@pgg did the same, so could also give you some insight.
I enjoyed cardiac the most of everything as a resident, and had been planning on fellowship for a while. I actually graduated in 2009, which left the practice pathway to full TEE certification open ... but as a generalist I just couldn't hope to get the cases and TEE numbers to meet that requirement. So fellowship was the only realistic way for me to achieve certification.
And after a few years of not doing cardiac as an attending, and getting dumber every day that passed after I walked out of my oral boards ... the more pertinent truth was that I really felt the need to do a fellowship just to acquire the skill and knowledge I thought I would need to be comfortable and safe doing those cases.
Don't get me wrong, I could've gotten credentialed and done hearts any time in the 7 years I was out between residency and fellowship. Lots of non-fellowship-trained people do hearts. I just wanted a better foundation to someday achieve indisputable mastery of it all. Right now, being 3/4 of the way through fellowship, I'm glad I came back for training. When I'm done, I'll still have a lot to learn and improve, but at this point I can't imagine doing these cases without this foundation year.
My circumstances are a little different than most who return late to fellowship. I'm still in the military, paying off a lengthy commitment, inching toward retirement eligibility.
The Navy agreed (eventually, after I asked a few times, but that's another story) to let me leave for a year to be a CT anesthesia fellow at a civilian institution. The fellowship program got me free for the year, which opened some doors to my late and outside-the-match application. The Navy is still paying me my normal paycheck - while that's somewhat sub-market in the grand scheme of things, it's still quite a bit more than usual fellow pay, so notable point #1 is that I didn't have to take much of a pay cut to go back to fellowship. (I can't moonlight as a fellow, so there's an indirect pay cut there.)
I didn't have to leave a partnership track or partnership position and take that pay/career hit.
I also continue to accrue military retirement credit during my fellowship year, so in the end, heading back to fellowship doesn't alter either my military service commitment length, or change the day I can retire from the Navy, start collecting all that delicious government pension cheese, and then head out to the private practice world to be a well-paid partner in control of my destiny, an AMC slave taking orders from some MBA-dropout CRNA, an academic, or something else.
I had an active duty service obligation after finishing residency, and at the time the Navy did not perceive a need to train additional CT anesthesiologists, and they chose to use me as a generalist rather than let me go directly to fellowship. It took a few years before retirements and other issues convinced the Navy that they needed to train more, so notable point #2 is that I wasn't allowed to go to fellowship as soon as I wanted to.
Notable point #3 is that leaving for fellowship got me out of the Navy for a year. I've been pretty happy in the Navy, for the most part, but I'd be lying if I said that the prospect of a year's sabbatical from the various pains and inanities of government service wasn't a perk.
It's been good having a year of no responsibilities, except to focus on my own cases and learning. No committees, no meetings, no directing, no schedule making, no people coming to me with their problems. The hours in fellowship are long, but honestly, all I do is wake up in the morning, go to the hospital, do some cases, get ready for tomorrow's cases, go home, read a bit, rinse, repeat. Sprinkle in some academic events here and there. It's a nice life.
Fellowship is ... awesome. I temper my enthusiasm a little at the hospital, since the tendency is to believe that any trainee who says he's happy is FOS, and I've kind of gotten tired of convincing skeptical people that yes, I really am happy to be here.
So given all that context, going back to fellowship is perhaps the biggest no-brainer of my professional life. The only reason I didn't do it sooner, is because the Navy wouldn't let me do it sooner.
Down sides? Few.
Every once in a while, mostly when finishing up a lung transplant at 4 AM, I do find myself asking ... Did I really walk away from my cushy staff job to be flogged like this? The total hours aren't bad, but it's a grind. I'm tired a lot. Call was easier when I was an intern 14 years ago. (I had a 3 year gap between PGY-1 and CA-1 courtesy of the Navy.)
I have kids in high school, including a senior, and didn't want to move them for the year. So I got an apartment across the street from the hospital and am living away from home for the year. Fellowship is about 3 hours away from home. I get home most weekends (my weekend call burden is very light). It still sucks for me and my family to be apart during the week. But again ... context. A year of fellowship with weekend visits is better than 7 months in Afghanistan or Iraq. And we did that. 3 times.
Thank god I married an understanding, go with the flow woman. That year was rough on her.
True words.
