Getting "trapped" in IM or other specialty

[Kentobari]

Hi all.

27 Year old Peace Corps volunteer going into pre-med in the fall, thinking about my future.

I'm looking into these NHSC programs and there seem to be a bunch of pros and few cons.

Pro: Work in a rural, impoverished setting. I spent two years in a village of 400 people in the jungle and loved it. Although this would be much, much, much, MUCH different, I'm going into medicine with a goal of being a medical anthropologist and address global health inequalities, so this is actually a smart career move.

Pro: Pays for medical school. Yup.

Neither pro nor con: Low-ish salary. There are people who want to be doctors who don't give a **** about money, including me and many reading this. If you pay for my med school you can give me a $50,000 salary as long as I get to practice my dream career. No golf clubs? No problem.

So you get the idea. The only con I see here is being restricted into a specialty such as peds, family med, or IM.

So my question is whether this can be skirted around in some creative way. After doing two years 0f NHSC, would one be able to redo another residency or a fellowship, or some similar plan to pursue a different path?

I'm not anti-family medicine, I just don't like the idea of having my options restricted.

Thanks for all thoughtful responses.

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[smq123]

So my question is whether this can be skirted around in some creative way. After doing two years 0f NHSC, would one be able to redo another residency or a fellowship, or some similar plan to pursue a different path?

I'm not anti-family medicine, I just don't like the idea of having my options restricted.

Completely technical answer: Yes.

Realistic answer: Maybe not.

You might be able to do another residency - it IS done. Keep in mind, though, that this option is easier in theory than it is in practice. For starters, federal funding for your residency position comes from Medicaid, and is limited to a finite number of residency training years; if a hospital were to accept you for a second residency, they would only receive half as much money to pay for your salary and training. Many residency programs do not have enough money to do this, and are not willing to accept anyone to do a second residency. Given how tight the Medicaid budget is (they've already talked about cutting all residency funding to pediatric hospitals, for example), I don't imagine it's going to get better any time soon.

It is also much harder to get into another residency once you've already been an attending for a few years. You would have to re-enter the Match, which is expensive. You would have to accept a huge paycut. Finally, you would have to take call again, possibly move to a far part of the country, and generally have a more time-intensive lifestyle. If you were to remain single for the rest of your life, this is probably fine. It's much harder when you have a spouse and kids.

As for doing a fellowship after you complete your service commitment, again, that depends on the fellowship. Many of the family med fellowships are not competitive (palliative care, obstetrics, womens health, geriatrics), and would likely accept you without any problems. Some of the peds and IM fellowships are also not competitive, and would be willing to accept someone who has been out of residency for a few years (allergy&immunology, rheum, ID, endocrine, renal). However, if you wanted to do something competitive like GI or cardiology, you might face a very tough time getting a spot.

If you are not sure of what specialty you want to do, and think you might not want to do family med, peds, IM, psychiatry, or OB/gyn, you should probably avoid taking the scholarship. A lot of jobs do offer some loan repayment as a job perk when you start working for them. There is also the NHSC loan repayment program, which is also another less-restrictive option.

Let me know if you have any other questions.

 

[Kentobari]

Completely technical answer: Yes.

Realistic answer: Maybe not.

You might be able to do another residency - it IS done. Keep in mind, though, that this option is easier in theory than it is in practice. For starters, federal funding for your residency position comes from Medicaid, and is limited to a finite number of residency training years; if a hospital were to accept you for a second residency, they would only receive half as much money to pay for your salary and training. Many residency programs do not have enough money to do this, and are not willing to accept anyone to do a second residency. Given how tight the Medicaid budget is (they've already talked about cutting all residency funding to pediatric hospitals, for example), I don't imagine it's going to get better any time soon.

It is also much harder to get into another residency once you've already been an attending for a few years. You would have to re-enter the Match, which is expensive. You would have to accept a huge paycut. Finally, you would have to take call again, possibly move to a far part of the country, and generally have a more time-intensive lifestyle. If you were to remain single for the rest of your life, this is probably fine. It's much harder when you have a spouse and kids.

As for doing a fellowship after you complete your service commitment, again, that depends on the fellowship. Many of the family med fellowships are not competitive (palliative care, obstetrics, womens health, geriatrics), and would likely accept you without any problems. Some of the peds and IM fellowships are also not competitive, and would be willing to accept someone who has been out of residency for a few years (allergy&immunology, rheum, ID, endocrine, renal). However, if you wanted to do something competitive like GI or cardiology, you might face a very tough time getting a spot.

If you are not sure of what specialty you want to do, and think you might not want to do family med, peds, IM, psychiatry, or OB/gyn, you should probably avoid taking the scholarship. A lot of jobs do offer some loan repayment as a job perk when you start working for them. There is also the NHSC loan repayment program, which is also another less-restrictive option.

Let me know if you have any other questions.

Thanks for the reply.

I'm now reading that there are the occasional combined residencies, for example IM-EM. Are these terribly rare and competitive? This is all a very long way down the road for me, but I'm curious to know.

 

[smq123]

Thanks for the reply.

I'm now reading that there are the occasional combined residencies, for example IM-EM. Are these terribly rare and competitive? This is all a very long way down the road for me, but I'm curious to know.

They are somewhat rare. I can't say how competitive they are.

However, more importantly, the NHSC will not allow you to do an IM/EM residency. They will allow IM/peds, and possibly an FM/psych or an IM/psych, but not anything combined with EM.

 

[michaelrack]

They are somewhat rare. I can't say how competitive they are.

However, more importantly, the NHSC will not allow you to do an IM/EM residency. They will allow IM/peds, and possibly an FM/psych or an IM/psych, but not anything combined with EM.

I don't think they allow IM/psych, as I recall from years ago. don't think they allow FP/psych

 

[smq123]

I don't think they allow IM/psych, as I recall from years ago. don't think they allow FP/psych

You're right...duh. I forgot that IM/psych and FP/psych are both generally 5 years long...the NHSC generally only allows 4 years for residency/post graduate work. They will make an exception if you're in psych and want to pursue a child psych fellowship, but that's the only exception I can think of off the top of my head.

 

[Brachyury]

Hi all.

27 Year old Peace Corps volunteer going into pre-med in the fall, thinking about my future.

I'm looking into these NHSC programs and there seem to be a bunch of pros and few cons.

Pro: Work in a rural, impoverished setting. I spent two years in a village of 400 people in the jungle and loved it. Although this would be much, much, much, MUCH different, I'm going into medicine with a goal of being a medical anthropologist and address global health inequalities, so this is actually a smart career move.

Pro: Pays for medical school. Yup.

Neither pro nor con: Low-ish salary. There are people who want to be doctors who don't give a **** about money, including me and many reading this. If you pay for my med school you can give me a $50,000 salary as long as I get to practice my dream career. No golf clubs? No problem.

So you get the idea. The only con I see here is being restricted into a specialty such as peds, family med, or IM.

So my question is whether this can be skirted around in some creative way. After doing two years 0f NHSC, would one be able to redo another residency or a fellowship, or some similar plan to pursue a different path?

I'm not anti-family medicine, I just don't like the idea of having my options restricted.

Thanks for all thoughtful responses.

Just as a side note, I think you need to put into perspective that the NHSC scholarship is fairly competitive. Unlike the military scholarships, you are far more likely to not get an NHSC scholarship than to be awarded one

 

[montessori2md]

If you want lots of options, with the scholarship you're probably best off going IM and then you can apply for fellowship after your obligation.
Scholar salaries are typically over 100k starting, higher in some areas (IHS tends to pay better with better benefits).

NO ONE should apply for the scholarship if underserved primary care is not what they want to do. Period. You can always get your loans paid off if you are willing to work in the middle of nowhere, there are plenty of programs, as well as hospitals who would rather give you a contract and pay off your loans than continue to pay through the nose for Locums. Or you could just work locums and pay of your loans while the hospital/locums agency pays your room and board.