ASA Community members weigh in on when and why to consider a fellowship.
Recently, an ASA Community member was asked whether residents should pursue fellowships to make themselves more marketable. The poster said, "I advised them to go for a fellowship if they desired to master a particular subspeciality," but then asked for others' thoughts on the subject. "Does fellowship training increase your earning potential? Does it vary based on the fellowship—will a cardiac-trained fellow have more marketability than an OB, peds, pain, or regional fellow?"
Here's what respondents had to say.
Don't do it for the money.
Pointing to today's economy, one community member noted that, "In the current market, fellowships aren't required to find a good job. So I would only pursue one if you are interested in getting more training in the area. Of course things could change, and a fellowship does provide some degree of job security."
Another colleague added more context. "True, right now you don't need it in this market, but that's temporary. And having good knowledge, competence, and skill in a specialty could make you more marketable and allow you to rise above the rest for that job you really want."
"In our current job market," concurred a third, "Fellowships do not make you 'more marketable' to most group practices. It's important to recognize that these things go in waves. If you absolutely love the kinds of cases a fellowship will train you for, go for it. You will be one of the few fellowship trained people in this wave, and thus you will be in demand."
One member cut right to the point, suggesting, "In the real world, compensation is not based on fellowships or credentials, but rather mostly productivity or a combination of salary and productivity."
Greater marketability? It depends.
When it comes to marketing yourself, posters were split. One participant felt that a fellowship in, "pain, peds, cardiac, or critical care will make you more marketable and you will make a little bit more money, but this is probably offset by the lost revenue during extra training."
Others asserted that it's even more complex. "It really depends on which job market and which specialty," noted one. "I'd advise people to seek out mentors in their area of choice." Another said that even if there isn't an overall trend, "hospitals or groups can choose to incentivize positions if they have trouble hiring subspecialists."
One long-term anesthesiologist summed it up by saying, "I believe an additional year of fellowship training is a very positive investment in one's long-term career, but it should be looked at through that lens rather than employability issue." Another went in the same direction, stating, "It's generally how valuable you are to the team. Do what you do best and you'll be more satisfied and a more valuable member of your staff."
Why a fellowship could work against you.
Many commenters weighed in on the practical value of a fellowship, especially if an anesthesiologist is seeking a generalist role in private practice.
"There is a misconception that having a fellowship makes a candidate more marketable, but that is actually quite the opposite in the real world," wrote one respondent. "In private practice, we really don't care if a candidate has a fellowship. As recruitment chair for my group for several years, I regularly passed up candidates with cardiac fellowships because we didn't have a need for them. We knew hiring someone with cardiac fellowship who wasn't going to be doing cardiac was not going to work out—how is that individual going to maintain their echo certification if they are not doing enough cardiac cases?"
Another seconded this idea, "It seems in private practice the most valued applicant is someone seeking a generalist position." A third agreed, stating, "Seems to me that a good all-around practitioner would be more desirable than one who's tied up in one specialty, except, perhaps in a large academic practice."
The first poster continued, "Most private practices don't have a need for peds fellowship candidates because most private practices do a small amount of pediatric cases and those are mostly healthy kids anyway. Anybody can do those cases, we don't need a peds trained anesthesiologist for tonsils or fractures. Same goes for OB. Everyone coming out of residency is expected to be comfortable taking care of pregnant women who in general are healthy patients."
In addition, another contributor pointed out, "If you're leaving fellowship and entering a general practice, the non-fellowship areas will be ones in which you haven't done a case (or very few) for a year or more. This may get you off to a rough start."
The right reasons to consider a fellowship.
In spite of everything noted above, there are still good reasons to pursue a fellowship.
For example, as one member offered, "In most private practices, fellowships are not required to do regional, peds, cardiac, or OB. The clear exception is pain, which requires a fellowship if you want to have an exclusive pain management practice." They continued, noting that a fellowship can be a positive "if you are looking to stay in academics or large multispecialty practices."
However, most commenters agreed that there's one truly compelling reason for continuing with a fellowship. "Don't just do a fellowship because you feel you have to. Do it because you want to and you see the value in it," said one.
"You have to have a strong desire to take care of these specialized patients to get through the programs and make it a career," offered another. A third added, "If one has a keen interest, the fellowship will expand their options and make it more likely that they will be able to find a position in a practice that has that subspecialty as a strength."
In short, as one physician mentioned, "If a person truly loves anesthesiology and wants to contribute in whatever practice setting they choose, at a greater level of expertise—and provide patients with the best care—then yes. Fellowship training is immensely valuable."
Start your own conversation or offer your point of view. Visit ASA Community now! And be sure to take a look at Resident Life posts while you're there.