Chief Resident

[Midnight Rider]

I have been approached and asked to put my name in the hat for chief. I am very much on the fence whether I want to do this. I am a resident at what lists on this forums say is a top 10 program. How much does having chief on your CV benefit you in the long run. I do not see academics in my future.

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[deleted126335]

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[sallyjoe]

I have been approached and asked to put my name in the hat for chief. I am very much on the fence whether I want to do this. I am a resident at what lists on this forums say is a top 10 program. How much does having chief on your CV benefit you in the long run. I do not see academics in my future.

UTSouthwestern wrote a nice review about being chief (below). I would recommend being chief since it will be looked on positively by future employers, however you will be expected to do more work than the average CA-3 resident.

Snitch. I plead the fifth.

Here is a thread from way back yonder on the subject:

http://forums.studentdoctor.net/showthread.php?t=180747

Here was one of my posts on that thread:

Chief resident:

Job description: Leader, innovator, scheduler, full time pinch hitter, administrative assistant, human juggling act, counselor, mother/father, brother/sister, bastard/bitc*, and enforcer.

Benefits: Nice ribbon on your resume. Jobs come looking for you. Almost automatic interview when they know you are chief. Automatic fellowship placement if you go that route. Faculty appointment if you so desire.

Detractors: Time, TIME, T I M E. You spend at least 2-3 hours each day answering pages and e-mails, putting out small fires, hunting down wayward residents, sitting on important but numerous committee meetings, planning schedules two months in advance, planning out the yearly schedule at the beginning of the year which you will then change at least three dozen times due to maternity/paternity leave, poor resident performance, family tragedies, personality conflicts, etc. Someone doesn't show up for any reason then you are there to take their place. Educational planning meetings, residency review committees, multispecialty chief residents' conferences, residents' meetings, etc. are all part of your year. You spend more time being chief than reading for the most part and if you are married with kids, you aren't going to be a very good spouse/parent for that year.

Many of you have asked me how and why I respond so quickly to questions and the answer is easy: I am always on the computer checking e-mail and charting out schedules for multiple clinical sites at nine different hospitals.

The job hunt becomes a lot easier, however, and I had people contacting me as well as myself initiating contact. California, Arizona, Washington state, Oregon, and Texas were my acceptable destinations and I interviewed at more than a dozen sites including some who had previously published that they were not hiring this year. One friend of mine is still not talking to me after she found out I interviewed and was offered by a group that she had been trying to get into since before she started residency. Some groups even stated flatly to me that they only hire chief residents for their groups (a little pompous and shortsighted in my opinion, but whatever floats your boat).

So does it help? Definitely. Should you campaign to get the position? Hell no. Every resident should work with the diligence and enthusiasm that would make them candidates for the position, but what will separate you from the pack is your willingness to go the extra mile and help your fellow residents and program whenever there is a need and even when there isn't a need. Recognition comes through merit and service, not backstabbing, politicking, or machinations. I have seen a couple of people in other residencies do the latter and claim the position but all that does is create a chief resident without the ability or backing of the residents to lead.

I always wanted to help and do extra work because I loved the extra opportunities to gain experience and even just watch other people in action to learn their secrets. You can also separate yourself from the pack by being lazy, showing up late, not being prepared, and having a me first/the world is against me attitude. YOU CANNOT JUST TURN OFF LAZINESS AND SUDDENLY BECOME AN ACHIEVER. You slack off early in your residency and not only does it become hard to deviate from your wayward path, but it is also hard to shake off the label of lazy/stupid/dangerous resident.

For our institution, the residents and faculty each vote and the top two vote getters become chief, although the chairman holds veto power if he feels a candidate isn't academically well positioned to handle the spot or for any reason he feels a person should be disqualified from holding the position.

Would I do it again?


Yes I would. It's been the most taxing year of my life trying to be a full time spouse, father, chief, clinical resident, and job seeker, but if this experience coupled with an already deep educational residency hasn't prepared me for what lies ahead, I don't know what else could.

 

[Masseter Spasm]

Being chief is challenging but rewarding. (See UTSouthwestern's excellent response above.) I think it helps with your hunt for your first position. (You may get interviewed for positions inaccessible to other senior residents.)

The best part of being chief is that it only lasts one year. You get some great experience and insight into a department of anesthesia. If you take on administrative responsibilities later in your career the commitment will last longer (unless you are a complete failure).

 

[Frank Rizzo]

I have been approached and asked to put my name in the hat for chief. I am very much on the fence whether I want to do this. I am a resident at what lists on this forums say is a top 10 program. How much does having chief on your CV benefit you in the long run. I do not see academics in my future.

This mirrors my exact situation. Keep the input coming!!!

 

[GassmanMD]

Any new insights into this topic which has not been discussed in years? Does being chief matter more now with the competitive climate of anesthesiology? Would being chief make up for not doing a fellowship in the marketplace?

I placed a bid to be chief last week because not only do I see it as a good line on the CV, but also because I will learn a lot of new skills without doing an additional year of fellowship.

 

[deleted171991]

Would being chief make up for not doing a fellowship in the marketplace?

NO. Unless it's an OR management "fellowship". Somebody with a useful fellowship from a good place will always bring more to the table.

because I will learn a lot of new skills without doing an additional year of fellowship.

Can you enumerate them?

 

[pjl]

There was a thread about this last year. Im too lazy to search for it.
I would recommend being chief for competitiveness for job. It does not replace fellowship experience, but does give you a leg up on your non-chief classmates. Responsibilities of being chief vary widely between programs, so while at one program you may be in charge of scheduling/filling shifts/resident discipline/lectures/various other jobs which give you valuable leadership skills and allow you to polish people skills, at other programs you are a glorified cheerleader for the program and program directors lackey. Being the second type gives you no benefit.

My personal feeling is that an applicant who put in the extra effort to be chief will likely put in the extra effort in my group to sit on committees and do other tasks that nobody really wants to do but gives you a more stable position. Looking at my current group (admittedly small sample size) we have 5 guys who were chiefs and 5 who were not. Within the past 5 years members of our department have been chief of staff, president of hospital, multiple on board of directors, leading the quality committee, co-chair of pharmacy committee, and obviously leadership roles within the department. Guess which 5 are doing those things. Of the non-chief 5 we have only one who has become active in this manner.
I am sure a lot of this is self selecting, but it still makes me place that extra responsibility during residency as an important marker of future group responsibility and department respectability within the hospital.

I also have a diminished view of what a fellowship brings to the table for a private practice job with a diverse patient population compared to others, but that is something that can be discussed elsewhere. Because of this, I may place a non-fellowship trained applicant over a fellowship trained applicant more readily than another. That said, we will probably be looking for a cardiac trained guy who wants to do general as our next hire. We wont be specifically looking for a former chief, so let that show you the rating of importance...

 

[kazuma]

NO. Unless it's an OR management "fellowship". Somebody with a useful fellowship from a good place will always bring more to the table.

I wouldn't say a fellowship trained individual always brings more to the table in private practice especially the less useful fellowships (for private practice) such as OB, Regional, or even CCM. The group I'm going to has definitely passed up on fellowship trained grads in favor of chiefs for a variety of reasons. Despite what many say on here, anesthesia fellowships really aren't that competitive. CCM has many unfilled spots each year, and I've known several low performing or mediocre residents that have secured peds and cardiac fellowships at good programs, even outside their home institution (not necessarily top tier fellowships, but solid programs).

In other words, 50-90% of graduates from most anesthesia classes could potentially do a fellowship whereas only 1-2 graduates in each class are selected as chief. Usually the chiefs are clinically and academically strong and have proven that they can get along well with others in addition to being able to handle various administrative responsibilities. Chiefs should be able to hit the ground running on July 1, work quickly/efficiently, do big cases (including hearts or neonates if credentialing allows), keep the surgeons/partners happy and fulfill hospital committee responsibilities and group administrative duties which help the group remain relevant in an uncertain market environment.

Show me a private group that's dying to recruit a CCM grad, especially a group that doesn't cover the ICU which is exceedingly rare in itself. Regional? OB? Most groups I've talked to say it's a waste of time, and I've yet to talk to a single group that's thrilled about CCM. If they really want a fellowship trained person to do hearts, generally they want an echo boarded cardiac person. FWIW, becoming echo boarded in CCM fellowship is very difficult/rare and even frowned upon by several staff I've talked to at different CCM fellowships. Otherwise most grads should be able to do private practice hearts without a fellowship (perhaps with advanced echo testamur status) like several recent grads from my program have done.


Everyone's experiences are different and maybe I'll have to dish myself up a nice serving of crow pie a la mode in 5-10 years. However, my experience and recent job hunt showed me that a CCM fellowship wasn't helpful (perhaps even detrimental in some ways) in securing a great PP gig. The only fellowships that might have added something to the table were peds>>cardiac but even then, most groups were fine w/o peds fellowship as long as you did them throughout residency and were comfortable doing neonate cases and up (no ped hearts etc) and I have colleagues that are doing hearts without a cardiac fellowship.

These aren't predatory, ACT model, BFE, or ASC/GI center only groups either. I'm talking about solid 50-200+ member, physician only, private groups with short/reasonable partnership tracks.

On the other hand, all groups I looked into took chief applicants very seriously, viewed their chief experience favorably and my future group happens to have many prior chiefs. And as a previous person mentioned, the chiefs are often times the ones involved with running the group and being involved with hospital committee positions.

Again, your experience will differ especially depending on the part of the country you are in and the people you know to network with.

 

[GaseousClay]

From my job hunting experience there were multiple places that put a lot of emphasis on chief resident. Some only wanted to interview chiefs if you did not have a fellowship. That being said each institution has different ways chiefs are picked and what they actually do so i think its kind of crap...

 

[deleted171991]

I wouldn't say a fellowship trained individual always brings more to the table in private practice especially the less useful fellowships (for private practice) such as OB, Regional, or even CCM. The group I'm going to has definitely passed up on fellowship trained grads in favor of chiefs for a variety of reasons. Despite what many say on here, anesthesia fellowships really aren't that competitive. CCM has many unfilled spots each year, and I've known several low performing or mediocre residents that have secured peds and cardiac fellowships at good programs, even outside their home institution (not necessarily top tier fellowships, but solid programs).

In other words, 50-90% of graduates from most anesthesia classes could potentially do a fellowship whereas only 1-2 graduates in each class are selected as chief. Usually the chiefs are clinically and academically strong and have proven that they can get along well with others in addition to being able to handle various administrative responsibilities. Chiefs should be able to hit the ground running on July 1, work quickly/efficiently, do big cases (including hearts or neonates if credentialing allows), keep the surgeons/partners happy and fulfill hospital committee responsibilities and group administrative duties which help the group remain relevant in an uncertain market environment.

Show me a private group that's dying to recruit a CCM grad, especially a group that doesn't cover the ICU which is exceedingly rare in itself. Regional? OB? Most groups I've talked to say it's a waste of time, and I've yet to talk to a single group that's thrilled about CCM. If they really want a fellowship trained person to do hearts, generally they want an echo boarded cardiac person. FWIW, becoming echo boarded in CCM fellowship is very difficult/rare and even frowned upon by several staff I've talked to at different CCM fellowships. Otherwise most grads should be able to do private practice hearts without a fellowship (perhaps with advanced echo testamur status) like several recent grads from my program have done.


Everyone's experiences are different and maybe I'll have to dish myself up a nice serving of crow pie a la mode in 5-10 years. However, my experience and recent job hunt showed me that a CCM fellowship wasn't helpful (perhaps even detrimental in some ways) in securing a great PP gig. The only fellowships that might have added something to the table were peds>>cardiac but even then, most groups were fine w/o peds fellowship as long as you did them throughout residency and were comfortable doing neonate cases and up (no ped hearts etc) and I have colleagues that are doing hearts without a cardiac fellowship.

These aren't predatory, ACT model, BFE, or ASC/GI center only groups either. I'm talking about solid 50-200+ member, physician only, private groups with short/reasonable partnership tracks.

On the other hand, all groups I looked into took chief applicants very seriously, viewed their chief experience favorably and my future group happens to have many prior chiefs. And as a previous person mentioned, the chiefs are often times the ones involved with running the group and being involved with hospital committee positions.

Again, your experience will differ especially depending on the part of the country you are in and the people you know to network with.

That's why I wrote useful. For me, that includes Cardiac, Peds, Pain... and even CCM. Plus maybe regional, if one didn't get proper training during residency, and if combined with acute pain management.

Let me develop the idea about CCM. While CCM by itself will never get somebody a good PP job, the comfort level one gains while dealing with really sick patients will. Also, being able to supervise multiple sick patients and midlevels at a time. Most of the CCM-trained anesthesiologists I know are comfortable doing any cases in any patients, except for maybe cardiac surgery. There are very few things you can scare them with. Now these guys trained in good programs, so that's probably why they are good. But I understand why CCM does not matter that much, as long as it does not translate to OR skills.

Are you saying that somebody with a good CCM fellowship (maybe with a few years of OR attending experience on top of it, maybe board-certified in both anesthesia and CCM) will be viewed worse than a fresh grad ex-chief?

Oh, and good luck finding an open CCM fellowship position in a decent program as a CA-3, unlike only 3-4 years ago. When the time of packaged hospital reimbursements will arrive (soon), I wouldn't be surprised if a lot of anesthesia groups will try to extend to the ICU, to grab a bigger piece of the pie. I can see it happening in academia already.

 

[kazuma]

That's why I wrote useful. For me, that includes Cardiac, Peds, Pain... and even CCM. Plus maybe regional, if one didn't get proper training during residency, and if combined with acute pain management.

Let me develop the idea about CCM. While CCM by itself will never get somebody a good PP job, the comfort level one gains while dealing with really sick patients will. Most of the CCM-trained anesthesiologists I know are comfortable doing any cases in any patients, except for maybe cardiac surgery. There are very few things you can scare them with. Now these guys trained in good programs, so that's probably why they are good. But I understand why CCM does not matter that much, as long as it does not translate to OR skills.

But you wanna tell me that somebody with a good CCM fellowship (maybe with a few years of OR attending experience on top of it, maybe board-certified in both anesthesia and CCM) will be viewed worse than a fresh grad ex-chief?

True, you did say useful.

To answer your question, no, probably not. You're competing on an entirely different level. Even an ex-chief has a number of uncertainties that could potentially lie ahead including board certification, lack of real world private practice experience etc. But if you're only considering new grads, then it depends.

It especially depends on what the motivating factors were for the CCM fellow to pursue the fellowship.

Didn't feel comfortable taking care of sick patients?
Needed and extra year to make up for residency deficiencies?
Don't know what they want to do so they thought a CCM year would give them time to sort things out?
They aren't a competitive candidate with no promising jobs in the works so they're doing CCM?
Hated being in the OR?

Any of the above factors would make me think twice before hiring them.

Obviously there are people out there including myself that genuinely like CCM that would like to practice it part time when they're done. With that said I've seen a number of weak residents or attendings that choose to do a variety of fellowships either due to their training being weak or their experience diluted by fellows who do the big cases. My point being that a fellowship doesn't always trump the chief card.

I also agree that it depends how chiefs are chosen. I'm leery of those that campaign for the job or programs who's PD's choose chiefs that will best serve as their spineless lackey.

At my place, chiefs are chosen by the residents with staff reserving the right to veto if someone horrible is elected but they've never had to exercise their veto rights as far as I know. I was on an outside specialty rotation when the voting took place and I never told anyone I wanted to be chief, but I have seen people campaign in years past.

 

[pjl]

CCM is almost worse than other fellowships. Note none of this is specific to you, but as a generalization. Yes you can handle sick cases and midlevels. When was the last time you cared for a kid in the OR? When was the last time you did regional? OB? A heart (in the OR)? Or even any OR case? For a group that doesnt have any interest in the ICU, you are not sought after. Maybe you found a fellowship where you can be in the OR some, or have more experience than just residency under your belt, but for the middle of the road resident that does a CCM fellowship, the ICU is a place for your newfound skills to die.
Fellowships take people with a decent starting point for their anesthesia skill set and virtually ignore all but the specific fellowship. It isnt that you cant overcome it and relearn that stuff, but you take new skills and give them a year to get rusty...I would rather have a rockstar guy just out of residency who is fresh on all areas. The reason we want a cardiac guy is that we want to make someone teach the rest of us more about TEE, including 3d, and can call for help on difficult reads/hearts as our program grows.

 

[kazuma]

CCM is almost worse than other fellowships. Note none of this is specific to you, but as a generalization. Yes you can handle sick cases and midlevels. When was the last time you cared for a kid in the OR? When was the last time you did regional? OB? A heart (in the OR)? Or even any OR case? For a group that doesnt have any interest in the ICU, you are not sought after. Maybe you found a fellowship where you can be in the OR some, or have more experience than just residency under your belt, but for the middle of the road resident that does a CCM fellowship, the ICU is a place for your newfound skills to die.
Fellowships take people with a decent starting point for their anesthesia skill set and virtually ignore all but the specific fellowship. It isnt that you cant overcome it and relearn that stuff, but you take new skills and give them a year to get rusty...I would rather have a rockstar guy just out of residency who is fresh on all areas. The reason we want a cardiac guy is that we want to make someone teach the rest of us more about TEE, including 3d, and can call for help on difficult reads/hearts as our program grows.

I agree, that's the same type of response I got from the private groups I talked to. I couldn't be happier with my decision to go straight into private practice, I can't wait to start this July.

 

[epidural man]

Don't do it.

LOTS of headaches and work - and no value added.

Remember...when Robert Frost wrote that he traveled the road less traveled and it make all the difference, he was talking about something like this. How many people that could have been chief turned it down because they saw the light? very few. Be an outstanding resident with good reviews and everything will be open to you. Chief does NOT add anything to that.

but if you love listening to other residents cry and complain - and staff cry and complain - and the director cry and complain...do it. Good luck and let us know after a year of being chief if it was a good idea (because I know you won't take my advice but will take the advice of everyone else who ...for some very strange reason...think it is a good idea).

 

[kazuma]

In my (former) place, residents vote but the department leadership decides. We never knew who got the most votes. So usually half of the chiefs were of debatable (human and/or professional) quality, and did not have my respect. This is why, for me personally, somebody having been a chief can be as much of a red flag as a positive.

I would expect somebody who really doesn't like sick patients to rather go into pain, or some outpatient-related fellowship, instead of self-inflicting the intensity of a CCM fellowship.

Again, I'd rather expect that with regional, OB, neuro and such. CCM fellows actually lose OR skills, in the year off. And nobody does CCM just to make up for poor ICU training during residency.

Again, there are way easier fellowships for this.

Again, you are assuming that CCM fellowships are available left and right. They are not (anymore).

Actually that can be a plus, in the ACT model.

Seriously, many attendings who have tasted the ACT model like the fact that they are not in the OR anymore. That's why many academics are not happy when one makes them work solo. I find nothing abnormal in it; stool sitting can be boring.

That makes sense, in regards to your chief experience. It's definitely a different situation at my place. I've always thought highly of my chiefs, in fact some of them are going to be my partners.

True, especially the hating the OR part. Most of my attendings literally hate being in the OR now, they virtually never do solo cases.

I don't know how this ranks compared to years past but this year we had a 15% of CCM spots left unfilled.

Critical Care Anesthesiology Fellowship June
2014
APPLICANT DATA
Applicant registrations196
# Applicant Rank Lists Submitted147
Matched Total127
Unmatched Total20
Applicant Matching %(Overall)86%
Total # of Withdrawals20
PROGRAM DATA
# of Participating Programs47
Positions Offered150
Positions Filled127
Unfilled Positions23






Edit: Sorry to derail the thread, to answer the OP or revival OP's question, yes, I would be chief if elected again. I guess it depends on your program, but the overwhelming majority of my co-residents are awesome and great to work with. Sure, a fair number of them complain, but that's the nature of residency. It is a lot of extra work and headaches, but I feel that the benefits usually outweigh the negatives.

 

[deleted171991]

Maybe you found a fellowship where you can be in the OR some, or have more experience than just residency under your belt, but for the middle of the road resident that does a CCM fellowship, the ICU is a place for your newfound skills to die.
Fellowships take people with a decent starting point for their anesthesia skill set and virtually ignore all but the specific fellowship. It isnt that you cant overcome it and relearn that stuff, but you take new skills and give them a year to get rusty...I would rather have a rockstar guy just out of residency who is fresh on all areas. The reason we want a cardiac guy is that we want to make someone teach the rest of us more about TEE, including 3d, and can call for help on difficult reads/hearts as our program grows.

What exactly does one get rusty at? Inducing a patient? Intubating? Putting in lines? Managing fluids? Managing intraop hemodynamics? Managing the vent? Muscle relaxation? Pain control? Blocks? I am bit biased here, since I am going to do CCM after a few years worked as a solo attending.

What's so science-fiction in the OR one does not do in the ICU? General anesthesia for healthy patients is no big deal (that's why the AANA has grown a mouth). And intensive care for the sick ones does not differ that much from taking care of them during GA. Again, maybe I am biased, but I don't really see a problem, except for losing muscle memory and regional/neuraxial skills.

I haven't had more than 3 month-long breaks in my career (non fellowship-trained), and I was rusty indeed for a few weeks, but that was it. Anybody well-trained should be able to get back to normal in a couple of months after just one year of interruption. If one needs to remember something, one watches somebody else do it (if it's not on youtube). It's not like one has never learned how to do anesthesia. I haven't done a neuraxial block in years, but I would be shocked if I can't do one if needed in a regular patient, especially if somebody helps me with a couple.

At the same time, a CCM-trained guy will probably run circles around many anesthesiologists at dealing with sick patients, neuro cases, extensive and long cases, doing a TTE if needed, doing a trach/cryc if needed, medical knowledge, codes, lines. Where does all this disrespect for CCM come from?

CCM is almost worse than other fellowships. Note none of this is specific to you, but as a generalization. Yes you can handle sick cases and midlevels. When was the last time you cared for a kid in the OR? When was the last time you did regional? OB? A heart (in the OR)? Or even any OR case? For a group that doesnt have any interest in the ICU, you are not sought after.

How many of non pedi-trained anesthesiologists will still care for kids in the OR in 10 years? Very few.

Regional is hand-eye coordination. Most blocks are not science-fiction, that's why they used to be taught in PP. And that was before ultrasound.

Same with OB. Seriously, what's the big deal with OB, except for neuraxial blocks? (And again, rusty doesn't mean the knowledge and skills are not there.) Airways are less and less of an issue because of technology. Intraop management will never be a big deal for somebody CCM-trained either. Judgment? That comes with experience, with or without a (non-OB) fellowship.

Hearts? Here I am biased, because my program did not teach me TEE, so I never even dreamed about doing hearts. But there are CCM programs where people get TEE training.

All I am saying I can't see why CCM is (such) a disadvantage. I find it shocking. Most anesthesiologists around the world are also CCM-trained and certified, and there is a reason for it.

 

[Planktonmd]

AH... I hate those " I am so great... they really love me ... but I am not sure what I want to do" kind of masturbatory discussions!
Do whatever the hell you want to do... it will make zero difference!

 

[norwood]

Many of the unfilled positions were in Texas (what's wrong there?)

The east coast and west coast like to run Texas down because it's culturally different from them. Meh, whatever but it somehow gets a lot of people to say "Ewww, Texas" and contributes to this kinda stereotypical attitude in people's minds.

 

[epidural man]

If you do take chief, I can then say about you that you will put your kids in private school because somehow you believe that will give them a huge advantage in life.

Well good on ya...

 

[pgg]

If you do take chief, I can then say about you that you will put your kids in private school because somehow you believe that will give them a huge advantage in life.

Well good on ya...

Wut

 

[pjl]

No disrespect meant for CCM, just not seeing the value added for a group that doesnt do ICU. All of us should be able to pick up lost skills over not all that long, but you are going to be "rusty." You have prior attending experience, which mens your OR skills are far more set in. I just dont think a guy who did 2 months of cardiac 2 years ago is going to be ready to jump into a heart case when done. Same with regional, people pick it up fast with U/S, but that gap after doing what, 150 total blocks leaves you with a decrease in your skills.
You are right that I overstated the placement of CCM as "the worst," I probably should have said the worst between cardiac, peds, and CCM. I think it is better than OB, regional, neuro, OR management, PACU or whatever else is out there.

 

[GassmanMD]

Thanks for all the helpful replies. I did not expect such passionate responses, but that's awesome. I know being chief won't make or break anyone's career, but I hope to get it since I'm not doing a fellowship.

 

[GA8314]

I was not chief, but I was a strong resident. I think being chief is a very good thing to have on the CV. No question.

On the subspecialty questions, here are a few things to consider.....
I'm doing just about every type of case except neonates and craniotomies (we just don't do them at my place). No fellowship but great training in residency (don't we all think that?)

We do tons of ortho/regional, B&B peds, hearts, thoracic, vascular, OB (I take a lot of extra call for extra $$). We see plenty of sick patients, and managing sick patients in the ICU is different from managing them in the OR.

Being in this type of practice is exactly what I was looking for and I love the variety. I honestly feel that I'm becoming a very solid and capable anesthesiologist and the variety of cases is helping that, versus being "pigeon-holed" into a subspecialty.....

Fellowships CAN be a very good thing. I will never say they aren't, but there are plenty of PP groups that NEED someone that does NOT suffer from skill attrition which happens when you do lots of one thing. Surely, sick neonates and specialty hearts warrant the type of specialization and focus afforded by fellowship training and keeping those types of teams.

But, the reality? MOST of anesthesia is not being delivered at tertiary care centers. There's a lot of anesthesia (just try avoiding sick, unhealthy patients) and pretty high acuity stuff going on in the "community".

The MVP of a group like ours would be a very solid GENERAL anesthesiologist capable of doing lots of regional, not scared of taking care of kids, being deft in cardiac and thoracic, and does OB as well. And while we don't do heads, we do do neuro with monitoring. I know lots of specialists that wouldn't fit into a group like this. Not immediately after fellowship, but after skill attrition takes place...

Just my 2 cents. Again, yes, chief is a good thing.

 

[deleted171991]

managing sick patients in the ICU is different from managing them in the OR.

How? Because of the blood loss and analgesia? Because the patients are in an artificial coma vs a natural one?

 

[nimbus]

Most of our new hires have no fellowship. The only fellowships we specifically recruit for are cardiac and peds. And yes, chief is a plus but not necessary. This is just one practice FWIW.