Did I make a huge mistake? M4 that need's clarification on fellowships and reimbursement

[asdfgissac]

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I'm an MS4 who applied to FM mainly because I like outpatient and to be completely frank I didn't quite have the scores or connections to match derm or ophto. However, I like the idea of focusing on one thing and I don't like the idea of doing a little of everything. I've been skimming through numerous threads about FM fellowships and my interpretation is that most fellowships other than say sports medicine tend to be a waste of time in that you can see those patient populations without a fellowship (ex: geriatrics, adolescent, addiction etc.).


1. Can you truly specialize in ONE thing as an FM doctor upon completing a fellowship? Or would I eventually have to see primary care patients?

2. How does reimbursement work for FM doctors going into fellowships that can also be entered in by other specialties? Does a PM&R, EM, and FM doctor going into sports medicine all get paid the same?

3. If I were to pick up shifts at a rural ER to help pay back my student loan debt would I as an FM doctor get paid roughly the same as a new EM physician? Or will my reimbursement be significantly less?

In my perfect world I would specialize in one thing and I'm now beginning to wonder if I should just try to SOAP into something instead.

 

[VA Hopeful Dr]

I'm an MS4 who applied to FM mainly because I like outpatient and to be completely frank I didn't quite have the scores or connections to match derm or ophto. However, I like the idea of focusing on one thing and I don't like the idea of doing a little of everything. I've been skimming through numerous threads about FM fellowships and my interpretation is that most fellowships other than say sports medicine tend to be a waste of time in that you can see those patient populations without a fellowship (ex: geriatrics, adolescent, addiction etc.).


1. Can you truly specialize in ONE thing as an FM doctor upon completing a fellowship? Or would I eventually have to see primary care patients?

2. How does reimbursement work for FM doctors going into fellowships that can also be entered in by other specialties? Does a PM&R, EM, and FM doctor going into sports medicine all get paid the same?

3. If I were to pick up shifts at a rural ER to help pay back my student loan debt would I as an FM doctor get paid roughly the same as a new EM physician? Or will my reimbursement be significantly less?

In my perfect world I would specialize in one thing and I'm now beginning to wonder if I should just try to SOAP into something instead.

1. You can specialize. Most of the fellowships out there open doors to practicing in 1 area if you're willing to look. Lots of the SM fellows from my program end up working full time in ortho offices doing all of their non-operative care. Geriatrics you can do NH medical director work or inpatient geriatric floors at larger hospitals. Addiction you can do just addiction and do very well. You get the idea.

2. Same

3. Depends on location.

That all said, is it too late to try for IM and then getting a fellowship from there as it sounds like you'd be much happier with that.

 

[Sushirolls]

FM can do Sleep Medicine fellowship.

 

[TableMD]

Be a good intern, apply to IM next year. There is enough overlap that getting a good letter(s) from faculty will help. Likewise talk to your IM PD from your med school NOW and come up with a plan to apply. If you take some IM electives you could have nice letters from the faculty to supplement your CV. Having the connections to IM faculty as a med student will make the switch much easier. Try to schedule elective time during what will be interview season next year if possible to make that process easier.

If you stay with FM, a month doing Endo and a month doing Rheum would be a valuable experience anyways.

 

[MedicineZ0Z]

I'm an MS4 who applied to FM mainly because I like outpatient and to be completely frank I didn't quite have the scores or connections to match derm or ophto. However, I like the idea of focusing on one thing and I don't like the idea of doing a little of everything. I've been skimming through numerous threads about FM fellowships and my interpretation is that most fellowships other than say sports medicine tend to be a waste of time in that you can see those patient populations without a fellowship (ex: geriatrics, adolescent, addiction etc.).


1. Can you truly specialize in ONE thing as an FM doctor upon completing a fellowship? Or would I eventually have to see primary care patients?

2. How does reimbursement work for FM doctors going into fellowships that can also be entered in by other specialties? Does a PM&R, EM, and FM doctor going into sports medicine all get paid the same?

3. If I were to pick up shifts at a rural ER to help pay back my student loan debt would I as an FM doctor get paid roughly the same as a new EM physician? Or will my reimbursement be significantly less?

In my perfect world I would specialize in one thing and I'm now beginning to wonder if I should just try to SOAP into something instead.

1. Absolutely. A lot of TRT clinics or docs who do TRT only (just an example FYI) are FM trained. The well known ones get a lot more referrals than the urologists/endos.

2. Yes.

3. If you want to work in a rural ER, you need additional skills. Which means investing time (electives) and likely money (courses) to have baseline proficiency in those skills. And that is highly dependent on the area and the volume.

 

[septoplasty]

1. Absolutely. A lot of TRT clinics or docs who do TRT only (just an example FYI) are FM trained. The well known ones get a lot more referrals than the urologists/endos.

2. Yes.

3. If you want to work in a rural ER, you need additional skills. Which means investing time (electives) and likely money (courses) to have baseline proficiency in those skills. And that is highly dependent on the area and the volume.

OP can also do a "fellowship", i.e. supervised practice where you get paid, and it counts towards experience/making you more comfortable.

Disclaimer, this isn't an accredited route, and thus has limitations.

 

[septoplasty]

Does a PM&R, EM, and FM doctor going into sports medicine all get paid the same?

Yes.

Your population and skill set is unique and thus you have an "edge" over the other two (or three as its open to Peds folks too), in that you're full spectrum, and manage primary care complaints very well.

 

[MedicineZ0Z]

OP can also do a "fellowship", i.e. supervised practice where you get paid, and it counts towards experience/making you more comfortable.

Disclaimer, this isn't an accredited route, and thus has limitations.

Fellowship for what? I just got a 3rd straight outside hospital transfer today and read through the note to find out that it was only a midlevel who saw the patient. In this case the patient was intubated (by the PA) without any doctor in house or even RT.

It's comical that these ERs are solo staffed by midlevels with an "attending at home" and FM docs can't cut it apparently.

 

[septoplasty]

Fellowship for what? I just got a 3rd straight outside hospital transfer today and read through the note to find out that it was only a midlevel who saw the patient. In this case the patient was intubated (by the PA) without any doctor in house or even RT.

It's comical that these ERs are solo staffed by midlevels with an "attending at home" and FM docs can't cut it apparently.

ER; no argument from my side about the rest of your statement, I agree.

The point I do want to bring up is, depending on the exposure during FM residency, the graduate may not feel competent to stabilize and manage (atleast temporarily) everything that comes through an ER door, especially in an rural setting.

The contrasting feature about this with mid-levels is, essentially they're not on the hook when things go south, we're the suckers for that.

 

[MedicineZ0Z]

ER; no argument from my side about the rest of your statement, I agree.

The point I do want to bring up is, depending on the exposure during FM residency, the graduate may not feel competent to stabilize and manage (atleast temporarily) everything that comes through an ER door, especially in an rural setting.

The contrasting feature about this with mid-levels is, essentially they're not on the hook when things go south, we're the suckers for that.

Oh no I totally agree. Just pointing out the hypocrisy.
Though usually those looking to staff those places seek out the right electives and courses in residency to be prepared for that. Whereas an average FM grad does not and is in no way prepared for working in an ER.