Fellowship or Not?

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I think there have been multiple threads like this. Short answer: Do Cardiac, Chronic pain or possibly Peds. Don't do any of the others (unless you have personal reasons e.g., waiting on a spouse to finish or really want to stay in academics -- possibly limiting your skillset to a narrow field).
 
NICMAN said:
I think there have been multiple threads like this. Short answer: Do Cardiac, Chronic pain or possibly Peds. Don't do any of the others (unless you have personal reasons e.g., waiting on a spouse to finish or really want to stay in academics -- possibly limiting your skillset to a narrow field).
Click to expand...

Do chronic pain fellowships train you in procedures like Kypho/vertebroplasty, spinal cord stimulator trials and implants, DRG stimulator trials and implants, superion interspinous spacers?
 
alsod epends on wher eyou want to work later on. if you want to work in academics, fellowships can definitely help. many academic places near me are hiring mainly fellowship trained. eg. regional trained for mostly ortho cases, OB trained for OB.
 
We are starting to see most applicants that are new grads with fellowships, especially cardiac, even though we are a general group in a small out of the way city.
Personality and references are still our deciding factors. We give a fellowship person an extra 25k first year, otherwise no extra benefits.
 
I have completed a fellowship. Unless you have a genuine interest in one, or a particular field "calls" to you, there is not a proven enough benefit to doing one that makes it worth it if you aren't inherently interested.
 
ainsky said:
Do chronic pain fellowships train you in procedures like Kypho/vertebroplasty, spinal cord stimulator trials and implants, DRG stimulator trials and implants, superion interspinous spacers?
Click to expand...

Some programs yes, some no
Gotta ask specifically

I had no kypho or DRG training but do them both now. Same with peripheral nerve stimulators. Easy to learn if you learn the basics + SCS at your fellowship

They want to train me for vertiflex but I am not sure if it is just gonna end up being another XSTOP falls by the wayside type of thing so am holding out for now

Everyone obsesses about this stuff on the interview trail, but its foolish. Surgery is monkey skills. Repetition. My last perm stim took 40 minutes to implant, and we closed super vast cuz I had a SA in the room. Procedures are the easy part. Learning the vast discipline of pain medicine and all of the musculoskelatal and CNS/PNS diagnostic considerations is really the challenging part that is critical for establishing a successful practice. And learning risk management and dealing with opioids in a reasonable way.

I learned more actual medicine in my first couple years out in practice post fellowship than probably all the rest of my medical education combined!
 
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Recent grad (2018), no fellowship, multiple great job offers in So Cal. I am a partner in a fantastic group while my classmates hustle to stretch their PGY-5 salary.

This topic has been beaten to death in general on here. Fellowship is a great way to donate more of your time and money to a big academic medical center and possibly pick up some useful skills if you choose wisely and are interested (cardiac, peds, pain). Fellowships can be useful especially for academic careers, but are not a must. Pain is basically a different specialty since you are learning how to create your own stand alone practice with a clinic and procedures, etc. It's possible to do pain and OR anesthesia, but some say you can be really good at one or the other, or mediocre at both. Those hybrid jobs can be tough to find, but I know people who have figured it out. Some people have been able to create a thriving business that generates significantly more than the average OR anesthesiologist, but recognize that this is the product of a huge amount of work, you have to build the business. Not everyone in chronic pain is gathering $3 million a year with their golden rake, but at least the potential exists for some.

Consider the significant investment in time and lost opportunities before signing up. Even with that minor salary bump, it takes a long time to catch up to making real $$$ one year sooner. For me, I viewed it as being able to retire one year sooner, although in reality it probably won't work out that exactly. Might be greater than a year advantage with compound interest at work. But that's up to the market.

In residency, fellowships are encouraged heavily because of the obvious benefit to the institution to retain the best worker bees for one more season. Out in PP land, it doesn't seem to matter to anyone as long as the work is getting done well and you are not causing headaches for the group. Obviously, certain groups may want certain fellowships because they are covering certain types of cases, but being specialized might also hurt you if they are looking for a generalist to tackle a variety of cases. But that is my own limited perspective as a simple minded non-fellowship trained guy who probably just doesn't get the benefits of fellowship since I didn't do one. To each their own.

As you will read if you do a quick search of past threads, many on here have explained how their fellowship was vital to their career and has been very satisfying to them for multiple reasons. Weigh your options, consider your interests and goals, and if you feel like you should do a fellowship, throw yourself into it with a passion. But if you conclude that it's not going to improve your career or make you a happier/better anesthesiologist, then get out of training and get to work ASAP. If you have specific questions, feel free to send me a private message.
 
I always noted that the attendings in residency who did cardiac fellowship working in on non cardiac anesthesia, they were usually the most anal\fearful\on edge, not the most favorable to work with. When I worked with those kind I knew I would not want to be that kind of anesthesiologist. I always admired those, usually non fellowship trained, who were just bosses: calm, great to learn under, and well respected due to their collected demeanor. The younger attendings are usually less crazy than the old ones, but I would have been truly unhappy to spend another year as a super resident so I'm glad I tapped out.
 
2Fast2Des said:
I always noted that the attendings in residency who did cardiac fellowship working in on non cardiac anesthesia, they were usually the most anal\fearful\on edge, not the most favorable to work with. When I worked with those kind I knew I would not want to be that kind of anesthesiologist. I always admired those, usually non fellowship trained, who were just bosses: calm, great to learn under, and well respected due to their collected demeanor. The younger attendings are usually less crazy than the old ones, but I would have been truly unhappy to spend another year as a super resident so I'm glad I tapped out.
Click to expand...

Interesting take. I have always found the complete opposite. Cardiac attendings seemed to be unphased be even the largest of crap storms given the see them so often.

I did a cardiac fellowship and found it incredibly useful. Most importantly, because the job I really wanted was only hiring cardiac-trained applicants. There are jobs out there that REQUIRE fellowship training, though I agree a fellowship is absolutely NOT required to find a good gig in this field. Just depends on what you are looking for.

I do take more call than my colleagues, but it comes with some small perks to make up for that (slightly higher salary and more vacation)

I do agree that you have to have a genuine interest in the field. Certainly don’t recommend doing a fellowship because you think you’ll make more money.
 
rakotomazoto said:
Recent grad (2018), no fellowship, multiple great job offers in So Cal. I am a partner in a fantastic group while my classmates hustle to stretch their PGY-5 salary.

This topic has been beaten to death in general on here. Fellowship is a great way to donate more of your time and money to a big academic medical center and possibly pick up some useful skills if you choose wisely and are interested (cardiac, peds, pain). Fellowships can be useful especially for academic careers, but are not a must. Pain is basically a different specialty since you are learning how to create your own stand alone practice with a clinic and procedures, etc. It's possible to do pain and OR anesthesia, but some say you can be really good at one or the other, or mediocre at both. Those hybrid jobs can be tough to find, but I know people who have figured it out. Some people have been able to create a thriving business that generates significantly more than the average OR anesthesiologist, but recognize that this is the product of a huge amount of work, you have to build the business. Not everyone in chronic pain is gathering $3 million a year with their golden rake, but at least the potential exists for some.

Consider the significant investment in time and lost opportunities before signing up. Even with that minor salary bump, it takes a long time to catch up to making real $$$ one year sooner. For me, I viewed it as being able to retire one year sooner, although in reality it probably won't work out that exactly. Might be greater than a year advantage with compound interest at work. But that's up to the market.

In residency, fellowships are encouraged heavily because of the obvious benefit to the institution to retain the best worker bees for one more season. Out in PP land, it doesn't seem to matter to anyone as long as the work is getting done well and you are not causing headaches for the group. Obviously, certain groups may want certain fellowships because they are covering certain types of cases, but being specialized might also hurt you if they are looking for a generalist to tackle a variety of cases. But that is my own limited perspective as a simple minded non-fellowship trained guy who probably just doesn't get the benefits of fellowship since I didn't do one. To each their own.

As you will read if you do a quick search of past threads, many on here have explained how their fellowship was vital to their career and has been very satisfying to them for multiple reasons. Weigh your options, consider your interests and goals, and if you feel like you should do a fellowship, throw yourself into it with a passion. But if you conclude that it's not going to improve your career or make you a happier/better anesthesiologist, then get out of training and get to work ASAP. If you have specific questions, feel free to send me a private message.
Click to expand...

Yeah I have a question, you guys hiring?
 
2Fast2Des said:
I always noted that the attendings in residency who did cardiac fellowship working in on non cardiac anesthesia, they were usually the most anal\fearful\on edge, not the most favorable to work with. When I worked with those kind I knew I would not want to be that kind of anesthesiologist. I always admired those, usually non fellowship trained, who were just bosses: calm, great to learn under, and well respected due to their collected demeanor. The younger attendings are usually less crazy than the old ones, but I would have been truly unhappy to spend another year as a super resident so I'm glad I tapped out.
Click to expand...

Yeah I’m sure your cardiac attendings were really ****ting their pants in those cystos and lap choles.
 
Turtlez said:
I would really appreciate responses from recent grads without fellowships. Feel free to chime in. Thanks a bunch!
Click to expand...

People who didn't do fellowships are going to tell you that everything's cool as a generalist, and they're doing fine, and that the extra year of profitable labor is a big deal in the grand scheme of things.

People who did do fellowships are going to tell you that everything's cool as a specialist, and they're doing fine, and that the extra year of unprofitable labor is no big deal in the grand scheme of things.

You'll never be able to tell how much of either answer is genuine objective truth, and how much is tainted by the person's hope that they'll keep doing fine, and won't have buyer's (or non-buyer's) remorse later. Humans are powerfully motivated to put positive spin on their decisions. You factor in the hint of a superiority complex some fellowship-doers have with the hint of an inferiority complex some fellowship-non-doers have ...

The only thing I can tell you for sure is that the question you asked will get you get the answer you are hoping to hear from somebody. 😉

You might get more useful answers if instead of polling recent grads who did (or didn't) do fellowships, you tried to poll senior people who've been practicing for a while and are involved in recruiting and hiring people. They'll tell you what they see, what they need and want. There is definitely a need and room for generalists out there, but it's a fantasy to think that generalists are going to be doing much (if any) cardiac, or any small kids, or any critical care in the foreseeable future.

Don't do something you hate, just because your residency PD told you to do a fellowship. That's weak.

Don't not do a fellowship because you're tired of being a resident and want to get away from the grind. That's also weak.
 
PGG is 100%. I did my fellowship because I LIKED MY FELLOWSHIP. Extra money didn't matter. Missing a year of six figure income didn't matter. It was the one year that I enjoyed getting up and going to do anesthesia everyday. I kind of miss that year right now.
 
I agree I can’t imagine doing a fellowship unless you live and breathe the subspecialty.

You couldn’t pay me a million to do chronic pain , likewise some people here wouldn’t do hearts for a million.
 
pgg said:
People who didn't do fellowships are going to tell you that everything's cool as a generalist, and they're doing fine, and that the extra year of profitable labor is a big deal in the grand scheme of things.

People who did do fellowships are going to tell you that everything's cool as a specialist, and they're doing fine, and that the extra year of unprofitable labor is no big deal in the grand scheme of things.

You'll never be able to tell how much of either answer is genuine objective truth, and how much is tainted by the person's hope that they'll keep doing fine, and won't have buyer's (or non-buyer's) remorse later. Humans are powerfully motivated to put positive spin on their decisions. You factor in the hint of a superiority complex some fellowship-doers have with the hint of an inferiority complex some fellowship-non-doers have ...

The only thing I can tell you for sure is that the question you asked will get you get the answer you are hoping to hear from somebody. 😉

You might get more useful answers if instead of polling recent grads who did (or didn't) do fellowships, you tried to poll senior people who've been practicing for a while and are involved in recruiting and hiring people. They'll tell you what they see, what they need and want. There is definitely a need and room for generalists out there, but it's a fantasy to think that generalists are going to be doing much (if any) cardiac, or any small kids, or any critical care in the foreseeable future.

Don't do something you hate, just because your residency PD told you to do a fellowship. That's weak.

Don't not do a fellowship because you're tired of being a resident and want to get away from the grind. That's also weak.
Click to expand...

Best synopsis of fellowship ever written. I loved my whole peds fellowship! Never was a grind, always exciting. Now as an attending if I am fast traching in peds gen or ent.... I mutter to my wife the night before and have an extra glass of scotch.....
 
rakotomazoto said:
Recent grad (2018), no fellowship, multiple great job offers in So Cal. I am a partner in a fantastic group while my classmates hustle to stretch their PGY-5 salary.

This topic has been beaten to death in general on here. Fellowship is a great way to donate more of your time and money to a big academic medical center and possibly pick up some useful skills if you choose wisely and are interested (cardiac, peds, pain). Fellowships can be useful especially for academic careers, but are not a must. Pain is basically a different specialty since you are learning how to create your own stand alone practice with a clinic and procedures, etc. It's possible to do pain and OR anesthesia, but some say you can be really good at one or the other, or mediocre at both. Those hybrid jobs can be tough to find, but I know people who have figured it out. Some people have been able to create a thriving business that generates significantly more than the average OR anesthesiologist, but recognize that this is the product of a huge amount of work, you have to build the business. Not everyone in chronic pain is gathering $3 million a year with their golden rake, but at least the potential exists for some.

Consider the significant investment in time and lost opportunities before signing up. Even with that minor salary bump, it takes a long time to catch up to making real $$$ one year sooner. For me, I viewed it as being able to retire one year sooner, although in reality it probably won't work out that exactly. Might be greater than a year advantage with compound interest at work. But that's up to the market.

In residency, fellowships are encouraged heavily because of the obvious benefit to the institution to retain the best worker bees for one more season. Out in PP land, it doesn't seem to matter to anyone as long as the work is getting done well and you are not causing headaches for the group. Obviously, certain groups may want certain fellowships because they are covering certain types of cases, but being specialized might also hurt you if they are looking for a generalist to tackle a variety of cases. But that is my own limited perspective as a simple minded non-fellowship trained guy who probably just doesn't get the benefits of fellowship since I didn't do one. To each their own.

As you will read if you do a quick search of past threads, many on here have explained how their fellowship was vital to their career and has been very satisfying to them for multiple reasons. Weigh your options, consider your interests and goals, and if you feel like you should do a fellowship, throw yourself into it with a passion. But if you conclude that it's not going to improve your career or make you a happier/better anesthesiologist, then get out of training and get to work ASAP. If you have specific questions, feel free to send me a private message.
Click to expand...
I used to work in Socal and I am not aware of a single decent group down there where you can become a partner fresh out of residency. I don't even know of a crappy group there where you can do this
 
somedumbDO said:
Best synopsis of fellowship ever written. I loved my whole peds fellowship! Never was a grind, always exciting. Now as an attending if I am fast traching in peds gen or ent.... I mutter to my wife the night before and have an extra glass of scotch.....
Click to expand...

Me pre-OB shift
 
Nooooo to fellowship unless extenuating circumstances. Ie desire cardiac in major academic institution, Peds same, or pain in a major metropolitan area

Or as twig stated you sumply enjoy the your area of expertise
 
pgg said:
There is definitely a need and room for generalists out there, but it's a fantasy to think that generalists are going to be doing much (if any) cardiac, or any small kids, or any critical care in the foreseeable future.
Click to expand...

I also want to stress this line of PGG's post. I get calls and emails about General jobs ALL THE TIME (so forget all that "our field is dying stuff), so there is definitely work for a general anesthesiologist out there, but I also agree that the field is continually "reformed" fellowship'd people will get tied to "fellowship" cases. Not everywhere, but I'd argue that the "popular" areas will do this. The areas of the country that struggle to get anesthesiologist will be more likely to take anyone who's "capable".
 
Ezekiel2517 said:
I used to work in Socal and I am not aware of a single decent group down there where you can become a partner fresh out of residency. I don't even know of a crappy group there where you can do this
Click to expand...

I know of one (my first job). Not the greatest payer mix, but otherwise not a bad gig.

I bet if you got away from the coast it wouldn’t be too hard to find more.
 
I'm into my 5th year of practice post-residency, with no fellowship. I am overall very happy with my choice, and probably really lucked out with stumbling into my group. It's proved to be a very nice gig.

I don't think it's "right" the way so many PD's and other academics essentially pitch the "fellowship or parish" mantra. I've seen this bias in several academic centers and from what I hear, this is pretty common. What makes matters worse is that many of the PD's and others working in academia can be really out of touch with the majority of anesthesia being provided out there, which happens NOT to be in large academic centers. I've heard PD's give advice to do a fellowship, any fellowship, seemingly without regard to actual interest or aptitude. This isn't serving the residents IMO.
 
I thought about fellowship, but going through the application process seemed too one sided:

My investment:
1. Pay to apply
2. Write essays
3. Ask for LORs
4. Pay to travel (flight, hotel(maybe program pays), rental car or taxi)
5. Time to travel
6. Interview where stupid questions are asked over and over: So why do you want to do X subspecialty? Me: replies with basically the same response/reason as everyone else that has ever interviewed there since the beginning of time.

Program investment:
Maybe read essays
Maybe pays for hotel
Interviews 20 people / day (minimal time investment)
No travel time


Already been there done that with med school and residency. Maybe I'm losing my tolerance for bull**** or maybe I just didn't want it bad enough to put up with the bull****.
 
Guillemot said:
Already been there done that with med school and residency. Maybe I'm losing my tolerance for bull**** or maybe I just didn't want it bad enough to put up with the bull****.
Click to expand...

This is probably the most correct part. You do a fellowship because you envision yourself doing that specialty everyday, even if that isn't the reality. Ironically enough, I find it interesting that for the most part anesthesiology is a field that has fellowships where you may go out in the "real world" and not practice that subspecialty everyday. Radiology fellowships potentially fall in that category as well and it's no surprise that Rads and Anesthesiology are similar fields in many ways.
 
Twiggidy said:
This is probably the most correct part. You do a fellowship because you envision yourself doing that specialty everyday, even if that isn't the reality. Ironically enough, I find it interesting that for the most part anesthesiology is a field that has fellowships where you may go out in the "real world" and not practice that subspecialty everyday. Radiology fellowships potentially fall in that category as well and it's no surprise that Rads and Anesthesiology are similar fields in many ways.
Click to expand...


We already have peds and critical care people who don’t do any of their respective subspecialties and we are approaching the point where we will have more cardiac fellows than cases. But we will make up for it with other cases. What we really need right now are butt abscess and rectal foreign body extraction fellows😉
 
nimbus said:
We already have peds and critical care people who don’t do any of their respective subspecialties and we are approaching the point where we will have more cardiac fellows than cases. But we will make up for it with other cases. What we really need right now are butt abscess and rectal foreign body extraction fellows😉
Click to expand...

The only worthwhile anesthesiology fellowship there should be is "Hosptial Fireman Fellowship". It did take me a couple of years to learn to do that.
 
Guillemot said:
I thought about fellowship, but going through the application process seemed too one sided:

My investment:
1. Pay to apply
2. Write essays
3. Ask for LORs
4. Pay to travel (flight, hotel(maybe program pays), rental car or taxi)
5. Time to travel
6. Interview where stupid questions are asked over and over: So why do you want to do X subspecialty? Me: replies with basically the same response/reason as everyone else that has ever interviewed there since the beginning of time.

Program investment:
Maybe read essays
Maybe pays for hotel
Interviews 20 people / day (minimal time investment)
No travel time


Already been there done that with med school and residency. Maybe I'm losing my tolerance for bull**** or maybe I just didn't want it bad enough to put up with the bull****.
Click to expand...

I totally hear you on this point. I would really hate to go through all that BS again...... Extreme fluff.
 
Twiggidy said:
This is probably the most correct part. You do a fellowship because you envision yourself doing that specialty everyday, even if that isn't the reality. Ironically enough, I find it interesting that for the most part anesthesiology is a field that has fellowships where you may go out in the "real world" and not practice that subspecialty everyday. Radiology fellowships potentially fall in that category as well and it's no surprise that Rads and Anesthesiology are similar fields in many ways.
Click to expand...
The difference is radiologists without a fellowship are almost unemployable and/or non-existent nowadays. Probably a predictor of what anesthesia will be in 10 years.
 
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