Residents in a Room
Episode Number: 47
Episode Title: To fellowship or not to fellowship
Recorded: January 2023
(SOUNDBITE OF MUSIC)
This is Residents in a
room, an official podcast of the American Society of Anesthesiologists, where
we go behind the scenes to explore the world from the point of view of
I think I have
developed myself into a marketable individual without having done fellowship.
Pursuing a fellowship
doesn't matter what speciality or subspecialty you
want to train in, just have clear goals. That's the most important thing.
I think over the past
year I've entertained every single fellowship out there.
And you almost feel
like you're letting people down by not doing one.
I am going to be a
generalist. Tbd where. Tbd
DR. ANNA EID:
Welcome to residents in
a room, the podcast for residents by residents. I'm Anna Eid and I'm a CA2 and
I'll be your host for this episode. Today day we've invited two
anesthesiologists to talk to us about why they did and didn't do a fellowship
and what they've learned from their experiences. Let's meet our guests first,
our speakers, Drs. Anwar and Reardon. Welcome.
DR. BRITTANY REARDON:
Thank you for having us
DR. MUHAMMAD FAROOQ
Good morning, everyone.
Thank you for having us.
And now, my fellow
DR. KIM AUT:
My name is Kim Aut. I'm a CA3 here at Vanderbilt.
DR. CHRISTY HENDERSON:
Hi, everyone. I'm
Kristie Henderson. I'm a CA 1to here at Vanderbilt as well.
Great. Let's get going.
Dr. Anwar, you did a fellowship, but. Dr. Reardon, you did not. Can you both
tell us about your experience and how you made your choice?
Just a background for
me. I'm an anesthesiologist and a chronic pain physician, an assistant
professor of anesthesiology at Duke Anesthesiology Department. I kind of always
knew during residency that I wanted to take the academic route, and I was
specifically interested in chronic pain, which is a field where you don't get a
lot of significant exposure during the residency. So I knew if I wanted to
practice outpatient interventional pain, then I need additional training for that.
So that was part of my reasoning among other reasons, that includes interest in
academics, fellow training and research as well.
So my name is Brittany
Reardon. I am an assistant professor of anesthesiology and an associate program
director at Mount Sinai West Morningside in New York City. I decided not to do
fellowship ultimately, and I had kind of a long list of reasons for that
decision. You know, I didn't have a particular field that I was very passionate
about. I didn't see myself as a pediatric anesthesiologist. I didn't see myself
necessarily as a cardiac anesthesiologist. I wasn't interested in pain or ICU.
And as residents and doctors, we kind of are always on this hamster wheel
where, you know, you're in college and you're like, I have to get into medical
school and you get into medical school and you're like, I have to get into the
best residency I can. And you get into residency and you're like, okay, I have
to keep training. I have to do fellowship now. I was a chief resident at the
time and I had a lot of leadership roles and I felt a lot of pressure where I
thought, I think I have to do fellowship. And after talking with a lot of
people and reflecting about it, I ultimately decided not to do fellowship. A
lot of factors played into this. I had the unique opportunity to stay at my
home institution, which was an academic center in New York City, so I was able
to still maintain access to the type of job I wanted without doing fellowship.
And then I also had a lot of student loan debt. And so I kind of had to
consider if I wanted to go into practice and start making an attending salary
or not. And then ultimately I had to just figure out if I had another path in
academic medicine that did not involve my fellowship training, which I sort of
did, which was medical education. So those were kind of the things that I
thought about while I was making this decision.
Thank you. What do you
both see as the pros of fellowship training?
I do think that having
fellowship training makes you more marketable. I don't think that there's any
way to debate that. If you specifically want a career in academic medicine,
doing a fellowship helps you obtain future roles such as like a head of an OB
division, the head of a regional division. When you're looking for jobs in the
private practice arena, I do think it makes you more marketable to say that you
do have fellowship training and I do feel like it gives you a clinical niche.
So for me I do a lot of head and neck anesthesia, which you don't need a
fellowship for, and I've sort of made that my clinical niche. But I had to sort
of be thoughtful about that because I didn't have an inherent clinical niche
because I did not do a fellowship.
Yes, I agree with
Brittany. I think some of the pros with fellowship depends on obviously what
you're looking for, what kind of job market you're looking for. Yes, a lot of
private practices. It's it makes you more marketable for that. But especially
if you're going for an academic practice being subspecialty, certified. And if
you have board certification, obviously you can get more leadership roles. If
you want to become like a program director, maybe you want to you want to
contribute more to that fellowship. So you could do that. Obviously it boosts
your resume as if you want to get into more research associated positions. And
at the same time, I think some of the people, depends on what their interests
are and what sort of fellowships, sometimes coming out of residency they may
not feel that comfortable. I've had some residents and fellows tell me that as
well, that, oh, I felt like I wasn't ready to just go out and be on my own. And
they take that fellowship years sometimes to get more comfortable because a lot
of fellowships you could actually act as a junior faculty. So I think if you're
not really interested in specific speciality, that's
one of the pros as well.
And on the flip side,
what are the cons of doing a fellowship and taking that year?
Any time that you are
going to defer a year of an attending salary is a con. This is something I
think a lot of doctors have to think about. Unfortunately, because the cost of
medical school is very high and some people have debt coming from college and
medical school. And so a lot of people think like, oh, the financial incentive
to become an attending is very strong. So I do think a con of fellowship is
that you sort of lose a year of an attending salary. Sometimes I think doing
fellowship doesn't necessarily get you more financially in a job. I think maybe
like the differential is not huge in anesthesia, and I honestly could be wrong
about that. But from most academic practices that I've seen, the increase for
doing fellowship is kind of small. And I think that there's different reasons
to do fellowship. If you're doing the fellowship for the wrong reason, that
obviously would be a con as well.
Yes, I agree with
Brittany. Obviously, just know the reasons why you're doing a fellowship. I
don't think financially, especially in today's market, any fellowship is
somewhat better than the other. There's a lot of demand for general
anesthesiologists out in the market, and sometimes you could be specialty kind
of like bound to one specialty if you're trained in that. So I've seen a lot of
that. I don't know if I would necessarily call it a con because at the same
time, I've seen a lot of fellowship trained people come back to just being
general anesthesiologists. Obviously, you do lose a year of clinical practice,
so you have to factor that into if you're going to make the switch after doing
the fellowship, just being in the OR sometimes it could be challenging.
The landscape has
changed in large part because of this shortage of anesthesiologists. We can
earn more money sooner if we skip a fellowship and go straight to the O. and do
general anesthesia. Dr. Reardon, you already touched on this a little bit. How
much did money weigh in on your decision? And how much do you think it should
I think it definitely
should be something that you think about. If you're passionate about pursuing
pediatric or cardiac anesthesiology or OB anesthesia. By all means, I don't
think you should say to yourself, oh, can I afford to do a fellowship or not?
But I think if you are sort of leaning between doing no fellowship and then
participating in some sort of fellowship training, then I think that's when you
can kind of weigh in finances as part of the package. You know, doing one more
year of training is not going to make a massive difference in your finances. So
I definitely think it's something that should be kind of looked at when you're
deciding whether or not to do one. Not if you're like, I don't think anyone
should be taking a step back and saying, Oh, I definitely can't do this because
I can't afford to do it, if that makes sense.
Do you think people ever
go back and do a fellowship later on after being an attending for a while?
I think in my personal
experience, I've seen people do the other way around. Most of the time they'll
do a fellowship and then go back to just practicing general anesthesia. But
it's definitely not an uncommon thing. Sometimes your interests do change.
Depends on what kind of job you initially signed into. People don't necessarily
end up liking the lifestyle or the jobs, and sometimes they find a niche that
they want to be specialty trained in. Or sometimes people may find certain
weaknesses. For example, if somebody started to do more cases in a private
practice and there are a lot of lot more cardiac cases and depending on the
kind of residency training they had, if they think that they like cardiac or on
the other hand, they lack the expertise to deal with those patients, sometimes
I've seen people go back and pursue that fellowship and then just try to do
those cases more often.
And since applications
to fellowships are pretty early on in a two year as an intern or a CA1, what
advice would you give to them about doing during residency If they're thinking
about doing a fellowship?
As an associate program
director, I have a lot of these conversations with the residents at our
institution. The fellowship applications do have to be an extremely early I
know our program and I'm sure many other programs across the country make an
effort to give you exposure throughout your CA1 one year. When we're making our
box schedule for the CA2 year, we encourage people to let us know what they're
thinking regarding fellowship so that we can get them that early exposure to
help them make a decision. So picking what kind of field you want to go into is
one aspect after you sort of decide whether or not you want to do fellowship.
And then a lot of conversations that I have with the residents are kind of, What
do you want your life to look like in the next five years? Where do you see yourself
working in the next ten years? Like, what are your goals? Someone says to me,
Brittany, I really just want a great private practice job. I'm looking to be
more of an administrator and I'm not really worried about having a clinical
niche that might be someone. I say, Okay, well, maybe then you don't do
fellowship and maybe you pursue some sort of credentials in an administrative
But you know, if someone
tells me, I live in a big area like New York City and I want to work in an
academic center and I want to be the head of a division, and that's their goal,
then it's more clear that they should do fellowship training. There are some
institutions where, like if you're not fellowship trained and you're a large
academic center, it would be very challenging for you to get a job. And this
kind of went back to what I was saying is that I sort of had the opportunity to
have a job in an academic center. And so that was something that weighed into
my decision. But I always tell residents that they should kind of consider all
of those things.
It's very challenging to
make a decision in your late twenties and early thirties that kind of projects
out your career, but having career conversations with the residents and kind of
pulling out of them, what they see for themselves in the future I think is the
best way to help make decisions about fellowships and give them that kind of
insight that you're kind of making a decision now that will impact you much
I agree with Dr.
Reardon. The only thing I would add is obviously not all residency programs
offer the same kind of subspecialty experience. So if you're interested in a
specific fellowship, then you want to have that down sooner than later, and
then you want to seek opportunities, even if it's outside your program, if it's
something your program doesn't offer, then you want to seek opportunities
outside your institution. Try to go rotate with those people, do outside
rotations, look for mentors who would be writing letters for you? I mean,
again, any good letter, it's a blessing. But at the same time, I think it just
increases your chances maybe slightly more if you have a letter from that
specially trained anesthesiologist. And also you can identify mentors earlier
on in that field. And some of these mentors will even continue to support you
after your residency program as well. No matter where you end up for the
Are all fellowships
created equally or are some more essential than others in order to practice in
certain subspecialties? Are some fellowships clinically relevant, while others
more relevant for leadership or other career priorities?
We would never, I guess,
say that none of the fellowships are essential. Obviously, they all offer a
breadth of clinical experience, which sometimes, depending on the residency
program, you may or may not have that experience during your training. But at
the same time, there are the fellowships are all just like you said, they're
not all created equal because if we talk about obstetric anesthesia or regional
anesthesia, again, depending on your training, you may have had a breadth of
exposure to regional anesthesia or OB anesthesia. And I don't know if it'll
make sense for you just from the status of like getting more clinical
experience if you want to do that fellowship. But it may make sense for you
more if you are looking for a leadership position in that subspecialty or you
want to be a leader in that specialty, you want to do more research. But at the
same time, again, and I'm talking from personal experience, like any kind of
training, like a chronic pain fellowship or for certain programs, a
cardiothoracic fellowship, you may or may not have had a lot of experience
during your residency training. So obviously in those cases, I think you want
to pursue a fellowship if you want to primarily practice in that arena.
I completely agree.
There are definitely fellowships that are going to expand your clinical
knowledge base and then there are fellowships where your clinical knowledge
base will be expanded, but not to the same extent. And I think you put it
beautifully, like for me, at my program that I trained at, we do so much
regional anesthesia that I had my regional bloc numbers by my intern year. So
for me, if I had decided to do a regional fellowship, I wouldn't have said to
myself, Gee, I don't really feel comfortable doing regional anesthesia. I would
have said to myself, Hmm, I think I want to be at the forefront of research. I
think in the future I see myself as the director of regional anesthesia or a
fellowship director. That would have been more the decision making, whereas if
I decided to do cardiac, I would have said to myself, you know, I don't
necessarily feel comfortable clinically right now in my stage of my career
performing cardiac anesthesia without a fellowship. Right. Same for pediatrics,
same for ICU, same for pain. So just because though a fellowship is not going
to enhance your clinical performance doesn't mean that you shouldn't do it. It
totally just depends on what your overall goals are. If you want to be a
cardiac anesthesiologist, there's no way around that, right? You've got to do
the fellowship. If you want to be the head of an OB division, you probably
should be OB trained.
So like I was saying
earlier, it's difficult because sometimes people don't necessarily project that
far in the future what they want to do and what their goals are. So I think if
you take anything away from this podcast, it would probably be that to start
reflecting on what you want your life to look like. And you know what's kind of
challenging? Because at the end of residency you may be a single person or just
gotten married or you may want a family in the future or you may not, and all
of these things kind of are going to go into what your day to day life is going
to look like. Like I've heard a lot of people, for example, say, Oh, I would
really like to do pain because then I won't be so beholden to the OR schedule.
I don't know if that works out, but know but these are just things that people
say. But that's something where someone has reflected on what they kind of want
for themselves and for their life in the future. And so I think that that's
what you need to consider when you're picking.
Thank you. I would love
to ask you guys about combined fellowships and what your thoughts on are about
So I can talk from a
second hand experience. At our institution, being a big academic center, they
have certain combined fellowships. I think one of the most popular one is ICU
and cardiothoracic anesthesia. So I think it's a good idea if you really want
to specialize in that area, like if you want to practice or you want to spend
most of your clinical time in a surgical ICU taking care of post cardiac
surgery patients, then I think the combined fellowship is an excellent idea and
it does give you the breadth of experience. And at the same time, I think the
other part of the thing is, other than the time commitment, obviously you have
to spend extra time doing that. The other thing is people sometimes don't want
to be limited to just one field and they want to go out and explore some of the
other stuff as well. So I think in that sense it also works out.
Yeah, I don't have much
experience. I only know of people who do the combined cardiac and ICU
fellowships. Again, most likely people who are planning to work in big academic
centers like Duke, who have very high cardiac volumes and very large robust
ICU. So I think that's particularly niche.
And Dr. Reardon, since
you have so many career conversations with residents, I was wondering which
fellowships do you think are most popular right now and why?
I don't know about other
people's institutions, but for us it ebbs and flows. Like a few years ago,
everybody did cardiac and then right now it seems like everybody really likes
regional. I think it just totally depends. Also, we only have a random sampling
of 15 people of the entire country and we're in like the Northeast in New York
City. So I'm not sure it's the best sample to kind of comment on. But I do
think usually in my experience, regional and cardiac are the two most popular
that people like to go into. I could totally see why for both. Both will
provide you great training for sure.
Would you make the same
choice if you guys could go back in time and decided all over again?
I think so. For me, I'm
just beginning my career. I'm just a few months out of fellowship, so obviously
I haven't had a chance to sit back and think, okay, would I do anything
differently. But definitely, I think at this point I still have a lot to learn
and a lot to incorporate into my practice. And I feel like I'm in that phase
where where I have to expand my practice and still
trying to find my niche. And Dr. Reardon may have different answer for that.
Honestly, I'm very happy
at my institution and with the job that I have and I have no plans of leaving.
The one thing I will say that I worry about is if I ever did like relocate or
have to get another job, I wonder if my prospects would be more limited not
being fellowship trained or if the fact that I was an experience attending
would sort of like make up for that, so to speak. I do think that in academics
I have had to work harder at taking on other leadership roles and finding my
own clinical niche that isn't related to fellowship training. So that's also
something to consider. So if you want to do a research project and you're OB
trained, you're like, Great, I'll do an OB project. But like for me it's like,
okay, I have to sort of think outside the box a little bit, work a little
harder to figure out what I want to do. But I think if you have a vision for
what you want, your, your clinical practice to look like, and if you're
interested in other things, like for me, medical education, now I'm involved
with the medical school, I think I have developed myself into a marketable
individual without having done fellowships. So in short, I have no regrets on
not doing fellowship. I took some good vacations and I'm just kidding. So I
think that ultimately I would make the same decision again.
So I know that we are
kind of wrapping up the show and we've answered a lot of questions that we've
received from you guys. But for our residents who are with us here today, if
you guys want to speak a little bit about where you are in the decision-making
process and kind of what your thoughts are or if you have any additional
questions for us, we'd love to hear from you guys.
I'm a CA3 and I last
year was really on the fence about whether or not I was going to do a cardiac
fellowship. I loved the patient population. I liked the big cases. I liked all
the procedures. And I thought doing another year of training with critically
ill patients with the cardiac population would only make me a better anesthesiologist.
I also was a little leery about doing a whole other year of training. I ended
up going to medical school as kind of a nontraditional student, and so I was
already older than a lot of my classmates and already had a kid and was kind of
excited just to be done with training. And so I was really on the fence about
it and talked to a lot of mentors. In the end, my perfect dream job popped up
in the perfect city that my husband and I wanted to settle down in, and I
decided that if I had done a cardiac fellowship one, I wasn't sure that that
perfect job would still be there for me. And secondly, I didn't know that I
would really get to use any of those extra cardiac skills I picked up for my
dream job. So I ultimately decided not to do a fellowship and just signed with
a practice where we wanted to live, doing all the things that I want to do and
I feel like I'm really excited for it and everything worked out perfectly.
And I think that's a
great example of sort of like knowing where you want your life trajectory to
be. Things like geography and knowing you need to move or just having a vision
of what your dream job is and knowing whether or not you can obtain that with
or without fellowship training. Kind of like what you're speaking about is
really like the best decision-making process I think you can do for fellowship.
And I think it's hard
when we train at these big academic centers that are really encouraging us to
pursue fellowships, and you almost feel like you're letting people down by not
doing one. But in the end, I knew I wasn't going to stay here forever and I
needed to do what was right for me and my family, and I feel like it ended up
working out perfectly.
Yeah, I mean, I felt a
lot of the same, not necessarily pressure from our from my chair or program
director, but more like pressure from myself because I was so used to always
trying to obtain the next thing, which, you know, I think when you're a
physician, that's just sort of like what's ingrained in you. And I think taking
the time to sort of like stop and evaluate what you want with your life is
totally relevant and something that you should be doing and it's something you
should be doing even while you're in residency regarding other things besides
I just applied to
Cardiac Fellowship cardiothoracic, and I miss you too. And I think over the
past year I've entertained every single fellowship out there. One minute I want
to be an OB anesthesiologist, then intensivist, then a cardiac
anesthesiologist. I just loved all of them. And so I was able to do these
rotations twice before making my choice, and I feel that was very helpful. I
think everything is super fun the first time you do
it and is very captivating. And so doing it again was really helpful and like,
why did I really why do I really want to become a CT anesthesiologist? And I
found that I love the big cases. I also particularly fond of tea and cardiac
physiology in general, so it is really early on. I feel like I was a little bit
overwhelmed these past two months and trying to get your letters in and trying
to present at a conference and having a wholesome CV, a comprehensive CV for
this application. So I would recommend for the CA1s to be able to do their
rotations once again as early on as they can if they have a particular
interest. And yeah, that was my choice.
And I would just add to
this great conversation, just like Kim and Anna said, I think pursuing a
fellowship doesn't matter what speciality or
subspecialty you want to train in, just have clear goals. That's the most
important thing you should know. Really clear early on why or why not. You want
to do a fellowship. And just like Dr. Reardon was saying, yes, there's going to
be a lot of clinical or maybe some pressure from your colleagues as well,
especially depending on what kind of residency program you're in. But you
should not let that dictate your plans. Like I said, a lot of times there's a
lot of personal life decisions we have to incorporate as well. And like Kim
talked about a couple of things that her family was looking for. And then we
talked about people having student loans and things like that. So you really
want to weigh all the pros and cons and then make an informed decision on what
you want to do. And just be very clear in that thought process, because if you
go do end up going for a fellowship, yes, people come back and sometimes they
don't necessarily practice in that subspecialty, but at the same time, I think
that's a big time commitment or it's only one year. But then. You want to be
satisfied and you want to have a satisfactory career. And that is something
you're going to be doing for the rest of your life. So just think about it
early on and as much as you can before you make that decision.
So I am going to be a
generalist. TBD where. TBD doing what. But I, similar to Anna, was privileged
enough here at Vanderbilt to get to see all the subspecialties once, sometimes
twice before last summer. So I was able to kind of evaluate how I felt on each
rotation. And similar to Anna, I liked a lot of things the first time, but found
some of them draining the second time around. And so I honestly just did an
evaluation with myself and recognized which rotations was I most energized by
the end of the day and which ones was I truly exhausted. And that kind of
helped guide what I was naturally enjoying and wanted to do again and again and
again and could see myself doing for decades and still enjoying it. And that
was a little bit of OB, a little bit of regional, a little bit of trauma. And
after talking to my mentors, it just seemed that a generalist job would fit
that role. So now I'm in the phase of networking all over the country, but
mostly where I have family back home in Texas and just trying to find that
perfect job, just like Kim found. So we'll see where I go.
The job market for
anesthesia is so good right now. You know, our residents who are moving
directly into who are generalists and are moving directly into various academic
places and private practices are getting amazing offers and having a very easy
time of finding a very competitive salary and competitive benefits. Definitely,
if you are on the fence about fellowship, you may as well take advantage of
this time period where things are kind of as promising as they are right now.
Now that we're
concluding our podcast for today, I'd like to thank my co residents, Dr.
Henderson and Dr. Aut. I'd also love to thank Dr.
Anwar and Dr. Reardon for joining us today and all your insight and advice.
We've learned a lot and we hope our listeners did too. Speaking of our
listeners, thank you for joining us for another episode of Residence in a Room,
the podcast, by residents. Please give the show a follow or a share with a
friend and join us again next month. Thank you again for your time.
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