Fellowships with future demand

[m3unsure]

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Going beyond general anesthesiologists, which fellowship graduates have the highest demand currently? I assume that CT is heading downhill. Any comments on the market in the next 4 years? Those CRNAs are probably going to force lots of people to do a fellowship to protect themselves.

 

[The_Sensei]

Going beyond general anesthesiologists, which fellowship graduates have the highest demand currently? I assume that CT is heading downhill. Any comments on the market in the next 4 years? Those CRNAs are probably going to force lots of people to do a fellowship to protect themselves.

Not really. Do pain if you are so inclined. Future is okay for at least 10 years.

 

[VentdependenT]

you can always do a neuroanesthesia fellowship....seriously though, peds is also useful.

 

[m3unsure]

10 years...that's all? I would hope around 20 years. I'm not looking to be Mr. 500K, but I certainly don't want to be chosen second to a CRNA. If I can average out 150-175K/yr over the next 20 years, I won't be pissed since I'll have it much better than an average American.

Anyway, which places have excellent/good regional anesthesia fellowships?

 

[cfdavid]

OP, why the assumption that cardiac will be declining?

I know open CABGs have been declining over the years in favor of less invasive interventional cardiology, but this doesn't necessarily speak to the supply/demand dynamics of cardiac anesthesiology.

Can anyone please shed some light on this matter? I've always been interested in cards, but really don't have any experience with cardiac anesthesia (though I will be shadwoing on some hearts cases this fall).

 

[cubs3canes]

OP, why the assumption that cardiac will be declining?

I know open CABGs have been declining over the years in favor of less invasive interventional cardiology, but this doesn't necessarily speak to the supply/demand dynamics of cardiac anesthesiology.

Can anyone please shed some light on this matter? I've always been interested in cards, but really don't have any experience with cardiac anesthesia (though I will be shadwoing on some hearts cases this fall).

Cards not declining. The long term mortality data on stenting is not looking that great (at least for drug-eluting stents). All 3 vessel disease equals CABG. People still smoke and are fat.

TEE certification is still a way to increase your earning potential. I think (not sure) that you will need a CV fellowship to get enough cases to sit for the exam.

cubs

 

[epidural man]

you can always do a neuroanesthesia fellowship....

...that was funny

 

[epidural man]

Any fellowship would be great - depends on what you like.

Cards I don't think will die, maybe decrease - but that so what.

Peds is really fun. If you work for a group that gets paid by startup units, then you can make BANK! imagine doing 20 - 25 T and A's and ear tubes in a day, vs 3 to 4 lab choles.

Pain - lots of fun and not a bad future if IR doesn't take everything

ICU - really cool and not going away.

 

[Stimulate]

Do a fellowship in something you enjoy... 10 years into practice the financial difference between fellowship and no fellowship may not be all that great. But if you choose a specialty based only on future demand you may not enjoy your career choice in the long-run.

That being said, there is a huge demand for pain, peds, and ICU.

Cardiac may stay fairly steady as well because if everyone thinks it is declining, nobody will pursue those fellowships and then demand will go up. Everything is cyclical. Plus now that cardiac anesthesia is ACGME-accredited it may increase demand further.

 

[flashgordon]

Why do a peds fellowship?

At the hospitals I rotated at, non-fellowship anesthesiologists were doing peds cases (nothing major though). Granted, this was not a children's hospital.

Is the extra year really worth it? Are there peds-only groups? Any demand?

I hear the pay is about the same as a general anesthesiologist. But if you love kids...

Thoughts?

 

[me454555]

This question should be filed in the same bin as every other "how much will X be worth in the future" where X is a speciatly, fellowship, or stock. The answer is that no one knows and no one can predict. 15 years ago anesthesia was dead and no one went into it, 30 years ago CT surg was the toughest specialty to get, 10 years ago google was a start up and nortel was worth top dollar.....see my point? All you can do is speculate and pray.

So why do a fellowship? B/c you like it. The funny part about this question is that the answer is right in front of your face and yet no one seems to find it. They always concentrate on every other aspect but don't consider whether or not they truly want to do it or be an expert at 1 particular area.

 

[n2bait]

10 years...that's all? I would hope around 20 years. I'm not looking to be Mr. 500K, but I certainly don't want to be chosen second to a CRNA. If I can average out 150-175K/yr over the next 20 years, I won't be pissed since I'll have it much better than an average American.

Anyway, which places have excellent/good regional anesthesia fellowships?

All I can tell you is that Virginia Mason regional fellowship = good volume, good variety, and opportunities to be involved in some cutting-edge research. Private groups looking to improve techniques as well as integrate more blocks into their practice will seek you out.

 

[BlackSails]

...that was funny

Why is neuroanesthesia considered a joke fellowship?

 

[epidural man]

Why do a peds fellowship?

At the hospitals I rotated at, non-fellowship anesthesiologists were doing peds cases (nothing major though). Granted, this was not a children's hospital.

Is the extra year really worth it? Are there peds-only groups? Any demand?

I hear the pay is about the same as a general anesthesiologist. But if you love kids...

Thoughts?

Children hospitals (at least the ones I am aware of) only hire Peds anesthesiologist.

And you are correct, most anesthesiologists can do most of peds cases. It only makes a difference (according to data) in kids under 6 months of age.

As I said, if you get a job at a childrens hospital that extubates in the PACU, you can do MANY more cases than ANY adult hospital - and some jobs pay the anesthesiologist based on the CPT coding units and all that jazz. Start up units pay a lot more than time units - so if you can start 20 to 25 cases that have 4 - 6 start up units, this pays a lot more than starting a cardiac case that has startup units of 22 (maybe? -somewhere around here) and then time units which I don't know what they are but around 3/hr or something. Even if you do a liver (which has the max number of startup units - over 30 I think) and do that case all freaking day, you are no where near a day of doing tonsills and ear tubes, or even 10 appendectomies.

Peds anesthesia is really fun. Most people like it. It adds a level of stress no doubt.

 

[Stimulate]

I had a brief time period where I was interested in peds. I enjoyed the quick turnover, healthy kids, and the occasional sick kid.
So when I interviewed with a big anesthesia group (>100 anesthesiologists) the hiring partner asked me what my ideal job would be. I said I would like to do quick turnover, healthy kids 3 days a week and sick kids or peds hearts maybe 2 days a week. He then said, "why would I hire a peds fellow to do healthy kids? Our general anesthesiologists do all healthy kids over 2 years of age. If groups hire a peds fellow it is usually for the challenging cases or to recruit surgeons to use the group who do challenging cases. So if you work with us you will probably be expected to do these type of cases every day, and also you will take more frequent call because less people are available for those calls."
That was a sobering moment for me. I then realized my enjoyment of peds was probably not from a realistic perspective. I enjoyed the nice peds anesthesia attendings, peds OR environment, and healthy kids. I didn't really enjoy true peds anesthesiology which is having a specialized set of skills with the intention of treating the sickest children.
I am sure peds anesthesiology would have increased my demand in the job market, and would have increased my income, etc. however it wasn't what truly interested me. I have a lot of respect for those who choose that path...

 

[m3unsure]

So then, what did you end up doing Stimulate? Just going for general jobs or picked something else.

 

[fakin' the funk]

Why is neuroanesthesia considered a joke fellowship?

Same question here!

 

[urgewrx]

The flip side is that there are many parents of healthy kids right know asking/insisting for a pediatric anesthesiologist even for ear tubes. Unless you have a fellowship or many years of experience, how are you supposed to answer them? I had my fair share of these when I was a resident working with a non peds attending. With an old geezer attending you can bs saying yes he is a pediatric anesthesiologist, since he has a lot of experience. But, with a young guy it's another story. Uncomfortable for sure. I have never seen this scenario with any other anesthesia subspecialty.

 

[urgewrx]

Why is neuroanesthesia considered a joke fellowship?

You don't need a fellowship in order to hyperventilate, induce hypotension, or give mannitol. Don't get me wrong, those are interesting cases(aneurysm, awake crani's, sitting position) and sometimes can become very bloody.

Ob, ambulatory surgery, trauma, +/-transplant, +/-regional fellowships are considered a waste of time by many.

 

[epidural man]

You don't need a fellowship in order to hyperventilate, induce hypotension, or give mannitol. Don't get me wrong, those are interesting cases(aneurysm, awake crani's, sitting position) and sometimes can become very bloody.

Ob, ambulatory surgery, trauma, +/-transplant, +/-regional fellowships are considered a waste of time by many.

your forgot neuro also -

 

[fakin' the funk]

You don't need a fellowship in order to hyperventilate, induce hypotension, or give mannitol. Don't get me wrong, those are interesting cases(aneurysm, awake crani's, sitting position) and sometimes can become very bloody.

Ob, ambulatory surgery, trauma, +/-transplant, +/-regional fellowships are considered a waste of time by many.

Even transplant? Aren't transplant (livers, hearts?) cases some of the most challenging out there?

 

[urgewrx]

Even transplant? Aren't transplant (livers, hearts?) cases some of the most challenging out there?

Cardiac anes do heart and lung transplants

General anes do livers. Yes, they are big bloody cases but there is not that much to them that would require 1 yr to learn.

 

[Masseter Spasm]

Do a pediatric fellowship if you really like pediatric anesthesia. This means that you like doing all pediatric cases not just healthy kids for T&A's, hernias, etc. Some residency programs are weak in pediatric cases and may not expose you to many ASA III and higher pediatric patients having complex procedures. (Realize that a fellowship at a high volume children's hospital will be different than a pediatric rotation at a community hospital.)

If you like caring for the healthy kids for routine procedures, consider doing multiple electives in peds during your CA-3 year. Then you can promote yourself to the average private practice group as someone with an interest and expertise in routine pediatric anesthesia.

A good peds fellowship will teach you to take care of the full spectrum of pediatric cases. Fellows are expected to handle the complex cases on the schedule: neonates, cardiac, transplants, craniofacial, major orthopedic, airway surgeries, craniotomies, thoracotomies, etc..

Your options are not limited after completing a pediatric fellowship. There are private groups looking for fellowship-trained pediatric anesthesiologists. Some academic groups pay their peds specialists quite well. Some fellows will practice in peds exclusively, others will continue to take care of some adults. Fellowship-training is generally the expectation at academic centers, children's hospitals, and large tertiary centers. (The exception is if you are experienced and board certified in something like pediatrics or pediatric critical care.)

Finally, do not be scared away from doing a fellowship by that uneasy feeling you get every time you go to the NICU to pre-op a patient. A good fellowship will prepare you to take care of these and other challenging cases.

 

[Arch Guillotti]

Finally, do not be scared away from doing a fellowship by that uneasy feeling you get every time you go to the NICU to pre-op a patient. A good fellowship will prepare you to take care of these and other challenging cases.

I seem to get pretty scared when the kid is as blue as my scrubs and the pulse ox sounds like a foghorn in my ear and I am unable to ventilate.

 

[Stimulate]

So then, what did you end up doing Stimulate? Just going for general jobs or picked something else.

Fortunately for me I hadn't yet rotated in Pain when I was thinking about Peds. After rotating through pain I realized that this was the specialty for me. It is kind of funny because the two are so different....

 

[Noyac]

You don't need a fellowship in order to hyperventilate, induce hypotension, or give mannitol. Don't get me wrong, those are interesting cases(aneurysm, awake crani's, sitting position) and sometimes can become very bloody.

Ob, ambulatory surgery, trauma, +/-transplant, +/-regional fellowships are considered a waste of time by many.

yes total waste of time.

And we don't hyperventilate in neuro all that often any longer.

 

[BLADEMDA]

yes total waste of time.

And we don't hyperventilate in neuro all that often any longer.

Those who do a REGIONAL fellowship at a top program learn every type of block that exists. Many Residency programs have "weak" regional departments or limited exposure so a fellowship in Regional is not always a bad idea. That said, 12 months is over-kill to get good block experience and you should learn most blocks during your CA-1 thru CA-3 years.

Some Groups are looking for a fellowship trained Regional person to place catheters, do Paravertebral blocks, Infraclavicular, Lumbar Plexus, etc.
Yes, a few Residents can do all these things without a fellowship but many are "deficient" and need more regional exposure.

As a private practice marketing tool Regional is NOT your best choice for a fellowship but it is an option especially if you want an ACADEMIC POSITION teaching Regional.

Blade

 

[epidural man]

Some Groups are looking for a fellowship trained Regional person to place catheters, do Paravertebral blocks, Infraclavicular, Lumbar Plexus, etc.
Yes, a few Residents can do all these things without a fellowship but many are "deficient" and need more regional exposure.


Blade

This seems very true. At our program, we have a very busy regional service and I did many blocks, but I still only ended up with one paravertebral block and never did a lumbar plexus.

I did plenty of infraclavicular however, since this is a great block - far superior to an ax block in my opinion.

 

[Carm]

Cards not declining. The long term mortality data on stenting is not looking that great (at least for drug-eluting stents). All 3 vessel disease equals CABG. People still smoke and are fat.

TEE certification is still a way to increase your earning potential. I think (not sure) that you will need a CV fellowship to get enough cases to sit for the exam.

cubs

It all depends on where you train. I am not saying this is common by any stretch, but we had a chief last year who did enough TEE's to sit for the exam last spring. He just recently found out that he passed.

There are definitety more things than just TEE to be learned during a CV fellowship, but an aggressive resident (ie UTSouthwestern) can get enough experience during residency to very closely simulate the experience.

 

[johankriek]

TEE certification is still a way to increase your earning potential. I think (not sure) that you will need a CV fellowship to get enough cases to sit for the exam.

cubs

yeah if you like doing the same case over and over and over and over again and sit through long pump runs and be in the same room as cardiac surgeons all day.. I did maybe prolly 110 hears my ca3 year.. I did a lot of cardiac. I liked it, but in practice there is no way i could do it. and most of the cases are medicare... you are not gonna make more than the guy who induces 4 patients a day.. no way..

 

[UTSouthwestern]

yeah if you like doing the same case over and over and over and over again and sit through long pump runs and be in the same room as cardiac surgeons all day.. I did maybe prolly 110 hears my ca3 year.. I did a lot of cardiac. I liked it, but in practice there is no way i could do it. and most of the cases are medicare... you are not gonna make more than the guy who induces 4 patients a day.. no way..

All depends on where you are located and the speed of the surgeon. Some of our heart surgeons routinely finish their 3-6 vessel CABG's in 3 hours or less. Faster hearts make them more profitable on a per hour basis. I have also been suprised by the volume of young privately insured hearts I have seen on our schedules.

 

[UTSouthwestern]

It all depends on where you train. I am not saying this is common by any stretch, but we had a chief last year who did enough TEE's to sit for the exam last spring. He just recently found out that he passed.

There are definitety more things than just TEE to be learned during a CV fellowship, but an aggressive resident (ie UTSouthwestern) can get enough experience during residency to very closely simulate the experience.

The testamur status is easy enough to get. Final certification is another story.

 

[Pinky]

i am actually in the process of inteviewing for a cardiac fellowship. Every fellowship coordinator that i've spoken to says that this is the most competitive year that they've seen. there are so many people applying for CT fellowship. Many places have already filled their spots for July 2008.

read the following article from the society of cardiovascular anesthesiologists.

http://www.scahq.org/sca3/newsletters/2007aug/PresMessage.pdf

 

[starsop93]

The thing about cardiac is that from a billing standpoint it isn't very lucrative (usually), but some places heavily subsidize their cardiac surgery programs because the cath lab is SO profitable for the hospital. You need cardiac backup to do more advance interventions. That can result in subsidies for cardiac anesthesia as well...

The TEE skills one learns in a fellowship should be much more advanced than you might learn as a resident or while in practice. In most cases, you don't need all the advanced knowledge, but it is definitely useful and impressive if you can do the advanced measurements. The surgeons at our institution trust my TEE exam much more than they trust the cardiologists' exam.

Overall it is hard to make up the income you lose by doing the fellowship, but it is possible. It does give you a leg up on the competition at competitive practices (like all fellowships) and I know I give a much better anesthetic having done it than I would have if I didn't. On the other hand, if someone were to put me in a room doing 10 cases at an outpatient facility, I'd be scared ****less!