CA-3 and Fellowships

Started by The Pill Counter
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The Pill Counter

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Wow, I haven't been on SDN in years since I was a know-it-all (but didn't know anything) med student
As CA-3 approaches in a weeks time and fellowships on the horizon, it'd be good to share some stories and get an idea what people are doing and where.
I'll be Critical Care 2010 at Columbia.
It'd be good to get a comparison of fellowship choices our cohort has made.

TPC
 
CT fellowship at Texas Heart in 2010.

I'm curious if more and more residents will be pursuing fellowships given the uncertainties facing our specialty and healthcare alike.
 
I think it would be wise to have some extra skills/credentials. Private practice groups don't have endowments/rainy day funds to weather a downturn in the economy.
 
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RussianJoo said:
wow doesn't leave much time for research or making a good impact on attendings for LORs.
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Research always helps but I don't think it is that big of a deal for most anesthesia fellowships. I wouldn't worry about the LOR thing. You will most likely be in the main OR a good portion of your CA-1 year and you will get a chance to work with most attendings enough (unless your residency is gigantic). It only takes a couple of shifts to get a feel for how someone is performing. That's why "Image is everything".

If you are interested in something like peds or CT you typically will get at least 2 months or so so of these each before the end of your CA2 year which is plenty of time to get to know the faculty, especially since their call pool is typically a small group of folks.

Depending on how your program schedules rotations if you are interested in pain you probably want to try and get in there as early as possible since face time is more important since the field is pretty competitive.
 
PillCounter and Veetz, first, congrats on your fellowships! That's exciting.

Can you guys elaborate on your decisions for choosing those two fellowships?


cf
 
Arch Guillotti said:
Research always helps but I don't think it is that big of a deal for most anesthesia fellowships. I wouldn't worry about the LOR thing. You will most likely be in the main OR a good portion of your CA-1 year and you will get a chance to work with most attendings enough (unless your residency is gigantic). It only takes a couple of shifts to get a feel for how someone is performing. That's why "Image is everything".

If you are interested in something like peds or CT you typically will get at least 2 months or so so of these each before the end of your CA2 year which is plenty of time to get to know the faculty, especially since their call pool is typically a small group of folks.

Depending on how your program schedules rotations if you are interested in pain you probably want to try and get in there as early as possible since face time is more important since the field is pretty competitive.
Click to expand...

thank you for the explanation.
 
cfdavid said:
PillCounter and Veetz, first, congrats on your fellowships! That's exciting.

Can you guys elaborate on your decisions for choosing those two fellowships?
Click to expand...

Well, for me, it is four-fold. 1) I enjoy doing cardiac surgeries. 2) Cardiac trained anesthesiologists tend to be more poised and collected in difficult clinical situations. 3) TEE will be more employed as a diagnostic tool in the OR in the coming years and I want to have TEE certification. Those finishing residency after 6/2009 must do an ACGME accredited fellowship in order to be eligible for TEE certification. 4) I wanted more specialized training to help distinguish me from other general anesthesiologists as well as other mid level providers such as CRNA's.
 
How much harder is it to get a fellowship after a few years of private practice, than it is straight out of residency? one of the many career options i am thinking of is to do a cardiac fellowship straight out of residency and then after a few years of practice do a CCM fellowship and then run a CT-ICU. I know you guys can't predict what will happen in the future, but what have you currently heard. Is it almost impossible to get a fellowship if you've been in practice for lets say 5years, and want a career shift?

as always, thank you in advance for your comments.
 
RussianJoo said:
How much harder is it to get a fellowship after a few years of private practice, than it is straight out of residency?
Click to expand...

Impossible...once you taste the freedom and lifestyle that comes from private practice you'll never want to go back to working 80H/week under someone else's supervision for 45 K.

I'm just a resident but with every passing year the idea of a fellowship becomes harder to swallow. I too am thinking about CC or CT but I can't imaging trying to make that decision after being out in the real world.
 
RickKane said:
Impossible...once you taste the freedom and lifestyle that comes from private practice you'll never want to go back to working 80H/week under someone else's supervision for 45 K.

I'm just a resident but with every passing year the idea of a fellowship becomes harder to swallow. I too am thinking about CC or CT but I can't imaging trying to make that decision after being out in the real world.
Click to expand...

thank you, however, my question wasn't about how difficult it would be to change my life style, or take a pay cut or anything like that. mine was strictly about getting another board certificate so that i can change what I do. I am very happy being in the OR right now but many of the attendings at the program I am rotating in find every excuse possible to not be there. they get residents or sometimes even students to watch the patient for them while they escape for as long as they can. if a resident is working with them they'll be there for the induction and then disappear for the whole case maybe show their face once in the middle to see how they're doing or even call the OR and talk to the resident for a bit, and then show up when the pt. is waking up. I guess they're bored with their work, I think it would be great to be able to do a year of training and then be able to do something else once you get bored with what you're doing. a CC fellowship would let me do that. I feel that if i get bored, i'll become careless and that's when things don't go as planned. So that's why I wanted to know how competitive or difficult it would be to get into a fellowship after a few years of practice. For me it's not about money or lifestyle, I plan on working 80 hour weeks as an attending anyway (cause I am just used to working hard, and don't know how to not work hard), for me it's about being happy and satisfied with my work.

Does anyone know of someone who went back to do a fellowship after a few years in private practice? I would think it would be easier to find a fellowship, especially if you're good friends with a program director or have mutual friends.
 
Anecdotally, when I was a med stud on anesthesia rotation I met a guy who was about 50 or so and had been out in private practice awhile. he had come back to do a pain fellowship. So he was taking a pay cut but I'll bet he was working on the side to make up some of the difference. It was worth it for him because I believe he already had a job set up for after fellowship that would be enough of a raise for him to make it all worthwhile. So it isn't impossible.
 
veetz said:
Well, for me, it is four-fold. 1) I enjoy doing cardiac surgeries. 2) Cardiac trained anesthesiologists tend to be more poised and collected in difficult clinical situations. 3) TEE will be more employed as a diagnostic tool in the OR in the coming years and I want to have TEE certification. Those finishing residency after 6/2009 must do an ACGME accredited fellowship in order to be eligible for TEE certification. 4) I wanted more specialized training to help distinguish me from other general anesthesiologists as well as other mid level providers such as CRNA's.
Click to expand...


Are you in TX?
 
RussianJoo said:
How much harder is it to get a fellowship after a few years of private practice, than it is straight out of residency?
Click to expand...

They tell me it's not much harder, provided you were a competitive applicant for a given spot in the first place.

I'm in the military, finishing residency in 3 days (not that I'm counting). I'd like to do a cardiac fellowship, but very little CT surgery gets done at military hospitals, and I don't want to spend the 6 years after the fellowship doing single- or barely double-digit CT cases. So I'll probably serve out my obligation, then do a fellowship right after I leave the military.

I don't anticipate any trouble finding a solid fellowship position in 5 years when I'm free to do it.

RickKane said:
Impossible...once you taste the freedom and lifestyle that comes from private practice you'll never want to go back to working 80H/week under someone else's supervision for 45 K.
Click to expand...

That's what I'm afraid of ... 🙂

I guess it's a "good" difficult decision to be forced to make ... make oodles of cash doing something you love ... or be a fellow for a year then make oodles of cash doing something you love even more.
 
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Arch Guillotti said:
Anecdotally, when I was a med stud on anesthesia rotation I met a guy who was about 50 or so and had been out in private practice awhile. he had come back to do a pain fellowship. So he was taking a pay cut but I'll bet he was working on the side to make up some of the difference. It was worth it for him because I believe he already had a job set up for after fellowship that would be enough of a raise for him to make it all worthwhile. So it isn't impossible.
Click to expand...

thanks for your help.
 
RussianJoo said:
mine was strictly about getting another board certificate so that i can change what I do.
Click to expand...

FYI, only CCM and Pain lead to additional board certification. Peds and Cardiac are accredited fellowships, but don't lead to board certificate. You just get a piece of paper saying you finished Bob's Fellowship. The other fellowships (neuro, OB, etc) have no national oversight.
 
pgg said:
They tell me it's not much harder, provided you were a competitive applicant for a given spot in the first place.

I'm in the military, finishing residency in 3 days (not that I'm counting). I'd like to do a cardiac fellowship, but very little CT surgery gets done at military hospitals, and I don't want to spend the 6 years after the fellowship doing single- or barely double-digit CT cases. So I'll probably serve out my obligation, then do a fellowship right after I leave the military.

I don't anticipate any trouble finding a solid fellowship position in 5 years when I'm free to do it.



That's what I'm afraid of ... 🙂

I guess it's a "good" difficult decision to be forced to make ... make oodles of cash doing something you love ... or be a fellow for a year then make oodles of cash doing something you love even more.
Click to expand...


thanks for your feedback.
 
Pilot Doc said:
FYI, only CCM and Pain lead to additional board certification. Peds and Cardiac are accredited fellowships, but don't lead to board certificate. You just get a piece of paper saying you finished Bob's Fellowship. The other fellowships (neuro, OB, etc) have no national oversight.
Click to expand...


thank you very useful info.
 
Pilot Doc said:
FYI, only CCM and Pain lead to additional board certification. Peds and Cardiac are accredited fellowships, but don't lead to board certificate. You just get a piece of paper saying you finished Bob's Fellowship. The other fellowships (neuro, OB, etc) have no national oversight.
Click to expand...

Numbers gained during a cards fellowship can lead to Echo cert, though.
 
I chose critical care because I want to have a skill set outside of general OR anesthesia. On the interview trail I was surprised by the number of faculty and fellows who have or will have both CCM and CV fellowships. CV fellowships may not be boarded but are becoming much more popular, esp. since now there's no practice pathway to TEE certification. But I'll be happy being a testamur. Even from the start of residency I've seen centres go from TEE for valves to TEE for every single cardiac case- so a skill that I think has become integral to cardiac anesthesia.
CCM- obviously is a complete change of gears and you can add intensivist to your title, but if you don't like the unit, don't think twice about it.
 
The Pill Counter said:
I chose critical care because I want to have a skill set outside of general OR anesthesia. On the interview trail I was surprised by the number of faculty and fellows who have or will have both CCM and CV fellowships. CV fellowships may not be boarded but are becoming much more popular, esp. since now there's no practice pathway to TEE certification. But I'll be happy being a testamur. Even from the start of residency I've seen centres go from TEE for valves to TEE for every single cardiac case- so a skill that I think has become integral to cardiac anesthesia.
CCM- obviously is a complete change of gears and you can add intensivist to your title, but if you don't like the unit, don't think twice about it.
Click to expand...

for those that had both CV and CCM fellowships, which one did they get first? does it matter which you get first? Would you apply for the more competitive fellowship first or second?

thank you in advance for your reply.
 
RussianJoo said:
is it possible to get echo certified in residency? how many cardiac cases do you have to do to be able to sit for the certification exam?
Click to expand...

Things may be different now but as of several years ago it was possible. It wasn't an easy task but certainly possible if you put (a lot) of effort in.
 
Arch Guillotti said:
Things may be different now but as of several years ago it was possible. It wasn't an easy task but certainly possible if you put (a lot) of effort in.
Click to expand...

It should be doable to take and pass the test at some programs (certainly not mine). But, without doing an accredited fellowship you are not "board-eligible". No one knows what that gives you. Likely nothing unless you do academics.
 
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thanks Arch very helpful thread.. I guess there's no point in trying to do extra cardiac cases then if i have to do a fellowship anyway, and i'll get enough TEE training during that year.
 
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RussianJoo said:
is it possible to get echo certified in residency? how many cardiac cases do you have to do to be able to sit for the certification exam?
Click to expand...

Any resident finishing their residency after 6/2009 is required to do an ACGME accredited fellowship in order to be eligible to become board certified in TEE. Thus, if you finish residency after the date mentioned above, you will not be eligible to become board certified in periopoerative TEE.
 
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veetz said:
Any resident finishing their residency after 6/2009 is required to do an ACGME accredited fellowship in order to be eligible to take the advanced perioperative TEE certification exam. Thus, if you finish residency after the date mentioned above, you will not be eligible to become board certified in periopoerative TEE and therefore will not be able to "use TEE as a diagnostic tool to direct or assess cardiac surgical interventions."
Click to expand...


thank you.
 
Correct me if I'm wrong but I thought the fellowship requirement was only if you wanted to be considered "Board-certified" in Advanced Perioperative Echo by the NBE:

For applicants finishing their core residency after June 30, 2009,
fellowship training must be obtained in an ACGME accredited fellowship
program before they can apply for certification. Training obtained during
core residency (anesthesiology, internal medicine, or general surgery) may
not be counted toward this requirement.

Compared to being a Testamur, meaning that you've passed the test but do not meet the eligibility criteria to be board certified:

For licensed physicians not meeting the criteria for certification, the NBE
will continue to allow access to the examination. This is to encourage
physicians to test and demonstrate their knowledge of perioperative
transesophageal echocardiography based on an objective standard and to
allow the medical community the opportunity to recognize individuals
who elect to participate in and successfully complete a comprehensive
examination in perioperative transesophageal echocardiography. Those
who successfully pass the examination, but do not fulfill the necessary
criteria for certification, will be granted testamur status as having successfully
completed the Examination of Special Competence in Perioperative
Transesophageal Echocardiography of the National Board of Echocardiography,
Inc.

The testamur simply requires passing the test, nothing else, and will still be an option after this summer.
 
proman said:
Correct me if I'm wrong but I thought the fellowship requirement was only if you wanted to be considered "Board-certified" in Advanced Perioperative Echo by the NBE:

For applicants finishing their core residency after June 30, 2009,
fellowship training must be obtained in an ACGME accredited fellowship
program before they can apply for certification. Training obtained during
core residency (anesthesiology, internal medicine, or general surgery) may
not be counted toward this requirement.

Compared to being a Testamur, meaning that you've passed the test but do not meet the eligibility criteria to be board certified:

For licensed physicians not meeting the criteria for certification, the NBE
will continue to allow access to the examination. This is to encourage
physicians to test and demonstrate their knowledge of perioperative
transesophageal echocardiography based on an objective standard and to
allow the medical community the opportunity to recognize individuals
who elect to participate in and successfully complete a comprehensive
examination in perioperative transesophageal echocardiography. Those
who successfully pass the examination, but do not fulfill the necessary
criteria for certification, will be granted testamur status as having successfully
completed the Examination of Special Competence in Perioperative
Transesophageal Echocardiography of the National Board of Echocardiography,
Inc.

The testamur simply requires passing the test, nothing else, and will still be an option after this summer.
Click to expand...

You are correct, testamur status will still be available. Just won't be board certified, which I feel, adds a lot of credibility.
 
"Board certified in TEE" means getting a certificate from the National Board of Echocardiography, Inc..

It is not recognized by th ABMS - this remains an issue. The only available ABMS "board certifications" are in CCM, pain as well as palliative medicine/hospice. Will be interesting to see if the ASA is successfull in getting a foot on the ground for echo (and hopefully TTE too). This would help to establish us as the true perioperative physicians.

AB


http://www.abms.org/Who_We_Help/Consumers/About_Physician_Specialties/anesthesiology.aspx



veetz said:
You are correct, testamur status will still be available. Just won't be board certified, which I feel, adds a lot of credibility.
Click to expand...
 
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