Fellowships

[EastCoast]

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Hello all,

Thanks for all the advice on this great forum. I'm currently an MS3 planning on applying to a residency in Anesthesia. I know it's a great fit for me, and really appreciate the insight some of you offer here.

With all this talk about cRNAs and this apparent "take over" that's mounting...can some of you with more experience give me an idea of when you see this really happening? I mean yes, if it's a case that a cRNA can do on there own, then perhaps an MD shouldn't be doing it (that's what one of the Anesthesia residents at my med school says). But cRNAs will never be able to do the complex cardiac or transplant cases correct? Or Peds Anesthesia?

In reference to the title of my post--I'm just curious if you guys think that in the future in order to be successful in Anesthesia, you'll have to do a Fellowship in Pain or Critical Care, etc. I've read on the ASA website the article by Dr. Ron Miller where he seems to allude to this---that in the future Anesthesia will be pushing more into the realm of critical care and less into the realm of the OR (since less trained individuals will be able to handle more OR cases as technology improves and surgeries become less invasive, etc).

Thanks a lot.

 

[militarymd]

Crystal ball question.

But it never hurts to do more training. Training that differentiate yourself from physician extenders.

As an intensivist, there is not a single physician extender (even the most militant) who will and can say that they can do what I do.

 

[EastCoast]

thanks mmd....
have you discussed your fellowship training on another thread already? if not, i would be very interested in hearing about how long it took, what it entailed, and if you're glad you went to the intensivist route via anesthesia (as opposed to doing it through IM).

Crystal ball question.

But it never hurts to do more training. Training that differentiate yourself from physician extenders.

As an intensivist, there is not a single physician extender (even the most militant) who will and can say that they can do what I do.

 

[militarymd]

I picked the anesthesia route thinking that private practice anesthesia ccm would be the same as academic (UH at CWRU, mgh, mayo, etc...) models.

Private practice is not like that...so I'm a little disappointed, but I enjoy anesthesia....so no big deal...life goes on.

CCM fellowship is only 1 year long with 6 month required in an anesthesia run unit....things will change, just keep an eye on the ABA requirements.

 

[davvid2700]

Hello all,

Thanks for all the advice on this great forum. I'm currently an MS3 planning on applying to a residency in Anesthesia. I know it's a great fit for me, and really appreciate the insight some of you offer here.

With all this talk about cRNAs and this apparent "take over" that's mounting...can some of you with more experience give me an idea of when you see this really happening? I mean yes, if it's a case that a cRNA can do on there own, then perhaps an MD shouldn't be doing it (that's what one of the Anesthesia residents at my med school says). But cRNAs will never be able to do the complex cardiac or transplant cases correct? Or Peds Anesthesia?

In reference to the title of my post--I'm just curious if you guys think that in the future in order to be successful in Anesthesia, you'll have to do a Fellowship in Pain or Critical Care, etc. I've read on the ASA website the article by Dr. Ron Miller where he seems to allude to this---that in the future Anesthesia will be pushing more into the realm of critical care and less into the realm of the OR (since less trained individuals will be able to handle more OR cases as technology improves and surgeries become less invasive, etc).

Thanks a lot.

I hope you do go into anesthesia. i would recommend it. BUt be informed about it.. CRNAs will never take over anesthesia. They may, gain more practice rights in more states but they will never take over. We wont allow it. not only us but the nation. I still believe there should be a physician involved in every single case. I dont care how easy or healthy the case or patient is perceived to be. I think every patient before an operation should be given informed consent. ( do you want a physician or a nurse anesthetist to medically direct your case?) That would solve the issues. SOme crnas do complicated hearts and transplants and they are quite adept.. Does that mean they can practice independently? I think not. There needs to be the judgement of a physician.

Just a question for anyone who knows? In the areas that crnas practice independently, who prescribes the medication since only physicians can prescribe medicine


A fellowship is NOT necessary if you go to a residency that is well represented in all the subspecialties.. If you go to a residency that doesnt do hearts and farms you out somewhere to do hearts.. You wont get many. Youw ill get the bare minimum. It doesnt matter unless you plan on doing some hearts when you graduate.

 

[pmichaelmd]

Any of you in the real world have any advice regarding pediatric anesthesia fellowship? I just finished 2 months and loved it...I think I might do peds fellowship. I have also heard that their is an increasing shortage in peds anesthesiologists and that reimbursement is improving.

Any of you do a peds fellowship or have colleagues that did?

Thanks,
PMMD

P.S. I guess the subtitle of this should be "I'd rather be happy than rich." 🙂

 

[militarymd]

Just a question for anyone who knows? In the areas that crnas practice independently, who prescribes the medication since only physicians can prescribe medicine

The surgeon.

 

[jetproppilot]

I hope you do go into anesthesia. i would recommend it. BUt be informed about it.. CRNAs will never take over anesthesia. They may, gain more practice rights in more states but they will never take over. We wont allow it. not only us but the nation. I still believe there should be a physician involved in every single case. I dont care how easy or healthy the case or patient is perceived to be. I think every patient before an operation should be given informed consent. ( do you want a physician or a nurse anesthetist to medically direct your case?) That would solve the issues. SOme crnas do complicated hearts and transplants and they are quite adept.. Does that mean they can practice independently? I think not. There needs to be the judgement of a physician.

Just a question for anyone who knows? In the areas that crnas practice independently, who prescribes the medication since only physicians can prescribe medicine


A fellowship is NOT necessary if you go to a residency that is well represented in all the subspecialties.. If you go to a residency that doesnt do hearts and farms you out somewhere to do hearts.. You wont get many. Youw ill get the bare minimum. It doesnt matter unless you plan on doing some hearts when you graduate.

Nicely said. Although when I went to Texas Heart during my Tulane residency, I did a ton of hearts. A place that does the same thing over and over gets pretty good at it...and as a result, you get really good at it...we even used masking tape in the OR to secure our IVs A-lines.

In areas where there is no anesthesiologist, the surgeon's name goes on the bottom of the anesthesia chart. He/she assumes responsibility for the surgery and the anesthesia.

 

[jetproppilot]

Nicely said. Although when I went to Texas Heart during my Tulane residency, I did a ton of hearts. A place that does the same thing over and over gets pretty good at it...and as a result, you get really good at it...we even used masking tape in the OR to secure our IVs A-lines.

In areas where there is no anesthesiologist, the surgeon's name goes on the bottom of the anesthesia chart. He/she assumes responsibility for the surgery and the anesthesia.

Speaking of Texas Heart, if you wanna see orchestra in motion, do some CABGs with David Ott and Mike Duncan. Best heart surgeons I've ever seen. Human sewing machines...

and you never need a second anesthesia record.

 

[Noyac]

Speaking of Texas Heart, if you wanna see orchestra in motion, do some CABGs with David Ott and Mike Duncan. Best heart surgeons I've ever seen. Human sewing machines...

and you never need a second anesthesia record.

On or off pump?
Baton Rouge was as fast as I have ever seen but I didn't do my training at Tex Heart as you know. we did 2 cases routinely b/4 noon and they were 3 or more vessels. 95% off pump unless we were replacing valves, obviously.
It was a nice day when you did 3 or 4 hearts and were home by 4pm. But thats all over for me these days. 😀

 

[jetproppilot]

On or off pump?
Baton Rouge was as fast as I have ever seen but I didn't do my training at Tex Heart as you know. we did 2 cases routinely b/4 noon and they were 3 or more vessels. 95% off pump unless we were replacing valves, obviously.
It was a nice day when you did 3 or 4 hearts and were home by 4pm. But thats all over for me these days. 😀

WOW. Thats fast.

This was back circa 1995 before off-pump was in vogue, so they were all pump cases.

 

[Gimlet]

I picked the anesthesia route thinking that private practice anesthesia ccm would be the same as academic (UH at CWRU, mgh, mayo, etc...) models.

Private practice is not like that...

Would you care to expand on that at all, Mil? I'd be curious to know what the differences btw. academic and PP CCM are, and why you like one more than the other.

 

[militarymd]

Would you care to expand on that at all, Mil? I'd be curious to know what the differences btw. academic and PP CCM are, and why you like one more than the other.

Because of reimbursement issues, groups don't like their docs doing CCM because you just don't generate the same amount of revenue as you would in the OR...unless you have a very busy CCM service.

 

[proman]

But isn't it a great way for a group to cement a relationship with hospital admin? A much needed service integral to hospital function provided by a group that shouldn't be easily replaced. My perspective comes from seeing a 30 year radiology practice booted recently. They ran a very respected residency (#3 board scores in the nation last year). Hospital obviously didn't care.

 

[militarymd]

true, if the hospital admin know enough to want it.

 

[UTSouthwestern]

On or off pump?
Baton Rouge was as fast as I have ever seen but I didn't do my training at Tex Heart as you know. we did 2 cases routinely b/4 noon and they were 3 or more vessels. 95% off pump unless we were replacing valves, obviously.
It was a nice day when you did 3 or 4 hearts and were home by 4pm. But thats all over for me these days. 😀

Fastest guy I've seen so far is Tea Acuff in Denton, Texas. Off pump, always late start at 9 am, two hearts, done by 1 pm. Dude has it down to a . . . T. Makes me happy to see him on my schedule because I know I'll be out in time to do something in the afternoon.