Peds fellowships

[Ravenclaw90]

What are some peds fellowships that have high acuity and case numbers? I know about CHOP, Boston Children’s and Texas Children’s, but can anyone vouch for other programs? I am just beginning the process of research. Thanks in advance for pointing me in the right direction.

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[Consigliere]

CHOP, Boston Children’s and Texas Children’s

 

[GassYous]

CHOP, Boston Children’s and Texas Children’s

 

[Ravenclaw90]

Amazing!

 

[abolt18]

Cincinnati?

 

[2010houston]

CHOP, Boston Children’s , Texas Children’s.

Lurie / Northwestern, Cincinnati, Seattle, Pitt, Children’s national DC.

 

[btbam]

Egleston (Emory)

 

[Justice4all]

Stanford

 

[2Fast2Des]

Pittsburgh?

 

[JiPo]

https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2020/10/430_MRS.pdf

Out of 58 programs, 32 of them went unfilled. This is likely due to the fact that the "top" pediatric programs also tend to be the biggest programs in terms of size. You will be fine going to any of the programs mentioned here, and will likely end up at one of them as long as you do not have a serious red flag.

 

[Justice4all]

And most of the top programs suffer from case dilution among the fellows.

 

[deleted697127]

And most of the top programs suffer from case dilution among the fellows.

I can’t imagine this is true at Boston children’s CHOP or Stanford

 

[btbam]

I can’t imagine this is true at Boston children’s CHOP or Stanford

Doesn't Boston have 16 fellows a year? Hard to imagine there's that many good cases going around every day.

 

[Justice4all]

For fellowship, it’s about repetition with the typical cases and not zebras. Those top places have their positives and each individual needs to decide how each programs will help them in achieving their goals. The faculty at those places are top notch and will be great mentors.

 

[Wolverines83]

Yeah with bigger programs (including some already mentioned in this thread )you need to be very careful of case dilution. It's real. Don't be wowed by big names, make sure to dig into the details. A good hospital (by whatever metric you use to evaluate) does not necessarily equate to a good fellowship.

Who does the lines? How many "super fellows" are there? Who does the blocks? How many of case x y z do you get? Do the faculty know who you are? What are post call days like?

I guess it's like evaluating residencies all over again in that way.

 

[ambiturner]

The top programs do have dilution of index cases - at the programs with greater than 10 fellows generally at least one will graduate without doing a TEF, or myelomeningocele, etc. However, these programs also have much higher sick neonate volume. I did WAY more sick neonates as a fellow at a large program than my current fellows do at a smaller one. I also saw much more complex pathology in general in the older patients, more difficult airways, etc.

The superfellow issue is a real one though, particularly for regional. The best way to get this information is talking to current fellows but there are programs where the peds fellows do a minority of the blocks.

 

[Wolverines83]

Off the top of my head, two other solid programs that seem to fly under the radar somewhat would be University of Michigan (no I didn't go there! But I was very impressed during my interview) and Riley Children's in Indianapolis. Both really kick ass programs top to bottom from what I could tell.

And any list that doesn't include Cincinnati is wrong. Again, not on either coast but those "in the know" know that it's great.

 

[Justice4all]

There are solid 20-25 solid pediatric fellowships around the country. Rest needs to be shutdown.

 

[JoelJoel84]

There are solid 20-25 solid pediatric fellowships around the country. Rest needs to be shutdown.

I would reduce that to 10-15.

If you're not doing sick neonates, cardiac w CPB, and enough of those (albeit rare) 'index' cases several times each week, I don't think you're being properly trained as a pediatric anesthesiologist.

And even if, like myself, you decide not to end up working at a tertiary Children's Hospital with those kinds of patients or sick kids in general, you still need that background to help you care for the healthier ones.

Program expansion has become way too diluted, with many programs basically a continuation of residency as an extra year of tonsils, hernias, and circs. And even if that's your career plan, you need to know the rest of the pediatric anesthesia field.

I had no interest in OB during residency, and don't do any now, but we'd never consider an anesthesia program valid if it didn't include those painful months and nights of training.

 

[ToKingdomCome]

I would reduce that to 10-15.

If you're not doing sick neonates, cardiac w CPB, and enough of those (albeit rare) 'index' cases several times each week, I don't think you're being properly trained as a pediatric anesthesiologist.

And even if, like myself, you decide not to end up working at a tertiary Children's Hospital with those kinds of patients or sick kids in general, you still need that background to help you care for the healthier ones.

Program expansion has become way too diluted, with many programs basically a continuation of residency as an extra year of tonsils, hernias, and circs. And even if that's your career plan, you need to know the rest of the pediatric anesthesia field.

I had no interest in OB during residency, and don't do any now, but we'd never consider an anesthesia program valid if it didn't include those painful months and nights of training.

Are no OB practices hard to find ?

 

[u0457738]

Hoping to revive this thread for fellowship year 2022-2023 cycle. I haven't used these forums in the past but it seems like the best option to chat with other prospective fellows with similar interests across the country. How are the interview invites coming along? I feel like they are just getting started... Ive heard from Texas Childrens, Cincinnati and Michigan so far.
Anybody heard if programs have seen an increase in applications with the virtual interview format or in the setting of Covid?
Good luck to everyone!

 

[Maverick13]

The big 3 - TCH, CHOP, BCH. The next 3 - Cincy, Seattle, Childrens National. But if looking for a smaller size - Duke. Only 2 fellows per year, but also medium sized residency program, so plenty of cases to go around. Get plenty of neonates, + cardiac cases every week (as opposed to a month at a time), more than the national average in lines. Excellent didactics and wonderful staff.

 

[Wolverines83]

Don't evaluate a program based on name or perceived reputation. Evaluate it based on actual case numbers, acuity, number of fellows and presence of superfellows. And ask attendings you respect what their opinions are. You'll be surprised at their responses. People who know what they're talking about (your future peers and future employers) know which programs are riding their name and which programs train fellows properly.

 

[Pedsanes]

Hoping to revive this thread for fellowship year 2022-2023 cycle. I haven't used these forums in the past but it seems like the best option to chat with other prospective fellows with similar interests across the country. How are the interview invites coming along? I feel like they are just getting started... Ive heard from Texas Childrens, Cincinnati and Michigan so far.
Anybody heard if programs have seen an increase in applications with the virtual interview format or in the setting of Covid?
Good luck to everyone!

I wonder if the programs are interviewing more people given the reduced costs of doing so with the virtual format. Is there third party objective data for those of us that don't have a ton of peds staff to talk to?

 

[Morzh]

I wonder if the programs are interviewing more people given the reduced costs of doing so with the virtual format. Is there third party objective data for those of us that don't have a ton of peds staff to talk to?

As you get further along in the med school --> residency --> fellowship --> job journey, the world becomes much smaller and there's less public data available to "do your research" with.

My PD says applications are slightly up in volume this year, but not dramatically. They know, historically, about how many people they need to interview to have a successful match and they plan on interviewing roughly around that number like they do every year.

Honestly if you want a peds fellowship and are willing to apply and interview broadly then you will almost certainly get a spot somewhere. So many unfilled spots the past few years.

It's actually become somewhat of a crisis in the peds anesthesia world because so many new fellowships have opened in the last decade or so, and many long standing programs have expanded the number of spots they offer. We are producing a little over 200 new fellowship grads each year nationally, however only ~60-75 academic FTE positions are opening annually. There's plenty of private practice jobs looking for pedi trained people, of course, but the vast majority of these are split practices where you only do peds maybe 30% of the time (and likely not the big "fellowship-level" cases that are done at the major children's hospitals). That means about 2/3 grads are not entering primarily pediatric anesthesia jobs. A lot of pedi-trained people are happy to maintain their adult skills, too, but at some point when you are only doing peds one or two days each week (and they're generally healthy, older kids) you start wondering what the point of doing the fellowship was in the first place and if it was worth the sacrifice and lost income.

 

[Pedsanes]

Thanks. I figured that would be the answer about available data. In the application process so far I've kind of felt the "small world phenomenon" when prior colleagues reached out to me after I submitted an app to a program of which they were an alumni or are currently going through. Is there a list of unfilled programs at least? Is there any sort of benchmark to gauge competiveness based on interview offers vs. applications? In discerning programs should I value a name or location where I would like to settle more? I have an idea, but I would value other's inputs.

 

[Morzh]

The top-5ish big name places will always be competitive, and, as usual, in order to match at these types of places you'll probably need some combination of high ITE scores (top 25%tile), reputable residency program, glowing letters of recommendation, demonstration of work ethic and academic interest, and social charisma. And then there are other programs that you are almost guaranteed to match so long as you have a pulse and are willing to be the cheap labor they're looking for for one year. To my knowledge there is no publicly available and accurate list of specific programs that go unfilled each year. Some, but certainly not all, available positions get posted on the SPA website.

As far as how evaluate programs: it's a similar decision making process to residency ranking. Exposure to high volume/acuity/complexity cases is desirable with a good mix of the stuff exlusive to peds like NICU emergencies and complex syndrome kids. No program is perfect, and even at the biggest places some things in peds are just rare and it's not like you'll being seeing more than a handful of severe CDH, TEF, sacral teratomas, etc. in a one-year fellowship. Skill and comfort with pediatric regional anesthesia is rapidly becoming more and more desirable, and there's a lot of variability between programs in regional experience, so that's something else to look for. Location is obviously personal, but in general if you know where you want to eventually practice it's a good idea to train in that geographic area (all other things being equal).

Lastly, not all "big name" programs are as good as you may think (some are coasting on their reputation), and some lesser known ones are definitely hidden gems. I think it's also important, especially in pediatric anesthesia, to have the right departmental cultural balance of supervision / autonomy / conditional independence. There's a sizeable cohort of peds anesthesiologists who can be pretty extreme with their obsessive degree of high-anxiety / micromanagent, and unfortunately a lot of these types end up in academics. After the first few months of fellowship it can be really difficult (and not very educational) to work with these faculty as they will treat everyone they supervise (be it CA-2, fellow, or experienced CRNA) like it's their first day in the OR. That kind of stuff is tough to tease out as an applicant, but you should be able to find a few clues as you interview and ask around about specific places.

 

[u0457738]

As you get further along in the med school --> residency --> fellowship --> job journey, the world becomes much smaller and there's less public data available to "do your research" with.

My PD says applications are slightly up in volume this year, but not dramatically. They know, historically, about how many people they need to interview to have a successful match and they plan on interviewing roughly around that number like they do every year.

Honestly if you want a peds fellowship and are willing to apply and interview broadly then you will almost certainly get a spot somewhere. So many unfilled spots the past few years.

It's actually become somewhat of a crisis in the peds anesthesia world because so many new fellowships have opened in the last decade or so, and many long standing programs have expanded the number of spots they offer. We are producing a little over 200 new fellowship grads each year nationally, however only ~60-75 academic FTE positions are opening annually. There's plenty of private practice jobs looking for pedi trained people, of course, but the vast majority of these are split practices where you only do peds maybe 30% of the time (and likely not the big "fellowship-level" cases that are done at the major children's hospitals). That means about 2/3 grads are not entering primarily pediatric anesthesia jobs. A lot of pedi-trained people are happy to maintain their adult skills, too, but at some point when you are only doing peds one or two days each week (and they're generally healthy, older kids) you start wondering what the point of doing the fellowship was in the first place and if it was worth the sacrifice and lost income.

I feel like there was an early batch of interview invites at a few good programs but that many other programs are holding...? Anyone had interview invites come in from the west coast yet? I heard a rumor that several programs had agreed to wait until a certain date to send out interview invites?... Anyone in the same boat as me?

 

[Pedsanes]

I feel like there was an early batch of interview invites at a few good programs but that many other programs are holding...? Anyone had interview invites come in from the west coast yet? I heard a rumor that several programs had agreed to wait until a certain date to send out interview invites?... Anyone in the same boat as me?

Mixed on my end. One of the first programs I heard from was West Coast, but also the only program I haven't heard from is West Coast. Not even the perfunctory email review of application/ITE/board exam email which makes me think they haven't started reviewing.