Delaying fellowship- disadvantages?

[betrhalf]

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Hi,

I am a PGY2 and hope to do a fellowship in Heme Onc in the future. I am an IMG and need a visa - which significantly reduces my options of fellowships. So I am seriously considering working as a hospitalist for a couple of years till I get my permanent resident status before I apply to fellowship programs. Will this delay affect my chances adversely?

Thanks in advance.

 

[NotAProgDirector]

Quite possibly. The farther you get from your residency, the more difficult (in general) it is to get a fellowship. If you want to work as a hospitalist, you will want to get a job somewhere with a strong H/O dept doing research, get involved, get connected.

 

[Gastrapathy]

Quite possibly. The farther you get from your residency, the more difficult (in general) it is to get a fellowship. If you want to work as a hospitalist, you will want to get a job somewhere with a strong H/O dept doing research, get involved, get connected.

But, he's probably much better off not needing a visa, right? So, overall, as long as he's doing research, shouldn't he be better off?

OP, why not just apply and see what happens?

 

[gutonc]

I agree w/ both of the above.

Visa issues are a problem, but so is taking significant time off. Having said that, the # of people taking a year or 3 between residency and fellowship seems to be increasing so you certainly won't be alone. Taking some time as a hospitalist allows you to get more connections and maybe do some more CV buffing.

FWIW, my IM program seemed to be split in thirds. 1/3 didn't specialize. 1/3 took the traditional IM-->Specialty route, applying as PGY-2's (or in a few cases, including mine, as interns for the research pathway). 1/3 applied either as PGY-3s or afterwards and worked for some period of time as hospitalists, locums or in urgent care. The match percentages between the 2 groups who went on to specialize didn't seem to differ much. NB that none of these folks, at least in the last 4y that I'm aware of, had visa issues.

Short answer long...If I were in your shoes, I'd apply now. If you get it, great. If not, apply again next year (and the year after that if needed) and in the meantime, get a job and get your visa issues dealt with.

 

[betrhalf]

Thanks aProgDirector, Gastrapathy and gutonc - I really appreciate your inputs.

So it seems taking years off after the residency program gets kind of tricky. The issue, in my case, is that I have been offered a Chief residency spot and that will take up the 4th year of my H1B visa - leaving me with 2 years to apply for permanent residency - which is very dicey during fellowship. Also as my husband is in school here - accepting the "Chief" offer will ensure that I can stay with hubby and kid and then we can all move to where I get a fellowship/job.

The other option for me would be to take up a J1 visa and join a fellowship after the year as Chief and people have strongly advised me against this type of visa- although it is easier to come by fellowships on a J1. I have a PhD degree and really want to practice academic medicine - do translational research. With a J1 I will have to take up a waiver job in an under served area for about 5 years after my fellowship - which will definitely take me away from academics and I do not know if working in a non-academic setting will ever make me competitive enough to get back to academics.

So I guess the question will be - should I take time off to get rid of my visa woes before a fellowship or take time off after one and hope that I can get back to an academic setting after doing a waiver job? Or perhaps the question is whether or not to be a Chief (which generally helps if I am in an academic setting)?
I really do not know if there are any right or wrong answers to these questions but what do others think? Am I missing anything here? Would really appreciate it if I can get some opinions/ inputs.

 

[dragonfly99]

I did a research year between medicine residency and fellowship, and didn't really even apply for fellowship until my 3rd year. I don't think it hurt me at all. I do agree with aprogdirector that taking time off that is more than a year or two can definitely hurt your fellowship application. I think the fact that you got offered chief residency shows that your program director and medicine dept chair think highly of you and it's a feather in your cap and also would help in getting a fellowship. I think you said hem/onc? That one is fairly competitive but I'd think you'd be competitive at lots of places, having done a chief resident year, assuming your USMLE scores are decent, etc.

I can't give good advice on the visa stuff since I just don't have the knowledge, but I think I'd try to avoid getting a J1 if you want to do academics, since the 5 years out in the middle of nowhere would hurt your academic career, or maybe even make it impossible. What about academic hospitals/medical centers in "underserved" areas (i.e. North Dakota or East Tennessee State U, etc.)? Would being an attending there count toward your J1 waiver service? I guess not...

Can someone at your current academic medical center help or give you good advice about what to do about your visa issues? Can they sponsor you to get the better kind of visa, since they liked you enough to want to appoint you chief resident? Congrats on that, by the way, and on managing so well all of your life (work + husband + kid + chief residency, wow!).

 

[zeloc]

Why does taking time in-between residency and fellowship hurt chances?

I was talking with a subspecialist who just completed his fellowship and he was saying that it wasn't more difficult for someone who worked as a hospitalist for a short amount of time applying for fellowship to get in, it was more of an issue from a personal perspective because as a hospitalist one isn't used to being under other people which is what happens when you go back into fellowship.

It sounds like research or other activities in-between doesn't hurt chances at all and probably could even help?

 

[ghettomd]

I applied and matched this past year as PGY-3... virtually every program asked me what I had planned for the year off, and were extremely encouraged when I mentioned research... i dont think mentioning taking a hospitalist job would great enhance ur application....

I think if you have visa issues, unless you have significant research background, cards are stacked against you.. I would talk to your program director and ask for his opinion also... problem with taking off time is:

1. The letter of recommendation, as you are away from your training program for yrs, become less powerful, unless you work in an academic center and become involved with the department
2. Once you start as a hospitalist and make attending salary, your motivation to work hard and become a fellow again will definitely decrease

-but on the other hand, if you have permanant residency status, your application will be much stronger.... so if you do have strong research background (especially basic science) i would roll the dice and apply..

Hi,

I am a PGY2 and hope to do a fellowship in Heme Onc in the future. I am an IMG and need a visa - which significantly reduces my options of fellowships. So I am seriously considering working as a hospitalist for a couple of years till I get my permanent resident status before I apply to fellowship programs. Will this delay affect my chances adversely?

Thanks in advance.