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Subspecializing pays off?

Discussion in 'Anesthesiology' started by ryanbeckworth, Apr 3, 2004.

  1. ryanbeckworth

    ryanbeckworth Member
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    I've heard that for areas like CT, peds, OB, ICU, doing a fellowship might give one a job where they would otherwise out of luck. However, aside from Pain Management, do any of these areas make substantially more than just general anesthesia?
     
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  3. BassDominator

    BassDominator Senior Member
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    To make money in pain management, you really need to run a cash business for procedures. A lot of pain managment is medical, and the insurance companies don't pay squat for this.... they're paying less and less for procedures, too. You can make some serious $$$ in pain, but it can be tough to get a cash practice going.
     
  4. gaseous

    gaseous Senior Member
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    unfortunately fellowship training doesn't afford a lot of extra cash in anesthesia except pain.

    I've often heard that one never makes up the cash lost during the extra year of training even if he/she works for 30 years.

    Anesthesia is different than a lot of specialties in that you are paid for time in the OR not for what you are doing in the OR. (correct me if I'm wrong) I've heard a set price paid per 15 mins of anesthesia time.

    I don't think that set price changes any if you are doing pedi hearts vs. gall bladders.

    One might get extra compensation in private practice if he/she is fellowship trained and there is a need for that training within their practice. If so, I doubt the extra cash is that significant.

    As for ICU, I think the billing is really screwed up where these guys work their arse off and don't get any $$ benefit for it. It is kind of like medicine; they can only bill for what they put in their notes and procedures that they do. All the other thinking is free.

    In the end, I would only do a fellowship if I was really interested in doing, something like pedi full time or if I wanted to stay in academics. (Not for the money)
     
  5. MDEntropy

    MDEntropy Member
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    MDAs are paid for their time, usually in units of 15 minutes. Yet, there is a baseline value/amount for each case and this varies with complexity and urgency. Thus an emergent pedi heart has a much higher value than an elective lap chole even if both took exactly 1 hour.

    I had always been under the impression that other than pain, fellowships don't add monetary value. The dept. chair at Emory said that he has a discounted cash flow model which demonstrates that the net present value of fellowship training is worth about 2 million dollars on average assuming 30 years working as an attending. I never asked him for his model although I should have. I wonder if anyone else remebers hearing this.
     
  6. Yogi Patel

    Yogi Patel Junior Member
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    I agree that unfortunately in anesthesia, your income does not increase with specialization.

    Cardiac: Make more per case, but tend to work longer hours so income per hour is about the same.

    Peds: May actually make less because you're mostly doing ASA 1 cases, plus you're likely to be practicing in an urban area with a larger population of indigent non-insured patients

    OB: Make about the same as a general anesthesiologist, less if you're doing high risk and have higher malpractice

    Critical Care: Almost always make less than a general anesthesiologist, hence fellowship programs are desperate for applicants
     
  7. ryanbeckworth

    ryanbeckworth Member
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    It sounds as if the only reason for doing a fellowship is to make yourself more marketable should things tighten up job-wise in the future.
     

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