Ether paranoia

[zippy2u]

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So this Ether dude has some of us old goats up in a wad with all this CRNA talk. Zip's gotta spice up the old sheepskin with a fellowship that will take him out of the CRNA supervision arena. Ether, what's a guy to do 12 years out and from the "lazy era" as Militaryman put it so eloquently in a long ago post(He is correct in this regard so I didn't harp on him)? Have a fantasy of doing a cardiac fellowship but don't have a feel of what these CV program dudes would think about a guy like me. Haven't done a heart since residency. Hell, what's a year--it'll go by quick. I got the money to tie me over. Baylor? I got a Texas license. Wife and kids say when are we moving(rather adventurous sap suckers I might add) Anyone with thoughts, ideas, suggestions? I'm game! Regards---- Zip

 

[toughlife]

So this Ether dude has some of us old goats up in a wad with all this CRNA talk. Zip's gotta spice up the old sheepskin with a fellowship that will take him out of the CRNA supervision arena. Ether, what's a guy to do 12 years out and from the "lazy era" as Militaryman put it so eloquently in a long ago post(He is correct in this regard so I didn't harp on him)? Have a fantasy of doing a cardiac fellowship but don't have a feel of what these CV program dudes would think about a guy like me. Haven't done a heart since residency. Hell, what's a year--it'll go by quick. I got the money to tie me over. Baylor? I got a Texas license. Wife and kids say when are we moving(rather adventurous sap suckers I might add) Anyone with thoughts, ideas, suggestions? I'm game! Regards---- Zip

Do it. I say just make sure you get enough echo training to get you certified. I think you need 300 reads or so but I may be wrong.

 

[johankriek]

So this Ether dude has some of us old goats up in a wad with all this CRNA talk. Zip's gotta spice up the old sheepskin with a fellowship that will take him out of the CRNA supervision arena. Ether, what's a guy to do 12 years out and from the "lazy era" as Militaryman put it so eloquently in a long ago post(He is correct in this regard so I didn't harp on him)? Have a fantasy of doing a cardiac fellowship but don't have a feel of what these CV program dudes would think about a guy like me. Haven't done a heart since residency. Hell, what's a year--it'll go by quick. I got the money to tie me over. Baylor? I got a Texas license. Wife and kids say when are we moving(rather adventurous sap suckers I might add) Anyone with thoughts, ideas, suggestions? I'm game! Regards---- Zip

dont waste your time...

read cardiac anesthesia a demythologized approach... if you are interested in getting back in the game.

if you hadnt noticed the serious decrease in cardiac surgeries all over..

but hey who am i to tell you what to do.. go for it.. enjoy your service..

 

[Mman]

if you hadnt noticed the serious decrease in cardiac surgeries all over..

Aren't they finding more and more problems with the amazing new drug eluding stents? Still hard to beat brand new grafts when it comes to perfusing myocardium.

 

[EtherMD]

So this Ether dude has some of us old goats up in a wad with all this CRNA talk. Zip's gotta spice up the old sheepskin with a fellowship that will take him out of the CRNA supervision arena. Ether, what's a guy to do 12 years out and from the "lazy era" as Militaryman put it so eloquently in a long ago post(He is correct in this regard so I didn't harp on him)? Have a fantasy of doing a cardiac fellowship but don't have a feel of what these CV program dudes would think about a guy like me. Haven't done a heart since residency. Hell, what's a year--it'll go by quick. I got the money to tie me over. Baylor? I got a Texas license. Wife and kids say when are we moving(rather adventurous sap suckers I might add) Anyone with thoughts, ideas, suggestions? I'm game! Regards---- Zip

I take it you want a different job. If your current job pays well and you are satisfied with the location, work hours, etc. why bother with a fellowship now? Any major changes in the field are still about 5 years out so why pursue a fellowship now? Are you interested in academics? Do you want to do all your own cases?

But, if you want to do a fellowship in Cardiac then with your years of experience most programs will view you as an asset. You could do the 12 months easily and be TEE eligible at the end. I recommend that you look for a program that will treat you well for 12 months. The last thing you need is to get killed on call as a Cardiac fellow at your age (just kidding a bit). I would avoid a program with busy trauma and transplants (a few are okay).
In other words, be very selective about the program because in your situation 'name recognition' means a lot less than for a new graduate.
At the end of your fellowship the job market (academic and private practice) will greet you with open arms.

 

[zippy2u]

Well, Ether what programs do you recommend? Thanks very much for the suggestions. ---Zip

 

[EtherMD]

Well, Ether what programs do you recommend? Thanks very much for the suggestions. ---Zip

Why not start looking close to home? I believe Texas has several Cardiac fellowship programs available. Are you planning on starting this July? If so, considering your age and experience you should call the program directors at these places. Even at this point in the year you have a shot at a spot for July. Also, why not speak with a fellow at several of the programs in Texas so you can get a feel for how bad the year is at that place.

 

[johankriek]

Aren't they finding more and more problems with the amazing new drug eluding stents? Still hard to beat brand new grafts when it comes to perfusing myocardium.

at the expense of slicing the sternum open with a circular saw, being on pump for 60 minutes and a nice 3 day hospital stay if NOTHING goes wrong. not to mention the 200,000 bill from the hospital..

 

[VentdependenT]

I saw the divinci robot on discovery. they did a valve repair on this woman. never cracked the chest. I dunno how the hell they did it.

 

[VolatileAgent]

cardiac fellowship is still unnecessary (and will be for the next 10 years) to do cardiac cases. excellent point about interventional cardiology... pump cases are WAY down everywhere, and it's going to be hard for a lot of programs to get their numbers to meet ACGME requirements.

i think that ether is far too alarmist and, quite frankly, doesn't understand the demographics at play. push hasn't come to shove yet. there isn't going to be any major changes in our field for at least a decade, and the anesthesia part of the equation is a small fry compared to the bigger fish of practice management. things will change, but not how he envisions.

even if crna's get independent practice rights in all 50 states, they're still going to have to compete. this overall may drive down reimbursement, but it certainly doesn't mean an end to anesthesiologists. i agree with the more diversified your personal portfolio is the better, but roles are and will continue to change. fact is, no one can predict with certainty what will happen by 2015. and, that's still a long way away...

iow, your job is secure. but, make hay while the sun shines and invest wisely.

 

[UTSouthwestern]

cardiac fellowship is still unnecessary (and will be for the next 10 years) to do cardiac cases. excellent point about interventional cardiology... pump cases are WAY down everywhere, and it's going to be hard for a lot of programs to get their numbers to meet ACGME requirements.

i think that ether is far too alarmist and, quite frankly, doesn't understand the demographics at play. push hasn't come to shove yet. there isn't going to be any major changes in our field for at least a decade, and the anesthesia part of the equation is a small fry compared to the bigger fish of practice management. things will change, but not how he envisions.

even if crna's get independent practice rights in all 50 states, they're still going to have to compete. this overall may drive down reimbursement, but it certainly doesn't mean an end to anesthesiologists. i agree with the more diversified your personal portfolio is the better, but roles are and will continue to change. fact is, no one can predict with certainty what will happen by 2015. and, that's still a long way away...

iow, your job is secure. but, make hay while the sun shines and invest wisely.

Cardiac surgeries are down but there will always be a need for valve surgery and the need for complicated bypass surgery in non-interventional candidates will always be present. The recent NEJM article on CABG versus stents has also raised some eyebrows and issues with medicated stents ensure that cardiac surgery will remain and can honestly only go up from its current low.

I am somewhat biased being in a busy cardiac anesthesia practice that sees typically more than 2,000 cardiac surgeries per year.

The benefit of the training in a cardiac anesthesia fellowship is greatest for those residents that skated by with the bare minimum of cardiac cases and/or had the minimum of intensive care training.

Cardiac Anesthesia for Dummies may give you a framework for doing a chipshot case, but the experience that allows you to anticipate complications or possible difficulties is invaluable.

 

[EtherMD]

cardiac fellowship is still unnecessary (and will be for the next 10 years) to do cardiac cases. excellent point about interventional cardiology... pump cases are WAY down everywhere, and it's going to be hard for a lot of programs to get their numbers to meet ACGME requirements.

i think that ether is far too alarmist and, quite frankly, doesn't understand the demographics at play. push hasn't come to shove yet. there isn't going to be any major changes in our field for at least a decade, and the anesthesia part of the equation is a small fry compared to the bigger fish of practice management. things will change, but not how he envisions.

even if crna's get independent practice rights in all 50 states, they're still going to have to compete. this overall may drive down reimbursement, but it certainly doesn't mean an end to anesthesiologists. i agree with the more diversified your personal portfolio is the better, but roles are and will continue to change. fact is, no one can predict with certainty what will happen by 2015. and, that's still a long way away...

iow, your job is secure. but, make hay while the sun shines and invest wisely.

NO MAJOR CHANGES IN OUR FIELD FOR A DECADE. Dude, what are you smoking? Maybe, you have early dementia? Or, those anti-depressants are really impacting your judgement. Do you realize that if a Democrat wins the election you will see major changes in health care? Do you realize that Medicare rates for Anesthesia across the board (which means all payers) is a DEATH sentence to your new practice as you now see it?

We are so poorly paid by Medicare that your new Group must collect at least THREE times that amount from private payers. Universal Health Care may mean the end to solo MDA practice and supervision ratios as we now know them.

Volatile may wish for NO changes for the next ten years but wishful thinking does not change reality. The next election will determine if the time frame is much sooner than that so vote Republican and keep smoking or taking the stuff that Volatile uses.

 

[nutmegs]

vote Republican

no thx i already hav sum!