Peds Anesthesia Fellowship to be Two Years?

[deleted50478]

Pretty much every academic job (and a lot of hospital based jobs) I ran across this year were only seeking fellowship trained people. Wouldn't be surprised if before too long the fellowship situation in anesthesia mimics radiology and it becomes a de facto 5 year residency

Nothing wrong with an optional second year. Nothing wrong with hiring those people if that's what they want as an individual department. The problem is forcing everyone to do an additional year with very limited value for academic preparation and no value for private practice. As has been said, training anesthesiologists to provide safer, better care for children is a valuable mission that shouldn't be looked down on by research-focused docs.

If a second year of fellowship has enough value, fellows will choose it and it won't have to be required at every program. Proponents of this change clearly know their idea is too weak to convince fellows so they don't want to give them any choice.

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[Psai]

Meanwhile...

Childrens Hospital at Vanderbilt

What a joke.

Vandy has always been overrun with midlevels doing things they shouldn't. Wouldn't go there.

 

[IlDestriero]

I did an away rotation and learned the program started a policy to only to hire fellowship-trained anesthesiologists for faculty positions. I wonder if this will soon be a common trend across all academic institutions.

I think it already is.
These big academic places don’t want generalists. They want people who will specialize in some field, engage in research in that field, lecture on that field, etc.
True generalists are seat fillers.
Even my specialty Pediatric hospital doesn’t want generalists. They want a 2, 5 and 10 year plan. That’s academia.

PS. As I mentioned above, and you probably know, many residencies and fellowships already have built in research years that anesthesia doesn’t. It’s not some radical decision.
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Il Destriero

 

[pgg]

I heard that last year there were ~170 peds fellow graduates and only 75 job openings at academic programs.

I’m not at all surprised that academic institutions are looking to hire only fellowship trained people. If market forces permitted it, nearly everyone would hire that top layer of graduates.

But this is something else entirely - they’re saying that fellowship trained people should only work at academic institutions, that the only reason a fellowship has value is if it lands the person an academic job. We give the ivory tower a lot of crap here, but it’s genuinely deserved in this case. This is a view that comes from an inbred, insular, self-licking-ice-cream-cone of a world that has forgotten that the primary purpose of academics is to produce graduates who leave and work somewhere else.

 

[HalO'Thane]

Wow suprised at the responses. I talked to the fellowship director at my program (an ivory tower) and he confirms that for many of the reasons stated above that this is likely going to be happening. They seem to be aware of the hit in applicaitons this will cause and everyone seems a-ok with it. I heard that last year there were ~170 peds fellow graduates and only 75 job openings at academic programs.

As many have said, there are hybrid private jobs out there but you probably doing need to be peds fellowship trained to do this type of job (but the fellowship would put your name to the top of the pile of applicants for sure.)

I also think this is the academicians basically forcing people to be more academic if they want this fellowship. Trust me when I say it- this is very 'Peds-y'- everyone in the general peds world loves to train forever.

Oh- and I also heard this will be done in conjunction with CT and pain moving to two years. Seems everyone will move the goal posts together.

I just don’t see how pediatric anesthesia will continue to attract the best and the brightest applicants if people are being forced to spend an extra two years after residency to obtain a pediatric job in which they will either be paid as much or possibly even less than their counterparts in general private practice (or cardiac or pain). They will be left with applicants who have no other viable options for work and are simply falling into pediatric anesthesia as a default. The whole idea of extending training to decrease the number of fellowship spots seems completely backwards. Why don’t the pediatric anesthesia programs just voluntarily cut back the number of fellowship spots that they currently have? They won’t because pediatric anesthesia fellows are much cheaper then either a CRNA or attending anesthesiologist. If pediatric anesthesia fellows with two years of fellowship training are truly more qualified and more desirable candidates then let the free market factors decide that. Don’t force people into an extra year of being underpaid and under appreciated or we will drive good applicants away from the specialty.

 

[GA8314]

I’m not at all surprised that academic institutions are looking to hire only fellowship trained people. If market forces permitted it, nearly everyone would hire that top layer of graduates.

But this is something else entirely - they’re saying that fellowship trained people should only work at academic institutions, that the only reason a fellowship has value is if it lands the person an academic job. We give the ivory tower a lot of crap here, but it’s genuinely deserved in this case. This is a view that comes from an inbred, insular, self-licking-ice-cream-cone of a world that has forgotten that the primary purpose of academics is to produce graduates who leave and work somewhere else.

I'm not sure I agree that people with fellowships are necessarily "top layer". I know plenty of reasonably weak residents to go on to fellowship. They gain valuable, extra skills, but does that make them strong all of the sudden? Perhaps in their specialty, but I'm not positive that one year translates over. Perhaps another year of maturation as a professional? But, don't think that doesn't happen in a busy PP environment as well....

 

[pgg]

I'm not sure I agree that people with fellowships are necessarily "top layer". I know plenty of reasonably weak residents to go on to fellowship. They gain valuable, extra skills, but does that make them strong all of the sudden? Perhaps in their specialty, but I'm not positive that one year translates over. Perhaps another year of maturation as a professional? But, don't think that doesn't happen in a busy PP environment as well....

I wondered if someone would take exception to that overly broad blanket statement of mine. Certainly the bell curves have always overlapped a lot - and I'm not talking anesthesiologist vs CRNA bell curves where the tails overlap. But I also believe that the curves will overlap less in the future.


The job market is weaker and more people are looking for fellowships to set themselves apart. Hospitals and groups have been on a credential creep kick for a while now. Cardiac is the obvious example. The people without a fellowship who've been doing hearts aren't incompetent. Yet since 2009 you can't get echo certified without the fellowship, and good luck to the new grads finding a place that will hire them or credential them to do hearts without a fellowship now. If you're not doing cardiac sans fellowship now, you won't be tomorrow.

These factors have increased competition for fellowship positions. There's no reason to believe that demand for fellowship slots will slacken. The resulting competition will ensure that the large majority of fellowship bound people are at least solid to begin with. I think the days when "plenty of reasonably weak residents" could ease into a fellowship is becoming an era where "few reasonably weak residents" are going to be able to do the same. At least, for peds pain and cardiac. CCM is kind of a special case given the tiny job market for anesthesiologist intensivists; maybe competition for those spots won't tighten up.

 

[DrZzZz]

I wondered if someone would take exception to that overly broad blanket statement of mine. Certainly the bell curves have always overlapped a lot - and I'm not talking anesthesiologist vs CRNA bell curves where the tails overlap. But I also believe that the curves will overlap less in the future.


The job market is weaker and more people are looking for fellowships to set themselves apart. Hospitals and groups have been on a credential creep kick for a while now. Cardiac is the obvious example. The people without a fellowship who've been doing hearts aren't incompetent. Yet since 2009 you can't get echo certified without the fellowship, and good luck to the new grads finding a place that will hire them or credential them to do hearts without a fellowship now. If you're not doing cardiac sans fellowship now, you won't be tomorrow.

These factors have increased competition for fellowship positions. There's no reason to believe that demand for fellowship slots will slacken. The resulting competition will ensure that the large majority of fellowship bound people are at least solid to begin with. I think the days when "plenty of reasonably weak residents" could ease into a fellowship is becoming an era where "few reasonably weak residents" are going to be able to do the same. At least, for peds pain and cardiac. CCM is kind of a special case given the tiny job market for anesthesiologist intensivists; maybe competition for those spots won't tighten up.

I agree with the direction of the market, but I'm not sure we're quite there yet. There are still plenty of jobs out there willing to hire non-fellowship trained docs to do cardiac. Especially if you can "prove" that your residency program provided you a strong enough background in cardiac to throw in a probe and get your views without hesitation. As for the academic centers - yea, good luck doing anything beyond B&B without a fellowship, but there are still some big centers out there hiring generalists if you're looking for an easy B&B gig.