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Fellowships

Discussion in 'Anesthesiology' started by asmith1121, Aug 1, 2015.

  1. asmith1121

    7+ Year Member

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    I have no gauge of competitiveness for matching the different fellowships? Which is the most competitive and which are the easiest, almost guaranteed to match?
     
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  3. secants

    secants about:blank
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    Pain, CV and peds have been the most popular. Anything non accredited you can walk into + critical care
     
  4. IlDestriero

    IlDestriero Ether Man
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    2015 match data.
    Peds- 169 U.S. Grads applied, 148 matched, 88% match.
    Pain- 266 U.S. Grads applied, 196 matched, 74% match.
    There is a lot of self selection, but they're not super competitive if you're a solid resident. Obviously the big name programs will be quite a bit more competitive. We get 10-20 applicants per spot.
     
  5. sevoflurane

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    I would recommend that anyone in PP that has been doing hearts for a while AND has graduated b4 2009 to get through the required 300+ hearts in 4 years and take the advanced PTExam.

    Being a diplomate of the NBE/Certified in advanced echo makes a huge difference when job hunting and in clinical practice. Testamur status does not cut it in many places. If you have the numbers you may want to consider doing it although it takes a long time and serious study + the NBE is notoriously slow with sending out certificates. However, once you get it you are good for 10 years.

    FWIW, I strongly believe that being certified via the practice pathway makes you a better practitioner if that option is available to you. Go for it.
     
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  6. hooride

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    Adult Cardiothoracic Anesthesiology Fellowship
    June 2013 June 2014 June 2015

    APPLICANT DATA

    Applicant registrations 267 268 268
    # Applicant Rank Lists Submitted 230 213 211
    Matched Total 166 172 182
    Unmatched Total 64 41 29
    Applicant Matching % (Overall) 72% 81% 86%
    Total # of Withdrawals 9 21 14

    PROGRAM DATA

    # of Participating Programs 54 55 57
    Positions Offered 168 174 183
    Positions Filled 166 172 182
    Unfilled Positions 2 2 1

    Link:
    https://www.sfmatch.org/SpecialtyInsideAll.aspx?id=24&typ=1&name=Adult%20Cardiothoracic%20Anesthesiology#
     
  7. Man o War

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    @sevoflurane +1. I'm finding a lot of groups don't accept basic certification for TEE. Has to be advanced.
     
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  8. BLADEMDA

    BLADEMDA ASA Member
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    Pain

    Peds

    Cardiac

    Critical Care


    Critical Care is by far the easiest to match into but the one most likely to make you a better Anesthesiologist for Adults. I highly recommend any of the 4 for job security. If you hate all 4 fellowships then go Cardiac to get TEE certified as that will help your job prospects down the line.
     
  9. FFP

    FFP Wiseguy
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    Careful with pain. People are getting out of pain, 10-15 years post-fellowship. I even know a person who's doing a second fellowship. That should say something.

    Same with peds: everybody's getting into peds nowadays, while there is just a limited number of positions where having the fellowship actually matters. At my former academic place, there were 10+ peds people on the waiting list for a job opening.

    Work hard during your residency to become the best anesthesiologist you can, and get a fellowship only if you love the subspecialty or the market wants it in the area you want to live.
     
    #8 FFP, Aug 3, 2015
    Last edited: Aug 3, 2015
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  10. Ezekiel2517

    Ezekiel2517 Anesthesiologist
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    Lol
     
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  11. nycitygas

    nycitygas ASA Member
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    I was always under the impression the peds market was always hot. Too many graduating fellows I guess? That's a shame.

    I didn't do pain bc I was worried about the future ect. I however have a friend who graduated a year ahead of me who is clearing close to mil a year so Im not so sure I made the right decision.

    It is extremely easy to match into a CCM fellowship. A bit more difficult to match into a program that will set you up for an academic career or provide you the training to practice as an intensivist in the community.
     
  12. FFP

    FFP Wiseguy
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    I concur. For the latter, I strongly recommend a mixed MICU-SICU program (or one that allows at least a couple of months in the MICU).
     
  13. ambiturner

    ambiturner ASA Member
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    My experience as a relatively recent grad in the northeast:

    Regarding the peds and cardiac markets, at least on the east coast I think the academic jobs are quite saturated. At my residency cardiac attendings have been hired by the dozen and the case mix is so dilute that they have trouble maintaining their TEE certifications. Peds was worse with the dept seriously considering only hiring attendings that had done at least 2 years of fellowship. Now, in private practice it's a different story - there's a huge demand in my area for peds (with the expectation you do adults and ob etc too). These jobs tend not to be advertised though and spread through the fellowship programs by word of mouth.

    CCM market is extremely tight but grads of the good fellowships in the area all got good academic jobs. Friends that went to the bay area went with the expectation they would not be able to stay as attendings.

    Pain market is tight and a lot of practices try to screw new grads (shocking) - from what I've observed, the scruples of the new grad tended to be inversely proportional to income...
     
  14. Shimmy8

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    Nothing to add except the poster above me has such an exceptional name, so I trust everything he/she says.
     
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  15. GasMan315

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    What is everyone's opinion on an OB fellowship? I'm considering because of interest and the potential for academic career in the future.
     
  16. criticalelement

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    what could you possibly learn in an ob fellowship? What kind of academia will you study? HOw many cm to thread the epidural catheter? how to avoid saying the heinous things that are going through your head whilst on the ob ward? The only people who do ob fellowships are.... well you can fill in the blank.
     
  17. G-Man82

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    Dunno. I have a friend who did an OB fellowship and his training was all about high risk OB. He didn't see them for mere pre-eclampsia and HELLP; he was involved with those people who had those plus ongoing cardiac (HOCM, severe pulm htn, congenital), pulmonary issues (fibrosis), other weird things like pseudoachondroplasia, and then he was also involved with intrapartum fetal surgeries. It can be a cool niche, but purely at an academic center where you see these kinds of anomalies.
     
  18. pgg

    pgg Laugh at me, will they?
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    Any time spent on directed education isn't entirely wasted.

    But, it seems like a huge opportunity cost to pay if you're destined for most jobs. Loss of a year's salary and a year toward a partnership in return for fellow pay and a non-ACGME fellowship certificate. I wouldn't think it would be near as useful as CCM, CT, or peds in terms of opening doors to competitive groups.

    Could be useful if you want an academic position.

    There are some people for whom the opportunity cost is zero. Some people serving military scholarship obligations fall in this category. I don't understand all the details, but some foreign-trained anesthesiologists who come to the US to practice can do such fellowships to get some useful training out of their required US training period. I met an OB anesthesia fellow from Germany who fell in that group.


    There are some aspects of anesthetic care of high risk OB patients that would be well served by some extra months of training. In-utero surgery, wacky congenital problems. A whole year seems like a lot.

    I briefly considered doing an OB / regional fellowship (partly because I fall in that zero-opportunity-cost military group and it'd be just dumb/lazy to NOT do a fellowship) but ultimately decided to do CT instead, because I like CT better.
     
  19. IlDestriero

    IlDestriero Ether Man
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    There's a huge difference between "the potential for an academic career in the future" and a genuine interest in both a career in academic medicine and specifically in OB anesthesia.
    Figure out what you want to do, then decide.
    If you really want to be involved in things like fetal surgery and very high risk OB you're job prospects are pretty limited.
     
  20. caligas

    caligas ASA Member
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    If you are 30 years old now and you skip the fellowship and take home $200k in year one, and you spend $60k that year and invest the rest in a stock index fund, assuming 8% annual you will have an extra $2 million at age 65.
     
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  21. gasdoc77

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    That ortho trauma fellowship just became a little less attractive.

    hat
     
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  22. pgg

    pgg Laugh at me, will they?
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    You assume that the employment opportunities and pay for the fellowship trained you, and the non-fellowship trained you, are identical.

    You also assume no taxes paid on that $140K income before it's invested.

    8% real return (over inflation) for 34 years is also a stretch.


    Realistic numbers might be $110K invested (most of it NOT in a tax advantages account!) at 4-5% above inflation for a total of $500K. If the fellowship is worth a mere $15K extra in pay/opportunity/happiness per year, the fellowship wins.
     
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  23. Ezekiel2517

    Ezekiel2517 Anesthesiologist
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    Man this is flawed.
    Even if it were accurate, over 35 freaking years there are a lot of ways to make much more than 2 mil
     
  24. caligas

    caligas ASA Member
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    Yes, my post was a little tongue in cheek. But I think folks do sometimes neglect the cost benefit analysis.
     
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  25. FFP

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    There is just one problem: those $2 million will buy less than $1 million buy today. There is a lot on inflation in the meantime. ;)
     
  26. ether123

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    where did u get these stats from?
     
  27. gasdoc77

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    How about for no traditional applicants? Do they look at Step 1 scores even if you've taken and passed the actual board exam? If you were in the top percentiles does that give more of an edge, or is it just passed or not? What if you are in PP and not around research? If I were to consider going back it would be to do pain and control my own destiny. Sorry about the syntax errors. My ipad is a POS.
     
  28. IlDestriero

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  29. Guillemot

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    How much do fellowships care about ite scores? Is it the higher the score the better or more like residency & usmle where beyond a cutoff it doesn't matter?
     
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  30. IlDestriero

    IlDestriero Ether Man
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    When you have a lot of applicants who are probably nearly all capable of completing the fellowship, you rely on numbers to help determine who to interview. We only interview about 1/3 of the people that apply and even then we don't rank everyone.
     
  31. pgg

    pgg Laugh at me, will they?
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    I'm 6 years out of residency, looking ahead to fellowship now. Programs have seemed to be much more interested in what I've done since residency than my Step 1 score from 15 years ago. Maybe my roundabout military pathway just makes for good conversation.

    I was asked how I'd adjust to being a trainee again, not the guy in charge, more than about my poor (sub-mean) Step 1/2 scores or my great (98+) ITE and written board scores.

    I assume they assumed I can do the work, based on scores/BC/post-residency work, and were more interested in determining if they wanted to spend a year working with me every day.
     
  32. FFP

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    What kind of fellowship, if I may ask?

    Btw, I got the same legit questions during my interviews. And they were right; it's pretty annoying to have to do stuff that you don't consider best practice, just because "the attending" said so.
     
  33. Guillemot

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    Im interpreting this as you interview the 1/3 of the applicants with the highest scores. Beyond that score doesnt matter.
     
  34. IlDestriero

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    The LORs are read as well. Some are extraordinary. Those are the people we want as well.
    Average scores and average LORs are not going to get you an interview for a competitive position, you need something to get noticed and get a foot in the door.
    Having said that almost 90% of US grads match in pediatric anesthesia, so the odds are that most applicants will get in somewhere, just not in one of the super competitive programs.
     
  35. pgg

    pgg Laugh at me, will they?
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    Cardiothoracic.

    My circumstances are a bit different than most applicants though, and not just because I'm not a CA-2 applying to go straight out of residency. The Navy owns me for a few years yet, so in order for me to disappear for a year to be a fellow, those powers need to both perceive a need for another CT anesthesiologist and decide that I am the specific person they want to go get that training. There's a process for us to apply and make our case.

    The last few years the master spreadsheet hasn't perceived a need for more CT anesthesiologists, so no one has been allowed to train in that field. This kind of force shaping is of course totally sane and appropriate - it wouldn't serve the Navy or the nation well if we had 3x as many CT anesthesiologists or radiation oncologists as we need to support military hospitals in the US or abroad. The problem is that the master spreadsheet hasn't match the reality of our need the last few years, so the Navy is short and no one's in the training pipeline. That's changing this year so a window is opening.

    I'll get a formal answer from the Navy in December if it's my turn to go. I'm hoping to start in 2016, if not then 2017. I have a position secured for 2017 outside the match, and could possibly start 2016 if certain things work out. I like my odds but nothing is certain.

    I mention this in part as idle conversation :) but also because the interview experiences I related above probably deserve the caveat that I'm a weird applicant applying under weird circumstances outside the match.
     
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  36. seinfeld

    seinfeld ASA Member
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    Where is it "extremely tight"? Are you talking academics in Boston and NYC? I could use another 2-3 CCM trained anesthesiologists.
     
  37. Man o War

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    @pgg- I went back after 10 years to do a CT fellowship. I know for a fact I would not have gotten as much out of it straight out of residency. Opportunity cost and all, it was the right move for me. Best of luck to you, it's been a unique experience for sure.
     
  38. pgg

    pgg Laugh at me, will they?
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    I'm really looking forward to it. Not having the distraction of oral board prep will be nice. Being part of a residency program this year now I have time to learn (and colleagues willing to teach me) some more advanced echo ahead of time. The learning curve post-residency is pretty steep, and I'm still climbing now 6 years out, but like everyone who's got some alone time out in the world, I'm better than I was as a new grad. And after a few years of non-clinical duties to the department and other non-anesthesia obligations, the notion of having to do nothing except cases and reading and learning has me giddy with anticipation. It's going to be awesome. :)

    I do have to check my enthusiasm a bit though; the Navy still has to agree to let me go. Never any guarantees from that quarter.
     
  39. ambiturner

    ambiturner ASA Member
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    Yes - CCM people are definitely in demand, but the last few years actually getting CCM time has been tough (as opposed to an abundance of general OR time). I think you'd find it easy to recruit here, by the end of training a lot of people are tired of the competitiveness and COL of the area and would probably be very willing to listen to a good offer.
     
  40. FFP

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    Where? ;)
     
  41. Sonny Crocket

    Sonny Crocket ASA Member
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    I know a cardiac fellowship trained attending who told me that he has not put in an epidural in over 2 years. By all means do a fellowship but remember that you may be doing that subspecialty close to 100% of the time. Good night and good luck.
     

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