Regional Anesthesia Fellowship

[serenity]

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Dear forum members,
I am planning to do a fellowship in regional anesthesia
What are your views on this fellowship and which are good places to apply to,especially in North east
Thanks
Serenity

 

[Planktonmd]

Dear forum members,
I am planning to do a fellowship in regional anesthesia
What are your views on this fellowship and which are good places to apply to,especially in North east
Thanks
Serenity

Why do you need a fellowship to do regional anesthsia?

 

[Gasworks]

http://gaswork.com/cgi-bin/ipbltview.exe?PostIDNum=7757

Thats the only one out there now.. in the spring there was a program in florida at an all ortho hospital offering a 6 month fellowship. If you really want to find something just call up the big joint hospitals around the country and ask... you'll be suprised how many places would love to hire a licensed anesthesiologist to run around and put in blocks all day for $35,000 a year.

 

[eagle0990]

Actually, If you look at the ASRA website (asra.com) there are over a dozen available regional fellowships. The reason you do a regional fellowship is due to a clinical interest in the subspecialty. In addition, If your interested in an academic practice having a fellowship under your belt will help. People could ask why do any non-acgme approved fellowship(neuro, regional, OB). Any well trained anesthesiologist should be able to do these cases, but the answer is the same(see above).

eagle

 

[loveumms]

Penn State has a regional fellowship - when compared to the program I went to med school at, we do WAY more regional procedures but, I don't know how many are a huge number. The fellow is involved in all the regional procedures (both peds and adults) and they also take .3 attending call (which means they get paid .3 of the attending salary).

 

[DireWolf]

HSS
Duke

 

[VentdependenT]

Iowa
Virgina Mason
Duke for sure

 

[Dejavu]

Mayo Clinic Rochester also has one.

 

[DreamLover]

I swore when I interviewed at Dartmouth I had lunch with a regional fellow

 

[UNEOSTEO]

St. Luke's-Roosevelt, NYC
HSS
UCSD
Columbia

 

[sbmed100]

Why do you need a fellowship to do regional anesthsia?

Having done a fellowship in regional, I can provide you with a couple of reasons:

1) you won't need a block room because you are so fast at what you do
2) you are exceedingly marketable to private practice groups (ask around if you don't believe me)
3) you join a group with 'something to offer' them instead of being just the 'new guy'
4) ALL your blocks work because you 'MAKE them work' as fellowship will teach you
5) you draw oohs and ahhs as surgery is performed without an LMA or ETT
6) the PACU nurses become your biggest fans
7) the patients 'who got sick from general last time' are your second biggest fans
8) the surgeons who 'thought you would slow them down' become your third biggest fans as they witness how you can provide effective anesthesia at least as fast or faster then GA
9) you increase your group's income (and your partners love you) because they can now bill for post-operative pain blocks that were done in additional to the primary anesthetic (i.e. popliteal block for ankle surgery in addition to the spinal)
10) you place the epidural/spinal that no-one else can as 'the new guy'
11) you learn during your fellowship how to manage complications, how to avoid them in the first place, how to deal with patient expectations, surgeons expectations, etc.
12)if a problem does arise, you have a piece of paper that says you are an expert in regional anesthesia and that does count for something in a court of law
13) you will become facile with ultrasound guided blocks which will probably become the standard of care 'sometime' in the future and your partners who don't know how to do it will ask you to teach them
14) you learn how to place catheter infusions for postoperative pain and how to set up home catheter programs where patients go home with their pain pumps
15) when surgeons ask your group if they are capable of doing xyz you can say yes I am capable of doing xyz and not "gee, I'm not really comfortable doing that, lets just do GA"
16) doing a fellowship will give you a jump on the future of anesthesia 😉

 

[Planktonmd]

Having done a fellowship in regional, I can provide you with a couple of reasons:

1) you won't need a block room because you are so fast at what you do
2) you are exceedingly marketable to private practice groups (ask around if you don't believe me)
3) you join a group with 'something to offer' them instead of being just the 'new guy'
4) ALL your blocks work because you 'MAKE them work' as fellowship will teach you
5) you draw oohs and ahhs as surgery is performed without an LMA or ETT
6) the PACU nurses become your biggest fans
7) the patients 'who got sick from general last time' are your second biggest fans
8) the surgeons who 'thought you would slow them down' become your third biggest fans as they witness how you can provide effective anesthesia at least as fast or faster then GA
9) you increase your group's income (and your partners love you) because they can now bill for post-operative pain blocks that were done in additional to the primary anesthetic (i.e. popliteal block for ankle surgery in addition to the spinal)
10) you place the epidural/spinal that no-one else can as 'the new guy'
11) you learn during your fellowship how to manage complications, how to avoid them in the first place, how to deal with patient expectations, surgeons expectations, etc.
12)if a problem does arise, you have a piece of paper that says you are an expert in regional anesthesia and that does count for something in a court of law
13) you will become facile with ultrasound guided blocks which will probably become the standard of care 'sometime' in the future and your partners who don't know how to do it will ask you to teach them
14) you learn how to place catheter infusions for postoperative pain and how to set up home catheter programs where patients go home with their pain pumps
15) when surgeons ask your group if they are capable of doing xyz you can say yes I am capable of doing xyz and not "gee, I'm not really comfortable doing that, lets just do GA"
16) doing a fellowship will give you a jump on the future of anesthesia 😉

Wow,
You certainly have given that some thought haven't you?
So you really think that anesthesiologists who did not do a fellowship in regional do crappy blocks that frequently don't work, slow surgeons down, are hated by PACU nurses and their partners ?
I really hate to burst your bubble but you are wrong!
If you chose to do an extra year making $50000 and you think it's a good investment good for you but that doesn't make it the gold standard.

 

[Lonestar]

PlanktonMD is right. I will just make a comparison. In our peds dept we only have one guy who did a fellowship. He is certainly not the best but does ok. Some of the best guys did no fellowship. Experience helps a lot. I guess a regional fellowship would give experience that you would not get otherwise. In my opinion, my year would be best spent honing my regional skills by joining a group that does a lot of them and the partners are willing to show me the ropes. This fellowship crap is just another gimmick for slavery. Just my two cents.

 

[Mman]

Having done a fellowship in regional, I can provide you with a couple of reasons:


4) ALL your blocks work because you 'MAKE them work' as fellowship will teach you

Any block will work with two nasal airways and enough propofol.



that quote was provided to me by an attending at one of the best regional fellowships in the country

 

[urge]

Having done a fellowship in regional, I can provide you with a couple of reasons:

1) you won't need a block room because you are so fast at what you do
2) you are exceedingly marketable to private practice groups (ask around if you don't believe me)
3) '
4) ALL your blocks work because you 'MAKE them work' as fellowship will teach you
5) you draw oohs and ahhs as surgery is performed without an LMA or ETT
6) the PACU nurses become your biggest fans
7) the patients 'who got sick from general last time' are your second biggest fans
8) the surgeons who 'thought you would slow them down' become your third biggest fans as they witness how you can provide effective anesthesia at least as fast or faster then GA
9) you increase your group's income (and your partners love you) because they can now bill for post-operative pain blocks that were done in additional to the primary anesthetic (i.e. popliteal block for ankle surgery in addition to the spinal)
10) you place the epidural/spinal that no-one else can as 'the new guy'
11) you learn during your fellowship how to manage complications, how to avoid them in the first place, how to deal with patient expectations, surgeons expectations, etc.
12)if a problem does arise, you have a piece of paper that says you are an expert in regional anesthesia and that does count for something in a court of law
13) you will become facile with ultrasound guided blocks which will probably become the standard of care 'sometime' in the future and your partners who don't know how to do it will ask you to teach them
14) you learn how to place catheter infusions for postoperative pain and how to set up home catheter programs where patients go home with their pain pumps
15) when surgeons ask your group if they are capable of doing xyz you can say yes I am capable of doing xyz and not "gee, I'm not really comfortable doing that, lets just do GA"
16) doing a fellowship will give you a jump on the future of anesthesia 😉

I cannot agree with you in all of these. You talk like the old guys in private practice didn't do blocks. Let me brake you the news: they all went to a week-end course a couple of years ago and they are all doing blocks.


1 A fellowship will give you the regional experience of a 3 to 5 year out of residency attending(who does blocks on a regular basis). After this I'm pretty sure they can block someone as fast as anyone, fellowship or not.

2 Marketable- Yes, any fellowship trained person has an advantage over a generalist. At a high price, though.

3 ? Where did reason 3 go?

4 infallible blocks- Are you insane?

5 Oooh, aahs- that was 5 years ago... Blocks are fairly common now.

6 Pacu nurses best friend- that's a ******ed reason to do a fellowship.

7 pt don't get sick- I'll give you that. But keep in mid it is very easy to do tiva nowadays.

8 happy surgeons- Agree, due to reason #1. Experiece, experience, experience.

9 increase income for the group- OK. Only if they are not already doing post op pain blocks

10 difficult/spinal epidural- Maybe, if your fellowship includes a good number of spinal/epidurals. But then, how good of a regional fellowship is that where you do a bunch of neuroaxial instead of blocks?

11..... I'll give you that.

12..... I wouldn't be so sure of that.

13 ultrasound- Ultrasound makes blocks easier for people with limited experience. Not sure how it helps you out if it is helping your competition. Might make you more marketable if they are hiring you with the expectation that you will teach the other guys. This in turn will pis you off since they are getting trained for free.

14 catheters- I'll give you that. I'm not sure if you really want to send home people with a LA drip, though. Not me!

15.... Yes, you'll be able to do advanced blocks. The benefit from them over an epidural is unclear.

16 jump start- gives you experience in regional. At a pretty high cost. You could have sent your bother to Harvard, or bought a condo/car with the amount of money you lost.


I only see 3 good reasons to do a regional fellowship:

1 academics
2 private practice- if group you are looking at will only hire regional fellows
3 personal satisfaction-for whatever reason(having more experience, doing advanced blocks,..., or having an extra paper on the wall.)

 

[OldManDave]

I swore when I interviewed at Dartmouth I had lunch with a regional fellow

You did. Dartmouth has a regional fellowship that is 6mos & tied with a Jr faculty slot for the other 6mos --> net income ~$100,000 for the year. And, it is virtually 100% ultrasound based...for better or for worse. Personally, I think much to the better.

 

[apellous]

anyone know where to find these programs, when to apply, and how to get an application?


thanks.

Interested in regional and hearts. not sure which to do. would like to do 6 months of each in a fellowship. anyway thanks for the info.

 

[Ferdie]

Wisconsin-Madison has a regional fellow this year. Similar to at Dartmouth - 1/2 time regional fellow, 1/2 time attending (and the pay reflects this). He has a really sweet gig... almost all u/s based also

 

[purplepumpkins]

Dear forum members,
I am planning to do a fellowship in regional anesthesia
What are your views on this fellowship and which are good places to apply to,especially in North east
Thanks
Serenity

In reponse the the question....
Whether or not you decide to do a regional fellowship might depend on how much regional training you received during your residency AND/OR whether or not you plan to do academics and therefore may like to have some fellowship training. Also, I know of at least 2 large private practice groups in the northeast that required their faculty to have had a fellowship completed before working with them....maybe another reason to do a fellowship of regional or otherwise.

I think regional "fellowships" are popping up all over the place. Some may have more meat to them then others. You need to decide what type of training you want from the fellowship before you can find a "good" one. Do you want mostly u/s, mostly out of the ordinary blocks, mostly blind, lots of catheters etc etc etc......... Most of these positions come coupled with some attending responsibility to make the fellowship year gentler.

I would say to look at the asra fellowship list and contact some of those places. Ask to speak with their fellows and figure out if its the kind of experience your looking for before wasting too much time interviewing etc. Thats precious time to spend when youre a resident!

Good luck with whatever you decide....

 

[350Z]

.

 

[monchi]

I'm doing a regional fellowship myself next year.
Here's a short list, there's more on the ASRA website:

Hospital for Special Surgery (HSS, in Manhattan) (Takes up to 6)
Columbia
NYSORA (Takes one)
Penn State
Pittsburgh (takes up to 6)
Duke
Wake Forest
Dartmouth
Gainesville, FL
Iowa
Virginia-Mason (in Seattle)
Utah
Toronto

These all have good reps. Penn State, Wake Forest, Dartmouth have part-time attending spots, so you are paid more.
Regional is not accredited, so you usually can moonlight to make more $$.

How to apply?
Every place has their own application. It's a pain in the ass, so I limited myself to the five I thought were the best. It's not cheap either, since you'll need to send a USMLE transcript to each. Information on applications are on each program's website.

Will you need it? No. There are lots of reasons to do one, and not to. It's a personal decision.

 

[sevoflurane]

I'm doing a regional fellowship myself next year.
Here's a short list, there's more on the ASRA website:

Hospital for Special Surgery (HSS, in Manhattan) (Takes up to 6)
Columbia
NYSORA (Takes one)
Penn State
Pittsburgh (takes up to 6)
Duke
Wake Forest
Dartmouth
Gainesville, FL
Iowa
Virginia-Mason (in Seattle)
Utah
Toronto

These all have good reps. Penn State, Wake Forest, Dartmouth have part-time attending spots, so you are paid more.
Regional is not accredited, so you usually can moonlight to make more $$.

How to apply?
Every place has their own application. It's a pain in the ass, so I limited myself to the five I thought were the best. It's not cheap either, since you'll need to send a USMLE transcript to each. Information on applications are on each program's website.

Will you need it? No. There are lots of reasons to do one, and not to. It's a personal decision.

One of the three you mention is my home program. Working 1/2 time as an attending and 1/2 as regional fellow is great if you want to make >100k while getting the regional experience.

That being said, I think that if you go to a residency that does a lot of ortho/regional it may be worth it to just jump into PP. That is what my wife and I did and we are now the ones teaching USD guided blocks to our group.
My 2cents. 🙂

 

[staydin]

I am curious, would it be possible for a PMR background, pain management trained (who trained in an anesthesia based acgme-pain fellowship) be able to do a regional anesthesia fellowship?

 

[amyl]

CCF has a regional fellowship.... i think it is somewhat flexible depending on circumstances regarding the 6 months to a year. two people in my class are actually doing a whole year and splitting it between regional and OB.
as a med student interviewing there dartmouth seemed strong in regional...

 

[epidural man]

10) you place the epidural/spinal that no-one else can as 'the new guy'

Ummm...where did you do a fellowship? I don't think this is the case at all...but I might be wrong. The conversation usually goes like this...."Well fellow, what anesthetic should we provide this patient?" At this point, the resident pipes in...."How about just do a spinal? That is the most cost effective anesthetic, works every time almost, is fast, easy, and really great!" The staff then pipes in again..."RESIDENT...YOu are ******ED! You FAIL for the day. Fellow, please answer the question for this stupid, stupid resident." Fellow then replies, "I think bilateral sciatic catheters, either anterior or posterior approach, will work and we can do single shot saphenous blocks, probably we can use the modified vastus medialis approach, and then up above, lets do bilateral TAP catheters. All under ultrasound of course!" And then the regional staff just beams and is so proud of his groomed fellow.


16) doing a fellowship will give you a jump on the future of anesthesia 😉

I agree....people should do fellowships - just my opinion given the current status and environment of the anesthesia work force.

 

[epidural man]

Dear forum members,
I am planning to do a fellowship in regional anesthesia
What are your views on this fellowship and which are good places to apply to,especially in North east
Thanks
Serenity

UCSD has a great regional fellowship. Although Mariano is no longer there, his legacy remains. I know one of the fellows there now. She really likes it.

 

[350Z]

http://forums.studentdoctor.net/showthread.php?p=10717684#post10717684

 

[desflurane]

I am curious, would it be possible for a PMR background, pain management trained (who trained in an anesthesia based acgme-pain fellowship) be able to do a regional anesthesia fellowship?

No.

 

[sevo85288]

I am a partner in a 22 member group. It is a MUST in our group for new hires to be regional anesthesia trained, preferably with ultrasound. We will NOT hire anyone who does not know how to place blocks, efficiently and quickly. It is a must in today's practice, pt's/surgeons are asking for it. We have one fellowship trained regional guy and will love to have more.

 

[anesval]

any other programs besides CCF that have split OB/Regional option for fellowship?

 

[nsinha81]

Im applying for Regional Pain Fellowship. I understand it is becoming more competitive and there are very few programs out there. Can anyone tell me what kinds of interview questions I can be asked. Also what are programs looking for in selecting someone for their regional pain fellowship. Thanks.

 

[nap$ter]

i

Having done a fellowship in regional, I can provide you with a couple of reasons:

1) you won't need a block room because you are so fast at what you do
2) you are exceedingly marketable to private practice groups (ask around if you don't believe me)
3) you join a group with 'something to offer' them instead of being just the 'new guy'
4) ALL your blocks work because you 'MAKE them work' as fellowship will teach you
5) you draw oohs and ahhs as surgery is performed without an LMA or ETT
6) the PACU nurses become your biggest fans
7) the patients 'who got sick from general last time' are your second biggest fans
8) the surgeons who 'thought you would slow them down' become your third biggest fans as they witness how you can provide effective anesthesia at least as fast or faster then GA
9) you increase your group's income (and your partners love you) because they can now bill for post-operative pain blocks that were done in additional to the primary anesthetic (i.e. popliteal block for ankle surgery in addition to the spinal)
10) you place the epidural/spinal that no-one else can as 'the new guy'
11) you learn during your fellowship how to manage complications, how to avoid them in the first place, how to deal with patient expectations, surgeons expectations, etc.
12)if a problem does arise, you have a piece of paper that says you are an expert in regional anesthesia and that does count for something in a court of law
13) you will become facile with ultrasound guided blocks which will probably become the standard of care 'sometime' in the future and your partners who don't know how to do it will ask you to teach them
14) you learn how to place catheter infusions for postoperative pain and how to set up home catheter programs where patients go home with their pain pumps
15) when surgeons ask your group if they are capable of doing xyz you can say yes I am capable of doing xyz and not "gee, I'm not really comfortable doing that, lets just do GA"
16) doing a fellowship will give you a jump on the future of anesthesia 😉

i can do all of this - without a regional fellowship. regional fellowships are moneymakers for academic depts. and an easy way for lazy faculty to get publications. you don't need a fellowship to be a regional guru if you work hard in residency.

i did a peds fellowship...

 

[chmd]

i


i can do all of this - without a regional fellowship. regional fellowships are moneymakers for academic depts. and an easy way for lazy faculty to get publications. you don't need a fellowship to be a regional guru if you work hard in residency.

i did a peds fellowship...

I also think this is true. But a fellowship is proof that you can do all of this and I think it makes getting the job you want easier. I would think in the near future everyone will receive good enough residency training that you wont need the proof though.

 

[Consigliere]

Im applying for Regional Pain Fellowship. I understand it is becoming more competitive and there are very few programs out there. Can anyone tell me what kinds of interview questions I can be asked. Also what are programs looking for in selecting someone for their regional pain fellowship. Thanks.

It's becoming competitive only because there are less programs out there. And there are less programs out there because doing a regional fellowship is completely unneccessary. You can learn the requisite blocks after residency AND, more importantly, bundled payments are coming very soon so it won't behoove you to do a bunch of esoteric blocks cuz' buddy....you ain't getting paid.

 

[Magnus67]

I would only do a regional fellowship if u have a real academic interest or if you have a job lined up with a group that specifically wants you to be regional fellowship trained. Otherwise you are are sacrificing lots of your life for little gain. By the way I did cardio thoracic fellowship, it definitely got me the job I wanted, and my partners and I do tons of regional and catheters.

 

[shaz8901]

Hi I was interested in doing a regional fellowship, I am a CA-2. I was wondering if people who did fellowships could comment on good ones and what I should look for in fellowship? Searched around and didn't get alot of info. I have heard of Upitt and Duke as good programs. I have done an adequate amount of blocks during my residency and I have put in a few PN-catheters too. But, definitely not enough to join a busy Ortho heavy private practice which is what kind of gig I am looking for. Any body know of good fellowships programs that would help me get a great experience because I don't want to go through another year with a resident salary for no reason (I have a wife and a child). Thanks

 

[Brookstacular]

Hi I was interested in doing a regional fellowship, I am a CA-2. I was wondering if people who did fellowships could comment on good ones and what I should look for in fellowship? Searched around and didn't get alot of info. I have heard of Upitt and Duke as good programs. I have done an adequate amount of blocks during my residency and I have put in a few PN-catheters too. But, definitely not enough to join a busy Ortho heavy private practice which is what kind of gig I am looking for. Any body know of good fellowships programs that would help me get a great experience because I don't want to go through another year with a resident salary for no reason (I have a wife and a child). Thanks

I'd look at Virginia Mason if you want to bridge academics and private practice efficiency. Plus, Seattle is a great city to live in.

 

[Noyac]

I am curious, would it be possible for a PMR background, pain management trained (who trained in an anesthesia based acgme-pain fellowship) be able to do a regional anesthesia fellowship?

What for?

 

[Noyac]

A regional fellowship is the ultimate waste of time in my opinion.

 

[OB1🤙]

Why pay $250-350K in opportunity cost to learn procedures you can learn just as well on Youtube? Or have colleagues teach you?

I didn't learn TAP blocks, fascia iliaca blocks, paravertebrals, or adductor canal blocks in residency. Learned these on the job either by watching colleagues or finding online resources. Med school should teach you the anatomy, and residency should teach you how to work an ultrasound and block needle, and any accredited residency should get you facile with the basic blocks (interscalene, supraclavicular, axillary, femoral, pop/sciatic, ankle) that you will use in 95% of cases needing regional. No need to cost yourself attending salary for a year for this.

 

[GaseousClay]

In my residency we do around 250-300 blocks. Put in tons of catheters as well. We mainly do Infraclav, interscalene, pop, fem, adductor, rarely supraclav or axillary. Fellows mainly do the paravertebrals but you get to do enough to learn. I agree with Hawaiian that the other blocks you can def learn on your own

 

[BLADEMDA]

In my residency we do around 250-300 blocks. Put in tons of catheters as well. We mainly do Infraclav, interscalene, pop, fem, adductor, rarely supraclav or axillary. Fellows mainly do the paravertebrals but you get to do enough to learn. I agree with Hawaiian that the other blocks you can def learn on your own

TAP blocks??

 

[GaseousClay]

TAP blocks??

We do tap and some intercostal blocks never seen any fascia iliaca blocks though

 

[IlDestriero]

You have 1.5 years to focus on block skills. Don't do a fellowship.

 

[Tee Cell]

I actually think it's a good idea not because you learn a new skill set (because you can learn it all in practice if you didn't in residency), but because having it on your CV might give you 1 more interview than the next guy and depending on where you live that's an advantage in a tight market.

 

[IlDestriero]

I actually think it's a good idea not because you learn a new skill set (because you can learn it all in practice if you didn't in residency), but because having it on your CV might give you 1 more interview than the next guy and depending on where you live that's an advantage in a tight market.

I'd rather have the extra $300k and put in my cover letter and/or CV how I did extra block time and did 2x, 4x, 8x or whatever times the required block numbers during residency. If you want, you could even list the blocks you are experienced and competent in placing. There really aren't that many to cover 99% of your patients.

 

[Noyac]

I'd rather have the extra $300k and put in my cover letter and/or CV how I did extra block time and did 2x, 4x, 8x or whatever times the required block numbers during residency. If you want, you could even list the blocks you are experienced and competent in placing. There really aren't that many to cover 99% of your patients.

Oh how true.
I recently interviewed a guy that came in and was no frills. He said I can do about 5 blocks real good. And those blocks cover 99% of the body. He didn't need US but could use it if necessary. I'm not saying this is how we should be or what we should be looking for but at the same time I completely understood where he was coming from. He had been around the block and knew how to do a very good anesthetic in a very efficient manner.
Those 5 blocks:
Interscalene
Infraclavicular
Axillary
Femoral
Sciatic (includes the popliteal)
So it's probably not 99% of the body but you get the point.

Personally, I think a regional fellowship would be somewhat fun to do if I were young but no way I would waste my time. I have to agree with the above, you would get so much more out of a very busy private group than a regional fellowship.

 

[BLADEMDA]

Regional fellowship sets you up for an academic career which looks better than many AMC jobs.

 

[Noyac]

You have a point there.

 

[nap$ter]

I actually think it's a good idea not because you learn a new skill set (because you can learn it all in practice if you didn't in residency), but because having it on your CV might give you 1 more interview than the next guy and depending on where you live that's an advantage in a tight market.

if a new grad interviews at my pp group c a regional fellowship it would not be an edge. it might even be a negative - why didn't this grad learn blocks/confidence during residency? that is an expensive addition to your CV. 300+K early in your career is worth far more than 300+K later in your career.

for academia, yes.