2nd Residency Instead of Fellowship

[thatonegrrl]

Is it possible to do a second residency after FM rather than going for a fellowship in order to tailor your scope of practice?

EG - I'm an incoming medical student interested in family medicine, general pediatrics and psychiatry. I love working with kids and families (I am a career changer coming to medicine after a decade in education) and am also very interested in mental health. I'm especially interested in the combined residencies for FM/Psych and Peds/Psych. If I were not to get accepted into either of those residencies out of the gate, would it be possible to do the 3 year FM (or Peds) residency and then do the Psych residency after?

I'm just asking what is even possible here, not looking for specific guidance on career decisions. Just want to know what options are even available to combine family medicine primary care with (insert additional field of interest here). For that matter what if you wanted to do FM and then EM if not accepted into a combined program at first? Could you do FM and then Peds to get more experience with 0-18 patients (I know there are adolescent med fellowships for FM, but suppose you want to do more full spectrum peds)? FM and then IM to be a hospitalist (again, if not accepted to the combined program out of the gate)?

Thanks in advance!

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[VA Hopeful Dr]

Is it possible to do a second residency after FM rather than going for a fellowship in order to tailor your scope of practice?

EG - I'm an incoming medical student interested in family medicine, general pediatrics and psychiatry. I love working with kids and families (I am a career changer coming to medicine after a decade in education) and am also very interested in mental health. I'm especially interested in the combined residencies for FM/Psych and Peds/Psych. If I were not to get accepted into either of those residencies out of the gate, would it be possible to do the 3 year FM (or Peds) residency and then do the Psych residency after?

I'm just asking what is even possible here, not looking for specific guidance on career decisions. Just want to know what options are even available to combine family medicine primary care with (insert additional field of interest here). For that matter what if you wanted to do FM and then EM if not accepted into a combined program at first? Could you do FM and then Peds to get more experience with 0-18 patients (I know there are adolescent med fellowships for FM, but suppose you want to do more full spectrum peds)? FM and then IM to be a hospitalist (again, if not accepted to the combined program out of the gate)?

Thanks in advance!

Yes, you can.

It can be tricky since you can't get full funding for second residencies and would have to find a place willing to accept that but it can be done.

That all being said, you're not even in medical school yet. You're several years away from needing to worry about this. Plus, at least 50% of medical students who come in wanting to do X end up not doing X. Focus on doing well during your pre-clinical years first, once you start clinicals you'll realize what you want to do and then can worry about how to accomplish it.

 

[thatonegrrl]

Yes, you can.

It can be tricky since you can't get full funding for second residencies and would have to find a place willing to accept that but it can be done.

That all being said, you're not even in medical school yet. You're several years away from needing to worry about this. Plus, at least 50% of medical students who come in wanting to do X end up not doing X. Focus on doing well during your pre-clinical years first, once you start clinicals you'll realize what you want to do and then can worry about how to accomplish it.

Interesting, I did not know about the funding for second residencies issue. So meaning that CMS wouldn't fund the position, so the hospital/program site would have to self-fund it?

I am fully aware of the second part (especially since that's what I get told literally *every* time I ask any sort of question about career prospects - it always feels rather dismissive, very discouraging, and it's actually becoming a major pet peeve/annoyance/frustration of mine).

 

[VA Hopeful Dr]

Interesting, I did not know about the funding for second residencies issue. So meaning that CMS wouldn't fund the position, so the hospital/program site would have to self-fund it?

I am fully aware of the second part (especially since that's what I get told literally *every* time I ask any sort of question about career prospects - it always feels rather dismissive, very discouraging, and it's actually becoming a major pet peeve/annoyance/frustration of mine).

That's correct.

If every single person is telling you the same thing, maybe there's something in it.

 

[thatonegrrl]

That's correct.

If every single person is telling you the same thing, maybe there's something in it.

Oh there is 100% something to it. In fact I completely agree. It's just annoying/frustrating when it's the answer you get every single time... regardless of the question you're actually asking... surely you can appreciate that. It's like my personal prior auth denial gauntlet - LOL!

 

[hallowmann]

Is it possible to do a second residency after FM rather than going for a fellowship in order to tailor your scope of practice?

EG - I'm an incoming medical student interested in family medicine, general pediatrics and psychiatry. I love working with kids and families (I am a career changer coming to medicine after a decade in education) and am also very interested in mental health. I'm especially interested in the combined residencies for FM/Psych and Peds/Psych. If I were not to get accepted into either of those residencies out of the gate, would it be possible to do the 3 year FM (or Peds) residency and then do the Psych residency after?

I'm just asking what is even possible here, not looking for specific guidance on career decisions. Just want to know what options are even available to combine family medicine primary care with (insert additional field of interest here). For that matter what if you wanted to do FM and then EM if not accepted into a combined program at first? Could you do FM and then Peds to get more experience with 0-18 patients (I know there are adolescent med fellowships for FM, but suppose you want to do more full spectrum peds)? FM and then IM to be a hospitalist (again, if not accepted to the combined program out of the gate)?

Thanks in advance!

You certainly could do sequential training. For two very different fields (e.g. IM-Psych, Peds-Psych, FM-Psych, IM-Peds, etc.), I think it makes sense if it's what you want. I think other combinations like FM then Peds seems odd, unless you really wanted to do inpatient Peds or a Peds fellowship, in which case you should just do Peds. Alternatively, you could just aim for an FM residency with very strong Peds training or a fellowship. Same with FM and EM honestly, although I know a couple people who did this because they decided they wanted to do EM.

Funding is an issue as the program would be making about a 1/3 less on you than someone fresh out of school, but at a lot of bigger institutions this isn't really an issue, because they already exceed their cap and are paying out of pocket for some residents anyway. The upside is that you could potentially get credit in the second program for at least some of the time in the first. I know people who have gotten 6-12 mos of training credit, so FM and then Psych could take 6-6.5 yrs to get through instead of 7. This is variable though, and depends heavily on the programs involved.

I'd agree not to worry about this right now. Med school is a long road and your interests can change very easily. Plus after 4 yrs of med school and 3+ yrs of training, the idea of doing intern year and residency again may seem like torture.

 

[cj_cregg]

Is it possible to do a second residency after FM rather than going for a fellowship in order to tailor your scope of practice?

EG - I'm an incoming medical student interested in family medicine, general pediatrics and psychiatry. I love working with kids and families (I am a career changer coming to medicine after a decade in education) and am also very interested in mental health. I'm especially interested in the combined residencies for FM/Psych and Peds/Psych. If I were not to get accepted into either of those residencies out of the gate, would it be possible to do the 3 year FM (or Peds) residency and then do the Psych residency after?

I'm just asking what is even possible here, not looking for specific guidance on career decisions. Just want to know what options are even available to combine family medicine primary care with (insert additional field of interest here). For that matter what if you wanted to do FM and then EM if not accepted into a combined program at first? Could you do FM and then Peds to get more experience with 0-18 patients (I know there are adolescent med fellowships for FM, but suppose you want to do more full spectrum peds)? FM and then IM to be a hospitalist (again, if not accepted to the combined program out of the gate)?

Thanks in advance!

I suppose you could, but in addition to the funding issues you're now looking down the barrel of 3 more years of residency making $60k with 200k (or more) student loan debt while the rest of your residency classmates are making 6 figure salaries and starting families and buying houses. That's a huge income loss, especially at the beginning of your career when that money has plenty of time to grow in a retirement account or mutual fund.

Also, I'm curious about the specific ideas you mentioned. You do not need to do a separate IM residency to be a hospitalist. There are plenty of FM residencies out there that prepare you well for hospitalist work. I would say probably 50% of the hospitalists at my residency's hospital are FM trained and there are probably 15+ local family docs that round on their own inpatients as well. And this is a 200+ bed referral center with good specialty support and an open ICU, not just a little podunk critical access hospital handling very low acuity cases. For peds, what are you envisioning that you could do with an additional peds residency that you could not do as a regular FM doc who went to a program with good peds training? What are you wanting to do with a psych residency that FM docs couldn't do (potentially with a behavioral health/psych fellowship if you wanted to get into the weeds a bit more with treating things like bipolar disorder or schizophrenia, or an addiction medicine fellowship)?

 

[thatonegrrl]

I suppose you could, but in addition to the funding issues you're now looking down the barrel of 3 more years of residency making $60k with 200k (or more) student loan debt while the rest of your residency classmates are making 6 figure salaries and starting families and buying houses. That's a huge income loss, especially at the beginning of your career when that money has plenty of time to grow in a retirement account or mutual fund.

Also, I'm curious about the specific ideas you mentioned. You do not need to do a separate IM residency to be a hospitalist. There are plenty of FM residencies out there that prepare you well for hospitalist work. I would say probably 50% of the hospitalists at my residency's hospital are FM trained and there are probably 15+ local family docs that round on their own inpatients as well. And this is a 200+ bed referral center with good specialty support and an open ICU, not just a little podunk critical access hospital handling very low acuity cases. For peds, what are you envisioning that you could do with an additional peds residency that you could not do as a regular FM doc who went to a program with good peds training? What are you wanting to do with a psych residency that FM docs couldn't do (potentially with a behavioral health/psych fellowship if you wanted to get into the weeds a bit more with treating things like bipolar disorder or schizophrenia, or an addiction medicine fellowship)?

Well, I'm an older non-trad (36), so if I have bio kids at all it'll have to be during med school or early residency anyway... and I've already got 10 yrs of professional work and building of a small start on retirement - so that's less of a worry to me than finding a niche where I can do what I most enjoy doing. Because, at the end of the day, like many elder millenials, I don't think I'll ever get to really retire, so I'd much rather have work that I can continue in for as long as I can, work that's enjoyable and fulfilling and pays the bills even if I were to semi-retire and go down to part-time at some point.

I mentioned IM just because it was one of the combined options that was listed on the AFMB website, it's not actually a personal interest of mine, just a for instance. (Though I've heard that the FM/IM combos don't actually exist currently).

 

[thatonegrrl]

You certainly could do sequential training. For two very different fields (e.g. IM-Psych, Peds-Psych, FM-Psych, IM-Peds, etc.), I think it makes sense if it's what you want. I think other combinations like FM then Peds seems odd, unless you really wanted to do inpatient Peds or a Peds fellowship, in which case you should just do Peds. Alternatively, you could just aim for an FM residency with very strong Peds training or a fellowship. Same with FM and EM honestly, although I know a couple people who did this because they decided they wanted to do EM.

Funding is an issue as the program would be making about a 1/3 less on you than someone fresh out of school, but at a lot of bigger institutions this isn't really an issue, because they already exceed their cap and are paying out of pocket for some residents anyway. The upside is that you could potentially get credit in the second program for at least some of the time in the first. I know people who have gotten 6-12 mos of training credit, so FM and then Psych could take 6-6.5 yrs to get through instead of 7. This is variable though, and depends heavily on the programs involved.

I'd agree not to worry about this right now. Med school is a long road and your interests can change very easily. Plus after 4 yrs of med school and 3+ yrs of training, the idea of doing intern year and residency again may seem like torture.

Yeah, the funding issue seems to be the bigger concern. Mostly I'm just curious as to how flexible FM can be, because most of the fellowships I've seen aren't really up my alley (sports med, geriatrics, sleep med, etc.) - I acknowledge that may change, but was just curious about what the non-fellowship options are for gaining more experience in an area of particular interest, especially if a fellowship for that interest doesn't currently exist.

I'm not trying to make these career decisions now - I'm trying to learn about my options now so that I can build my knowledge and ask even better questions and target my shadowing and elective opportunities once I'm in school so that in 3.5 years when I'm applying to residency I feel confident in my decision. I know that time passes all too quickly and there is so much else to learn in med school too, figure it doesn't hurt to ask as questions arise instead of waiting!

 

[cj_cregg]

Well, I'm an older non-trad (36), so if I have bio kids at all it'll have to be during med school or early residency anyway... and I've already got 10 yrs of professional work and building of a small start on retirement - so that's less of a worry to me than finding a niche where I can do what I most enjoy doing. Because, at the end of the day, like many elder millenials, I don't think I'll ever get to really retire, so I'd much rather have work that I can continue in for as long as I can, work that's enjoyable and fulfilling and pays the bills even if I were to semi-retire and go down to part-time at some point.

I mentioned IM just because it was one of the combined options that was listed on the AFMB website, it's not actually a personal interest of mine, just a for instance. (Though I've heard that the FM/IM combos don't actually exist currently).

What I'm trying to get at is: what is it that you want to do that you don't think FM can prepare you for if you seek out those opportunities? Just with the specific options/interests you mentioned mostly within the primary care field, there's enough overlap that I think the value of another residency would be limited especially in comparison to the costs. We certainly can't do EVERYTHING, but from the medical side of the spectrum we can seek out the training to do almost ANYTHING.

If you go to a good FM residency, you really don't need any additional peds training to take excellent care of pediatric patients. Or any additional psych training to take excellent care of most psych patients (all but the most treatment resistant cases of depression, anxiety, panic disorder, and PTSD, and again there are FM psych fellowships for things like bipolar, schizophrenia, and that end of the spectrum so I'm not sure why a whole extra residency would be needed if you really want to be treating those particular patients). I am not sure what an IM residency would add unless you're wanting to do a specialty fellowship or went to a program with poor inpatient training, in which case you could just do a hospitalist fellowship.

I certainly don't expect you to share all the nitty gritty details about your career goals on the internet if you don't want to, I'm just saying I would encourage you to talk to people in the field during medical school about what you would actually gain from an additional residency, if anything, and consider if that's something that you really want to add to your practice.