What is the best fellowship path?

[deleted162650]

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I got some interviews off of cold calls and I know a handful of people working in desirable areas who are there because they made cold calls without any prior connections. Don't discount them. Low yield? - ya mostly, but you won't get 100% of the jobs you never inquire about.

 

[GravelRider]

I got some interviews off of cold calls and I know a handful of people working in desirable areas who are there because they made cold calls without any prior connections. Don't discount them. Low yield? - ya mostly, but you won't get 100% of the jobs you never inquire about.

True. Focus on one or two places you have a good idea would be a place you would want to work. Sending your CV and a follow-up phone call would be enough. What I am referring to are some of these complicated charting strategies that involve maps and drawing a radius like you are searching for someone lost at sea. It's very time consuming and likely low yield.

 

[BLADEMDA]

1. Do a Fellowship (for private practice that means Cardiac, Pain or Peds)
2. Plan on going WEST- That means Southwest, Midwest or West Coast (if you have connections).
3. The toughest spots for true "PP" are the Northeast and now the Southeast as well (sales to AMCs).

 

[divinemsm]

You are probably in pain (no pun intended). My advice to you is to look very carefully at the HPM program before you give up a year. I know people who regretted that year, once they discovered that 1. their program wasn't as good as they had hoped, 2. their post-fellowship job choices sucked even more than with pain.

If you are not in pain, I hope you have a very good and palpable reason for going the HPM route.

Actually , there is not much worse of a fate than I can think of besides practicing pain. I've been a true general anesthesiologist in a busy, busy PP group where I do everything from routine peds, major vascular, neuro, regional , transplant , OB etc . My take , and I work in a truly desirable area, is that he traditional fellowship route seems to be of little advantage / benefit unless you are a peds person who does truly sick, congenital anomalies etc in an academic center. Most peds in PP end up doing tonsils etc..and like any skill set , if you don't use it , you lose it.
A good anesthesiologist should be able to do any case type including routine CABG and valves. Yes , I know I will get the argument about prestigious institutions wanting the fellowship , but truly -if you are well trained you can place lines etc., as well as get certified in echo on your own time.
HPM is truly a calling for me and the patient population is one I work with on the daily in my current practice model-only now I won't have the expectation of miracles during increasingly ridiculous elective case types.( you see my bias here )
One could also argue that I'm losing income for a year and that's a fact . My plan is to have a more diversified career in which I function as a medical director of a hospice as my main gig . There is always opportunity to practice anesthesia on the side as a board cert. anesthesiologist . As for lack of job opportunities in HPM-hardly . Last year 230 or so positions were available nationally. Who better to take care of this patient type , than an anesthesiologist ? My 2 cents 🙂

 

[turnupthegas]

Thank you all for the responses. Out of curiosity, if I worked for a year or two on the east coast (significant other still in residency), would have some private practice/academic attending experience increases chances of getting a better job in desirable locales?



Thank you again!


Sent from my iPhone using SDN mobile

 

[GravelRider]

Actually , there is not much worse of a fate than I can think of besides practicing pain. I've been a true general anesthesiologist in a busy, busy PP group where I do everything from routine peds, major vascular, neuro, regional , transplant , OB etc . My take , and I work in a truly desirable area, is that he traditional fellowship route seems to be of little advantage / benefit unless you are a peds person who does truly sick, congenital anomalies etc in an academic center. Most peds in PP end up doing tonsils etc..and like any skill set , if you don't use it , you lose it.
A good anesthesiologist should be able to do any case type including routine CABG and valves. Yes , I know I will get the argument about prestigious institutions wanting the fellowship , but truly -if you are well trained you can place lines etc., as well as get certified in echo on your own time.
HPM is truly a calling for me and the patient population is one I work with on the daily in my current practice model-only now I won't have the expectation of miracles during increasingly ridiculous elective case types.( you see my bias here )
One could also argue that I'm losing income for a year and that's a fact . My plan is to have a more diversified career in which I function as a medical director of a hospice as my main gig . There is always opportunity to practice anesthesia on the side as a board cert. anesthesiologist . As for lack of job opportunities in HPM-hardly . Last year 230 or so positions were available nationally. Who better to take care of this patient type , than an anesthesiologist ? My 2 cents 🙂

👍

The hospital that I practiced as a hospitalist at had a very robust and engaging palliative care service. They were one of the most useful services that I would consult. I was guided through many tough cases by the palliative care service. They also provided some non-end of life guidance as well. I have actually heard of more and more anesthesiologists becoming interested in hospice/palliative care and I think that is a good thing. We have a certain expertise that we can bring to an underutilized specialty. Early intervention by a hospice/palliative care service can mean the difference between a patient dying a comfortable death with dignity and a long, protracted ICU stay with multiple futile interventions. Good hospital systems will have a great deal of interest in building up a palliative care service. In the end, it is not all about money, but rather doing something that gives you some satisfaction at the end of the day.

 

[sevoflurane]

Cold calls don't work.

Yeah... Wrong.
Not good advice.

 

[sevoflurane]

Timing can be everything and cold calling is part of that equation.

 

[sevoflurane]

Actually , there is not much worse of a fate than I can think of besides practicing pain. I've been a true general anesthesiologist in a busy, busy PP group where I do everything from routine peds, major vascular, neuro, regional , transplant , OB etc . My take , and I work in a truly desirable area, is that he traditional fellowship route seems to be of little advantage / benefit unless you are a peds person who does truly sick, congenital anomalies etc in an academic center. Most peds in PP end up doing tonsils etc..and like any skill set , if you don't use it , you lose it.
A good anesthesiologist should be able to do any case type including routine CABG and valves. Yes , I know I will get the argument about prestigious institutions wanting the fellowship , but truly -if you are well trained you can place lines etc., as well as get certified in echo on your own time.
HPM is truly a calling for me and the patient population is one I work with on the daily in my current practice model-only now I won't have the expectation of miracles during increasingly ridiculous elective case types.( you see my bias here )
One could also argue that I'm losing income for a year and that's a fact . My plan is to have a more diversified career in which I function as a medical director of a hospice as my main gig . There is always opportunity to practice anesthesia on the side as a board cert. anesthesiologist . As for lack of job opportunities in HPM-hardly . Last year 230 or so positions were available nationally. Who better to take care of this patient type , than an anesthesiologist ? My 2 cents 🙂

Nice post.

 

[deleted171991]

Nice post.

Except that it may be somewhat wishful thinking, about HPM at least. I think the most underrated question for fellowship PDs is "where did each of your graduates go, in the last 3 years?". Just because there are 230 positions/year doesn't mean that anybody actually needs those people, or that there are even 100 good jobs lined up post-fellowship.

My very inflated two cents, as an outsider, are that s/he's way too optimistic about HPM. There is a reason people are not lining up for that fellowship, the same way they don't line up to do CCM. Mr. Market knows what he's doing (in both cases).

 

[Nivens]

My very inflated two cents, as an outsider, are that s/he's way too optimistic about HPM. There is a reason people are not lining up for that fellowship, the same way they don't line up to do CCM. Mr. Market knows what he's doing (in both cases).

I keep hearing how in-demand the combined cardiac-ccm folks are. If this is true (likely primarily an academic phenomenon), what is it about the combo that is desirable when ccm alone is not?

 

[deleted171991]

I keep hearing how in-demand the combined cardiac-ccm folks are. If this is true (likely primarily an academic phenomenon), what is it about the combo that is desirable when ccm alone is not?

Don't do CCM only. Do CCM+cardiac, preferably in that order. The combination is in demand because hospitals want their cardiac surgeons in the OR, and cardiac surgeons prefer the same anesthesiologists in the OR and in the ICU.

CCM is academic. CCM is useless in PP (for anesthesiologists), at least for now. Unless one can do cardiac (and except for the few places that also cover the ICU), many PP employers just don't appreciate what a CCM guy knows. They respect CCM training about as much as some surgeons respect anesthesiologists (i.e. "no big deal, I too could do that"), or they simply couldn't give a crap. Intensivists have been out of practice for a year, so they would rather take the fresh residency grad. Plus what kind of anesthesiologist would enjoy doing ICU, and sacrifice a year for a tough fellowship? Must be a bad one.

 

[Nivens]

Don't do CCM only. Do CCM+cardiac, preferably in that order. The combination is in demand because hospitals want their cardiac surgeons in the OR, and cardiac surgeons prefer the same anesthesiologists in the OR and in the ICU.

CCM is academic. CCM is useless in PP (for anesthesiologists). Unless one can do cardiac (and except for the few places that also cover the ICU), many PP employers just don't appreciate what a CCM guy knows. They respect CCM training about as much as some surgeons respect anesthesiologists (i.e. "no big deal, I too could do that"), or they simply couldn't give a crap. Intensivists have been out of practice for a year, so they would rather take the fresh residency grad. Plus what kind of anesthesiologist would enjoy doing ICU, and sacrifice a year for a tough fellowship? Must be a bad one.

Im a bit confused by the tone of your posts. Are you regretting the year? If you could do it over again, would you do cardiac, ccm, or the combo?

 

[IlDestriero]

I know a guy that did a
1.peds residency
2.pediatric cardiology fellowship
3.anesthesia residency
4.pediatric anesthesia fellowship
5.Pediatric cardiac anesthesia fellowship.
And he wanted to do a peds cardiac ICU year as well, but his wife dropped the veto.
He can get a job anywhere.
As long as anywhere is a major children's hospital with a large congenital cardiac program.
And even with all those certificates and experiences, some chairs still tried to mess with him, low balling, etc. Know what you're worth and stand up to bullies.
That's probably not the best path to follow though.


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Il Destriero

 

[deleted171991]

Im a bit confused by the tone of your posts. Are you regretting the year? If you could do it over again, would you do cardiac, ccm, or the combo?

The combo or cardiac only.

CCM is beautiful, makes you a more knowledgeable doc than the average anesthesiologist, but nobody gives a ****, because it doesn't make them money hand over fist, like cardiac does (unless they do a ton of liver transplants and crazy stuff). One job I interviewed for told me I would not be able to do liver transplants ever, because they have "fellowship-trained people" for that (they meant cardiac-, not transplant-trained).

So do train for and, preferably, in your market. That also means only the subspecialties that make them offer you a partnership.

P.S. It's probably the weather making me more cynical. 😉

 

[deleted171991]

I know a guy that did a
1.peds residency
2.pediatric cardiology fellowship
3.anesthesia residency
4.pediatric anesthesia fellowship
5.Pediatric cardiac anesthesia fellowship.
And he wanted to do a peds cardiac ICU year as well, but his wife dropped the veto.
He can get a job anywhere.
As long as anywhere is a major children's hospital with a large congenital cardiac program.
And even with all those certificates and experiences, some chairs still tried to mess with him, low balling, etc. Know what you're worth and stand up to bullies.
That's probably not the best path to follow though.


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Il Destriero

Actually, he could probably get a good job only in select few places, almost none of them PP. Most others will be suspicious about his motives and future plans, and won't care that he's an expert in stuff they don't need (and hasn't practiced recently what they do). That's why chairs have played games with him ("that's what they do" - Geico). All his certifications are worthless if the market is not in his favor. Getting a better job or salary is like buying a new car: you play the dealers against each other, if you can.

 

[Robotic Wis-Hipple]

The combo or cardiac only.

CCM is beautiful, makes you a more knowledgeable doc than the average anesthesiologist, but nobody gives a ****, because it doesn't make them money hand over fist, like cardiac does (unless they do a ton of liver transplants and crazy stuff). One job I interviewed for told me I would not be able to do liver transplants ever, because they have "fellowship-trained people" for that (they meant cardiac-, not transplant-trained).

So do train for and, preferably, in your market. That also means only the subspecialties that make them offer you a partnership.

P.S. It's probably the weather making me more cynical. 😉

Cardiac definitely doesn't make money "hand over fist", most of the payers are low reimbursement. What it does do is make you better, possibly more attractive to the group, and allows the group to get cardiac work which adds stability and shows off the breadth the group can handle. But even with higher starting units for a cardiac case, a day of sports ortho or ent murders the cardiac day in money brought in.

 

[deleted171991]

Cardiac definitely doesn't make money "hand over fist", most of the payers are low reimbursement. What it does do is make you better, possibly more attractive to the group, and allows the group to get cardiac work which adds stability and shows off the breadth the group can handle. But even with higher starting units for a cardiac case, a day of sports ortho or ent murders the cardiac day in money brought in.

I am sure that many outpatient cases make more profit for the anesthesia groups than long inpatient ones, but (academic) hospitals make a lot of money from cardiac surgeries, otherwise they wouldn't fight so much to have them and wouldn't kiss cardiac surgeons' behinds. Also the anesthesia departments wouldn't work so hard at getting the coverage for the CTICUs, while not caring that much about the SICUs.

 

[Man o War]

Cardiac definitely doesn't make money "hand over fist", most of the payers are low reimbursement. What it does do is make you better, possibly more attractive to the group, and allows the group to get cardiac work which adds stability and shows off the breadth the group can handle. But even with higher starting units for a cardiac case, a day of sports ortho or ent murders the cardiac day in money brought in.

No, hospitals make tons of money off of the cardiac service line. The anesthesia group won't, but that's why there's a big subsidy given to the group to cover it.

 

[GravelRider]

Timing can be everything and cold calling is part of that equation.

I knew a gambler who used to say the same thing.