Pediatric fellowship after PP

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Anestheezee

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Hi folks,
I have been in an MD only private practice group as a generalist for the last 2.5 years that requires a fairly hefty pediatrics load of about ~20-25% of the practice. I have done pyloromyotomies, airway cases, neonates, frequent overnight peds call, frequently doing children under 2 years old. No peds hearts, no TEFs, no young thoracotomies (though I probably could if I really showed enthusiasm and the right circumstances happened),

The thing is, we are opening a new pediatric hospital that wants to have ONLY fellowship-trained peds people which will be a tough transition for us as a group to make happen. It would be great if I could somehow get a peds fellowship, since the alternative path to peds certification is a pretty serious bear to accomplish for most of us.

I'm curious - is it possible to do an "express fellowship" or somehow get some component of the fellowship waived based on previous experience? I mean, it would be a complete waste of time for me to do most of the curriculum in the fellowship as our current hospital has a significantly large pediatrics exposure already. I would need the case numbers for the really sick stuff - preemies, hearts, thoracotomies, etc.

Thanks!
 
I have written elsewhere about going back to do a fellowship after being out of training... it is really, really hard. I was only out for a year- can’t imagine how frustrating it would be if you were out for even longer.

if you decide to do this, you need to recognize a couple of things:
- No one is going to give a **** that you were an attending. Especially in the pedi world, You are going to be micromanaged and treated like a dummy by people who may or may not know more than you. You will be left to rot in the room with no control over when you get your pee break, doing an anesthetic plan that is not yours and you do not necessarily agree with
- Even at a really good pedi fellowship, 90% of what you do will not be educational for you (sick neonates, TEF, etc). Most of your time will be spent doing cases that you already know how to do without a fellowship, and getting micromanaged while you do them
- Being treated like a trainee can feel like being treated like a kid after having already been an adult. People who were just recently your colleagues aren’t your colleagues any more- now they are your superiors, and whether or not they realize it, they will act like it
- When you are stuck in the OR at 6:30pm because your case ran late, but you’re getting paid $200/hr, it is frustrating but not the end of the world. When you are stuck late in the OR at 6:30 because your case ran late, you are 1:1 with an attending who is getting paid $200/hr to put his or her feet up in their office, and you aren’t making a DIME to sit in the OR watching the clock... Well, that doesn’t feel very good at all
- It also doesn’t feel very good when you get your first month paycheck and it is for $5000 after taxes

Maybe some of these issues are better if you can work out a way to get paid more. I am also probably (definitely) bitter as it gets close to the end of this year. Ultimately at the end of this year I will have a fellowship under my belt and I’ll be happy to have done it- but I didn’t realize at the outset just how frustrating it was going to be
 
Yea, agree with the micromanagement( guilty as a new attending). Unless they subsidize you going for the 1-year fellowship, move on with your career and decide on a age where non-pediatric trained can still perform the anesthetic. At my residency, it was 2 years of age if not complicated.
 
When I was a resident, we had a brand new attending who finished residency the same year I started. Prior to anesthesia residency he was in a busy PP pulmonary/icu for over 10yrs. Our chairman would always say, “I don’t know how he did it. He’s a better man than me.”
 
nimbus said:
When I was a resident, we had a brand new attending who finished residency the same year I started. Prior to anesthesia residency he was in a busy PP pulmonary/icu for over 10yrs. Our chairman would always say, “I don’t know how he did it. He’s a better man than me.”
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You don't happen to be in the southeast do you ...
 
Hork Bajir said:
I have written elsewhere about going back to do a fellowship after being out of training... it is really, really hard. I was only out for a year- can’t imagine how frustrating it would be if you were out for even longer.

if you decide to do this, you need to recognize a couple of things:
- No one is going to give a **** that you were an attending. Especially in the pedi world, You are going to be micromanaged and treated like a dummy by people who may or may not know more than you. You will be left to rot in the room with no control over when you get your pee break, doing an anesthetic plan that is not yours and you do not necessarily agree with
- Even at a really good pedi fellowship, 90% of what you do will not be educational for you (sick neonates, TEF, etc). Most of your time will be spent doing cases that you already know how to do without a fellowship, and getting micromanaged while you do them
- Being treated like a trainee can feel like being treated like a kid after having already been an adult. People who were just recently your colleagues aren’t your colleagues any more- now they are your superiors, and whether or not they realize it, they will act like it
- When you are stuck in the OR at 6:30pm because your case ran late, but you’re getting paid $200/hr, it is frustrating but not the end of the world. When you are stuck late in the OR at 6:30 because your case ran late, you are 1:1 with an attending who is getting paid $200/hr to put his or her feet up in their office, and you aren’t making a DIME to sit in the OR watching the clock... Well, that doesn’t feel very good at all
- It also doesn’t feel very good when you get your first month paycheck and it is for $5000 after taxes

Maybe some of these issues are better if you can work out a way to get paid more. I am also probably (definitely) bitter as it gets close to the end of this year. Ultimately at the end of this year I will have a fellowship under my belt and I’ll be happy to have done it- but I didn’t realize at the outset just how frustrating it was going to be
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This resonates with me so much. I'm happy I did the fellowship and I believe it will set me up for a very rewarding career, but the year has not been nearly as enjoyable as I had hoped. I've been having a hard time putting my finger on exactly what I dislike - on paper the training is good, hours are fairly reasonable (for a trainee), and the people are friendly enough... but you put into words exactly what my frustrations have been. Pedantic micromanagement that is unintentionally insulting combined with the fact that neonatal emergencies and truly challenging syndromic patients are rare even at a huge quarternary care children's hospital... so the majority of my time is spent doing stuff I'm already comfortable doing independently but with less autonomy than a CA-2 resident.
 
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OK, I'll bite and post here for a moment. Hopefully that will help OP (or another poster in the same situation), since I have walked in the same shoes, just not in Peds.

I agree that micromanagement is hard to tolerate for a board-certified anesthesiologist. There are a few things that personally helped me with that, at least in the ICU.

1. I chose a smaller place for training, with nice people, where everybody knew every fellow. I was not just their drone. I gave up on the very big places, because those places tend to come with more stress. You're just a drone to a lot of people you interact with.

2. I read some pretty good up-to-date handbooks before my fellowship. That means that I knew my stuff on day 1, unlike many of the other fellows. All I needed was the practical experience and some procedures I didn't know before. The fact that I did not need to study for the boards, also helped a lot throughout the year, allowing me to concentrate only on the fellowship.

3. I made sure that they knew my story, and the fact that I was board-certified and had practiced for years. I also "owned" my patients, as if I were the attending, and tried to minimize the need for hand-holding and supervision.

4. I treated all my attendings with respect, as if I had just come out of residency, doing things their way, showing initiative but easily bending to their will. I knew they had been concerned that I would be too independent and hard to teach (the subject actually came up during my interview). After a few good outcomes, all of them learned to trust me and let me be pretty autonomous when on call. I did call them (rarely), usually for outside transfers or stuff I would have liked to be called for, as an attending. That overnight call autonomy probably contributed a lot to my positive experience; I would have gone nuts had I been micromanaged.

5. I did the fellowship not because I had to, but because I was already wasting a ton of time on reading critical care, same as OP already practicing a lot of peds. So I was excited to be there and learn, every single day. I can't emphasize this enough. I didn't do the fellowship because somebody else wanted me to. When once asked by my PD if the fellows weren't being overworked, I looked at him as if he were from a different planet; the question had not even crossed my mind. As CCM fellowships go, it was a gentlemen's fellowship, and I got to read about 2 hours/day on average. That (and my solo in-house call time) taught me probably more than all of my attendings. I was self-sufficient and pretty competent, but I tried not to come across as arrogant or cocky. We had a subspecialty fellow like that, back when I was a CA-3, and his excessive self-confidence was just a daily reminder of how not to behave after having practiced for a while (i.e. when in Rome...).

6. I still love the place and have great memories. One of the best decisions of my life, especially after a residency at a big program where I had been just a drone to them. But it requires passion and the right (can do) attitude. If you feel like there isn't much they can teach you, if you are not open-minded, if you can't swallow your pride and execute with a smile even when you disagree deep inside, you'll have a miserable year, especially in the wrong place. In the end, every unusual decision from an attending is just an opportunity to learn to do things in a different way. As faculty, it drives me crazy when I have a trainee who complains when I do something in a way she's not used to, or doesn't agree with.
 
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I didn’t really have any of those problems going back from attending to fellow. I was there to learn a sub specialty not just check a box. I was changing career paths and the fellowship was the pathway. And it’s only one year. Look at the peds and IM fellowship pathways and be happy instead of bitter. Did it suck working until 6 when not on call vs 3? Sure. Were the attendings making 400k vs my 75? Sure, but I had plenty of money and didn’t really change my lifestyle that year. I still went on vacation to a 5 star resort, rented a nice house, etc.
I learned a lot, and had a great year. Some people are very particular, there’s usually a reason for that, whatever- it’s their party. I’m just here to learn and move on. Everyone is particular about different things. Being flexible and learning different techniques is part of the practice of anesthesia.
Maybe I got lucky with fellowship program choice?
 
Agree 100% that if you are going to do a fellowship after being in practice, the only way to do it is to smile, say yes, try different things , be flexible, not be cocky or arrogant, have a good attitude, be a team player, etc. I would just caution OP, or anyone else considering this route, to go into the decision with eyes wide open and recognize that what @FFP described is probably not the norm... Or maybe I’m just a soy boy 😉
 
Hork Bajir said:
Agree 100% that if you are going to do a fellowship after being in practice, the only way to do it is to smile, say yes, try different things , be flexible, not be cocky or arrogant, have a good attitude, be a team player, etc. I would just caution OP, or anyone else considering this route, to go into the decision with eyes wide open and recognize that what @FFP described is probably not the norm... Or maybe I’m just a soy boy 😉
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I am looking forward to when they start censoring soy boy
 
Hork Bajir said:
Agree 100% that if you are going to do a fellowship after being in practice, the only way to do it is to smile, say yes, try different things , be flexible, not be cocky or arrogant, have a good attitude, be a team player, etc. I would just caution OP, or anyone else considering this route, to go into the decision with eyes wide open and recognize that what @FFP described is probably not the norm... Or maybe I’m just a soy boy 😉
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Absolutely agree. 🙂

Seriously, it's really hard to go back, and I have a lot of respect for anybody who's done it. The key for it to work is PASSION. If one's not passionate and excited about doing the fellowship, I am not so sure it's worth it.

Even then, the wrong program can make the year miserable. Still, keep your eye on the target, OP; you want that second board certification, while learning as much as possible.

It's just one year, though one that will cost you 200K+ net, let's not mention the future value of that. And the loss of skills during a peds fellowship.
 
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shepardsun said:
No, but you could see if your group would subsidize you at or close to your current salary to do the fellowship yearthe
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shepardsun said:
No, but you could see if your group would subsidize you at or close to your current salary to do the fellowship year
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One of the best docs in my pedi fellowship class did exactly this. Your group will be getting a known entity (you’ve done a 2.5 year job interview for the position) and saves on recruitment costs (assuming you don’t go somewhere else after fellowship opens new possibilities for you)
 
anesthesiadoc said:
One of the best docs in my pedi fellowship class did exactly this. Your group will be getting a known entity (you’ve done a 2.5 year job interview for the position) and saves on recruitment costs (assuming you don’t go somewhere else after fellowship opens new possibilities for you)
Click to expand...
I would imagine they put a clause in that you better come back to the group if they're subsidizing your education. I would be pissed as a group if I paid a full salary or close to it for a year if the person bailed for different pastures
 
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