Professor of Clinical Anesthesiology, New York Medical College
Residency Program Director, Westchester Medical Center
Valhalla, New York.
SNACC member since 1987
1987-1988 Fellowship in Neuroanesthesia and Research at SUNY Downstate Medical School
Fellowship Director: Audree Bendo MD
Chair: James E. Cottrell MD
Lab supervisor: Ira S. Kass PhD
Q 1. Do you think fellowship training in neuroanesthesia improves patient care?
“I do think so. It’s not a secret that in many medical specialties data supports the value of expertise. Why would it be any different for neuroanesthesia?”
“My many years of collaboration with neurosurgeons would indicate that the number and severity of complications attributed to anesthesia decreases when experts (either fellowship-trained or self-selected and primarily practicing neuroanesthesia) are involved”.
“When an awake craniotomy is scheduled, surgeons look for an expert. You cannot be one unless you do these cases”.
Q 2. What do you see as the value in a neuroanesthesia fellowship?
“Dedicating a year of training to any subspecialty brings lasting benefits to one’s career in the form of recognition of expertise. This brings satisfaction and a steeper career trajectory. For neuroanesthesia, there is a great job market in larger hospitals, and a huge need for real interest and expertise in the care of neuro patients”.
“Neuro experts are looked to for guidance by nursing, QI and risk management departments, in addition to the role of anesthetic/medical care leader”.
“Consultants Internists often need help understanding the perioperative issues they are called to opine on; this type of collaboration really makes for a much more fruitful and patient-centered management process. And as a fellowship-trained anesthesiologist, you have huge credibility”.
Q 3. Does fellowship training factor into your hiring decisions?
“Yes. It does. Fellowship training is also a career accelerator. An additional year signifies not just more expertise in the field, but also more experience overall, as a clinician, as a consultant, as a teacher, maybe as a researcher, and as a more business-savvy physician. Nothing but benefits”.
Q 4. What career benefits do you see for a resident pursuing a neuroanesthesia fellowship?
“There are short-term and long-term benefits. Short term, the career trajectory is steeper and it is very likely your compensation will be higher. Long-term, there is also professional growth in belonging to SNACC, neurocritical care society, and other organizations for “neuro” professionals”.
“Of course, doing what you really enjoy doing, day in and day out, is a huge benefit, which lasts forever. And, as we all well know, being a valued contributor to patient care is fulfilling. It is tough to be great at everything in a large, specialized hospital”.
Q 5. Would you recommend anesthesia residents consider a neuroanesthesia fellowship?
“I do recommend it to those who look for opportunities for professional growth and who are inclined towards working in a large hospital setting; as we all know this is not necessarily everyone’s goal”.
“I also tell them the practice can have quite a bit of variety; they can do both pediatric and adult cases, both in and out of the OR and they can, if they want to, become experts and certify in IOM, TCD; there are so many options”.
Q 6. What would you say to a resident who is considering a neuroanesthesia fellowship, but is unsure if it’s worth it?
“Well, this is both a financial and a professional growth and goal decision, and there is always more than one answer to this conundrum”.
“I think that exploring the pros and cons by talking to local mentors and outside experts speaking with your family and doing a bit of soul-searching, all together will help you make the right decision”.
“There is this need to just leave the long years of getting ready for being a doctor, and the need to focus on a longer-term outlook. Friends and family will help. Ambition may drive you. Or maybe just the mundane financial considerations must take priority? So much goes into career decisions”.
Q 7. Any other thoughts you would like to share?
“My experience as a fellowship-trained neuroanesthesiologist has been very rewarding. By having a narrower practice focus, I have had the privilege of being a part of longitudinal patient care. For some, more complex patients, and even for their family members, I have become the go-to doctor”.
“One of my patients used to bring me a home-cooked ethnic dinner on every anniversary of her brain tumor surgery. I watched a little kid who received a record-approaching blood transfusion grow into a poised teenager who refused sedation for his follow up angiograms”.
“I also have stories where I wished I had been the anesthesiologist for a case. I just know it would have turned out differently. How do we capture this? I do not know, but those who work in teams which provide 24/7 neuroanesthesia coverage agree that patient care, and resident teaching are better”.
“We have to, as a specialty, figure out a way to measure our value”.