Serious advice on multiple fellowships?

[danielmd06]

I am a PGY-4 Neurology resident who will be entering a Sleep fellowship in July.

I have always had plenty of interest in multiple areas of Neurology (hence the residency choice) and was curious what other senior residents, fellows, and attendings thought of individuals completing multiple fellowships. I'm not desirous of becoming a permanent student, but I continue to be very excited at the prospect of adding training to what I've already gotten and reading acedemic websites about their various programs.

My research interests would revolve around Sleep. I have strong interest in teaching and academic medicine, but also am perfectly interested and potentially happy to go into private practice...

I've trimmed my list down to areas that feasibly complement Sleep (and vice versa) but also give better clinical training for General Neurology. The fellowships I have been thinking about are Epilepsy/Clinical NP, Movement Disorders, and Advanced Clinical Neurology.

Is this career overkill and an exercise in wasting time (not to mention prolonging loan repayment) or a potentially wonderful addition to my abilities and future resume?

I'm just asking for general opinions and anecdotal stories to help persuade or dissuade...any thoughts?

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[Fencer]

In academia, you need a "niche" where you become the local expert, who eventually earns national (Associate) and international (Professor) recognition for scholarly activities. Multiple fellowships give you more choices as the needs in a particular university may vary (if you look for a particular town), but also dilute your interest. However, there are people who have made a career of the cross-over of two areas (i.e.: Epilepsy and Sleep; Stroke and Epilepsy; Neuromuscular and Rehabilitation).

 

[neurologist]

Speaking as a multiply-fellowshipped person myself, I think you can look at this from three different perspectives.

The first is purely from the angle of "what will advance my career." If you are planning on going into academia, I'd suggest you just go for the one area you like the most and pursue it intensively. As Fencer noted, multiple fellowships may, on the surface, seem to make you more "flexible" a fit, but in the long run, with few exceptions, not too many academics truly subspecialize in multiple areas. You'll probably end up "wasting" one of them.

The second is "what will make me the most money"? Probably not a big issue unless you plan on private practice. In that case, you probably want to do sleep and EMG, since those are what float the financial boat for many practices (at least for now).

The final perspective is simply "what am I interested in"? If you really like a field and want to learn it and get really good at it, do the fellowship. You can try to tailor your practice (private or academic) to as much an extent as possible afterward. This was pretty much my approach. I really didn't think much about career path (like you, I was ambivalent regarding private practice vs academics), and I wasn't really counting out my future benjamins either. I just knew I wanted to learn more and focus on a couple of areas just 'cause I really liked them. Now, I'm not advocating endless fellowships, but if you're thinking about doing two, it's really not that huge a sacrifice. Heck, some programs actually pay pretty reasonably now once you hit PGY 5 and 6. I didn't starve during mine.

 

[danielmd06]

Thank you both for the replies.

Fencer, I've seen your comments on soon-to-be pure, accredited Epilepsy fellowships in very recent threads. Do you fell that there is any great educational difference between an NP fellowship with predominant emphasis on Epilepsy versus a 100% Epilepsy fellowship? With the upcoming ACGME changes, will billing be affected for EEG interpretations regarding the two?

Neurologist, out of curiosity which two fellowships did you complete? I've seen you in the Sleep forums, so I am guessing that Sleep was one...

 

[Fencer]

I have Neurology, trained as CNP fellowship but with a PhD doing models of epilepsy. Although I am boarded by ABPN and ABCN in CNP (+ Neurology in ABPN) and I am program director for CNP, what I practice is Epilepsy, EEG, EP and EMU. I am still board eligible for Sleep.

If I needed to get certifications today, I would only pursue the Epilepsy board (+ Neurology). Tests will be available in 2011 or 2012. ACGME program certification is expected to start in 2013 or 2014.

 

[neurologist]

Neurologist, out of curiosity which two fellowships did you complete? I've seen you in the Sleep forums, so I am guessing that Sleep was one...

Yup. Did sleep and CNP fellowships. The CNP was focused on EEG/epilepsy. Work-wise, I do mostly sleep with some EEG/epilepsy.