CC after Anesthesiology

[Dam272]

---

Members do not see this ad.

I am interviewing for anesthesiology residencies right now, with an ultimate goal of getting into Critical care (I know, I know people must be laughing/smirking).
Should I rank the places on the basis of in-house CC fellowships? OR their CC fellowship matches into other places? OR just think about this later and rank how I liked the place for residency?

 

[BLADEMDA]

I am interviewing for anesthesiology residencies right now, with an ultimate goal of getting into Critical care (I know, I know people must be laughing/smirking).
Should I rank the places on the basis of in-house CC fellowships? OR their CC fellowship matches into other places? OR just think about this later and rank how I liked the place for residency?

It's a personal decision based on how you feel about moving for a fellowship. Since the fellowship is just 12 months and not particularly competitive I think it would be easier just to stay at your Residency program for the extra year.

That said, even if you match at a midtier program if you are willing to move for the fellowship there are so many options available to you. A top level fellowship (which means moving for the year) would help open doors for that job in academia.

The concept of ranking a program just based on its CCM fellowship doesn't make much sense because the goal is to become a good Anesthesiologist first which should be your priority. That said, there are great programs out there among the top 10-15 which will allow you to accomplish both.

 

[Robotic Wis-Hipple]

I am interviewing for anesthesiology residencies right now, with an ultimate goal of getting into Critical care (I know, I know people must be laughing/smirking).
Should I rank the places on the basis of in-house CC fellowships? OR their CC fellowship matches into other places? OR just think about this later and rank how I liked the place for residency?

1.) Find a residency you like; this is most important as it's 3-4 years and you may decide you don't like critical care or like something else more.

2. Prioritize programs with CCM fellowships. This is because you'll work within an academic CCM hierarchy, you'll have an "in" at your home institution if you elect to stay, and if not your Fellowship Director can put in a good word to the other programs if you wish to leave. The "who you know" and letters of rec are very important.

3.) If you don't love a residency program that satisfies those first two then look at programs that place fellows in decent CCM programs.

4.) with all that said, I don't think CCM is all that competitive (though 4 yrs is a long time for that to shift) so refer to #1.

 

[Dam272]

What are the general views about ACGME accredited vs non accredited fellowships?

 

[GravelRider]

What are the general views about ACGME accredited vs non accredited fellowships?

For critical care? Why on earth would you do a non-accredited critical care fellowship?

 

[fakin' the funk]

I am interviewing for anesthesiology residencies right now, with an ultimate goal of getting into Critical care (I know, I know people must be laughing/smirking).
Should I rank the places on the basis of in-house CC fellowships? OR their CC fellowship matches into other places? OR just think about this later and rank how I liked the place for residency?

Rank the "best" residencies however you like. Many of the "top" residencies have well-thought-of CCM fellowships because their departments are involved in hospital administration, the ICUs, cutting edge procedures, research, etc. Even if you go to a "lesser" residency program, getting into a top CCM fellowship isn't really a big deal per se, b/c demand is low.

 

[Dam272]

You guys rock. Thank you so much for the "mature" perspective and advices

 

[Katheudontas parateroumen]

Similar note: What are your guy's opinions on Combined Anes/CCM 5 yr residencies where they split the fellow year? I'd say I'm highly interested in doing CCM fellowship in the future but obviously no way of knowing for sure unless in the thick of it. Loved the OHSU program but worth it to pigeon-hole oneself? I hear to get a good CCM fellowship isn't all that competitive although probably still competitive at top tier. OHSU would be an already great fit for example. Thanks!

 

[deleted171991]

Similar note: What are your guy's opinions on Combined Anes/CCM 5 yr residencies where they split the fellow year? I'd say I'm highly interested in doing CCM fellowship in the future but obviously no way of knowing for sure unless in the thick of it. Loved the OHSU program but worth it to pigeon-hole oneself? I hear to get a good CCM fellowship isn't all that competitive although probably still competitive at top tier. OHSU would be an already great fit for example. Thanks!

Don't go for a combined residency! Get into a good anesthesia program, then a good CCM fellowship afterwards, if you still fancy it. My advice for the latter is to couple it with cardiac, or not do it at all.

 

[MoMoGesiologist]

Don't go for a combined residency! Get into a good anesthesia program, then a good CCM fellowship afterwards, if you still fancy it. My advice for the latter is to couple it with cardiac, or not do it all.

Why do you think CCM should be coupled to cardiac vs not done at all? Why not CCM by itself?

 

[Robotic Wis-Hipple]

Because you're not really taking over the MICU or SICU's but the CTICU's are allowing Anesthesia trained Intensivists in in greater numbers. The CT Surgeons trust the CT Anesthesiologists and if those same guys are watching over their patients in the ICU they seem to calm down a bit.

But FFP can give far more insight than I. I will say there is definitely a movement and/or slight pressure to do both, especially if you pick CT like I did. Program's are allowed to pick you up out of the match if you're doing both for instance.

 

[Dam272]

Do people also do Peds with CC?

 

[Man o War]

Don't go for a combined residency! Get into a good anesthesia program, then a good CCM fellowship afterwards, if you still fancy it. My advice for the latter is to couple it with cardiac, or not do it all.

I second all of this.

 

[deleted171991]

Why do you think CCM should be coupled to cardiac vs not done at all? Why not CCM by itself?

Because it's not appreciated properly for a $300K investment. Based on its market in my area, I wouldn't do it again. The regional guy makes the same amount of money or more for less work and stress, even when he knows about as much medicine as an intensivist has forgotten.

Most people just look at the glamour of it and the intellectual challenge (that was my mistake). The market looks at its added value, which doesn't exist, and there is not enough demand for it (except at joke salaries). Plus the market itself is small for anesthesia-CCM (mostly academic underpaid jobs), and you will be ignored for most good PP jobs (unless you can do cardiac).

Do yourself a favor and forget CCM. Even where you are paid the same hourly amount as an anesthesiologist, you don't get enough credit for the extra stress or the night shifts. One academic place I interviewed at suggested that it was a favor to pay me at the level of an anesthesiologist when I produce less (despite their need for my specialized skills - beyond CCM). All while paying less (even for anesthesia) than what the crappy AMC in the hood pays its non-board-certified employees. Don't do CCM unless you want only CCM (without anesthesia - more and better jobs).

Look at it long-term. Look at everything long-term. Figure out a smart business and retirement plan for life, decades ahead, and make sure your dreams fit into it (and the surrounding market and reality). If not, find better ones that do. Forget glamorous fellowships (even cardiac or pain), if they don't lead to a clearly better life.

 

[deleted162650]

Do people also do Peds with CC?

That would require a PICU fellowship which can only be done after a peds residency. That being said, I know of a number of peds, PICU, Anes, peds Anes guys out there. And they're not as crazy as you think they would have to be.

 

[Dam272]

That would require a PICU fellowship which can only be done after a peds residency. That being said, I know of a number of peds, PICU, Anes, peds Anes guys out there. And they're not as crazy as you think they would have to be.

Damn.. Must be really devoted guys.

 

[AdmiralChz]

FFP has brought this up previously, but several programs offer combined residency-fellowships to beef up interest in their CCM program. Per SF Match, for anesthesiology CCM the match rate was 97% with 37 unfilled positions nationally. There simply is not a lot of demand, at all. Compare this to cardiac - 77% match rate with 0 (!) unfilled positions.

We get many students who come to interview that are interested in CCM, and it totally makes sense - you probably had a great Sub I experience and if you show initiative as an MS-4 you can be a real contributor to the team and do several procedures. I was one such person, was so sure on CCM... for reasons detailed by others above, my interest waned and I will be doing a cardiac fellowship next year.

Anyway, a well-rounded academic program with several CCM-trained anesthesiologists will get you the exposure and advice you need during residency - ask about it during interviews (that option versus rotating in SICUs with mostly surgery attendings).

 

[Katheudontas parateroumen]

Yeah, I've only talked with academic guys at my institution. Said they love their lifestyle except for some difficult night every once in a while. That could be said just about any specialty though. They had flexible schedule and set hours. Usually did 7 days on one of SICU/NeuroICU/CTICU followed by 3 days off then either doing OR anesthesia or picking up some more ICU days. Every team has 2 residents and a CCM fellow. They usually took the ortho room in their OR days though due to wanting the easy cases after working in the ICU 🙄. Overall, were very happy. Getting paid same as every other academic anesthesia trained person 300-330K.

 

[deleted171991]

One can make 300 at the VA, with much less headache than in cacademia, where one gets to work 10 hours on a regular day. The base salaries (before late and overnight call) are getting closer and closer to CRNA salaries. In some places, one will do CCM and still get included in the OR call schedule at the same time. WTF is this, fellowship for life?

And, no offense, but getting paid the same for treating sick and complicated patients as for doing ultrasound-guided nerve blocks or outpatient anesthesia is not fair in my book. It's just not the same responsibility or amount of medical knowledge, or work. Plus the regional guy can work anywhere, not just in cacademia. Just my 2 cents and food for thought.

The CT surgeons want the same people in the OR and in the ICU. Hence the relative value of cardiac+CCM training. I say relative, because I don't think one gets reimbursed properly for the extra-CCM year AFAIK, plus many CT surgeons treat the anesthesiologists like midlevels both in the OR and the ICU.

(I am still biased towards cardiac-only in this market. CCM is just insurance for the future and orgasmic brain masturbation, and not worth 300K in my book, for an anesthesiologist. Not yet. Do something easier, get paid the same, just with a higher risk of midlevel encroachment. Make hay while the sun shines. 300K now would be worth 2 million after 35 years - that's your real loss.)

 

[deleted171991]

Yeah, I've only talked with academic guys at my institution. Said they love their lifestyle except for some difficult night every once in a while. That could be said just about any specialty though. They had flexible schedule and set hours. Usually did 7 days on one of SICU/NeuroICU/CTICU followed by 3 days off then either doing OR anesthesia or picking up some more ICU days. Every team has 2 residents and a CCM fellow. They usually took the ortho room in their OR days though due to wanting the easy cases after working in the ICU 🙄. Overall, were very happy. Getting paid same as every other academic anesthesia trained person 300-330K.

The last person any academic attending would bitch to is a trainee. We've said it many times here, and it's just common sense. First of all, there is little thinking behind the wide-eyed syndrome, so anything we say can and will be misunderstood. Second, one never knows what gets back to the boss, and I can think of a number of things worse than having a bad job. So nobody will tell you the Truth, except maybe here.

On the other hand, there are some great academic places where it's a pleasure to work. I did my fellowship in one of those, looked forward to going to work every single morning. But those are the exceptions, especially in certain markets.

 

[BLADEMDA]

I'd like to add there are still plenty of Academic jobs doing Critical Care plus some O.R. out there. The expected pay range is $325-$350K after just 5 years of experience at most places. Since the vast majority of academic centers want/require a fellowship anyway there is no "penalty" for doing that extra year. In addition, CCM offers one the opportunity to become an outstanding Physician in terms of knowledge base.

Finally, once a CCM trained Anesthesiologist passes his her boards in CCM and passes the basic echo exam many private practice groups will consider that person for a job doing hearts. There are a few on SDN who have passed the advanced echo exam without doing the CT fellowship and that is all one needs to do Cardiac in 90% plus of private practices.

 

[GravelRider]

Why do you think CCM should be coupled to cardiac vs not done at all? Why not CCM by itself?

If it's not too late and you are still in med school, do internal medicine if you want critical care. It's a much better route to critical care. It's the same time commitment as doing anes+cardiac+ccm. The difference with IM+pulm+ccm is you gain a specialty that becomes one that patients seek out. Patients don't seek out cardiac anesthesiologists, but they do seek out pulmonologists. The market for anesthesia/ccm is growing slowly, but it is tiny compared to the pulm/cc market.

In terms of anesthesia critical care, I agree with many of the above sentiments regarding the job market. However, doing a ccm fellowship is still better than doing no fellowship at all because at the very least it gives you a route back to academics. I have friends who did cardiac fellowships and are working for AMCs for 350 with not much room for growth, so cardiac isn't always the golden ticket in this market.

I do think that as a specialty, we need to be encouraging more people to go into critical care. The specialty needs more people who think outside the OR. Unfortunately, the job market doesn't think the same way.

 

[Dam272]

In terms of monetary outcome in the current market, is doing CCM after anesth vs no fellowship counterproductive?

 

[BLADEMDA]

In terms of monetary outcome in the current market, is doing CCM after anesth vs no fellowship counterproductive?

No. FFP may disagree with me but there are plenty of jobs where CCM trained people with just the basic TEE exam do hearts. I think a CCM trained person looking to do sick patients and some hearts would be an asset to many large groups. In fact, I would argue a CCM trained Anesthesiologist is a better anesthesiologist at handling tough cases than most generalists.

But, in PP you would be doing cases in the O.R. and not much, if any, ICU work.

 

[BLADEMDA]

Critical Care Work Force Supply vs Demand:

 

[BLADEMDA]

 

[BLADEMDA]

Here is why I would choose Anesthesiology plus Critical Care over Pulm/CCM: the ability to do cases in the O.R.

 

[deleted171991]

Critical Care Work Force Supply vs Demand:

That may be true, mostly for community critical care (which are many times also IM hospitalist) jobs. Anesthesiology-CCM, which is almost 100% academic, just doesn't have the market that would make the fellowship worth it financially or career-wise. One should do it for personal reasons only.

 

[BLADEMDA]

That may be true, mostly for community critical care (which are many times also IM hospitalist) jobs. Anesthesiology-CCM, which is almost 100% academic, just doesn't have the market that would make the fellowship worth it financially or career-wise.

I disagree if one pursues academic medicine.

 

[BLADEMDA]

This is a great list of jobs. The market place really does know its stuff:

 

[GravelRider]

Here is why I would choose Anesthesiology plus Critical Care over Pulm/CCM: the ability to do cases in the O.R.

There's no silver bullet in medicine. Everything is a trade off. I prefer being in the OR to being in clinic, but I wonder if in 15 years I would rather be doing work in a clinic rather than doing night call in the OR at a trauma or busy OB center. Pulm is a better option if you really want critical care because there simply are more pulm/cc jobs. Plus, most MICUs are closed, which is not only better for patient care, but better for physician satisfaction.

 

[AdmiralChz]

This is a great list of jobs. The market place really does know its stuff:

I would disagree a little bit - my cousin and several friends recently finished cards fellowship and the job market is really, really tight. Tough to find anything in desirable areas, some opted for super-fellowships solely with job prospects. This list looks to be purely number of training spots.

 

[Ezekiel2517]

There are several PP groups where you can practice both CCM and anesthesia. I don't know where you reside but obviously you may have to relocate if you want the gig.
You can't have everything. If you want the dough, go into PP but you have to realize you may have to give up icu. But the fellowship will help you land a great job. If you want to do more CCM and don't want to move to join a group that does both, you'll likely be limited to academics, which isn't a bad gig at all actually in many places

 

[BLADEMDA]

I would disagree a little bit - my cousin and several friends recently finished cards fellowship and the job market is really, really tight. Tough to find anything in desirable areas, some opted for super-fellowships solely with job prospects. This list looks to be purely number of training spots.

The list is just the number of spots. But, after a fellowship in Cards or Gi there are lots of opportunities out there if you are geographically flexible. Want a certain big city? Sure, the market could be tight. Want a medium sized city in central USA? no problem at all.

 

[deleted171991]

The list is just the number of spots. But, after a fellowship in Cards or Gi there are lots of opportunities out there if you are geographically flexible. Want a certain big city? Sure, the market could be tight. Want a medium sized city in central USA? no problem at all.

One could argue that one doesn't need a fellowship for that. 😉

 

[nimbus]

That would require a PICU fellowship which can only be done after a peds residency. That being said, I know of a number of peds, PICU, Anes, peds Anes guys out there. And they're not as crazy as you think they would have to be.

Yes they are😉

 

[Robotic Wis-Hipple]

As far as I know there is no pathway for new grads to acquire the Advanced PTEeXAM Certification except thru a Cardiothoracic Fellowship.

Some PP groups may let you do hearts with no cert or the basic as long as the hospital doesn't push for it, but you're not doing CCM and then taking the Advanced Exam afaik.

 

[psychbender]

As far as I know there is no pathway for new grads to acquire the Advanced PTEeXAM Certification except thru a Cardiothoracic Fellowship.

Some PP groups may let you do hearts with no cert or the basic as long as the hospital doesn't push for it, but you're not doing CCM and then taking the Advanced Exam afaik.

Oh, you can take the Advanced exam, after CCM, you just won't be certified (maybe, if you go to Duke). I passed the exam this year, and start CCM fellowship in July. I'll only ever be a testamur, but all of the private groups I spoke to in my search for post-fellowship jobs say that is enough to join the cardiac team. So, if I want to remain in just the OR after fellowship, I have found several good options. To me, that would be a waste of the fellowship. I have to agree with FFP, though, in that the market for mixed Anes/CCM private practice sucks, and you have to accept arbitrary limits to your practice for academic jobs.

 

[Robotic Wis-Hipple]

Oh, you can take the Advanced exam, after CCM, you just won't be certified (maybe, if you go to Duke). I passed the exam this year, and start CCM fellowship in July. I'll only ever be a testamur, but all of the private groups I spoke to in my search for post-fellowship jobs say that is enough to join the cardiac team. So, if I want to remain in just the OR after fellowship, I have found several good options. To me, that would be a waste of the fellowship. I have to agree with FFP, though, in that the market for mixed Anes/CCM private practice sucks, and you have to accept arbitrary limits to your practice for academic jobs.

Lol, fair enough.

 

[psychbender]

I should add the caveat that I am not looking in "desirable" areas or big cities. For those, I wouldn't be surprised if they required Advanced certification and fellowship for CT, as they can more afford to be picky.

 

[deleted171991]

Let's clear some things up for the residents.

Why do a fellowship? (besides improving one's knowledge in a subspecialty one likes, being a requisite for practice of the subspecialty, better chances for an academic career, personal reasons)

1. Jobs in better locations.
2. Better paid jobs.
3. Easier jobs.
4. Getting out of the OR.
5. PP partnership.
6. Easier to find a job/more opportunities (as an anesthesiologist).

Yes and No below should not be taken as absolutes, but as likelihood for most positions.

Let me answer for CCM:
1. No.
2. No.
3. No.
4. Yes.
5. No.
6. No.

For cardiac:
1. Yes.
2. Yes.
3. No-ish.
4. No.
5. Yes.
6. Yes-ish.

For regional/acute pain:
1. Maybe.
2. No.
3. Yes.
4. Yes.
5. No.
6. Yes.

For pain:
1. Yes.
2. Yes.
3. Yes.
4. Yes.
5. Yes.
6. Yes-ish.

For peds:
1. Yes.
2. No.
3. Yes.
4. No.
5. No.
6. Yes-ish.

Food for thought.

 

[partydoc]

I like the way ffp puts it. I'm a ca3 doing cc next year, talked to a couple of pp groups, it's nice to have it on your resume but these groups don't cover the unit so ultimately nobody cares.

 

[Dam272]

Let's clear some things up for the residents.

Why do a fellowship? (besides improving one's knowledge in a subspecialty one likes, being a requisite for practice of the subspecialty, better chances for an academic career, personal reasons)

1. Jobs in better locations.
2. Better paid jobs.
3. Easier jobs.
4. Getting out of the OR.
5. PP partnership.
6. Easier to find a job/more opportunities (as an anesthesiologist).

Yes and No below should not be taken as absolutes, but as likelihood for most positions.

Let me answer for CCM:
1. No.
2. No.
3. No.
4. Yes.
5. No.
6. No.

For cardiac:
1. Yes.
2. Yes.
3. No-ish.
4. No.
5. Yes.
6. Yes-ish.

For regional/acute pain:
1. Maybe.
2. No.
3. Yes.
4. Yes.
5. No.
6. Yes.

For pain:
1. Yes.
2. Yes.
3. Yes.
4. Yes.
5. Yes.
6. Yes-ish.

For peds:
1. Yes.
2. No.
3. Yes.
4. No.
5. No.
6. Yes-ish.

Food for thought.

Which of the points is for chances for an academic job in an institute? maybe geared towards research?

 

[nimbus]

I like the way ffp puts it. I'm a ca3 doing cc next year, talked to a couple of pp groups, it's nice to have it on your resume but these groups don't cover the unit so ultimately nobody cares.

Good to go in with your eyes open. We can all agree there is value to CCM training even if the market doesn't reward it.

 

[nimbus]

No. FFP may disagree with me but there are plenty of jobs where CCM trained people with just the basic TEE exam do hearts. I think a CCM trained person looking to do sick patients and some hearts would be an asset to many large groups. In fact, I would argue a CCM trained Anesthesiologist is a better anesthesiologist at handling tough cases than most generalists.

But, in PP you would be doing cases in the O.R. and not much, if any, ICU work.

Agree except the basic TEE exam won't cut it. We get more and more new hires straight out of residency who pass the advanced TEE exam. I think that's a minimum in most places to do hearts. Hopefully a CCM fellow will get some education in echocardiography and other ultrasound diagnostic skills that will be useful for both preop assesssment and intraop management.

 

[Robotic Wis-Hipple]

Agree except the basic TEE exam won't cut it. We get more and more new hires straight out of residency who pass the advanced TEE exam. I think that's a minimum in most places to do hearts. Hopefully a CCM fellow will get some education in echocardiography and other ultrasound diagnostic skills that will be useful for both preop assesssment and intraop management.

You guys are actually seeing CA3's that are taking the advanced exam? Wow. I guess I should know more about testamur status but as a CT Fellow I haven't actually looked into that. Certainly that means they've studied the material and know the physics as well as how to make quantitative assessments, but I'm not sure that means they're any good at actually performing the exam. How many performed exams are these guys coming out with?

Lastly, your hospital(s) are not pressuring you to have only certified TEE Physicians doing cardiac? Do you anticipate this happening? The groups I've interviewed/negotiated with have mostly described this as the case or if not the quickly approaching reality.

 

[AdmiralChz]

You guys are actually seeing CA3's that are taking the advanced exam? Wow. I guess I should know more about testamur status but as a CT Fellow I haven't actually looked into that. Certainly that means they've studied the material and know the physics as well as how to make quantitative assessments, but I'm not sure that means they're any good at actually performing the exam. How many performed exams are these guys coming out with?

Yeah I don't know about this, the jobs I'm looking at post-fellowship for hearts almost exclusively require CT fellowship to be on the heart team. Im a CA-3 now and there's zero chance it would be appropriate or passable for me to take the advanced exam - that's thekpurpose of a fellowship. Plus residents' focus needs to be on passing the Anesthesiology boards not optional echo board exams - for this reason many of our recent grads have even opted to hold off on taking the bask exam.

 

[nimbus]

You guys are actually seeing CA3's that are taking the advanced exam? Wow. I guess I should know more about testamur status but as a CT Fellow I haven't actually looked into that. Certainly that means they've studied the material and know the physics as well as how to make quantitative assessments, but I'm not sure that means they're any good at actually performing the exam. How many performed exams are these guys coming out with?

Lastly, your hospital(s) are not pressuring you to have only certified TEE Physicians doing cardiac? Do you anticipate this happening? The groups I've interviewed/negotiated with have mostly described this as the case or if not the quickly approaching reality.

Yes we've had several new hires who have passed the advanced PTEEXAM straight out of residency. And many experienced non-fellowshipped cardiac guys who have also passed. You are correct just because you pass the test doesn't necessarily mean you can do a good exam.

Our hospitals don't have a clue about TEE exam certification. As the anesthesia department we decide what would be required to do hearts and at my particular hospital we decided you need advanced testamur status. Most of the hospitals in my area don't even require that yet because they still have a lot of older guys doing hearts. As they retire I'm sure that will change. If you are a resident and you want to do hearts, you should do a fellowship. But we have had several new hires over the past3-4 years do hearts without a fellowship. They are good and self-motivated and could handle it.

 

[nimbus]

Yeah I don't know about this, the jobs I'm looking at post-fellowship for hearts almost exclusively require CT fellowship to be on the heart team. Im a CA-3 now and there's zero chance it would be appropriate or passable for me to take the advanced exam - that's thekpurpose of a fellowship. Plus residents' focus needs to be on passing the Anesthesiology boards not optional echo board exams - for this reason many of our recent grads have even opted to hold off on taking the bask exam.

It's just another standardized test and most anesthesiologists are good at them. It's been done by MANY people without fellowship, including several on this board. Especially when the test first came out, a lot of the people who took and passed it were not fellowship trained.

 

[Ezekiel2517]

Let's clear some things up for the residents.

Why do a fellowship? (besides improving one's knowledge in a subspecialty one likes, being a requisite for practice of the subspecialty, better chances for an academic career, personal reasons)

1. Jobs in better locations.
2. Better paid jobs.
3. Easier jobs.
4. Getting out of the OR.
5. PP partnership.
6. Easier to find a job/more opportunities (as an anesthesiologist).

Yes and No below should not be taken as absolutes, but as likelihood for most positions.

Let me answer for CCM:
1. No.
2. No.
3. No.
4. Yes.
5. No.
6. No.

For cardiac:
1. Yes.
2. Yes.
3. No-ish.
4. No.
5. Yes.
6. Yes-ish.

For regional/acute pain:
1. Maybe.
2. No.
3. Yes.
4. Yes.
5. No.
6. Yes.

For pain:
1. Yes.
2. Yes.
3. Yes.
4. Yes.
5. Yes.
6. Yes-ish.

For peds:
1. Yes.
2. No.
3. Yes.
4. No.
5. No.
6. Yes-ish.

Food for thought.

just as you were mistaken about what you thought prior to starting your fellowship, you are mistaken here. surprisingly by a lot in fact. funny how that works