Regional Fellowship

[regionalapplicant]

Hello,

I wanted to get everyone's opinion about a regional fellowship. Some are adamant that I do not need one - it is a waste of a year. I could get a job and make attending level salary and learn on the fly.

But I don't want to take it for granted that I can just go out there and get a job. Also what about the future? Does a regional fellowship offer some type of insurance for myself in the future?

Thanks!

-Possible regional applicant

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[Consigliere]

If you're gonna waste a year of your life, at least do a marketable fellowship: cardiac, critical care, peds, or pain. Regional fellowship!? Might as well do a transplant fellowship, or an OB fellowship, or a perioperative medicine fellowship, or whatever other horsesh_it, waste of time fellowships J-1 visa holders do to stay in the USA.

 

[ghastly75]

If you're gonna waste a year of your life, at least do a marketable fellowship: cardiac, critical care, peds, or pain. Regional fellowship!? Might as well do a transplant fellowship, or an OB fellowship, or a perioperative medicine fellowship, or whatever other horsesh_it, waste of time fellowships J-1 visa holders do to stay in the USA.

Agree with above- should be able to get necessary skills in residency, or learn as you go. We have this fellowship and it goes unfilled, the last fellow to do it was terrible...
Don't do this unless you have a dream job that is conditional upon completing this fellowship. Your choice , but there are much better ways to spend a year.

 

[IlDestriero]

-Do you suck at regional?
-Can you do a basic set of blocks if you can watch a YouTube video to refresh your memory first?
-Do you want an academic career in regional/acute pain?

Answer those 3 questions and you'll know what to do.


--
Il Destriero

 

[facted]

regional is super marketable, actually. And like anything in life, the more you do, the better you get. I can tell you for sure regional fellowship opened up a lot of doors for me. It's also a hybrid salary year usually and you can moonlight so financially, not all is lost.

 

[Aether2000]

It is rare in job advertisements for anesthesiologists that a requirement or even a desire for a regional fellowship. Most will specify "comfortable with regional" if there is a lot of regional to be performed.

 

[Gern Blansten]

There are much better ways to spend your year. I agree with all of the others.

 

[AdmiralChz]

Some random musings...

If you are very interested in regional, it can be worth it especially if you are interested in a more academic-minded career. Regardless I'd seek out a very strong program with an active and diverse acute pain program that does a large amount of catheter placements including home pumps. Also more exotic (but honestly more esoteric) like paravertebral blocks, lumbar plexus etc...

We have a strong regional shop here and our graduates either head to academics or go to private groups where they've started inpatient/home catheter programs. I think this is a very small and niche subset of physicians though. You have to be super motivated.

Finally regional fellowships are also popular since at many programs you can function as a junior attending and make more than double what other fellows do while getting extra training, as well as take faculty call. Helpful if you are waiting for a spouse to finish up training, for example. This is probably on its last legs as ACGME accredition is coming which largely prohibits such arrangements.

 

[deleted171991]

If you're gonna waste a year of your life, at least do a marketable fellowship: cardiac, critical care, peds, or pain. Regional fellowship!? Might as well do a transplant fellowship, or an OB fellowship, or a perioperative medicine fellowship, or whatever other horsesh_it, waste of time fellowships J-1 visa holders do to stay in the USA.

For the nth time: critical care is not marketable, not even in academia, at least not more than regional. Those times are over. To me marketable means you get a better deal than others, not that it's easier to get a job. Of course it's easier to get a job when you work more for the same money.

Most employers want to have their cake and eat it too. They want intensivists to work in the ICU for pay that's calculated for easier OR work and unadjusted to the longer ICU hours and everything else. Why? Because intensive care bills less than anesthesia, and they have IM intensivists who work for less than a general anesthesiologist.

No reason to waste a year on that subspecialty, except sheer dumb passion. Btw, I've met J-1 visa holders among critical care fellows, too.

 

[sevoflurane]

Why not do cardiac and split your time between cardiac and regional once in pp? It's basically what I do 80% of the time. 20% would be other areas like OB/trauma/neuro brain/spine /general.

Good mix and not stuck doing one thing.

 

[Mman]

Hello,

I wanted to get everyone's opinion about a regional fellowship. Some are adamant that I do not need one - it is a waste of a year. I could get a job and make attending level salary and learn on the fly.

But I don't want to take it for granted that I can just go out there and get a job. Also what about the future? Does a regional fellowship offer some type of insurance for myself in the future?

Thanks!

-Possible regional applicant

I'd agree with those that say it could be useful if you want to do it as an academic career. But that's probably about it. Doing a regional fellowship won't hurt you with job offers, but it might not offer much help either. We do a ton of regional and we can teach you on the job anything you don't already know how to do.

 

[GravelRider]

I think this is the first "should I do a regional fellowship" thread ever.

I used to think regional fellowships were silly because I did a lot of regional in residency. When I want to refresh myself on a block I don't do often, I brush up with Dr. YouTube. However, there seems to be a growing market for regional fellows in both academics and private practice. Hospitals like to see certificates. You should know the market you want to end up in. If I were to go back and choose a fellowship, I would choose cardiac, though.

I have come around to agreeing with @FFP on the critical care front. I've considered doing a critical care fellowship, but after doing a bit of "market research," I'm not convinced it is worth it. In most places it does not give you a salary differential and it arguably gives you a worse lifestyle (there are some exceptions to this, but not many). It just becomes another way for a large hospital system to work you. The intensivist market is growing rapidly, but if you have any notion of practicing both critical care and anesthesia, you are committing yourself to academics. I would do a regional fellowship over critical care...at least in current market conditions.

 

[Noyac]

Complete waste of time.

 

[kidthor]

I'm in academics so I've got that bias... but many of my friends who did regional fellowships have moved onto nice academic jobs that pure generalists (non-fellowship trained folks) would not have access to. Some are quickly made directors of regional anesthesia, for example... or at least part of the regional team. Others have moved onto private practice jobs that certainly would have been open to pure generalists.

So I think there's value in a regional anesthesia fellowship if you want to go into academia. It's certainly not a "wasted year" for those really interested in regional, especially given that many of the fellowships allow for hybrid attending time.

 

[waterbottle10]

Regional has become very popular lately. Some employers I heard from prefer regional fellows but not a requirement. The issue is if you do cards or peds, they'll prob put you in a lot of those cases. I wouldn't recommend pain if you just want to work in or...

 

[zebalong]

People are saying peds or cardiac.. but i heard that peds jobs are starting to dry up. Is cardiac still in heavy demand? I also have seen employers looking for regional fellows to help set up a block program in their practices.

 

[kidthor]

People are saying peds or cardiac.. but i heard that peds jobs are starting to dry up. Is cardiac still in heavy demand? I also have seen employers looking for regional fellows to help set up a block program in their practices.

Not true... there are plenty 50/50 peds/adults jobs in private practice and academia, and a decent number of 100% peds jobs at pure peds (mostly academic) hospitals too.

 

[Aether2000]

You could do a cardiac fellowship and do regional blocks on the cardiac patients (infraclavicular blocks for the a-line, pecs block for the sternotomy, adductor canal block for the vein harvesting, etc....)

 

[facted]

Regional fellowship is def marketable in the PP world in the NYC area. Granted, it's a saturated market. But it definitely opened doors and at both jobs I've been at, they were only looking for peds or regional trained people. Non fellowship trained were not entertained, no matter how comfortable you are with blocks.

Looking at it from a hiring perspective: if you could hire two equal candidates and one did an extra year of training and is better at blocks than the one who didn't, why on earth hire the generalist?

On the other hand, in the middle of nowhere USA, there is more demand than supply and I don't think a fellowship in anything is as useful.

ICU, OB are useless. Cardiac totally depends on where your end up but as cases keep moving to less invasive cardiac procedures, there are fewer and fewer cardiac attendings doing tons of cardiac. You become the sick patient anesthesiologist. That may be what you're looking for, but be aware. Peds can be marketable but depending on how much you want to do, you might be tying your hands when it comes to jobs.

 

[sevoflurane]

I don't think regional is a terrible idea (although I never did a fellowship). We are very ortho heavy and have a select group of docs who can place a reliable interscalene and sciatic catheters between cases. Those with a lot of experience or those with fellowships do the best. We were recently recruiting and one of those positions has been filled by a fellowship trained regional guy.

In the end, it really depends on your experience and the job you are taking. Learning how to place catheters on the job is not going to earn you extra points when your competitor has the fellowship.

 

[Mman]

You could do a cardiac fellowship and do regional blocks on the cardiac patients (infraclavicular blocks for the a-line, pecs block for the sternotomy, adductor canal block for the vein harvesting, etc....)

I'm sorry, are you seriously suggesting doing those blocks on a patient for a heart? Like actually doing it and not just mental masterbation?

 

[IlDestriero]

Not true... there are plenty 50/50 peds/adults jobs in private practice and academia, and a decent number of 100% peds jobs at pure peds (mostly academic) hospitals too.

The 100% peds jobs at children's hospitals are definitely tighter than a few years ago. Everyone did the post recession expansion when Obamacare didn't destroy medicine as we know it and now hiring is more limited.
Iowa is hiring though if that's your thing. People are still getting jobs, but it's a sellers market.


--
Il Destriero

 

[CriTICAL]

theres value in any fellowship imho all depends on what your goals are, but dont do a fellowship just because u think it will somehow make your CV look better because then thats worthless and yr of wasted income

like Echo and want to do hearts = cardiac fellowship required to be TEE cert
want to do critical care = ICU fellowship required
want to do Pain = pain fellowship required

want to do primarily Peds or academic Peds = do Peds fellowship
want to do primarily Regional and stay academic = do regional
want to do primarily OB and stay academic = do OB

any other "fellowship" is literally BS marketing for slave labor

I did ICU and have zero regrets and would do it again in a heartbeat, dont really understand the comments saying ICU fellowship is useless unless it is in reference to someone doing it and then planning on working as a general anesthesiologist

 

[Arch Guillotti]

I'm sorry, are you seriously suggesting doing those blocks on a patient for a heart? Like actually doing it and not just mental masterbation?

I don't think he's serious. Need an emoji in his response.

 

[Consigliere]

Here's the dealio daddy-o's.......I don't think I'd ever want to work in a place that required someone to do a regional fellowship as a condition of employment.

 

[Aether2000]

Not serious- just fun to think about all the possibilities....

 

[Ezekiel2517]

useless. shouldn't even exist as a "fellowship". if there weren't so many weak programs and residents out there, people wouldn't go into this "fellowship" and it would cease to exist. it's not a real fellowship unless you get a second board out of it. when all you get at the end of the year is a piece of paper like you just finished 6th grade, that should give you a clue.

 

[deleted171991]

Not true... there are plenty 50/50 peds/adults jobs in private practice and academia, and a decent number of 100% peds jobs at pure peds (mostly academic) hospitals too.

Except that academic hospitals have more than enough peds people, and the PP places do less and less peds beyond T&As. So if one wants to do a fellowship for T&As once or twice a week, and adults in the rest, be my guest.

If anything, I can see academic places starting to use more CRNAs for peds, not just for adults.

 

[Noyac]

I'm in academics so I've got that bias... but many of my friends who did regional fellowships have moved onto nice academic jobs that pure generalists (non-fellowship trained folks) would not have access to. Some are quickly made directors of regional anesthesia, for example... or at least part of the regional team. Others have moved onto private practice jobs that certainly would have been open to pure generalists.

So I think there's value in a regional anesthesia fellowship if you want to go into academia. It's certainly not a "wasted year" for those really interested in regional, especially given that many of the fellowships allow for hybrid attending time.

So, I wonder, would someone like me not be offered a spot on the regional team if I went into academics for my last few years? Because I can guarantee that I can block anything that a regional fellowship trained person can block. And I can do it in half the time. Does that matter?
Yes, part of my statement is tongue in cheek but not completely. I have done more blocks than any regional fellow.
It this isn't a pissing match. I get that. I'm just saying a regional fellowship is a waste of time. If you want to be an academic person all of your life, it's still a waste of time. Do something else like cardiac or critical care and rotate through the ICU. Shi*t, even Ped's is better than regional.

 

[deleted171991]

I did ICU and have zero regrets and would do it again in a heartbeat, dont really understand the comments saying ICU fellowship is useless unless it is in reference to someone doing it and then planning on working as a general anesthesiologist

Nope. It's in reference to the jobs in some (many?) markets. In my experience, the main reason academic chairs (and some SICU leadership) want anesthesiologist-intensivists for is to be their ICU workhorses, to be the surgeons' highly educated bitches minions, not because of their clinical knowledge (which is the reason some PP groups want one). That's why most SICUs are open, which sucks royally. If one works in the ICU, one should expect to work more (hours, nights, weekends etc.) for the same money as the OR generalist. That's my very biased (n=1, geographically, you name it) personal opinion.

Let me put it this way: if I work in the ICU, especially a busy one, I expect those hours and calls and weekend days to count. So I expect to have no OR overnight calls, and very few if any late days, just the regular 7-4. Also, since I am not dealing with ASA 2-3 patients in the ICU, but trainwrecks, I expect to either have more days off or a better salary or easier OR days or something, anything, in exchange for the extra responsibility and stress. The one thing I don't expect is to be (treated like) just another cog, because then there are way better fellowships to waste a year and $300K on.

In that setting, regional is a better deal, thank you very much. Especially if one works in outpatient with no overnight calls, no weekends, no OB, no sick patients, all the spoils with none of the crap. Possibly even as a partner.

 

[facted]

So, I wonder, would someone like me not be offered a spot on the regional team if I went into academics for my last few years? Because I can guarantee that I can block anything that a regional fellowship trained person can block. And I can do it in half the time. Does that matter?
Yes, part of my statement is tongue in cheek but not completely. I have done more blocks than any regional fellow.
It this isn't a pissing match. I get that. I'm just saying a regional fellowship is a waste of time. If you want to be an academic person all of your life, it's still a waste of time. Do something else like cardiac or critical care and rotate through the ICU. Shi*t, even Ped's is better than regional.

The question is not if someone with many years of experience doing blocks would benefit in today's job market. The question is if someone straight out of residency could benefit with a regional fellowship. The answer to that is definitely yes in my geographical area (in PP).

 

[deleted171991]

So, I wonder, would someone like me not be offered a spot on the regional team if I went into academics for my last few years? Because I can guarantee that I can block anything that a regional fellowship trained person can block. And I can do it in half the time. Does that matter?

You are correct: you wouldn't. Some academic places I know are transitioning to fellowship-trained divisions, meaning that you don't get to practice the subspecialty without a fellowship, except when on call. The reason being that, when they have too many people wanting to do regional, or cardiac, or peds, or thoracic, or neuro, or OB, or you name it, it's the easiest way to select the small team of people to do it every day.

The surgeons love the arrangement, because they work with a limited number of anesthesiologists they get to know well. Anesthesia leadership adores it, because they can literally handicap their employees, by not allowing them to practice the whole spectrum of anesthesia. After a decade or more in academia, many of those people couldn't even consider a "full spectrum" PP job anymore, especially solo, which is great if one wants to keep salaries and turnover low.

 

[thinkorswim]

You could do a cardiac fellowship and do regional blocks on the cardiac patients (infraclavicular blocks for the a-line, pecs block for the sternotomy, adductor canal block for the vein harvesting, etc....)

I'm sorry, are you seriously suggesting doing those blocks on a patient for a heart? Like actually doing it and not just mental masterbation?

We actually do paravertebral and pectoral nerve blocks for our robotic mitral valves. They work quite well.

But on the fellowship topic, I agree with everyone else. All you need to know are maybe 6 basic nerve blocks for most private practice jobs, and you should have performed plenty of those during your training.

 

[nimbus]

You are correct: you wouldn't. Some academic places I know are transitioning to fellowship-trained divisions, meaning that you don't get to practice the subspecialty without a fellowship, except when on call. The reason being that, when they have too many people wanting to do regional, or cardiac, or peds, or thoracic, or neuro, or OB, or you name it, it's the easiest way to select the small team of people to do it every day.

The surgeons love the arrangement, because they work with a limited number of anesthesiologists they get to know well. Anesthesia leadership adores it, because they can literally handicap their employees, by not allowing them to practice the whole spectrum of anesthesia. After a decade or more in academia, many of those people couldn't even consider a "full spectrum" PP job anymore, especially solo, which is great if one wants to keep salaries and turnover low.

It's funny because most of the regional fellowship directors and faculty, at least on the West coast, haven't done a regional fellowship themselves. And we've hired a few regional fellows but we can't really tell a difference. We have a lot of people coming straight out of residency who are slick and fast.

 

[deleted171991]

It's funny because many of the regional fellowship directors, at least on the West coast, haven't done a regional fellowship themselves. And we've hired a few regional fellows but we can't really tell a difference. We have a lot of people coming straight out of residency who are slick and fast.

The current generations are much better at regional than the ones from 5-10 years ago, I am sure. Still, a regional/acute pain fellowship can open the door to some cushy academic jobs on the regional and/or pain service.

Regarding fellowship-trained people, remember when one didn't need a cardiac fellowship to do cardiac in academia? Or to cover cardiac SICU? Or just to become certified in advanced TEE?

 

[nimbus]

The question is not if someone with many years of experience doing blocks would benefit in today's job market. The question is if someone straight out of residency could benefit with a regional fellowship. The answer to that is definitely yes in my geographical area (in PP).

And for PP in my area the answer is no. If anything I've noticed regional fellowship grads have a tendency to avoid or not be enthusiastic about taking on big cases (n=2). This is the opposite of cardiac fellows.

 

[sevoflurane]

It's funny because most of the regional fellowship directors and faculty, at least on the West coast, haven't done a regional fellowship themselves. And we've hired a few regional fellows but we can't really tell a difference. We have a lot of people coming straight out of residency who are slick and fast.

Really agree 100%. I guess from a hiring perspective, how do you weed out the ones that come out of residency ready to hit the road vs. the ones that really shouldn't be doing a regional day due to lack of skill and inefficiency? Not easy, unless you are picking from a known basket with known references.

IMO, there are lots of residencies that produce graduates that are not capable of dealing with a heavy day of regional. It is becoming less common I will admit, but it's still out there in not so small quantities a some may think. Now if we are talking about some of the "old guys" who are transitioning to a different job... now that can be a big problem as there is a set of mid 40's to end of time candidates that may not posses the necessary skills.

From a resident point of view, only interview at programs with strong regional. It will help you succeed- especially if you are not planning on peds or cardiac.
Graduate with 50 blocks and you will be struggling. 300-400 blocks sounds about right for a 4 year program including catheters and the less "prime time" blocks-( pecs, genicular, LPB, BP terminal nerve blocks, supracapular, PVTs, etc.) If you know how to do those blocks and been trained well, you can put catheters in them. Not hard, but it requires a certain foundation and comfort. Also, lets not forget about pediatric blocks. Caudals, epidurals, PVNBs, and other peds blocks under GA.

Hard to really tell proficiency on an interview unless you know where they are coming from.

Just my 2cents.

 

[CriTICAL]

Nope. It's in reference to the jobs in some (many?) markets. In my experience, the main reason academic chairs (and some SICU leadership) want anesthesiologist-intensivists for is to be their ICU workhorses, to be the surgeons' highly educated bitches minions, not because of their clinical knowledge (which is the reason some PP groups want one). That's why most SICUs are open, which sucks royally. If one works in the ICU, one should expect to work more (hours, nights, weekends etc.) for the same money as the OR generalist. That's my very biased (n=1, geographically, you name it) personal opinion.

Let me put it this way: if I work in the ICU, especially a busy one, I expect those hours and calls and weekend days to count. So I expect to have no OR overnight calls, and very few if any late days, just the regular 7-4. Also, since I am not dealing with ASA 2-3 patients in the ICU, but trainwrecks, I expect to either have more days off or a better salary or easier OR days or something, anything, in exchange for the extra responsibility and stress. The one thing I don't expect is to be (treated like) just another cog, because then there are way better fellowships to waste a year and $300K on.

In that setting, regional is a better deal, thank you very much. Especially if one works in outpatient with no overnight calls, no weekends, no OB, no sick patients, all the spoils with none of the crap. Possibly even as a partner.

Academia compared to Private Practice will for sure screw you whether as a general anesthesiologist or Intensivist, but agree most academic ICU setups suck and have you work much more for same pay working as an Intensivist compared to an OR generalist which is totally unfair, I guess there may be some benefits to being academic but for me I just dont get it. Theres lots of good PP jobs out there as an Intensivist that pay well with plenty of time off, I do 7on/off ICU and when needed take on extra ICU shifts in lieu of per diem Anesth because I actually make much more doing ICU for a day than a 12hr Anesth day (see more patients and do more procedures)
If your in a ****ty market sounds like you may want to look more broadly and think about relocating, for me working harder and sacrificing salary and lifestyle just for the "Privilege" of being at XYZ University just isnt worth it

 

[deleted171991]

And for PP in my area the answer is no. If anything I've noticed regional fellowship grads have a tendency to avoid or not be enthusiastic about taking on big cases (n=2). This is the opposite of cardiac fellows.

Why take on big cases when you are paid the same? More stress, more work, more risk, same everything else.

 

[Mman]

Theres lots of good PP jobs out there as an Intensivist that pay well with plenty of time off, I do 7on/off ICU and when needed take on extra ICU shifts in lieu of per diem Anesth because I actually make much more doing ICU for a day than a 12hr Anesth day (see more patients and do more procedures)

There is probably something fundamentally a little off in your job if you are getting paid more for the work in the ICU than in the OR. I suspect there must be some sort of subsidization of the ICU work because the OR work should reimburse more.

 

[facted]

And for PP in my area the answer is no. If anything I've noticed regional fellowship grads have a tendency to avoid or not be enthusiastic about taking on big cases (n=2). This is the opposite of cardiac fellows.

That's possible. But I've yet to see a cardiac fellow run an ambi center doing 12-15 blocks in a day, 3 rooms, with 10 minute TO's between cases. Just sayin...

 

[Mman]

That's possible. But I've yet to see a cardiac fellow run an ambi center doing 12-15 blocks in a day, 3 rooms, with 10 minute TO's between cases. Just sayin...

we have plenty of docs that did cardiac fellowships and handle themselves just fine at our busy outpatient surgery center that has a ton of blocks at it.

just sayin

 

[psychbender]

Not serious- just fun to think about all the possibilities....

You joke, but in the days of the awake off-pump CABG (early 2000s), radial artery was harvested under axillary block, saphenous vein under femoral, and the case was done under a T1/2 epidural.

Sent from my SM-G920V using SDN mobile

 

[pgg]

That's possible. But I've yet to see a cardiac fellow run an ambi center doing 12-15 blocks in a day, 3 rooms, with 10 minute TO's between cases. Just sayin...

How many cardiac fellows would want to?

Here's the thing though - it might be a rough couple weeks at first as the cardiac fellow got back into the high turnover outpatient scene, but by week 3 he'd have done 100+ blocks at the place. He'll be OK.

 

[deleted162650]

That's possible. But I've yet to see a cardiac fellow run an ambi center doing 12-15 blocks in a day, 3 rooms, with 10 minute TO's between cases. Just sayin...

You're kidding yourself if you think a regional fellowship is necessary to do this. I know you are very proud of your regional training and you found a PP job that lets you use all your esoteric blocks (a product solely of being in NYC) which is very cool, but you need to step back to reality for a minute.

 

[facted]

You're kidding yourself if you think a regional fellowship is necessary to do this. I know you are very proud of your regional training and you found a PP job that lets you use all your esoteric blocks (a product solely of being in NYC) which is very cool, but you need to step back to reality for a minute.

Didn't say that. It was a response to the idea that regional fellows refuse to do big cases, which is BS. similarly, there are plenty of people that feel comfortable doing cardiac coming out of residency (and do in pp). Is cardiac fellowship useless then?

 

[Nivens]

Conclusions I can draw from this, and other, threads:

You need a fellowship, preferably something that goves you a broadened skillset, BUT:

Cardiac: saturated market, dwindling volume, more and more interventional procedures
Regional: waste of time
OB: waste of time
Peds: shrinking market, do you really need it to do T&As?
Pain: reimbursement dropping like a stone, but youre the boss. On the other hand, youre the boss...
Critical care: more work for less money

 

[Robotic Wis-Hipple]

That's possible. But I've yet to see a cardiac fellow run an ambi center doing 12-15 blocks in a day, 3 rooms, with 10 minute TO's between cases. Just sayin...

Lol. Maybe not day 1, but the time to become proficient wouldn't be that long doing basic blocks on ASA 1 -3s. The same could not be said for the avg Regional fellow if asked to do hearts. But none of that matters. CV guys choose CV for the physiology and the love of the complex case, I'd go nuts if my career was gonna be needle jockeying away all day running like a mad man in an ASC. Likewise, the guy that chooses Regional likes the anatomy and doing cases in ways that isn't always a GETA.

Pick your fellowship based on what you like. Not what you think is most marketable. I have friends signing in academic Peds for more than myself and my cofellows are signing for PP cards jobs. I have buddies doing Regional that are getting jobs easily. Jobs are there, do what you like.

 

[Mman]

Conclusions I can draw from this, and other, threads:

You need a fellowship, preferably something that goves you a broadened skillset, BUT:

Cardiac: saturated market, dwindling volume, more and more interventional procedures
Regional: waste of time
OB: waste of time
Peds: shrinking market, do you really need it to do T&As?
Pain: reimbursement dropping like a stone, but youre the boss. On the other hand, youre the boss...
Critical care: more work for less money

pretty much.

I'd say the main reason for choosing a fellowship is to pick which area you'd like to work in if forced to have an academic job.

 

[sevoflurane]

Agree with the above. Def. do what you like.
Fellowship is not required, but proficiency is expected. IF you can't become proficient in a short amount of time, then you won't be doing those cases... especially if a surgeon starts complaining about long turnovers.
Goes back to how you were trained. For residency I interviewed at 3 different places in PA, including UPenn... let's just say that at the time, one of the other residencies had nearly zero regional training. Those are the places that you graduate from and will have a hard time making it on the fly in PP.
By my second year in residency, I felt comfortable with most regional blocks and catheters (mind you this was stimulation years as well).
By the time I was a senior regional resident, I gave all the morning blocks to the junior residents as I spent time in the cardiac rooms doing echo.
Your particular training institution has everything to do with your "need" to do a fellowship or not.