Fellowships now and beyond

[hrmm]

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I've searched and seen some previous posts on fellowships but wanted to get a more current and comprehensive opinion from sdn. I'm sure most would give advice about fellowships to residents in the same way they would give advice about residencies to medical students (i.e., pick the one you enjoy most, are the most passionate about, can see yourself doing everyday, etc.). But beyond the the immediate subjective likes/dislikes of certain subspecialties, are there some more objective generalizations that can be made about fellowships? Here's a list of the main ones: Cardiac, Critical Care, OB, Pain, Regional, Neuro, Periop, Peds.

For example:
Salary
Hiring outlook
Stress level
Hours
Lifestyle
Future of subspecialty
Other

What are your thoughts?

 

[Consigliere]

I've searched and seen some previous posts on fellowships but wanted to get a more current and comprehensive opinion from sdn. I'm sure most would give advice about fellowships to residents in the same way they would give advice about residencies to medical students (i.e., pick the one you enjoy most, are the most passionate about, can see yourself doing everyday, etc.). But beyond the the immediate subjective likes/dislikes of certain subspecialties, are there some more objective generalizations that can be made about fellowships? Here's a list of the main ones: Cardiac, Critical Care, OB, Pain, Regional, Neuro, Periop, Peds.

For example:
Salary - much less
Hiring outlook - piss poor
Stress level - high
Hours - sh_itty
Lifestyle - sucks
Future of subspecialty - abysmal
Other - see above

What are your thoughts?

As above

 

[hrmm]

As above

Haha thanks. Maybe I should've been more clear. I was wondering if anyone had any experience or opinions about one fellowship versus another, and not just fellowships overall.

I guess the best advice would be from recent fellows who've finished and have entered their field of choice. In other words: What are the best and worst fellowships, and why?

 

[IlDestriero]

Here's a list of the main ones: Cardiac, Critical Care, OB, Pain, Regional, Neuro, Periop, Peds.

For example:
Salary
Hiring outlook
Stress level
Hours
Lifestyle
Future of subspecialty
Other

What are your thoughts?

Useless outside of academia/research (and probably useless there as well, if you can get a job w/o one)- OB, trauma, periop, OR management, neuro. I wouldn't recommend them to anyone. Some are pushing "periop specialist" as the future. We'll see.

Possibly useful if your residency was weak- regional, research (if you have no real research background from a shady residency and want to get a research track faculty job) Note- Many places will bring you in as an instructor and mentor you if they think you have potential.

Probably useful if you have an interest in the field, and may help get you an interview IF the group needs what you're offering- cardiac, peds.

Useful if you want to change your practice to 100% x- peds, CC, pain.

Useful if you think anesthesia as we know it is a dead field- pain, CC.

 

[countingdays]

Useless outside of academia/research (and probably useless there as well, if you can get a job w/o one)- OB, trauma, periop, OR management, neuro. I wouldn't recommend them to anyone. Some are pushing "periop specialist" as the future. We'll see.

Possibly useful if your residency was weak- regional, research (if you have no real research background from a shady residency and want to get a research track faculty job) Note- Many places will bring you in as an instructor and mentor you if they think you have potential.

Probably useful if you have an interest in the field, and may help get you an interview IF the group needs what you're offering- cardiac, peds.

Useful if you want to change your practice to 100% x- peds, CC, pain.

Useful if you think anesthesia as we know it is a dead field- pain, CC.

Agree with that and add that fellowships exist primarily to get another year of servitude out of you. If it were about education, you could still do 6 months as a CA3.

 

[hrmm]

Useless outside of academia/research (and probably useless there as well, if you can get a job w/o one)- OB, trauma, periop, OR management, neuro. I wouldn't recommend them to anyone. Some are pushing "periop specialist" as the future. We'll see.

Possibly useful if your residency was weak- regional, research (if you have no real research background from a shady residency and want to get a research track faculty job) Note- Many places will bring you in as an instructor and mentor you if they think you have potential.

Probably useful if you have an interest in the field, and may help get you an interview IF the group needs what you're offering- cardiac, peds.

Useful if you want to change your practice to 100% x- peds, CC, pain.

Useful if you think anesthesia as we know it is a dead field- pain, CC.

Excellent response. Thanks. Do you guys think the days of graduating as a non-specialized general OR anesthesiologist are really coming to an end? I wonder what the job market is like even now for non-specialized anesthesiologists trying to find a decent semi-urban gig.

 

[Yo GabbaPentin]

I looked into my crystal ball this morning and this is what I saw....

I saw a two tiered system where you can either pay for your quality health care, or you can't, in which case you will be getting the government system. For a preview of that, tour almost any VA system and imagine it 100 x busier.

There is only a few anesthesia subspecialties that could potentially tell the government F.U. IMO those are pain, sleep medicine and palliative care. All three of those fields could potentially be cash based practices.

Something to think about

 

[deleted126335]

Excellent response. Thanks. Do you guys think the days of graduating as a non-specialized general OR anesthesiologist are really coming to an end? I wonder what the job market is like even now for non-specialized anesthesiologists trying to find a decent semi-urban gig.

No. Just plan on working harder for less as an at will employee.

Depends on what you define as decent. Compared to 5 years ago it sucks. Compared to what the average family medicine doc takes home today, it's a good gig.

 

[Airzonk]

This is a dead end job that rarely filled and only with FMG's for good reason so many years ago. With the exception of leaders in our field this job is mundane. Why you have to be aoa, with a 230 usmle score is stupid. Im sure the academic directors are salivating over this. This job is equivalent to a politician or garbage man job. Choose your poison but realize you will be frustrated for many years.

 

[IlDestriero]

You're still in training Az. If you really feel that way, you should resign, get a research position somewhere for a year or two and figure out what you want to do with your life. There is no reason for you to complete your residency in a field you don't enjoy or respect. It's foolish to continue training in anesthesia.
I like my job. I enjoy the lifestyle, the challenging cases, and the diversity of practice. I think I get paid reasonably well for my time, have good relationships with many of the surgeons. If I was not happy, I would have changed careers, or gone into pain.
Good luck.

 

[IlDestriero]

Btw, you might like it more when you're making >$300k working 50 hrs a week vs. $45k for 70 hrs.
Something else to consider.

 

[Noegrus]

Arizonk is a troll. Been posting stuff like that on multiple threads today.

 

[gasattack3]

After a LOT of thought on this matter, and speaking to many many people (none of whom can give you a definitive answer btw), I've decided to apply to a handful of fellowships for CT.

If I get a good fellowship spot, well, great. Do I think it will make me, necessarily, a better overall anesthesiologist? Not sure. I'll be way better at CT and be Echo boarded.

Even if I do get a spot somewhere, I will always believe that if you make the most out of residency and take on additional tough cases. The complex ones. Volunteer for them etc. Take advantage of CA3 elecives etc. Then you can be a very good anesthesiologist without a fellowship.

We've all heard the opinions on here and through our contacts in our programs. Clearly there tends to be a bias towards fellowships at many residencies. But, I've also spoken to a lot of PP guys and there's more of a mixed feeling on this one.

It's not as if you're going to be standing still if you DON'T do a fellowship. That's one year of making attending level salary. It's one year sooner that you'll have attending level responsibility. And, it's one year working your a.ss off in a busy (hopefully) PP where you're working towards partnership (or not) and making contacts (surgeons) and establishing your professional reputation.

I will always believe that being a good anesthesiologist is up to the individual. How you carry yourself. Do you READ?? Do you embrace your cases to the full extent? Do you seek ways to ADD VALUE? (another discussion) Do you communicate well? Are you personable, and able to instill calm in patients and others in the OR when things aren't going well? Do you treat people with respect and act calm under stressful situations? Are you skilled at the procedures this specialty requires you to perform?

A fellowship provides none of the above.(except for subspecialty procedures etc.)

 

[orangballoon123]

which fellowships are associated w highest salary in PP (in order)?

 

[88845]

This is a dead end job that rarely filled and only with FMG's for good reason so many years ago. With the exception of leaders in our field this job is mundane. Why you have to be aoa, with a 230 usmle score is stupid. Im sure the academic directors are salivating over this. This job is equivalent to a politician or garbage man job. Choose your poison but realize you will be frustrated for many years.

So what would you do differently if you could go back? Which specialty would you go for and, even still, would you be content?

 

[sevoflurane]

I do peds (<1 y/o), regional, cardiac and acute and chronic pain.
The only thing I don't do is trauma.

I love my job. Great f'n variety bro....!

Still hella fun and interesting and yes... I make a difference.

The future of anesthesiology is pre/intra/post-op care.

We are well suited for that.

 

[Mman]

which fellowships are associated w highest salary in PP (in order)?

none

Salary in private practice isn't determined by fellowship or lack thereof. The only thing a fellowship might do in terms of job hunting is open some doors to a group that was looking to hire someone with specific training for a specific reason. But then again the extra year spent training might also prevent you from getting a job at that same place if they were looking to hire the year before and have already filled.

Getting a job is all about who you know and timing. Whenever you are looking for a job, some places will be hiring and some won't and you'll have to find the one that best fits you.

 

[Consigliere]

none

Salary in private practice isn't determined by fellowship or lack thereof. The only thing a fellowship might do in terms of job hunting is open some doors to a group that was looking to hire someone with specific training for a specific reason. But then again the extra year spent training might also prevent you from getting a job at that same place if they were looking to hire the year before and have already filled.

Getting a job is all about who you know and timing. Whenever you are looking for a job, some places will be hiring and some won't and you'll have to find the one that best fits you.

Now that's some good advice, newbies!

 

[Random Anesthesiologist]

4 years is a long way off, but if I were interested in practicing in a smaller area, say 150K people or less (thinking of college towns or similar), what fellowships would be good to market myself with, if I wanted to do one?

I've always thought peds and pain were 2 good ones to think about for my career goals. Also flirted with CC ideas, and did a Pulm ICU rotation 4th year of med school.

Like I said, it's a long way off, but it doesn't hurt to pay attention to what might be a plus for me.

 

[Mman]

4 years is a long way off, but if I were interested in practicing in a smaller area, say 150K people or less (thinking of college towns or similar), what fellowships would be good to market myself with, if I wanted to do one?

I've always thought peds and pain were 2 good ones to think about for my career goals. Also flirted with CC ideas, and did a Pulm ICU rotation 4th year of med school.

Like I said, it's a long way off, but it doesn't hurt to pay attention to what might be a plus for me.

In medicine, "practicing in a smaller area" is generally referring to hospital size, not town size. Many of the largest and most prestigious hospitals in the country are in what you'd call college towns.

I think a more relevant question is determining what type of setting you might want to work in. Large academic center, small community hospital, or something in between. Jobs in medicine are far more dependent on the type of hospital than they are the size of the town. For example, I work in a "college town" with a population of under 100K but in a level 1 trauma center with just shy of 1000 beds and a catchment area of several million people. But it's not a big city.

 

[Random Anesthesiologist]

In medicine, "practicing in a smaller area" is generally referring to hospital size, not town size. Many of the largest and most prestigious hospitals in the country are in what you'd call college towns.

I think a more relevant question is determining what type of setting you might want to work in. Large academic center, small community hospital, or something in between. Jobs in medicine are far more dependent on the type of hospital than they are the size of the town. For example, I work in a "college town" with a population of under 100K but in a level 1 trauma center with just shy of 1000 beds and a catchment area of several million people. But it's not a big city.

Oooh. Good point. I guess there's not very many good examples where I'm at.

I'm thinking something in between would be ideal for me. I just want to maximize my marketability, and trying to get a feel for what would be marketable in those in-between areas, or maybe even the small community hospital. Who knows. I'm pretty dead set on not settling in a very large city though.

I'm a country girl at heart and need some sort of space.

 

[Wiscoblue]

Most jobs are at community hospitals, where small groups still have a decent income and good quality of life. Cardiac or pain will bring value to a small group. Peds automatically puts you into a big city working for a larger group or as a hospital employee. If I was going to do a fellowship today, I'd pick cardiac or pain.