Any CA3s NOT doing fellowship?

[26B]

---

Members do not see this ad.

As a current resident at one of those "ivory tower academic programs", nearly all of the graduating residents pursue some sort of fellowship, most commonly cardiac, pain, or peds, but lately a few regional, ICU, and OB as well. Some go even further and do 2 fellowships, (Cardiac/ICU, Peds/Cardiac, etc). In the last few years, I believe the % of graduates who did not pursue fellowship training was less than 5%. Because we almost never interact with recent non-fellowship trained grads to see how they are doing in their careers, I feel that my perception of the value/necessity of a fellowship is biased. As someone who doesn't really have a strong need to be in a big metropolitan area on one of the coasts, I've started to question whether the opportunity cost of a fellowship is really worth it.

So, for the current CA3s or new attendings on SDN, how many of you did not (or do not plan to) do a fellowship, and looking back, do you feel happy with that decision? How's the job market out there for general anesthesiologists, both in academics and private practice? Very interested to hear from both sides.

 

[2Fast2Des]

Didn't do a fellowship, I feel comfortable with my knowledge and skillset. Didn't have any passion for a specific part of anesthesia to spend another year as a trainee and I'm happy with being in the real world. Market is certainly out there for general guys

 

[Mikkel]

Units are units. Fellowship doesn't magically increase the value of a unit so that you get paid more. Only in salaried jobs where they stratify based on fellowship would you see maybe $10-15k difference, but that's usually offset by increased call (cardiac, peds).

Losing out on $400k for a year so that you maybe get $10k more in a salaried gig, is STOOPID.



Edge cases don't count (tons of OB in wealthy hospital, doing high volume cardiac in a major specialty hospital, high volume pain procedures).

 

[T-burglar]

Units are units. Fellowship doesn't magically increase the value of a unit so that you get paid more. Only in salaried jobs where they stratify based on fellowship would you see maybe $10-15k difference, but that's usually offset by increased call (cardiac, peds).

Losing out on $400k for a year so that you maybe get $10k more in a salaried gig, is STOOPID.



Edge cases don't count (tons of OB in wealthy hospital, doing high volume cardiac in a major specialty hospital, high volume pain procedures).

Fellowship won’t make you more money. Lucrative jobs that require subspecialty training don’t count.

 

[UrbanAchievers]

The fellowship push is out of control. Minimal need for fellowship outside of an academic center.

Plenty of very good general jobs available in my area where the salary loss in the one year fellowship will never be recuperated.

Pain/CC are a different story as most people doing those would be unable to practice in these roles without the fellowship.

 

[Mikkel]

The fellowship push is out of control. Minimal need for fellowship outside of an academic center.

Plenty of very good general jobs available in my area where the salary loss in the one year fellowship will never be recuperated.

Pain/CC are a different story as most people doing those would be unable to practice in these roles without the fellowship.

And with CC you lose income, and pain can be a crapshoot where you can lose money too compared to just anesthesia.

Fellowship won’t make you more money. Lucrative jobs that require subspecialty training don’t count.

It's anecdotal, but I've seen the most lucrative jobs not requiring subspecialty training. On the contrary, I've found the most important qualification for lucrative jobs is efficiency/ethic/skill instead of a piece of paper.

(I'm referring up lucrative private practice, $700k+. I'm not referring to "academic lucrative" where administrative stipends push you to high 6 figures.)

 

[AdmiralChz]

The fellowship push is hardly limited to our field - it’s just how it goes at big ivory tower places (as typically you need one to be employed there) for all specialties (Anes, Surgery, etc...). For other specialties (Path, Rads and Cardiology even) it can be difficult to find a job as a generalist and so fellowships (sometimes more than one!) are a necessity. Not the case for anesthesia.

There are absolutely some jobs out there that would not be open to you without a fellowship so you get a little bit more flexibility geographically, but there is plenty of work out there for generalists as well. Not a requirement at all, do what you like!

 

[pgg]

Pain/CC are a different story as most people doing those would be unable to practice in these roles without the fellowship.

Many (most?) places it's become difficult if not impossible for a new person to get credentialed to do hearts without the fellowship year and TEE boards. We can debate whether a community program doing 95% normal EF CABGs needs or measurably benefits from a fellowship trained anesthesiologist, but hospital credentialing is slowly but surely closing that door.

Current residents who like cardiac and want to do it in the future should do the fellowship.

 

[AdmiralChz]

Many (most?) places it's become difficult if not impossible for a new person to get credentialed to do hearts without the fellowship year and TEE boards. We can debate whether a community program doing 95% normal EF CABGs needs or measurably benefits from a fellowship trained anesthesiologist, but hospital credentialing is slowly but surely closing that door.

Current residents who like cardiac and want to do it in the future should do the fellowship.

Agreed.

The same is also true for younger kids under the age of 2 or so, many places even in the community are requiring a fellowship.

 

[Mikkel]

Many (most?) places it's become difficult if not impossible for a new person to get credentialed to do hearts without the fellowship year and TEE boards. We can debate whether a community program doing 95% normal EF CABGs needs or measurably benefits from a fellowship trained anesthesiologist, but hospital credentialing is slowly but surely closing that door.

Current residents who like cardiac and want to do it in the future should do the fellowship.

The irony is that there are places that are making it easier for CRNAs to do hearts, with none of the experience or knowledge required to do the job competently.

 

[T-burglar]

If you’re in training currently and you want a career in ACTA you should do the fellowship. Otherwise your prospects may be very low volume centers with dinosaur surgeons where respiratory therapy intubates your cardiac patients in the OR

 

[abolt18]

If you’re in training currently and you want a career in ACTA you should do the fellowship. Otherwise your prospects may be very low volume centers with dinosaur surgeons where respiratory therapy intubates your cardiac patients in the OR

RT intubating in the OR? That's a thing?

 

[Mikkel]

RT intubating in the OR? That's a thing?

RTs put in radial art lines as well.

 

[AdmiralChz]

The irony is that there are places that are making it easier for CRNAs to do hearts, with none of the experience or knowledge required to do the job competently.

Eh, not independently. There are certainly a lot of places out there that do ACT in the cardiac room (yep, including residencies) and it works well. The MD is the one directing the care anyway and doing the echo, the anesthetist is just a technician like any other case.

 

[pgg]

The irony is that there are places that are making it easier for CRNAs to do hearts, with none of the experience or knowledge required to do the job competently.

That is disturbing. Thankfully rare. 🙁

 

[XRanger]

RT intubating in the OR? That's a thing?

RTs put in radial art lines as well.

This is all part of ASA plan to have RTs replace CRNAs

 

[Mikkel]

This is all part of ASA plan to have RTs replace CRNAs

RTs put in art lines and intubate while in the ICU, has nothing to do with the ASA.

 

[DM27]

Out of the OR intubations tend to vary widely amongst facilities. I have seen Anesthesia only as airway management, I have seen Anesthesia attending only, I have seen CRNA only, I have seen Pulm only, RT only, CCM only, the list just keeps going.

 

[T-burglar]

RTs put in art lines and intubate while in the ICU, has nothing to do with the ASA.

*sound of a jet flying overhead very fast*

 

[rakotomazoto]

This issue comes up fairly frequently on here, try searching the threads and you will find plenty of discussion on the pros/cons of fellowship.

I chose to not do fellowship, I have been in private practice for one year now. That is my bias, so most people like me will say that there is no need to spend another year being told what to do, being treated like scum, and missing out on a significant amount of money in order to do a fellowship.

On the other hand, people who did fellowship will tell you that it was the best decision they could have made and that it set up their awesome career, doing cases they love.

The good news is that in anesthesia, you can find a great career either way, but it depends on what suits you. The hard part is that we tend to train in big academic centers where many attendings did fellowships and where there are strong incentives to influence the residents to sign up for fellowship. It's an echo chamber. Looking back, most of my academic attendings did not have an accurate sense of what it is really like to be in private practice. The ones that did were the few who had actually spent some time in private practice before returning to academia. There weren't very many of them.

Not once have I regretted my decision. Some of my partners are fellowship trained and we have subgroups that cover peds under age 2 and open heart cases. Everyone does everything else. Other than figuring out which partner to assign to do those special cases, no one cares who did fellowship and who didn't.

About half of my residency class ended up going into fellowships. I was recruited for every fellowship at some point by someone in residency, which I think was fairly common at my institution unless you were universally considered to be completely terrible. Politely declining interest was good enough for some people, but others tried to push a little harder or bring it up frequently. But I just knew fellowship wasn't for me.

Personally, I had plenty of job interviews and job offers, no one challenged my decision since they were obviously considering me as a candidate for a general position, not to fill a specialty need. In that regard, if the group you hope to join needs a specialist, then you will be glad you did fellowship. Conversely, if you did a fellowship but the group doesn't need your fellowship level skills, they might pass you by. If you are a cardiac trained, most people assume that you actually want to do cardiac cases and if I can't offer them to you, then I also assume that you are going to jump ship once you find another job where you can do hearts. In this scenario, fellowship can be a significant liability. But then again, if that perfect group really needs to cover some cardiac cases, then you are golden. This is why the best strategy is to pursue fellowship if you are either going into academics for sure or if you truly love that part of anesthesiology because it is difficult to project if it will help or hurt your prospects at specific private practice groups since hiring needs vary from year to year.

 

[zizzer]

I'm at a pretty academic-oriented major hospital residency program too, but a good chunk of our residents don't do fellowship (maybe a third).

I'll add a couple of reasons *not* to do a fellowship.
1. Money. That year of lost income to do a fellowship is tough to make back up.
2. Concern for needing more further training in general. If your program is weak in pediatrics or something and that's really important to you, go for it. That makes sense. But if you're concerned about what your end-residency general anesthesiology skills will be like while you're in CA-1 year or early CA-1 year making this decision, you have to realize you're not even halfway through your training and that you will improve a lot (with studying and effort). In fact, not doing fellowship and knowing you'll be responsible for making the decisions sooner is a great motivator to study.

 

[aneftp]

It feels like it’s 1994-1996 graduating anesthesia class years again. Where people did fellowships (those graduating med school 1990-1992)

Half the people I know from that era don’t even specialize in their fellowship trained areas

The funny thing is all the cardiac/critical care docs see the light. They do lucrative chill mainly outpatient gigs bread and butter community hospital jobs with low beeper call back.

My friend did cardiac fellowship. Did it for a couple of years out of training. Guess what he’s doing now? Outpatient ortho and gi 4 days a week.

 

[2Fast2Des]

It feels like it’s 1994-1996 graduating anesthesia class years again. Where people did fellowships (those graduating med school 1990-1992)

Half the people I know from that era don’t even specialize in their fellowship trained areas

The funny thing is all the cardiac/critical care docs see the light. They do lucrative chill mainly outpatient gigs bread and butter community hospital jobs with low beeper call back.

My friend did cardiac fellowship. Did it for a couple of years out of training. Guess what he’s doing now? Outpatient ortho and gi 4 days a week.

Wouldn't you be bored out of your mind doing that though? I mean a little challenge is good and keeps the wheel spinning. ASA 1 can only be so stimulating

 

[deleted171991]

Wouldn't you be bored out of your mind doing that though? I mean a little challenge is good and keeps the wheel spinning. ASA 1 can only be so stimulating

Good easy money is almost never boring. As the oldies say: in medicine, boring is good.

I am CC-trained, and still my favorite job is (non-GI) solo ASC, 7-3, Mon-Fri, especially as a partner, especially part-time. If I ever get it, I may just stop practicing CCM.

In the end, one has just one life, and one should work to live, not the other way round.

 

[2Fast2Des]

Good easy money is almost never boring. As the oldies say: in medicine, boring is good.

I am CC-trained, and still my favorite job is (non-GI) solo ASC, 7-3, Mon-Fri, especially as a partner, especially part-time. If I ever get it, I may just stop practicing CCM.

In the end, one has just one life, and one should work to live, not the other way round.

I guess as a guy 1 year out, I don't know if I'm ready to go on autopilot yet... Still getting my feet wet and enjoying a little bit of figuring things out as required, maybe when I'm more gray haired and burnt out I'll fall into that. How many years you think one has before that becomes okay to accept?

 

[p30doc]

Don’t do a fellowship unless you love and want to practice whatever the fellowship is in or if you want to be an academic. Waste of money otherwise, one more year until partner, one more year of slavery, one more year of student loan interest accruing. Don’t give into the peer pressure of academic self flagellation unless you truly want to do it for yourself.

There are private practice groups which don’t cover specialty cases who won’t hire a fresh fellow grad because they think you won’t be happy in the practice since you took the time out to pursue the fellowship. There are good jobs out there for new grads that don’t require a fellowship.

 

[deleted171991]

I guess as a guy 1 year out, I don't know if I'm ready to go on autopilot yet... Still getting my feet wet and enjoying a little bit of figuring things out as required, maybe when I'm more gray haired and burnt out I'll fall into that. How many years you think one has before that becomes okay to accept?

It took me about 5. 🙂

 

[Temeraire]

So, for the current CA3s or new attendings on SDN, how many of you did not (or do not plan to) do a fellowship, and looking back, do you feel happy with that decision? How's the job market out there for general anesthesiologists, both in academics and private practice? Very interested to hear from both sides.

Current CA-3 at an ivory tower program. Trends seem to change year to year. In contrast to the last few graduating classes, my class is heavily leaning no-fellowship this year. If you ask us why, there’s a general consensus that 1) we are tired of the trainee lifestyle why on earth would we sign up for more, and 2) recent graduates have told us that fellowship actually isn’t necessary to land a good job, even in our highly desirable geographic region (exception = you want to leave the OR entirely -> go pain/CC).

I worked with a highly competent and highly jaded cardiac attending who actively discouraged residents from pursuing fellowships —unless it was pain (lol).

 

[deleted697535]

You guys have to stop with this money business. Fellowship and money are not the same conversation. Fellowship is about learning. You cannot ever get the same opportunity if you just go work and hope to pick it up yourself.

Let's face it, every north American anesthesiiologist makes 10x the average wage at least and will be able to retire at 55 to 60.

A fellowship is about sorting out an internal need for some more skill or knowledge, which may or may not benefit you monetarily or job wise down the line but who cares. Do it if you want. Ignore the naysayers.

 

[T-burglar]

i actually like going to work on my cardiac days. In the general OR I watch the clock and it feels more like a job (a job that sucks)

 

[Mikkel]

You guys have to stop with this money business. Fellowship and money are not the same conversation. Fellowship is about learning. You cannot ever get the same opportunity if you just go work and hope to pick it up yourself.

Let's face it, every north American anesthesiiologist makes 10x the average wage at least and will be able to retire at 55 to 60.

A fellowship is about sorting out an internal need for some more skill or knowledge, which may or may not benefit you monetarily or job wise down the line but who cares. Do it if you want. Ignore the naysayers.

1) How many years out are you?

2) Do you realize that 90% of the advertisement for doing a fellowship from academic faculty is "more money, better job"?

 

[AdmiralChz]

2) Do you realize that 90% of the advertisement for doing a fellowship from academic faculty is "more money, better job"?

Any faculty with half a brain does not say this - we didn’t say it in residency nor fellowship. The reimbursement just isn’t there and the payer mix (much higher Medicare) isn’t the best. See other threads about dismal TEE reimbursement. Quite often pay IS better because it’s specialized but it’s not a huge difference for the most part. So your statement is at best a reach, at work just wrong/a lie.

There are other advantages which are more realistic - you can break into (potentially?) more markets, academic jobs are open across the country, perhaps job security (overrated).

 

[Mikkel]

Any faculty with half a brain does not say this - we didn’t say it in residency nor fellowship. The reimbursement just isn’t there and the payer mix (much higher Medicare) isn’t the best. See other threads about dismal TEE reimbursement. Quite often pay IS better because it’s specialized but it’s not a huge difference for the most part. So your statement is at best a reach, at work just wrong/a lie.

There are other advantages which are more realistic - you can break into (potentially?) more markets, academic jobs are open across the country, perhaps job security (overrated).

90% of my attendings said that because their salaries reflected fellowships.

 

[abolt18]

90% of my attendings said that because their salaries reflected fellowships.

I've definitely never had an attending ever say anything remotely like that.

 

[Mikkel]

I've definitely never had an attending ever say anything remotely like that.

How did your attendings justify spending a year of your life just to give up $400k?

 

[AdmiralChz]

How did your attendings justify spending a year of your life just to give up $400k?

Yelling at CA-2/3s made it worth it.

More seriously, are you for real? Or just trolling?

 

[Mikkel]

Yelling at CA-2/3s made it worth it.

More seriously, are you for real? Or just trolling?

What part of what I wrote can you not believe? My attendings always made it a pitch about money, because that was the only thing that could convince my co-residents to give up $400k and a year of their lives.

You can do pain, cardiac, ob, peds, regional all without fellowships, though it's getting harder because of credentialing.

 

[rakotomazoto]

OP: check this out to get another perspective. This guy in academics throws down some very specific numbers. Just keep in mind that one specific example is not representative of the entire market, but hopefully you can use this type of modeling exercise to crunch some numbers.

Is a Medical Fellowship Worth It? [ROI Calculations] | White Coat Investor

Does a fellowship make sense for your finances? Do some calculations to determine your return on investment and know if you'll end up ahead financially or in the red.

www.whitecoatinvestor.com

 

[rakotomazoto]

The idea that you shouldn't consider the finances involved is completely off base. Being an anesthesiologist is a job, the money involved is at the very root of this question, although it might be hard to predict the exact financial ramifications of different paths. But you should still be thinking of things in these terms.

 

[rakotomazoto]

The anesthesiologist who is not financially literate is a sucker. Clearly, there are those who will take advantage. Educate yourself as much as possible, hard to do in residency since most academics don't understand the outside market. I asked my attendings to teach me about billing CA3 year and most of them said, "I have literally no idea how it all works. We just hand it over to ABC billing company and they handle that."

 

[fakin' the funk]

Many (most?) places it's become difficult if not impossible for a new person to get credentialed to do hearts without the fellowship year and TEE boards. We can debate whether a community program doing 95% normal EF CABGs needs or measurably benefits from a fellowship trained anesthesiologist, but hospital credentialing is slowly but surely closing that door.

What? Hospital credentialing is the bad guy here? You mean like the people who work in the credentialing office?

 

[fakin' the funk]

1. Fellowship might get you a job you wouldn't get otherwise
2. Fellowship costs you money up front you may never make up for
3. Fellowship is a year and potentially a move
4. Fellowship may itself be fun or awful
5. Fellowship may not be useful, or may be useful even if you don't practice in that area

 

[pgg]

What? Hospital credentialing is the bad guy here? You mean like the people who work in the credentialing office?

I have no idea where my post gave you the idea that I think this is either good or bad, much less that the people doing clerical work in the credentialing office are either good guys or bad guys. They don't set policy; their moral character isn't really the question here.

It is simple truth that fewer and fewer hospitals will credential non-fellowship-trained anesthesiologists to do cases requiring CPB. This decision is ultimately made with input from committees that usually include physicians at that hospital, risk management, and other administrators.

 

[pjl]

What? Hospital credentialing is the bad guy here? You mean like the people who work in the credentialing office?

The “bad guy” here is ourselves.
In order to care for a kid under ____ you have to be a pediatric fellowship trained anesthesiologist who takes care of a set amount of kids, or any new grad CRNA. The position statement from the very self interested pediatric anesthesiologists ensured that. We stopped doing peds general cases in all the hospitals of our mid sized city thanks to that paper, and all those kids just get to drive 2+ hours to a peds hospital for their simple mass excisions.

Cardiac is significantly better, but hopefully that doesn’t go that route as well.

With regards to the original question, we hire good people who come with outstanding references from our personal acquaintances. Some have fellowships, most do not.
All get paid the same, except the people with fellowships get an additional 25k the first year, just like any experienced MD would get. After than, it is all equal.

 

[abolt18]

How did your attendings justify spending a year of your life just to give up $400k?

First, our facility does not have a ton of fellowship trained people. Of those who HAVE done fellowships, they're all peds, cardiac, CCM, or chronic pain. We have one attending who has done a regional anesthesia fellowship, who is in charge of our acute pain service, and specifically wanted a career in academics. One peds cardiac guy as well. That's it! No one who did Liver, trauma, OB, PSH, or other random non-accredited fellowships.

I have never had a single attending try to influence me or my co-residents that I've heard of into pursuing fellowship. The usual teaching expressed is to pursue a fellowship if it's what you want out of your life and career.

I've never heard an attending try to justify their fellowship as anything other than something they just wanted to do. If you express desire to pursue a fellowship, people will support you, but won't push you.

So while you apparently had a very different experience, perhaps you should realize not all programs or attendings are cut from the same cloth.

 

[Ronin786]

You guys have to stop with this money business. Fellowship and money are not the same conversation. Fellowship is about learning. You cannot ever get the same opportunity if you just go work and hope to pick it up yourself.

Let's face it, every north American anesthesiiologist makes 10x the average wage at least and will be able to retire at 55 to 60.

A fellowship is about sorting out an internal need for some more skill or knowledge, which may or may not benefit you monetarily or job wise down the line but who cares. Do it if you want. Ignore the naysayers.

Yup.

If you're going to look at numbers and wage, there's very little chance a fellowship gives you a bonus ROI. The overall package is another consensus that you make based off what you want in life and what matters to you.

 

[deleted697535]

Maybe we should have another thread to explore why people are so crippled by their fear and love of money? I've found a good % of my older colleagues are retiring with some element of debt and it really blows my mind. Just made very poor decisions. 1 year fellowship doesn't explain 30+ years of waste

 

[deleted171991]

Maybe we should have another thread to explore why people are so crippled by their fear and love of money? I've found a good % of my older colleagues are retiring with some element of debt and it really blows my mind. Just made very poor decisions. 1 year fellowship doesn't explain 30+ years of waste

I just love this post.

During my last job interview (I keep looking for better jobs the same way I follow slickdeals.net), when I asked about a part-time job, I got an answer inquiring whether I had any medical problems.

That's the American thinking about life/work balance. If you don't want to spend your life fattening somebody else's business, something MUST be wrong with you. I sincerely think there is something wrong with the American brainwashed worker. I'd rather spend less than work more, regardless of how much I would enjoy the latter.

 

[dannyboy1]

Maybe we should have another thread to explore why people are so crippled by their fear and love of money? I've found a good % of my older colleagues are retiring with some element of debt and it really blows my mind. Just made very poor decisions. 1 year fellowship doesn't explain 30+ years of waste

I definitely subscribe to the work less spend less lifestyle... but, if I’m going to spend a year of my life working for an hourly rate less than what the guy who cleans the OR makes, when I have the opportunity to make over 400k, then there had better be some tangible benefits to that year....

 

[psychbender]

My group shaves one year off the two year partnership track for those with fellowship. Normally, it's 85% partner pay, then 95%, so I got to jump right to 95%. Otherwise, no direct financial benefit to the added training.

I'm with you, FFP. I think another ten years, then maybe cut down to one week per month in the ICU, with maybe just some prn anesthesia, if I feel like it. My wife and I have no debt, so going to one week per month in my mind-40s, making about $200k per year won't be so bad.