Applying to jobs and fellowships at the same time

[angrywombat]

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I have applied to a few fellowships and have even received interview invitations, but I am starting to have second thoughts about the fellowship.
I have been thinking about applying to some attending jobs as well to see what they have to say and see if that might help me decide.
Is it bad to apply to jobs while also applying to fellowship?
Should I be worried that the people who gave me recommendation letters for fellowship will be offended if they find out that I'm not actually going through with the fellowship?
Or is it common for people to check out all their options?
One of my big concerns is that the people who wrote letters recommending me for fellowship might feel like I made them look bad or wasted their time by deciding not to do the fellowship after all. Or that my reputation at my residency might be harmed by looking flaky, and that could affect how much help they give me in my career.
Does anyone else have a story about changing your mind once you had applied to fellowship? Did it cause any problems or harm your reputation?

 

[Winged Scapula]

Personally, as a letter writer, if I am willing to write you a letter of reference it wouldn't matter whether that was for fellowship or future employment. If I know you well enough to write such a letter I would expect that you would share your confusion with me because you may be asked to provide references when you apply for jobs, as I would need to be prepared for the possibility of a call from a potential employer.

As an employer however I would be understandably miffed if you wasted my time and money flying you out and wining and dining you for a job that you're not sure you're really interested in.

I'm not sure that your situation is very common as I would venture most people have made up their minds by the time fellowship applications are due. As to whether or not it makes you look flaky, I guess that depends on the reasons for your confusion and if you have a prior history of flakiness.

 

[gutonc]

I don't think it's that uncommon to pursue both tracks, especially in IM (although I certainly wouldn't call it common). I also don't think it matters all that much to your LOR writers as WS pointed out.

A fair number of my residency colleagues started out pursuing fellowships, even going so far as interviewing for spots, before changing their minds. I think with the new application timeline (again, for IM), this is becoming less common as you now have 2 full years of residency before you have to make the call to apply for fellowships or not.

 

[QofQuimica]

I came into residency planning to do a fellowship, but then started having second thoughts because of how much my second year of residency had burned me out. What I decided to do was take a year or two off to work, get my boards done, etc. This year has been better so far, and right now I feel like I could probably start fellowship next year after all. But I'm still going to take the year off. Fortunately for me, the fellowship I want to do is not very competitive. If you're gunning for something super competitive, a year off might not be such a good option for you. Just thought I'd throw the idea out there though in case it was something you wanted to consider.

 

[angrywombat]

I came into residency planning to do a fellowship, but then started having second thoughts because of how much my second year of residency had burned me out. What I decided to do was take a year or two off to work, get my boards done, etc. This year has been better so far, and right now I feel like I could probably start fellowship next year after all. But I'm still going to take the year off. Fortunately for me, the fellowship I want to do is not very competitive. If you're gunning for something super competitive, a year off might not be such a good option for you. Just thought I'd throw the idea out there though in case it was something you wanted to consider.

I would definitely be interested in that option...except that I have already applied for the fellowship so it seems like it's now or never.
I feel like if I were to back out of doing the fellowship now, I probably would not be able to count on getting new letters and the places where I have received interview offers probably would not give me a second chance.

If I could go back in time, I think I probably would not have applied for fellowship this year. I do think the subspecialty is interesting still, but it would be easier from a family life perspective (and also from a financial perspective) to not do it at this point.

 

[QofQuimica]

I would definitely be interested in that option...except that I have already applied for the fellowship so it seems like it's now or never.
I feel like if I were to back out of doing the fellowship now, I probably would not be able to count on getting new letters and the places where I have received interview offers probably would not give me a second chance.

I think it's still worth checking into it. At least ask your own program's faculty. I'm sure people change their minds about doing fellowships or have family issues, etc. come up all the time where they have to postpone fellowship. I don't know how you physically arrange to postpone though, especially if you're not applying for something with a match system.

If I could go back in time, I think I probably would not have applied for fellowship this year. I do think the subspecialty is interesting still, but it would be easier from a family life perspective (and also from a financial perspective) to not do it at this point.

Likewise. I figured, I'm going to be finishing residency at age 39 anyway. What the heck difference will one or two more years make?

 

[angrywombat]

If anyone else is struggling with this decision, here is a story I found on an ophtho site. It sounds like this guy was in fact interviewing for jobs at the same time he interviewed at fellowships yet somehow managed to avoid burning bridges.

Changing Your Mind
Of course, there are occasions when the answer isn’t so straightforward. When Lance Kugler, MD, was at the end of his residency, he considered pursuing a fellowship in cornea and refractive surgery. He had registered for the match and was deep into the process, having even gone on several interviews.

“I found the interview process to be very educational,” says Dr. Kugler, also a member of the YO Info editorial board. “And through the process of evaluating my opportunities, I got the impression that I didn’t actually need a fellowship for what I wanted to do. I wanted to have a practice that focused on cataract surgery without giving up other aspects of general ophthalmology, such as medical retina, lid surgery and refractive surgery.”

During the fellowship interview process, he received three very strong job offers in markets he wanted to live in — none of which required a fellowship. Nor did any of the practices think a fellowship would enhance his marketability in their market. Dr. Kugler decided to withdraw from the match and accepted a position with a practice that was looking for a cataract surgeon with an interest in refractive surgery.

It proved to be a very good decision for him. The community had an open-access laser center, which meant that there was no need for the upfront overhead of starting a refractive surgery practice. Shortly after starting, he was seeing a steady stream of cataract patients and several refractive patients, and after one year, he accepted partnership.

However, over the course of the four years Dr. Kugler has been with the practice, it has become clearer to him that his passion and interest in cataract and refractive surgery has grown exponentially. And although he has been able to do some refractive surgery, he doesn’t feel he would be able to reach his potential without subspecialty training. Therefore, he recently decided that a year of subspecialty training in cornea and refractive surgery would be valuable for the rest of his career.

“This was a huge decision for me as well as my family,” Dr. Kugler said. “Obviously, this decision involves a significant pay cut. Plus, I have to move my family from Omaha, Neb., to Nashville, which carries with it its own set of expenses.”

While it certainly would have been less disruptive to enter a fellowship immediately after residency, Dr. Kugler sees advantages to doing it later. “First of all, I have been able to pay off my school loans by working for the past four years, therefore my financial situation is much better now,” he says. “Plus, I have become active in the Academy and have gained valuable perspective on the national level.

“Most importantly, the learning curve for the first four years of practice has been very steep and I am entering fellowship with a stronger skill set and more experience. I now know what my weaknesses are and know specifically what I need to learn during fellowship.”

Interestingly, the criteria Dr. Kugler used to choose a fellowship program this time is completely different than it was after residency. This time around, he placed an emphasis on fellowships that provide strong refractive surgery experience but, just as importantly, provide education in the business and marketing of a medical practice, including financing, patient relationships and ethical marketing strategies — in other words, the “real world” of ophthalmology.

“By postponing my fellowship, I have learned to look at the entirety of ophthalmology and everything you have to experience, understand and navigate above and beyond the science,” Dr. Kugler says.