OB Anesthesia Fellowship - A Bit Silly?

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MD Dreams

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So it looks like OB anesthesia fellowship is now becoming ACGME accredited. Just curious what your thoughts are on this. Are we getting a bit carried away with the fellowship trend? Wouldn't an accredited residency position teach all there is to know about OB anesthesia?
 
i dont think its intended for one to obtain the fellowship and then go out into the private practice world as a hotshot OB anesthesiologist. But if one wants to teach residents in a university setting it likely looks good on the CV.
 
Its a double edged sword. The biggest advantage is being able to set standards for the fellows. Standardize case numbers, experiences, etc. Without ACGME accreditation any program can create their OB fellowship, and they could use and abuse the fellows as cheap staff with offering much OB anesthesia training. That was originally some of the rationale for establishing peds anesthesia ACGME programs. I really don't see the "slippery slope," if one considers peds anesthesia board certification that, developing for OB anesthesia.

Of course, I think being non-acgme accredited has some advantages. That year as a non-accredited fellow one can function as a staff. Take call solo, do your own cases. As long as this isn't exploited for labor, I think it offers a great learning experience. Our neuro anesthesia fellows worked like this. One day they could your staff on a complex neurovascular case, the hot shot staff were around if they had questions, but as the fellow they were staff. Next day they could the main OR staff on call. They had research time built in. And of course they made more than the ACGME fellows.
 
MD Dreams said:
So it looks like OB anesthesia fellowship is now becoming ACGME accredited. Just curious what your thoughts are on this. Are we getting a bit carried away with the fellowship trend? Wouldn't an accredited residency position teach all there is to know about OB anesthesia?
Click to expand...
we are getting a bit carried away.

people wanna distinguish themselves from crnas so they feel doing a fellowship is absolutely necessary to do that. A four year anesthesia residency produces.. Just another glorified CRNA. stupid really... but alas retirement soon.
 
Doing a fellowship is great if you are really interested in a particular area or want to do research or need it for a specific location, but it seems an idea has creeped in (from MDs) that 1 extra year of fellowship separates an anesthesiologists from a CRNA. Going to medical school and finishing anesthesia residency separates me from a CRNA. Fellowship separates MD from MD.
 
Yes it is foolish... what will they think of next ambulatory fellowships? Preop clinic fellowships.... Oh wait. Those already exist?

Hmmm, maybe we need ENT and Gyne anesthesia fellowships too.

- pod
 
periopdoc said:
Yes it is foolish... what will they think of next ambulatory fellowships? Preop clinic fellowships.... Oh wait. Those already exist?

Hmmm, maybe we need ENT and Gyne anesthesia fellowships too.
Click to expand...

Don't give the AANA any ideas, pretty soon we'll have our friends getting 'urologic anesthesia fellowship' certificates after a grueling 12 months of M-F 7-3 no-weekend no-call days in the cysto room.


When I was a resident I rotated through a hospital that had OB fellows. It seemed there two kinds of people - US residency grads who wanted academic positions and liked OB, and foreign residency grads (from reputable western European joints) who wanted to move to the US and needed the in-training time to get licensed/certified here. I don't recall the details, but one of the German guys was doing his 2nd non-ACGME fellowship year ... he was good.

I briefly considered doing an OB anesthesia fellowship (and at the time there was actually Navy funding and a perceived need for it, so I almost certainly could have done so in the 09-10 academic year) but after rotating there, I couldn't justify doing it for a year.
 
MD Dreams said:
So it looks like OB anesthesia fellowship is now becoming ACGME accredited. Just curious what your thoughts are on this. Are we getting a bit carried away with the fellowship trend? Wouldn't an accredited residency position teach all there is to know about OB anesthesia?
Click to expand...



Yes.
It is silly.
 
Ambulatory fellowships are already out there and i know two people doing them. I really think this is a huge waste. Its not hard, propofol, lma, extubate repeat.
 
Yangkower said:
Doing a fellowship is great if you are really interested in a particular area or want to do research or need it for a specific location, but it seems an idea has creeped in (from MDs) that 1 extra year of fellowship separates an anesthesiologists from a CRNA. Going to medical school and finishing anesthesia residency separates me from a CRNA. Fellowship separates MD from MD.
Click to expand...


Then why does Medicare pay the CRNA the exact same fee as you Dr. "MD"?
Why can a CRNA do the exact same procedures as you in most rural hospitals?

If a CRNA can legally do the same procedures as you and gets paid the same fee from the government then what exactly does separate a CRNA from you?

Those with EXTRA Certification beyond the CRNA's scope of practice are indeed better off.
 
pain, peds, and critical care are the only fellowships that make any sense in a career move outside of academia. Everything else you should of had vast exposure in residency, if not, you went to a bad residency.
 
somedumbDO said:
pain, peds, and critical care are the only fellowships that make any sense in a career move outside of academia. Everything else you should of had vast exposure in residency, if not, you went to a bad residency.
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I'd add cardiac to your list. Similar to peds. Coming out of a "good residency" you could practice peds or hearts, but to be competitive or jump into a higher acuity practice in either fellowship is key.

Agree on CCM and pain, life outside of the OR. You could put palliative care on that list too 🙂
 
I think you could also add a "dental anesthesia fellowship" for the non-DDS/DMD anesthesiologists if they were interested in perusing that type of practice.


MTGas2B said:
I'd add cardiac to your list. Similar to peds. Coming out of a "good residency" you could practice peds or hearts, but to be competitive or jump into a higher acuity practice in either fellowship is key.

Agree on CCM and pain, life outside of the OR. You could put palliative care on that list too 🙂
Click to expand...
 
MTGas2B said:
I'd add cardiac to your list. Similar to peds. Coming out of a "good residency" you could practice peds or hearts, but to be competitive or jump into a higher acuity practice in either fellowship is key.

Agree on CCM and pain, life outside of the OR. You could put palliative care on that list too 🙂
Click to expand...

Agree. Peds, Cardiac, Pain and Critical Care are all excellent fellowships. I like advanced Regional but you can learn 95 percent of that on the job. Ob? Waste of time for PP
 
MTGas2B said:
I'd add cardiac to your list. Similar to peds. Coming out of a "good residency" you could practice peds or hearts, but to be competitive or jump into a higher acuity practice in either fellowship is key.

Agree on CCM and pain, life outside of the OR. You could put palliative care on that list too 🙂
Click to expand...

I agree with palliative care, but there are no residencies where you do enough neonates, neonatal emergencies or peds hearts to be comfortable to do them in PP. But there you should be able to do adult hearts in PP.
 
I'm in pp and I do adult hearts without a fellowship (thus far). Most of our hearts are healthy compared to the ones seen in tertiary centers so I'm pretty comfortable doing them. I'm also comfortable doing a basic tee exam. However, I believe a cards fellowship is important for 2 reasons: first if your going to do sick hearts. You need to be comfortable with these Pts and that comes from lots of exposure. Not all residencies have such degree of exposure. Second if you want to be a true consultant, you'll need to know the ins and outs of tee, not just the basics. I'm not content with the basics, I want to make the intraop decisions (along with surgeon) and know as much as cards about tee and the heart. I believe this too requires a fellowship and this is the direction that anesthesia is heading and hence acgme accreditation and the high demand for cards fellowship folks.
 
what's the reason for pedi hearts fellowship?

is there TEE involvement for this as well? is it best to do a fellowship at a program where they don't have a pedi hearts fellowship and hence no pedi hearts fellows to steal the complex cases?

thanks
 
somedumbDO said:
I agree with palliative care, but there are no residencies where you do enough neonates, neonatal emergencies or peds hearts to be comfortable to do them in PP. But there you should be able to do adult hearts in PP.
Click to expand...

Actually the program at WVU sees enough peds hearts cases on a regular basis that you could get comfortable doing them, especially if you actively requested to be in that OR frequently. There was a resident who finished there within the past 10 years who basically did that, and he was doing ped hearts in PP last time I heard of him.
 
Pedi hearts is included in a peds fellowship. Usually cardiology does the tee for pedi hearts and the pedi ologists manage the case.
 
i'm waiting for an anesthesia fellowship for cataract surgeries.
 
Trisomy13 said:
Actually the program at WVU sees enough peds hearts cases on a regular basis that you could get comfortable doing them, especially if you actively requested to be in that OR frequently. There was a resident who finished there within the past 10 years who basically did that, and he was doing ped hearts in PP last time I heard of him.
Click to expand...

You need a good 6 months of pedi hearts to do norwoods, arterial switches, and glens. TOF repairs, AV canal repairs, VSD/ASD are not as technical but I wouldnt want a NON fellowship new grad doing them on my child. He must of had on the job training for a while before doing this....

AND

There are pedi heart fellowships.. Texas childrens, Oschner, ACH are some that come to mind..
 
somedumbDO said:
You need a good 6 months of pedi hearts to do norwoods, arterial switches, and glens. TOF repairs, AV canal repairs, VSD/ASD are not as technical but I wouldnt want a NON fellowship new grad doing them on my child. He must of had on the job training for a while before doing this....

AND

There are pedi heart fellowships.. Texas childrens, Oschner, ACH are some that come to mind..
Click to expand...

I agree with you, and I stand by my statement. At least when I was there a few years ago, there were plenty of arterial switches and glens, BT shunt, hypoplastic ventricles, etc. to get good experience over the course of a residency if someone has the inclination to volunteer themselves for the peds heart room often enough.

Not that I ever wanted to be that person...
 
Trisomy13 said:
I agree with you, and I stand by my statement. At least when I was there a few years ago, there were plenty of arterial switches and glens, BT shunt, hypoplastic ventricles, etc. to get good experience over the course of a residency if someone has the inclination to volunteer themselves for the peds heart room often enough.

Not that I ever wanted to be that person...
Click to expand...

🙄

Being proficient in pedi hearts based on residency alone nowadays?

Sounds like your training was "second to none".
 
Coastie said:
🙄

Being proficient in pedi hearts based on residency alone nowadays?

Sounds like your training was "second to none".
Click to expand...

No, my training was probably average, maybe a little above average considering the volume of cases and "independence" allowed. You certainly won't find WVU listed anywhere near the "top ten" anesthesiology residency programs. :laugh:

However, if you're a peds heart gunner, there is opportunity to be had there.
 
I think it would be extremely difficult for you to find a job doing Peds hearts without at least a peds fellowship. The big centers usually want at least 6 months of peds cardiac. I'm certain that I could do "healthy" hearts after my fellowship, but the complex repairs that are at the heart 😉 of peds cardiac really require significant experience. Now I wouldn't touch them with a barge pole.😀

Cheers!
 
IlDestriero said:
I think it would be extremely difficult for you to find a job doing Peds hearts without at least a peds fellowship. The big centers usually want at least 6 months of peds cardiac. I'm certain that I could do "healthy" hearts after my fellowship, but the complex repairs that are at the heart 😉 of peds cardiac really require significant experience. Now I wouldn't touch them with a barge pole.😀

Cheers!
Click to expand...

Why do you end every post with 'Cheers!'? It's odd.
 
If truth does exist - as temporal beings in a finite universe, shielded by ignorance, none of us will ever discover or discern it. Therefore, from our perspective it does not exist and cannot be attacked or derided.


IlDestriero said:
better? That's my usual one.

"The truth is incontrovertible, malice may attack it, ignorance may deride it, but in the end; there it is."
Click to expand...
 
IlDestriero said:
It's the signature when I post on my iPhone. It was a carry over from a whisky forum.
How about
Fµç# off? 😀
Click to expand...
That's a better answer than I'm Madonna and like pretending to be British.

**** off would be good for posts responding to me but probably not many other posts.
 
Doctor4Life1769 said:
what's the reason for pedi hearts fellowship?

is there TEE involvement for this as well? is it best to do a fellowship at a program where they don't have a pedi hearts fellowship and hence no pedi hearts fellows to steal the complex cases?

thanks
Click to expand...

cause you're smokin a crack pipe if you try to do a child for a congenital cardiac case unmentored without very significant numbers under your belt

we did tons in residency and a lot more in my peds fellowship--but I wouldn't dream of taking care of one of those kids--outside of an emergency--without significantly more supervised, mentored training. In my opinion, very irresponsible.
 
my fellow pedi peeps who've replied have it right. Noone wants you doing pedi hearts just cause you did a bunch during residency. Peds fellowship gives you much more experience with them, but in order to be a pediatric cardiac anesthesiologist comfortable doing any pedi heart case, you MUST do some advanced training-- there are debates as to how much, how long-- at our institution we are doing 6 months minimum of mentored training with an experienced pedi cardiac anesthesiologist. Helpful to do fellowship wherever you think you're going to end up working so that you learn the ways and whims of the pedi cardiac surgeon(s) in a mentored environment before you're on your own. If you're not staying on as an attending at that hospital, you'll most likely have another "mentored" phase (a week-month) before you're sent off on your own. As of now, our pedi cardiac "fellows" are paid as attendings because they still work in the general peds OR and take peds OR call. So it's a pretty good gig.
 
michigangirl said:
my fellow pedi peeps who've replied have it right. Noone wants you doing pedi hearts just cause you did a bunch during residency. Peds fellowship gives you much more experience with them, but in order to be a pediatric cardiac anesthesiologist comfortable doing any pedi heart case, you MUST do some advanced training-- there are debates as to how much, how long-- at our institution we are doing 6 months minimum of mentored training with an experienced pedi cardiac anesthesiologist. Helpful to do fellowship wherever you think you're going to end up working so that you learn the ways and whims of the pedi cardiac surgeon(s) in a mentored environment before you're on your own. If you're not staying on as an attending at that hospital, you'll most likely have another "mentored" phase (a week-month) before you're sent off on your own. As of now, our pedi cardiac "fellows" are paid as attendings because they still work in the general peds OR and take peds OR call. So it's a pretty good gig.
Click to expand...

That is exactly how my old program works. Some of the pedi fellows stay on staff, get some additional mentoring in pedi cardiac anesthesia after they finish fellowship and then the leash is cut. Pretty sweet gig actually.... and tremendous experience.
 
Does anyone know if the ob fellowship is going to be part of the nrmp match or not? I beleive that peds joined the match shortly after it became an acgme accredited program.
 
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