Back for a fellowship after being in practice?

[Bearsfan01]

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I wanted to see if anyone has had experience going back to do a cardiac fellowship after being in private practice. I started work as a private practice attending this past august after completing residency. I don't see myself working in this group long term. In addition, I have been strongly considering going back to do a cardiac fellowship. I really enjoyed my cardiac rotations toward the end of my residency and regret not applying for one during residency. I felt the rush to graduate and start working in the real world after being in school for what felt like an eternity. My questions on going back are:

1. Will there be any built-in bias against me when applying for not having decided on pursuing a fellowship earlier? i.e. Will this make me appear weak and indecisive? For the record, I don't have any issues on my record: Graduated from my residency well liked by the department, good board scores, and so far a nice working relationship with my anesthesia group

2. When should I break it to my group that I want to go back to pursue a fellowship (and not come back). I am concerned about burning bridges with them and pissing them off. I don't plan on asking any of the attendings in the group for a LOR. I know they will obviously find out eventually but wasn't sure when in the application process I should let them know

3. How competitive is a cardiac fellowship now? I would ideally like to start in 2011 but it is getting late and I would be OK waiting until 2012 to start. Are there any issues with a non-accredited fellowship vs. an accredited fellowship?

I know this is a long post but any insight or advice would be greatly appreciated. Thanks.

 

[urge]

Go for it. The fellowship attendings will admire you.

 

[proman]

1. Will there be any built-in bias against me when applying for not having decided on pursuing a fellowship earlier?

Shouldn't be a problem. Are you ready to be a CA2 again? Can you stand having an attending tell you how to do an a-line, PIV, draw an ABG, intubate the "right" way? I see that being the hardest part.

2. When should I break it to my group that I want to go back to pursue a fellowship (and not come back).

What does your contract say? 2 months, 2 weeks? If you have no interest in going back to the group or area then I'd just give the notice you're required to.

3. How competitive is a cardiac fellowship now?

It's significantly more competitive now than when you were a resident. What do you plan on doing afterwards? I've found the academic cardiac market very tight. Not sure about PP. Granted you'll be looking for 2013 job so it will likely be different. I wouldn't do a non-accredited fellowship: you won't be able to be echo certified (can still take the test).

 

[Bearsfan01]

I have thought about the idea of being a CA-2 again, especially after being on my own now. However, I can tolerate most things if I know it is only temporary.

My contract says I need to give 60 days notice. I wasn't sure if I needed to give even more advanced notice in case someone from a fellowship I am applying to knows someone from my current anesthesia group and contacts them for a "background check"

I am leaning towards private practice in the future. I am in private practice now and I like the pace, autonomy, and laid back attitude of the surgeons in this type of setting. I would also prefer not to limit myself to 100% cardiac as I like multiple others fields of anesthesia (regional, peds, etc.). However, if a good job presents itself that is 100% cardiac then I will be fine with that also.

 

[Gern Blansten]

Leave on good terms. It is highly likely that somewhere down the road, you will be asked for a reference from all of the places you worked or they will be sent a form asking them to evaluate you on the core competencies including professionalism. Much easier to just be professional and leave on good terms than to explain away an answer of "No, I would not hire this person again" on the form letter they send out.
As long as you are upfront and honest with the group, I suspect they will understand your motivations and, while they will probably be frustrated, they would be unlikely to hold a grudge like they would if you left with little notice (when you could have easily left with much more notice-assuming most fellowships are on a normal academic calendar cycle).
In general, I would just say that you should treat your group like you would want someone else to treat you, to the best of your ability.

 

[pgg]

This thread is relevant to my interests.

My military obligation threw a few kinks into my thoughts of doing a cardiac fellowship right after residency; long story short it wasn't a reasonable option then. I'm thinking of doing it when my time is up in a couple years.


I've known a few military anesthesiologists who spent a couple years as attendings before doing fellowships, mainly because serving out a scholarship payback committment usually makes it difficult to roll straight from CA3 into fellowship. Every single one of them has said it sucked reverting to being someone's bitch - and every single one of them said they quickly got over it.

I had a lesser but comparable experience going back to start my CA-1 year after spending 3 years as a medical officer with the Marines. 30 days after owning the medical department, answering to nobody except a hands-off Marine colonel, being responsible for 1000 Marines and 50-60 Corpsmen, coming off two deployments, I was a know-nothing CA-1 being treated like the dangerously ignorant menace to patient safety that all new CA-1s are. I figure if I can survive that adjustment I can be a fellow without strangling someone who tells me I'm taping the tube wrong.

 

[periopdoc]

Just do it. Not all fellowships treat you like a CA-2. Mine certainly didn't, but then again I did several months of cardiac as a CA-2 and CA-3 with the same attendings I did my fellowship with, so that helped a lot.

There is some attending somewhere that will look askance at you for not going directly into fellowship, but there will always be something in life that someone will question about you so don't let this stop you. It won't be a MAJOR issue.

The rough part is actually getting a fellowship now. I don't think the ACGME fellowship is necessary, but it doesn't hurt. So you become a NBE PTEeXAM certified instead of testamured. Big whoop. That and 2 bucks will get you a tall Americano at Starbucks. You may get some extra bargaining power with your future hospital, if your group is savvy enough to take advantage of your certification, but it is likely that you could get the same power just from having done the fellowship. There are some damn good non-ACGME fellowships, especially in Canada. The biggest drawback to non-ACGME is you lose work hours restrictions and you may become the call coverage bitch for the non-cardiac stuff.

Make your decision, then tell your group, then apply. They will respect you for it, if they are worth anything, even if they are unhappy about finding another partner. Just know that it may take a couple of cycles to get a spot.

Good luck. The CT fellowship is awesome so have fun.

- pod

 

[IlDestriero]

Unless you live in a very difficult location to recruit to, I would not tell the group that you're leaving until you have an offer somewhere. If you get passed over this year, your group could hire someone else and than drop you, after all, you're leaving anyway. Don't assume that they will be OK with your decision, or accept it as anything but a betrayal of sorts. Locums is not so hot these days, from what I read. You could find yourself in a bad, bad position. See what your contract requires, estimate how hard you are to replace and decide what is fair for the both of you.. Again, I wouldn't let them know your intentions to leave until you have somewhere to go.
BTW, I did the fellowship after staff/faculty thing as well. You'll get over the pain soon enough, and I was at a fairly painful and dogmatic place. When people realize you have skills, they'll let you run. I found all the fellowship directors were extremely interested in bringing in someone from the military, with real world skills, proven leadership, and board certification. I was offered a spot everywhere I applied. How can a resident compete with years of experience and board certification? The only thing I didn't have was recent research, it didn't seem to matter.
Some ******* (or several) is (are) still going to whine that you didn't tape the tube, sew the central line, etc the way they want. Whatever makes you happy chief... Keep an open mind, you MAY learn something. Even it's just how to NOT tape a tube, sew a line, etc. It's also nice to be practicing on someone else's malpractice insurance again for a while, especially when you get a giant Stool Sandwich, or 2. Beware of the random saboteur that hates you because your skills rival theirs, or your flash PP lifestyle, automobiles, etc. Academic practices can breed some seriously malcontented individuals.

Just do it. Not all fellowships treat you like a CA-2. Mine certainly didn't, but then again I did several months of cardiac as a CA-2 and CA-3 with the same attendings I did my fellowship with, so that helped a lot.

There is some attending somewhere that will look askance at you for not going directly into fellowship, but there will always be something in life that someone will question about you so don't let this stop you. It won't be a MAJOR issue.

The rough part is actually getting a fellowship now. I don't think the ACGME fellowship is necessary, but it doesn't hurt. So you become a NBE PTEeXAM certified instead of testamured. Big whoop. That and 2 bucks will get you a tall Americano at Starbucks. You may get some extra bargaining power with your future hospital, if your group is savvy enough to take advantage of your certification, but it is likely that you could get the same power just from having done the fellowship. There are some damn good non-ACGME fellowships, especially in Canada. The biggest drawback to non-ACGME is you lose work hours restrictions and you may become the call coverage bitch for the non-cardiac stuff.

Make your decision, then tell your group, then apply. They will respect you for it, if they are worth anything, even if they are unhappy about finding another partner. Just know that it may take a couple of cycles to get a spot.

Good luck. The CT fellowship is awesome so have fun.

- pod

 

[periopdoc]

Beware of the random saboteur that hates you because your skills rival theirs, or your flash PP lifestyle, automobiles, etc. Academic practices can breed some seriously malcontented individuals.

This.

Saw it at Hopkins in a guy who was doing a second residency after being in PP (Family Practice) for 5 years or so. He had a really nice place (compared to other residents), drove a really nice car, and was really generous with inviting folks over to party on his dime. It engendered some friends, but also engendered a lot of jealousy.

Get a modest place and a modest car and be reasonably generous.

- pod

 

[proman]

So you become a NBE PTEeXAM certified instead of testamured. Big whoop. That and 2 bucks will get you a tall Americano at Starbucks.
- pod

Passing up on a certification by not doing an accredited fellowship is short sighted, I think. All the academic jobs I've looked at require certification. I think that's where the future is going to head.