Is fellowship a MUST for Anesthesia in 2020?

[deleted171991]

A fellowship as opposed to no fellowship: look at the equivalent difference in internal medicine between hospitalists - generalists and specialists - cardiology, pulmo, GI: it's huge. Hospitalists jobs are being taken over by NPs and PAs as an equivalent to CRNAs.

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You're comparing apples and oranges. Anesthesiology is not internal medicine.

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[KENY1]

That's why I said 'equivalent' - meaning 'not the same'. An analogy can be useful as it brings up the issue in a different light. Anyway..I agree with u..you it's not the same there the difference is more..but still..what is the same is that the basic jobs are going to the people with lower education.
In internal medicine just as well as in anesthesia !
Act on it or not - that's up to u.
I have been following it for 30 years - so I have a good perspective - the change in IM and in surgery is massive - tons of PAs and NPs and it's big in anesthesia now as well. It's an exponential growth ! Ignoring that is a major error.

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[deleted171991]

That's why I said 'equivalent' - meaning 'not the same'. An analogy can be useful as it brings up the issue in a different light. Anyway..I agree with u..you it's not the same there the difference is more..but still..what is the same is that the basic jobs are going to the people with lower education.
In internal medicine just as well as in anesthesia !
Act on it or not - that's up to u.
I have been following it for 30 years - so I have a good perspective - the change in IM and in surgery is massive - tons of PAs and NPs and it's big in anesthesia now as well. It's an exponential growth ! Ignoring that is a major error.

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You just can't compare anesthesiology and internal medicine, for practical purposes. The depth and breadth of the latter doesn't come close to the former.

The amount of anesthesiology one needs to know to do 99% of the cases is much less than the "equivalent" amount for internal medicine.

The right solution would be doing a completely different residency that allows one to practice independently. Or investing that 300K into a good side business. A fellowship is rarely the solution, except for cardiac (and only until every ***** will have it).

 

[abolt18]

Maybe you posted it before and I missed it, but can I ask what region of the country you're in? And are you doing your cases solo or supervising?

Yeah it does have its benefits. Twice the pay, and twice the vacation as the big city job offer I had. Also I only work at 2 facilities versus the 12+ facilities they would have had us driving between. It’s a simpler life.

 

[vector2]

The amount of anesthesiology one needs to know to do 99% of the cases is much less than the "equivalent" amount for internal medicine.

To preface, let me say that I 100% would want an IM physician to care for myself or my family member. However, let's be real. If you look at at the top 5 admission ICD codes for the average IM ward, a mid-level could probably bumble through the care from admission to discharge using some algorithm from uptodate and 90% of the patients would do "OK." Obviously though, for some patients they're going to miss additional diagnoses that a board-certified IM physician would have caught, they are going to consult too much, they will probably not know the latest guidelines or pharmacotherapy recs from the various IM subspecialty societies, and they'll likely miss some of the subtle signs that should tell them when care needs to be escalated. But let's not pretend that every IM admission requires a House MD clone who spends 20 hrs a day with his nose buried in Harrison's.

 

[zyovka]

I agree with this sentiment, but many, if not most, ICU experience for ca 1-3 is basically doing intern work. Doing more “intern level work” in icu wont prepare anesthesiologists to be able to cover ccm.

icu experience for anesthesiology residents should change to mirror IM residents’ experience. You do intern level work as intern, and you take on senior role as senior, overseeing all of the patients, and making appropriate decisions. Only very few anesthesiology residency give this icu experience to residents.

Completely agree with this statement. In our institution, SICU became completely taken over by Trauma/CC certified surgeons, who absolutely hate antesthesia, stripped us from doing Senior positiones ( who needs that sh...t anyway, when you're being abused by surgeon-peacocks most of the time), CCM/anesthesiologists leaving due to the oppressive/toxic environment. I think we ( as a founders of CCM) lost the game in this country in general.

 

[chocomorsel]

The alternative to fellowship is BFE. I was sick of residency and decided to be a generalist. By the end, residency call was like a sweat shop, with lots of autonomy, so I felt ready to move on. Many of the good private practice jobs are in the overlooked locations that most millennials would never want to live (I am a millennial). But, if you are willing to spread a wider net than just the larger cities you can find jobs where you do good work, get paid well(higher than most numbers I see on here), and have plenty of time off (15 weeks for me this year). I also made partner last year, while many of my residency colleagues were in groups in large cities that sold out while they were still on the partnership track. We have a collegial/respectful relationship with our surgeons and I have never felt disrespect from them. This is much different than the academic hospital I trained at. But, the hard part is living in BFE, and finding a fair group to work with. Many are not willing (and I get it, it can be a little boring in BFE). Hopefully I’ll get out after we save >50% of our income for a few more years.

Are you doing solo cases or supervising/medically directing nurses?

 

[chocomorsel]

Completely agree with this statement. In our institution, SICU became completely taken over by Trauma/CC certified surgeons, who absolutely hate antesthesia, stripped us from doing Senior positiones ( who needs that sh...t anyway, when you're being abused by surgeon-peacocks most of the time), CCM/anesthesiologists leaving due to the oppressive/toxic environment. I think we ( as a founders of CCM) lost the game in this country in general.

This sounds an awful lot like my residency program. Toxic.

 

[victor le cube]

Are you doing solo cases or supervising/medically directing nurses?

I would say 70% supervision and 30% doing my own cases. I would love to just do my own cases, but also don’t miss being stuck in the OR for hours on end.

 

[victor le cube]

Maybe you posted it before and I missed it, but can I ask what region of the country you're in? And are you doing your cases solo or supervising?

When I walked in this morning and saw that the flag was half-mast, I thought ‘All right, another bureaucrat ate it!'

Southwest

 

[chocomorsel]

I would say 70% supervision and 30% doing my own cases. I would love to just do my own cases, but also don’t miss being stuck in the OR for hours on end.

How many nurses do you supervise at a time?

 

[KENY1]

Here:

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[Status Sciaticus]

A fellowship as opposed to no fellowship: look at the equivalent difference in internal medicine between hospitalists - generalists and specialists - cardiology, pulmo, GI: it's huge. Hospitalists jobs are being taken over by NPs and PAs as an equivalent to CRNAs.

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The difference is that IM fellowships are 3 years whereas anesthesiology fellowships are 1 year. That means an additional 2 years of lost income which can be close to $500,000 POST TAX, thus not an accurate comparison at best.

If youre comparing proceduralist specialties, then you can compare GI/Cards to pain, and you can see that pain will make as much, if not more than IM specialties.

Doing a fellowship on the off chance that it may protect you from encroachment seems like an endeavor doomed to failure, unless it is providing you with an entirely different avenue, such as pain, and to a lesser extent, cardiac.

 

[26B]

I may be a bit late to this thread, but wanted to chime in from the perspective of a resident currently in the middle of the job search process.

While originally set on cardiac, I ultimately decided not to pursue fellowship training. So far, I have not had any issues with the job search process. With 1 exception, every single place (PP and academic) which I have cold-emailed with my CV and a brief message has responded positively, and I have gotten a number of interviews and several contract offers from both academic places and PP shops. Perhaps coming from a big-name residency helps to some degree, but overall I don't feel that the lack of fellowship training has hindered me in the job search so far.

Just my 2 cents.

 

[Drwine]

Whatever fellowship you choose retain the willingness and ability to do everything you are allowed to do. I did a cardiac fellowship over 30 years ago and have done everything at some point in my career to get the work done. Even nearing retirement I only don't do chronic pain, critical care and major peds cased. I only just stopped signing up for OB call. I would urge anyone doing a cardiac, critical care, pain or peds fellowship to keep your hand in other cases enough to be proficient.

 

[ChasingMavericks]

I may be a bit late to this thread, but wanted to chime in from the perspective of a resident currently in the middle of the job search process.

While originally set on cardiac, I ultimately decided not to pursue fellowship training. So far, I have not had any issues with the job search process. With 1 exception, every single place (PP and academic) which I have cold-emailed with my CV and a brief message has responded positively, and I have gotten a number of interviews and several contract offers from both academic places and PP shops. Perhaps coming from a big-name residency helps to some degree, but overall I don't feel that the lack of fellowship training has hindered me in the job search so far.

Just my 2 cents.

Very insightful response thank you