Transfusion Medicine fellowship as anesthesia

[Katheudontas parateroumen]

Hey everyone!
I'm currently just starting my PGY3 of my anesthesia residency. I have come to realize that I really miss medical diagnosis, consultation, direct patient care (go figure from an anesthesiologist lol). I recently found out that blood banking/transfusion medicine is offered by some fellowships to anesthesiology. The only real experience I have from BB/Transfusion medicine are the consults I've put in while doing ICU intern year/ICU months and found their knowledge base extraordinary and fascinating. My questions are:
-what's the day to day of transfusion medicine?
-how competitive generally are these spots? Do I have a chance coming from anesthesia?
-Do you know any BB/TFM people that were anesthesiologists?

Thanks and feel free to add your general advice/comments!

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[rirriri]

Wow that’s really interesting. When I was training one of my BB attendings was IM but didn’t know Gas going into BB was a thing too!

As far as I know these fellowships aren’t overly competitive. It’s a niche which usually attracts a small crowd every year.

 

[Ziehl-Neelsen]

-Do you know any BB/TFM people that were anesthesiologists?

I know an anesthesiologist who is board certified in BB/TM, but I would say his primary vocation is anesthesiology while his avocation is BB/TM and specifically the hemostasis/resuscitation of actively bleeding patients part where BB/TM more directly intersects with perioperative/critical care medicine.

-how competitive generally are these spots? Do I have a chance coming from anesthesia?

Getting a spot is not super competitive (there are unfilled spots every year), and you'll have a unique application being an anesthesiologist instead of the usual pathologists that apply. Getting the right spot for you will take some extra doing... Most programs are set up for the standard route of taking a pathologist and training him or her to be the medical director of a large transfusion service/donation center. If you envision a career practicing where transfusion and perioperative care meet, it will take a special program (and not a program based at a blood center). If you want to totally jettison anesthesia and practice purely transfusion medicine, any old program will do (though you will have a steep learning curve not coming from a lab medicine background, so I'd make sure that whatever program you went to had solid didactics and was comfortable training someone with your background).

-what's the day to day of transfusion medicine?

So variable as to defy adequate description on a message board. You really need to get some experience in this space to see what practice avenues are possible (though your idealized vision of BB/TM being a haven of erudite consultation, direct patient care, and medical diagnosis is callow--like all specialties we have our own special forms of drudgery that comprise most of the day to day punctuated by scattered satisfying moments).

I think that generally describing the anesthesiologist I referenced above may be of some help. He completed anesthesiology residency at a top institution and (as I said) his particular niche is hemostasis and resuscitation of the actively bleeding in the perioperative/critical care arenas. He was focused on a clinical research career at an academic institution along the lines of Waters at UPitt or Kor at Mayo in the region where BB/TM intersects with the perioperative/critical care medicine role of anesthesiology, i.e. he was still going to be primarily an anesthesiologist but with a hemostasis/transfusion expertise. The BB/TM was meant to enhance his abilities as an anesthesiologist not replace them with an entirely new skill set (illustrated by the fact that he went on to a cardiac anesthesiology fellowship after BB/TM).

If you are proposing to never practice anesthesiology again and plan on exclusive BB/TM practice (which by the way is relatively rare in and of itself), I'd ask why you why not resign from your anesthesiology residency in order to do a clinical pathology residency followed by BB/TM fellowship?

 

[Katheudontas parateroumen]

I know an anesthesiologist who is board certified in BB/TM, but I would say his primary vocation is anesthesiology while his avocation is BB/TM and specifically the hemostasis/resuscitation of actively bleeding patients part where BB/TM more directly intersects with perioperative/critical care medicine.


Getting a spot is not super competitive (there are unfilled spots every year), and you'll have a unique application being an anesthesiologist instead of the usual pathologists that apply. Getting the right spot for you will take some extra doing... Most programs are set up for the standard route of taking a pathologist and training him or her to be the medical director of a large transfusion service/donation center. If you envision a career practicing where transfusion and perioperative care meet, it will take a special program (and not a program based at a blood center). If you want to totally jettison anesthesia and practice purely transfusion medicine, any old program will do (though you will have a steep learning curve not coming from a lab medicine background, so I'd make sure that whatever program you went to had solid didactics and was comfortable training someone with your background).


So variable as to defy adequate description on a message board. You really need to get some experience in this space to see what practice avenues are possible (though your idealized vision of BB/TM being a haven of erudite consultation, direct patient care, and medical diagnosis is callow--like all specialties we have our own special forms of drudgery that comprise most of the day to day punctuated by scattered satisfying moments).

I think that generally describing the anesthesiologist I referenced above may be of some help. He completed anesthesiology residency at a top institution and (as I said) his particular niche is hemostasis and resuscitation of the actively bleeding in the perioperative/critical care arenas. He was focused on a clinical research career at an academic institution along the lines of Waters at UPitt or Kor at Mayo in the region where BB/TM intersects with the perioperative/critical care medicine role of anesthesiology, i.e. he was still going to be primarily an anesthesiologist but with a hemostasis/transfusion expertise. The BB/TM was meant to enhance his abilities as an anesthesiologist not replace them with an entirely new skill set (illustrated by the fact that he went on to a cardiac anesthesiology fellowship after BB/TM).

If you are proposing to never practice anesthesiology again and plan on exclusive BB/TM practice (which by the way is relatively rare in and of itself), I'd ask why you why not resign from your anesthesiology residency in order to do a clinical pathology residency followed by BB/TM fellowship?

Thanks for the perspective! I still enjoy the OR but it's not something that I feel like I would do for the majority of my time. I would really like to be a separate physician from OR anesthesia one of these days which is quite common (pain, addiction, critical care, sleep, etc) for anesthesiologists.

 

[Med Director New England]

Hey everyone!
I'm currently just starting my PGY3 of my anesthesia residency. I have come to realize that I really miss medical diagnosis, consultation, direct patient care (go figure from an anesthesiologist lol). I recently found out that blood banking/transfusion medicine is offered by some fellowships to anesthesiology. The only real experience I have from BB/Transfusion medicine are the consults I've put in while doing ICU intern year/ICU months and found their knowledge base extraordinary and fascinating. My questions are:
-what's the day to day of transfusion medicine?
-how competitive generally are these spots? Do I have a chance coming from anesthesia?
-Do you know any BB/TFM people that were anesthesiologists?

Thanks and feel free to add your general advice/comments!

In general TM is not competitive

Any clinical background would be fine with TM and could help you out when you are dealing with stewardship issues - you would have a better background than path trained Blood bankers.

Complicated TM (like managing apheresis, complicated bleeders, etc) imo is better managed by folks with a clinical background

The most skilled blood banker I know is Internal medicine boarded.

 

[Katheudontas parateroumen]

Thank you for all the input here. I will be doing a critical care fellowship for 2021-22, but i am still considering applying next year for BB/TM starting 2022-23.

 

[deleted642280]

I chose Transfusion Medicine also because I missed seeing patients. I love it, but you will make a lot more money in critical care. I found CCU and ICU work a little depressing though so I didn't go that route. Doing that fellowship first is a very good choice and will give you a feel for if you like it. It's generally love-hate or both at the same time The benefits are more money and also shift work so no call from home. Day shift is better for your health but night shift is more fun people-wise because all the admins are home. If you want a 9-5 Transfusion Medicine can give you that. Make sure to only interview at programs that offer at least 50% clincial service hospital time which must include hospitals that have Apheresis. There are a number around the country if location is not an issue. PM me if you have more questions and good luck!

 

[Dro133]

I chose Transfusion Medicine also because I missed seeing patients. I love it, but you will make a lot more money in critical care. I found CCU and ICU work a little depressing though so I didn't go that route. Doing that fellowship first is a very good choice and will give you a feel for if you like it. It's generally love-hate or both at the same time The benefits are more money and also shift work so no call from home. Day shift is better for your health but night shift is more fun people-wise because all the admins are home. If you want a 9-5 Transfusion Medicine can give you that. Make sure to only interview at programs that offer at least 50% clincial service hospital time which must include hospitals that have Apheresis. There are a number around the country if location is not an issue. PM me if you have more questions and good luck!

I'm an incoming CP-only resident. Could you talk a little bit more about the day-to-day of transfusion med, and what the job/salary prospects are? Thanks!

 

[deleted642280]

I'm an incoming CP-only resident. Could you talk a little bit more about the day-to-day of transfusion med, and what the job/salary prospects are? Thanks!

It depends on the location. I think rural places pay more, but you are on call more. Here's an idea for academic Transfusion Medicine in a large city though:

Pay offers were anywhere from 180K-300K (the 300 was a very rural area where I just didn't want to live). Most of the urban places I visited (3 in 3 different states were right around 200ish)

I do not need to fund my salary with grant money.

On call/on-service 25%--this is a consult service so there is patient care, blood bank consults, resident teaching
Administration 50%-- directorship work, writing SOPs, going to meetings, politicking, preparing for inspections, QA, teaching didactics

Research 25%

I have friends who prefer more research and different University Medical centers will offer more research/less admin or more clinical/less something else if you have a preference. The new hire before me is 75% research/25% clinical.

On any given day this breaks out for me to a solid week on service/on call with the rest of the days a variety of meetings, phone calls, paperwork, office work, writing research papers or book chapters etc. Also I get follow up questions on a lot of the patients who are my regulars because I get to know their primary clincians well.

 

[Dro133]

It depends on the location. I think rural places pay more, but you are on call more. Here's an idea for academic Transfusion Medicine in a large city though:

Pay offers were anywhere from 180K-300K (the 300 was a very rural area where I just didn't want to live). Most of the urban places I visited (3 in 3 different states were right around 200ish)

I do not need to fund my salary with grant money.

On call/on-service 25%--this is a consult service so there is patient care, blood bank consults, resident teaching
Administration 50%-- directorship work, writing SOPs, going to meetings, politicking, preparing for inspections, QA, teaching didactics

Research 25%

I have friends who prefer more research and different University Medical centers will offer more research/less admin or more clinical/less something else if you have a preference. The new hire before me is 75% research/25% clinical.

On any given day this breaks out for me to a solid week on service/on call with the rest of the days a variety of meetings, phone calls, paperwork, office work, writing research papers or book chapters etc. Also I get follow up questions on a lot of the patients who are my regulars because I get to know their primary clincians well.

Sounds like a nice variety of roles/responsibilities and a flexible schedule. Thanks for the reply!

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[abc2019]

It depends on the location. I think rural places pay more, but you are on call more. Here's an idea for academic Transfusion Medicine in a large city though:

Pay offers were anywhere from 180K-300K (the 300 was a very rural area where I just didn't want to live). Most of the urban places I visited (3 in 3 different states were right around 200ish)

I do not need to fund my salary with grant money.

On call/on-service 25%--this is a consult service so there is patient care, blood bank consults, resident teaching
Administration 50%-- directorship work, writing SOPs, going to meetings, politicking, preparing for inspections, QA, teaching didactics

Research 25%

I have friends who prefer more research and different University Medical centers will offer more research/less admin or more clinical/less something else if you have a preference. The new hire before me is 75% research/25% clinical.

On any given day this breaks out for me to a solid week on service/on call with the rest of the days a variety of meetings, phone calls, paperwork, office work, writing research papers or book chapters etc. Also I get follow up questions on a lot of the patients who are my regulars because I get to know their primary clincians well.

How has Covid impacted your work? What impacts do you think Covid will have on the field of transfusion medicine?

 

[Katheudontas parateroumen]

I chose Transfusion Medicine also because I missed seeing patients. I love it, but you will make a lot more money in critical care. I found CCU and ICU work a little depressing though so I didn't go that route. Doing that fellowship first is a very good choice and will give you a feel for if you like it. It's generally love-hate or both at the same time The benefits are more money and also shift work so no call from home. Day shift is better for your health but night shift is more fun people-wise because all the admins are home. If you want a 9-5 Transfusion Medicine can give you that. Make sure to only interview at programs that offer at least 50% clincial service hospital time which must include hospitals that have Apheresis. There are a number around the country if location is not an issue. PM me if you have more questions and good luck!

Thank you I appreciate your reply! How much discrimination do you all think I will get by being an anesthesia/CCM physician for a job doing transfusion/BB? I think ideally I'd do 1 week ICU and 1 week transfusion/BB. I don't mind scattered OR as needed but definitely prefer to be out of the OR.

 

[deleted642280]

I don't think any. Fellowship prepared me for my job more than anything else. I know at least 2 hematology/TM trained attendings and I once med a peds/TM trained person interestingly. All great at their jobs.

 

[deleted642280]

How has Covid impacted your work? What impacts do you think Covid will have on the field of transfusion medicine?

For me so far I've been busier. More people in the hospital has meant more type and screens, more need for convalescent plasma, more people with solid organ rejection needing apheresis. Fewer stem cell collections.