Fellowship Advice

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Hey guys, I'm a CA-2 here and really have gotten some great advice from this forum through the years. Now I have a fellowship question:

Recently I did an ICU rotation which I really enjoyed, and I think that might be the direction I want to go. However, I have already applied for a Cardiothoracic fellowship and feel that I have a good chance there.

My question is, can you think of any advantages to having both a CV and critical care fellowship? Do you think it is worth doing both, or is it just another year of training and lost salary? If I had to pick now, I would do just critical care, but I thought I would ask for the general opinion out there. Thanks in advance!

 

[cchoukal]

I think it depends. If you want to go out into practice, I think most people would think the CV fellowship is the more useful. If you want to do academics, either or both would be great.

 

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Thanks!

 

[michigangirl]

doing both would only be useful if you plan on doing a lot of service time in the cardiac SICU--- otherwise, pick one or the other depending on whether you like the cardiac OR or the ICU more.

 

[countingdays]

If you love hearts I would do CV.
If you don't like anesthesia, I would do ICU.
Otherwise I would do neither.

 

[doctadre]

IMO, the main benefit of doing a hearts fellowship is to become proficient with the echo. most anesthesiologists can figure out the other stuff, but TEE is a skill that requires training.

with that in mind, i've heard that there are many ICU fellowships that enable you to become certified with the echo. so if you're interested in both, i think that would be a good option. it will give you the skills to be an ICU doc and it will also allow you to acquire one of the most important skills that a "cardiac" anesthesiologist has.

 

[Dejavu]

IMHO, some of the reasons to do a Fellowship include making yourself more marketable or to learn something you consider important to your career that you cannot learn somewhere else.

Doctadre points out that Echo may be the most important thing about a cardiac fellowship, but it may make you more marketable.

However, remember that a fellowship costs you, personally, about $200k from lost income from that year you are not working toward partnership, so it better land you a more lucrative position later on. There are plenty of PP positions in which you do cardiac and do not require you to have a fellowship. In fact, other than academia, most of the world's practices have people without fellowship who do the cardiac stuff.

ICU will make you more marketable, if you want to do ICU.

Just remember the $200k you are "spending", neither of these fellowships gets you extra money as an attending, in the institutions I have been involved with. And when you burn out with all the call and rounding and sick pts, you end up being a POA (plain old anesthesiologist) like the rest of us, having had an extra year of slave labor and minus $200k.

Jaded opinion? Surely.

 

[seinfeld]

If you don't like anesthesia, I would do ICU.

Talking out your ass/making generalizations???? Seeing i practice both and love doing both i find your generalization upsetting and it gives many people out there considering ICU an inappropriate impression.

As i have said in the past only Pain medicine and critical care give you the option to be another type of doctor. It allows more flexibility in a changing and unknown future anesthesia market.

 

[IveGotTwins]

Talking out your ass/making generalizations???? Seeing i practice both and love doing both i find your generalization upsetting and it gives many people out there considering ICU an inappropriate impression.

As i have said in the past only Pain medicine and critical care give you the option to be another type of doctor. It allows more flexibility in a changing and unknown future anesthesia market.

If someone were planning for the changing anesthesia market, would doing only a CV fellowship be sufficient training to run a CVICU?

 

[countingdays]

talking out your ass/making generalizations???? Seeing i practice both and love doing both i find your generalization upsetting and it gives many people out there considering icu an inappropriate impression.

As i have said in the past only pain medicine and critical care give you the option to be another type of doctor. It allows more flexibility in a changing and unknown future anesthesia market.

ICU bills less than OR anesthesia right? So as an ICU/OR anesthesiologist either you give up income so that you can spend time in the ICU, or your partners give up their income so you can go to the ICU. I just doubt that this is appealing to a lot of private practices out there, and I wouldn't find it appealing either.

I'm sure you do academics so it's less obvious that the other faculty are losing income to support your love of ICU. Plus, residency programs have to have anesthesia CC, so there is a small but real demand for ICU fellows unrelated to billing.

You might love teaching, but you probably aren't going to train as a teacher and work part time at your local junior high. It just doesn't make sense to lose income to switch from one job you like to another job you like equally.

I wasn't trying to give advice from your point of view. I was giving advice based on how I see it. Nothing inappropriate about that.

 

[seinfeld]

ICU bills less than OR anesthesia right? So as an ICU/OR anesthesiologist either you give up income so that you can spend time in the ICU, or your partners give up their income so you can go to the ICU. I just doubt that this is appealing to a lot of private practices out there, and I wouldn't find it appealing either.

I'm sure you do academics so it's less obvious that the other faculty are losing income to support your love of ICU. Plus, residency programs have to have anesthesia CC, so there is a small but real demand for ICU fellows unrelated to billing.

You might love teaching, but you probably aren't going to train as a teacher and work part time at your local junior high. It just doesn't make sense to lose income to switch from one job you like to another job you like equally.

I wasn't trying to give advice from your point of view. I was giving advice based on how I see it. Nothing inappropriate about that.

You are right about billing but not necessarily about the pay. If you work in an area in which getting ICU docs is difficult you can call your own price. We just so happen to make our ICU pay close to our Anesthesia income. Also after just having gone through negotiations with our hospital over stipend i can tell you having a big presence outside the OR allows you to bring more to the table.

Incomes in medicine are normalizing, the gap is closing between most specialties. Its obvious, based on medicare reimbursement rates, that the government doesn't believe we are worth what we are currently getting paid. Add fighting for a piece of a bundled payment and you have the making of ICU and OR incomes becoming similar. Also you have to do what you like. IF you really want to make money in anesthesia, do pain, do outpt only anesthesia where most billing is private or actual self pay. The fact that i get paid 3x more to do labor epidural than a complex Cardiac case is ridiculous. But i would rather do the heart, it give me personal fulfillment. Luckily my group redistributes income equally.

I am in Private Practice and an owner in my group.

 

[periopdoc]

ICU bills less than OR anesthesia right? So as an ICU/OR anesthesiologist either you give up income so that you can spend time in the ICU, or your partners give up their income so you can go to the ICU. I just doubt that this is appealing to a lot of private practices out there, and I wouldn't find it appealing either.

Not necessarily, a lot of hospitals will subsidize the income of certified intensivists so they can have them on staff.. When I was interviewing I ran across a few jobs that were 1:4 ICU to OR time and the hospital made up for any lost income during that week.

- pod