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Career Connection
Is It Worthwhile to Do a Fellowship After Residency?
Devin Van Gorden
T
he number of anesthesiologists
applying for fellowships after
graduating from residency has
grown substantially over the last
20 years. From 2017-2020, the percent-
age of anesthesiologists completing their
residency and entering fellowships more
than doubled. Fellowship participants will
be primed to take on the most complex,
interesting cases throughout their careers.
Yet, many claim that fellowship training
has little impact on the likelihood of em-
ployment. Nearly all 2020 anesthesiology
fellows (96%) found employment in their
specialty, as did 95% of anesthesiology
residents who completed training in 2020
(asamonitor.pub/44ywQNI). Entering a
fellowship also means sacrificing a year’s
worth of income, not to mention poten-
tial relocation and extended training.
Given such a massive uptick in fellowship
training, some wonder about the implica-
tions on anesthesiologists’ careers and on
the profession at large.
Increased requirements
Certain hospitals are requiring fellow-
ship training to be hired for specialty
cases. Moreover, the American Board of
Anesthesiology (ABA) continues to offer
more subspecialty certifications, some of
which require relevant fellowship training.
These certifications could make a physi-
cian a better candidate for specific roles
or even be required by hospitals in some
instances. “We are seeing jobs where anes-
thesiologists are going to be doing cardiac
cases, increasingly looking for applicants
with a cardiac fellowship training. A lot of
the specialties have required extra board
certification,” said Srikanth Sridhar, MD,
FASA, Associate Professor, Vice Chair for
Quality of Anesthesiology, and Assistant
Vice President for Healthcare Quality and
Safety at McGovern Medical School at
UTHealth Houston. This has contributed
to mounting pressure for young anesthesiol-
ogists to apply for fellowships. Completing
a fellowship post-residency can open the
door to new opportunities, but it also has
drawbacks for physicians eager to get their
careers under way.
Dr. Sridhar engaged in a debate about
the pros and cons of entering into an an-
esthesiology fellowship at last year’s ASA
annual meeting. Dr. Sridhar has been an
Devin Van Gorden is an intern at Wolters
Kluwer, ASA’s publications partner.
anesthesiologist at the UTHealth Houston
for 11 years. At the debate, Dr. Sridhar
countered the idea that fellowships are es-
sential for anesthesiologists.
Subspecialty fellowship grace
period options
The decision to continue his career with-
out undertaking a fellowship wasn’t one
Dr. Sridhar made lightly. After wrestling
with the idea for some time, he was able
to get board certified for pediatric anesthe-
siology anyway – a certification that now
requires a fellowship. Initially instituted in
2013, the ABA subspecialty certification
in pediatric anesthesiology did not require
fellowship training until 2016.
“I decided not to, mostly because I
wasn’t sure that I wanted to practice pri-
marily pediatric anesthesiology. I knew I
wanted to be in academic medicine, so if
I had subspecialized in pediatrics, I pretty
much would have done all pediatrics all
the time instead of having a mix,” recalled
Dr. Sridhar. He still feels that opting not
to do the fellowship afforded him more
variety in his career. Dr. Sridhar was able,
however, to practice some part-time pedi-
atric anesthesiology and eventually obtain
his board certification. At the time, the
ABA considered physicians with experi-
ence practicing pediatric anesthesiology
to be eligible for their certification. The
ABA no longer allows anesthesiologists to
gain board certification for pediatric anes-
thesiology without fellowship training.
Today’s new graduate anesthesiologists
need to consider fellowship requirements
as they finish their residencies. Not all
ABA subspecialty certifications require
a ­fellowship. Moreover, the ABA certi-
fications offer a grace window after they
institute the necessity of a fellowship for el-
igibility. Qualifying physicians with enough
experience have a few years to obtain cer-
tification before a fellowship is mandated.
The ABA instituted a grace period as a
way of letting physicians – who may have
been practicing in their subspecialty for
years – obtain new certifications without
having to go back and perform a fellow-
ship. In doing so, this allows the ABA to
reward on-the-job experience while still
emphasizing the need for fellowship train-
ing. This option allows physicians to segue
into a subspecialty after employment with
a variety of clinical experiences. Moreover,
practicing in a mixed model setting may
give younger anesthesiologists more expo-
sure and a better idea of the subspecialties
to pursue.
Fellowship benefits
Despite benefitting from the ABA’s grace
window, Dr. Sridhar sees fellowship re-
quirements for board certification as a
positive: “They want people who are board
certified in a subspecialty to be formally
trained to do that subspecialty. So, I think
that’s actually a positive.” While segueing
into a subspecialty from general anesthesi-
ology is possible, fellowship training offers
unique advantages and experience.
A fellowship offers the opportunity
to spend an entire year getting in-depth,
unique experiences in a highly specialized
field. Those with a defined interest within
one area of anesthesiology can use a fellow-
ship to distinguish themselves from other
anesthesiologists. Being f­ ellowship-trained
allows a more sophisticated level of unique
clinical insight. Specialized perspectives
and depth of experience help to create
dynamic caregiving teams that improve
patient safety.
Moreover, while delayed income may
give pause to many finishing their resi-
dencies, some fellowships allow for higher
earning potential. Obstetric anesthesiology
Downloaded from http://pubs.asahq.org/monitor/article-pdf/87/9/27/691369/20230900.0-00022.pdf by guest on 30 December 2023
is a growing field with a lot of promise, for
both physicians and patients. With mater-
nal mortality on the rise in both developed
and developing nations, the demand for
anesthesiologists with obstetric subspe-
cialty training will continue to rise (Indian
J Anaesth 2021;65:43-7). The American
College of Obstetricians and Gynecologists
(ACOG) and the Society for Maternal-
Fetal Medicine (SMFM) have also contrib-
uted to the demand for anesthesiologists
with obstetric subspecialty training. In re-
cent years, ACOG and SMFM outlined a
ranking system for obstetric and maternal
health care offered by hospitals. The top
two tiers incorporate subspecialty-trained
obstetric anesthesiologists into their staffing
requirements.
Personal choice
Ultimately, a lot goes into the decision to
pursue a fellowship. Beyond professional
considerations, fellowship training is ac-
companied by income sacrifice, potential
relocation, extended training, and often-
times intimidating workloads. These are
worth serious consideration at the begin-
ning of one’s career. Today’s physicians are
lucky that fellowships are now an option
at times other than the early years of one’s
career. After gaining some experience,
physicians may steer their practice in a
different direction or aspire toward certain
positions. “We’ve had people who prac-
tice for one to five years and then go back
and do a fellowship because they wanted
to switch gears or want more expertise,”
confirmed Dr. Sridhar. “That door is never
closed.”
Fellowship training offers real oppor-
tunities and benefits to physicians, care
teams, and patients alike. However, the
pressure on graduating residents to enter
one may be unduly high. “You shouldn’t
feel like you absolutely have to do a fel-
lowship just for the sake of doing a fellow-
ship or just for the sake of getting extra
training. It should be a personal choice
that progresses you toward a goal in your
practice,” said Dr. Sridhar. n