To those that did a fellowship, what were your reasons?

[Status Sciaticus]

Im currently a PGY-1 at a mid-low tier program in the northeast, and as intern year is ending, I am trying to look into fellowship as an option for job security as well as a genuine interest in the topic.
My question to you all is, if you are planning on doing/are doing/have done a fellowship, what were your motivations, what did you look for in a program, how has it helped your career, etc...

Thanks.

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[deleted171991]

- Fellowship: CCM.
- Wasn't sure initially if it was worth doing a fellowship, and which one. Went back after a few years as an attending. Made the mistake of believing some of the positive stories and recommendations on SDN; all that glitters is not gold.
- Reasons: become a well-rounded physician, get out of the OR, love for internal medicine, get more comfortable with treating the sickest patients, truly a second specialty, insurance for the future if anesthesiology goes south.
- Program choice: liked the people, broad MICU and good SICU exposure, plenty of elective time, non-malignant schedule with time for reading, plenty of responsibility running the ICU and consult service after business hours pretty much independently.
- Results: made me a much better anesthesiologist and physician, learned lung/heart echo, minor bump in salary, PP anesthesia groups suspicious of CCM (expected me to leave for a combined job), probably got me my current hospital-employed job.
- Worth it? Definitely, maybe. The former based on my inner scorecard, the latter on my outer one. Would probably do it again if stuck with anesthesiology and bad jobs. Would not recommend it except to few select people.

 

[UrbanAchievers]

- Fellowship: CV.

- I did the fellowship solely because I had a job offer contingent on completing the fellowship. I was happy doing a little bit of everyrhing(except hearts) for a couple of years post residency. A job opportunity opened up with a really good group of coworkers, better hours, and better pay than my current job so I decided to go back to fellowship.

There were times that I regretted going back to fellowship and having to play the hierarchical game again. It was frustrating having to defer to attendings at times, but I am glad that I did the fellowship. TEE skills were the biggest plus of the actual fellowship. Financially, the fellowship has already paid for itself, and I would definitely do it again if faced with the same decision. I am glad I got to experience attending life, finish my boards, and make some money before going to fellowship.

 

[Man o War]

I did a CV fellowship.
I was a partner in a PP group, and left to pursue CV fellowship. Took my buy out from my group so didn’t need to change lifestyle in order to go back to slave wages.
I went back because I like the cases and wanted the TEE training. I also had my eye on some really good PP groups that were only hiring TEE boarded CV docs.
Fellowship paid for itself and then some quickly.
Case mix/exposure was my number 1 priority in picking a program. Pick a program that is going to prepare you for anything that rolls through the door at your post fellowship job.

 

[Hoya11]

Im currently a PGY-1 at a mid-low tier program in the northeast, and as intern year is ending, I am trying to look into fellowship as an option for job security as well as a genuine interest in the topic.
My question to you all is, if you are planning on doing/are doing/have done a fellowship, what were your motivations, what did you look for in a program, how has it helped your career, etc...

Thanks.

Fellowship: Pain

I was genuinely interested in learning the injections. I liked the idea of clinic and no call and lots of money. I went on to hate it and back to anesthesia despite those other things being true. All of the neuraxial experience certainly helps and familiarity with different newer analgesic drugs/management helps. And the idea that if something ever happened to my current job I could have the option to go back to pain to survive is comforting but I hope it doesnt happen.

 

[pocafx]

Can you expand on your pain experience

 

[DM27]

Cardiac Fellowship.

I knew myself well enough to know that when I finished residency I wouldn't want to be an attending yet. I also did not find typical cases especially interesting (aside from regional blocks) and could only entertain myself on the pursuit of perfection in an "easy" case for so long. I found cardiac cases to require overall more thought, to often rely on communication and a team based approach, and to be somewhat more distinguishing in academics. I also liked the idea of TEE as a skillset and it definitely comes in handy often, as do the ultrasound concepts that inevitably come along with learning it.

That being said, I wanted to practice as a "renaissance man" and did not want to be pigeon-holed to cardiac cases purely because I did a CV fellowship. I wanted to be in an institution where I could do cardiac/transplant in moderation (2-3x a week) and be able to spend the other days doing a nice mix of regional cases as well as typical general surgery cases. Finding a job was easy, but finding a job where I was allowed this mix was slightly harder, however, I was still able to find a job I wanted in fall of my fellowship year.

 

[abolt18]

Cardiac Fellowship.

I knew myself well enough to know that when I finished residency I wouldn't want to be an attending yet. I also did not find typical cases especially interesting (aside from regional blocks) and could only entertain myself on the pursuit of perfection in an "easy" case for so long. I found cardiac cases to require overall more thought, to often rely on communication and a team based approach, and to be somewhat more distinguishing in academics. I also liked the idea of TEE as a skillset and it definitely comes in handy often, as do the ultrasound concepts that inevitably come along with learning it.

That being said, I wanted to practice as a "renaissance man" and did not want to be pigeon-holed to cardiac cases purely because I did a CV fellowship. I wanted to be in an institution where I could do cardiac/transplant in moderation (2-3x a week) and be able to spend the other days doing a nice mix of regional cases as well as typical general surgery cases. Finding a job was easy, but finding a job where I was allowed this mix was slightly harder, however, I was still able to find a job I wanted in fall of my fellowship year.

What you describe is exactly what I want out of a job and the reasons I am likely applying to CT next year. Don't want to do hearts all day every day, but would love to do it a few days a week!

 

[T-burglar]

ACTA fellowship for the reasons mentioned above. Cardiac is the only area where you truly collaborate with the surgeon and the other OR staff to get a surgery accomplished, and actually feel like a doctor diagnosing and treating (except in the ICU i suppose). For that reason it's a lot more engaging to me. Elsewhere in the OR i just felt like I was the technician there to sedate or knock a patient out and keep them knocked out, while the surgeon does their thing mostly separate from what you're doing and I don't like to just sit there with stable vitals or minor troubleshooting issues for hours.

I also chose anesthesia because I love resuscitation. It is by far my favorite topic in medicine. So cardiac is naturally appealing to people who love resuscitation physiology and hemodynamics. Learning echocardiography and doing your own right heart caths on a variety of sick cardiovascular conditions elevates your understanding of real physiology to a height that you can't get to any other way.

Basically I'm just passionate about the subject matter. It doesn't hurt that CT seems to open more doors to "better" private practices either. I don't believe the same can be said about ICU (with a few exceptions maybe), pain or pediatrics.

 

[pgg]

I did an adult cardiac fellowship. I've written about it here a bunch of times before, search if you want the verbose version. Short summary, I liked doing hearts, and it's clear that getting credentialed to do them in the future at 90%+ of facilities will require the fellowship. I also had some good cardiac attendings as role models and admired their comfort and ability to handle just about everything. I didn't like the thought of something going on in a nearby OR that I wasn't well qualified and comfortable handling. (This will always be the case of course, e.g. I don't now do neonates and never will, but the cardiac fellowship filled some of the comfort holes.) Echo is fun and awesome and useful and I wanted to be good at it. It's good for the CV in terms of future job prospects. Learning is fun and so is being the best you can be.

I practiced as a generalist for 7 years before going back to training as a fellow. There were a few reasons for this, but mainly my active military service kept the door closed for a while. On the plus side I didn't take a financial hit as a fellow, also because of the military.

I chose a workhorse program doing my own cases, as opposed to a so-called "echo fellowship" involving mostly supervision. Being a powerless peon again for a year had its less fun moments, but my ego doesn't need a lot of massaging and mostly I was content learning new stuff while having a smart, experienced attending behind me to help out and teach.

Glad I did it, would buy again, five stars.

 

[2Fast2Des]

Did not pursue a fellowship, mostly because I did not really feel exceptionally passionate about anything in particular, I liked doing everything and being capable in that light. Honestly I would have been miserable if I had to do an extra year. I felt comfortable and well trained to be a good generalist and feel comfortable in that role. Attending life is better and no longer do I have to do things to please residency attendings, rather do a good job in my own style and zone. I certainly still have a lot to learn and hope I can keep up with changes being out of the academic life as PP is more churn em out rather than doing the "cool" stuff in residency. Don't feel forced to do a fellowship unless you feel it's your cup of tea and enjoy it truly, unless you truly feel deficient in residency then you can do a periop\cancer\surgical home\simulation\transplant\work for peanuts fellowship .

 

[DM27]

Did not pursue a fellowship, mostly because I did not really feel exceptionally passionate about anything in particular, I liked doing everything and being capable in that light. Honestly I would have been miserable if I had to do an extra year. I felt comfortable and well trained to be a good generalist and feel comfortable in that role. Attending life is better and no longer do I have to do things to please residency attendings, rather do a good job in my own style and zone. I certainly still have a lot to learn and hope I can keep up with changes being out of the academic life as PP is more churn em out rather than doing the "cool" stuff in residency. Don't feel forced to do a fellowship unless you feel it's your cup of tea and enjoy it truly, unless you truly feel deficient in residency then you can do a periop\cancer\surgical home\simulation\transplant\work for peanuts fellowship .

I will say in response to this, I did a fellowship that I thoroughly enjoyed and felt benefited me, but about 6 months in I definitely felt "done with it" and just wanted to have a job and actually make money for a change. So training fatigue is very real, even if its a decision you're happy with.

 

[Ronin786]

I'm in the midst of my critical care fellowship. I read enough of FFP's work to go in knowing the pitfalls. I was driven to anesthesia because of the requirement of a broad knowledge base and critical care is a natural extension of that. The unfortunate side effect is you're almost certainly pigeonholed into academics if you want to take care of advanced pathology and to practice in a comfortable ICU/OR environment. Based off my current job search, the offers are quite lucrative in terms of lifestyle and salary, but I have had to sacrifice in location a little bit.

That said, I was heavily torn between cardiac and CC going into fellowship decisions. My ultimate deciding factor was two questions:
1) Would you survive never doing a cardiac case again vs. never practicing in the ICU again? For me, the ICU was an easy choice and I realized my biggest motivator to do cardiac was my interest in US and echocardiography which I have ample opportunity to practice in the ICU

2) When you're doing something other than cardiac/CC/peds/OB, are you sitting around thinking about what your fellow residents are doing on that block? I realized I didn't care to see who was doing the most recent thoracoabdominal aneurysm or TEF repair, but I'd peek into the ICU and see what "cool" disaster was sitting on ECMO.

Ultimately, I've been quite happy with my fellowship. The name recognition has helped supplement my "lesser-name" program, and the academic environment has complimented my prior workhorse training. But I definitely did a lot of homework before hand and may ultimately end up practicing more ICU than OR, something I've been surprisingly OK with.

 

[deleted171991]

I'm in the midst of my critical care fellowship. I read enough of FFP's work to go in knowing the pitfalls. I was driven to anesthesia because of the requirement of a broad knowledge base and critical care is a natural extension of that. The unfortunate side effect is you're almost certainly pigeonholed into academics if you want to take care of advanced pathology and to practice in a comfortable ICU/OR environment. Based off my current job search, the offers are quite lucrative in terms of lifestyle and salary, but I have had to sacrifice in location a little bit.

That said, I was heavily torn between cardiac and CC going into fellowship decisions. My ultimate deciding factor was two questions:
1) Would you survive never doing a cardiac case again vs. never practicing in the ICU again? For me, the ICU was an easy choice and I realized my biggest motivator to do cardiac was my interest in US and echocardiography which I have ample opportunity to practice in the ICU

2) When you're doing something other than cardiac/CC/peds/OB, are you sitting around thinking about what your fellow residents are doing on that block? I realized I didn't care to see who was doing the most recent thoracoabdominal aneurysm or TEF repair, but I'd peek into the ICU and see what "cool" disaster was sitting on ECMO.

Ultimately, I've been quite happy with my fellowship. The name recognition has helped supplement my "lesser-name" program, and the academic environment has complimented my prior workhorse training. But I definitely did a lot of homework before hand and may ultimately end up practicing more ICU than OR, something I've been surprisingly OK with.

Anything I've been wrong about, regarding critical care fellowships?

I'm asking sincerely. When I went into CCM, it was partly because I believed all the rosy BS that one of the people I respect had posted here (with the best intentions, I am sure). The wake-up call was painful.

 

[chocomorsel]

I did it for the money and lifestyle!!! Money, money, money, money, MONEY!111

 

[chocomorsel]

But on a serious note, I always wanted to do CCM. It's what got me into anesthesia in the first place. Just couldn't get my TX license in time to start fellowship at the end of residency six years ago. So I started working instead outside of TX.

Now over halfway done and I am still excited about it. For me, the money I am gonna be making is more than I made in PP anesthesia.
Getting out of the OR has been a huge breath of fresh air. I have learned and continue to learn a ton. I feel like a real clinician instead of just the surgeon's bi.... I prefer the slower pace of the ICU to give one time to think, whereas in PP I felt like it was, go, go, go, money, money, money.

Nervous about going out into the real world again, however and having the end all decisions be on me again. I plan on doing full time CCM with part time anesthesia. Till I get burnt that is.

 

[pgg]

I did it for the money and lifestyle!!! Money, money, money, money, MONEY!111

Why did I become a doctor? Well gosh, I guess it's because ever since I was a little boy I just wanted to help people. You know, I don't tell this story often, but I remember when I was seven years old, one time I found a bird that had fallen out of its nest, so I picked him up and I brought him home and I made him a house out of an empty shoebox and... oh my God! [breaks up laughing] I became a doctor for the same four reasons everybody does: chicks, money, power, and chicks. But, since HMOs have made it virtually impossible to make any real money, which directly affects the number of chicks that come sniffin' around, and don't ask me what tree they're barking up, 'cause they're sure as hell not pissing on mine, and as far as power goes, well: Here I am during my free time letting some thirteen-year-old psychology fellow who couldn't cut it in real medicine ask me questions about my personal life, so here's the inside scoop there, pumpkin, why don't you go ahead and tell me all about power.

 

[Psai]

Why did I become a doctor? Well gosh, I guess it's because ever since I was a little boy I just wanted to help people. You know, I don't tell this story often, but I remember when I was seven years old, one time I found a bird that had fallen out of its nest, so I picked him up and I brought him home and I made him a house out of an empty shoebox and... oh my God! [breaks up laughing] I became a doctor for the same four reasons everybody does: chicks, money, power, and chicks. But, since HMOs have made it virtually impossible to make any real money, which directly affects the number of chicks that come sniffin' around, and don't ask me what tree they're barking up, 'cause they're sure as hell not pissing on mine, and as far as power goes, well: Here I am during my free time letting some thirteen-year-old psychology fellow who couldn't cut it in real medicine ask me questions about my personal life, so here's the inside scoop there, pumpkin, why don't you go ahead and tell me all about power.

I read it in his voice!

 

[chocomorsel]

Awesome @pgg!!! That was hilarious.
Not pissing on your tree!!! HAHAHAHAH!!!!

 

[psychbender]

Why did I become a doctor? Well gosh, I guess it's because ever since I was a little boy I just wanted to help people. You know, I don't tell this story often, but I remember when I was seven years old, one time I found a bird that had fallen out of its nest, so I picked him up and I brought him home and I made him a house out of an empty shoebox and... oh my God! [breaks up laughing] I became a doctor for the same four reasons everybody does: chicks, money, power, and chicks. But, since HMOs have made it virtually impossible to make any real money, which directly affects the number of chicks that come sniffin' around, and don't ask me what tree they're barking up, 'cause they're sure as hell not pissing on mine, and as far as power goes, well: Here I am during my free time letting some thirteen-year-old psychology fellow who couldn't cut it in real medicine ask me questions about my personal life, so here's the inside scoop there, pumpkin, why don't you go ahead and tell me all about power.

Still the best and most accurate medical show of all time.

 

[chocomorsel]

Still the best and most accurate medical show of all time.

I figured it was a show or movie. Scrubs?

 

[psychbender]

Indeed

 

[bigdan]

I did cardiac and critical care.

Did cardiac because I wanted that swag...seems like all the trouble we got into in residency ended up with a call to the cardiac guys. I figured "I should get some of that". I did critical care because I was fascinated by the care of sick patients.

Would re-do the fellowships - both of them - over again, 100 times out of 100. I landed in a job where I do (almost) exactly what my perfect job would be: high end cardiac (everything but lung transplant ), liver transplant, blended critical care (surgical + postop cardiac/thoracic/vascular + periodic medical), and no kids nor Ob. Would like to do more mechanical support in my unit, but that would mean going to the ICU in our heath system where I wouldn't get the respect, autonomy, and responsibility that I have now.

The two fellowships have paid off in spades, financially and professionally.

 

[Ronin786]

Anything I've been wrong about, regarding critical care fellowships?

I'm asking sincerely. When I went into CCM, it was partly because I believed all the pink eyeglass BS that one of the people I respect had posted here (with the best intentions, I am sure). The wake-up call was painful.

I think you were right on when you cautioned away from it as a means to increase competitiveness for a PP job. The CC/Anesthesia model is just not a good mix for most groups for monetary reasons. It might allow you to get a job compared to a generalist, but you probably won't be practicing in the ICU in any meaningful capacity. I gave up on the idea of PP CC and my job search has been much more satisfying as a result.

The other problem I saw was that many private groups are just as indebted to their surgeons in the ICU as in the OR, and as a result end up practicing older medicine to appease them. Their population also tends to be on the healthier end and ICU acuity isn't as challenging, though that obviously depends on the job.

The thing that I remember you saying that I have found to be questionable, is the characterization of cardiac ICUs. I recall you saying that they're the worst places to work because of the meddling of cardiac surgeons. While that is true in some places, and was definitely the case for me in residency, some younger cardiac surgeons want nothing to do with mechanical support devices, ECMO and a lot of the intricacies of post-op management of their sicker patients. This is however contingent on joining a good ICU group that has a strong showing in the hospital and has shown their worth over time. There are so many jobs out there looking for intensivists, but they number 1-5 anesthesiologists trying to cover half the shifts in an ICU. Couple that with a department that doesn't respect them for being out of the OR call pool and it leads to an unsatisfying job environment where you spend half the time arguing with surgeons about ventilator management.

My job search has primarily focused on finding a group that has an established presence and an advanced acuity that is out of the comfort zone of most cardiac surgeons. I think if you can find that mix then there is no better place for a critical care anesthesiologist. Other good job opportunities are SICUs with young, critical care trained intensivists. If you're considered part and parcel of the surgical ICU team and that team is practicing evidence-based medicine, then the other surgeons have no choice but to respect your groups shared decisions since they usually won't argue with other surgeons. MICUs are also great for autonomy, but I personally prefer the post-surgical population and most departments are even more reluctant to farm out their anesthesiologists to a medical ICU.

At the end of the day, you really need to enjoy critical care medicine to do an ICU fellowship because it will definitely limit your job opportunities or end up being a wasted year. And if you end up in a hospital rooted in their old ways, and you're one of a handful of ICU docs, you're going to have a tough battle enacting any sort of meaningful patient care. On the other hand, if you can find an established group with surgeons that are too busy in the OR to care about the post-op care then the lifestyle and compensation can be just as good as anesthesia and the autonomy is loads better.

Tl;dr find a well-established ICU group that has heavy support from the department, otherwise you're in for poor job satisfaction.

 

[chocomorsel]

Or go full time CCM. At least for a few years. With a few days a month in the OR.

 

[acidbase1]

Fellowship: Pain

I was genuinely interested in learning the injections. I liked the idea of clinic and no call and lots of money. I went on to hate it and back to anesthesia despite those other things being true. All of the neuraxial experience certainly helps and familiarity with different newer analgesic drugs/management helps. And the idea that if something ever happened to my current job I could have the option to go back to pain to survive is comforting but I hope it doesnt happen.

Just out of curiosity, why did you dislike pain?

 

[OneTyme]

I really did a lot of soul searching prior to applying for fellowship.

Starting in MS1 year I fell in love with Peds anesthesia thanks to my mentor. In Ms4 year I fell in love with pediatric pain medicine, and I decided to pursue a dual fellowship so I could Split my attending time between Peds OR and pediatric pain medicine.

Starting around HOUR ONE of intern year I began seriously doubting that I would pursue additional training (let alone 2 fellowships) because I just really hated being a pee-on.

I seriously struggled with the decision, a lot. Especially given the fact that I have a young and growing family.

Ultimately it came down to my CA2 pediatric rotation. It totally sealed my fate. There is NO WAY that I would be able to work outside of the pediatric anesthesia/pain field, I just love it too much.

So here I am, a Ca3 headed towards two more years of training.

Will it be worth it? Ask me in 2 years and 6 months.

 

[acidbase1]

Why did I become a doctor? Well gosh, I guess it's because ever since I was a little boy I just wanted to help people. You know, I don't tell this story often, but I remember when I was seven years old, one time I found a bird that had fallen out of its nest, so I picked him up and I brought him home and I made him a house out of an empty shoebox and... oh my God! [breaks up laughing] I became a doctor for the same four reasons everybody does: chicks, money, power, and chicks. But, since HMOs have made it virtually impossible to make any real money, which directly affects the number of chicks that come sniffin' around, and don't ask me what tree they're barking up, 'cause they're sure as hell not pissing on mine, and as far as power goes, well: Here I am during my free time letting some thirteen-year-old psychology fellow who couldn't cut it in real medicine ask me questions about my personal life, so here's the inside scoop there, pumpkin, why don't you go ahead and tell me all about power.

Please define “real money”

 

[Cranjis McBasketball]

Please define “real money”

 

[Urzuz]

For those that didn't get pgg's reference:

 

[T-burglar]

I think you were right on when you cautioned away from it as a means to increase competitiveness for a PP job. The CC/Anesthesia model is just not a good mix for most groups for monetary reasons. It might allow you to get a job compared to a generalist, but you probably won't be practicing in the ICU in any meaningful capacity. I gave up on the idea of PP CC and my job search has been much more satisfying as a result.

The other problem I saw was that many private groups are just as indebted to their surgeons in the ICU as in the OR, and as a result end up practicing older medicine to appease them. Their population also tends to be on the healthier end and ICU acuity isn't as challenging, though that obviously depends on the job.

The thing that I remember you saying that I have found to be questionable, is the characterization of cardiac ICUs. I recall you saying that they're the worst places to work because of the meddling of cardiac surgeons. While that is true in some places, and was definitely the case for me in residency, some younger cardiac surgeons want nothing to do with mechanical support devices, ECMO and a lot of the intricacies of post-op management of their sicker patients. This is however contingent on joining a good ICU group that has a strong showing in the hospital and has shown their worth over time. There are so many jobs out there looking for intensivists, but they number 1-5 anesthesiologists trying to cover half the shifts in an ICU. Couple that with a department that doesn't respect them for being out of the OR call pool and it leads to an unsatisfying job environment where you spend half the time arguing with surgeons about ventilator management.

My job search has primarily focused on finding a group that has an established presence and an advanced acuity that is out of the comfort zone of most cardiac surgeons. I think if you can find that mix then there is no better place for a critical care anesthesiologist. Other good job opportunities are SICUs with young, critical care trained intensivists. If you're considered part and parcel of the surgical ICU team and that team is practicing evidence-based medicine, then the other surgeons have no choice but to respect your groups shared decisions since they usually won't argue with other surgeons. MICUs are also great for autonomy, but I personally prefer the post-surgical population and most departments are even more reluctant to farm out their anesthesiologists to a medical ICU.

At the end of the day, you really need to enjoy critical care medicine to do an ICU fellowship because it will definitely limit your job opportunities or end up being a wasted year. And if you end up in a hospital rooted in their old ways, and you're one of a handful of ICU docs, you're going to have a tough battle enacting any sort of meaningful patient care. On the other hand, if you can find an established group with surgeons that are too busy in the OR to care about the post-op care then the lifestyle and compensation can be just as good as anesthesia and the autonomy is loads better.

Tl;dr find a well-established ICU group that has heavy support from the department, otherwise you're in for poor job satisfaction.

In my ideal world, i would be in a private CT group that owned the CTICU - so that the patients could get more than mid-level management, and also I could learn things like bedside resuscitation of CT patients (emergency bedside resternotomy) and ECMO cannulation, etc. I briefly considered ACTA and CCM but stopped with just the cardiac fellowship because I realized that doing both in a private setting is just very hard to find.

 

[pgg]

Please define “real money”

$30K per episode season one, reportedly $300-500K per in season eight.

 

[Hoya11]

Just out of curiosity, why did you dislike pain?

I felt like I was spending so much time helping the worst people in society. And was I really even helping? Its easy to convince yourself that you are... I needed to do more serious/acute things than give grandma injections that may or may not help. I learned that it was important to me to do more serious/impactful things and deal mostly with normal people, pain patients are the special education of medicine and I just didn't want to dedicate my life to that ,been so much happier since I left..

 

[Man o War]

I felt like I was spending so much time helping the worst people in society. And was I really even helping? Its easy to convince yourself that you are... I needed to do more serious/acute things than give grandma injections that may or may not help. I learned that it was important to me to do more serious/impactful things and deal mostly with normal people, pain patients are the special education of medicine and I just didn't want to dedicate my life to that ,been so much happier since I left..

This is why I hated OB so much at my last job. Our hospital had a huge free clinic OB service and day in, day out of seeing complete scum bags giving birth to drug addicted babies really wore me down.
And then to find out from the DCS social worker that this is baby #5 in as many years just disgusted me to no end.

 

[2Fast2Des]

Those of you who did fellowship, or went from PP back to fellowship and then your current job, how much more are you commanding than being a generalist? 50% 75% 100% higher? Does it make the one year or 2 of lost income worth it financially?

 

[DM27]

I make about 20% more than someone who didn't do a fellowship. The larger advantage is that I am now in a position where because of my training, I am one of the few people where I am who does what I do and I replaced two people. If I leave it will end up being a major headache for my boss and a huge quality of life hit to everyone else I work with, so I will likely be discussing this when I renegotiate my salary.

 

[Man o War]

Those of you who did fellowship, or went from PP back to fellowship and then your current job, how much more are you commanding than being a generalist? 50% 75% 100% higher? Does it make the one year or 2 of lost income worth it financially?

This is tough to quantify because it depends on how much you’re working, how much call you’re taking, etc. I would say for me my CTA fellowship got me access to join the good PP groups that are making 90-100% MGMA. I wouldn’t have my current job without the fellowship because at the time they didn’t need any more generalists.

 

[Psai]

This is tough to quantify because it depends on how much you’re working, how much call you’re taking, etc. I would say for me my CTA fellowship got me access to join the good PP groups that are making 90-100% MGMA. I wouldn’t have my current job without the fellowship because at the time they didn’t need any more generalists.

Whoa when are you hiring. brb applying to ct

 

[Man o War]

Whoa when are you hiring. brb applying to ct

@Psai i like your sense of humor on here, you’d be fun to work with. Do CTA for sure if you like it, definitely better selection of jobs.

 

[deleted171991]

Those of you who did fellowship, or went from PP back to fellowship and then your current job, how much more are you commanding than being a generalist? 50% 75% 100% higher? Does it make the one year or 2 of lost income worth it financially?

5%. I am easily replaceable, because it's a decent job.

 

[DM27]

If you feel like you need to do a fellowship just to do one and want to work in the OR, I recommend CT. I am not saying this transformation actually happens, or that the reputation is earned, but if you do a CT fellowship you are often labelled as "this guy can do anything" and you gain an illogical sense of credibility when applying to jobs even if CT is not involved with what you are interviewing for.

The one caveat I will add is that CT fellowship does change one thing about you. The best analogy I can give is it's the anesthesia equivalent of the gravity training chamber in the old dragonball Z show. If this analogy does not make sense then you will not benefit much from reading beyond this sentence. You get very accustomed to the level of investment the cardiac cases require in terms of initial access and monitoring, surgeon personality management, and irritating transport. This results in you becoming exponentially faster than you were before in normal cases because you are so used to having to do x, y, and z that you speed through x to then realize you're already done since this is a normal general surgery case. I was a slower resident, I did not feel the need to go faster than I felt comfortable going just to please the surgeon of the day. Now I am unintentionally one of the more efficient people where I work because I am programmed to expect to do so much more for each case that I move expecting there will always be more to do. It also makes a lot of hemodynamic swings and levels of care escalation a lot less interesting than they were before.

 

[deleted162650]

The best analogy I can give is it's the anesthesia equivalent of the gravity training chamber in the old dragonball Z show.

NEEEERRRRRDDDD!!!!!

 

[psychbender]

Fellowship: CCM
It was critical care that brought me to anesthesiology, and I had great experiences in the ICU as a med student and resident. The military did not permit me to go straight into fellowship after residency, so I worked for a few years until I fulfilled my service obligation and became a civilian again. As a young attending, I sought out the sickest patients coming to the OR, built up my cardiac and echo experience, and continued to work with the ICU staff at my hospital. I struggled between CT and CCM, but ultimately went with CCM. This was in part because I saw plenty of non-CT fellowship trained docs (particularly CCM guys) in the heart room in residency and out in practice, but didn't see anyone in the unit that didn't do CCM. I have not yet decided if this was a mistake. Fellowship was exhausting, but great. The patients were sick, I had a good amount of autonomy in most units, and I learned a ****-ton. The job market, however, absolutely blows. Due to family, I am tied to a good-sized geographic region where nearly all Anes/CCM opportunities are academic jobs, and the vast majority of straight anesthesia jobs in any place with acuity are ACT practices now (mostly Mednax, Napa, et al). I strongly dislike academics, and there is nothing about a corporate ACT practice that is attractive to me. I took a job that offered what I was looking for (solo cases, cardiac, ICU), but the leadership at the hospital were both less than honest and less than competent at their jobs, so I'm back in the market again.

Regarding compensation for fellowship, where I am now, I make $25,000 more than my non-fellowship colleagues, and don't take OR call (just ICU call).

Without any debt, at least I do have the option of saying screw everything, and semi-retiring to one week a month in the unit, making close to $200,000.

 

[deleted59964]

I did an adult cardiac fellowship. I've written about it here a bunch of times before, search if you want the verbose version. Short summary, I liked doing hearts, and it's clear that getting credentialed to do them in the future at 90%+ of facilities will require the fellowship. I also had some good cardiac attendings as role models and admired their comfort and ability to handle just about everything. I didn't like the thought of something going on in a nearby OR that I wasn't well qualified and comfortable handling. (This will always be the case of course, e.g. I don't now do neonates and never will, but the cardiac fellowship filled some of the comfort holes.) Echo is fun and awesome and useful and I wanted to be good at it. It's good for the CV in terms of future job prospects. Learning is fun and so is being the best you can be.

I practiced as a generalist for 7 years before going back to training as a fellow. There were a few reasons for this, but mainly my active military service kept the door closed for a while. On the plus side I didn't take a financial hit as a fellow, also because of the military.

I chose a workhorse program doing my own cases, as opposed to a so-called "echo fellowship" involving mostly supervision. Being a powerless peon again for a year had its less fun moments, but my ego doesn't need a lot of massaging and mostly I was content learning new stuff while having a smart, experienced attending behind me to help out and teach.

Glad I did it, would buy again, five stars.

This is exactly how I feel about having done a paeds fellowship

 

[dchz]

I wish to hear more from people with OB or regional fellowships.

 

[dhb]

I wish to hear more from people with OB or regional fellowships.

:troll:

 

[chocomorsel]

:troll:

I think he’s serious. Regional is becoming a thing now for fellowship.
For me, I haven’t signed a contract, but it looks like I will be making about 20% more than I was when I did full time anesthesia. So far still interviewing but this is the job I am leaning towards. Of course I will be working half the weekends a year and no real vacation time besides the 26 on/off.
For me, I enjoy being out of the OR and not constantly freezing and not dealing with surgeons all day long. That’s the bigger benefit.

 

[anbuitachi]

I think he’s serious. Regional is becoming a thing now for fellowship.
For me, I haven’t signed a contract, but it looks like I will be making about 20% more than I was when I did full time anesthesia. So far still interviewing but this is the job I am leaning towards. Of course I will be working half the weekends a year and no real vacation time besides the 26 on/off.
For me, I enjoy being out of the OR and constantly freezing and dealing with surgeons all day long. That’s the bigger benefit.

Interesting that CCM is bringing higher incomes than anesthesia. usually hear the other way aruond or similar incomes.. 20% increase in income while working less is a lot.

 

[chocomorsel]

Interesting that CCM is bringing higher incomes than anesthesia. usually hear the other way aruond or similar incomes.. 20% increase in income while working less is a lot.

Well, like I said many times before. I probably made less than the median MGMA while I was out.

Didn’t have the contacts to land the best paying PP gig; did not I want to supervise 3-4:1 all the time nor bust my ass at a 60+ hr a week job. I worked hard (50-60hrs) in Vegas for two years doing mostly BS spine cases when I really preferred brain and realized it wasn’t worth it for me. Dealing with some of the crazy, money hungry neurosurgeons was giving me back pain and head pain.

So for me, it’s a job that’s gonna pay me >425K W2 with residents to help with paperwork.

 

[Psai]

Well, like I said many times before. I probably made less than the median MGMA while I was out.

Didn’t have the contacts to land the best paying PP gig; did not I want to supervise 3-4:1 all the time nor bust my ass at a 60+ hr a week job. I worked hard (50-60hrs) in Vegas for two years doing mostly BS spine cases when I really preferred brain and realized it wasn’t worth it for me. Dealing with some of the crazy, money hungry neurosurgeons was giving me back pain and head pain.

So for me, it’s a job that’s gonna pay me >425K W2 with residents to help with paperwork.

Don't you mean with residents to teach and guide into fine careers???