1. Cardiac- TEE certified Anesthesiologist. Every Group wants one or two of these for the difficult heart/valve cases. We all do the cases but TEE certification makes you legitimate in the eyes of the surgeon. Also, good P.R. for the Group. This does not make much money for the Group but a necessary "evil" for many practices. Of course, this means the Group does hearts and a lot of difficult valve cases.
2. Pain- Still hot right now. Pain Anesthesiologists still command a premium and some might list this as number 1. For me, a close call but with more Pain Docs available these days and the fact that many of them want less O.R. call because of "clinic" days. Regardless, Pain is a smart choice.
3. Critical Care- USA is getting older, fatter and sicker every day. We need more ICU docs and hospitals like Anesthesia trained Intensivists. You will find less Groups doing ICU but those that do want a fellow trained Anesthesiologist. Those that don't still value your training and appreciate your unique knowledge and experience.👍
4. Peds- If you want to be the "go to" person for the sickest kids in a large metropolitan Group then Peds is valuable.
5. Neuro/Regional- Medicare is not paying for catheters post-operatively. Most older guys learn these techniques quickly. If you like Regional then do a lot U/S guidance in your fellowship.
With due respect: a fellowship year may not always be worthwhile. Sure, if you want to do some hearts, or all hearts, then TEE certification would be great. But, spending a year on this in a non-ACGME fellowship? New grads right now can still sit for the TEE exam. I would agree that this is the best fellowship option, but it isn't necessary. Most anesthesiologists don't want to do hearts, so this is useful only if you plan to do many of them for a large portion of your career.
CCM is the intellectual foundation of our specialty, and but most of us don't want to attend in the ICU, and most groups don't want someone to attend in the ICU. The incentive to train isn't there. I think that the ABA should integrate this into the residency, but that's another discussion.
Pain makes sense if you want to do pain. I'm not sure where this subspecialty will go in a few years, but it seems like it will get saturated due to all the interest now. I have come across many pain fellowship trained attendings who found they didn't care for it, and don't practice pain medicine. Sure it's interesting, but many go towards anesthesiology because they don't want to have long term patients and run a clinic.
Peds - great fellowship, if you like peds. You will be the go-to person for the sickest kids. Doesn't make sense if you want to do only community peds cases.
Neuro/Regional - you don't need a fellowship for this, maybe some learning on the job, and some CME if you feel deficient. Certainly not a year for this unless you are planning an academic career.
I would add Ob as something groups look for, as no one else really wants to do these cases, and it is good PR for the group to have a fellowship trained 'director' of Ob anesthesia...
Unless you are planning an academic career, or have J-1 issues, or plan to have a sharp focus on your practice (greater than 1/2 hearts, pedi, pain, or OB), a fellowship has a large opportunity cost in lost income, lost time on a partnership track, lost experience in cases you don't spend a year doing. It has been said on these forums in the past that working hard at your residency, and studying hard for the boards, is the best approach to becoming a skillful and well-rounded anesthesiologist. Your first couple of years in practice will still be learning experiences, more varied and realistic then another year of supervised practice, i.e. pgy-5 year...
