Should I do a cardiac fellowship

[halflife94]

I am trying to decide whether or not to do a cardiac fellowship. After doing a couple months of cardiac I really like it but dont know if I need the fellowship to do them? Any one care to help lay out the pros and cons? Is there a big salary bump for the fellowship? What is the lifestyle like during the fellowship? Im looking to relocate south any good places for fellowships?

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[Pilot Doc]

I am trying to decide whether or not to do a cardiac fellowship. After doing a couple months of cardiac I really like it but dont know if I need the fellowship to do them? Any one care to help lay out the pros and cons? Is there a big salary bump for the fellowship? What is the lifestyle like during the fellowship? Im looking to relocate south any good places for fellowships?

Lifestyle - variable, generally better than residency, generally worse than the attending job you'd otherwise be taking

Pay - generally no increase. What it may do is open the door to getting jobs that would otherwise not be available. (i.e. big group in desirable location wants a cardiac guy. You get hired, do 30% cardiac and are equal partners with the 27 other guys, 2 of which have cards fellowships)

There are a couple of threads on this from the last few years

 

[Fastrach]

There are a couple of threads on this from the last few years

More like a couple DOZEN threads...
Search function: use it.

 

[InductionAgent]

I am trying to decide whether or not to do a cardiac fellowship. After doing a couple months of cardiac I really like it but dont know if I need the fellowship to do them? Any one care to help lay out the pros and cons? Is there a big salary bump for the fellowship? What is the lifestyle like during the fellowship? Im looking to relocate south any good places for fellowships?

Do a fellowship. It's needed for TEE certification, which is important in looking for jobs. Most of the jobs prefer someone fellowship trained. Go to http://www.scahq.org to search ACGME certified fellowships. ACGME certification is needed for TEE certification.

 

[periopdoc]

Yes, you will get more job offers and you will have the luxury of holding out for a better job. You will work hard, but you will have a blast.

I used to think that it is pretty much a waste of money, but it is still a lot of fun. Blade disagreed,

Blade was right and I was wrong. The job opportunities are significantly easier to come by with the fellowship. Several of my R4 colleagues cannot believe the number and quality of the jobs that I turned down while they are struggling to find any work.

Do an ACGME fellowship. Get TEE certified. Get a job. Plus make your group more valuable to the hospital administration so you may be able to keep the job.

- pod

 

[Dejavu]

If you think you will be a more sell-able product by doing the Fellowship and could get more job offers where you want to go, do it.

Do keep in mind though that it will personaly cost you $200,000 or so in lost income (that first year salary), and a year of your life, to do it. So be sure you will eventually get back that investment.

 

[Meds1]

As an anesthesia resident I have been contemplating the same thing. I feel as though it may to some extent, future proof the job, especially the way that anesthesia seems to be going. I worry that as we move towards obama care, general anesthesia will be completely replaced by crnas.

Also, why is it that we need to do a f'ing one year fellowship to do TEE and crna can do it with a course? Is this really the case?

Yes, you will get more job offers and you will have the luxury of holding out for a better job. You will work hard, but you will have a blast.

I used to think that it is pretty much a waste of money, but it is still a lot of fun. Blade disagreed,

Blade was right and I was wrong. The job opportunities are significantly easier to come by with the fellowship. Several of my R4 colleagues cannot believe the number and quality of the jobs that I turned down while they are struggling to find any work.

Do an ACGME fellowship. Get TEE certified. Get a job. Plus make your group more valuable to the hospital administration so you may be able to keep the job.

- pod

 

[Bertelman]

As an anesthesia resident I have been contemplating the same thing. I feel as though it may to some extent, future proof the job, especially the way that anesthesia seems to be going. I worry that as we move towards obama care, general anesthesia will be completely replaced by crnas.

Also, why is it that we need to do a f'ing one year fellowship to do TEE and crna can do it with a course? Is this really the case?

You don't "need" to do a fellowship to drop a probe down someone's throat. I can do it tomorrow if I wished.

This past year, the ASE passed a requirement that you must complete a 1-yr fellowship to obtain full periop echo certification. You can obtain "testamur" certification without doing a fellowship by completing 150 supervised exams. For most people, that's more than good enough. Many people are using echo daily without any certification at all. Nurses included.

 

[sevoflurane]

As an anesthesia resident I have been contemplating the same thing. I feel as though it may to some extent, future proof the job, especially the way that anesthesia seems to be going. I worry that as we move towards obama care, general anesthesia will be completely replaced by crnas.

Also, why is it that we need to do a f'ing one year fellowship to do TEE and crna can do it with a course? Is this really the case?

If you graduated residency before 2010 you can still get TEE certified. I'm contemplating getting my TEE cert. I do hearts with/out a cardiology presence. I don't do them everyday... but I like it like that. I actually like regional more than hearts. But that is just me. I dibble into every aspect of anesthesia: Peds, Regional, Cards, Pain, CC. It makes my days interesting and less routine. You may end up selling those aspects of your practice if you do a cardiac fellowship. Maybe not... depends on the group.

 

[GoodmanBrown]

If you graduated residency before 2010 you can still get TEE certified. I'm contemplating getting my TEE cert. I do hearts with/out a cardiology presence. I don't do them everyday... but I like it like that. I actually like regional more than hearts. But that is just me. I dibble into every aspect of anesthesia: Peds, Regional, Cards, Pain, CC. It makes my days interesting and less routine. You may end up selling those aspects of your practice if you do a cardiac fellowship. Maybe not... depends on the group.

Sev, how easy is it to dabble in a general anesth. gig? Peds, regional, and cards make sense to me as you can just as for cases that have extra peds and cards, and regional, you can always try your hand at nifty blocks when the situation calls for them.

However, pain and CC seem harder to dabble in. Both of them seem like the hospital/group is already going to have dedicated folks working in those areas. Do you just offer to work a CC shift or spend extra time hanging in the SICU reviewing pre-op and post-op patients?

Pain seems potentially even more tricky as there are a lot of very specialized procedures that a general anesthesiologist wouldn't feel comfortable with (I would think.). There's obviously more to pain than just these procedures, but I would think you'd have a hard time getting assigned to pain clinic without a fellowship. Am I missing the boat somehow here?

 

[sevoflurane]

Sev, how easy is it to dabble in a general anesth. gig? Peds, regional, and cards make sense to me as you can just as for cases that have extra peds and cards, and regional, you can always try your hand at nifty blocks when the situation calls for them.

However, pain and CC seem harder to dabble in. Both of them seem like the hospital/group is already going to have dedicated folks working in those areas. Do you just offer to work a CC shift or spend extra time hanging in the SICU reviewing pre-op and post-op patients?

Pain seems potentially even more tricky as there are a lot of very specialized procedures that a general anesthesiologist wouldn't feel comfortable with (I would think.). There's obviously more to pain than just these procedures, but I would think you'd have a hard time getting assigned to pain clinic without a fellowship. Am I missing the boat somehow here?

Good questions. I was vague. Did a GSW this weekend. The only reason we did it (instead of shipping out like we usually do) was because she needed to go to the OR stat. .45 cal to the abdomen from point blank range. 10 holes through vicera. I dropped the patient off at 5:00am. I wanted to keep the CC doc at home so I put in the orders and made decisions regarding vent management, abx, gtt's, xrays, etc. He appreciated that. Really though... every cardiac case or difficult case could be considered CC.

Regarding pain... I get consulted by my surgeon collegues when they get a difficult patient where the dilaudid pca + god knows how much ativan just doesn't cut it . Sometimes an epidural comes out and the patient goes from 2/10 to 10/10 and IV meds just make them confused. Acute and Chronic pain overlap significantly and it is not infrequent that I end up putting these consults on gabapentin, lyrika, duloxetine or whatever if I feel they need it. I don't like clinic and would not do invasive pain procedures (stallate, celiac plexus, lumbar sympathetic, etc). I am a black belt at trigger points .

 

[maximuum]

How do people feel about getting the basic PTEexam certificate? I am finishing up residency this year and could potentially have the numbers to qualify for the exam. This is the first year that they are offering it and there is no information on the content of the exam itself.

 

[ProRealDoc]

I am trying to decide whether or not to do a cardiac fellowship. After doing a couple months of cardiac I really like it but dont know if I need the fellowship to do them? Any one care to help lay out the pros and cons? Is there a big salary bump for the fellowship? What is the lifestyle like during the fellowship? Im looking to relocate south any good places for fellowships?

In the words of one of the former prolific posters of this forum who's now a tenured professor like JPP et al...

"Yup, most definitely will be a bad ass anesthesiologist with that fellowship. I wish I would have done one years ago... You be totally bad ass when you can walk into a hospital as a locums guru and start doing CT cases literally that same day as if you've worked there your whole life--just nailin' that shiit. Runnin' Top Coin, dog, wherever ya go!! Regards, -----Zip "

 

[GoodmanBrown]

Good questions. I was vague. Did a GSW this weekend. The only reason we did it (instead of shipping out like we usually do) was because she needed to go to the OR stat. .45 cal to the abdomen from point blank range. 10 holes through vicera. I dropped the patient off at 5:00am. I wanted to keep the CC doc at home so I put in the orders and made decisions regarding vent management, abx, gtt's, xrays, etc. He appreciated that. Really though... every cardiac case or difficult case could be considered CC.

Regarding pain... I get consulted by my surgeon collegues when they get a difficult patient where the dilaudid pca + god knows how much ativan just doesn't cut it . Sometimes an epidural comes out and the patient goes from 2/10 to 10/10 and IV meds just make them confused. Acute and Chronic pain overlap significantly and it is not infrequent that I end up putting these consults on gabapentin, lyrika, duloxetine or whatever if I feel they need it. I don't like clinic and would not do invasive pain procedures (stallate, celiac plexus, lumbar sympathetic, etc). I am a black belt at trigger points .

I appreciate the extra thoughts. Does any of this increase your longitudinal time with a patient? (i.e. do you see the patient a few times before they go on their way?) And speaking of being a broad anesthesiologist, has anyone ever done some hospice or palliative care as an anesthesiologist? It seems like if not a way to pull in extra income, maybe a way you could do some volunteer time and see patients over a longer period of time than the typical anesthesia encounter.

 

[sevoflurane]

I appreciate the extra thoughts. Does any of this increase your longitudinal time with a patient? (i.e. do you see the patient a few times before they go on their way?) And speaking of being a broad anesthesiologist, has anyone ever done some hospice or palliative care as an anesthesiologist? It seems like if not a way to pull in extra income, maybe a way you could do some volunteer time and see patients over a longer period of time than the typical anesthesia encounter.

There are ways to increase your income. Recently i was asked to run a suboxone clinic for 3 hours a week. Take home for those three hours would be $1800-2000. I declined because it just ain't my thing. One of my colleagues does do it. This boosts his income by about 40K. It would be even more if you are the sole proprietor of said practice.
Another partner has exclusive rights at an eye center and has hired a CRNA to run cases with him. He gets a good chunk of change out of that as well as a lot of paperwork.
Volunteering is another option. There are a lot of people who travel abroad to do this type of work. I find this most fulfilling.

 

[GoodmanBrown]

Volunteering is another option. There are a lot of people who travel abroad to do this type of work. I find this most fulfilling.

Thanks again! I am mainly thinking of the hospice/palliative as a volunteer kind of thing. I did all of my medical volunteering with a hospice program, spending time with the patients. I thought it was a lot of good folks trying to do good things for people.

It's crossed my mind that anesthesiologists deal with pain a lot and could potentially be put to good use in hospices.

 

[RussianJoo]

I appreciate the extra thoughts. Does any of this increase your longitudinal time with a patient? (i.e. do you see the patient a few times before they go on their way?) And speaking of being a broad anesthesiologist, has anyone ever done some hospice or palliative care as an anesthesiologist? It seems like if not a way to pull in extra income, maybe a way you could do some volunteer time and see patients over a longer period of time than the typical anesthesia encounter.

most anesthesiologists don't want continuity of care or spending more time with patients than needed, that's why they went into this specialty, to get in do your thing and get out.

 

[GoodmanBrown]

most anesthesiologists don't want continuity of care or spending more time with patients than needed, that's why they went into this specialty, to get in do your thing and get out.

That's definitely true, but I think everyone appreciates a little variety in their day. Being the doc for a hospice house would entail following up on 4-5 patients total probably, so I would think it would appeal to some anesthesiologists, even if not many of them.

 

[RussianJoo]

That's definitely true, but I think everyone appreciates a little variety in their day. Being the doc for a hospice house would entail following up on 4-5 patients total probably, so I would think it would appeal to some anesthesiologists, even if not many of them.

not if obama has his way.. we'll be placing most people who are in the ICUs now into hospice.

 

[kmurp]

not if obama has his way.. we'll be placing most people who are in the ICUs now into hospice.

Specifically, what does the President "want to do" or what has Congress passed and what has been signed into law that will "place ICU patients into hospice?"
I follow the updates from the ASA on healthcare reform and have heard nothing of this. Perhaps the physicians in charge at the ASA should be informed of this moral travesty. I urge you to contact them immediately with this alarming information. I imagine that they will be so pleased that they will fly their black helicopters to your location right away.
Don't worry, they know who you are and they know where you live........

 

[Arch Guillotti]

not if obama has his way.. we'll be placing most people who are in the ICUs now into hospice.

What exactly are you referring to and talking about?

MI pts. in the CCU, trauma pts in the SICU, post CABG pts in the CTICU, neurosurg pts in the NSICU and kids in the PICU are all going to hospice?

I think you are being quite dramatic here.

 

[IlDestriero]

What exactly are you referring to and talking about?

MI pts. in the CCU, trauma pts in the SICU, post CABG pts in the CTICU, neurosurg pts in the NSICU and kids in the PICU are all going to hospice?

I think you are being quite dramatic here.

In answer to the OP's question, if the current healthcare reform bill passes, no you should not do a CV fellowship. You should go to business or law school instead. It's not to late to chart a different course.

 

[Coastie]

In answer to the OP's question, if the current healthcare reform bill passes, no you should not do a CV fellowship. You should go to business or law school instead. It's not to late to chart a different course.

Law school, even at top programs, is a bad, bad place to be.

Business school the same.

Stick with medicine, as it will pay decently long enough to pay off your loans and save up a bit. Live wisely. Invest wisely.

Then make your escape.

If you're a pre-med, change to pre-dent. If you're in med school, consider a change to dental school. If you're a resident, finish out.

 

[IlDestriero]

Law school, even at top programs, is a bad, bad place to be.

Business school the same.

Stick with medicine, as it will pay decently long enough to pay off your loans and save up a bit. Live wisely. Invest wisely.

Then make your escape.

If you're a pre-med, change to pre-dent. If you're in med school, consider a change to dental school. If you're a resident, finish out.

All of the lawyers I know are actually in business, and a couple of them have MBAs as well. They're not hurting at all. Even my old friends in finance are still living the high life. I'm hoping to make it out alive in 20 years.

 

[kmurp]

Law school, even at top programs, is a bad, bad place to be.

Business school the same.

Stick with medicine, as it will pay decently long enough to pay off your loans and save up a bit. Live wisely. Invest wisely.

Then make your escape.

If you're a pre-med, change to pre-dent. If you're in med school, consider a change to dental school. If you're a resident, finish out.

I've been around long enough to see a few of these "death of medicine" moments. This too shall pass. That said , if money is your prime motivation, perhaps you will be better off in a different field.