considering regional fellowship

[signumvitalis]

Soon to be CA 2 resident strongly considering a regional fellowship.

I'll enumerate the reasons why I feel this is the right move for me:
- The opportunity to get really comfortable with USG guided blocks. My goal is to be able to travel, to (eventually) be able to spend significant amounts of time each year doing pro bono work in underdeveloped countries and I think that regional techniques will be a nice 'something extra' to have up my sleeve.
- The types/varieties of cases being considered appropriate for ambulatory centers utilizing regional techniques is increasing, and the trends indicate (to me) that regional skills will always be in high demand.
- 15-20 years from now, I want to have something that sets me apart and make me more valuable compared to the plethora of CRNAs.
- I enjoy working in the OR (don't want to do crit care or pain) and I enjoy the variety of cases I can do with regional. I also like that on days I am not doing blocks, I will be hands on in the OR.
- While I accumulate the funds and experience to begin international pro-bono work, I would very much like to work at an ASC type setting doing blocks and running rooms.

Now, I have heard that most residents at most residency programs are able to pick up decent regional skills and therefore there is no need to be fellowship trained in regional anesthesia. In other words, it may be a possible waste of time and I will have nothing extra to gain from it, and I won't be more desirable than a non fellowship trained anesthesiologist who is comfortable with blocks.

I am aware that I might have a very naive picture of my future practice. Please do open my eyes to any major cons that I might have completely missed, or any reasons why a regional fellowship would be a complete waste of time and effort.

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[urge]

Soon to be CA 2 resident strongly considering a regional fellowship.

I'll enumerate the reasons why I feel this is the right move for me:
- The opportunity to get really comfortable with USG guided blocks. My goal is to be able to travel, to (eventually) be able to spend significant amounts of time each year doing pro bono work in underdeveloped countries and I think that regional techniques will be a nice 'something extra' to have up my sleeve.
- The types/varieties of cases being considered appropriate for ambulatory centers utilizing regional techniques is increasing, and the trends indicate (to me) that regional skills will always be in high demand.
- 15-20 years from now, I want to have something that sets me apart and make me more valuable compared to the plethora of CRNAs.
- I enjoy working in the OR (don't want to do crit care or pain) and I enjoy the variety of cases I can do with regional. I also like that on days I am not doing blocks, I will be hands on in the OR.
- While I accumulate the funds and experience to begin international pro-bono work, I would very much like to work at an ASC type setting doing blocks and running rooms.

Now, I have heard that most residents at most residency programs are able to pick up decent regional skills and therefore there is no need to be fellowship trained in regional anesthesia. In other words, it may be a possible waste of time and I will have nothing extra to gain from it, and I won't be more desirable than a non fellowship trained anesthesiologist who is comfortable with blocks.

I am aware that I might have a very naive picture of my future practice. Please do open my eyes to any major cons that I might have completely missed, or any reasons why a regional fellowship would be a complete waste of time and effort.

Business wise, there is only 1 block you need to know well: Supraclavicular. It will allow you to do all upper arm ortho and av fistulas.

The bundled payments and the big push for rapid recovery and discharge has made all lower extremity blocks virtually undesirable. Long gone are the days of Femoral, Sciatic or Popliteal blocks. The powers that be want the patients ready to walk the same day and with a lower extremity block it is not possible.

Sure there are Adductor Cannal blocks and Tap blocks but I consider a percocet as better than those. I know some will disagree.

So to answer you question: We are talking about only 1 block that matters, and 2 others that are +/-. Will you be comfortable with Supraclavicular blocks by the time you graduate? I hope so.

Now, business aside, if regional is your passion and you don't mind another year to hone your skills with like minded people, I say go for the fellowship.

Caveat: A lot of the faculty in Regional fellowships have not done a fellowship themselves. And it is not because the fellowship wasn't around. Keep that in mind.

 

[Noyac]

Wow. I totally disagree with Urge here which is unusual.

So my $0.02 is:
Regional fellowship is useless, period!
But for the reasons you mention, even less useless. Third world countries most likely won't have US. YOu would be a much greater commodity to them if you could teach them how to perform every block needed with out US.
YOU WILL WASTE YET ANOTHER YEAR OF REAL INCOME.
Sign on to a group that is regional heavy and there's your fellowship but with a lot more income.

 

[signumvitalis]

Won't a regional fellowship train me well on landmark techniques for blocks?
Are homegoing catheters going to be popular in the future?

 

[urge]

Won't a regional fellowship train me well on landmark techniques for blocks?
Are homegoing catheters going to be popular in the future?

Not where I'm at.

 

[psychbender]

In the age of ultrasound and the changing definition of standards of care, I doubt a Regional/APS fellowship will teach landmark or stim blocks. If anything goes wrong with practicing the blocks on live patients, the first question asked will be why didn't you use the ultrasound which is dedicated for that very purpose?

Catheters are cool and effective, but don't seem terribly popular, as they have greater overhead and are more manpower intensive to manage, compared to single-shot blocks.

Your residency should be teaching you all of the blocks that you need to know, and you should be graduating with a number well in excess of the ACGME required minimums (which should also be true about every other ACGME case requirement). If, after that, you feel that you still need more practice, then learn from your partners in your post-residency job.

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[sevoflurane]

Business wise, there is only 1 block you need to know well: Supraclavicular. It will allow you to do all upper arm ortho and av fistulas.

The bundled payments and the big push for rapid recovery and discharge has made all lower extremity blocks virtually undesirable. Long gone are the days of Femoral, Sciatic or Popliteal blocks. The powers that be want the patients ready to walk the same day and with a lower extremity block it is not possible.

Sure there are Adductor Cannal blocks and Tap blocks but I consider a percocet as better than those. I know some will disagree.

So to answer you question: We are talking about only 1 block that matters, and 2 others that are +/-. Will you be comfortable with Supraclavicular blocks by the time you graduate? I hope so.

Now, business aside, if regional is your passion and you don't mind another year to hone your skills with like minded people, I say go for the fellowship.

Caveat: A lot of the faculty in Regional fellowships have not done a fellowship themselves. And it is not because the fellowship wasn't around. Keep that in mind.

Do you do regional for total ankles/triple arthrosesis?

If not, why not?

I send these people home with sciatic catheters and it's a home run for everyone. Patient, ortho, hospital.

 

[sevoflurane]

Sciatic isn't enough on these cases.
You need an ACB or a good saphenous.

So yeah... You need to know way more than a SCB by the time you are done. If not, forget being part of any regional team in PP.

 

[BLADEMDA]

I like Regional. It is one of my favorite things to do at work. That said, I see CRNAs being able to do all these blocks in 15 years due to the advancement of technology.

Reason to do a Regional Fellowship:

1. Academic- It helps to get hired in academia with a fellowship. If Regional is your favorite area then do that fellowship vs let's say OB.
2. ASC- Busy ASCs may like that you have a fellowship. I have seen ads on Gaswork.com demanding Regional fellowships.
3. Private Practice- Maybe a few high volume practices will give you the Regional spot they have open. Some big practices like "niche areas" for their people.

Honestly, one is much better off doing a Pain Fellowship with 1-2 months of Acute regional as electives vs doing a Regional fellowship.

 

[sevoflurane]

Blade: Why would you let your CRNAs perform these blocks? How about your lines or TEE?

They wouldn't do any of them under my watch in this or any other parallel universe.

 

[signumvitalis]

Thanks everyone for all the input. I definitely want to keep my options open regarding academia vs PP, and it seems that doing a fellowship is a safe choice. I like regional more than any of the others, so if I did have to spend an extra year, it makes sense to do something I enjoy.
ASC jobs that require regional fellowships would then be perfect for me.

 

[Noyac]

Thanks everyone for all the input. I definitely want to keep my options open regarding academia vs PP, and it seems that doing a fellowship is a safe choice. I like regional more than any of the others, so if I did have to spend an extra year, it makes sense to do something I enjoy.
ASC jobs that require regional fellowships would then be perfect for me.

I've never seen an ASC job that "required" a regional fellowship.
I'm sure there may be some but not many.

 

[pjl]

I would second the comment that in a developing third world country you will not be likely to have access to ultrasound. Unless you plan to buy one and waste valuable space taking it along. Just FYI, they are freaking expensive. Just the probes are ~6500-8500 new.
-I do forsee a probe add on to an Ipad or similar in the semi near future that may change this. I bet someone will chime in that there is a sweet bluetooth probe out there already one of these years. I could see myself picking one of those up for travel if it ended up around the 5k price point.

If your goal is to go international and be a regional stud, just go to a practice where you can become a regional stud. You will achieve the required money a year sooner, and will be just as good for what you need. A busy practice will get you as many blocks as many regional fellowships, and you are unlikely to do catheters and other fancy stuff internationally that you spend a lot more time on in academics.
On an international trip you need the basic blocks, and all of them you should be able to do by landmark. You aren't working on decreasing hospital length of stay in that setting, you are trying to get the fastest, cheapest anesthetic with a rock solid safety record. Spinals are great. A plain old femoral is great for postop, especially if you do a sciatic too. Nobody cares if they cant walk POD 1. Supraclaviculars are great, but due to safety, without ultrasound you are going to do a plain old ax block.
All that said, the majority of people in third world countries are freaking tough as nails. They maybe pop a tylenol with the type of pain that has our patient population at a 15/10 pain. I think it comes from actually feeling pain in everyday life.

If you want to do regional because you love it, and want to become an academic regional guru, that is about the only reason I would see to do that fellowship.
CRNAs out there are already doing any block you have heard about. They took a weekend course. A regional fellowship is probably the least protective of all the fellowships (except OB/neuro). I guess it does put you in front of the generalist like me in the unemployment line though.




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[Psai]

I would second the comment that in a developing third world country you will not be likely to have access to ultrasound. Unless you plan to buy one and waste valuable space taking it along. Just FYI, they are freaking expensive. Just the probes are ~6500-8500 new.
-I do forsee a probe add on to an Ipad or similar in the semi near future that may change this. I bet someone will chime in that there is a sweet bluetooth probe out there already one of these years. I could see myself picking one of those up for travel if it ended up around the 5k price point.

If your goal is to go international and be a regional stud, just go to a practice where you can become a regional stud. You will achieve the required money a year sooner, and will be just as good for what you need. A busy practice will get you as many blocks as many regional fellowships, and you are unlikely to do catheters and other fancy stuff internationally that you spend a lot more time on in academics.
On an international trip you need the basic blocks, and all of them you should be able to do by landmark. You aren't working on decreasing hospital length of stay in that setting, you are trying to get the fastest, cheapest anesthetic with a rock solid safety record. Spinals are great. A plain old femoral is great for postop, especially if you do a sciatic too. Nobody cares if they cant walk POD 1. Supraclaviculars are great, but due to safety, without ultrasound you are going to do a plain old ax block.
All that said, the majority of people in third world countries are freaking tough as nails. They maybe pop a tylenol with the type of pain that has our patient population at a 15/10 pain. I think it comes from actually feeling pain in everyday life.

If you want to do regional because you love it, and want to become an academic regional guru, that is about the only reason I would see to do that fellowship.
CRNAs out there are already doing any block you have heard about. They took a weekend course. A regional fellowship is probably the least protective of all the fellowships (except OB/neuro). I guess it does put you in front of the generalist like me in the unemployment line though.




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http://www.medcorpllc.com/ge-vscan.html?gclid=CJ_slurats0CFUodgQodFLkIzQ
Saw an em guy have one of these things that they carried around although I'm not sure if it was this model. The picture was pretty small but you could make out all of the relevant anatomy. Definitely was good enough to do blocks and lines although it does take 2 hands to use

 

[Magnus67]

My small private practice group does about 1200 to 1400 blocks per year the last five years. Mostly catheters, all kinds of blocks. A new hire a few years ago really wanted to do a regional fellowship and asked if that would increase her chances of us hiring her. We offered to pay her 40,000 a year do all our blocks. We couldn't keep straight faces and started laughing our ass off during the interview. Two years later she is really happy she joined us without doing the fellowship. Unless you're going into academics for a regional position, or you have a signed contract with the group that you really think you will like requiring you to do the fellowship...... A regional fellowship continues to be a giant waste of time and $$$.


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[WholeLottaGame7]

Thanks everyone for all the input. I definitely want to keep my options open regarding academia vs PP, and it seems that doing a fellowship is a safe choice. I like regional more than any of the others, so if I did have to spend an extra year, it makes sense to do something I enjoy.
ASC jobs that require regional fellowships would then be perfect for me.

Assuming you are committed to your long-term plan and it's not just smoke and dreams, I actually think a regional fellowship might be a good fit for you, but not for the reasons you're thinking.
A good residency program should leave you proficient in a good number of USG blocks: supraclav, IS, fem, and popliteal at the least. But, you probably won't get proficient at landmark/nerve-stim techniques. Meanwhile, almost all I saw the fellows doing over at the ASC were nerve-stim blocks, especially the 2nd half of the year. So if you're going to work in some 3rd world country and it's just going to be you, a needle, and a nerve stim, it might be worth your while.

Otherwise, probably wouldn't waste time with it if you're just going to be doing SC and popliteal blocks in the good ol' US of A.

 

[pjl]

http://www.medcorpllc.com/ge-vscan.html?gclid=CJ_slurats0CFUodgQodFLkIzQ
Saw an em guy have one of these things that they carried around although I'm not sure if it was this model. The picture was pretty small but you could make out all of the relevant anatomy. Definitely was good enough to do blocks and lines although it does take 2 hands to use

Funny, they liked my price point.


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[Crash cart]

If you are headed toward academics, a regional fellowship will help you get hired. For PP, it's unnecessary.

I disagree that LE regional is obsolete. Yes, there is clearly a movement toward early mobility, but there are plenty of LE surgeries performed where the patient is non-weight bearing. We do lots of sciatic/femoral/AC blocks.

That being said, extra training is never a bad thing and so long as you understand that you'll be taking a financial hit with a fellowship and a regional fellowship (specifically) may or may not make you more attractive, I'd say go for it. The trend is to specialize but truthfully there fellowships that will make you more valuable and provide more monitory return to you than regional (cardiac, peds). But if regional is your thing, go for it.


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[fakin' the funk]

Soon to be CA 2 resident strongly considering a regional fellowship.

I'll enumerate the reasons why I feel this is the right move for me:

IMO, regional fellowship is kind of a waste of time. Since they're non-ACGME, there is a mild upside that you can moonlight and make like 30-50% of an attending salary at your institution. BUT, that's a year that you're spending NOT making 100% of attending salary, btw.

No, a regional fellowship won't train you well on landmark techniques since it's below the standard of care in the U.S., so you won't be doing them.

90%+ of the "requested" blocks in my PP group are upper extremity blocks for wrists, shoulders, elbows, etc. IS, SC, or IC all work. You should know those by the end of residency.

The demand for blocks for TKAs and the like is going wayyyy down, for the aforementioned reasons of pt mobility, bundled payments, hospital LOS, etc.

Paravertebrals seem to be the "flavor of the month" for breast and occasional VATS, and only a few of our (regional-trained) people do them effectively. Who knows how long the demand for these will last.

People going home with catheters is still "boutique medicine." Mostly we only do them if the pt is staying inpatient for a day or two.

 

[confusingleaf]

agreed with most of above posters. i think if you're very honest with a PP group and say hey, i have a big interest in regional but not a ton of experience they will help you get there. it does NOT take that long to learn to be good at blocks. and, IMHO, for a fellowship to be worth the 200k+ cost in lost income it needs to get you something that you don't or can't get from residency--and right now, that' sjust a peds certification or an echo board. OB fellowship, neuro fellowship, pain fellowship--no test, no extra certification, lots of cost for little perceived benefit unless you're going into academics.

 

[confusingleaf]

and i just realized that i'm the dumbbutt that didn't include CC or chronic pain as fellowships that would give you a cerification...i'll see myself out...

 

[signumvitalis]

Thanks to everyone for their input. I am a little more confused than before but I will continue to gather information before making a choice.
It seems that the majority opinion is that a regional fellowship isn't worth the time and loss of attending income as a lot of it can be perfected 'on the job'. I will have to do some deep thinking to figure out just how much i love regional, do I love it enough to do a fellowship despite knowing all these cons.

Are there any other cons that haven't been brought up?

 

[Tuohy]

If you are passionate about regional, then do a fellowship. Don't listen to all that you hear on these forums. I did a regional fellowship and a lot of these PP experts have gotten in trouble with thinking they're awesome at blocks (ie lawsuits).

 

[Noyac]

If you are passionate about regional, then do a fellowship. Don't listen to all that you hear on these forums. I did a regional fellowship and a lot of these PP experts have gotten in trouble with thinking they're awesome at blocks (ie lawsuits).

So a fellowship will prevent you from having a lawsuit?

That's a new one to me.

 

[gasdoc77]

If you are passionate about regional, then do a fellowship. Don't listen to all that you hear on these forums. I did a regional fellowship and a lot of these PP experts have gotten in trouble with thinking they're awesome at blocks (ie lawsuits).

I would be interested in hearing details surrounding these lawsuits. I am in a very busy PP and it is quite common for a doc to do 8-10 catheters in a day. I recognize that it is dumb luck, but thus far neither I nor any of my partners (to my knowledge) have had legal issues (we would like to keep it that way).

 

[SurferBoyMD]

Soon to be CA 2 resident strongly considering a regional fellowship.

I'll enumerate the reasons why I feel this is the right move for me:
- The opportunity to get really comfortable with USG guided blocks. My goal is to be able to travel, to (eventually) be able to spend significant amounts of time each year doing pro bono work in underdeveloped countries and I think that regional techniques will be a nice 'something extra' to have up my sleeve.
- The types/varieties of cases being considered appropriate for ambulatory centers utilizing regional techniques is increasing, and the trends indicate (to me) that regional skills will always be in high demand.
- 15-20 years from now, I want to have something that sets me apart and make me more valuable compared to the plethora of CRNAs.
- I enjoy working in the OR (don't want to do crit care or pain) and I enjoy the variety of cases I can do with regional. I also like that on days I am not doing blocks, I will be hands on in the OR.
- While I accumulate the funds and experience to begin international pro-bono work, I would very much like to work at an ASC type setting doing blocks and running rooms.

Now, I have heard that most residents at most residency programs are able to pick up decent regional skills and therefore there is no need to be fellowship trained in regional anesthesia. In other words, it may be a possible waste of time and I will have nothing extra to gain from it, and I won't be more desirable than a non fellowship trained anesthesiologist who is comfortable with blocks.

I am aware that I might have a very naive picture of my future practice. Please do open my eyes to any major cons that I might have completely missed, or any reasons why a regional fellowship would be a complete waste of time and effort.

I was hesitant to reply given that there are a lot of posts saying its not worth it, but I wanted to share my opinion. To be honest, if you are just trying to learn how to do nerve blocks well, then no, you don't need a fellowship to get proficient (just like doing central lines, A lines, and IVs, you get better with practice)

I did a regional anesthesia fellowship at the place where I did my residency. I was 50/50 as a CA-3 to do a fellowship, and actually went and looked for a PP job during that year and did not find a job around the area I wanted to be in (Bay Area, CA) granted that was the year there was a major buy out by a management company of a big private practice group in the area. So, I decided to do the fellowship to 1) buy some time till the market opened up 2) pursue some research projects I didn't get to do as a resident 3) cater my year as a fellow the way I wanted 4) moonlight at my hospital to make up some of the opportunity costs of not being a full attending.

The year was great. I published a few papers, some still on going. I did a lot of blocks both BB and newer blocks (PECS I/II/III, US paravertebral, suprascapular, QL blocks, etc), I got to attend on the acute pain service (sucked, but good learning experience running a 20+ patient list), and one of the best experiences was being an attending at a center I felt comfortable with ( I was able to bounce tough cases with attendings that trained me, and worked with residents that knew me). I would say after 4 months I was happy with the amount of blocks I had already done, and went on and focused on research and grant writing, and by month 10 to 12 I was just trying to pick up more shifts to make money.

I was happy with my year, and I stayed on faculty for 4 more months as full time, until I landed my current job, which I was lucky to land in the area I grew up. If they offered me this job before my fellowship, I would have taken it hands down without doing the fellowship year. However, I am glad it worked out the way it did, since I learned a lot during the year and now a lot of the partners in my group look towards me to be the regional "expert" for what that's worth. I also think the fellowship made me more competitive in a highly competitive market. The opportunity cost was about $100k difference in what I made as a fellow versus what I could have made as an attending. Pretty steep price for some, but I think it was a good personal decision for myself.

So for the OP, you have to decide for yourself what it's worth to you and what you want out of the year if you do decide the fellowship. You are giving up a substantial amount of cash ($100-$200k?) for the trade off of a year of learning more blocks, doing research, learning acute pain, working on other projects, etc. That's up to you.

BTW, to comment on your reasons to do a fellowship:
- If you are working in underdeveloped countries, a lot of the ultrasound companies will lend you their ultrasounds for free, i.e. Sonosite, phillips, etc. usually older models, however better than only nerve stim. Where I trained we had 3-4 missions a year and used regional heavily and had US machines with us that we brought.
- Regional skills are high in demand, a fellowship will help you be efficient at blocks; however, so will experience
- CRNAs do blocks, so what makes you different? What a regional fellowship will provide you with that will set you apart is being the "expert" and "leader" in the field of regional anesthesia, where your knowledge and skills will be used to: start a regional service, run an acute pain service appropriately, educate other practitioners on current/new evidence in regional anesthesia, be a highly valuable consultant to your surgical colleagues. (Being "fellowship trained" is a feather in the cap, you can be an "expert" without doing a fellowship with experience) Will this make you more valuable than a CRNA? I hope so, but you never know.

good luck OP. PM me for any questions.

 

[Tuohy]

So a fellowship will prevent you from having a lawsuit?

That's a new one to me.

Obviously, I am not inferring that a fellowship prevents you from having a lawsuit. However, when reading over a deposition from someone who has had a nerve block complication, it is quite evident that several of these providers do not have the inherent knowledge re: blocks/anatomy that a regional fellowship may afford you.

 

[Tuohy]

I was hesitant to reply given that there are a lot of posts saying its not worth it, but I wanted to share my opinion. To be honest, if you are just trying to learn how to do nerve blocks well, then no, you don't need a fellowship to get proficient (just like doing central lines, A lines, and IVs, you get better with practice)

I did a regional anesthesia fellowship at the place where I did my residency. I was 50/50 as a CA-3 to do a fellowship, and actually went and looked for a PP job during that year and did not find a job around the area I wanted to be in (Bay Area, CA) granted that was the year there was a major buy out by a management company of a big private practice group in the area. So, I decided to do the fellowship to 1) buy some time till the market opened up 2) pursue some research projects I didn't get to do as a resident 3) cater my year as a fellow the way I wanted 4) moonlight at my hospital to make up some of the opportunity costs of not being a full attending.

The year was great. I published a few papers, some still on going. I did a lot of blocks both BB and newer blocks (PECS I/II/III, US paravertebral, suprascapular, QL blocks, etc), I got to attend on the acute pain service (sucked, but good learning experience running a 20+ patient list), and one of the best experiences was being an attending at a center I felt comfortable with ( I was able to bounce tough cases with attendings that trained me, and worked with residents that knew me). I would say after 4 months I was happy with the amount of blocks I had already done, and went on and focused on research and grant writing, and by month 10 to 12 I was just trying to pick up more shifts to make money.

I was happy with my year, and I stayed on faculty for 4 more months as full time, until I landed my current job, which I was lucky to land in the area I grew up. If they offered me this job before my fellowship, I would have taken it hands down without doing the fellowship year. However, I am glad it worked out the way it did, since I learned a lot during the year and now a lot of the partners in my group look towards me to be the regional "expert" for what that's worth. I also think the fellowship made me more competitive in a highly competitive market. The opportunity cost was about $100k difference in what I made as a fellow versus what I could have made as an attending. Pretty steep price for some, but I think it was a good personal decision for myself.

So for the OP, you have to decide for yourself what it's worth to you and what you want out of the year if you do decide the fellowship. You are giving up a substantial amount of cash ($100-$200k?) for the trade off of a year of learning more blocks, doing research, learning acute pain, working on other projects, etc. That's up to you.

BTW, to comment on your reasons to do a fellowship:
- If you are working in underdeveloped countries, a lot of the ultrasound companies will lend you their ultrasounds for free, i.e. Sonosite, phillips, etc. usually older models, however better than only nerve stim. Where I trained we had 3-4 missions a year and used regional heavily and had US machines with us that we brought.
- Regional skills are high in demand, a fellowship will help you be efficient at blocks; however, so will experience
- CRNAs do blocks, so what makes you different? What a regional fellowship will provide you with that will set you apart is being the "expert" and "leader" in the field of regional anesthesia, where your knowledge and skills will be used to: start a regional service, run an acute pain service appropriately, educate other practitioners on current/new evidence in regional anesthesia, be a highly valuable consultant to your surgical colleagues. (Being "fellowship trained" is a feather in the cap, you can be an "expert" without doing a fellowship with experience) Will this make you more valuable than a CRNA? I hope so, but you never know.

good luck OP. PM me for any questions.

Thank you for this post. To each his own-but I fully agree that a regional fellowship makes you more marketable. As a current fellowship director in regional anesthesia, I can tell you that I have recruiters that contact me on a regular basis looking for someone with regional experience (ie fellowship trained rather than a generalist) for a solid, desirable private practice setting.

 

[signumvitalis]

Some thoughts, comments appreciated?

Why is regional such a terrible waste of time -
A good resident from a good program should be comfortable doing blocks (and neuro, OB, healthy peds, maybe cardiac too). CRNAs can do blocks (and neuro, OB, healthy peds)
Why is regional more wasteful of time compared to the other fellowships?

- I am optimistic that imaging technology is going to get better and cheaper as the years go by (the trend with most technology) - I am inclined to believe that imaging technology is not going to be completely out of reach for third world countries.

- what happens to non-fellowship trained residents in 20 years IF (hypothetical) CRNAs are able to do most cases and are cheaper and admin decides that they prefer fellowship trained physicians to supervise. Having a fellowship may not make me 'better' but will it provide some protection?

Sorry if a lot of this sounds really naive

 

[Psai]

Some thoughts, comments appreciated?

Why is regional such a terrible waste of time -
A good resident from a good program should be comfortable doing blocks (and neuro, OB, healthy peds, maybe cardiac too). CRNAs can do blocks (and neuro, OB, healthy peds)
Why is regional more wasteful of time compared to the other fellowships?

- I am optimistic that imaging technology is going to get better and cheaper as the years go by (the trend with most technology) - I am inclined to believe that imaging technology is not going to be completely out of reach for third world countries.

- what happens to non-fellowship trained residents in 20 years IF (hypothetical) CRNAs are able to do most cases and are cheaper and admin decides that they prefer fellowship trained physicians to supervise. Having a fellowship may not make me 'better' but will it provide some protection?

Sorry if a lot of this sounds really naive

Because if it's actually that important they will come up with a "regional certificate" from a 1 day weekend course that they will claim is just as good, if not better than your fellowship training

 

[Ezekiel2517]

Obviously, I am not inferring that a fellowship prevents you from having a lawsuit. However, when reading over a deposition from someone who has had a nerve block complication, it is quite evident that several of these providers do not have the inherent knowledge re: blocks/anatomy that a regional fellowship may afford you.

Gotta be kidding me.

 

[Noyac]

Obviously, I am not inferring that a fellowship prevents you from having a lawsuit. However, when reading over a deposition from someone who has had a nerve block complication, it is quite evident that several of these providers do not have the inherent knowledge re: blocks/anatomy that a regional fellowship may afford you.

Really?
Or is it that the vast majority of Anesthesiologists don't see the benefit of wasting a year doing a regional fellowship.
And since you used the term "provider" I must assume you are looking at nurses. In that case, I would agree with you. But nurses don't have fellowships or residencies for that matter. Or the knowledge base to form safe blocks either.

 

[deleted162650]

Just an oft overlooked point on the "opportunity cost" of doing a fellowship:

The opportunity cost is not the difference in $ you make as a fellow and the amount of money you would be making your first year in PP. It's the difference between fellow salary and the salary you would be making in you last year of PP when you are a partner. It's a year off the back end you're losing.