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SleepyTimeDO

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I'm a CA1 at a midwest program. I just recently did my first OB rotation, and I really loved it.

I know that our OB department is rather odd in that there does not seem to great communication b/w the OBs and the anesthesia, and is overall slightly dysfunctional.

I was hoping that some ppl who either are OB fellowship-trained or who work in OB a lot could discuss the role of the OB anesthesiologist at their practice so I can see what other institutions look like. I am now seriously a fellowship in OB and want to see what kind of diversity there is in OB.

Follow up question: how would y'all break up OB fellowships into tiers? is there a small number of programs that stand out clearly at the top? Which programs are those? Are there programs you wouldn't go near?

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Prepare for the onslaught. I apologize in advance.

That said, the right OB anesthesia practice can be incredible.
 
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Umm... role of the OB anesthesiologist?
To place epidurals for labor and provide anesthesia for c-sections.
 
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You want to waste another extra year learning how to do epidurals, c/s and crashes for resident pay when you could be just doing that in a good OB practice and make 300-400k + a year?

OB and anesthesia has always been dysfunctional. Our job is to put epidurals and make sure these wannabe surgeons don't kill the patient.
 
OB is always dysfunctional. Our department has been working on it for 20 years, hasn't changed a bit and it actually might be worse. It's a function of who goes into it.

The diversity in OB is whether you want to use phenylephrine vs ephedrine for hypotension while bolusing fluids, Epidural vs DPE vs CSE and putting oxytocin in a bag vs bolusing it with a catchy name (rule of 3s). BTW there are hundreds of papers on these topics that you can peruse at your leisure during your first year of attendinghood.
 
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Your description of your OB experience accurately described that of myself and others I know at other institutions.
 
Private practice OB is not worth much but if you want to do academics then the OB fellowship at Wake Forest is really great with some very good (private practice) surgeons, great research, and three oral board examiners in the OB section. The Mayo Clinic Rochester residents that rotate through Wake Forest OB adds a little diverse thinking that shakes things up every once in a while.
 
I know that our OB department is rather odd in that there does not seem to great communication b/w the OBs and the anesthesia, and is overall slightly dysfunctional.
Heh, that's not the least bit odd at all. :)

OB anesthesia can be the best of times, or the worst of times. The patient population is hugely important and to be blunt, it's all about their socioeconomic state. Work someplace busy with a high percentage of teenage moms, drug use, super morbid obesity, and self-pay/no-pay insurance to boot, and it's the eleventh circle of hell. Work someplace with an educated and insured cohort of patients, and it can be nice.

There's a place for OB anesthesia fellowships. The general consensus here is that it's not a smart way to spend an entire year if you're destined for a generalist practice or a non-academic job. Since it's not an ACGME fellowship though, a lot of people tailor the year to their own desires. This may include some time functioning (and getting paid) as an attending. I know one person who did a split OB/regional year.

Anyway, decide what job you want and then, only then, do a fellowship if you can point to objective ways in which that fellowship helps you get that job.

The opportunity cost of any fellowship is very high. Be sure you get your money's worth out of whatever one you end up doing.
 
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I know that our OB department is rather odd in that there does not seem to great communication b/w the OBs and the anesthesia, and is overall slightly dysfunctional.

That's common. That's the nature of OB.

The stars are maligned in a non-specific-Aquarius-metaphysical-metro-grade---sense? Time for a C/S. NOW. By now I mean right after shift change. Maybe. Ok I'm enjoying my Matcha - so in 10 minutes. FHRT have been 13 degrees acreta-inverted after all.

Note that almost everyone else hates OB anesthesia, despite it being one of the most lucrative anesthesia fields (if you have a decent private payor mix). The post-OB fellowship role is that you're good at managing complicated OB patients. Also you're expected to be extra good at bread and butter epidurals / general OB management.

Again many anesthesiologists hate OB anesthesia. But if you like it and do a fellowship you will be desired as an OB anesthesia director somewhere.

Just do what you like in medicine and don't worry about it. You'll be happiest that way. OB anesthesia is ok.
 
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Think twice before going into an OB anesthesia fellowship. There is a reason many of us have sworn off any job that requires OB coverage. It's very nice and satisfying to take parturients' pain away, like magic, but that's just the full half of the glass. There is a very deep and very empty "half" that you don't see much as a resident.

If you like dealing with psych issues, pain may be a better choice. If you like high acuity emergencies, cardiac.

Also, not to be ignored is the huge malpractice risk with OB. The economic damages can be huge (imagine a lifetime of care). Some of the highest malpractice awards I know of have been in OB cases.
 
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If you want to deal with OB nurses for another year, more power to you. I stopped doing OB 10 years ago and will NEVER do it again.
 
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If there's a super sick OB patient, I feel like an anesthesiologist who's done cardiac or transplant or even ICU would be more useful. I'm really not sure how an OB fellowship prepares you for sick patients...
 
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If there's a super sick OB patient, I feel like an anesthesiologist who's done cardiac or transplant or even ICU would be more useful. I'm really not sure how an OB fellowship prepares you for sick patients...

There's some truth to this. The most concerning patients I've taken care of on OB were cardiac patients who happened to be pregnant.
 
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If there's a super sick OB patient, I feel like an anesthesiologist who's done cardiac or transplant or even ICU would be more useful. I'm really not sure how an OB fellowship prepares you for sick patients...
This. What exactly are you learning in OB fellowship?
 
What do you actually do for a whole year in ob anesthesia fellowship? Seriously?
 
Ob fellowship is simply a year for an academic career. If you can't match into anything competitive and don't like regional blocks then Ob is for you.

These days almost every academic department wants fellowship trained Anesthesiologists. So, here is a list of a Few fellowships just for academia:

1. Ob
2. Perioperative Fellowship
3. Ambulatory Fellowship
4. Simulation Fellowship
5. Trauma Fellowships
6, liver transplant fellowship
7. Neuro fellowship.

I've actually seen really good academic jobs posted for these attendings. I've seen high pay for numbers 6 and 7.
 
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Ob fellowship is simply a year for an academic career. If you can't match into anything competitive and don't like regional blocks then Ob is for you.

These days almost every academic department wants fellowship trained Anesthesiologists. So, here is a list of a Few fellowships just for academia:

1. Ob
2. Perioperative Fellowship
3. Ambulatory Fellowship
4. Simulation Fellowship
5. Trauma Fellowships
6, liver transplant fellowship
7. Neuro fellowship.

I've actually seen really good academic jobs posted for these attendings. I've seen high pay for numbers 6 and 7.

These sound suspiciously like another ca1 year.
 
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A lot of the fellowships like that fall into a wide spectrum of substance rehab and monitoring year to junior attending audition year.
 
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Could some people who did OB fellowships comment on them? Like why you did them? What you see as their utility? Would you do it again? Did you have a good experience?
 
Could some people who did OB fellowships comment on them? Like why you did them? What you see as their utility? Would you do it again? Did you have a good experience?

OB anesthesiologists don't have time for silly things like commenting in online threads. They're busy with important things like testing whether 1.543 cc of heavy bupi is just as effective as 1.6 cc, etc
 
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I did an OB fellowship. It was called anesthesia residency.
 
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Could some people who did OB fellowships comment on them? (Do those people exist?)Like why you did them? (Tempoary insanity) What you see as their utility? (None) Would you do it again? (No)Did you have a good experience? (No)

I didn't do an OB fellowship because I'm not ret_arded but I did answer your questions. You're welcome.
 
I’m sorry, OP, but you aren’t going to find much support for the fellowship here. You’re better off asking your academic faculty about it, to be honest.

If you want to do it, by all means go for it and it isn’t in the slightest competitive. But know the only doors you are opening by doing it are academic ones.
 
I’m sorry, OP, but you aren’t going to find much support for the fellowship here. You’re better off asking your academic faculty about it, to be honest.

If you want to do it, by all means go for it and it isn’t in the slightest competitive. But know the only doors you are opening by doing it are academic ones.
While closing most of the others.

A lot of good anesthesiologists have trouble taking seriously anybody with certain semi-useless resume-padding fellowships. The OB fellowship is one of the DNP degrees for anesthesiologists. It screams "I wasn't able to get into a real fellowship, so I wasted one year on losing skills" (unless practicing high-risk academic OB).

Btw, the reason cardiac anesthesiologists are so good (even at OB), it's not just the acuity, it's the extra year of "residency". They end up doing complicated anesthetics on sick patients every day, for another year, something few other fellowships offer. Hence they probably lose the fewest skills among all anesthesia fellows.
 
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While closing most of the others.

A lot of good anesthesiologists have trouble taking seriously anybody with certain semi-useless resume-padding fellowships. The OB fellowship is one of the DNP degrees for anesthesiologists. It screams "I wasn't able to get into a real fellowship, so I wasted one year on losing skills" (unless practicing high-risk academic OB).

Btw, the reason cardiac anesthesiologists are so good (even at OB), it's not just the acuity, it's the extra year of "residency". They end up doing complicated anesthetics on sick patients every day, for another year, something few other fellowships offer. Hence they probably lose the fewest skills among all anesthesia fellows.

But they lose skills in regional, peds, etc things they don't normally get exposed to while doing cardiac, like any fellowship.
 
But they lose skills in regional, peds, etc things they don't normally get exposed to while doing cardiac, like any fellowship.

Most CT fellowships have a ped CT month. A lot of them are utilizing different regional techniques. (But these places are not second to none :p).

At the risk of getting trolled, I'd say those skills atrophied in CT fellowship is much easier to pick up than those skills atrophied in an OB fellowship.

Btw, the reason cardiac anesthesiologists are so good (even at OB), it's not just the acuity, it's the extra year of "residency". They end up doing complicated anesthetics on sick patients every day, for another year, something few other fellowships offer. Hence they probably lose the fewest skills among all anesthesia fellows.

I've said it before and i'll say it again. Super sick OB cases ARE cardiac cases.
 
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Could some people who did OB fellowships comment on them? Like why you did them? What you see as their utility? Would you do it again? Did you have a good experience?

The ONLY reason I know people doing an OB fellowship is to break into the lucrative OB group in that region. That's it.
 
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Most CT fellowships have a ped CT month. A lot of them are utilizing different regional techniques. (But these places are not second to none :p).

At the risk of getting trolled, I'd say those skills atrophied in CT fellowship is much easier to pick up than those skills atrophied in an OB fellowship.



I've said it before and i'll say it again. Super sick OB cases ARE cardiac cases.

Totally agree, and after a few weeks in PP I was right back in the saddle for regional blocks. I did a select few in fellowship, mostly with residents on sick cardiac patients that are to the OR for extremity surgery.

The ONLY reason I know people doing an OB fellowship is to break into the lucrative OB group in that region. That's it.

I’ve heard this mentioned before... but is there actually any evidence of this? A “lucrative OB group” sounds like an oxymoron. The vast, VAST majority of high risk OB will be on a very marginal patient population with state and/or federal insurance. Maybe low risk? But what anesthesiologist needs to do a fellowship for low risk OB???
 
Totally agree, and after a few weeks in PP I was right back in the saddle for regional blocks. I did a select few in fellowship, mostly with residents on sick cardiac patients that are to the OR for extremity surgery.



I’ve heard this mentioned before... but is there actually any evidence of this? A “lucrative OB group” sounds like an oxymoron. The vast, VAST majority of high risk OB will be on a very marginal patient population with state and/or federal insurance. Maybe low risk? But what anesthesiologist needs to do a fellowship for low risk OB???

Probably a very heavy OB group, lot of units to be collected... So they want their pick of the litter to show they have the "best" anesthesiologist. Little do they know they are probably picking someone who probably hasn't done a real case in a long time... Unless it's high risk fellowship with all day everyday preeclamptics, AFE, single ventricle moms, seizing and bleeding to death everyday
 
I’ve heard this mentioned before... but is there actually any evidence of this? A “lucrative OB group” sounds like an oxymoron. The vast, VAST majority of high risk OB will be on a very marginal patient population with state and/or federal insurance. Maybe low risk? But what anesthesiologist needs to do a fellowship for low risk OB???

Abosolutely there is. The most lucrative PP gig in the town where I did residency was the women’s center. It was the main referral center in the hospital system where they did the bulk of the OB/GYN stuff. Over 7500 deliveries/year. 10+ epidurals placed every shift. Payer mix ok.

OB fellowship certainly wasn’t needed to do the work there, but it’d be a tough sell trying to get in there without one.
 
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Over 7500 deliveries/month.

I'll assume you mean yearly since there's no way they do 90k deliveries annually. For that you WOULD need an OB fellowship. Check that....even then you wouldn't.
 
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I prepared for my cardiac fellowship by intentionally doing everything I wouldn't be doing on cardiac as much as possible my CA-3 year, so lots of regional, lots of peds, lots of OB. I found that the cardiac fellowship significantly improved my ultrasound skills, and I actually hit the ground running with blocks immediately as an attending. I also quickly became better with blocks than I was as a resident.

While closing most of the others.

A lot of good anesthesiologists have trouble taking seriously anybody with certain semi-useless resume-padding fellowships. The OB fellowship is one of the DNP degrees for anesthesiologists. It screams "I wasn't able to get into a real fellowship, so I wasted one year on losing skills" (unless practicing high-risk academic OB).

Btw, the reason cardiac anesthesiologists are so good (even at OB), it's not just the acuity, it's the extra year of "residency". They end up doing complicated anesthetics on sick patients every day, for another year, something few other fellowships offer. Hence they probably lose the fewest skills among all anesthesia fellows.

This is also 100% true. It's an extra year of residency where every day you are doing a case on the patient everyone dreads, so it gives you a lot of context for what a "difficult" patient is.
 
I'll assume you mean yearly since there's no way they do 90k deliveries annually. For that you WOULD need an OB fellowship. Check that....even then you wouldn't.

You are obviously unaware of the new DeWalt shop-vac octo-birther. It can accelerate 8 labors simultaneously to an average of < 15 minutes. Then you just open the trapdoor under the mother's bed and she falls into her post L&D room. If no insurance I believe some rooms have a slide that goes to the loading dock.
 
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OB can certainly be lucrative. The problem is the pain that comes with it. In my current group, I can certainly make more if I chose to do more ob but I just can't get motivated to. OB calls are the calls people are most frequently looking to give away. Gotta understand not all money is equal. There's easy money and hard money
 
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I’ve heard this mentioned before... but is there actually any evidence of this? A “lucrative OB group” sounds like an oxymoron. The vast, VAST majority of high risk OB will be on a very marginal patient population with state and/or federal insurance. Maybe low risk? But what anesthesiologist needs to do a fellowship for low risk OB???

No, the OB group is a subset of the main Anesthesia group but retains a semblance of autonomy in billing, busy OB practice and residents to do the work. It's a pretty sweet gig. I know cause we rotated through there for residency. The issue isn't that the OB fellowship is useful it's that that was their requirement in order to join their group. Honestly, what's another year when you can make a crap ton of money on residents' backs? I also have a friend in Nevada who works in a huge OB group with basically a monopoly on all OB in that city and he makes >500K a year. So, it's definitely possible.
 
No, the OB group is a subset of the main Anesthesia group but retains a semblance of autonomy in billing, busy OB practice and residents to do the work. It's a pretty sweet gig. I know cause we rotated through there for residency. The issue isn't that the OB fellowship is useful it's that that was their requirement in order to join their group. Honestly, what's another year when you can make a crap ton of money on residents' backs? I also have a friend in Nevada who works in a huge OB group with basically a monopoly on all OB in that city and he makes >500K a year. So, it's definitely possible.

I don't know about you, but wouldn't it become boring as hell doing OB all day everyday? I would need some case diversity
 
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I don't know about you, but wouldn't it become boring as hell doing OB all day everyday? I would need some case diversity

Yeah, I can't deal with that no matter how good the money is. My friend's been trying to come out there for awhile now. Plus I like my sleep at night. I hate getting woken up.
 
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