should I do psychosomatic fellowship?

[angrywombat]

I am a PGY-IV who applied for psychosomatic fellowship but have struggled a lot with whether to actually go through with it or not. I hope that getting some opinions on the specific fellowship will clarify things.

The one big reason I am thinking about doing the fellowship:
Psychosomatic medicine is, by far, the most interesting and fun part of psychiatry for me. Right now I feel very jaded and bored with most of psychiatry (possibly due to PGY-IV senioritis?) but when the topic is psychosomatic medicine I still feel passionate and interested.

Other factors in favor of the fellowship:
I wonder if, as time goes by and there are more psychosomatic fellowship graduates, it will become an expectation that you'll have done the fellowship as a requirement to be hired for the most interesting psychosomatic/CL jobs.

I have already applied and lined up interviews, so I feel like the fellowship is "now or never". I worry that if I cancel my interviews now I would be burning my bridges at those places. I also feel kind of like I would be letting down my mentors in my program who believed in me enough to write letters of recommendation. I worry they won't want to give me recommendations again in the future (or recommend me for jobs) if I flake out on them now.

Here are the reasons I don't want to do it though:
It seems like most people who do psychosomatic fellowship end up in academics. I am not certain that I want to stay in academia.
Looking at job postings, I don't see that many jobs that specifically require a psychosomatic fellowship - so I wonder if it's even really worth it at all?

My sig. other doesn't make very much money, so I feel that doing the fellowship would be a bigger financial sacrifice for me than it is for the people I know who did the fellowship whose spouse had a lucrative career (I have noticed a lot of the people I know who did the fellowship had a spouse who was also a doctor for example - so losing a year of attending salary wasn't that big of a deal for them). When I look at my friends who are getting great attending salary offers, when recruiters send me these seductive job ads, it is tempting to jump into an attending job just for the money alone. I so want to start paying down my debt and building up savings again.

Psychosomatic fellowship seems more "worth it" if you go to a prestigious program where you get to see the zebras and work with the true experts. I do have some interviews lined up at a few prestigious fellowship programs...however they are all in different states.
Since applying I have started to realize that the logistics of relocating for a fellowship would be harder than I thought. My sig other can't relocate with me so we'd be in a long distance relationship for a year. We have talked a bit about having a child sooner rather than later, but obviously that would be put on hold if I'm doing fellowship in another state.
Is it worth the emotional costs to be long distance for a year for this? Is it worth the extra financial cost of moving away for a year for this?

tl,dr: I love the idea of psychosomatic medicine but due to financial worries, family needs, and worrying the job market doesn't really demand this fellowship, I am questioning if I should do it.
What do you guys think?

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[michaelrack]

Psychosomatics isn't really worth it for nonacademics.

You may want to do just a few interviews at prestigious places and leave it up luck on whether you do a felllowship or not.

 

[vistaril]

I am a PGY-IV who applied for psychosomatic fellowship but have struggled a lot with whether to actually go through with it or not. I hope that getting some opinions on the specific fellowship will clarify things.

The one big reason I am thinking about doing the fellowship:
Psychosomatic medicine is, by far, the most interesting and fun part of psychiatry for me. Right now I feel very jaded and bored with most of psychiatry (possibly due to PGY-IV senioritis?) but when the topic is psychosomatic medicine I still feel passionate and interested.

Other factors in favor of the fellowship:
I wonder if, as time goes by and there are more psychosomatic fellowship graduates, it will become an expectation that you'll have done the fellowship as a requirement to be hired for the most interesting psychosomatic/CL jobs.

I have already applied and lined up interviews, so I feel like the fellowship is "now or never". I worry that if I cancel my interviews now I would be burning my bridges at those places. I also feel kind of like I would be letting down my mentors in my program who believed in me enough to write letters of recommendation. I worry they won't want to give me recommendations again in the future (or recommend me for jobs) if I flake out on them now.

Here are the reasons I don't want to do it though:
It seems like most people who do psychosomatic fellowship end up in academics. I am not certain that I want to stay in academia.
Looking at job postings, I don't see that many jobs that specifically require a psychosomatic fellowship - so I wonder if it's even really worth it at all?

My sig. other doesn't make very much money, so I feel that doing the fellowship would be a bigger financial sacrifice for me than it is for the people I know who did the fellowship whose spouse had a lucrative career (I have noticed a lot of the people I know who did the fellowship had a spouse who was also a doctor for example - so losing a year of attending salary wasn't that big of a deal for them). When I look at my friends who are getting great attending salary offers, when recruiters send me these seductive job ads, it is tempting to jump into an attending job just for the money alone. I so want to start paying down my debt and building up savings again.

Psychosomatic fellowship seems more "worth it" if you go to a prestigious program where you get to see the zebras and work with the true experts. I do have some interviews lined up at a few prestigious fellowship programs...however they are all in different states.
Since applying I have started to realize that the logistics of relocating for a fellowship would be harder than I thought. My sig other can't relocate with me so we'd be in a long distance relationship for a year. We have talked a bit about having a child sooner rather than later, but obviously that would be put on hold if I'm doing fellowship in another state.
Is it worth the emotional costs to be long distance for a year for this? Is it worth the extra financial cost of moving away for a year for this?

tl,dr: I love the idea of psychosomatic medicine but due to financial worries, family needs, and worrying the job market doesn't really demand this fellowship, I am questioning if I should do it.
What do you guys think?

if you're not interested planning on working in academic medicine, there is no way I would even consider the fellowship.

 

[MindBodyMD]

I agree, no point doing one if you're not interested in academics. Tons of CL jobs out there.

 

[Bartelby]

It looks like a lot of more senior people beat me to the reply, but I am struggling with the same question as well (CL fellowship v just take a job). A few factors to consider in your situation:

1- Are you staying where you are now (since SO can't relocate) forever? What jobs can you get there without the fellowship? Would the fellowship help you land your ideal job there?

2- If you are thinking of academic positions I think fellowship training gives a pay bump, I don't know if this carries over to other non-academic salaried positions. Maybe check locally to see and factor this into your calculations.

3- Are there acceptable fellowship options nearby? Long distance for a year doesn't sound worth it especially if you are planning a family now.

Overall the advice I tend to get about CL is to consider a fellowship if I want to move to and break into a new tough market or if I want to do academic work, though I have heard (like you are hearing above) from multiple attendings that you would learn much more as a first year attending than you would in a fellowship anyway and that just going for a job is the way to do it.

 

[MacDonaldTriad]

The one big reason I am thinking about doing the fellowship:
Psychosomatic medicine is, by far, the most interesting and fun part of psychiatry for me. Right now I feel very jaded and bored with most of psychiatry (possibly due to PGY-IV senioritis?) but when the topic is psychosomatic medicine I still feel passionate and interested.

This is your strongest reason for doing a fellowship. This is probably the only reason anyone should do a fellowship.

Other factors in favor of the fellowship:
I wonder if, as time goes by and there are more psychosomatic fellowship graduates, it will become an expectation that you'll have done the fellowship as a requirement to be hired for the most interesting psychosomatic/CL jobs.

The CL field hopes so, but probably not going to happen.

I have already applied and lined up interviews, so I feel like the fellowship is "now or never". I worry that if I cancel my interviews now I would be burning my bridges at those places. I also feel kind of like I would be letting down my mentors in my program who believed in me enough to write letters of recommendation. I worry they won't want to give me recommendations again in the future (or recommend me for jobs) if I flake out on them now.

Again, most fellowships would be glad to have you even if you are a few years out. The likelyhood of your taking the pay cut is very low however.

Here are the reasons I don't want to do it though:
It seems like most people who do psychosomatic fellowship end up in academics. I am not certain that I want to stay in academia.
Looking at job postings, I don't see that many jobs that specifically require a psychosomatic fellowship - so I wonder if it's even really worth it at all?

CL is a strange beast when it comes to pay. Hospitals have to fund you, but generally at a loss for them. This means that there are plenty of jobs, but you will be employeed by hospital systems large enough to keep you busy and have enough need to take the hit.

My sig. other doesn't make very much money, so I feel that doing the fellowship would be a bigger financial sacrifice for me than it is for the people I know who did the fellowship whose spouse had a lucrative career (I have noticed a lot of the people I know who did the fellowship had a spouse who was also a doctor for example - so losing a year of attending salary wasn't that big of a deal for them). When I look at my friends who are getting great attending salary offers, when recruiters send me these seductive job ads, it is tempting to jump into an attending job just for the money alone. I so want to start paying down my debt and building up savings again.

One year of hardship will be hard for that year, but in the totality of life, this is probably not going to be that finacially noticeable down the road. The question is, are you interested enough in this work to make the 12 month training extention worth it?

Psychosomatic fellowship seems more "worth it" if you go to a prestigious program where you get to see the zebras and work with the true experts. I do have some interviews lined up at a few prestigious fellowship programs...however they are all in different states.
Since applying I have started to realize that the logistics of relocating for a fellowship would be harder than I thought. My sig other can't relocate with me so we'd be in a long distance relationship for a year. We have talked a bit about having a child sooner rather than later, but obviously that would be put on hold if I'm doing fellowship in another state.
Is it worth the emotional costs to be long distance for a year for this? Is it worth the extra financial cost of moving away for a year for this?

We can not tell you how to handle this, but relocate with spouse would me the right answer for most. If that is a deal killer, only you can say.

tl,dr: I love the idea of psychosomatic medicine but due to financial worries, family needs, and worrying the job market doesn't really demand this fellowship, I am questioning if I should do it.
What do you guys think?[/QUOTE]

The last pro fellowship factor depends upon your commitment to doing CL full on. If this is going to be what you do, it is nice to have advance training as it is something you will use the rest of your life and particular competence in something is golden. I do agree with everyone who says the fellowship isn't "necessary", but if you become 5% more effectual at it over 30 years, maybe..

 

[zolof]

I would add that it is very location and hospital dependent as well, because in some states, cities etc, I had applied to, only wanted a Psychosomatic trained doctor and yes they were more academic and very connected to medicine. I did a psychosomatic fellowship and I don't regret it. I do regret the pay cut, though, but moonlighting helped, and I will take it any day over just inpatient psych, or just plain outpatient full time.

I will add, that when I do consults, there is definitely a discrepancy with the non-psychosomatic psychiatrist who moonlight on weekends, that I see when I come in on Monday. I would say around 20 to 30 percent of the time I have to clean up some messes they created over the weekend, so I actually see the differences throughout the year. Now that really depends on many different factors of course that I don't feel like getting into now. I also like academia and teaching and the fast pace of the consults and running to different floors and departments and dealing with cardiology, ICU, renal, ID, etc, which I feel challenged my treatment skills more. I have seen some interesting cases, that I wouldn't have been exposed to and some difficult calls that I wouldn't have felt comfortable with if not doing it during fellowship. Just my 2cents.

 

[Hospital Dwelling Nomad]

Residents from my program do so much consults, if they are even half decent they will know what to do without requiring "clean up" from anyone else.

My two cents: apply for a consults only job, read up on every patient you get, hopefully the hospital will have another physician in practice and/or a psych medical director. If they are willing to mentor you, even better (not just the medical science, but also the art, the practice, and the business). On the job experience is just as good if you are motivated, and this sounds like it would put less of a strain on you and your sig other.