workday of ultrasound fellow

[j_sde]

hey,
out of curosity, what does completing an ultrasound fellowship allow you to do? my impression is that residents get good training in ultrasound and that attendings are able to read most imaging studies w/out consulting a u/s expert. so, in that case, what is the advantage of doing an ultrasound fewllowship, unless for the research applications of it.

are there jobs where ultrasound fellowships just sit around (like office based) and read ultrasounds similar to what a radiologist or even what a nonintervential cardiologist may do with image readings?

i'm a 4th yr interested in EM ... thanks ahead of time.

---

Members don't see this ad.

 

[roja]

Ultrasound fellowship is not the same as radiology.

Yes, you can get exposure to ultrasound in residency, if you make sure you are at a program that encourages it, and teaches you. There are deifnately a ton of attendings who don't do ultrasound.

Fellowship usually entails becoming RDMS certified, giving lectures, lots of hands on with residents, research and other typical fellowship stuff. It puts one in a very strong position coming out of residency (as does any fellowship) if you want to do academia.

I intend to be RDMS certified by the time I finish residency but am planning to do a fellowship in U/S as well.

Our fellows do 8 10 attending shifts a month and have to work with the residents that are on their ultrasound elective as well as residents from other progrmas

 

[Sessamoid]

If you aren't interested in an academic career, then I'd say that an ultrasound fellowship isn't financially worth the time you put into it. It doesn't really make you much more marketable.

If you want to go into academics, then a fellowship is pretty much required in something if you're not graduating from a 4 year program. Ultrasound is as good a choice as any in that regards, I think.

 

[peksi]

If you aren't interested in an academic career, then I'd say that an ultrasound fellowship isn't financially worth the time you put into it. It doesn't really make you much more marketable.

I would have to respectfully disagree here with Sessamoid.

We are seeing a real interest in the private sector for those truely and highly trained in the performance, QA and administration of active EM US programs. Though many programs train residents to perform ultrasound, few if any train them to a degree to fully initiate, train, QA, and administrate such programs.

The incorperation of such a a dedicated skill set allows graduates to bring something more to the table than just the EM training, a facet that can improve patient care, group productivity and intrainstitutional recogniotion.

We are seeing some groups such as large CMG's and private fee for service are looking very closely for EM US Fellowship graduates with the explicite intention to initiate, train, QA and administrate EM US for these groups. I am familiar with 2 recent EM US Fellowship graduates obtaining such private positions last year..competative, non academic practices with dedicated administrative time for EM US program administration and seeking an EM US fellowship graduate. Often times these are groups that are routinely difficult to enter unless the graduate has a personal "in" or brings more to the table than the meriade of EM residency graduate applications that such competative groups see on a yearly basis.

Now obviously I may be biased, since I completed and run such an EM US Fellowship, however this does seem to add a level of marketability for the graduates which is still defining itself. This may be why we are seeing an increase in applications to our Fellowships by those who have been in practice for several years with the explict goal to bring this training back to their 5-10 member FTE ED groups.

I just don't think that the EM US Fellowship graduate can be pigeonholed into academics alone. I believe and we are finding that the EM marketplace is more flexible, inovative and dynamic than many of us may have initially tought.

Paul

 

[docB]

I just don't think that the EM US Fellowship graduate can be pigeonholed into academics alone. I believe and we are finding that the EM marketplace is more flexible, inovative and dynamic than many of us may have initially tought.

Paul

Good point. I'm in exactly the situation I described; recent grad with a practical knowledge of EM US but no knowledge of the QA or admin aspects. My group does community, non-trauma EM and the older, leadership guys have no interest in training in US or in fighting the political battles necessary to bring EM US to us. But I think the writing is on the wall. I expect that in ~10 yrs we will be forced by the standard of care to provide EM US. Do you agree? How do you think the advent of US will work for private groups? How does it work for the smaller groups you mentioned?

 

[roja]

I think dr. Sierzenski makes a very valid point. The management of an ultrasound department, etc are some of the key points of completing an u/s fellowship. I already have 400+ scans and am in my second year of residency, however, residency doesn't allow me the time to really learn the Q/a, etc that goes with running an u/s division in the ED.

 

[peksi]

I expect that in ~10 yrs we will be forced by the standard of care to provide EM US. Do you agree? How do you think the advent of US will work for private groups? How does it work for the smaller groups you mentioned?[/QUOTE]

The time frame for this may be shorter than 10 years, in Australia the Australian Society for Anesthesia has a policy statement that ALL cnetral lines should be US guided...now i don't agree with that, but the fact is clear. If a resident in EM has had a "real" exposure to the benefits of US most might not want to work without it...let's be honest, how many folks have you seen or heard walk out of the hospital from an ED thoracotomy....now how many times have you heard of someone picking up a AAA, a pericardial effusion, unexpected FF, an ectopic, where US assisted in a very difficualt proceedure.. more often I'm sure.

I actually see smaller groups looking to obtain EM US beyond just the patient care aspects but also to gain the "young guns" of EM... as a tool to attract the best and brightest EM graduates many of whom are well versed in EM US.

Now let's be clear, there are thousands of ED's that don't do EM US at this time, my brother's private group in AZ is one of them. And some of these departments may never do EM US. But there is a rapid growth in this sector, and I don't see it slowing down despite anthing I may do or say in or about the world of EM US.... and that is probably the way it should be.

Smaller groups work at smaller hospitals, thus less resouces...often no 24 hour in house CT scans, 3-4 hour waits for an US sonographer if one is evern available, and a frequently the need to transport ill patients at times with no definitive diagnostic testing...in these senarios US has been shown and can help diagnosis as well as risk stratify patients. the index cases of saving that ruptured ectopic, or rare trauma etc go waaaay further in the small hospital with a 10-20K volume than the level 1 or 2 center that sees it frequenctly. Now thats REAL 20th century medicine on the front lines!


Paul

 

[roja]

I think there is definately an element of comfort that keeps many EP's from utilizing u/s. The habit wasn't formed during training and it thus takes a significant amount of desire on the EP to re-encorporate it into practice. (Where I trained, no EP's did u/s... the radiology residents were 'on-call' for the ED and still are).

When I was interviewing for residency, despite the EMRA's astute list of questions including 'ask about ultrasound', I essentially dismissed this. I had no clue as to what it involved or really how it would be involved in EM, as I had never really seen it.

However, I can't imagine practicing EM without an ultrasound machine. It is indispencable in assessing patients. Not only in helping hone IN diagnosis, but helping eliminate things from a diagnosis.

I truly think that ultrasound is a good 'habit' to develop. It takes concious effort to develop the habit of pulling out the machine. I am forever grateful that I am in a program that emphasized U/S.

Although I intend to go academic, one never knows. And if I ever do go private, I will have a hard time considering a hospital that doesn't have u/s at the hands of trained ep's.

Now if only I could figure out how to have one strapped to my back....

 

[Sessamoid]

Now if only I could figure out how to have one strapped to my back....

We don't have ED ultrasound at either of the hospitals I work at since we have 24 hr US tech in house. Still, I miss having it for quick looks. Maybe I can come up with a way to have a cybersonic implant in my brain and a transducer implanted in my left hand.

 

[roja]

Now, that's what I'm talking about!!

 

[Jeff698]

Maybe I can come up with a way to have a cybersonic implant in my brain and a transducer implanted in my left hand.

Oh my. Just imagine the recreational implications of that. Talk about X marking the spot.

Take care,
Jeff