hearts

[Jeff05]

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what are the advantages of doing hearts?

the disadvantages?

can someone quickly discuss the reality of doing cv anes.

thank you very much.

 

[jetproppilot]

what are the advantages of doing hearts?

the disadvantages?

can someone quickly discuss the reality of doing cv anes.

thank you very much.

Big monetary advantage if you practice where alotta insurance-laden people come.

You'll make three-large for a case.

Do a cuppla hearts a day, and you're in seven figures.

Only one problem.

These sites are few and far between.

And the majority of hearts done in the US are 65 years old and older, which means you get medicare reimbursement.

About 800 bucks.

SO, the answer to your question is that unless your dad is a CV anesthesiologist at one of the coveted insurance sites in the nation, theres no monetary advantage to doing hearts.

Or a CV fellowship.

The reality of doing CV anesthesia in most practices is that the MDs equally distribute the heart room.....it is more work, obviously, than throwing an LMA into an ASA-1 knee scope.

Looks sexy as a med student/resident.....

great pickup line at The Clevelander on Miami Beach....

"Huh? For a living? Oh. I'm a CARDIAC ANESTHESIOLOGIST."

I'm sure Andy Weisenger, a dude I went to med school with, wouldda loved that line back in the days of our MS-1 lives in Miami. Dude was a great looking, gregarious chick hunter......funny that now he is actually a cardiac anesthesiolgist in South Carolina...albeit married....so this s hit means nothing to him now....but wouldda greatly benefitted him in 1988...

Not sexy as a private practice dude.

You either:

1) Absolutely love it, do a fellowship in it, and stay at a powerhouse academic place like Tinker, Levy, Barron et al

2)Don't really care, but do a CV fellowship cuz your dad is at one-of-about-five places in the US where you can make a mil-plus as a cardiac anesthesiologist, and your job is waiting for you

3)Tolerate the heart room when its your turn amongst your partners, which is where most of us are.

 

[The_Sensei]

Option 4: Realized that the allure of doing hearts disappears as you enter private practice and purposefully choose one of the approximately 90% of jobs where they don't do hearts.

 

[Noyac]

Option #5:
Take that jobs were you do 10 - 15 PE tube and T&A's a day. Wrap it up around noon to 2pm. No weekends or holidays. And make serious JACK.

 

[VentdependenT]

So youre saying I shouldn't do CV fellowship. I'm not ga-ga for hearts but my feeling is that after you do one of these you're a very solid practitioner...like a go to kinda guy. WHaddya think?

My other routes are pain or regional. I'm leaning towards the former however.

 

[Noyac]

So youre saying I shouldn't do CV fellowship. I'm not ga-ga for hearts but my feeling is that after you do one of these you're a very solid practitioner...like a go to kinda guy. WHaddya think?

My other routes are pain or regional. I'm leaning towards the former however.

The only fellowships I would consider are pain and CCM. The rest are a waste of time IMHO. Unless of course you trained were there were a ton of CV fellows and never got to do many hearts except on the rare occasion just for you CV month. These are my opinions only. But hearts are not hard, regional is easy, and trauma is fluids mostly. These don't warrant fellowships in my mind.

I would look for the perfect job at the end of my CA-3 year and if I didn't find it then I would consider a CCM fellowship. I have said it before, I learned much much more in my 1st year of private practice than in residency.

 

[Robert Loblaw]

Option #5:
Take that jobs were you do 10 - 15 PE tube and T&A's a day. Wrap it up around noon to 2pm. No weekends or holidays. And make serious JACK.

Dear Knowledgables,

I have to admit that my burgeoning career in cardiology was hijacked by a chance to do cardiac anesthesia, but I have cooled on it recently for a number of reasons...My question is this: is the lifestyle really that much different? Let say in a large practice with 3-5 cardiac guys, would you really be busting your balls? And let's make sure to make this a relative discussion, as in busting your balls relative to a dermatologist, a "regular" anesthesiologist, a cardiologist, or a cardiac surgeon. Remember, my future career hangs in the balance of your responses.

Sincerely,
Freshly Minted, M.D. (!!!)

 

[Noyac]

Dear Knowledgables,

I have to admit that my burgeoning career in cardiology was hijacked by a chance to do cardiac anesthesia, but I have cooled on it recently for a number of reasons...My question is this: is the lifestyle really that much different? Let say in a large practice with 3-5 cardiac guys, would you really be busting your balls? And let's make sure to make this a relative discussion, as in busting your balls relative to a dermatologist, a "regular" anesthesiologist, a cardiologist, or a cardiac surgeon. Remember, my future career hangs in the balance of your responses.

Sincerely,
Freshly Minted, M.D. (!!!)

I don't think doing hearts is really bustin your balls. Most days in the heart room were quite enjoyable. The cases were easy. The turnovers were maybe 2 or 3 in a day. You mostly managed drips and hemodynamics while shooting the **** with your buds. Regular anesthesiologists will be much busier putting out fires, pre-oping pts, putting in blocks, giving lunch breaks, chatting up the nurses, moving from location to location, the list goes on. Does that help?

 

[2ndyear]

Dear Knowledgables,

I have to admit that my burgeoning career in cardiology was hijacked by a chance to do cardiac anesthesia, but I have cooled on it recently for a number of reasons...My question is this: is the lifestyle really that much different? Let say in a large practice with 3-5 cardiac guys, would you really be busting your balls? And let's make sure to make this a relative discussion, as in busting your balls relative to a dermatologist, a "regular" anesthesiologist, a cardiologist, or a cardiac surgeon. Remember, my future career hangs in the balance of your responses.

Sincerely,
Freshly Minted, M.D. (!!!)

I'm still a resident, but I've seen several private practices. None had exclusive cardiac anesthesia. And some were pretty high volume places. Sure, some people had done cardiac fellowships. They might spend more time in the heart room, but not exclusively. They still took general and OB call. Non-fellowed people also rotated through the heart room. Now the complex valve cases, disaster cases, etc would go to the fellowed. I know there are some groups that have a separate cardiac call system. I guess my point is that, outside of academia, you're probably not going to do 100% hearts.

 

[urgewrx]

If you do a heart fellowship and join a community hosp where everyone rotates in the heart room, you are going to be kicking yourself for losing >200k that you could have made as an attending. These cases are usually easy. That's why everybody does them. Now, if you plan to join a academic or busy private center with dedicated fellowship trained anesthesiologists, your year lost in the fellowship will prepare you for this. You have to understand that in these places patients arrest a few times a week and a couple die every month. Can you deal with this stress over, and over, and over? Would you rather be running around pre-opping pts and putting out fires? Salary wise there is not much difference nowadays. In fact I have heard quite a few people say that cardiac anesthesia is not self sufficient anymore. Basically part of their salary in groups comes from what other general anesthesiologists are billing.
The time when cardiac people made a bundle more than general is long gone.

 

[The_Sensei]

One of my buddies wasted a year at the Cleveland Clinic (his words) doing a cardiac fellowship. He's been in practice 4 years doing locums (since it's more lucrative) and still looking for that "perfect job". Be careful when/if you decide to do a fellowship.

 

[BISof60]

Would doing a fellowship (i.e. cv, peds) make one a more valuable hire for a group and hence put one in better position to find that "perfect job?"

 

[johankriek]

Dear Knowledgables,

I have to admit that my burgeoning career in cardiology was hijacked by a chance to do cardiac anesthesia, but I have cooled on it recently for a number of reasons...My question is this: is the lifestyle really that much different? Let say in a large practice with 3-5 cardiac guys, would you really be busting your balls? And let's make sure to make this a relative discussion, as in busting your balls relative to a dermatologist, a "regular" anesthesiologist, a cardiologist, or a cardiac surgeon. Remember, my future career hangs in the balance of your responses.

Sincerely,
Freshly Minted, M.D. (!!!)

doing hearts is a tad bit harder than regular stuff,. plus more stress.. the cases are longer....... they usually start much earlier... there is less banter in the OR.. the patients are much much sicker.... and there is a possibility the patient will not come off pump... and multiple ionotropic support will be needed.. in which case the patient wont be an early extubation.. etc etc etc etc.. granted .when doing this stuff everysingle day i guess everything will come routine... really.. but its harder than just tossing an LMA in for a knee.. That being said, when a cardiac patient arrests.. a little less stress than when a 27 year old asa 2 patient arrests in the OR.

 

[jetproppilot]

Would doing a fellowship (i.e. cv, peds) make one a more valuable hire for a group and hence put one in better position to find that "perfect job?"

usually not.

I posted a year or so ago on this.

Would be cool if someone could post a link to that long post I posted.

 

[militarymd]

doing hearts is a tad bit harder than regular stuff,. plus more stress.. the cases are longer....... they usually start much earlier... there is less banter in the OR.. the patients are much much sicker.... and there is a possibility the patient will not come off pump... and multiple ionotropic support will be needed.. in which case the patient wont be an early extubation.. etc etc etc etc.. granted .when doing this stuff everysingle day i guess everything will come routine... really.. but its harder than just tossing an LMA in for a knee.. That being said, when a cardiac patient arrests.. a little less stress than when a 27 year old asa 2 patient arrests in the OR.

How many of those have you had?

 

[militarymd]

Would doing a fellowship (i.e. cv, peds) make one a more valuable hire for a group and hence put one in better position to find that "perfect job?"

After that kind of training, you will be locked into a VERY small market...while the rest of the market doesn't really care about that narrow range of training.

 

[WalterSobchak]

I can speak as to job opportunities after a CV fellowship. When I was in my residency, I contacted numerous groups, and basically was told, "If you are ever in the area, gives us a call and we'll talk" (Basically if you pay your way here, I'll talk to you). After being in the fellowship, I have had many of those same groups contact me, and offer to pay for my interview expenses. I went on 8 interview trips this year, and I paid for the airfare one time. Everything else was covered. This is distinctly different from my job search as a senior resident. I got interest from groups which would not have even considered me before. I was even told this at several interviews. In terms of compensation, about 50% of the times I was offered more than a comparable non-fellowship trained person, and 50% of the time I was offered the same (typically these are groups not really hurting for good people - I wouldn't have even gotten in the door without the fellowship). So I would say that it was helpful for the search for my job.

The other huge advantage was the echo experience. Now that I have seen some of the weirdest stuff I can imagine, typical stuff is extremely easy. The volume of echo you do in fellowship is immense, and that is one of the major reasons I did it.

As for what I am doing, I will be doing about 40% cardiac, and 60% general in my job. I like doing cardiac, but I also like practicing the art of anesthesia too (sedation, blocks, etc). This is what works for me.

That's my $0.02

 

[toughlife]

So how would having a CCM fellowship make you more competitive?

 

[Noyac]

I can speak as to job opportunities after a CV fellowship. When I was in my residency, I contacted numerous groups, and basically was told, "If you are ever in the area, gives us a call and we'll talk" (Basically if you pay your way here, I'll talk to you). After being in the fellowship, I have had many of those same groups contact me, and offer to pay for my interview expenses. I went on 8 interview trips this year, and I paid for the airfare one time. Everything else was covered. This is distinctly different from my job search as a senior resident. I got interest from groups which would not have even considered me before. I was even told this at several interviews. In terms of compensation, about 50% of the times I was offered more than a comparable non-fellowship trained person, and 50% of the time I was offered the same (typically these are groups not really hurting for good people - I wouldn't have even gotten in the door without the fellowship). So I would say that it was helpful for the search for my job.

The other huge advantage was the echo experience. Now that I have seen some of the weirdest stuff I can imagine, typical stuff is extremely easy. The volume of echo you do in fellowship is immense, and that is one of the major reasons I did it.

As for what I am doing, I will be doing about 40% cardiac, and 60% general in my job. I like doing cardiac, but I also like practicing the art of anesthesia too (sedation, blocks, etc). This is what works for me.

That's my $0.02

Great post.

I wonder what would those interviews and offers be if you had done a CCM fellowship? Sounds like things worked out well for you. And it sounds like you did what I recommended, the perfect job was not available therefore you did a fellowship and now you are in a god position.👍

 

[johankriek]

How many of those have you had?

umm im assuming when bad complications happen its more forgiving then when its in a cardiac patient vs asa 2 patients. Tha being said one of my colleagues had a asa2 patient arrest in the pacu while he was on the 10 freeway. I happened to be in the hospital hitting on one of the nurses upstairs when they called me. I had to come down and manage and get this totally healthy guy out of cardiac arrest.. it was clearly a hypoxic arrest.... from neg pressure pulm edema. I went to talk to the guy the next day. Total dirt bag. but hey even he deserves the best..

 

[urgewrx]

That being said, when a cardiac patient arrests.. a little less stress than when a 27 year old asa 2 patient arrests in the OR.

That's because you know you'll be torn another hole later on. Not because of the situation.

27 y/o asa 2 pt arrests> family will probably assume its related to malpractice.

82 y/o asa 4 pt arrests> family probably will assume the disease killed him/her.

Everything is about managing expectations