Best ultrasound fellowships at the moment?

[lucid_interval]

I am currently in my final year of residency at an university program, and am really interested in academic EM and possibly doing a fellowship in ultrasound next year.

I'm just looking for any input regarding which are some really good fellowship programs out there at the moment.

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[Brigade4Radiant]

Well if you want to do academics just do the fellowship at whatever place you want to do academics at

Ultrasound is ultrasound you won’t be able to read echos and it won’t change your practice much

 

[EctopicFetus]

I am currently in my final year of residency at an university program, and am really interested in academic EM and possibly doing a fellowship in ultrasound next year.

I'm just looking for any input regarding which are some really good fellowship programs out there at the moment.

The proper answer is In N Out Residency. Does this date me much on here?

 

[JacobMcCandles]

The best ultrasound fellowship is no ultrasound fellowship.

 

[Siggy]

The proper answer is In N Out Residency. Does this date me much on here?

Does Dr. McFatpants still run it?

 

[GonnaBeADoc2222]

Never really understood the point of EM ultrasound fellowship.

Learn a bunch of US exams that no one in the real world of EM cares about (US for pneumonia and fracture diagnosis...like come on lol), then in academics, produce research that no one will read...except other EM US people.

The classic argument I guess is you get buy down of shifts...but it seems like every academic EM person I know is more stressed out than I am as straight clinical.

 

[JacobMcCandles]

Never really understood the point of EM ultrasound fellowship.

Learn a bunch of US exams that no one in the real world of EM cares about (US for pneumonia and fracture diagnosis...like come on lol), then in academics, produce research that no one will read...except other EM US people.

I had an attending in residency that loved to ultrasound for fractures. He'd go in, cover the patients arm in gel, and spend 15-20 minutes ultrasounding. He'd find a fracture, be super proud of himself, and then go put an order in for an xray. What a colossal waste of time. I'd also love to see someone call Ortho about a fracture with just a bedside ultrasound being done with no xray.

 

[Groove]

Wasted fellowship. I used to think US was like our force power as a specialty or something. Hell, I even got ARDMS certified. Nowadays? I pretty much use it for codes or abscess hunting. Occasionally for line placement or DVT r/o. That's it. I love watching residents hunting for B lines and A lines while I order a portable CXR.

 

[DeadCactus]

Try Reddit. This place is mostly just depressed or burnt out physicians who don't think a residency is worth doing let alone a fellowship. It's great if you want opinions from people who have neither done the thing you are asking about nor happy with their own careers.

 

[bougiecric]

I'll raise my hand as someone who did an US fellowship (many years ago). Shouldn't have. Even that one year of lost income... *sigh*

I use ZERO skills from fellowship that I hadn't already gained in residency.

US has exploded in academic emergency medicine as a positive feedback loop that only serves to enhance the careers of those involved in it. The vast majority of bedside US research has zero applicability in the practical care of patients. Maybe this is being hyperbolic, but it's kind of like a cult, and only after I was out of academics could I reflect back and see that.

That said, it does get your foot in the door if you're certain you want to be in academics. I don't fault people for using it as an entry into an academic career.

 

[doggydog]

Try Reddit. This place is mostly just depressed or burnt out physicians who don't think a residency is worth doing let alone a fellowship. It's great if you want opinions from people who have neither done the thing you are asking about nor happy with their own careers.

Are you talking about here or Reddit?

 

[DeadCactus]

Are you talking about here or Reddit?

I guess the last line is true of the internet in general.

 

[EctopicFetus]

Try Reddit. This place is mostly just depressed or burnt out physicians who don't think a residency is worth doing let alone a fellowship. It's great if you want opinions from people who have neither done the thing you are asking about nor happy with their own careers.

The post right above yours is someone who did more than just a fellowship. Fwiw I love my job.

 

[EctopicFetus]

Most academic programs have their us fellowship trained folks. They don’t need any more.

If it is an interest go for it. Just understand the trade offs.

 

[RustedFox]

Are you talking about here or Reddit?

Reddit is full of naive students, residents, and fresh out the box attendings who suffer a lot of cognitive dissonance and really will tell you that they are unique and special and they will find the perfect SDG a half hour from the beach and mountains with great schools and (whatever) and follow that up with "you're just burnt out; I'm different, you'll see!!"

In fact, the mods went so far as to remove the truth telling sermon that one of our well-regarded members (pretty sure it was cyanide12345678) posted to that subreddit. That should tell you all you need to know.

 

[Apollyon]

The post right above yours is someone who did more than just a fellowship.

Without more context, this just sounds cryptic. He said he did a fellowship, you say he did more then just. Huh?

 

[Birdstrike]

EM fellowships that pigeonhole-focus your skills tighter into ED-dependent work are of questionable value, and could actually be bad for you.

EM fellowships that add to your skill-stack in a way that makes you more employable, either totally or in part, outside of EDs, are very valuable.

 

[Clean7795]

I've always been a bit curious about POCUS for diagnosing pulmonary edema and pneumonia. There are papers saying it's better than CXR. It's hard for me to imagine it being better than a 2 view chest x-ray on average.

Legit or academic fake news?

 

[hoot504]

Try Reddit. This place is mostly just depressed or burnt out physicians who don't think a residency is worth doing let alone a fellowship. It's great if you want opinions from people who have neither done the thing you are asking about nor happy with their own careers.

While you did nail the overall stereotype of this forum, as a community ER doc I would say this thread is balls on the money accurate regarding the usefulness of US in anything but the academic setting.

 

[Jabbed]

I've always been a bit curious about POCUS for diagnosing pulmonary edema and pneumonia. There are papers saying it's better than CXR. It's hard for me to imagine it being better than a 2 view chest x-ray on average.

Legit or academic fake news?

Definitely true, but still probably not practice changing for the most part.

You KNOW what a pulmonary edema patient looks like. You can see it, hear it, and you’ll have collateral diagnostics (BNP, BP).

If a (non-covid) patient has 18K WBC and still has abnormal vitals after Tylenol/NSAIDs and fluids but the CXR is clear it probably is a PNA. CT chest w/o if you want pictures.

The other thing to bear in mind is people’s ****ty anatomy and chronic pathology making any one CXR difficult to interpret for acute change. Even CTPA isn’t 100% sensitive or specific for PE. This makes zero sense on paper until you start looking at scans with mistimed contrast boluses, lung masses compressing vasculature, motion/beam hardening artifact, post-surgical changes, etc.

 

[EctopicFetus]

Without more context, this just sounds cryptic. He said he did a fellowship, you say he did more then just. Huh?

The post above his the poster said he "Hell, I even got ARDMS certified."

Thats all i meant nothing cryptic.

 

[Apollyon]

The post above his the poster said he "Hell, I even got ARDMS certified."

Thats all i meant nothing cryptic.

I thought they were part and parcel, i.e., if you did the fellowship, you were set up to get the ARDMS.

 

[hopeful22213]

I am currently in my final year of residency at an university program, and am really interested in academic EM and possibly doing a fellowship in ultrasound next year.

I'm just looking for any input regarding which are some really good fellowship programs out there at the moment.

Not an US enthusiast personally (and have no affiliation with this program) but Highland has a pretty prominent reputation nationally. It's a place that has pushed a lot of the more sophisticated nerve blocks.

Ultrasound Fellowship — Highland EM Ultrasound Fueled pain management

highlandultrasound.com

 

[GonnaBeADoc2222]

Try Reddit. This place is mostly just depressed or burnt out physicians who don't think a residency is worth doing let alone a fellowship. It's great if you want opinions from people who have neither done the thing you are asking about nor happy with their own careers.

Don't let the truth get in the way of a good insult to your colleagues!

 

[Birdstrike]

This place is mostly just depressed or burnt out physicians

“Depressed, burned out physicians” are a group that can offer a lot of valuable advice. It’s not necessarily the only people one should listen to, but you sure don’t want to ignore them completely.

 

[DeadCactus]

Don't let the truth get in the way of a good insult to your colleagues!

This place cannot stop itself from dumping on any career that isn't living in some undesirable location for as much money per hour as possible and leaving medicine as quick as possible. There is nothing collegial about that. If the posts here were about legitimate concern that the person may be heading down the wrong path, they would have started with asking questions to better understand the person's goals and expectations from the fellowship. There's plenty of room for a legitimate conversation with a colleague but that's not what's happening here.

 

[CoolDoc1729]

I’m not depressed or burnt out but in my community job US fellowship would have added literally nothing. I order a formal US and it gets done while I see the next two patients. None of my consultants would accept my scan over the appropriate formal imaging. If I did the us myself instead of seeing the next two patients it would benefit no one because the us tech is usually immediately available, then my next two patients would have to wait longer, and there are pretty much always people waiting for me. Agree with others it will be of minimal/no benefit outside academics.

 

[Birdstrike]

Can an ultrasound fellowship ensure that an EP can make the same income while working less ED shifts? If so, how much less?

 

[RustedFox]

This place cannot stop itself from dumping on any career that isn't living in some undesirable location for as much money per hour as possible and leaving medicine as quick as possible. There is nothing collegial about that. If the posts here were about legitimate concern that the person may be heading down the wrong path, they would have started with asking questions to better understand the person's goals and expectations from the fellowship. There's plenty of room for a legitimate conversation with a colleague but that's not what's happening here.

Or hey, we could skip the feelings part because we're all adults and get right to "this is a bad idea; many of us have made that mistake and are sorry that we did". That's pretty much what happened.

 

[DeadCactus]

Or hey, we could skip the feelings part because we're all adults and get right to "this is a bad idea; many of us have made that mistake and are sorry that we did". That's pretty much what happened.

No one said anything about feelings. If you want to give advice, then give advice. That means actually talking to people and figuring out what their goals. If you just want to vomit your poor life choices at someone, go to therapy.

"I want to use an ultrasound fellowship to go into academics. What are good programs?"
"I DON'T USE ULTRASOUND IN MY COMMUNITY PRACTICE SO THE FELLOWSHIP MAKES NO SENSE FOR ANYONE!"

 

[RustedFox]

No one said anything about feelings. If you want to give advice, then give advice. That means actually talking to people and figuring out what their goals. If you just want to vomit your poor life choices at someone, go to therapy.

"I want to use an ultrasound fellowship to go into academics. What are good programs?"
"I DON'T USE ULTRASOUND IN MY COMMUNITY PRACTICE SO THE FELLOWSHIP MAKES NO SENSE FOR ANYONE!"

Pretty sure that homeboy made it clear in his first post and we don't need to spend a bunch of time posting: "Y THO?"

 

[Mount Asclepius]

Another good question then might be, "For those that went into academics, were they satisfied with US as the choice of their niche or wish they had pursued another area?" Probably a small number available to answer, but probably would be the most valuable responses. I don't know anything about US programs though so don't have anything to offer the OP.

 

[GonnaBeADoc2222]

No one said anything about feelings. If you want to give advice, then give advice. That means actually talking to people and figuring out what their goals. If you just want to vomit your poor life choices at someone, go to therapy.

"I want to use an ultrasound fellowship to go into academics. What are good programs?"
"I DON'T USE ULTRASOUND IN MY COMMUNITY PRACTICE SO THE FELLOWSHIP MAKES NO SENSE FOR ANYONE!"

Except it's not even useful in academics.

Like people can spend time and opportunity cost doing fellowships that are ckncentrated in academic settings in say: pediatric heme onc; pedi infectious disease; even stuff like child abuse (which pays very poorly) because those things have intrensic value. I *care* very much what the child abuse specialist has to say.

EM US fellowship adds no value. You write research no one reads except other US people.

 

[Mount Asclepius]

Ultrasound certainly felt sexy in residency. You could tangibly look inside someone at the bedside producing an image. Some of us trained in the era where it was the hot new thing. EM was also the hot thing at the time... We've made clear that in the community there is little value add. There is a reason Radiologists don't perform their own ultrasounds. We are comparing a tech trained positioned to that of a physician. Your time is better spent interpreting than scanning. I suspect there is more value in academics, but you you need carefully explore if that value aligns with your goals.

 

[cyanide12345678]

US is one of the more useless fellowships in my opinion. The following are the usual outcomes:

1) Opportunity cost of 300k.
2) Post fellowship work in community medicine - pretty much no benefit to the fellowship. No added value of the fellowship training.
3) Get an academics job - get paid 100k/year less than your peers working in a community shop for as long as you work in academics.

Chances are you'll still end up burned out since you're still working in the pit. A fellowship that gets you out of the pit is the only fellowship that has benefit.

 

[RustedFox]

US is one of the more useless fellowships in my opinion. The following are the usual outcomes:

1) Opportunity cost of 300k.
2) Post fellowship work in community medicine - pretty much no benefit to the fellowship. No added value of the fellowship training.
3) Get an academics job - get paid 100k/year less than your peers working in a community shop for as long as you work in academics.

Chances are you'll still end up burned out since you're still working in the pit. A fellowship that gets you out of the pit is the only fellowship that has benefit.

BUT DID YOU UNDERSTAND HIS G O A L S?

 

[GatorCHOMPions]

Except it's not even useful in academics.

Like people can spend time and opportunity cost doing fellowships that are ckncentrated in academic settings in say: pediatric heme onc; pedi infectious disease; even stuff like child abuse (which pays very poorly) because those things have intrensic value. I *care* very much what the child abuse specialist has to say.

EM US fellowship adds no value. You write research no one reads except other US people.

I’ll offer one counter to this and OP. At my prior academic gig they hired a new grad fresh out of fellowship to be director of US. This was a few years ago now. Full time faculty are 120 hours per month and he got a buy down to about 88 hours/month. Makes the same or more as the pit doctors. He publishes a lot, though. You could argue no one reads the publications but promotion points don’t care too much about that.

I think this is the only value of US fellowship, finding a job where you can spearhead the division and get significant buy down time. These jobs are getting fewer and fewer the more US fellowship grads there are.

 

[Jabbed]

I thought they were part and parcel, i.e., if you did the fellowship, you were set up to get the ARDMS.

No. ARDMS is actually not intended for physicians as it’s the certification pathway for ultrasound technologists. You don’t see radiologists with ARDMS certification.

Some EM US fellows will pursue the certification in order to add credentials as there is no relevant certification pathway that you can pursue as an EM physician. Some people will also take cardiology echocardiography board examinations, which you are allowed to sit for but will only be awarded “Testamur” status instead of certification.

SCCM recently established a “Critical Care Echocardiography” certification in conjunction with the National Board of Echocardiography that allows for additional certification.

Other than that, a big pitfall of EM US fellowships is that they add skills without credentials.

 

[Apollyon]

No. ARDMS is actually not intended for physicians as it’s the certification pathway for ultrasound technologists. You don’t see radiologists with ARDMS certification.

Some EM US fellows will pursue the certification in order to add credentials as there is no relevant certification pathway that you can pursue as an EM physician. Some people will also take cardiology echocardiography board examinations, which you are allowed to sit for but will only be awarded “Testamur” status instead of certification.

SCCM recently established a “Critical Care Echocardiography” certification in conjunction with the National Board of Echocardiography that allows for additional certification.

Other than that, a big pitfall of EM US fellowships is that they add skills without credentials.

As I'm old, maybe I was thinking of RDMS? Without the "A"? I don't even recall for what it stands.

 

[Jabbed]

As I'm old, maybe I was thinking of RDMS? Without the "A"? I don't even recall for what it stands.

They are interchangeable. ARDMS is the certification body and RDMS is the certificate.

American Registry for Diagnostic Medical Sonography.

Registered Diagnostic Medical Sonographer.

To the prior point, it is not an intrinsic part of EM US fellowship training and represents an additional effort by an EM doc to obtain credentialing where none presently exists.

 

[deuist]

.
Other than that, a big pitfall of EM US fellowships is that they add skills without credentials.

ABEM now offers a Focused Practice Designation (FPD) in Advanced Emergency Medicine Ultrasonography (AEMUS). It's a pseudo board certification.

 

[Brigade4Radiant]

Where the real benefit is the sim fellowship the true way out of the ED

 

[Tiger26]

Also did an ultrasound fellowship and barely use it in the community. I'd rather just order the ultrasound at this point.

 

[DetroitERDO]

Henry Ford ultrasound fellowship is great. So is DMC.

 

[skougess]

My take is that ultrasound is awesome and helpful regularly in community practice, but the advanced techniques learned on fellowship are either useless in practice or so far outside of standard of care to have an ED doc performing that you are playing Russian roulette.

 

[Brigade4Radiant]

My take is that ultrasound is awesome and helpful regularly in community practice, but the advanced techniques learned on fellowship are either useless in practice or so far outside of standard of care to have an ED doc performing that you are playing Russian roulette.

Not really for community practice nurses can be trained to do ultrasound IVs I use it to relieve patient anxiety when o don’t think a formal study should be done but unless it’s getting an IV it doesn’t change much for me

 

[thegenius]

Reddit is full of naive students, residents, and fresh out the box attendings who suffer a lot of cognitive dissonance and really will tell you that they are unique and special and they will find the perfect SDG a half hour from the beach and mountains with great schools and (whatever) and follow that up with "you're just burnt out; I'm different, you'll see!!"

In fact, the mods went so far as to remove the truth telling sermon that one of our well-regarded members (pretty sure it was cyanide12345678) posted to that subreddit. That should tell you all you need to know.

In fact there are a lot of non medical there. And lots of nursing, wanna be nursing, and random public postings about “what is my diagnosis” and “what should I do about my problem.”

 

[AlvinKamara]

Y’all aren’t answering OP’s question.

Best US fellowships in the country: highland, Denver, Penn, mgh

Ucla and Stanford are good but they’re two year fellowships which brings down the competitiveness and is less palatable.

 

[Brigade4Radiant]

It seems for the two-year UCLA fellowship program you have to graduated from a 4 year program lol

 

[RustedFox]

Some animals have to live in the zoo.