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Transplant Anesthesia Fellowship opportunity
Started by zyovka
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deleted171991
Not competitive. Not worth doing. The End.
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yup, there are quite a few out there. If they have an OB fellowship with Neuro, then Transplant makes even more sense to me, because of a specialized management that is not exercised routinely, despite doing OB/Neuro in residency all the time. The thing is that the place i might be looking in terms of employment, states they do a lot of transplants (liver, kidneys, hearts), so my CV would look pale and lifeless for that kind of job.
Who cares? That's probably not the kind of job you'd want anyway, unless you enjoy getting underpaid and overworked.
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deleted171991
Then do a strong critical care fellowship. That will both prepare you to do transplant in the OR and give you a second board certification. If you don't like critical care, you probably won't like transplant either (or won't be really good at it). 😉
Heart (and probably lung) transplants should be done by cardiac anesthesiologists (or intensivists). Kidney transplants could be done by a CA-1. A sick liver should get an intensivist.
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So far found this -one of co-founders of the Society for the Advancement of Transplant Anesthesia (SATA). He talks about the cross between the Critical Care and a liver transplantology etc.
I'm sure he has no conflict of interest.
Yep. Did like ~40 liver transplants during residency. Getting underpaid for another year just to do more liver call sounds ridiculous....
Man, you had quite a residency!!! We have no prospective with this kind of transplant. Recently started cardiac, but the 2nd one went south, so the future is quite foggy at this point
If you can do cardiac case, you can do a liver. Liver is just a prolonged blood bath transfusion case minus cpb.
Not worth it! Your opportunities will not be limited by lack of transplant experience
They are vastly different cases. But I would agree with this statement.
The add says: "Strong interest in those with liver transplantation experience", that after they say that they have well established heart and abdominal transplant program.
WTF is abdominal transplant? also will you be doing the heart transplant?
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May this is a fancy way of saying "liver transplant"?
Quote:
- Established cardiac and abdominal transplant programs
- Diverse general case mix includes general and vascular surgery, ortho, ENT, etc.
- Strong interest in those with liver transplantation experience
- Cardiac and neuro cases for those with subspecialty or fellowship training
- Opportunity to do approximately 75% of your own cases with some medical direction of lower risk cases
- Potential for fellowship trained in cardiac and neuro
- Skills in all areas of general anesthesia
Abdominal transplant means liver, kidney, pancreas, small bowel. When I was looking for jobs as a CC fellow, most academic places tried to steer me towards their liver team, even though I have never actually done a liver transplant (not an ACGME requirement, so the Army didn't have us rotate out to get those numbers). They all said that there could bring me up to speed once there. One of several things that tells me it's that they'll take just about anyone who is used to caring for sick patients, so those dedicated fellowships are essentially useless outside of a very niche academic market.
One of my residency colleagues does livers now in his academic job, and he didn't even take care of sick patients for three or four years post-residency. They needed more bodies for liver call, and he was willing to learn on the job, while they paid him his regular attending salary.
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One of my residency colleagues does livers now in his academic job, and he didn't even take care of sick patients for three or four years post-residency. They needed more bodies for liver call, and he was willing to learn on the job, while they paid him his regular attending salary.
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There you go so then, you could be the one doing all the transplants....
They're not going to have you doing heart or lung transplants unless you have a cardiac fellowship under your belt already. The shadiness they're spewing right there is reason enough not to consider it.
What else would you expect? He is a generalist attending already being paid generalist salary. Once part of the liver call pool, he can get the extra liver call money (which isn't much), but the salary is still the same.
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I read that as they have a well established transplant program, and candidates with cardiac fellowship will get to take part in the heart and lungs transplants, not that liver fellowship trained people will be doing hearts and lungs.
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This is how it is in my place. You don't get paid extra, you merely get more overtime hours doing challenging cases at all hours of the night.
UNDERPAID.
CPT 47135
CVC
PAC
TEE
Arterial line
3-6 hours of case time
If you do 1-2 livers per day, you should be making $1 million at least.
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deleted162650
Ya, because liver transplant patients always have sweet PPO insurance plans.
I was figuring Medicaid rates for 90% of your case load.
If 50% PPO at a world renowned transplant center and you're BUSY all year, $1.2-1.5 million.
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deleted162650
Your math is very fuzzy.
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deleted87051
Most of the busiest programs are around 150 cases/year. You could be on call every day at one of those programs and still not get that many cases.
I stand corrected, didn't realize Oschner only has 200 per year, probably split between a pool of anesthesiologists.
Even more reason not to do liver transplant fellowship since the financials aren't there to support the wasted year and all the extra call, even for a non-salaried job.
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deleted171991
Like most ICU patients.
My favorite fellowship is the one that guarantees a solo ASC no endo job for life. You guys should see the faces on the department chiefs when I ask about ICU + ambulatory anesthesia. 😀
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You put a PAC and TEE for every liver? Even these days where the mega sickies aren’t getting as many organs?
I think TEE definitely has a role if things go sideways but PAC... the sick cardiac crowd with pulmonary hypertension are disqualified from the registry. Do you CCM folks prefer to have a swan for these cases post-op?
I haven't done livers since residency, but all those lines and echo were "standard of care". 90% of the livers were definitely *sick*.
There are some candidates who look like they're one toenail clipping away from death yet we still bring them, definitely need the lines I think. I do remember canceling one case after floating the swan because of noted unacceptable pulmonary htn
If someone is listed for liver txp, that should be caught and worked up preop, no?
Why people put in swans this day and age I don’t really get. Unless if a pt has RV dysfunction or pulmonary HTN, the swan numbers are just noise IMO. Anyone else feel different?
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deleted171991
Beyond what you said, the main value I see in it is measuring CO (and calculating SVR). CVP, SvO2, PCWP are mostly worthless.
I would take a TEE over a Swan any day (but I am just an intensivist).
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deleted87051
The disadvantage of TEE is that they are expensive and you need to keep a machine and a capable sonographer at bedside in the ICU if it is going to be useful for postop care. You can get useful information and trend it with a PA catheter.
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deleted171991
The problem is "trending" data that's not proven to be either sensitive or specific, such as those I mentioned above. For every clinical decision, one has a 50-50 chance of being right/wrong. So do most of these numbers; actually, the CVP predicts fluid responsiveness correctly in only 40% of the patients. 😛
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I don't do livers anymore but I do recall a similar situation of cancelling for pHTN after putting in the PA cath when I was a resident.
I confess to having put in approximately 1 PA cath in the last 10 years.
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deleted171991
Whatever floats your boat. 🙂
A post op heart, yes. A post op liver? Any decline in BP is bleeding, bleeding, bleeding; maybe under resuscitation. Once reperfusion is done, if there are no cardiac issues at the end of the case, I’m very hard pressed to believe the pt will develop a cardiac issue in the ICU that only PA cath can identify
A PA cath is gonna get you in trouble in the SICU when the surgeon comes by and sees wonky numbers and then demands the wrong intervention like epi or volume or lasix. The numbers are NOT simple and straightforward to interpret and can be harmful in the wrong hands. I’ve had multiple times in residency where we would all look at the same PA numbers and different people would come to different conclusions.
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deleted87051
Good point. That said, 90% of the time the problem for postop hearts is bleeding too.
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deleted171991
I was thinking EXACTLY the same thing. It's the reason why I don't put extra numbers on the screen. It's enough that I have to deal with "why is the patient's BP target 75 and not 65?". (Because I am the F-ING intensivist and I said so.)
Also, we all know about the low informational value of a high CVP. How about a low one? Does that mean that the patient is dry, or venodilated, or has increased intra-abdominal pressures? I am sure there are many other reasons one can come up with.
What the heck does a high PAP or normal PCWP mean for left heart disease? Nada. The degree of increase in PAP does not correlate with LVEDP - one can have so-called "reactive" (unexpectedly high) PHTN with relatively decent LVEDP, because the increase in PA pressures is neurohormonally-mediated (i.e. vasoconstriction), not hydrostatically (i.e. backflow) like they teach it in the school of (history of) medicine. And the PCWP does not correlate with the LVEDP either. And even the LVEDP itself couldn't tell me if I have systolic or diastolic dysfunction.
Yes, we can keep rationalizing/debating about "the trend", like about global warming.
</rant> I still like you all.
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“Down with the afterload!”
-Bartlett, CHEST, 1995
-Bartlett, CHEST, 1995
Mandatory ICU reading for my residents.
