CA-400,000! Skip the Fellowship: 5 Reasons

A while back I wrote a blog post in which I described four reasons why you should do a fellowship. Well, as we close out 2023, it's time to look at the other side of that coin. And what a big coin it is! Without further adieu, let's look at the five reasons why you should skip the fellowship and go straight from CA-3 to "CA-400,000".

1. Demand for anesthesia is strong. 

It's been a strange, wild ride since Covid: many anesthesiologists have reduced their hours or retired altogether, and we still have surgical backlogs from Covid due to nationwide staffing shortages. Non-OR-Anesthesia ("NORA") continues to grow as more procedures move outside the OR. The increase in demand for anesthesia isn't being met with an increase in residency positions; residencies are funded by Medicare, and expanding residency positions is a time-consuming, budget-conscious process. Put these all together, and it's likely that demand for anesthesia providers will be healthy for the foreseeable future.

2. Anesthesia salaries have increased.

Medicare's valuation of anesthesia services continues its inexorable decline every year, but paradoxically, private practice salaries have had a healthy bump since Covid. This is based on my knowledge of the Northern California market, but it's almost certain that salaries have increased in most of the US based on the hourly rates I'm seeing offered by locum companies. The recent boost in anesthesia salaries means that you get a leg up on paying off your loans!

3. You might not see a return on your investment.

I did a cardiac anesthesia fellowship, so I speak with certainty in saying that a cardiac fellowship will produce a financial return in the form of a higher salary, more billable units, and more call stipends. I don't know much about pediatrics, but I've had colleagues who have enjoyed very significant financial benefits by practicing pediatric anesthesia in underserved rural areas. However, I'm not sure the same can be said for fellowships such as regional anesthesia or OB. Of course, there's much more than money that should go into a decision about fellowship, but it's definitely something to consider.

4. You can get a head start on your financial future.

One year might seem like a short period of time in your 20's, but someday when you're in your 50's or 60's and thinking about cutting back on work (or retiring), one additional year of work will be a big deal. If you skip the fellowship and head straight into a high-paying job, you get a head start on paying back your loans and creating your nest egg. 

5. Be done with training.

You've spent the first 25-30 years of your life in delayed gratification mode: planning ahead, taking countless exams, enduring awkward conversations while soliciting letters of recommendation, paying application fees, and putting up with all the minor indignities of medical training--it's time to practice independently and enjoy your life!