most marketable fellowship

Started by GasDaddy
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GasDaddy

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I keep hearing conflicting information about what is the most marketable fellowship. A lot of the job postings that I've seen are looking for cardiac trained anesthesiologists. Not as many job postings looking for pedi trained. It's a little strange because everyone I talk to in practice says that having a pedi fellowship makes you much more marketable and that this trend will continue. Anyone want to chime in ?
 
after several interviews (pain/anes) people still like pain.
peds is very useful - but, most places only do bread and butter peds - so you'll have to do a bunch of adult stuff, as well.

i think being confident in doing any case: bb peds, thoracic, neuro, regional, ent, etc - is the most important in getting a generalist position. so, if you still get nervous putting in DLTs/blockers, do another month of thoracic.


i think that in PP you can do very well, still, without a fellowship, however it may help getting your foot in the door in more desirable areas.
 
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I was thinking of a peds fellowship, but was told that that would pigeon-hole me into working for a big academic center pediatric hospital. If I were to apply to a normal group practice at a normal sized hospital, they may look at the peds fellowship and think that I'm not very proficient with adults and that they don't have enough peds cases to keep me busy.
 
my issues with pain: 1) fluoro 2) annoying patients 3) have to be business saavy to an extent if u wanna make the big money in this market. that being said there are also a ton of pluses with pain: 1) can have your own office 2) can do stuff outside the OR 3) better lifestyle 4) can potentially make a crapload of money if you can set up your own office and do all that business stuff..... all of which will and can compromise your lifestyle.


cardiac pluses: 1) TEE skills (which is only truly useful in the cardiac room, i dont care what anyone says haha) 2) be the "strong" cardiac guy who can handle the toughest and sickest patients 3) a lot of places are hiring cardiac guys because the senior partners DONT WANT TO DO THE CASES anymore; so its in demand to a large extent. Negatives 1) lifestyle can potentially really suck, especially at a place with high load of cardiac cases 2) cardiac surgeons are prima donnas; youll be stuck in the box with them all day. 3) it can be stressful

pedi pluses 1) be the "pedi guy/gal" and not the "cardiac guy/gal" and still have a better lifestyle than the cardiac guy 2) makes you marketable
negatives: 1) potentially annoying parents 2) sick kids = stressful 3) inhalation induction = inhaling 50% of the gas yourself!

icu pluses 1) u get another board out of it 2) can potentially be a TEE testamur 3) makes you a stronger physician, and what an anesthesiologist was intended to be (that is how it works in europe) 4) can do stuff outside the OR 5) On paper you are more marketable. negatives 1) the ICU can suck, especially with crappy nurses and super sick patients (and that is a big one) 2) cannot do ICU full time; defeats the whole purpose of doing gas. 3) you're not necessarily brining more money to the table for the group; guess that depends on the set up 4) and depending on the way the culture in that hospital/icu is, you may be in an open ICU where u are merely there for the ride while the surgeon runs the show; surgeons will want their input on THEIR patient regardless
 
Impromptu said:
I was thinking of a peds fellowship, but was told that that would pigeon-hole me into working for a big academic center pediatric hospital. If I were to apply to a normal group practice at a normal sized hospital, they may look at the peds fellowship and think that I'm not very proficient with adults and that they don't have enough peds cases to keep me busy.
Click to expand...


hahaha, are you serious? who told you this? sorry, i completly disagree. at your avg community hospital, you will probably take more of the pedi load, but you will still be doing your bread and butter gas stuff. only way to be pure cardiac or pure pedi is to go to an academic center that has a heavy volume of your specialty cases. that being said, every place is different.
 
sat through a panel today at the asa about future needs , about the shortage, etc.

1) generalist
2) peds
3) cards
4) ccm

that's what the speaker listed.....

I disagree, but oh well...
 
militarymd said:
sat through a panel today at the asa about future needs , about the shortage, etc.

1) generalist
2) peds
3) cards
4) ccm

that's what the speaker listed.....

I disagree, but oh well...
Click to expand...


interesting. guess there is still a major need for providers, period. nonetheless, pedi, cardiac and icu guys will pick up that load too.
 
panetrain said:
Pain >>>>> Cardiac (with TEE cert.) >>> Peds (with Peds hearts) >> ICU > regional = OB = Neuro = everything else. 👍
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pedi hearts is completely useless unless youre the "pedi hearts guy" at a children's hospital.

i think a strong regional guy is key too; a lot of the pain guys are really good at their regional.
 
a lot more people are cramming into fellowships it seems, but on the same token, the job market isn't particularly dead either..... from what I hear and see, groups are still hiring a lot of generalists right out of training. your first year as an attending is almost like a fellowship too, just based on seeing buddies fresh in the market
 
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ive read some of milMD's posts in the past where he talked about basically incorporating a pure icu year into the residency. when i was on the interview trail few years back, there was a lot of talk about this going to happen. i think it fell through because not every program could facilitate that, additionally i think there was some general resistance as well... remember, anesthesiologists outside of the U.S. essentially run ALL icu's. so i think the compromise in the past couple years was to incorporate more pain months, 2 more icu months, a pacu rotation, pre anesthesia clinic month. THIS is why anesthesia residencies have been expanding....there is a shortage of OR staffing, as people are being pulled to do non OR based rotations.

what would be cool is to make it a 5 year residency and allow graduates to choose to be double boarded in icu and or anesthesiology.

radiology, as it stands now, is 5 year residency (1+4) and their last year is now their "fellowship" year where they specialize in what they want to do....they still have fellowships after that, but that last year is to place emphasis on what they want to focus on.

if you make anesthesiology a 5 year residency, you can include more icu training, but also more opportunities to do cardiac, pedi etc. so u can be double boarded in icu, anesthesiology and have more experience doing the complex cases if you desire. the problem is that not every program can be able to simply offer that level of training... that is the REAL problem. i think it's really doable, considering we only do 4 months now of ICU; add on an addition 7-8 months of ICU (MICU, sicu, ccu, picu, nicu? etc... ) and the remainining 4-5 months you can do additional months of pure cardiac or pure pedi or whatever. you can actually save time if you think about it. this would require relationships between residency programs to allow intertraining of residents, as some programs may have stronger ICU training vs pedi training etc. Ultimately, economic and market factors will drive change in the future.
 
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For long-term protection, ICU or Pain. They are the only subspecialties that allow you to bill like every other doctor instead of the unique system that operative anesthesiology uses. In the past we have been able to take advantage of our unique billing methodology. We may not be so lucky in the future.

In the short term, it all depends on the practices you want to work with.

Of course the best reason to do a fellowship is still that is is a lot of fun!

- pod
 
Coastie said:
Your thoughts are half the training slots with 5 year residency for all, correct? Please elaborate.
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yes....right now...we (anesthesia) are the bitches of the hospital...we are there to wait, hand and foot, on the surgeons...while at the same time....90% + of the surgerys that are being done are not NECESSARY....ie they can wait their turn.......and in the coming years of rationing....

I say that we want to be difficult to find specialists ....where hospitals value us...because there are so few of us....and ARE willing to subsidize our presence.

We (and crnas) are putting ourselves out of business by training TOO many of us....with many who are poorly trained.
 
militarymd said:
yes....right now...we (anesthesia) are the bitches of the hospital...we are there to wait, hand and foot, on the surgeons...while at the same time....90% + of the surgerys that are being done are not NECESSARY....ie they can wait their turn.......and in the coming years of rationing....

I say that we want to be difficult to find specialists ....where hospitals value us...because there are so few of us....and ARE willing to subsidize our presence.

We (and crnas) are putting ourselves out of business by training TOO many of us....with many who are poorly trained.
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Very well said. I completely agree.
 
militarymd said:
yes....right now...we (anesthesia) are the bitches of the hospital...we are there to wait, hand and foot, on the surgeons...while at the same time....90% + of the surgerys that are being done are not NECESSARY....ie they can wait their turn.......and in the coming years of rationing....

I say that we want to be difficult to find specialists ....where hospitals value us...because there are so few of us....and ARE willing to subsidize our presence.

We (and crnas) are putting ourselves out of business by training TOO many of us....with many who are poorly trained.
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Mil, what do you consider poorly trained?
 
If we want to cut our numbers, and I get the sense that many agree....then how else do you do it....cut the upper 80%?

This is one of those things where there is ....no way of being nice about it......

"look to your left, look to your right, and the end of all this only one of you will be here"...

where did that come from?
 
Discouraging students from entering the field won't do you any good. In fact it will be counterproductive, b/c you'll get a less qualified pool for the same # of slots. But the slots will still fill.

You have to work at the policy level to cut back the # of slots. But this is at odds with the Rand data you presented. So what do you do?
 
militarymd said:
If we want to cut our numbers, and I get the sense that many agree....then how else do you do it....cut the upper 80%?

This is one of those things where there is ....no way of being nice about it......

"look to your left, look to your right, and the end of all this only one of you will be here"...

where did that come from?[/QUOTE]


Alec Baldwin in Pearl Harbor?
Click to expand...
 
Prof Moriarty said:
Discouraging students from entering the field won't do you any good. In fact it will be counterproductive, b/c you'll get a less qualified pool for the same # of slots. But the slots will still fill.

You have to work at the policy level to cut back the # of slots. But this is at odds with the Rand data you presented. So what do you do?
Click to expand...

This is exactly right. I don't think the militarymd approach of talking down the specialty to med students is helpful. At worst, we'll find ourselves in the midst of a 1990s rerun when programs didn't fill or filled with FMGs. Back then the CRNAs were mostly right when they smirked and said only the dregs of medicine chose anesthesiology.

Our specialty suffered >50% written board failure rates in that era, but those people still practiced ... and most are practicing today. Any time I see a crappy anesthesiologist who's about 10 years older than me making the specialty look bad, I think of what happened in the 90s and how to avoid repeating history.

Cut slots? OK, but that won't happen. Let's be realistic.

Raise the standards for board certification? I guess you could arbitrarily double the number of people who fail the written, but they'll still practice. So long as board certification isn't necessary to get paid, there's no leverage there.

Chase off med students with stories of doom and gloom? You're cutting off your nose to spite your face. The qualified and talented ones will find another competitive specialty and get on with their lives. The worst will be glad it's the 1990s all over again because they'll be able to get a spot.
 
First of all, MS4 here so I am not at all experienced or in touch with the reality but here is what I think...

I am not sure how talking med students out of this specialty is going to help. On the other hand, I feel that if we want to attract the more competitive candidates, then we need to sell this specialty. I mean - really sell the specialty to those who are not only showing interests but also those who you think might add to the specialty. Show them how great this specialty is. Tell them what you are doing behind the drapes. Teach them and be enthusiastic. Actively recruit those who you think are a good fit and who have the potential to be a great anesthesiologist.

I don't know how you guys decided to choose anesthesia but I personally, for sure, would not have chosen this field (or have known anything about this field, for that matter) if I didn't meet the anesthesia resident / attending who I worked with...by the same token, there are specialties that I still like but end up not going into because I wasn't "properly introduced."

Just 2cents.
 
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Having met MMD in NO last week, I take the comments more as a kind of "truth in jest" b/c reality is he and the other guys went out of their way to be supportive and encouraging.

If it's politically unrealistic to cut back on residency slots, would it make sense to push for a moratorium on new spots? And presupposing this would help the situation, how feasible is it?
 
Prof Moriarty said:
Having met MMD in NO last week, I take the comments more as a kind of "truth in jest" b/c reality is he and the other guys went out of their way to be supportive and encouraging.

If it's politically unrealistic to cut back on residency slots, would it make sense to push for a moratorium on new spots? And presupposing this would help the situation, how feasible is it?
Click to expand...

number 1 - you are right.....it's hard to come across with just text...especially my personality.

number 2 - nothing is unrealistic....it's just that some things require more effort.
 
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One way curb people going into anesthesia is to continue to require more ICU time, perhaps that will push those who are looking only for a lifestyle into other specialties.

Also i fear that as we train more anesthesiologist the training cant be as good as the number of specialty case is unlikely to rise as fast.
 
GasDaddy said:
ive read some of milMD's posts in the past where he talked about basically incorporating a pure icu year into the residency. when i was on the interview trail few years back, there was a lot of talk about this going to happen. i think it fell through because not every program could facilitate that, additionally i think there was some general resistance as well... remember, anesthesiologists outside of the U.S. essentially run ALL icu's. so i think the compromise in the past couple years was to incorporate more pain months, 2 more icu months, a pacu rotation, pre anesthesia clinic month. THIS is why anesthesia residencies have been expanding....there is a shortage of OR staffing, as people are being pulled to do non OR based rotations.

what would be cool is to make it a 5 year residency and allow graduates to choose to be double boarded in icu and or anesthesiology.

radiology, as it stands now, is 5 year residency (1+4) and their last year is now their "fellowship" year where they specialize in what they want to do....they still have fellowships after that, but that last year is to place emphasis on what they want to focus on.

if you make anesthesiology a 5 year residency, you can include more icu training, but also more opportunities to do cardiac, pedi etc. so u can be double boarded in icu, anesthesiology and have more experience doing the complex cases if you desire. the problem is that not every program can be able to simply offer that level of training... that is the REAL problem. i think it's really doable, considering we only do 4 months now of ICU; add on an addition 7-8 months of ICU (MICU, sicu, ccu, picu, nicu? etc... ) and the remainining 4-5 months you can do additional months of pure cardiac or pure pedi or whatever. you can actually save time if you think about it. this would require relationships between residency programs to allow intertraining of residents, as some programs may have stronger ICU training vs pedi training etc. Ultimately, economic and market factors will drive change in the future.
Click to expand...

adding an extra year is the most ridiculous idea i have ever heard. If you cannot train a well rounded anesthesiologist in four years there is something majorly wrong. And most anesthesiologist dont want anything to do with ICU care.. thats why there are intenisvists around
 
I have seen enough. This boils down to supply vs demand. You guys want their to be a smaller supply so you can continue to make the same salaries even in an envirorment of health care reform. Its not about increasing the breath of knowledge for anesthesia residents. If I can recall anesthesia residency was 3 yrs in the 80's and you guys came out ok. Whos to say with stricter medical school standards and with the increase in competitiveness in anesthesia, I would argue that the residents now are better then then the one's a decade ago.
 
militarymd said:
If we want to cut our numbers, and I get the sense that many agree....then how else do you do it....cut the upper 80%?

This is one of those things where there is ....no way of being nice about it......

"look to your left, look to your right, and the end of all this only one of you will be here"...

where did that come from?
Click to expand...


Nancy Pelosi's speech to the democrats regarding the next election.
 
so it seems like most people on this board think cardiac is a more marketable fellowship than pedi? pedi vs cardiac, which do you guys think is more marketable in terms of breaking into a saturated market?
 
ProRealDoc said:
militarymd said:
If we want to cut our numbers, and I get the sense that many agree....then how else do you do it....cut the upper 80%?

This is one of those things where there is ....no way of being nice about it......

"look to your left, look to your right, and the end of all this only one of you will be here"...

where did that come from?[/QUOTE]


Alec Baldwin in Pearl Harbor?
Click to expand...

Come on guys!!! It's Gross Anatomy with Matthew Modine. Circa 1980-something.....LOL
Click to expand...
 
Bertelman said:
Hows about you just do the fellowship that interests you more.
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I agree with Bertelman. Another thing that you need to consider and what few people seem to talk about is what job setting you are more likely to work in when you finish your fellowship. Many of the current available jobs in pediatric anesthesia seem to be at stand alone children's hospitals. This means that they are likely to be 100% pediatric, in an urban setting, and somewhat academic. You have to be OK with that. While there are plenty of exceptions, my observation has been that most of the job growth and demand seem to be at children's hospitals. Perhaps this reflects a growing trend for generalists to avoid pediatric cases and pediatric specialists to avoid adult cases. With a cardiac fellowship it does seem that there are a lot more opportunities in private practice. Not sure if anyone has had a different experience.
 
Bertelman said:
Hows about you just do the fellowship that interests you more.
Click to expand...

My primary goal is to go back to southern cali, L.A. to be exact. So whatever is going to get me there. What I like about peds is that you kind of have a niche. With cardiac, you can handle the bigger cases with ease. Nurses at pedi hospitals are hot! TEE is cool!
 
GasDaddy said:
My primary goal is to go back to southern cali, L.A. to be exact. So whatever is going to get me there. What I like about peds is that you kind of have a niche. With cardiac, you can handle the bigger cases with ease. Nurses at pedi hospitals are hot! TEE is cool!
Click to expand...

I'm not sure you will be able to predict with any reliability which of those two fellowships is more likely to get you a job in a particular city, unless you have an inside source telling you in the year 201x, they will be hiring a ped/card new grad.

Thus, the question comes down to which you would be happier doing if you don't make it to L.A. as a fresh graduate. I would imagine that if L.A. means that much to you, you could always compromise something, be it type of practice or reimbursement, to land you there. If you're going to go the extra mile of the fellowship, you should choose something that will get you a job anywhere, and something that you actually enjoy.

People may have different opinions on whether a fellowship is beneficial, if it nets you more income in the long run, or which are more valuable. I think there is uniform agreement, however, that it is unwise to slog through a fellowship for the sole purpose of making yourself more marketable. When your group hires you as "the peds guy", they expect a certain level of competence and interest in the specialty.
 
GasDaddy said:
My primary goal is to go back to southern cali, L.A. to be exact. So whatever is going to get me there. What I like about peds is that you kind of have a niche. With cardiac, you can handle the bigger cases with ease. Nurses at pedi hospitals are hot! TEE is cool!
Click to expand...

From my admittedly limited experience with looking for a job in California, I think that cardiac/peds/pain fellowships are all helpful for finding a job in the relatively competitive job market because you can do both general cases and speciality cases(btw Northern California aka SF Bay Area seems to be a lot tighter than Southern California at the moment). Just a note, your income in California will probably be significantly less than in most other states but the income does depend on how hard you want to work (although for me coming from NYC I will get a comparable income with a lot lower cost of living=higher relative income). Just choose a fellowship you enjoy and then go all out in applying for a job in California. Good luck with your choice.
 
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