where do i get the data on competitiveness of anesthesia fellowships?

neutro

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yah?

maybe im not looking at the right places..but does anyone have this info?

im curious...

thanks.
 

Masseter Spasm

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Do you mean how difficult is it to obtain a fellowship postion? or how competitive will fellowship-training make you as a job applicant?
 

neutro

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hello sir:

yes, i meant how difficult is it to get anesthesia fellowships...i know i havent even started residency yet (starting in july), but its good to keep things in perspective.

i am very interested in acute pain management, and blocks.

i just wanted to get an idea as to what numbers im looking at

i actually found on FREIDA that there are 207 spots from 93 programs...


but i wanted to get REAL data, as in how many interviews does one need to be confident in matching, etc. :)
 

IlDestriero

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hello sir:

yes, i meant how difficult is it to get anesthesia fellowships...i know i havent even started residency yet (starting in july), but its good to keep things in perspective.

i am very interested in acute pain management, and blocks.

i just wanted to get an idea as to what numbers im looking at

i actually found on FREIDA that there are 207 spots from 93 programs...


but i wanted to get REAL data, as in how many interviews does one need to be confident in matching, etc. :)
you don't need a fellowship for acute pain and regional anesthesia, unless your residency training sucks.
 

IlDestriero

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Chronic pain management with diagnostic blocks and permanent ablation requires advanced training. Regional anesthesia and "acute pain" does not, at the vast majority of facilities.
 

neutro

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ok, thank you.

any ideas in regards to the competitiveness of pain medicine as an anethesia resident from a mid tier univ. program? (that doesnt have its own in house fellowship in pain?)
 

ultm8frisbee

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Based on the last several years:
1)Chronic/Interventional Pain Fellowships
2)CV
3)Peds
4)Regional
5)ICU

Pain is overall much more competitive than the rest because you are not only competing with other bright anesthesia folk, but also PMR, neuro, psych, etc. CV is getting tougher, especially popular this year. From what I've heard the strong pediatric programs fill very early. Regional is usually wide open unless you want to go to Virginia Mason or NYSORA, etc. ICU, ehh pick any shiny institution and you can probably get a spot there. These trends can all change by the time you get ready to apply.
 

Jeff05

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agree with below.
i think that all fellowships, but especially pain will peak in competitiveness in the coming couple of years.


Based on the last several years:
1)Chronic/Interventional Pain Fellowships
2)CV
3)Peds
4)Regional
5)ICU

Pain is overall much more competitive than the rest because you are not only competing with other bright anesthesia folk, but also PMR, neuro, psych, etc. CV is getting tougher, especially popular this year. From what I've heard the strong pediatric programs fill very early. Regional is usually wide open unless you want to go to Virginia Mason or NYSORA, etc. ICU, ehh pick any shiny institution and you can probably get a spot there. These trends can all change by the time you get ready to apply.
 

heathermed

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Based on the last several years:
1)Chronic/Interventional Pain Fellowships
2)CV
3)Peds
4)Regional
5)ICU

Pain is overall much more competitive than the rest because you are not only competing with other bright anesthesia folk, but also PMR, neuro, psych, etc. CV is getting tougher, especially popular this year. From what I've heard the strong pediatric programs fill very early. Regional is usually wide open unless you want to go to Virginia Mason or NYSORA, etc. ICU, ehh pick any shiny institution and you can probably get a spot there. These trends can all change by the time you get ready to apply.
I didnt know about this. Once you do a pain fellowship, does it matter that you have a background in anesthesia or PMR or does everyone pretty much do the same thing? Is any one more successful in getting a pain fellowship than the other?
 

Jeff05

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I didnt know about this. Once you do a pain fellowship, does it matter that you have a background in anesthesia or PMR or does everyone pretty much do the same thing? Is any one more successful in getting a pain fellowship than the other?
good acgme pain fellowships heavily favor anesthesia applicants, however, due to some acgme requirements now accept other specialties - mostly PMR, neuro, psych (all these are a small minority). once you are in the fellowship, curriculum is the same for all.
 

Masseter Spasm

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Competition for fellowships slots is somewhat cyclical. If the job market looks great for new graduates, expect many slots to go unfilled. When the market is tight many will do a fellowship to appear more "attractive" to prospective employers or buy time until the market improves. Also geography is important. Many fellowship slots in "desirable" areas will receive more applicants.

Regardless, you should pursue a fellowship only if you enjoy the subspecialty and intend to practice it. Search elsewhere on this forum for discussions of fellowship training in the individual subspecialties in anesthesia and their benefits/disadvantages
 

periopdoc

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There is no "match" for fellowships. It is like a real job or medical school. You apply to multiple places. You interview at multiple institutions and if they like you they offer you a position. You can have multiple offers and you get to select the one you want. You have to play the game of getting your interviews timed right so that the bulk of your offers come at the same time so that you don't end up losing spots while holding out for a better offer.

If you want to do Peds or CV apply in your CA-2 year. If you want to do Regional you have some flexibility. If you want to do ICU/ OB/ Neuro. etc apply whenever you feel like it.


- pod
 

neutro

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ok cool...thanks for the info...

so if lets say for example, PAIN medicine doesnt have a match...so how does one go about applying for a fellowship?

fill out individual applications and send it?
 

IlDestriero

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Yes. Fill out an application for each location. They are usually online. The most competitive programs fill up quickly and have rolling admission. You should apply as early as possible.
 

shift_roro

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What are considered the top 3-5 / most competitive fellowship programs for each subspecialty (particularly on the East coast)?
 

IlDestriero

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What are considered the top 3-5 / most competitive fellowship programs for each subspecialty (particularly on the East coast)?
Peds-
CHOP
Boston Children's
Hopkins
Seattle
The top 10 programs in Peds anesthesia are probably equivalent for training. They vary in some details that may or may not be important to you. (in house call, research, time in cardiac, # of fellows, sub sub specialty fellowship opportunities {chronic pain, cardiac}, internal moonlighting, etc).
 
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Jeff05

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East Coast Most Competitive in my opinion:

Harvard Programs and NYP Tri-Institute (Sloan-Kettering/Cornell/HSS).
 

countingdays

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There are only 46 peds fellowship programs. Probably 30 of those are at hospitals that are at prestigious institutions and/or well known in peds. The others probably also provide good training. I think you can hardly go wrong training-wise.
 

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Hi everyone,
It looks like times are changing in the field of anesthesia:
I spoke with someone who just finished his chronic pain fellowship at a prestigious program and stayed on as a faculty member. When I talked to him at the ASRA conference, he told me that their chronic pain fellowship program received an astonishingly low number of applicants this year (2015). His theory for this precipitous drop in applicants was that since reimbursements have dropped (and will continue to decrease), not as many people want to go into the field.
Regarding cardiac fellowships, 2 of my cardiac attendings told me that the field is over-saturated, and because there aren't enough cardiac cases per CT anesthesiologist, they end up doing a lot of general cases instead. This is their theory as to why CT anesthesia has become less competitive.
The hot fellowship seems to be regional/acute pain for several reasons. It WILL BE acgme certified in 2 years (3 at the most). The fellowships not only teach their trainees how to do common and obscure blocks effectively and efficiently, but they show them how to run an ambulatory surgical center (perioperative surgical home model), which is a very valuable skill to bring to any program. In terms of how competitive the applicants are, I know from my program alone, the top 4 residents (highest ITE scores and 3 chief residents) in the last 2 years have pursued regional fellowships. I think it's very inaccurate to say things like, "A regional fellowship is a waste of time", because coming out of a top regional program will really help you get the job you want.
There isn't any objective data to say which fellowships are the most "competitive". All of these posts seem to be based on "he said, she said" antecdotes, so I thought I'd share my opinion.
Anyone interested in regional fellowships, the top programs seem to be:
DUKE
VIRGINIA MASON
DARTMOUTH
HSS
UPMC
 

IlDestriero

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Sorry, but if you are proficient in the handful of blocks needed for most surgeries, I don't think you need a regional fellowship and I'm not sure what that has to do with "running" an ambulatory surgical center.
Tying PSH training into fellowships is not a selling point in my opinion, and it is certainly not part of our fellowship. Some lip service may be paid in the form of a lecture or pre op optimization, which is what we've always done anyway.
 
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Blockdoc22

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Sorry, but if you are proficient in the handful of blocks needed for most surgeries, I don't think you need a regional fellowship and I'm not sure what that has to do with "running" an ambulatory surgical center.
Tying PSH training into fellowships is not a selling point in my opinion, and it is certainly not part of our fellowship. Some lip service may be paid in the form of a lecture or pre op optimization, which is what we've always done anyway.
But if you really think about it, almost every fellowship in anesthesia is simply an extra year to fine-tune your skills from residency. I think we do enough regional, peds, cardiac, OB, (maybe not chonic pain) during residency to say that we are "proficient" in those respective subspecialties without having to do a fellowship, but I believe that that extra year from a top program (regardless of which fellowship you do) adds great value to your CV.

What I meant by "running" an ASC is that the fellows are trained to not only place the blocks, but also to manage all the perineural catheters and run the acute pain service. In my opinion, when programs are looking to hire a non-fellowship-trained applicant vs. trained in regional to run an ASC down the road, the latter will definitely have an advantage.
 

IlDestriero

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You keep saying "run an asc". I have been the medical director of a smaller department in the military (essentially a department head equivalent) and I've been an acting medical director of an ASC (ambulatory surgery center) in my current job from time to time, and running an acute pain service and managing catheters on the floor has no overlap with the duties and responsibilities of that job. I'm not sure why you think it does. Perhaps ASC has some other meaning that I'm not familiar with. Do you mean APS, as in acute pain service? Experience as a medical director and with ASC management would certainly be valuable to someone looking for a job.
PS. I doubt very many (any?) residents could function independently without a fellowship at a specialty children's hospital without significant supervision and OJT. There is no way that you would get enough experience doing the complex cases that are done regularly here during residency. That is very different than saying I am proficient in X regional blocks and Y catheters which would be good for essentially all the blocks you would likely need.
I could do a routine heart when I graduated, but I wasn't very slick and I certainly wasn't a TEE expert, which is the point of a CV fellowship. Anyone should probably be able to do a routine CABG and healthy kids, etc. but that's not the focus of a fellowship. Though having said that, there probably are jobs that would prefer someone trained in regional anesthesia, especially if they do a lot of blocks and have been burned with a bad hire before that couldn't actually deliver on their promises of regional proficiency.
 
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Blockdoc22

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You keep saying "run an asc". I have been the medical director of a smaller department in the military (essentially a department head equivalent) and I've been an acting medical director of an ASC (ambulatory surgery center) in my current job from time to time, and running an acute pain service and managing catheters on the floor has no overlap with the duties and responsibilities of that job. I'm not sure why you think it does. Perhaps ASC has some other meaning that I'm not familiar with. Do you mean APS, as in acute pain service? Experience as a medical director and with ASC management would certainly be valuable to someone looking for a job.
PS. I doubt very many (any?) residents could function independently without a fellowship at a specialty children's hospital without significant supervision and OJT. There is no way that you would get enough experience doing the complex cases that are done regularly here during residency. That is very different than saying I am proficient in X regional blocks and Y catheters which would be good for essentially all the blocks you would likely need.
I could do a routine heart when I graduated, but I wasn't very slick and I certainly wasn't a TEE expert, which is the point of a CV fellowship. Anyone should probably be able to do a routine CABG and healthy kids, etc. but that's not the focus of a fellowship. Though having said that, there probably are jobs that would prefer someone trained in regional anesthesia, especially if they do a lot of blocks and have been burned with a bad hire before that couldn't actually deliver on their promises of regional proficiency.
All very good points. Thanks for sharing your insight and experience. I'm thinking of ASC's that have the entire perioperative experience led by an ASC director, which includes placing blocks, managing catheters, and rounding on APS post-operatively. I guess ASC directors have different roles and responsibilities depending on which practice you're in.

What do you think about my initial post regarding what my cardiac attendings and the chronic pain attending said about their respective fellowships and how they are becoming less competitive? Agree/disagree? Thanks.
 

nimbus

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What I meant by "running" an ASC is that the fellows are trained to not only place the blocks, but also to manage all the perineural catheters and run the acute pain service. In my opinion, when programs are looking to hire a non-fellowship-trained applicant vs. trained in regional to run an ASC down the road, the latter will definitely have an advantage.

People skills will determine your ability and suitability to run an ASC. Fellowship has nothing to do with it.
 
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Blockdoc22

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People skills will determine your ability and suitability to run an ASC. Fellowship has nothing to do with it.
If you have 2 applicants with great people skills, but one of them has a regional fellowship under their belt, don't you think the fellow would be favored in the decision process?
 

Man o War

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All very good points. Thanks for sharing your insight and experience. I'm thinking of ASC's that have the entire perioperative experience led by an ASC director, which includes placing blocks, managing catheters, and rounding on APS post-operatively. I guess ASC directors have different roles and responsibilities depending on which practice you're in.

What do you think about my initial post regarding what my cardiac attendings and the chronic pain attending said about their respective fellowships and how they are becoming less competitive? Agree/disagree? Thanks.
I'm currently in the midst of a nation wide job search and cardiac doesn't seem saturated at all. Most of the places I've cold called are looking, gas work is full of cardiac openings as well.
 
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IlDestriero

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I'm thinking of ASC's that have the entire perioperative experience led by an ASC director, which includes placing blocks, managing catheters, and rounding on APS post-operatively. I guess ASC directors have different roles and responsibilities depending on which practice you're in.

What do you think about my initial post regarding what my cardiac attendings and the chronic pain attending said about their respective fellowships and how they are becoming less competitive? Agree/disagree? Thanks.
As to the second point, I don't know anything about the competitiveness of other fellowships or their job prospects post fellowship, but since the peds anesthesia match, we are swamped with applicants and can be quite selective about who to interview. We get well over 10 applicants per spot, and we have a lot of spots. We interview 5-6 people per spot so, at least here, it's still quite competitive. Once you couldn't make a $1M a year in pain, I think that a lot of the interest in managing these "painful" patients went away. Our fellows all seem to get jobs they are happy with, including jobs in known tight markets. Things seem fine in the peds world.

Regarding the ASC role you note above, how is that different from any anesthesiologist at any ASC?
Someone, usually the medical director, signs off on the complicated patients making sure they are optimized for surgery and appropriate for scheduling at the ASC and requests labs, consults, etc as needed. That's one of about 20 collateral duties that the medical director has to do btw. Then someone, anyone, does the case, +/- a block, and you "round" on them in the PACU before you DC them home. We "round" on every patient and write our discharge note after every anesthetic. There are no inpatient rounds as it is an Ambulatory surgery center, and the patients all go home. I think your fellowship directors are exaggerating on what they are really offering you as part of this fellowship.
ASCs are set up many different ways I'm sure, but ours are multidisciplinary and as such are managed by a nurse manager and an anesthesiologist medical director. The nurse manages the nurses and tech support and equipment, and the physician manages the surgical and anesthesia related issues in conjunction with administration at the big house, and there is obviously some overlap in duties and responsibilities. That's staffing, block utilization, adding new procedures and equipment, scheduling, dealing with administration and billing, dealing with the health department, the joint commission, etc.
In a stand alone surgeon owned practice, they would probably do much of that themselves and only dump patient related issues on the anesthesiologist. Nobody wants to have a case scheduled for the ASC cancelled, so it's in their best interests to leave pre op clearance to the anesthesiologists.
Maybe you don't know what an ASC is, or maybe I don't, but your comments don't make sense to me regarding how a regional fellowship would prepare you in any way for an administrative job that requires working with nurse management, supply chain, hordes of unruly surgeons, hospital administration, and government agencies, and doing it in a way that keeps people satisfied, keeps the doors open, the money coming in, and doesn't end with you getting you fired.
 
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Blockdoc22

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As to the second point, I don't know anything about the competitiveness of other fellowships or their job prospects post fellowship, but since the peds anesthesia match, we are swamped with applicants and can be quite selective about who to interview. We get well over 10 applicants per spot, and we have a lot of spots. We interview 5-6 people per spot so, at least here, it's still quite competitive. Once you couldn't make a $1M a year in pain, I think that a lot of the interest in managing these "painful" patients went away. Our fellows all seem to get jobs they are happy with, including jobs in known tight markets. Things seem fine in the peds world.

Regarding the ASC role you note above, how is that different from any anesthesiologist at any ASC?
Someone, usually the medical director, signs off on the complicated patients making sure they are optimized for surgery and appropriate for scheduling at the ASC and requests labs, consults, etc as needed. That's one of about 20 collateral duties that the medical director has to do btw. Then someone, anyone, does the case, +/- a block, and you "round" on them in the PACU before you DC them home. We "round" on every patient and write our discharge note after every anesthetic. There are no inpatient rounds as it is an Ambulatory surgery center, and the patients all go home. I think your fellowship directors are exaggerating on what they are really offering you as part of this fellowship.
ASCs are set up many different ways I'm sure, but ours are multidisciplinary and as such are managed by a nurse manager and an anesthesiologist medical director. The nurse manages the nurses and tech support and equipment, and the physician manages the surgical and anesthesia related issues in conjunction with administration at the big house, and there is obviously some overlap in duties and responsibilities. That's staffing, block utilization, adding new procedures and equipment, scheduling, dealing with administration and billing, dealing with the health department, the joint commission, etc.
In a stand alone surgeon owned practice, they would probably do much of that themselves and only dump patient related issues on the anesthesiologist. Nobody wants to have a case scheduled for the ASC cancelled, so it's in their best interests to leave pre op clearance to the anesthesiologists.
Maybe you don't know what an ASC is, or maybe I don't, but your comments don't make sense to me regarding how a regional fellowship would prepare you in any way for an administrative job that requires working with nurse management, supply chain, hordes of unruly surgeons, hospital administration, and government agencies, and doing it in a way that keeps people satisfied, keeps the doors open, the money coming in, and doesn't end with you getting you fired.

I'm sorry if my prior posts seem unclear, but I'm not referring to the "administrative" aspect of an ASC. I admit that I have been using the phrase "running an ASC" incorrectly, as that does entail a lot of administrative work. What I meant is that top regional fellowships (like Duke, Virginia Mason, Dartmouth, etc...) will train their fellows to be extremely efficient and effective in blocks, perineural catheter management, APS, and perioperative care as a whole. Now, your hospital/ASC may not value that kind of training right now because you have faculty who have been there long enough to be proficient in their regional practice, but what about years down the road, when there will be a lot more fellowship-trained applicants who will applying for fewer spots?
In the past 2 years, 13 out of 16 residents from my program pursued fellowships, and like I alluded to in my prior post, 4 of the most competitive residents went into regional (and 2, who were on academic probation, matched into TOP peds fellowships). Because of this pattern seen at our program, as well as the added benefits seen in a regional fellowship, I know that 4 out of 8 current CA-2's are pursuing regional fellowships. The reason why I say this is that, again, there is no data out there about which fellowship is the most competitive or most useful, but I know that there is more interest in regional fellowships, and very strong applicants are attracted to this subspecialty, so discounting the fellowship as a waste of time may not be the best approach. Maybe most of our trainees are interested in academic practice, but regardless, I believe that a regional fellowship can really bolster one's CV and get them the job they want in the future.
 

Blockdoc22

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I'm currently in the midst of a nation wide job search and cardiac doesn't seem saturated at all. Most of the places I've cold called are looking, gas work is full of cardiac openings as well.
Interesting. I'll definitely share this with my attendings. Thanks for sharing.
 

Blockdoc22

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except that the one without the fellowship showed up a year ago
but he won't have anything to distinguish himself from every other anesthesiologist who isn't fellowship trained in a job market that will eventually have less job opportunities due to CRNAs.
 

nimbus

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but he won't have anything to distinguish himself from every other anesthesiologist who isn't fellowship trained in a job market that will eventually have less job opportunities due to CRNAs.
6 months into your first job, nobody will care what if any fellowship you did. They will only care how fast, safe and efficient you are. And that you get along with people. It also helps if you are fun to be around. That's how to distinguish yourself.
 
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Blockdoc22

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6 months into your first job, nobody will care what if any fellowship you did. They will only care how fast, safe and efficient you are. And that you get along with people. It also helps if you are fun to be around. That's how to distinguish yourself.
And a fellowship can train you to be faster, safer, and more efficient in your respective subspecialty, thereby distinguishing yourself further. I completely agree that you need to get along with others and have a great rapport with co-workers, but to me, that's just a base-line requirement.
 

nimbus

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And a fellowship can train you to be faster, safer, and more efficient in your respective subspecialty, thereby distinguishing yourself further. I completely agree that you need to get along with others and have a great rapport with co-workers, but to me, that's just a base-line requirement.
You'd be surprised how many people sabotage their own careers.
 

Man o War

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Interesting. I'll definitely share this with my attendings. Thanks for sharing.
While I do agree with your attendings that the overall number of open heart procedures is probably going to decline further, when you start adding TAVRs, EP lab, and liver transplant call (for TEE), on top of some of the thoracic/vascular surgeries, there's still a huge need for that TEE/TTE and management cardiac anesthesia provides.
 
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Magnus67

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Our group of 14 did over 1800 blocks last year. 80% of them catheters. No fellowship required, we do almost every block known. If u want to do a regional fellowship , I'll pay u peanuts and can do all the blocks u want for me. ;). Right now we r hiring only Peds and Cards because those skills/experience u can't get from watching a YouTube video. Academics or an employed position may be different though.

2cents
 
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teeva

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I still don't understand how "running an ASC" is related to regional fellowship.

Sounds like it's just the PACU person you're describing, who runs the PACU, makes sure preops are ready to go, reviews charts for any questions on upcoming cases, discharges patients, runs the board, gives breaks to colleagues if needed, and keeps things moving. Anyone with organizational skills who doesn't go ape **** crazy when things get busy can run an ASC. That person in charge can rotate on a daily basis at some places.

The PACU person can also do blocks or cover for someone while they do the block. Again, regional fellowship not necessary.

Even my residency program started a loosely defined "rotation" for "running the board" that some senior residents got to do. I spent the last 3 months of CA3 year running the PACU at an ASC and hospital, doing all the stuff mentioned above, including managing the residents' case assignments and breaks, and doing blocks or covering for other senior residents in the OR so they could do blocks and increase efficiency/turnover. I'd cover pre-surgical testing clinic sometimes too when they were too busy or short staffed.

Managing PSH, whatever the f*ck that is, can't be any different.

Becoming good at it just requires practice and experience.
 
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Blockdoc22

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I still don't understand how "running an ASC" is related to regional fellowship.

Sounds like it's just the PACU person you're describing, who runs the PACU, makes sure preops are ready to go, reviews charts for any questions on upcoming cases, discharges patients, runs the board, gives breaks to colleagues if needed, and keeps things moving. Anyone with organizational skills who doesn't go ape **** crazy when things get busy can run an ASC. That person in charge can rotate on a daily basis at some places.

The PACU person can also do blocks or cover for someone while they do the block. Again, regional fellowship not necessary.

Even my residency program started a loosely defined "rotation" for "running the board" that some senior residents got to do. I spent the last 3 months of CA3 year running the PACU at an ASC and hospital, doing all the stuff mentioned above, including managing the residents' case assignments and breaks, and doing blocks or covering for other senior residents in the OR so they could do blocks and increase efficiency/turnover. I'd cover pre-surgical testing clinic sometimes too when they were too busy or short staffed.

Managing PSH, whatever the f*ck that is, can't be any different.

Becoming good at it just requires practice and experience.
I'm thinking more along the lines of obtaining a job as the director of regional/APS at an academic institution. It seems like every attending at top academic institutions are fellowship-trained in 1 or 2 subspecialties. I'm certainly not referring to running the board or being the "PACU person".
 

teeva

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Employment at top academic institutions generally requires fellowship training. Regional fellowship checks that box same as any other fellowship.
 
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Blockdoc22

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Our group of 14 did over 1800 blocks last year. 80% of them catheters. No fellowship required, we do almost every block known. If u want to do a regional fellowship , I'll pay u peanuts and can do all the blocks u want for me. ;). Right now we r hiring only Peds and Cards because those skills/experience u can't get from watching a YouTube video. Academics or an employed position may be different though.

2cents
Academic programs are definitely different. I know for a fact that of the anesthesiologists who do blocks, the attendings who came out of top regional programs are much better in terms of procedural skills and level of sophistication in clinical decision-making surrounding blocks and acute pain management. We had one faculty member who did a regional fellowship at a top program, and the rest of the department unequivocally agreed that he was the most efficient, effective regional anesthesiologist, and he brought so much to our department in the way of teaching regional and acute pain management strategies to not only the residents, but to other faculty members. Also, an advantage of doing a regional fellowship at a top program is that if you're interested, you have the opportunity to be invited as faculty at regional workshops every year... Just an added bonus =)
 

Magnus67

Lord of Sleepytime
10+ Year Member
Jan 29, 2006
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Academics and PP are two different worlds, depends on what u want out of a career I guess.