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MS-IV here, and this month is my first month doing a rotation in Anesthesiology. What I find interesting is that every single one of the anesthesiologists I've worked with are fellows. A couple of them told me that in this day and age it's all but required to protect yourself against CRNA competition. I'm personally interested in Cardiac, and have been contemplating doing a fellowship anyway. But now it seems that it's almost as if I have no choice.

Would love to hear your thoughts.
 

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Just another MS4 here, so take what I say with a grain of salt.

I've talked to a number of attendings and residents about the issue of fellowship vs. no fellowship, and most have said that while a fellowship is a great way to set yourself apart, it's not always a requirement to get a good job. In certain parts of the country (Midwest for example), there are still desirable job opportunities out there which do not require fellowship.

By the way, cardiac match is getting more competitive. The match rate for the last 3 years was 81% → 86% → 77%.
 

AdmiralChz

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You absolutely still have a choice of whether to do a fellowship, the CRNA thing has been around for a very long time. That being said, with a lot of the changes coming rapidly to medicine, I felt a bit of need to do a fellowship but I was also very much interested in cardiac so it went along nicely.

Tons, tons of generalist jobs out there and that doesn't appear to be changing anytime soon.
 

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Tons, tons of generalist jobs out there and that doesn't appear to be changing anytime soon.
One thing I'm curious about: does having fellowship training (cardiac, peds) provide more opportunities for running your own cases vs. supervising/preop-ing 3-4 rooms at a time?
 
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One thing I'm curious about: does having fellowship training (cardiac, peds) provide more opportunities for running your own cases vs. supervising/preop-ing 3-4 rooms at a time?
This is pretty regionally/location dependent I'd say, though with cardiac, and I'd expect peds your ratios would be lower. But I'd agree that overall cardiac seems to offer more hands on options.
 

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MS-IV here, and this month is my first month doing a rotation in Anesthesiology. What I find interesting is that every single one of the anesthesiologists I've worked with are fellows. A couple of them told me that in this day and age it's all but required to protect yourself against CRNA competition. I'm personally interested in Cardiac, and have been contemplating doing a fellowship anyway. But now it seems that it's almost as if I have no choice.

Would love to hear your thoughts.
There are lots of jobs out there for generalists; that said, I highly recommend a fellowship in this climate. Those who have done fellowships over the past 5 years have gotten better jobs vs their none fellowed peers. In addition, there are opportunities in academia if one chooses to go that route.

I totally agree there are good jobs for a solid Anesthesiologist who has not done a fellowship. But again, there are even more opportunities for those who did a fellowship. If you don't mind a medium to rural location the need for a fellowship is certainly less than a major city. These days your first job may not be your last one so hedge your bets and do a fellowship if one interests you.

As for CRNA competition a fellowship is more insurance against the onslaught of the AANA which seeks to take the low hanging fruit.
 

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Oh god I can't even imagine trying to supervise multiple crna cardiac rooms. Couldn't pay me enough for that stress
I came across a job on gaswork when I was looking that was 4:1 supervision for cardiac. They weren't just doing simple CABGs either. Scary. My idea of hell basically.
 

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As someone who transitioned from one "competitive" market to another, I can say in my case, my cardiac fellowship probably helped (plus it's from a name institution, as my residency program was lower tiered). A cardiac fellowship implies you'll handle the tougher cases and TEE is a nice skill to possess. But I would recommend to only do a fellowship if you have a genuine interest. No sense in doing something for a year if you don't plan on doing it or never really liked it (say peds for example).

That being said, being proactive on the job hunt will help also whether you did a fellowship or not. A simple phone call will get you far. I interviewed at all physician practices and academics.


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AdmiralChz

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Oh god I can't even imagine trying to supervise multiple crna cardiac rooms. Couldn't pay me enough for that stress
These jobs are certainly out there, although I haven't heard of more than 1:3. Supervision vs solo is mostly regional (very few solo practices from what I've seen on east coast) as the above had said. Cardiac is probably the last holdout, even in academics it's sometimes 1:2 (with a very low-key other room like Optho) and often 1:1.
 

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These jobs are certainly out there, although I haven't heard of more than 1:3. Supervision vs solo is mostly regional (very few solo practices from what I've seen on east coast) as the above had said. Cardiac is probably the last holdout, even in academics it's sometimes 1:2 (with a very low-key other room like Optho) and often 1:1.
I've seen 1:1 supervision and I don't understand it. At that point why not do the case yourself?
 
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I've seen 1:1 supervision and I don't understand it. At that point why not do the case yourself?
Extra trained hands are helpful. Some cases are tough to do by yourself, just from a logistics/efficiency standpoint, no matter how good you are.
 

Man o War

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I've seen 1:1 supervision and I don't understand it. At that point why not do the case yourself?
Although my job now is solo, there are so many times it would be awesome to have another set of hands who is specifically anesthesia trained. I make it work, but I'm relying on circulators to assist me at times. This is especially true when things get hairy or for the big, messy, super sick cases.
I would do that with AAs instead of CRNAs of I had a choice.
 
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I've seen 1:1 supervision and I don't understand it. At that point why not do the case yourself?
I used to do 1:1 supervision for hearts, although they would frequently pull the crna for an add-on or even just to give breaks and I'd end up solo, and it was nice. An extra set of hands never hurt anybody and I mainly needed to be there for induction, lines, and coming off bypass. Having the crna saved me hours of sitting around, and allowed me to help out elsewhere.
 

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I've seen 1:1 supervision and I don't understand it. At that point why not do the case yourself?
At my program, only residents go into cardiac rooms so it allows for some pretty solid teaching opportunities.
 

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I see, I thought it was more like letting the crna run the case but I totally understand having extra hands. Thanks guys
 

sigrhoillusion

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Not sure about peds.
Cardiac, yes. Every job I interviewed for was no supervision.
I'm recently peds trained working at academic center which does some peds. But since I'm peds trained one of few docs here that do the peds cases. I'd say my breakdown is 50/50 peds adult. Maybe 40/60.

Hasn't affected my supervision. I'm always 2:1 at start of day but occasionally get 1:1 if I'm with a ca1 or an srna :eek:.

Even if I'm doing peds room, I'll have another room. I'll have T+As in one room and old lady hips in another. Luckily(?) they have 3-4 crnas they stick with for peds. So at least I'm not training residents from scratch most days and surprisingly many of the nurses are receptive to suggestions and practice changes.
 

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I think residents now should think of it this way...a fellowship will never give you less job security or less job options. A fellowship has the potential to make you more marketable if that type of training is needed. Having more skills will always give you more job security and it opens up more doors for potential jobs. If there is a specialty that you like then I would highly recommend doing a fellowship. You can still find jobs in rural areas without a fellowship, but if you are near a bigger town/city then a fellowship will be helpful.
 

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I feel in today's lousy environment (which will only get worse), a fellowship is absolutely mandatory. If you want a crap job, for crap pay, in a crap location or generally don't give a crap, then do not do a fellowship. Most DECENT jobs from 2020 and beyond will require a fellowship.
 

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I have a different perspective. I'm in a large PP group in a very desirable city. Most of our needs are for generalists and so most of our new hires have no fellowship. Once in a while we have a need for cardiac or peds. Regional , ob, critical care definitely don't help. (Or they help only in the sense that if you do one of those fellowships at the local residency program you can build local connections during the fellowship year.) It helps more to be from a top program with great references.
 
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anes121508

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MS-IV here, and this month is my first month doing a rotation in Anesthesiology. What I find interesting is that every single one of the anesthesiologists I've worked with are fellows. A couple of them told me that in this day and age it's all but required to protect yourself against CRNA competition. I'm personally interested in Cardiac, and have been contemplating doing a fellowship anyway. But now it seems that it's almost as if I have no choice.

Would love to hear your thoughts.
I'm a CT fellow, my thoughts....

First and foremost don't do a fellowship in something you dislike. With that said, I agree with previous posters that having a fellowship makes you more marketable and is the growing trend amongst residents (although different residencies have different cultures, ie my residency 10/10 applied to fellowship where others its 50/50).

What I have seen is that groups are looking for a person with a certain skill set to round out their group or provide a service that the surgeons are asking for. In my case, several groups were specifically looking for a cardiac trained person with echo certification because the surgeons were asking for it. Had I not chosen to do a fellowship, I would not have had the opportunity to join one of the private groups back home. Others with more experience can comment, but from what I've seen, fellowship training doesn't increase your compensation in a fair democratic group. Several places I talked to divided things up evenly and each partner played a role in rounding out the practice. With that said, I have seen bonuses tied to TEE certification or systems where you are able to get paid extra for home cardiac call (so maybe you can make a little extra).

In my N of 1 experience, academics pays an extra 15K on top of the base for having the fellowship (how many years does that take to make back the 250K you sacrificed to do the fellowship).

So all in all, I believe (from my limited experience) that fellowship will help you find a better job in a more desirable location where there aren't as many opportunities. It won't make you double the salary of the generalist within your group or institution, but it could mean the difference between working for an AMC and pp group making great $$.

The downside of having a real love of a specialty where you want to do mainly cardiac is that you might have to pass up that perfect pp group who wants a cardiac guy, but you will barely hit 50 cases a year. Hard pill to swallow. So in a way, it could be limiting (depending on your personal desires).
 
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dr doze

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I have a different perspective. I'm in a large PP group in a very desirable city. Most of our needs are for generalists and so most of our new hires have no fellowship. Once in a while we have a need for cardiac or peds. Regional , ob, critical care definitely don't help. (Or they help only in the sense that if you do one of those fellowships at the local residency program you can build local connections during the fellowship year.) It helps more to be from a top program with great references.
But when you get multiple applicants for a position, don't those who have a fellowship on their CVs have an edge on getting the job?


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nimbus

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But when you get multiple applicants for a position, don't those who have a fellowship on their CVs have an edge on getting the job?


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No unless we have or anticipate a need for peds or cardiac at the that time. The other fellowships don't hurt or help. There are some fantastic applicants who don't want or need a fellowship.
 
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No unless we have or anticipate a need for peds or cardiac at the that time. The other fellowships don't hurt or help. There are some fantastic applicants who don't want or need a fellowship.
But I guess this is the point. If the applicant had not done the peds or cardiac fellowship then they may have missed out on the job with your group when you did have a need. Otherwise, they can still do general anesthesia and be ready to fill the role when your group does have a need for peds or cardiac. I think the point is that a fellowship never hurts you and can only help. Yes, it is a year of lost income, but if it gets you into job with a good group then that lost income is totally worth it. There is nothing worse than working for a bad group. I would choose fellowship over a job with a bad group any day...even with the lost income.

Critical care and pain give you a way out of the OR, so those are kind of different than peds or cardiac. You have to really want to do either one of those fellowships. They definitely don't hurt, but it is also more of a niche. OB and regional are a waste of time...unless you truly are gunning to be some guru at a top academic place.

Fellowship + geographic flexibility = best way to find a good situation in this field.

The equation is probably more like: Fellowship + 4(geographic flexibility) = best way ...meaning that geographic flexibility gives you the best chance at finding a good job with fellowship probably helping you.
 

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I think this thread title has it all wrong.

Fellowship might give you more marketability, not job security.

Job security is related to your competency level, not your fellowship. A really good anesthesiologist (be it general, ped, card, OB, regional, etc.) is not easily replaced.
 
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nimbus

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I think this thread title has it all wrong.

Fellowship might give you more marketability, not job security.

Job security is related to your competency level, not your fellowship. A really good anesthesiologist (be it general, ped, card, OB, regional, etc.) is not easily replaced.

Disagree. There are a lot of really good anesthesiologists out there. For example, everybody on SDN;)
 
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GravelRider

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I think this thread title has it all wrong.

Fellowship might give you more marketability, not job security.

Job security is related to your competency level, not your fellowship. A really good anesthesiologist (be it general, ped, card, OB, regional, etc.) is not easily replaced.
I think marketability and security are the same thing. The previous generation might have gotten away with resting on their laurels, but that is not the case anymore. Big hospital systems are taking over and they want to run lean...you want to be irreplaceable. In the end, what is a "really good anesthesiologist?" These huge hospital systems don't really care so long as the cases get done and their "quality" ratings don't go down. You can replace a "really good" anesthesiologist with a mediocre anesthesiologist and a couple of "really good" CRNAs. A fellowship gives you a piece of paper that sets you apart.

As a caveat, I totally disagree with how the market is evolving. I think it devalues our medical education as well as our residency training. However, the reality is that is what is happening. Anesthesiologists are competing more and more with CRNAs for jobs...especially in crowded markets.
 
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Just for another perspective.

New CA3 since July. I never even thought about a fellowship. Heard all the doom and gloom, so started looking early. Lo and behold, I'm one of two or three people in my residency class who are not doing a fellowship. So what happens? All the attendings at my institution focus on me and one other guy, reaching out to their networks, plus I'm cold calling and emailing, hustling a bit. End result? Multiple contract offers, mostly in metro areas in the Midwest and southeast, for both AMC (bleh) and partner track jobs.

I signed THIS week. Short term partner track. Very reasonable pay, benefits, vacation, call schedule, etc. from the get go. Partners make >90% MGMA. Not everybody needs a fellowship trained new grad, and (according to multiple groups) if they don't need them they don't want them, because they often expect more and want to be treated special.


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thinkorswim

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I believe that, in general, a fellowship will do the following for you:

1. Open more job opportunities (i.e. general only, subspecialty only, or a combination of both).

2. Provide longer job security. There is no absolute guarantee with job security, but those with fellowships will be the last to fall.

3. Will not significantly increase your salary over time.

In the end, you need to realize that there is only one way to win this game -- work hard, save a lot, then get out. Good luck!
 

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Take a moment to appreciate how we've allowed this field to sink to this level of absurdity.
 

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Just for another perspective.

New CA3 since July. I never even thought about a fellowship. Heard all the doom and gloom, so started looking early. Lo and behold, I'm one of two or three people in my residency class who are not doing a fellowship. So what happens? All the attendings at my institution focus on me and one other guy, reaching out to their networks, plus I'm cold calling and emailing, hustling a bit. End result? Multiple contract offers, mostly in metro areas in the Midwest and southeast, for both AMC (bleh) and partner track jobs.

I signed THIS week. Short term partner track. Very reasonable pay, benefits, vacation, call schedule, etc. from the get go. Partners make >90% MGMA. Not everybody needs a fellowship trained new grad, and (according to multiple groups) if they don't need them they don't want them, because they often expect more and want to be treated special.


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Did you end up in the Midwest? You are correct that not everybody needs a fellowship and I think top level residents can perform on par with many fellowship trained Anesthesiologists.
But, in certain pockets of the country that Peds fellowship or Cardiac TEE certification can be worth its weight in gold. In the end, if you are a top performing resident with glowing recommendations and are geographically flexible whose goal is private practice then skip the fellowship. But, for the other 80% of residents out there I recommend a fellowship.
 

dr doze

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Take a moment to appreciate how we've allowed this field to sink to this level of absurdity.
"We've allowed?" Maybe You too?

Everyone just wants theirs before the oyster completely closes.


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GravelRider

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"We've allowed?" Maybe You too?

Everyone just wants theirs before the oyster completely closes.


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Doesn't "we" include "you and I?"

There was blatant misconduct in all of medicine in the 80s and 90s that brought on things like HMOs and now ACOs in order to try to control cost. This is a punishment we, as physicians, have brought upon ourselves. Unfortunately, the current generation of physicians will never have the earning potential and respect from society that previous physicians have enjoyed.
 

dr doze

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Doesn't "we" include "you and I?"

There was blatant misconduct in all of medicine in the 80s and 90s that brought on things like HMOs and now ACOs in order to try to control cost. This is a punishment we, as physicians, have brought upon ourselves. Unfortunately, the current generation of physicians will never have the earning potential and respect from society that previous physicians have enjoyed.
partially true. But the majority of the problem is the massive costs coupled with burgeoning demand and an inability to ration care.
 

dr doze

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Man, I sure wish my generation could get some of those pearls, why do oysters have to be shellfish?! ;)
Sorry you were late to the party. The steak and lobster is mostly gone from the buffet table. Hot dogs an mac and cheese are in abundance.
 
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sevoflurane

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There are still lots of PP groups who are not very facile with TEE. Cardiology does the intraop tee- which is a bit old school.
These are the groups that can benefit from a fellowship trained anesthesiologist. Cardiologists don't want to come to the OR at 3am for a type a dissection and honestly, we don't want a cardiologist taking up space at the head of the table.
 

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I'm in charge of hiring for our group. I've even posted a recent job opening we had in this forum. We are straight up PP. We ended up hiring two people, one for 2017 (regional fellow) and 2018 (will be a CT fellow). Our foremost goal was to find the right fit more than anything. That includes schooling, residency program, and definitely recommendations. The interview also has a ton of weight as that gives us a chance to meet you face to face and maybe get a glimpse of how you interact with people. We do general anesthesia which includes cardiac, OB, trauma, etc. The only fellowship that adds any value to our practice, IMO, is CT. We do have a regional fellow coming in next year but he is a grade A superstar and spends half the year doing regional and the other half medically directing. He also has the opportunity to jump in on TEEs.

There are plenty of good, general anesthesia positions out there but I believe CT, peds, and pain are the only ones worth while (in general, especially for academics). Of course people will disagree with me but for me, I don't see any added value in the other fellowships. Peds and pain wouldn't add any value to our practice though. If anyone has any specific questions for me, feel free to PM me. I'd be happy to talk to anyone.
 
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GravelRider

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partially true. But the majority of the problem is the massive costs coupled with burgeoning demand and an inability to ration care.
This is the wrong thread for this discussion, but:

I think the increased demand is created by us. It is created by the healthcare system. There was a study out of Dartmouth a few years ago that said something to the effect that the more cardiologists in a given area, the more cardiology procedures that are being done. Now that might seem obvious, but the way it looked was a lot of these procedures were unnecessary. In fact, there is more and more data coming out that a lot of cardiology procedures are unnecessary. I think the best example is the afib ablation. It has a high failure rate, a high rate of needing to be done again, and has a perfectly easier, better, and cheaper alternative...it's called metoprolol. So, I think all this talk about demand and need to ration needs to be looked at in the context that a lot of what we do is unnecessary and expensive. I'm sure we all participate in surgeries that we could argue are unnecessary.

In a way, this idea of the healthcare system creating the demand is related to the discussion about needing a fellowship. In certain markets, like the northeast, they won't even consider letting you do a simple peds case or routine cabg without a fellowship. The hospitals want to be able to advertise that a pediatric specialist is going to be taking care of your child for his or her tonsillectomy. Therefore, patients have come to expect that. It used to be that internists and family medicine doctors could round on their patients in small community ICUs, but now most hospitals are requiring ICUs to be staffed by critical care docs (the data suggests that this is probably for the better). I guess the point here is that if you want to do even bread & butter peds, hearts, pain procedures, or critical care then you have to do a fellowship.
 

kazuma

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At my program, only residents go into cardiac rooms so it allows for some pretty solid teaching opportunities.
Or great time for the attending to do "research" in their office. I actually liked that after I got the hang of things my first and second month of CT in residency.
 

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I think the biggest thing that brings job security is to not suck at what you do (while providing multiple, high value services to your group and hospitals), be fast, efficient, and easy to work with. I've seen my fair share anesthesiologists that either suck (slow, inefficient, can't do big cases or peds or regional and OB etc) or have significant personality issues. This problem isn't unique to anesthesiology, it's rampant throughout medicine and I think it might self select to some extent. I left my first job out of residency mainly to be closer to family and I couldn't believe the how many people (techs, RN's, surgeons, partners etc) were sad or genuinely pissed I was leaving because they say I'm easy to work with, don't yell at them and stay calm and collect when SHTF. I barely knew some of them or hadn't said more than a few sentences to them over the year. During my first year out I saw 2 seasoned partners (7-10+ years of experience, including ped fellowship) get let go for either skill or personality issues with staff. I thought it was sad that the high volume pediatric surgeon would allow me, a new grad, no fellowship and not boarded for my first 8 months, to do her neonate and peds cases but not 2 individuals in town with 7+ years of experience and pediatric fellowships. This is just my limited experience so take it with a grain of salt. I'm not trying to toot my own horn, I'm just pointing out the obvious thing I didn't see spoken about much in this thread. If you suck clinically or inter-personally, no number of fellowships will help you get a job, let alone keep the job. Think about your residency class, how many co-residents would you actually want to have as a partner or take care of your family members? 25%? 50%?

With that said, a fellowship can certainly open up doors, but I am not convinced one bit that it offers much, if any job security. We provide a service and ultimately it boils down to cost, so if someone is willing to or can do it for cheaper, they'll often times succeed even if quality takes a hit.
 

kazuma

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Or great time for the attending to do "research" in their office. I actually liked that after I got the hang of things my first and second month of CT in residency.
I have on good authority from the secretaries that some of this "research" involved seedy websites, doors they thought were locked, and self experimentation. :zip::banana::barf:
 

aneftp

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I think this thread title has it all wrong.

Fellowship might give you more marketability, not job security.

Job security is related to your competency level, not your fellowship. A really good anesthesiologist (be it general, ped, card, OB, regional, etc.) is not easily replaced.
Totally agree.

Almost feels like 1994-1998 job market. People just got fellowships just cause nothing out there for them.

There are lots of "generalists" practicing these with those fellowship.

Against it doesn't hurt. But do it for the right reasons.
 

dr doze

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I think the biggest thing that brings job security is to not suck at what you do (while providing multiple, high value services to your group and hospitals), be fast, efficient, and easy to work with. I've seen my fair share anesthesiologists that either suck (slow, inefficient, can't do big cases or peds or regional and OB etc) or have significant personality issues. This problem isn't unique to anesthesiology, it's rampant throughout medicine and I think it might self select to some extent. I left my first job out of residency mainly to be closer to family and I couldn't believe the how many people (techs, RN's, surgeons, partners etc) were sad or genuinely pissed I was leaving because they say I'm easy to work with, don't yell at them and stay calm and collect when SHTF. I barely knew some of them or hadn't said more than a few sentences to them over the year. During my first year out I saw 2 seasoned partners (7-10+ years of experience, including ped fellowship) get let go for either skill or personality issues with staff. I thought it was sad that the high volume pediatric surgeon would allow me, a new grad, no fellowship and not boarded for my first 8 months, to do her neonate and peds cases but not 2 individuals in town with 7+ years of experience and pediatric fellowships. This is just my limited experience so take it with a grain of salt. I'm not trying to toot my own horn, I'm just pointing out the obvious thing I didn't see spoken about much in this thread. If you suck clinically or inter-personally, no number of fellowships will help you get a job, let alone keep the job. Think about your residency class, how many co-residents would you actually want to have as a partner or take care of your family members? 25%? 50%?

With that said, a fellowship can certainly open up doors, but I am not convinced one bit that it offers much, if any job security. We provide a service and ultimately it boils down to cost, so if someone is willing to or can do it for cheaper, they'll often times succeed even if quality takes a hit.
fellowship is more likely to get your foot in the door, but your skills and work ethic will decide if you get to stay in the room.
 

loveumms

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Just for another perspective.

New CA3 since July. I never even thought about a fellowship. Heard all the doom and gloom, so started looking early. Lo and behold, I'm one of two or three people in my residency class who are not doing a fellowship. So what happens? All the attendings at my institution focus on me and one other guy, reaching out to their networks, plus I'm cold calling and emailing, hustling a bit. End result? Multiple contract offers, mostly in metro areas in the Midwest and southeast, for both AMC (bleh) and partner track jobs.

I signed THIS week. Short term partner track. Very reasonable pay, benefits, vacation, call schedule, etc. from the get go. Partners make >90% MGMA. Not everybody needs a fellowship trained new grad, and (according to multiple groups) if they don't need them they don't want them, because they often expect more and want to be treated special.


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This is right on - coming from an attending who has been out for five years. I've practiced at an academic center and have seen residents who graduate as lowly generalists get very good jobs.

The problem with everyone saying that all grads need a fellowship is that it's untrue - it does not always give you a competitive edge and don't forget it causes you to lose out on a year of potential attending salary. I personally considered CT and critical care but decided I didn't want to get stuck doing all CT or critical care (and I'm SO glad I didn't do a fellowship now). The world needs general anesthesiologist and many know that fellowship training doesn't make you a better anesthesiologist. It gives you further knowledge (and sometimes skills) on one particular area of anesthesia. I know lots of general anesthesiologists who do CT.

There are still plenty of general jobs out there and you are different from a CRNA regardless of whether you did a fellowship or not. Do what makes you happy and if you really like one specific area of anesthesia, then do a fellowship but don't think it's absolutely critical to you getting a job. You can still get a job if you graduate from a good residency - even if you are just a regular old generalist.
 
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nimbus

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This is right on - coming from an attending who has been out for five years. I've practiced at an academic center and have seen residents who graduate as lowly generalists get very good jobs.

The problem with everyone saying that all grads need a fellowship is that it's untrue - it does not always give you a competitive edge and don't forget it causes you to lose out on a year of potential attending salary. I personally considered CT and critical care but decided I didn't want to get stuck doing all CT or critical care (and I'm SO glad I didn't do a fellowship now). The world needs general anesthesiologist and many know that fellowship training doesn't make you a better anesthesiologist. It gives you further knowledge (and sometimes skills) on one particular area of anesthesia. I know lots of general anesthesiologists who do CT.

There are still plenty of general jobs out there and you are different from a CRNA regardless of whether you did a fellowship or not. Do what makes you happy and if you really like one specific area of anesthesia, then do a fellowship but don't think it's absolutely critical to you getting a job. You can still get a job if you graduate from a good residency - even if you are just a regular old generalist.
Despite my earlier post I don't completely agree with this. Yes we have older and mid career generalists doing CT. But if you are just finishing residency and you want CT to be any part of your practice, you should do a CT fellowship. It is basically expected for new hires. And it will not lock you into doing exclusively hearts at most practices.
 

GravelRider

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I think the biggest thing that brings job security is to not suck at what you do (while providing multiple, high value services to your group and hospitals), be fast, efficient, and easy to work with. I've seen my fair share anesthesiologists that either suck (slow, inefficient, can't do big cases or peds or regional and OB etc) or have significant personality issues. This problem isn't unique to anesthesiology, it's rampant throughout medicine and I think it might self select to some extent. I left my first job out of residency mainly to be closer to family and I couldn't believe the how many people (techs, RN's, surgeons, partners etc) were sad or genuinely pissed I was leaving because they say I'm easy to work with, don't yell at them and stay calm and collect when SHTF. I barely knew some of them or hadn't said more than a few sentences to them over the year. During my first year out I saw 2 seasoned partners (7-10+ years of experience, including ped fellowship) get let go for either skill or personality issues with staff. I thought it was sad that the high volume pediatric surgeon would allow me, a new grad, no fellowship and not boarded for my first 8 months, to do her neonate and peds cases but not 2 individuals in town with 7+ years of experience and pediatric fellowships. This is just my limited experience so take it with a grain of salt. I'm not trying to toot my own horn, I'm just pointing out the obvious thing I didn't see spoken about much in this thread. If you suck clinically or inter-personally, no number of fellowships will help you get a job, let alone keep the job. Think about your residency class, how many co-residents would you actually want to have as a partner or take care of your family members? 25%? 50%?

With that said, a fellowship can certainly open up doors, but I am not convinced one bit that it offers much, if any job security. We provide a service and ultimately it boils down to cost, so if someone is willing to or can do it for cheaper, they'll often times succeed even if quality takes a hit.
I agree with all of this. However, residents now need to understand that in a lot of competitive markets, hospitals won't even credential you for peds or hearts if you don't have a fellowship. If you want to retain the ability to deal with either of those patient populations then you have to do fellowship. You could be a rockstar with neonates, but the hospital administration could decide tomorrow that they want peds certified docs only to take care of the kids. Residents need to understand what they want from their career when deciding on a fellowship. If you really want to have pediatric cases or hearts be a part of your practice then you have to do a fellowship. If you can live without them then don't do a fellowship.
 

kazuma

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I agree with all of this. However, residents now need to understand that in a lot of competitive markets, hospitals won't even credential you for peds or hearts if you don't have a fellowship. If you want to retain the ability to deal with either of those patient populations then you have to do fellowship. You could be a rockstar with neonates, but the hospital administration could decide tomorrow that they want peds certified docs only to take care of the kids. Residents need to understand what they want from their career when deciding on a fellowship. If you really want to have pediatric cases or hearts be a part of your practice then you have to do a fellowship. If you can live without them then don't do a fellowship.
True, but there aren't enough fellowship trained docs where I practice for them to do that. They'd have nights of neonate call uncovered. That could change in the future with the fellowship explosion.
 

IlDestriero

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Or great time for the attending to do "research" in their office. I actually liked that after I got the hang of things my first and second month of CT in residency.
I do a lot of "research" in the physician's lounge. Especially on the 2 CRNA rooms days.


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Il Destriero