Concerns about fellowship

[canttouchit]

Congratulations to everyone who matched today!

I have some concerns that I know will appear foolish to most, but I'm hoping for some advice to help me sift through everything going through my head right now. I'm just applied and matched into a GI fellowship program.

Within the past 3 weeks (since I submitted my ROL), my S.O interviewed for and accepted a fellowship position for stroke at an amazing program. The program I matched at is a good, mid tier program, but is very far away, and was not very high on my rank list. We both thought (foolishly) that my home program and where he matched would keep me as a GI fellow, and did not really ever imagine we'd have to face the idea of distance.

I am now very torn. In the recent weeks/months, we've been discussing more and more about getting married and having children, which is something I would really like to do, and would put higher on my priority list right now than work. I'm ecstatic about matching, and would be happy at this program, but I think the lack of my S.O and long distance for 3 years would make me an overall very unhappy person. I know there are probably people who would love to take this spot if I gave it up.

I've spent my day reading about the NRMP waivers and wondering if anybody has been in a similar situation, and whether the above would ever be considered an approvable reason to submit a waiver?

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[gutonc]

Just to be clear, your situation does not qualify for an NRMP waiver. So take that out of consideration.

The rest of the issues are something that only you can answer.

EDIT: Isn't stroke only a 1 year fellowship? Can you not do long-distance for a year?

 

[canttouchit]

Just to be clear, your situation does not qualify for an NRMP waiver. So take that out of consideration.

The rest of the issues are something that only you can answer.

EDIT: Isn't stroke only a 1 year fellowship? Can you not do long-distance for a year?

He has one more year of neurology residency and is entering into a stroke/research fellowship which would be two additional years. 1 year of long distance is definitely doable. 3 years is tough.

So what exactly would qualify for a waiver?

 

[Raryn]

He has one more year of neurology residency and is entering into a stroke/research fellowship which would be two additional years. 1 year of long distance is definitely doable. 3 years is tough.

So what exactly would qualify for a waiver?

Waivers are basically only for things like change of specialty (if the match is >1 year prior to starting, so things like anesthesia or derm) or a "serious unanticipated hardship". Serious hardships count as things like illnesses in you or close family members. Say, if your SO got diagnosed with cancer last week and you didn't want to leave them, that would qualify. In addition, serious things that would make it so you can't start on time can get a valid waiver from the program standpoint: Visa issues. Criminal convinctions.

Geographic reasons that you could (and should) have anticipated ahead of time don't count.

 

[IM2GI]

I dont know anything about neurology, but is a stroke fellowship hard to get? Is he/she a die hard academic?

Take the GI spot and see what your significant other can figure out. You fell hard on your list for a reason. I would not play games with the spot you have if you really want to be a gastroenterologist.

 

[canttouchit]

I dont know anything about neurology, but is a stroke fellowship hard to get? Is he/she a die hard academic?

Take the GI spot and see what your significant other can figure out. You fell hard on your list for a reason. I would not play games with the spot you have if you really want to be a gastroenterologist.

Stroke itself is not that competitive, but he is an academic who has an amazing spot that I would never dream of asking him to give up. If it's one or the other, I feel like I should be the one to sacrifice.

 

[gutonc]

Stroke itself is not that competitive, but he is an academic who has an amazing spot that I would never dream of asking him to give up. If it's one or the other, I feel like I should be the one to sacrifice.

If that is the case, you need to make sure that you're OK not doing GI as a career.

 

[canttouchit]

If that is the case, you need to make sure that you're OK not doing GI as a career.

This is all pretty fresh, and I'm very emotional today. That beings said, I am okay not doing GI as a career. I still don't see an acceptable waiver reason to submit to the NRMP.

I assume this would mean I would have to complete at least 45 days or a year of fellowship prior to leaving if that is what I decide.

 

[mcworbust]

Edit: sorry didn't see the posts above sorry for redundancy...also didn't see how the 3 years added up so disregard below


I'm just a naive med student, but my wife had a similar question about the NRMP waiver with her fellowship match today in a much less competitive subspecialty as she didn't match her first choice and we will be a 1.5 hr drive apart with a baby next year as a result. After reading the materials online, we've concluded her situation does NOT qualify, and I'd be surprised if your situation would be considered, but again just a med student here.

I do have an interesting potential solution for you:
So your S.O. accepted a stroke fellowship recently. The vascular neurology match usually in May, so I'm assuming he accepted a position outside the match. The thing about vascular neurology is that a lot of programs don't fill (http://www.nrmp.org/wp-content/uplo...Neurology-Match-Results-Statistics-AY2018.pdf)
And there are a a few open programs listed on Frieda: Tennessee and Sparrow/Mich St. (has option to continue to neurointerventional) (Residency & Fellowship Positions Not Filled through the NRMP | AMA)...
Basically, my thinking is that maybe you should see if HE would move if there is an open vascular neurology program near where you matched.

Also, you mention 3 years apart, which makes me wonder if he is doing vascular and then interventional neurology for 3 years total. If that is the case, he should stay at his amazing stroke program to help his chances for matching interventional. However, if he wants to practice after the 1 year stroke fellowship, he could most likely call your program and area hospitals to get a job as stroke is in huge demand in general (which would mean only 1 year apart). I think anyone can put up with being apart for 1 year....

 

[canttouchit]

Edit: sorry didn't see the posts above sorry for redundancy...also didn't see how the 3 years added up so disregard below
Also, you mention 3 years apart, which makes me wonder if he is doing vascular and then interventional neurology for 3 years total. If that is the case, he should stay at his amazing stroke program to help his chances for matching interventional. However, if he wants to practice after the 1 year stroke fellowship, he could most likely call your program and area hospitals to get a job as stroke is in huge demand in general (which would mean only 1 year apart). I think anyone can put up with being apart for 1 year....

So he still has 1 more year of neurology residency followed by a research stroke fellowship which would make 3 years total.

 

[mcworbust]

So he still has 1 more year of neurology residency followed by a research stroke fellowship which would make 3 years total.

Gotcha, my bad, took too long to write my reply and i missed it! I feel for you as my wife/baby and I will be separated too due to her match today, but only for 1 year. Best of luck in your decision!

 

[Raryn]

This is all pretty fresh, and I'm very emotional today. That beings said, I am okay not doing GI as a career. I still don't see an acceptable waiver reason to submit to the NRMP.

I assume this would mean I would have to complete at least 45 days or a year of fellowship prior to leaving if that is what I decide.

You can always just tell your program you're not interested and quit ahead of time. Just understand, doing that without an NRMP waiver means you're blacklisted by the NRMP and will never qualify to do a fellowship. Any fellowship.

 

[IM2GI]

This is all pretty fresh, and I'm very emotional today. That beings said, I am okay not doing GI as a career. I still don't see an acceptable waiver reason to submit to the NRMP.

I assume this would mean I would have to complete at least 45 days or a year of fellowship prior to leaving if that is what I decide.

Don't make an emotional decision. You don't have to decide today.

I obviously don't know you or your family, but IMO the sacrifice to be made here is your spouses stroke fellowship.

Stroke fellowship sounds like fake academia, which he likely could get into a program closer to where you will be.

So the options are: He goes to a less "prestigious" fluff fellowship vs. you giving up your entire career plan.

Does he have a phd?

 

[canttouchit]

Don't make an emotional decision. You don't have to decide today.

I obviously don't know you or your family, but IMO the sacrifice to be made here is your spouses stroke fellowship.

Stroke fellowship sounds like fake academia, which he likely could get into a program closer to where you will be.

So the options are: He goes to a less "prestigious" fluff fellowship vs. you giving up your entire career plan.

Does he have a phd?

He does not have a PhD. I at this point see my options as (1) go to fellowship and gamble with my personal life a little, and potentially be very unhappy, (2) discuss with the PD after starting and quit if I am unhappy, (3) try to apply for a waiver for hardship (which I wouldn’t get), or waiver for specialty change (which I don’t even know if I qualify for) with the understanding that I would never be able to apply for any fellowship again and would remain a hospitalist for the rest of my days, which wouldn’t be the worst thing in the world.

I feel like it’s poor form to call the GI PD and say “hey just wanted to let you know, I don’t wanna come to your program and may end up leaving”...
Would you recommend talking to my own current PD about all this?

 

[texmax]

He does not have a PhD. I at this point see my options as (1) go to fellowship and gamble with my personal life a little, and potentially be very unhappy, (2) discuss with the PD after starting and quit if I am unhappy, (3) try to apply for a waiver for hardship (which I wouldn’t get), or waiver for specialty change (which I don’t even know if I qualify for) with the understanding that I would never be able to apply for any fellowship again and would remain a hospitalist for the rest of my days, which wouldn’t be the worst thing in the world.

I feel like it’s poor form to call the GI PD and say “hey just wanted to let you know, I don’t wanna come to your program and may end up leaving”...
Would you recommend talking to my own current PD about all this?

I feel for you, I really do. I am in a very similar situation in which my SO and I were able to couples match for peds and medicine residency, but upon applying for fellowship we found that the peds fellowship match and medicine subspecialty match was incompatible. To make things worse, the two matches occur almost simultaneously (they are a week apart) and thus we could not find out where one matched before the other submitted a ROL. First of all, the NRMP needs to clean this up. I understand there are probably behind the scenes issues that we as applicants are not privy to, but it seems that merging the fellowship matches would be a common sense move. It is absurd that we as applicants need to suffer. You hit it right on the spot, we are literally gambling our careers versus our personal lives. Spending 3 years apart from one's significant other is no easy task and I would not be surprised to find that the majority of couples will fracture as a result of this. This is arguably not as bad if your SO is simply bf/gf, but imagine what it's like for a family with children.

I decided to put my career on hold for a year, essentially going the hospitalist route for a year to allow my SO to match this year. I will then plan to suicide match whichever city they are in. Is this ideal? Hell no. I absolutely love the field of GI and cannot imagine doing anything else. I am not a big fan of General internal med, I will need to find a job in a new city, obtain a license in a new state, the ABIM boards are much higher stakes now, I feel pressured to keep up with a high volume of research, I feel that I will be disadvantaged going into the match next year because I will need to explain away why I did hospitalist for a year when my application was strong enough to match this year. Suicide matching into the same city and/or medical center may not be an easy task because we all know how difficult the GI match is. And most importantly, I feel that I am wasting a year of my life by doing this. Has some of my bitterness towards the NRMP for putting me in this position perhaps overflowed towards my SO (who is also a co-victim of this situation)? Probably. Do I feel like **** when my frustration with the system inadvertently boils over and it effects my SO? Yes, and that is perhaps the worst feeling in the world.

I hope that years down the line, after prioritizing my relationship over my career, I will reap the benefits and feel good about what I did. Right now, I just feel royally screwed over by the NRMP.

 

[JP2740]

Don't make an emotional decision. You don't have to decide today.

I obviously don't know you or your family, but IMO the sacrifice to be made here is your spouses stroke fellowship.

Stroke fellowship sounds like fake academia, which he likely could get into a program closer to where you will be.

So the options are: He goes to a less "prestigious" fluff fellowship vs. you giving up your entire career plan.

Does he have a phd?

I was thinking the same thing... the stroke fellowship doesn’t really sound that amazing.

 

[Gastrapathy]

Don't talk to anyone about this. You have plenty of time to figure it out so there's no reason to do it today. You matched into a highly competitive field.

You believe you should sacrifice why? Part time GI is a good way to make a living. BF could shorten fellowship or follow you. The gap between IM and GI is very different than that between neuro and...neuro.

Take your time to process this.

 

[rokshana]

He does not have a PhD. I at this point see my options as (1) go to fellowship and gamble with my personal life a little, and potentially be very unhappy, (2) discuss with the PD after starting and quit if I am unhappy, (3) try to apply for a waiver for hardship (which I wouldn’t get), or waiver for specialty change (which I don’t even know if I qualify for) with the understanding that I would never be able to apply for any fellowship again and would remain a hospitalist for the rest of my days, which wouldn’t be the worst thing in the world.

I feel like it’s poor form to call the GI PD and say “hey just wanted to let you know, I don’t wanna come to your program and may end up leaving”...
Would you recommend talking to my own current PD about all this?

but your SO is not willing to make the "sacrifice" for your career? Have you discussed this with him...what if the situation was the opposite and he had the harder to get fellowship ...because let's face it a stroke fellowship is not nearly as difficult to get as GI.

and discussing getting married and actually making the commitment are 2 different things...you need to take sometime to think about this, discuss with each other what the options are and decide what makes sense.

 

[rokshana]

I feel for you, I really do. I am in a very similar situation in which my SO and I were able to couples match for peds and medicine residency, but upon applying for fellowship we found that the peds fellowship match and medicine subspecialty match was incompatible. To make things worse, the two matches occur almost simultaneously (they are a week apart) and thus we could not find out where one matched before the other submitted a ROL. First of all, the NRMP needs to clean this up. I understand there are probably behind the scenes issues that we as applicants are not privy to, but it seems that merging the fellowship matches would be a common sense move. It is absurd that we as applicants need to suffer. You hit it right on the spot, we are literally gambling our careers versus our personal lives. Spending 3 years apart from one's significant other is no easy task and I would not be surprised to find that the majority of couples will fracture as a result of this. This is arguably not as bad if your SO is simply bf/gf, but imagine what it's like for a family with children.

I decided to put my career on hold for a year, essentially going the hospitalist route for a year to allow my SO to match this year. I will then plan to suicide match whichever city they are in. Is this ideal? Hell no. I absolutely love the field of GI and cannot imagine doing anything else. I am not a big fan of General internal med, I will need to find a job in a new city, obtain a license in a new state, the ABIM boards are much higher stakes now, I feel pressured to keep up with a high volume of research, I feel that I will be disadvantaged going into the match next year because I will need to explain away why I did hospitalist for a year when my application was strong enough to match this year. Suicide matching into the same city and/or medical center may not be an easy task because we all know how difficult the GI match is. And most importantly, I feel that I am wasting a year of my life by doing this. Has some of my bitterness towards the NRMP for putting me in this position perhaps overflowed towards my SO (who is also a co-victim of this situation)? Probably. Do I feel like **** when my frustration with the system inadvertently boils over and it effects my SO? Yes, and that is perhaps the worst feeling in the world.

I hope that years down the line, after prioritizing my relationship over my career, I will reap the benefits and feel good about what I did. Right now, I just feel royally screwed over by the NRMP.

was that because the peds fellowships are fewer? because they certainly not as competitive as GI in the IM world.

 

[Lccjblu]

was that because the peds fellowships are fewer? because they certainly not as competitive as GI in the IM world.

Yup that’s exactly it.

 

[ShiShiMD]

This is not a hard decision.

Start the program, look at your home program and see if anyone wants to switch.

This also allows more time for you both to re-think and re-evaluate your situation,

also not trying to be a bugger, but I have to have my say in this since you posted,

why do you want to change your career path, let him change his career path <--- sorry if it is just blunt and out there

 

[DokterMom]

As has been stated, you don't need to do anything now, so don't. Wait until you've calmed down before taking any actions that could backfire on you.

Why not consider the tentative plan of going ahead with your GI fellowship per match rules and seeing how you like it. You kind of have to anyway, right? Genuinely try to like it and give it a fair shake. If it's bad, try to find another spot closer to your SO. If it's awful, you can leave and go back to the place you are now but without a match-violator flag.

But if your fellowship is a good one, your SO can then do his fellowship where you are. As has been said, stroke is much less competitive, so for him, it's not a change of specialty as it would be for you -- just potentially a somewhat less desirable program.

If he's not willing to consider that for you, then that tells you something you might not want to hear but really need to know...

 

[canttouchit]

Don't talk to anyone about this. You have plenty of time to figure it out so there's no reason to do it today. You matched into a highly competitive field.

Take your time to process this.

but your SO is not willing to make the "sacrifice" for your career? Have you discussed this with him...what if the situation was the opposite and he had the harder to get fellowship ...because let's face it a stroke fellowship is not nearly as difficult to get as GI.

Just to provide an update for everyone's responses. I actually spoke with my own IM PD and one of my chief residents. The conversations mirrored what everyone has said up here, and I'm going to make the sensible decision and go to fellowship. Frankly, I know I'm being pretty childish about the whole thing. We haven't quite had the conversation where I say "well I've seriously considered giving up GI but you haven't even considered following me for your fellowship" yet.

I honestly matched at I think a good university program but it was just pretty far down my list because of a combination of the ; the result was unexpected and I had my sights set on staying at my home program.

If it's bad, try to find another spot closer to your SO. If it's awful, you can leave and go back to the place you are now but without a match-violator flag.

Start the program, look at your home program and see if anyone wants to switch.

^^ Is this even an option?

 

[IM2GI]

Just to provide an update for everyone's responses. I actually spoke with my own IM PD and one of my chief residents. The conversations mirrored what everyone has said up here, and I'm going to make the sensible decision and go to fellowship. Frankly, I know I'm being pretty childish about the whole thing. We haven't quite had the conversation where I say "well I've seriously considered giving up GI but you haven't even considered following me for your fellowship" yet.

I honestly matched at I think a good university program but it was just pretty far down my list because of a combination of the ; the result was unexpected and I had my sights set on staying at my home program.





^^ Is this even an option?

Why not have the conversation with your husband about his "fellowship"? Shame he doesn't have the insight to bring this up himself.

GI is pretty awesome with lots of career and lifestyle flexibility.

As for switching, it is mostly a fantasy proposition. Technically can happen but not likely.

 

[rokshana]

Why not have the conversation with your husband about his "fellowship"? Shame he doesn't have the insight to bring this up himself.

GI is pretty awesome with lots of career and lifestyle flexibility.

As for switching, it is mostly a fantasy proposition. Technically can happen but not likely.

in her OP, she states not husband...talking about getting married...

 

[IM2GI]

in her OP, she states not husband...talking about getting married...

Oh man, not even a ring on it yet and we are debating giving up your career? Insanity.

No matter how you slice it, him staying with his fellowship with no flexibility is the selfish and wrong decision to anyone objectively looking at this situation.

 

[Celestine]

Agree with all that was stated above.
My husband and I are going to be apart for a year while I start GI fellowship in July and he pursues a one year surgical fellowship. I am currently finishing my second year as a hospitalist. I waited the two years because his residency was longer and we did not want to risk being apart, but he would have supported me applying earlier. He will need to find a job for my second and third year of fellowship, and it may not be ideal given the geographic constraints but like I did, he is willing to make a temporary sacrifice to fulfill our career goals and minimize our time apart.
The two doctor dynamic is never ideal but it is absolutely impossible if only one person is willing to make sacrifices.
You need to have an honest conversation about your life plans together and make sure that he will be your partner on an ultimately long and stressful journey.