OB or Regional?

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flyknit

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All around the country, academicians are indiscriminately encouraging young residents to do fellowships and inevitably, some will apply for OB or regional. It is no secret that these two fellowships are regarded as less useful, particularly in this forum. I wanted to open up a conversation about the merits of these fellowships (a career in academics doesn't count), which programs are strongest, the future of these fellowships, why choose one over the other, and anything else other posters would like to hear about.

My goal for this post is not to create another avenue for people to dump on these fellowships without any context. My hope is that you accompany your disdain with some reasoning and maybe real-life experience.

I look forward to hearing from the usual suspects, but I also hope some former regional or OB fellows chime in and tell us why they did what they did, and how things are turning out for them.

Some recent news...
Regional programs are moving full steam ahead with ACGME accreditation, with the big, brand-name programs already becoming accredited.
Meanwhile, it appears the OB fellowships are no longer participating in the match.
 
recently heard more and more places are hiring OB fellowship trained only for their OB positions. I think we are starting to see this more because 90% of the people are doing fellowships so there are more than enough to go around.
 
Here is the deal:
OB anesthesia is not really a sub-specialty, it is basically about doing more spinals and epidurals than GA because they teach you to be so scared of doing GA on pregnant women.
Regional anesthesia fellowship is not a sub-specialty either since all the nerve blocks you actually need to do in the real world could be done successfully by a well trained monkey or a CRNA.
 
Join date: yesterday. Thanks for all your contributions to the forums.

All fellowships do is waste people's lives as they spend extra time doing things they already know how to do. Residency prepares you to do everything that fellowship does. Maybe you'll see an esoteric block or two that your attendings didn't do in residency. But really fellowship just takes away good learning cases from residents and unnecessarily extends training for people who have already deferred much of their earning potential.
 
Does anybody know anything about the “anesthesia/sports medicine” fellowship that is supposed to better prepare its candidates to take care of athletes?
“ASA 3? Sorry, I specialize in 1’s”
 
I left residency with over 260 peripheral nerve blocks and over 300 epidurals. I even did the weird stuff like erector spinae/TAP/QL catheters that I would never do in my current job. Go to a strong residency and you will never think a fellowship for private practice is warranted--unless you really want to do academics. If you really like doing neuraxial and other nerve blocks, then do a pain fellowship.
 
Psai said:
Join date: yesterday. Thanks for all your contributions to the forums.

All fellowships do is waste people's lives as they spend extra time doing things they already know how to do. Residency prepares you to do everything that fellowship does. Maybe you'll see an esoteric block or two that your attendings didn't do in residency. But really fellowship just takes away good learning cases from residents and unnecessarily extends training for people who have already deferred much of their earning potential.
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This is true!

But the deal is now that residents are being shamed almost into doing a fellowship these days.

'If you don't do a fellowship you're lazy, underprepared.
There are no jobs
There are no good jobs
There's no job security
You're under threat from nurses etc'

I'm an img so a fellowship for me was always going to happen

The most common con of doing a fellowship I read on here is the lost income, but if you like you're job chances are you will work on into your 60s anyway. At that stage is any anestheiologist short of money? If they are, then this extra year isn't the issue
 
My two bits: Cardiac fellowships make sense because you will acquire skill sets that are not taught through traditional residency programs. Peds fellowships make sense only if you plan on limiting your job to pediatrics and ICU babies. ICU fellowships never made sense to me....if you want to be a flea, then be a flea and don't enter ICU from anesthesiology: internal med makes far more sense. Regional fellowships are only infrequently useful since regional anesthesia is becoming limited by insurance considerations, and sufficient experience is often obtained for primary blocks in residency. Pain fellowships make no sense at all in this day and age given collapsing scope of practice, limitations by insurance, increasing limitations on standard procedures, and the penchant of many pain physicians to offer experimental treatments not taught in fellowship. OB fellowships are not reasonable unless you plan to limit your practice to OB, and even then, a fellowship offers you only a limited enhancement of skills obtained during anesthesia residency.
 
Newtwo said:
This is true!

But the deal is now that residents are being shamed almost into doing a fellowship these days.

'If you don't do a fellowship you're lazy, underprepared.
There are no jobs
There are no good jobs
There's no job security
You're under threat from nurses etc'

I'm an img so a fellowship for me was always going to happen

The most common con of doing a fellowship I read on here is the lost income, but if you like you're job chances are you will work on into your 60s anyway. At that stage is any anestheiologist short of money? If they are, then this extra year isn't the issue
Click to expand...

How much loans do you have? If you look at the surveys plenty of anesthesiologists do not have a lot of money. A significant portion of graduates today have 250k+ loans going up at 6.8%.
 
algosdoc said:
Pain fellowships make no sense at all in this day and age given collapsing scope of practice
Click to expand...

I dunno man, the pain program at my shop is teaching fellows to perform minimally invasive lumbar decompressions under fluoro. I asked the pain guys what the spine surgeons think about this, and of course they were like, “oh they hate it.”
 
algosdoc said:
My two bits: Cardiac fellowships make sense because you will acquire skill sets that are not taught through traditional residency programs. Peds fellowships make sense only if you plan on limiting your job to pediatrics and ICU babies. ICU fellowships never made sense to me....if you want to be a flea, then be a flea and don't enter ICU from anesthesiology: internal med makes far more sense. Regional fellowships are only infrequently useful since regional anesthesia is becoming limited by insurance considerations, and sufficient experience is often obtained for primary blocks in residency. Pain fellowships make no sense at all in this day and age given collapsing scope of practice, limitations by insurance, increasing limitations on standard procedures, and the penchant of many pain physicians to offer experimental treatments not taught in fellowship. OB fellowships are not reasonable unless you plan to limit your practice to OB, and even then, a fellowship offers you only a limited enhancement of skills obtained during anesthesia residency.
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I agree and disagree.

ICU makes you a better doc. Your patients from the oror wi have better outcomes I think. And having an anesthesiologist is the ICU definitely improves patients outcomes in the initial resus.

IM physicans are great when everything settles down but their resus skills are terribly poor. Airway Management even grade 1s can be horrific. I think patients benefit when we're in the ICU when they initally come in. Then in 3 hours time let the im ICU guy take em...

Just 2 days ago, we had a guy come in crapped out. I had a look in to his mouth and actually could see the cords with my gloved hand and a small chin lift. The im fellow intubated with the glidescope at his third attempt. Rammed the stlyet in. Fairly traumatic. It was awful...

So all that to say. ICU makes us better I believe but I'm biased
 
I did minimally invasive lumbar decompressions for many years, but would not recommend them at this time since there is no insurance or Medicare reimbursement possible at this time, nor in the past 8 years. It seems like training doctors with skillsets they will not or only rarely use in practice may not be the best use of time. As for ICU- IMHO what needs to happen is better training of IM docs and hospitalist to intubate rather than taking an expert in that realm and sticking them in an ICU setting, but perhaps ICU has changed over the years.
 
Newtwo said:
I agree and disagree.

ICU makes you a better doc. Your patients from the oror wi have better outcomes I think. And having an anesthesiologist is the ICU definitely improves patients outcomes in the initial resus.

IM physicans are great when everything settles down but their resus skills are terribly poor. Airway Management even grade 1s can be horrific. I think patients benefit when we're in the ICU when they initally come in. Then in 3 hours time let the im ICU guy take em...

Just 2 days ago, we had a guy come in crapped out. I had a look in to his mouth and actually could see the cords with my gloved hand and a small chin lift. The im fellow intubated with the glidescope at his third attempt. Rammed the stlyet in. Fairly traumatic. It was awful...

So all that to say. ICU makes us better I believe but I'm biased
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how you give some examples of how ICU trained doctors do better in the OR with better outcomes?
 
I do a lot of OB, for the life of me I don’t know what experience you would gain that you didn’t get in a good residency program. Never once have I thought, “man, an OB fellowship would’ve helped me out there”. Same holds true for regional.
 
anbuitachi said:
how you give some examples of how ICU trained doctors do better in the OR with better outcomes?
Click to expand...
0 proof cause a study like that couldn't be done or feasible. But loads of real world examples...

A lot of anesthetic s I've worked with have become too comfortable in the or and aren't used to seeing sickies. Couldn't even name a fluid trial or any kind of critical care trial over the last decade...

It's ok to know and have read these things and disregard them if the situation doesn't suit but not even be aware of them isn't good!

If one of my loved ones is struck down I know exactly the guys I want to give them their anesthetic. And all of them have done ICU fellowships.
 
Our training is much shorter than other specialties. The idea of an extra year of training being a waste of money is real but also slightly overblown. If you love a subspecialty and it makes you more fulfilled being mentored, immersed in higher level discussions in it, better prepared for consultations in it, and potentially pushed into doing a lot of it in whatever practice you join, go for it. Residency has shifted away from discussions of research and towards getting the work done and being prepared for board exams testing esoteric nonsense. Placing an epidural isn’t hard and you’re missing the point if you think that’s the goal of an OB fellowship. Obviously cardiac, peds, ICU, and pain offer more skills you cannot possibly get during residency, but for example, as much as i enjoy peds the idea of potentially preopping and covering multiple complex peds rooms every day with lots of room for emergent dosing errors sounds exhausting to me. Do what you actually like doing and be good at it. For some people, that may be Ob or regional. You have to decide for yourself what your career goals and whether or not a fellowship will be worth it to you personally.
 
Newtwo said:
I agree and disagree.

ICU makes you a better doc. Your patients from the oror wi have better outcomes I think. And having an anesthesiologist is the ICU definitely improves patients outcomes in the initial resus.

IM physicans are great when everything settles down but their resus skills are terribly poor. Airway Management even grade 1s can be horrific. I think patients benefit when we're in the ICU when they initally come in. Then in 3 hours time let the im ICU guy take em...

Just 2 days ago, we had a guy come in crapped out. I had a look in to his mouth and actually could see the cords with my gloved hand and a small chin lift. The im fellow intubated with the glidescope at his third attempt. Rammed the stlyet in. Fairly traumatic. It was awful...

So all that to say. ICU makes us better I believe but I'm biased
Click to expand...

I think your "agree" reason, is an good reason anesthesiologists are better suited for the ICU. Both IM and anesthesiologists know the medicine quite reasonably because in all honesty, if you keep up with the reading, you'll be up to date on all ICU therapies. It's when it comes down to procedural medicine where the anesthesiologists shine. We do many of the ICU procedures more ofter and quite safer and I think that benefits ICU patients. Ideally, I think and ICU anesthesiologists would need to do 1-2 ICU then 1-2 OR every month to keep the skills and in that ratio the income will outshine a medicine trained ICU doc. Medicine trained ICU doctors are basically just pulmonologist who cover the unit.
 
acidbase1 said:
I do a lot of OB, for the life of me I don’t know what experience you would gain that you didn’t get in a good residency program. Never once have I thought, “man, an OB fellowship would’ve helped me out there”. Same holds true for regional.
Click to expand...

This right here.

An OB fellowship is absolutely worthless. If you didn't get the skills in residency to place epidurals and spinals pregnant women, both big and "small", then you completed a terrible residency. Sorry not sorry. I feel like an OB fellowship is a way for lazy academic attendings covering OB to do absolutely nothing while they cover that shift, ie "have the fellow cover that (while I surf the net in the call room)"

I'm +/- on regional, mainly because I stink at blocks, but as others have said, the gig that hires you can probably teach you every block they do in a couple of weeks. Now some gigs may not WANT to teach a new hire, therefore they'll say "strong regional skills required" so maybe that's where the fellowship helps, because someone like me who isn't strong with peripheral blocks would be hesitant to apply for one of those jobs.
 
Planktonmd said:
Here is the deal:
OB anesthesia is not really a sub-specialty, it is basically about doing more spinals and epidurals than GA because they teach you to be so scared of doing GA on pregnant women.
Regional anesthesia fellowship is not a sub-specialty either since all the nerve blocks you actually need to do in the real world could be done successfully by a well trained monkey or a CRNA.
Click to expand...


I second the well trained monkey idea, they don’t lobby to take your job (yet), and are far more entertaining.
 
I also strong disagree with the "loss of income" defense for not doing a fellowship with regard to Cardiac, Peds, and ICU. My year long cardiac/TEE certification investment has well paid off and if any cardiac job every comes up my CV should be top of the pile vs anyone who didn't do cardiac. Plus I'm an asset to any academic institution who needs someone who can do everything when it comes to taking care of a complex case without hesitation.

That's where a fellowship may pay off in the future. That was the defense an anesthesia/ICU attending sold to me on fellowship training. Basically if anything 'crazy' happened in the future and academic departments needed to cut back, it's likely that the fellowship trained people would be low on the "cut" list. Not that this is the case for the future, but who knows, the field of medicine, especially when it comes to money, can be crazy.
 
The bottom line is this, do a fellowship because you like it a lot, not because of “job security.” OB and regional fellowships are wastes of time for 99% of people...unless your residency is terrible and you are only there to be the workforce doing lap appys as a CA3. Job security only comes from your own financial security, so if that is your reason for doing a fellowship, your time is better spent strengthening your marriage and not blowing your money on fancy cars.

There is a certain natural history that happens with these fellowships. At first a few major national referral centers will start OB fellowships because they see a lot of sick pregnant women. That’s fine. A few people who want a career in these centers doing research will do the fellowship. Then what happens is every Tom, Dick, and Harry program starts licking their chops at the prospect of cheap labor so they start their own “OB fellowship” where you do a few extra pre-eclamptics for the year. Big deal. It’s a waste for most people, but you have attendings spending 3 years guilting people into doing these waste-of-time fellowships.
 
I could possibly see a regional fellowship if you’re working at a top flight ortho center. But again, outside of a few blocks, I can do pretty much anything. And the few blocks I don’t perform could easily be figured out with reading and workshops
 
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algosdoc said:
My two bits: Cardiac fellowships make sense because you will acquire skill sets that are not taught through traditional residency programs. Peds fellowships make sense only if you plan on limiting your job to pediatrics and ICU babies. ICU fellowships never made sense to me....if you want to be a flea, then be a flea and don't enter ICU from anesthesiology: internal med makes far more sense. Regional fellowships are only infrequently useful since regional anesthesia is becoming limited by insurance considerations, and sufficient experience is often obtained for primary blocks in residency. Pain fellowships make no sense at all in this day and age given collapsing scope of practice, limitations by insurance, increasing limitations on standard procedures, and the penchant of many pain physicians to offer experimental treatments not taught in fellowship. OB fellowships are not reasonable unless you plan to limit your practice to OB, and even then, a fellowship offers you only a limited enhancement of skills obtained during anesthesia residency.
Click to expand...

Well, the rest of the world would strongly disagree with you about anesthesiologists running the ICU. Of course, that is, unless your world only consists of America.
 
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Aren't all the sick OB patients truly cardiac patients?? Off the top of my head the last 3 truly sick patients that I encountered on OB at a tertiary referral centers were better cared for by a cardiac anesthesiologist : 35 y/o Eisenmenger, 20 y/o Ebstein, and 40 y/o w/ severe AS.... I don't know how doing an OB fellowship helps one take care of those pts... may be you're a little more comfortable with a continuous spinal catheter, but that's not exclusive to fellowships....
 
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dchz said:
Aren't all the sick OB patients truely cardiac patients?? Off the top of my head the last 3 truly sick patients that I encountered on OB at a tertiary referral centers were better cared for by a cardiac anesthesiologist : 35 y/o Eisenmeng, 20 y/o Ebstein, and 40 y/o w/ severe AS.... I don't know how doing an OB fellowship helps one take care of those pts... may be you're a little more comfortable with a continuous spinal catheter, but that's not exclusive to fellowships....
Click to expand...

And even still, the answer is a) epidural b) spinal for c-section c) GA for section

You don’t need a fellowship for that.
 
Twiggidy said:
And even still, the answer is a) epidural b) spinal for c-section c) GA for section

You don’t need a fellowship for that.
Click to expand...

Totally agreed with not needing fellowship for it. But I have to say your "answers" are not necessarily the only choices. The actual anes that happened were:

1) CT anes GA C section
2) epidural for svd and ice on face to break SVT
3) continuous spinal c section

The learning came from as much seeing the case done as much as talking to the attendings about the intricacies of the cases. Either way, OB fellowship is neither sufficient nor necessary for a good outcome in those truly sick patients.
 
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dchz said:
Totally agreed with not needing fellowship for it. But I have to say your "answers" are not necessarily the only choices. The actual anes that happened were:

1) CT anes GA C section
2) epidural for svd and ice on face to break SVT
3) continuous spinal c section

The learning came from as much seeing the case done as much as talking to the attendings about the intricacies of the cases. Either way, OB fellowship are neither sufficient not necessary for a good outcome in those truely sick patients.
Click to expand...

True
 
dchz said:
Aren't all the sick OB patients truely cardiac patients?? Off the top of my head the last 3 truly sick patients that I encountered on OB at a tertiary referral centers were better cared for by a cardiac anesthesiologist : 35 y/o Eisenmeng, 20 y/o Ebstein, and 40 y/o w/ severe AS.... I don't know how doing an OB fellowship helps one take care of those pts... may be you're a little more comfortable with a continuous spinal catheter, but that's not exclusive to fellowships....
Click to expand...
That's a truly excellent point!
 
dchz said:
Aren't all the sick OB patients truly cardiac patients?? Off the top of my head the last 3 truly sick patients that I encountered on OB at a tertiary referral centers were better cared for by a cardiac anesthesiologist : 35 y/o Eisenmenger, 20 y/o Ebstein, and 40 y/o w/ severe AS.... I don't know how doing an OB fellowship helps one take care of those pts... may be you're a little more comfortable with a continuous spinal catheter, but that's not exclusive to fellowships....
Click to expand...

Yep, in residency these patients were referred straight to the cardiac (and peds cardiac) folks over OB faculty each and every time.

We can have a somewhat balanced discussion about the usefulness of a regional fellowship. But an OB fellowship is just not defensible outside of academics. There are some great, super cushy jobs out there for OB (Baylor’s setup in Houston comes to mind) but other than that it’s sort of a joke.

The OB anesthesia society (SOAP?) has some ridiculous recommendation out there that high-risk OB floors have a medical director that’s OB fellowship trained. No evidence to merit that, of course. They are only trying to artificially increase the limited interest in the sub specialty
 
AdmiralChz said:
Yep, in residency these patients were referred straight to the cardiac (and peds cardiac) folks over OB faculty each and every time.

We can have a somewhat balanced discussion about the usefulness of a regional fellowship. But an OB fellowship is just not defensible outside of academics. There are some great, super cushy jobs out there for OB (Baylor’s setup in Houston comes to mind) but other than that it’s sort of a joke.

The OB anesthesia society (SOAP?) has some ridiculous recommendation out there that high-risk OB floors have a medical director that’s OB fellowship trained. No evidence to merit that, of course. They are only trying to artificially increase the limited interest in the sub specialty
Click to expand...


Im doing the OB refresher right now from the ASA for some CME since it’s related to my practice. The questions are so stupid and have almost ZERO to do with anesthesia. The OB patients that were mentioned above are the zebras. Just about 99% of OB jobs will have a patient like that once in a blue moon and given that rarity it doesn’t justify a fellowship. A strong PP job with OB coverage would be way more useful ...and lucrative.

I think regional is more justified because you’re literally (if it’s a strong program) doing blocks all the time and a variety of blocks at that.
 
GravelRider said:
The bottom line is this, do a fellowship because you like it a lot, not because of “job security.” OB and regional fellowships are wastes of time for 99% of people...unless your residency is terrible and you are only there to be the workforce doing lap appys as a CA3. Job security only comes from your own financial security, so if that is your reason for doing a fellowship, your time is better spent strengthening your marriage and not blowing your money on fancy cars.

There is a certain natural history that happens with these fellowships. At first a few major national referral centers will start OB fellowships because they see a lot of sick pregnant women. That’s fine. A few people who want a career in these centers doing research will do the fellowship. Then what happens is every Tom, Dick, and Harry program starts licking their chops at the prospect of cheap labor so they start their own “OB fellowship” where you do a few extra pre-eclamptics for the year. Big deal. It’s a waste for most people, but you have attendings spending 3 years guilting people into doing these waste-of-time fellowships.
Click to expand...

It's not a waste of time! You can become an expert at quoting the 1993 study of 50 patients that shows a 0.01 difference in umbilical ph between phenylephrine and ephedrine.
 
dchz said:
Aren't all the sick OB patients truly cardiac patients?? Off the top of my head the last 3 truly sick patients that I encountered on OB at a tertiary referral centers were better cared for by a cardiac anesthesiologist : 35 y/o Eisenmenger, 20 y/o Ebstein, and 40 y/o w/ severe AS.... I don't know how doing an OB fellowship helps one take care of those pts... may be you're a little more comfortable with a continuous spinal catheter, but that's not exclusive to fellowships....
Click to expand...

Yeah this is the hard truth for the OB "specialists". If mom is complicated its almost always because they have heart or aortic disease and if baby is complicated its the same story - these cases don't go to the "OB specialists" they go to CT anesthesia.
 
T-burglar said:
Yeah this is the hard truth for the OB "specialists". If mom is complicated its almost always because they have heart or aortic disease and if baby is complicated its the same story - these cases don't go to the "OB specialists" they go to CT anesthesia.
Click to expand...


That’s why you need dual OB/CT fellowships😉. While you’re at it, throw in ICU too since they’re the best doctors in the hospital. Oh and peds too since the moms are congenital.
 
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nimbus said:
That’s why you need dual OB/CT fellowships😉.
Click to expand...

0E6857CB-E3E7-45DE-89DE-FB26B8DFDC7F.gif
 
algosdoc said:
My two bits: Cardiac fellowships make sense because you will acquire skill sets that are not taught through traditional residency programs. Peds fellowships make sense only if you plan on limiting your job to pediatrics and ICU babies. ICU fellowships never made sense to me....if you want to be a flea, then be a flea and don't enter ICU from anesthesiology: internal med makes far more sense. Regional fellowships are only infrequently useful since regional anesthesia is becoming limited by insurance considerations, and sufficient experience is often obtained for primary blocks in residency. Pain fellowships make no sense at all in this day and age given collapsing scope of practice, limitations by insurance, increasing limitations on standard procedures, and the penchant of many pain physicians to offer experimental treatments not taught in fellowship. OB fellowships are not reasonable unless you plan to limit your practice to OB, and even then, a fellowship offers you only a limited enhancement of skills obtained during anesthesia residency.
Click to expand...

I agree with you - if I had known, I would not have done a pain fellowship.
But to be honest with you, towards the end of residency, I truly hated some of my anesthesia attendings and people in the OR, and made a promise to myself that I will never let myself be like them. At the same time, my pain attending really impressed me. I thought of pain management as an escape from OR, IF needed. I always thought that pain is pretty safe from CRNAs also - it is to a certain degree.

There is always hope that the current landscape in pain may change. I do miss managing those 20-30% of legitimate pain patients that are not rude, eternally grateful, compliant, and were overall good decent old folks who sought my help and I could help them. Unfortunately the other 70% just slowly chewed my soul and I got out out.

Actually, I do think that there is true value in perioperative pain management as well as pain consults. That was a big part of my pain fellowship. That has real impact on reimbursement, patient outcome, and is potentially a goldmine. There is a colleague of mine who is trained in regional anesthesia, and we are trying to set that up that service at my hospital and get paid on an RVU/consult basis which translates into a $ figure. If the program does well, then hire a mid level. Its not easy work, but its easy enough. Definitely easier that seeing a chronic pain patient in the hospital where the plan is eventual discharge vs. clinic where they suck your life til you live.

In all honesty - if you do a fellowship, it does not matter. You should not be discouraged. Follow your passion.
I am of the belief that knowledge is useful. I happened to choose pain. Yes, I am using 10-20% of pain in my practice, but it did teach me a lot of people management, how to negotiate ad bring the hammer down if needed, taught me lots of medicine outside of OR, and of course ton of fluoro and most importantly, whats safe to inject, when to inject, and what to do when it does not work.

In hindsight, I would have done cardiac but again, my goals were to have the option to be outside OR if needed. I think if you are going to do a fellowship, cardiac is the one. The TEE certification will be essential. And with the constant battle against CRNAs for turf, I do not see them ever be smart or capable enough to perform TEE.
 
neutro said:
I agree with you - if I had known, I would not have done a pain fellowship.
But to be honest with you, towards the end of residency, I truly hated some of my anesthesia attendings and people in the OR, and made a promise to myself that I will never let myself be like them. At the same time, my pain attending really impressed me. I thought of pain management as an escape from OR, IF needed. I always thought that pain is pretty safe from CRNAs also - it is to a certain degree.

There is always hope that the current landscape in pain may change. I do miss managing those 20-30% of legitimate pain patients that are not rude, eternally grateful, compliant, and were overall good decent old folks who sought my help and I could help them. Unfortunately the other 70% just slowly chewed my soul and I got out out.

Actually, I do think that there is true value in perioperative pain management as well as pain consults. That was a big part of my pain fellowship. That has real impact on reimbursement, patient outcome, and is potentially a goldmine. There is a colleague of mine who is trained in regional anesthesia, and we are trying to set that up that service at my hospital and get paid on an RVU/consult basis which translates into a $ figure. If the program does well, then hire a mid level. Its not easy work, but its easy enough. Definitely easier that seeing a chronic pain patient in the hospital where the plan is eventual discharge vs. clinic where they suck your life til you live.

In all honesty - if you do a fellowship, it does not matter. You should not be discouraged. Follow your passion.
I am of the belief that knowledge is useful. I happened to choose pain. Yes, I am using 10-20% of pain in my practice, but it did teach me a lot of people management, how to negotiate ad bring the hammer down if needed, taught me lots of medicine outside of OR, and of course ton of fluoro and most importantly, whats safe to inject, when to inject, and what to do when it does not work.

In hindsight, I would have done cardiac but again, my goals were to have the option to be outside OR if needed. I think if you are going to do a fellowship, cardiac is the one. The TEE certification will be essential. And with the constant battle against CRNAs for turf, I do not see them ever be smart or capable enough to perform TEE.
Click to expand...

CRNAs do TEE, and just googling that will turn up quite a few providers that talk about how the MDAs are teaching them as well . Trans-esophageal Echocardiography [Archive] - WWW.NURSE-ANESTHESIA.ORG
 
It blows my mind that any hospital out there credentials nurses to perform and generate reports for TEE. The liability for a missed finding or wrong interpretation is staggering.
 
Sounds like the crnas do the tees during cases, cardiologists read and bill for them.
 
Rocky222Balboa said:
Sounds like the crnas do the tees during cases, cardiologists read and bill for them.
Click to expand...

Allowing a non physician to drive the machine is pretty ballsy too. Especially if you aren’t looking over their shoulder to catch all the stuff you want to take a closer look at but that they would just miss. TEEs have traumatized and killed people too.

It just blows my mind. Our specialty is plagued with people who take no pride in being a physician or their work.
 
T-burglar said:
Allowing a non physician to drive the machine is pretty ballsy too. Especially if you aren’t looking over their shoulder to catch all the stuff you want to take a closer look at but that they would just miss. TEEs have traumatized and killed people too.

It just blows my mind. Our specialty is plagued with people who take no pride in being a physician or their work.
Click to expand...

Probably older guys who no longer give any fux about the future and just want to get that retirement check and run
 
Twiggidy said:
Probably older guys who no longer give any fux about the future and just want to get that retirement check and run
Click to expand...

According to what they’re writing on that forum, this is happening in crna only groups. Their forum is from 2013 so imagine it has been going on for some time.
 
Rocky222Balboa said:
According to what they’re writing on that forum, this is happening in crna only groups. Their forum is from 2013 so imagine it has been going on for some time.
Click to expand...

So it's likely cardiologists teaching the CRNAs how to get the images and then the cardiologist reads the exam later.
 
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