RESPONSE TO Dr. Block's QUESTION ON CARDIAC FELLOWSHIPS

[jetproppilot]

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Geez, my wireless router took a **** on the first go around so I'll re-write this post.

Very good question, Blocks. I don't think I'd do a cardiac fellowship unless you are planning on
1)staying academic
2)you want to work at a well established "hearts only" hospital, like Denton Cooley's crib, Texas Heart Institute.

I was lucky in that I obtained more than adequate exposure to cardiac anesthesia during residency (mini-fellowship or whatever you call it at Texas Heart for 4 months, where I did 3-4 pump cases a day Mon-Fri, then took ICU call there every 4th night; yeah it sucked but it was a great rotation that provided me with ample cardiac exposure), and my previous job did over 400 hearts a year. Well, lucky isnt really the right word..bottom line is I'm a well rounded gas dude that has done alot of everything except transplants, so I could fit into just about any practice if I had to.

I like cardiac anesthesia too, but at this point (eight years outta residency) I'm just as happy, no, probably happier on easy knee-scope kinda days.
Thats what cracks me up when someone asks on a thread Is Anesthesia Boring? I wouldnt call cardiac anesthesia boring, but myself and my high power heart surgeon/neurosurgeon/ortho dude buddies that are in the 5-10 year post-residency years are all comfortable with what we do, our heart rate stays the same regardless of what case we're doing, and believe me, ANY specialty becomes a job after a while. Yeah, I'm happy with my job, but it would be alot more fun to be Lear-Jet-Rich!
Bottom line though, is I'm comfortable with whatever case hits the OR doors, which is a good feeling, cuz I've seen anesthesiologists and surgeons alike who pee on themselves when something goes wrong or a challenging case arises.
Geez, I did a C-section a cuppla months ago on a Marfan's lady with Harrington Rods who I tried in vain to get a combined spinal/epidural on...then tried with a 22 gauge spinal needle to no avail...popped in an A line and another good IV, said a prayer, and put her to sleep (which I REALLY didnt wanna do), waited until I was pretty sure she had adequate anesthetic depth so the Miller 2 wouldnt cause her aortic arch to explode, and just did it....stepped up to the mike with Micatin...she did fine, thank God. My heart rate never left 65. 😀.......5 years ago I would've needed some new Fruit-of-the-Looms, and I would've needed adenosine 12mg..

 

[jetproppilot]

Geez, my wireless router took a **** on the first go around so I'll re-write this post.

Very good question, Blocks. I don't think I'd do a cardiac fellowship unless you are planning on
1)staying academic
2)you want to work at a well established "hearts only" hospital, like Denton Cooley's crib, Texas Heart Institute.

I was lucky in that I obtained more than adequate exposure to cardiac anesthesia during residency (mini-fellowship or whatever you call it at Texas Heart for 4 months, where I did 3-4 pump cases a day Mon-Fri, then took ICU call there every 4th night; yeah it sucked but it was a great rotation that provided me with ample cardiac exposure), and my previous job did over 400 hearts a year. Well, lucky isnt really the right word..bottom line is I'm a well rounded gas dude that has done alot of everything except transplants, so I could fit into just about any practice if I had to.

I like cardiac anesthesia too, but at this point (eight years outta residency) I'm just as happy, no, probably happier on easy knee-scope kinda days.
Thats what cracks me up when someone asks on a thread Is Anesthesia Boring? I wouldnt call cardiac anesthesia boring, but myself and my high power heart surgeon/neurosurgeon/ortho dude buddies that are in the 5-10 year post-residency years are all comfortable with what we do, our heart rate stays the same regardless of what case we're doing, and believe me, ANY specialty becomes a job after a while. Yeah, I'm happy with my job, but it would be alot more fun to be Lear-Jet-Rich!
Bottom line though, is I'm comfortable with whatever case hits the OR doors, which is a good feeling, cuz I've seen anesthesiologists and surgeons alike who pee on themselves when something goes wrong or a challenging case arises.
Geez, I did a C-section a cuppla months ago on a Marfan's lady with Harrington Rods who I tried in vain to get a combined spinal/epidural on...then tried with a 22 gauge spinal needle to no avail...popped in an A line and another good IV, said a prayer, and put her to sleep (which I REALLY didnt wanna do), waited until I was pretty sure she had adequate anesthetic depth so the Miller 2 wouldnt cause her aortic arch to explode, and just did it....stepped up to the mike with Micatin...she did fine, thank God. My heart rate never left 65. 😀.......5 years ago I would've needed some new Fruit-of-the-Looms, and I would've needed adenosine 12mg..

Sorry Blocks, I forgot to answer your question "Are most anesthesiologists who handle the big heart cases fellowship trained?" The answer is no. Most anesthesiologists have acquired prowess in the areas that their practices need. In other words, if you go into a practice that does alot of hearts, you'll be intimidated for a while, but your senior partners will show you the ropes, and you'll become comfortable with the environment/cases/surgeons after a period of time.
Think about the number of CAGS/valves/major vascular cases done annually in this country, then find the number of fellowship trained anesthesiologists, and PRESTO! Theres your answer.

 

[blocks]

Great stuff, Jet. It is always good to see someone who enjoys what he does for a living. Here's to seeing many more posts in the future.

I am hoping to be comfortable with just about any tough cardiac case, while still having a variety of cases including regional etc. Sounds like if you can get a strong cardiac exposure during residency, you can build on that as an attending, and keep your other skills sharp since you are not exclusively hearts. The ideal would probably be a residency that does a lot of tough heart cases, that aren't given as priorit to cards anesth. fellows.

That's cool you did hearts at Texas Heart. A buddy of mine from med school was interviewing there for GSurg this year and said the residents were all talking about Denton Cooley. Said that he still keeps an apartment in the hospital, brings his dog around, bestows knowledge, etc.

Muchas Gracias

 

[Justin4563]

Geez, my wireless router took a **** on the first go around so I'll re-write this post.

Very good question, Blocks. I don't think I'd do a cardiac fellowship unless you are planning on
1)staying academic
2)you want to work at a well established "hearts only" hospital, like Denton Cooley's crib, Texas Heart Institute.

I was lucky in that I obtained more than adequate exposure to cardiac anesthesia during residency (mini-fellowship or whatever you call it at Texas Heart for 4 months, where I did 3-4 pump cases a day Mon-Fri, then took ICU call there every 4th night; yeah it sucked but it was a great rotation that provided me with ample cardiac exposure), and my previous job did over 400 hearts a year. Well, lucky isnt really the right word..bottom line is I'm a well rounded gas dude that has done alot of everything except transplants, so I could fit into just about any practice if I had to.

I like cardiac anesthesia too, but at this point (eight years outta residency) I'm just as happy, no, probably happier on easy knee-scope kinda days.
Thats what cracks me up when someone asks on a thread Is Anesthesia Boring? I wouldnt call cardiac anesthesia boring, but myself and my high power heart surgeon/neurosurgeon/ortho dude buddies that are in the 5-10 year post-residency years are all comfortable with what we do, our heart rate stays the same regardless of what case we're doing, and believe me, ANY specialty becomes a job after a while. Yeah, I'm happy with my job, but it would be alot more fun to be Lear-Jet-Rich!
Bottom line though, is I'm comfortable with whatever case hits the OR doors, which is a good feeling, cuz I've seen anesthesiologists and surgeons alike who pee on themselves when something goes wrong or a challenging case arises.
Geez, I did a C-section a cuppla months ago on a Marfan's lady with Harrington Rods who I tried in vain to get a combined spinal/epidural on...then tried with a 22 gauge spinal needle to no avail...popped in an A line and another good IV, said a prayer, and put her to sleep (which I REALLY didnt wanna do), waited until I was pretty sure she had adequate anesthetic depth so the Miller 2 wouldnt cause her aortic arch to explode, and just did it....stepped up to the mike with Micatin...she did fine, thank God. My heart rate never left 65. 😀.......5 years ago I would've needed some new Fruit-of-the-Looms, and I would've needed adenosine 12mg..

My heart rate never leaves 65 and Im eight months out of training.... knock on wood.. I did a lot of stuff in residency and fellowship