yah?
maybe im not looking at the right places..but does anyone have this info?
im curious...
thanks.
maybe im not looking at the right places..but does anyone have this info?
im curious...
thanks.
you don't need a fellowship for acute pain and regional anesthesia, unless your residency training sucks.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.
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.
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?
.but does anyone have this info?
thanks.
What are considered the top 3-5 / most competitive fellowship programs for each subspecialty (particularly on the East coast)?
What about Cardiothoracic fellowships on the east coast?
Duke, emory and columbia come to mind.
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.
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.
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.
except that the one without the fellowship showed up a year agoIf 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?
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 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.
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.
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.
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.
Interesting. I'll definitely share this with my attendings. Thanks for sharing.
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.
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
Employment at top academic institutions generally requires fellowship training. Regional fellowship checks that box same as any other fellowship.