a few years and a generalist, and see how much you want to go back and do a fellowship.

Not many people go back, and that might be a good thing.

Maybe you'll find the right job without a fellowship, and you might be able to dabble in cardiac.

Definitely something I've considered. It's a big ask of my wife though. It's one thing to continue the neverending training for an extra year. A whole different request to go BACK to this life after years of practice and $$$. I don't think she could support the return to training haha.

 

[deleted171991]

That's the thing. I am just about that pumped every single day about ANESTHESIA. It's just extra pump when doing CT. I enjoy echo and want to become an expert in it (which I know will happen from personal drive rather than just fellowship serving it up on a platter.)

But loving these things doesn't mean I don't want to ALSO do the other parts of anesthesia. I do think I could be happy doing purely CT but I want to remain well-rounded and maintain the skills I'm developing in residency.

I love TEE, too. Went into PP thinking that I can do cardiac for 1-2 days a week. Hated it, stopped after a few weeks. Not for me. I used to like it as a resident; not the same thing.

Do you love crazy big cases, polytraumas, liver/lung transplant, ruptured aortic aneurysms etc.? Do you look forward to them even at 3 am, after 20 hours in the OR? Then cardiac is for you.

 

[Mikkel]

My concern is that if in 10 (or however many) years I want to move jobs and still want CT, it'll likely only be HARDER to find these places that let you do cardiac without a fellowship.

Anecdotal: I know of a good chunk of CT-fellowship attendings want to give it up anyway after 10 years because they are sick of the complexity and call.

I also know two guys who did cardiac after residency without fellowship, and they stopped doing it after 3-4 years.

 

[Mikkel]

Definitely something I've considered. It's a big ask of my wife though. It's one thing to continue the neverending training for an extra year. A whole different request to go BACK to this life after years of practice and $$$. I don't think she could support the return to training haha.

That's the funny thing, the desire for fellowship dramatically changes after you finish training... Too bad so many people do it right after residency without the wisdom of working in private practice first.

 

[vector2]

That's the thing. I am just about that pumped every single day about ANESTHESIA. It's just extra pump when doing CT. I enjoy echo and want to become an expert in it (which I know will happen from personal drive rather than just fellowship serving it up on a platter.)

But loving these things doesn't mean I don't want to ALSO do the other parts of anesthesia. I do think I could be happy doing purely CT but I want to remain well-rounded and maintain the skills I'm developing in residency.

Doing CCM with enough elective time to do a ton of TEE and comfortably pass the advanced PTE was one of the best things I ever did from a personal growth standpoint. I just couldn't justify doing two years and following CCM with ACTA. I work in academics so I doubt fellowship was that helpful from a pay standpoint (maybe a slightly higher base), but I consider it a blessing that I'm at an institution where I can do cardiac/thoracic/vascular, bread and butter GA, occasional regional, occasional OB, and then get a break from it all and round in an essentially closed SICU with fellows and residents, not annoying AF PA's and NP's.

 

[vector2]

Definitely something I've considered. It's a big ask of my wife though. It's one thing to continue the neverending training for an extra year. A whole different request to go BACK to this life after years of practice and $$$. I don't think she could support the return to training haha.

I know you hear about ppl who have done it, and every now and then I think I might have to do it if my job or the market for jobs that allow cardiac with only aPTE testamur status dries up, but the farther out I get it's just unimaginable being a fellow again. Not just the pay, but getting the treatment of being a "PGY - X." Even though I'm not ACTA fellowship trained, my echo, cardiac anesthesia, and physiology knowledge base has only continued to grow with the studying I've done and case log I've built up as an attending, and I really don't think I'd be able to deal with some guy who's been staff for a shorter time than me trying to give me the business about weaning a B&B CABG or pimping about what a Simpson's method is. If I did do it though, it'd have to be at a place that's doing a ton of transplant, LVAD, clinical trial structural heart, clinical trial MCS devices, i.e. stuff I don't see every day.

 

[dchz]

If the door is closed because you don't have a fellowship, maybe it's better that you didn't take that job anyway (reasons above).


Regarding pain...
Either you can do chronic pain or you can't, whether by skills or by bylaws.

I know of plenty of non-fellowship trained anesthesiologists, who are recent graduates, who are now doing occasional pain days.

They bill on procedures, is blind to fellowship.

Having the fellowship advertises the fact that you might be skills deficient compared to a generalist. This could hurt your chances.

I respectfully disagree with your opinion.

Your quarrel with is really about geographical locations, it is a same problem that applies to both people who did fellowships and those who didn't.

Doing a fellowship means you've spent more time doing a particular aspect. For some aspects of anesthesia. It matters. All others equal, would you rather not have someone who did a CT fellowship do your cardiac anesthesia compared to someone who hasn't?

Finally, to say someone who did a fellowship that they have "skills deficits compared to a generalist" is frankly quite insulting.

You've responded to every part of my post except the part where i'm asking you about the geographical location and the size of the city you live in. Is that because you don't want me to discredit you? or is it because perhaps your world view is biased by your surroundings?

 

[Mikkel]

Finally, to say someone who did a fellowship that they have "skills deficits compared to a generalist" is frankly quite insulting.

So, you're saying that a peds cardiac anesthesiologist after ten years doing that is as good doing blocks for adults as someone who does it every day? 😵

 

[dchz]

So, you're saying that a peds cardiac anesthesiologist after ten years doing that is as good doing blocks for adults as someone who does it every day? 😵

4). This is true whether you have done a fellowship or not. Pigeonholing of any sort can give you skills atrophy. Again, neither a necessary nor a sufficient result of a fellowship.

I guess when we are talking in circles. one of us should end the conversation.

 

[psychbender]

That's the thing. I am just about that pumped every single day about ANESTHESIA. It's just extra pump when doing CT. I enjoy echo and want to become an expert in it (which I know will happen from personal drive rather than just fellowship serving it up on a platter.)

But loving these things doesn't mean I don't want to ALSO do the other parts of anesthesia. I do think I could be happy doing purely CT but I want to remain well-rounded and maintain the skills I'm developing in residency.

If that's your situation, then you should do the CT fellowship, and look for mixed practices when you start the job search. I and other colleagues on the cardiac team here have plenty of days doing general cases, too. Several other practices I've either experienced through locums or with whom I've interviewed expected their cardiac folk to spend time doing general cases and take some regular call (but less than the generalists). You don't have to get siloed into a pure cardiac practice unless you want that.

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[psychbender]

Why would you get a stipend? How many CCM guys? Are you the only group offering coverage?

I'm the only CCM guy currently in my group. The hospital had a need of intensivists when I was looking, and this group was willing to work to make a combined opportunity happen. My group bills the hospital a set rate for my time in the unit, and that money makes it's way to me. My activities are a small net profit to the group, and they are pleased enough that we've now interviewed two other anesthesia intensivists. Because of the higher valuation of a day in the unit compared to a day in the OR, I actually make a little more than most of my generalist partners, unless they take extra call or weekends.

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