Fellowship vs work

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Powdermonkey

ninja doctor in training
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Hey all, I'm a rising PGY 3 at a busy community style hybrid program. I got in to EM because of my interest in prehospital and wilderness medicine, mainly through my involvement in ski patrol. As third year looms so soon ahead, I'm debating more on what to do after finishing up next June.

Initially my itention when starting residency was to find a wilderness medicine fellowship to complete. I really enjoy the austere medicine component of prehospital stuff, and I like adventure races and medical command and support for these events. I'm lucky to have one of the 10 programs associated with my program, and I would love the chance to stay and be here for the fellowship, but I'm starting to wonder if it will be worth it.

I've been talking with the fellowship director as well as the current fellow and what I've heard from both of them as been positive. I've spoken with some of the fresh attendings that are 1-2 years out of residency in the past few years to get their take as well, and in their opinion they think I would be able to have the same trip experiences, go to the same conferences and as a benefit I'd get to make twice the money. I'm not extremely interested in research necessarily, but I do have some interests that might be fun to further investigate.

I think that the fellowship would be a great time to further learn about a subtopic in me that interests me and I'd get paid to do it. If I don't do the fellowship I'll probably end up being the EM guy you work with that is the local wilderness guru.

My question is for those of you who have completed a fellowship like this one or any of the non accredited ones, has it made a difference in your practice? In your happiness? Was it worth it?

As far as the finances go, I think our fellows work 8-9 days a month, so the ability to moonlight in house or locally would help make up for the pay cut of attending vs fellow. Plus our fellows make half attending pay typically.


I'm leaning towards the fellowship at this point, but getting all these job offers via email almost daily and the thought of moving on and moving back closer to home is very tempting and it's a strong pull. I know the fellowship is only one more year, and that year will be as an attending and not a resident, I'll be working less and will be busy with trips and classes.

But is it worth it?

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Finishing up my fellowship. Have an academic job starting immediately thereafter. I would not have been offered the academic job I took (although I definitely could have had AN academic job) without my fellowship.

I think it's important to take a good look at your career goals and decide from there. Do you want to be the local wilderness medicine guru? Then you probably don't need a fellowship. Do you want to be a keynote speaker at wilderness medicine conferences, be a very prominent figure within the field, or lead a wilderness medicine section within a residency training program? Then fellowship is probably important to consider.
 
I went through the same thoughts a while back, i ended up joining wms/nols in residency and am in the process of getting my wilderness fellowship (FAWM) through them. there's a whole checklist of stuff to do including conferences, a research project, and/or taking one of those $$$$ trips. if ski patrol/mountains is your thing, there's even a DMM (diploma in mountain medicine). it's $225 to join the fellowship portion, I think $180/yr for membership and you have 5 years to obtain fawm from the time you sign up.
 
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I'm not in EM but I think you kind of answered your own question. It's not like you're going to be giving up that much money. And you'll be doing something you seem to be really inspired by...in the day to day grind of modern medicine, that's something you may really need and that money can't buy. If I were in your shoes, I'd go for it.
 
Hey all, I'm a rising PGY 3 at a busy community style hybrid program. I got in to EM because of my interest in prehospital and wilderness medicine, mainly through my involvement in ski patrol. As third year looms so soon ahead, I'm debating more on what to do after finishing up next June.

Initially my itention when starting residency was to find a wilderness medicine fellowship to complete. I really enjoy the austere medicine component of prehospital stuff, and I like adventure races and medical command and support for these events. I'm lucky to have one of the 10 programs associated with my program, and I would love the chance to stay and be here for the fellowship, but I'm starting to wonder if it will be worth it.

I've been talking with the fellowship director as well as the current fellow and what I've heard from both of them as been positive. I've spoken with some of the fresh attendings that are 1-2 years out of residency in the past few years to get their take as well, and in their opinion they think I would be able to have the same trip experiences, go to the same conferences and as a benefit I'd get to make twice the money. I'm not extremely interested in research necessarily, but I do have some interests that might be fun to further investigate.

I think that the fellowship would be a great time to further learn about a subtopic in me that interests me and I'd get paid to do it. If I don't do the fellowship I'll probably end up being the EM guy you work with that is the local wilderness guru.

My question is for those of you who have completed a fellowship like this one or any of the non accredited ones, has it made a difference in your practice? In your happiness? Was it worth it?

As far as the finances go, I think our fellows work 8-9 days a month, so the ability to moonlight in house or locally would help make up for the pay cut of attending vs fellow. Plus our fellows make half attending pay typically.


I'm leaning towards the fellowship at this point, but getting all these job offers via email almost daily and the thought of moving on and moving back closer to home is very tempting and it's a strong pull. I know the fellowship is only one more year, and that year will be as an attending and not a resident, I'll be working less and will be busy with trips and classes.

But is it worth it?
Do the fellowship, any fellowship, preferably the one that makes you the most uniquely marketable. Anything that will set you apart from all the other replaceable, grunt cog-monkeys, is a win-win. (You'll still be replaceable like all of us, but less so, and that can make a huge difference). You won't regret it. Mark my words.
 
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Do the fellowship, any fellowship, preferably the one that makes you the most uniquely marketable. Anything that will set you apart from all the other replaceable, grunt cog-monkeys, is a win-win. (You'll still be replaceable like all of us, but less so, and that can make a huge difference). You won't regret it. Mark my words.

Although most of the time I find Birdstrike to be wise like Buddha, I disagree here. You have to think about what you want to do, what your fellowship is, and who that fellowship matters to.

If you want to specialize in Peds EM, a PEM fellowship will make you much more marketable and less replaceable in large metro areas that staff CED's with PEM docs. In this way, Birdstrike is right.

With something like wilderness med, however, you should realize that it will only give you additional marketability and job security in an academic setting. If you want to practice in academia then Birdstrike has a point. But few employers in the community will think that the fellowship makes you less replaceable or more useful.

Certain things like an MBA may make you more useful and irreplaceable across the board but I think you get my point.
 
I went through the same thoughts a while back, i ended up joining wms/nols in residency and am in the process of getting my wilderness fellowship (FAWM) through them. there's a whole checklist of stuff to do including conferences, a research project, and/or taking one of those $$$$ trips. if ski patrol/mountains is your thing, there's even a DMM (diploma in mountain medicine). it's $225 to join the fellowship portion, I think $180/yr for membership and you have 5 years to obtain fawm from the time you sign up.

I second this. Working on FAWM myself now.
 
If you want to actively be involved in Wilderness Medicine, a fellowship will offer you networking, credentials, and a bolus of academic opportunities/research to firmly plant your foot in the field. The lost income is negligible for the chance to tailor your career to what you want.

If you just like the outdoors and want to formalize your medical involvement in a hobby, the WMS and conferences is more than enough...
 
Although most of the time I find Birdstrike to be wise like Buddha, I disagree here. You have to think about what you want to do, what your fellowship is, and who that fellowship matters to.

If you want to specialize in Peds EM, a PEM fellowship will make you much more marketable and less replaceable in large metro areas that staff CED's with PEM docs. In this way, Birdstrike is right.

With something like wilderness med, however, you should realize that it will only give you additional marketability and job security in an academic setting. If you want to practice in academia then Birdstrike has a point. But few employers in the community will think that the fellowship makes you less replaceable or more useful.

Certain things like an MBA may make you more useful and irreplaceable across the board but I think you get my point.
Feel free to disagree. I'm no Buddha, maybe just "balda" (Boston pronunciation of "balder").

A wilderness medicine fellowship wouldn't be the first one I personally would recommend (from a "marketability" standpoint, since it's such a tiny niche and non-accredited), but if it's something he/she loves and is passionate about, then he should do it. Follow your dreams, and you'll have no regrets.

As far as my "marketability" comment, let me explain. Like you said, the more academic fellowships like Peds EM, CCM, Tox definitely make you more unique and marketable to academic places and probably very large and competitive private jobs. Hospital administrators basically and so-called "policy makers" see a BC/BE Emergency Physician (or any physician, for that matter) as an overly paid nurse practitioner or PA. They'd rather have 20 cheaper midlevels staffing a department if they could, and one BC/BE EP to put their name on the chart to cover liability, make the visit "legit" and be able to advertise that all patients are "seen" by a "Board Certified" doctor. I truly believe that there is no limit to the extent these people will bastardized and Walmartize the profession of Medicine and patient care. Feel free to disagree and say I'm too cynical, but that's my opinion. If you're the one guy that allows them to advertise "Double Boarded Peds EM" on staff or "fellowship trained toxicologist" on staff, then you've just got one leg up on the grunt docs. You're still replaceable, but not the first on the chopping block, and you're valued more. I think this is a big deal in today's world where doctors are considered a necessary evil, overpaid, over-trained customer service reps, who are over-ordering drains on the system. Cynical? Yes, but my opinion nonetheless.

What about Pain? What about Hospice & Palliative care?

These are great opportunities! People b--ch and whine about "oh, the nights, the days, the weekends, the holidays, the circadian rythms, oy vey." Not if you do one of those two fellowships. They open the door to completely different specialties. "Oh, but Palliative care is boring, and people die on you!" So what? People die on you in the ED, and your 4 thousanth chest pain is boring, too.

"Oh but Pain, the seekers, oh vey!" So what? You'll see them in the ED anyways, but at 2 am, with zero control over the matter, and spend the entire encounter with the jackboot of Press-Ganey to your throat. This fellowship is super competitive amongst Anesthesia residents for a good reason. Derm hours, procedures, control of your patients, your practice setting, your hours and your life. Do you hear these specialties b--tching about Press-Ganey, EMTALA, burnout, sleep deprivation or stress overload? Do these fellowships and you're still an ER doctor, just a double boarded one, and a "subspecialist" too.

Think outside the box people.
 
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I love Wilderness Medicine. But no, it won't be worth it. But it's only a year. Do what you love and you'll never work a day in your life.

Agree. However, as alluded to in another thread (article referring to Generation Y folks), this is still "work." Think about it, even NFL players, who all grew up "loving" football as their passion, etc., largely end up hating/dreading a lot of the less enjoyable aspects/commitments/endless calendar of their sports. But in the end, for many of them it's worth it because on game day (16+ Sundays, Saturdays, Mondays, Thursdays, and now Wednesdays maybe WTF?) they ultimately love playing the game and financially it is generally very worth while. Physicians aren't much different, we like the ethos, the "game day" where we're actually providing patient care but a lot of the other things really sap our enjoyment. However, for the most part (for now at least) the compensation is generally worth it. I know the "sky is falling" and everything, but most of the people on this thread stand to possibly make more in their career than MOST professional athletes, and MOST will also be able to walk without the assistance of full titanium lower extremities and a walker AND they'll be able to complete MMSE questionnaires after their 40th birthday to boot!
 
I think it really depends on how much academics interests you. If you're 100% committed and gung-ho about academics then I think doing the fellowship would probably be a good idea to increase your competitiveness and help you become "the wilderness guy" at your shop. If you're not really sure you might consider getting a job, earning some cash but still pursuing the FAWM option (which you'll probably want to earn anyway even if you end up deciding you want to do a fellowship)...if you decide you want the fellowship it'll still be there and you'd have some FAWM credit already.


And a related question for those who have done a fellowship: with what you know now, would you recommend doing a fellowship right after residency to just get your training over with and not have a fellow's salary be a major disruption in your income down the line (ie "I just kept living like a resident and it was fine")? Or would you have waited a year or two to solidify your EM knowledge base and practice style while putting some $$ away to help pay off loans, get some retirement funds going and earning interest, etc? I recall birdstrike touching on this in another thread, and would love to hear more thoughts/input.
 
I am finishing mine now and I am glad i started right after residency. that way you're still in that "I am putting in a ton more hours than an attending mode". plus from a loan repayment standpoint, if you do the interest based they calculate your payment from last years taxes. you know, the residency one. that's less painful than getting a full attending salary, then dropping to pgy4 level (maybe some moonlight pay) and having to pay the higher repayment
 
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