OB anesthesia fellowship - future landscape

[whiteorgo]

Hey guys,

I'm likely going to do an OB anesthesia fellowship and wanted to hear some opinions regarding the field.

It seems like most are against OB fellowship, especially if going into PP. I actually enjoy it a lot and will likely go into PP after training but possibly coming back to academics later in my career.

Especially with the whole ASA/SOAP/ACOG starting to stratify hospitals based on OB care, I've heard (mostly from OB faculty and fellows) the landscape of OB anesthesia is changing and will likely make OB trained anesthesiologist more attractive.

If anybody here can shed a light on general job market for OB trained anesthesiologists and the lifestyle of these jobs, it would be really great. I don't plan on practicing 100% OB since I do want to do general OR cases as well. Thanks!

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[Fajardo04]

I've never really understood the purpose of an OB anesthesia fellowship. What skills exactly are you trying to gain? Did you not do enough spinals and epidurals as a resident to feel comfortable with placing them as an attending? Are you just wanting to see more complex OB cases? At the end of a good residency program, you should have more than enough experience to feel comfortable doing these things. To be honest, it's a bit of a red flag if you don't. Keep in mind you will be sacrificing roughly $300,000 to do this extra year of fellowship. Also keep in mind that most private practices, including mine, could not care less if you have an OB anesthesia fellowship.

 

[Southpaw]

Unless you want to stay in academics after fellowship there's no point in spending an extra year doing OB.

 

[pgg]

It's probably worthwhile if you're aiming for an academic position, and expect to be doing the complicated cases at a referral center.

Or if some really desirable lucrative private practice sets it as the bar for getting in. OB hospitals with the right payor mix can be ridiculously profitable.

Otherwise it's an awfully high opportunity cost.

 

[deleted171991]

You should couple it with a year of ambulatory fellowship with focus on gynecologic cases, so you'll be well-rounded.

 

[MoMoGesiologist]

You'll spend a year taking care of mostly healthy patients doing neuraxial unless if you go somewhere that serves primarily sick OB patients. Do such places exist? Otherwise, I can't help but imagine at the end of the year you would lose skills and become uncomfortable with sicker patients and doing GA. But that's just my opinion!

 

[d9sccr]

You'll spend a year taking care of mostly healthy patients doing neuraxial unless if you go somewhere that serves primarily sick OB patients. Do such places exist? Otherwise, I can't help but imagine at the end of the year you would lose skills and become uncomfortable with sicker patients and doing GA. But that's just my opinion!

I can tell you that we take care of primarily "high-risk" patients. It's an exaggeration but not much of one to say our only healthy OB patients are fellow residents or their spouses.

That said, I don't get the purpose of an OB fellowship. The various syndromes we get are interesting but something you'll see rarely, if ever, outside an academic setting I imagine. The congenital cardiac cases are also interesting but the same thing applies. In addition, if there's a real concern for the patient tanking after delivery, the cardiac team is there anyway. Accreta/Increta/Percreta are mostly just about good preparation from the surgical side with the potential for turning into a trauma case. I presume the PP guys have a sort of protocol for these as well?

At the end of the day, you don't really learn an additional skillset, but can probably use that year to write some publications and use it as a good launch pad into academia.

 

[anbuitachi]

From my experience Ob trained attendings are much better at knowing what the abbreviations the OBs use mean.

 

[pgg]

From my experience Ob trained attendings are much better at knowing what the abbreviations the OBs use mean.

:notsureifserious:

 

[anbuitachi]

:notsureifserious:

one of the general attendings didn't know what AC stood for. the OB anesthesiologists knew =)

 

[Psai]

one of the general attendings didn't know what AC stood for. the OB anesthesiologists knew =)

antecubital? anticoagulation? ante cibum? acromioclavicular? assist control?

 

[anbuitachi]

antecubital? anticoagulation? ante cibum? acromioclavicular? assist control?

abdominal circumference! haha

 

[dhb]

You'll need it in the not so distant future to comply with hospital credentialing for OB epidurals.
Of course some "providers" will only need a week-end course.

 

[anbuitachi]

You'll need it in the not so distant future to comply with hospital credentialing for OB epidurals.
Of course some "providers" will only need a week-end course.

I just found out residents in nys are not allowed to do run abg by law. Only attendings are licensed to do so

 

[teeva]

I think it was in my last month of residency that I finally asked an OB resident what "IOL" meant after seeing half the patients on their sign out list were IOL.

 

[Planktonmd]

You should couple it with a year of ambulatory fellowship with focus on gynecologic cases, so you'll be well-rounded.

 

[Planktonmd]

I think it was in my last month of residency that I finally asked an OB resident what "IOL" meant after seeing half the patients on their sign out list were IOL.

Intra Ocular Lens? They fix cataracts in OB now?

 

[Consigliere]

I just sat here for a good 15 minutes trying to think of a bigger waste of a year and came up with NOTHING.

 

[dhb]

I just sat here for a good 15 minutes trying to think of a bigger waste of a year and came up with NOTHING.

Well you just lost 14.59min right there

 

[AdmiralChz]

Hey guys,

I'm likely going to do an OB anesthesia fellowship and wanted to hear some opinions regarding the field.

It seems like most are against OB fellowship, especially if going into PP. I actually enjoy it a lot and will likely go into PP after training but possibly coming back to academics later in my career.

Especially with the whole ASA/SOAP/ACOG starting to stratify hospitals based on OB care, I've heard (mostly from OB faculty and fellows) the landscape of OB anesthesia is changing and will likely make OB trained anesthesiologist more attractive.

If anybody here can shed a light on general job market for OB trained anesthesiologists and the lifestyle of these jobs, it would be really great. I don't plan on practicing 100% OB since I do want to do general OR cases as well. Thanks!

Look, the thing is that an OB fellowship won't really give you any extra skills which will be utilized for private practice. Like others have said, you should be versatile with spinals and epidurals with your residency. You mention some stratification by the ACOG for OB centers of care, and yes there is some sort of recommendation out there from SOAP (which is the obstetric anesthesiology subsection, yes apparently there is such a thing) that an OB fellowship-trained anesthesiologist be in charge of the care at complex institutions. Those institutions are almost exclusively academic and you'd probably need a fellowship anyway to get a job within the department (at least a tenure-track position), so if you want that then definitely do the fellowship.

The fact is the crazy cases done at those institutions have such a minimal chance of happening in the community. Our OB faculty in residency trained at a place where they had "OB Anesthesiology clinic" (just go ahead and shoot me now at the thought) where they met with extremely high-riskers ahead of time and came up with an anesthetic plan. Almost all of them had repaired or unprepared congenital heart disease and had been referred from the country or up to 5-7 hours away. No community OB is going to get very excited about electively delivering an unprepared TOF immigrant or someone with rip-roaring NICM with an EF of 5-10% on the transplant list - they are heading straight for the university academic center, as they should.

You could make a very similar argument for a regional fellowship - although there are at least different blocks you could learn, even if some are fairly esoteric - or a neuroanesthesia/transplant/liver/insert-random-interest-here fellowship. All are primarily geared for academics and lends time to getting some clinical research off the ground.

 

[IlDestriero]

From my experience Ob trained attendings are much better at knowing what the abbreviations the OBs use mean.

G, P, A ... whatever, who friggin cares. Is it a crash section or not?
This is a waste of a year, unless you want to go into academics now AND want a research career.
PS As an aside, some of the PP now academics later people might not find it as easy as they think to get back to academia. Especially at a place that actually produces some academic output. A big name place might not want to offer you an academic appointment at all, or bring you in as an assistant professor, with your 20 years of experience, and with little hope of promotion. Something to consider if you REALLY aspire to an academic career. Good academic jobs are harder and harder to secure as interest increases 2/2 the continued spread of the AMC cancer jobs.


--
Il Destriero

 

[deleted171991]

Bell's palsy?

 

[Planktonmd]

Bell's palsy?

No just a small cerebral aneurysm

 

[deleted59964]

+1 don't get attraction for OB fellowship.
highest risk OB patients need intraoperative TEE ... you learn that in an OB fellowship?

 

[psychbender]

+1 don't get attraction for OB fellowship.
highest risk OB patients need intraoperative TEE ... you learn that in an OB fellowship?

One of my previous co-workers wanted to do an OB fellowship, and the programs she looked at included electives in TEE and cardiac anesthesia.

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[AdmiralChz]

One of my previous co-workers wanted to do an OB fellowship, and the programs she looked at included electives in TEE and cardiac anesthesia.

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Just hire a cardiac fellow who wants to join a multi specialty practice then. They completed a residency so will have all the OB exposure they need, plus add TEE skills to your group applicable to your sickest patients. Or hire an OB grad who adds... um.........

 

[psychbender]

Just hire a cardiac fellow who wants to join a multi specialty practice then. They completed a residency so will have all the OB exposure they need, plus add TEE skills to your group applicable to your sickest patients. Or hire an OB grad who adds... um.........

Oh, I get what you're saying. I think OB is one of those unnecessary fellowships like Trauma and Transplant. However, people are free to spend their time doing whatever they want, they just have to accept the significant loss of income for probably negligible benefit. All of the super complicated OB patients I saw in residency could have been managed just as well (if not better) by a cardiac anesthesiologist (or good generalist who grasps CV disorders and can echo) who was willing to be on L&D.

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[dhb]

All of the super complicated OB patients I saw in residency could have been managed just as well (if not better) by a cardiac anesthesiologist (or good generalist who grasps CV disorders and can echo) who was willing to be on L&D.

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There's the catch

 

[anbuitachi]

Oh, I get what you're saying. I think OB is one of those unnecessary fellowships like Trauma and Transplant. However, people are free to spend their time doing whatever they want, they just have to accept the significant loss of income for probably negligible benefit. All of the super complicated OB patients I saw in residency could have been managed just as well (if not better) by a cardiac anesthesiologist (or good generalist who grasps CV disorders and can echo) who was willing to be on L&D.

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I think only liver transplant fellowship trained attendings do liver transplants here

 

[deleted171991]

I think only liver transplant fellowship trained attendings do liver transplants here

Ivory tower. AKA The Matrix.