Dropping Fellowship

[imthere]

Hi everyone,

So the title says it, I’m going to drop out of my fellowship I started this year. I’ve read the posts about people dropping out of their fellowships and have seen good advice overall provided by this community.

First of all, I would not have any regret not practicing this subspecialty for the rest of my life.

Second, I got into this speciality due to an open spot at my home program, so not through eras or nrmp (not sure if this changes anything)

Finally, my question is how do I go about leaving professionally? I don’t want to burn any bridges, but I’m sure this already short handed fellowship is going to feel some type of way when I do leave and I really don’t want them to take it out on me (if they can?)

If I just decided after my shift to quit, walk out of here and never look back, could they do anything that would potentially harm my future career?

Appreciate any help or reassurance you guys could offer.

Thanks!

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[IMGASMD]

Hi everyone,

So the title says it, I’m going to drop out of my fellowship I started this year. I’ve read the posts about people dropping out of their fellowships and have seen good advice overall provided by this community.

First of all, I would not have any regret not practicing this subspecialty for the rest of my life.

Second, I got into this speciality due to an open spot at my home program, so not through eras or nrmp (not sure if this changes anything)

Finally, my question is how do I go about leaving professionally? I don’t want to burn any bridges, but I’m sure this already short handed fellowship is going to feel some type of way when I do leave and I really don’t want them to take it out on me (if they can?)

If I just decided after my shift to quit, walk out of here and never look back, could they do anything that would potentially harm my future career?

Appreciate any help or reassurance you guys could offer.

Thanks!

If you walk out, you’ve burned the bridge.

Give some sort of truth that can be understood by leadership. The usual suspects are, family, health and money/debts (?) maybe.

Are you moving away? Will you seek employment where you are? You may not find a job right away, will you be okay without any income? Or by the time you land on something, maybe your fellowship is half over? Will the leadership let you moonlight (since it’s your home institution), that may or may not let you use reason number 3 from above.

Medicine is a small field. If you intend on opening your own practice and not worry about politics of medicine. If you’re not, I’d find a way to let them down gently and have a back up plan.

 

[HemeOncHopeful19]

Are a lot of places hiring in the COVID environment? I am in fellowship so have no clue, just thought I’d read an overall decrease in hospital volumes the past few months.

Not that it would matter if you hate your current fellowship I guess. You could find a job working a week a month and probably make the same salary as you do as a fellow...

 

[DrMetal]

Hi everyone,

So the title says it, I’m going to drop out of my fellowship I started this year. I’ve read the posts about people dropping out of their fellowships and have seen good advice overall provided by this community.

First of all, I would not have any regret not practicing this subspecialty for the rest of my life.

Second, I got into this speciality due to an open spot at my home program, so not through eras or nrmp (not sure if this changes anything)

Finally, my question is how do I go about leaving professionally? I don’t want to burn any bridges, but I’m sure this already short handed fellowship is going to feel some type of way when I do leave and I really don’t want them to take it out on me (if they can?)

If I just decided after my shift to quit, walk out of here and never look back, could they do anything that would potentially harm my future career?

Appreciate any help or reassurance you guys could offer.

Thanks!

what subspecialty?

give some notice, 2 weeks or something. It's the professional thing to do, at the least.

 

[chessknt]

A few points:

1-legal consequences could exist, look at your contract that you signed when you started the job to see what those are.

2-they may be able to bar you from the match in the future but even if they don't no fellowship would take you if you quit after 3 weeks, it shows a complete lack of commitment.

3-screwing their schedule over is going to burn bridges unless you have an incredible reason. Depending on the field, how big of an area you are, how connected leadership is, and where you intend to work they could make it next to impossible to find a job locally through offline blacklisting. Also a remotely competitive area is going to see quitting in less than a month as a huge red flag to hiring you.

Obviously if you're switching to locums it won't matter as much initially but it will follow you around forever and always be a potential hiring barrier for a permanent job.

 

[imthere]

Thank you for the responses.

Just to follow up:

We were supposed to have 5 fellows, but we only filled 2 spots. So our work load is doubled for the year.

I could complete the fellowship, but I know it’s not what I want to do for the rest of my life. Wish I came to that conclusion before I accepted, but here I am.

I did not get the position via the match so could they ban me from the match?

If I gave them a couple months notice would the above still apply? Blacklisting, commitment issues, follow me around everywhere I apply etc.?

I would want to do hospitalist/primary care moving forward.

Thanks!

 

[imthere]

Thank you for the responses.

Just to follow up:

We were supposed to have 5 fellows, but we only filled 2 spots. So our work load is doubled for the year.

I could complete the fellowship, but I know it’s not what I want to do for the rest of my life. Wish I came to that conclusion before I accepted, but here I am.

I did not get the position via the match so could they ban me from the match?

If I gave them a couple months notice would the above still apply? Blacklisting, commitment issues, follow me around everywhere I apply etc.?

I would want to do hospitalist/primary care moving forward.

Thanks!

I guess my basic question is how do I get out of this program safely?

 

[chessknt]

By completing it.

Nobody knows what kind of people run the program, how connected they are, how vindictive they'll be when you peace out right after starting etc.

You need to be aware of these possibilities. It is t like quitting your primary residency--youll be able to find a job and work, it just might not be in the area where the fellowship has connections. A competitive area will also wonder why you quit after a month and if they have 2-3 potential applicants for a spot that is going to obviously make you disfavored.

If you work somewhere where they are desperate for anyone this is not going to matter.

Any program director will see this stepping out as a massive red flag for any fellowship. Even the underfilled ones who would take anybody would pause because why wouldn't you just do the same thing to them? So even if you aren't barred from the match I doubt you'll have much success after leaving.

 

[DrMetal]

Thank you for the responses.

Just to follow up:

We were supposed to have 5 fellows, but we only filled 2 spots. So our work load is doubled for the year.

I could complete the fellowship, but I know it’s not what I want to do for the rest of my life. Wish I came to that conclusion before I accepted, but here I am.

I did not get the position via the match so could they ban me from the match?

If I gave them a couple months notice would the above still apply? Blacklisting, commitment issues, follow me around everywhere I apply etc.?

I would want to do hospitalist/primary care moving forward.

Thanks!

Ahh Nephro.

I don't know that they could 'ban' you from the match, or blacklist you anywhere. You're quitting, on your own accord, you're not getting fired for adverse reasons. Now of course, quitting doesn't look good, but I don't think it'll necessarily perturb other future professional endeavors . 3 years from now if you want to apply to Cards, if you're a strong applicant otherwise, you'd probably have a decent shot. We all know folks who've quit training of some sort and landed subsequent residencies/fellowships.

If you really want to quit, don't say anything negative about the program, tell them it's just a personal decision, "It's not you, it's me" (like breaking up with a bad girlfriend), and do give them some notice so they can plan accordingly. Sucks for that one lone-standing fellow!

 

[HemeOncHopeful19]

To be fair last year a former resident from my program quit their fellowship within a few months of starting and last I saw they were working primary care for the same hospital system they matched into fellowship at. I don’t think that situation is guaranteed but the program doesn’t HAVE to be vindictive about things. They might be realistic if they only match 1 person and had to sell OP on doing the fellowship just to get a 2nd.

I do not envy your cofellow, that’s the person you’d really be screwing. That wouldn’t really be your fault though and I don’t think it should factor in.

 

[DrMetal]

I don’t think that situation is guaranteed but the program doesn’t HAVE to be vindictive about things.

It's also hard to be vindictive these days. As a PD, what are you gonna do, call every future program that you think the applicant is gonna try for, derail him, call the ABMS, ACGME??? You certainly could do such things, but you better have a good reason. Such vindictiveness comes with it's own liability (accusations of defamation, favoritism, pick-your-favorite flavor of racism, sexism, etc). Knowing this, I think most PDs would not pursue that unless seriously warranted.

Someone leaving a program for personal reasons is hardly a good reason. I think OP will be fine.

The lone co-fellow will be fine too. You can't ask one person to do the job of 5 because you couldn't fill spots. Their attendings will have to pick up the slack, boo hoo!

 

[CCM-MD]

Don’t waste your 2 years if you are 100% sure you never want to do the field, especially if it’s nephro. Cut your losses. There is no national physician blacklist that you are gonna get added to.

 

[NotAProgDirector]

Just be professional about it and it shouldn't be a problem. This wasn't a match position, so there's no risk of being "banned from the match" - and as long as you stay 45 days, it wouldn't be a problem in any case.

Most physicians (and other highly paid professionals) give more than 2 weeks notice. I would give them at least 2-3 months notice. It's going to take you that amount of time to find a new position anyway (probably). This will give them a chance to remake the schedule. You can ask them if less time would be acceptable - 6 weeks would also be reasonable.

The schedule is already doomed with only 2/5 fellows.

Best of luck.

 

[rokshana]

It's also hard to be vindictive these days. As a PD, what are you gonna do, call every future program that you think the applicant is gonna try for, derail him, call the ABMS, ACGME??? You certainly could do such things, but you better have a good reason. Such vindictiveness comes with it's own liability (accusations of defamation, favoritism, pick-your-favorite flavor of racism, sexism, etc). Knowing this, I think most PDs would not pursue that unless seriously warranted.

Someone leaving a program for personal reasons is hardly a good reason. I think OP will be fine.

The lone co-fellow will be fine too. You can't ask one person to do the job of 5 because you couldn't fill spots. Their attendings will have to pick up the slack, boo hoo!

Bad letter from PD will take care of it and they don’t have to call every possible person... any prospective employer will want a letter from previous PD... and all they have to ask is “ would you rehire this person?” And thru can say no...
Best to leave on the best terms possible... though it seem like it would make sense for the OP to say the year out ... this will let your program find someone to replace you.

 

[chessknt]

It is a logistical mess to onboard and schedule a fellow/attending. To go through that and have someone leave with only a month of payoff would be a huge concern if I were looking to hire.

It isn't as bad as showing up drunk to work with a medical board action but it can definitely be a roadblock in positions that can afford to be picky about their hires.

 

[JamaicanHerb]

Bad letter from PD will take care of it and they don’t have to call every possible person... any prospective employer will want a letter from previous PD... and all they have to ask is “ would you rehire this person?” And thru can say no...
Best to leave on the best terms possible... though it seem like it would make sense for the OP to say the year out ... this will let your program find someone to replace you.

Not true, i havent had one job askforaPDletter(myspacebarbroke).

 

[Renal_Prometheus]

Two points:

1) people drop out of nephrology all the time, both during and after fellowship(not trying to be sarcastic)

2) There's a reason fellowship positions don't fill. You should never have started a fellowship just because it's easy to get into.

 

[CCM-MD]

I haven’t given a PD letter for any of my jobs.

 

[Chemist0157]

I would do what’s best for you.

I would try to be as professional as possible, give them as much notice as possible, etc.

I do not think they can stop you from being successful somewhere in hospital medicine or primary care.

 

[rokshana]

Not true, i havent had one job askforaPDletter(myspacebarbroke).

Credentialing in the first few years after fellowship at most hospitals have asked for verification/letter from fellowship PD for me.

 

[deleted392989]

Credentialing in the first few years after fellowship at most hospitals have asked for verification/letter from fellowship PD for me.

Yes, this will be an issue. Applying for state licenses usually requires a letter of recommendation from all programs that you trained at, including this fellowship program if you leave...

 

[NITRAS]

My 2 cents worth.

1. It is really soon to be regretting starting a program. I'd give it another 2 months. Any time you jump programs/jobs, you are losing at least a hundred thousand dollars in income.
2. If I was to leave, I'd get some job interviews set up. When I had some offers, (or at least felt comfortable enough to step into a job), I'd talk with my PD and discuss my departure, and how to make it amicable.

 

[Bobblehead]

If you're in a multi-year program, leaving after one year will not make you eligible for the subspecialty board so it won't matter in some ways. Even if you don't plan to practice, depending on what you end up doing it can be helpful to be certified in multiple boards. However if it's only a year fellowship you might be better off just finishing it and using the time to interview wisely. Alternatively depending on your reading of the program, I would bring up your intent to quit to the PD and if it's primarily due to the work hours that might leave some room for negotiating the schedule. Realistically the program should have already drawn up non-teaching contingency plans if they knew they weren't going to fill.

If you're planning on taking time off it's probably not an issue but I know many places are looking at their budgets and there's already plenty of salary freezes/reductions/benefits reductions so this will likely not be a good time to get anything but locum work.

Practically speaking if I were interviewing you it would be a red flag that you a) didn't understand what you were signing up for and b) couldn't handle it for more than 3 weeks. You will need to plan ahead for those type of questions, assuming you even get to that part of the process.

 

[IMGASMD]

If you're in a multi-year program, leaving after one year will not make you eligible for the subspecialty board so it won't matter in some ways. Even if you don't plan to practice, depending on what you end up doing it can be helpful to be certified in multiple boards. However if it's only a year fellowship you might be better off just finishing it and using the time to interview wisely. Alternatively depending on your reading of the program, I would bring up your intent to quit to the PD and if it's primarily due to the work hours that might leave some room for negotiating the schedule. Realistically the program should have already drawn up non-teaching contingency plans if they knew they weren't going to fill.

If you're planning on taking time off it's probably not an issue but I know many places are looking at their budgets and there's already plenty of salary freezes/reductions/benefits reductions so this will likely not be a good time to get anything but locum work.

Practically speaking if I were interviewing you it would be a red flag that you a) didn't understand what you were signing up for and b) couldn't handle it for more than 3 weeks. You will need to plan ahead for those type of questions, assuming you even get to that part of the process.

My mom is sick with covid, I really needed to go back to X to take care of her.

During is pandemic time, I really learned the value of family. I need to be closer to my parents.

I have no child care, and I don’t feel completely comfortable to sent Johnny to daycare, so I am moving back to be closer to my family.

My SO is furloughed at his/her work. I cannot stay in fellowship. I need to provide for the family.

The stimulus check is being cut, we cannot survive on my salary.

I am pregnant, my SO is pregnant.

I want to help where they really need me, FL, TX whatever.

My SO got a big promotion, I am going to be a stay home parent. Once in the life time opportunity.

Any of these will sort of work.... 😀

Of course, I hate the field.

 

[blue.jay]

Ahh Nephro.

I don't know that they could 'ban' you from the match, or blacklist you anywhere. You're quitting, on your own accord, you're not getting fired for adverse reasons. Now of course, quitting doesn't look good, but I don't think it'll necessarily perturb other future professional endeavors . 3 years from now if you want to apply to Cards, if you're a strong applicant otherwise, you'd probably have a decent shot. We all know folks who've quit training of some sort and landed subsequent residencies/fellowships.

If you really want to quit, don't say anything negative about the program, tell them it's just a personal decision, "It's not you, it's me" (like breaking up with a bad girlfriend), and do give them some notice so they can plan accordingly. Sucks for that one lone-standing fellow!

Though Nephro seems more likely, Why can't it be ID ??

 

[DrMetal]

Though Nephro seems more likely, Why can't it be ID ??

Certainly could be. Though I think ID is a little more popular these days. The head ID doc is on TV all of the time!

 

[smartparts]

To be fair last year a former resident from my program quit their fellowship within a few months of starting and last I saw they were working primary care for the same hospital system they matched into fellowship at. I don’t think that situation is guaranteed but the program doesn’t HAVE to be vindictive about things. They might be realistic if they only match 1 person and had to sell OP on doing the fellowship just to get a 2nd.

I do not envy your cofellow, that’s the person you’d really be screwing. That wouldn’t really be your fault though and I don’t think it should factor in.

I've seen this too. I don't think leaving a fellowship is career suicide. If your hospital system is desperate to fill a particular role (think primary care, nocturnist, bad location, teaching role, busy/brand new/unfilled fellowship slot) you could offer to take that position. It works for both parties because you get out of the fellowship and they get help in a job they haven't been able to hire for immediately. I would talk to someone in the program you trust to keep things confidential to see if there is some unmet need and to find out what the PD/fellowship PD's reaction has been to people leaving.

 

[GassYous]

My mom is sick with covid, I really needed to go back to X to take care of her.

During is pandemic time, I really learned the value of family. I need to be closer to my parents.

I have no child care, and I don’t feel completely comfortable to sent Johnny to daycare, so I am moving back to be closer to my family.

My SO is furloughed at his/her work. I cannot stay in fellowship. I need to provide for the family.

The stimulus check is being cut, we cannot survive on my salary.

I am pregnant, my SO is pregnant.

I want to help where they really need me, FL, TX whatever.

My SO got a big promotion, I am going to be a stay home parent. Once in the life time opportunity.

Any of these will sort of work.... 😀

Of course, I hate the field.

As I was reading through your post I thought that all of these things were happening to you at the same time and felt sooo bad.

 

[IMGASMD]

As I was reading through your post I thought that all of these things were happening to you at the same time and felt sooo bad.

Awww. Thank you. I am fine.

 

[Scope guy]

I read the first line and was sure it was nephro. I hope you can confirm.
Leaving with 2 week notice would be professional. So they can make some schedule changes so the remaining 1 fellow will be screwed even more. Feel bad for him/her. Many places are in hiring freeze. Start by applying for medical license in the state you intend to practice. At least you can do locums as bridge, while you wait for more permanent options.

 

[Splenda88]

Yes, this will be an issue. Applying for state licenses usually requires a letter of recommendation from all programs that you trained at, including this fellowship program if you leave...

Got my "full or unrestricted" license last month, and a PD letter was not asked. However, 3 physicians that you work with have to fill a form and send it.

 

[tacowithgreensauce]

Hi everyone,

So the title says it, I’m going to drop out of my fellowship I started this year. I’ve read the posts about people dropping out of their fellowships and have seen good advice overall provided by this community.

First of all, I would not have any regret not practicing this subspecialty for the rest of my life.

Second, I got into this speciality due to an open spot at my home program, so not through eras or nrmp (not sure if this changes anything)

Finally, my question is how do I go about leaving professionally? I don’t want to burn any bridges, but I’m sure this already short handed fellowship is going to feel some type of way when I do leave and I really don’t want them to take it out on me (if they can?)

If I just decided after my shift to quit, walk out of here and never look back, could they do anything that would potentially harm my future career?

Appreciate any help or reassurance you guys could offer.

Thanks!

so ... op did u drop fellowship?

 

[Suture15]

Certainly could be. Though I think ID is a little more popular these days. The head ID doc is on TV all of the time!

It's funny because he is actually Allergy/Immunology trained haha

 

[CCM-MD]

It's funny because he is actually Allergy/Immunology trained haha

Good one.

 

[Suture15]

Good one.

View attachment 317573

huh, interesting. I swear I was on some university website back in the day when he was on TV and his education had listed A/I and I was very surprised. Good to know, thanks!

 

[michaelrack]

It's possible that his training is different from certification (due to grandfathering for new specialties ).... however I know nothing about this individual's background

 

[CCM-MD]

A&I doesn't show up since it is separate from ABIM. Looks like he is everything.

 

[IMGASMD]

Whatever he has, would be better than “neuroradiology”......

 

[deleted1070955]

I'll throw this out there as well.
New fellow, 2 months in. Like the field, don't like part of the work environment (let's say the US's largest healthcare system that funds many GME positions...), and the hours are taking a toll on the family life already. Kids saying "we never see you, why aren't you here when we get up, have dinner, go to bed, etc." Spouse bearing more of the burden and I do not get to be as involved in their activities and lives.

I bring work home just like I did as a PCP except now there are many expectations and additional tasks that I have no control over plus trying to read and learn the field. It seems even if I stick it out, I won't be able to maximize the time in fellowship for projects etc because at baseline it's pulling me away more than my family really needs. To do become more involved (research, QI, trying to change or implement new opportunities) or just engage in the field more only adds time, it doesn't offset other fellowship time.

And looking forward to practicing the specialty, I cannot reasonably consider taking a lower academic salary to do a job I think I'd enjoy more after giving up years of income for fellowship.

I disliked much about being a PCP in the private world as well. I do not always enjoy being the first call person at the whim of the various time consuming scenarios that play themselves out each clinic day. Nor do I enjoy the aches, pains, controlled substances, and mental health which is why the "pure" medicine fellowship to distill that away. However, for a time I had a scribe and it did substantially improve QOL and should bring the hours/week of time commitment to all aspects of work to be less than that of fellowship while earning more money.

I both hate and miss being there for the whole person and wonder how much differently things would be were I in a practice for the long term

So I have several considerations:
- stick fellowship out yet suffer potentially long-term impact on my relationship with the kids and spouse, deal with a poorly designed system that goes out of its way to make life harder
- investigate trying to create an old-school internist-as-specialist for a group of PCPs and use the training I have to focus on aspects of my current fellowship speciality that I can do as an internist to try to minimize the take-all-comers GIM PCP and have a niche
- go back to IM clinic, hire a scribe to solve many of the charting headaches and annoyances
- seek out different type of IM work--FQHC/rural/underserved environment
- find a nonclinical job that can make use of my training or not and leave medicine behind aside from volunteer work

Signed,
conflicted

 

[DrMetal]

I'll throw this out there as well.
New fellow, 2 months in. Like the field, don't like part of the work environment (let's say the US's largest healthcare system that funds many GME positions...), and the hours are taking a toll on the family life already. Kids saying "we never see you, why aren't you here when we get up, have dinner, go to bed, etc." Spouse bearing more of the burden and I do not get to be as involved in their activities and lives.

Jeez I wish you guys would do a little forecasting in your lives and come to these realizations before you start training. You know what it's like to be a trainee. It's a PITA ! That's why I chose not to sub-specialize (not because of a lack of interest in anything). I wanted to spend more time with my kids, who are in middle school---and now I'm tutoring them a lot, b/c the whole school system has gone to sht as per COVID. I also wanted to work on my music ambitions, on my golf game, and my whiskey habit.

I bring work home just like I did as a PCP except now there are many expectations and additional tasks that I have no control over plus trying to read and learn the field. It seems even if I stick it out, I won't be able to maximize the time in fellowship for projects etc because at baseline it's pulling me away more than my family really needs. To do become more involved (research, QI, trying to change or implement new opportunities) or just engage in the field more only adds time, it doesn't offset other fellowship time.

Yeah, the life of a trainee.

I both hate and miss being there for the whole person and wonder how much differently things would be were I in a practice for the long term

You gotta pick a role. Can't do everything. Either role (that of a PCP or sub-specialist) can be rewarding and fulfilling.

So I have several considerations:
- stick fellowship out yet suffer potentially long-term impact on my relationship with the kids and spouse, deal with a poorly designed system that goes out of its way to make life harder

What system? What sub-specialty? Nephro again?! Jeez, what happened to Nephro? The family stuff you gotta sort out yourself. Depends on how old your kids are, how crazy your spouse is, etc etc.

- investigate trying to create an old-school internist-as-specialist for a group of PCPs and use the training I have to focus on aspects of my current fellowship speciality that I can do as an internist to try to minimize the take-all-comers GIM PCP and have a niche
- go back to IM clinic, hire a scribe to solve many of the charting headaches and annoyances
- seek out different type of IM work--FQHC/rural/underserved environment
- find a nonclinical job that can make use of my training or not and leave medicine behind aside from volunteer work

Sure, you could try any of the above. Will it work and make you happy? Who knows.

 

[Splenda88]

I'll throw this out there as well.
New fellow, 2 months in. Like the field, don't like part of the work environment (let's say the US's largest healthcare system that funds many GME positions...), and the hours are taking a toll on the family life already. Kids saying "we never see you, why aren't you here when we get up, have dinner, go to bed, etc." Spouse bearing more of the burden and I do not get to be as involved in their activities and lives.

I bring work home just like I did as a PCP except now there are many expectations and additional tasks that I have no control over plus trying to read and learn the field. It seems even if I stick it out, I won't be able to maximize the time in fellowship for projects etc because at baseline it's pulling me away more than my family really needs. To do become more involved (research, QI, trying to change or implement new opportunities) or just engage in the field more only adds time, it doesn't offset other fellowship time.

And looking forward to practicing the specialty, I cannot reasonably consider taking a lower academic salary to do a job I think I'd enjoy more after giving up years of income for fellowship.

I disliked much about being a PCP in the private world as well. I do not always enjoy being the first call person at the whim of the various time consuming scenarios that play themselves out each clinic day. Nor do I enjoy the aches, pains, controlled substances, and mental health which is why the "pure" medicine fellowship to distill that away. However, for a time I had a scribe and it did substantially improve QOL and should bring the hours/week of time commitment to all aspects of work to be less than that of fellowship while earning more money.

I both hate and miss being there for the whole person and wonder how much differently things would be were I in a practice for the long term

So I have several considerations:
- stick fellowship out yet suffer potentially long-term impact on my relationship with the kids and spouse, deal with a poorly designed system that goes out of its way to make life harder
- investigate trying to create an old-school internist-as-specialist for a group of PCPs and use the training I have to focus on aspects of my current fellowship speciality that I can do as an internist to try to minimize the take-all-comers GIM PCP and have a niche
- go back to IM clinic, hire a scribe to solve many of the charting headaches and annoyances
- seek out different type of IM work--FQHC/rural/underserved environment
- find a nonclinical job that can make use of my training or not and leave medicine behind aside from volunteer work

Signed,
conflicted

Not too late to quit... One of my residency buddies left 4 months into a Pulm/Crit fellowship and get a hospitalist job making~300k/yr.. Being a medical trainee just suck.

I have been working ~80 hrs for the past 3 month, and it sucks.

 

[Renal_Prometheus]

I'll throw this out there as well.
New fellow, 2 months in. Like the field, don't like part of the work environment (let's say the US's largest healthcare system that funds many GME positions...), and the hours are taking a toll on the family life already. Kids saying "we never see you, why aren't you here when we get up, have dinner, go to bed, etc." Spouse bearing more of the burden and I do not get to be as involved in their activities and lives.

I bring work home just like I did as a PCP except now there are many expectations and additional tasks that I have no control over plus trying to read and learn the field. It seems even if I stick it out, I won't be able to maximize the time in fellowship for projects etc because at baseline it's pulling me away more than my family really needs. To do become more involved (research, QI, trying to change or implement new opportunities) or just engage in the field more only adds time, it doesn't offset other fellowship time.

And looking forward to practicing the specialty, I cannot reasonably consider taking a lower academic salary to do a job I think I'd enjoy more after giving up years of income for fellowship.

I disliked much about being a PCP in the private world as well. I do not always enjoy being the first call person at the whim of the various time consuming scenarios that play themselves out each clinic day. Nor do I enjoy the aches, pains, controlled substances, and mental health which is why the "pure" medicine fellowship to distill that away. However, for a time I had a scribe and it did substantially improve QOL and should bring the hours/week of time commitment to all aspects of work to be less than that of fellowship while earning more money.

I both hate and miss being there for the whole person and wonder how much differently things would be were I in a practice for the long term

So I have several considerations:
- stick fellowship out yet suffer potentially long-term impact on my relationship with the kids and spouse, deal with a poorly designed system that goes out of its way to make life harder
- investigate trying to create an old-school internist-as-specialist for a group of PCPs and use the training I have to focus on aspects of my current fellowship speciality that I can do as an internist to try to minimize the take-all-comers GIM PCP and have a niche
- go back to IM clinic, hire a scribe to solve many of the charting headaches and annoyances
- seek out different type of IM work--FQHC/rural/underserved environment
- find a nonclinical job that can make use of my training or not and leave medicine behind aside from volunteer work

Signed,
conflicted

It depends on what subspecialty you are doing. If it's cards/GI/heme/onc then I thinks it's worth it financially to stick it out. If its nephro, do you realize how many nephrologists are working as hospitalist in the community? It's easy to get into for a reason. Don't believe that BS that academics try to sell you.

 

[grt398]

I'll throw this out there as well.
New fellow, 2 months in. Like the field, don't like part of the work environment (let's say the US's largest healthcare system that funds many GME positions...), and the hours are taking a toll on the family life already. Kids saying "we never see you, why aren't you here when we get up, have dinner, go to bed, etc." Spouse bearing more of the burden and I do not get to be as involved in their activities and lives.

I'll preface this by saying I'm not married/no kids, but with that said, there are lots of physicians I've met over the years who regretted prioritizing their career over their family and only one I can think of who felt otherwise. I love medicine and the work I do, but I know very well it won't be there for me once I'm no longer "useful" to it. Also, I think certain fellowships are pretty rough when you start and you feel like a new intern again, which doesn't help.

 

[blue.jay]

@imthere and @suboptimal are you talking about Nephrology fellowship ? Are we all assuming because it is the most miserable fellowship in IM?

The Three Most Valuable Specialists In Your Hospital

From reading the title of this post, you’re probably thinking that I am going to list some surgical specialties, interventional cardiology, or gastroenterology since these specialties bring in fina…

hospitalmedicaldirector.com

This guy thinks Nephrology and ID are in bear market and doing it now when it is less competitive is a good investment. Any thoughts on that?

 

[Chemist0157]

I'll throw this out there as well.
New fellow, 2 months in. Like the field, don't like part of the work environment (let's say the US's largest healthcare system that funds many GME positions...), and the hours are taking a toll on the family life already. Kids saying "we never see you, why aren't you here when we get up, have dinner, go to bed, etc." Spouse bearing more of the burden and I do not get to be as involved in their activities and lives.

I bring work home just like I did as a PCP except now there are many expectations and additional tasks that I have no control over plus trying to read and learn the field. It seems even if I stick it out, I won't be able to maximize the time in fellowship for projects etc because at baseline it's pulling me away more than my family really needs. To do become more involved (research, QI, trying to change or implement new opportunities) or just engage in the field more only adds time, it doesn't offset other fellowship time.

And looking forward to practicing the specialty, I cannot reasonably consider taking a lower academic salary to do a job I think I'd enjoy more after giving up years of income for fellowship.

I disliked much about being a PCP in the private world as well. I do not always enjoy being the first call person at the whim of the various time consuming scenarios that play themselves out each clinic day. Nor do I enjoy the aches, pains, controlled substances, and mental health which is why the "pure" medicine fellowship to distill that away. However, for a time I had a scribe and it did substantially improve QOL and should bring the hours/week of time commitment to all aspects of work to be less than that of fellowship while earning more money.

I both hate and miss being there for the whole person and wonder how much differently things would be were I in a practice for the long term

So I have several considerations:
- stick fellowship out yet suffer potentially long-term impact on my relationship with the kids and spouse, deal with a poorly designed system that goes out of its way to make life harder
- investigate trying to create an old-school internist-as-specialist for a group of PCPs and use the training I have to focus on aspects of my current fellowship speciality that I can do as an internist to try to minimize the take-all-comers GIM PCP and have a niche
- go back to IM clinic, hire a scribe to solve many of the charting headaches and annoyances
- seek out different type of IM work--FQHC/rural/underserved environment
- find a nonclinical job that can make use of my training or not and leave medicine behind aside from volunteer work

Signed,
conflicted

The first issue you present is mainly with the work environment and not the work itself so the next question would be if grinning and bearing the rest of fellowship is worth it. Attending world is drastically different from fellow world. Do not forget that. Do you have to become more involved in those side items? That seems like an opportunity to avoid further work/life imbalance.

What is this line about lower academic salary? Private practice or other is not going to be an option?

I really enjoy being a subspecialist for the PCP reasons you mentioned above. BUT, if you were fairly happy with a scribe/little less money, and you think you would be happier doing that and with better work/life balance than what life would hold for you after fellowship (again, this part is unclear), at least that is a viable option.

You seem to be most unhappy with where you are working, not the work itself. Correct me if I am wrong. That workplace is finite FWIW.

I do not see how you add any value to a group of PCPs with only 2 months of fellowship.

 

[Chemist0157]

@imthere and @suboptimal are you talking about Nephrology fellowship ? Are we all assuming because it is the most miserable fellowship in IM?

The Three Most Valuable Specialists In Your Hospital

From reading the title of this post, you’re probably thinking that I am going to list some surgical specialties, interventional cardiology, or gastroenterology since these specialties bring in fina…

hospitalmedicaldirector.com

This guy thinks Nephrology and ID are in bear market and doing it now when it is less competitive is a good investment. Any thoughts on that?

I don't know about that first line...I didn't have to look very far for a cards or pulm/cc fellow looking far more overworked and stressed out than I ever was. Sure, they go on to make more money as they have more procedures to charge for because that is how the system is set up, but they had a longer fellowship and worked harder and earned it quite frankly IMO.

As for the article, I would point out that he is writing from an administration's point of view. Nephrology inpatient has limitations. Money can certainly be made if an initial consult leads to a line and an initial dialysis treatment. All that can be billed the same day. Subsequent visits however will generally be about the same, whether it is a progress note or a dialysis note. To be fair, that is less work to be sure. However, there is no room to grow. Interventional nephro can do well, but a general nephrologist employed at a hospital may or may not have access to clinic patients, outpatient dialysis (the real money), etc. It would depend on the overall number, whether it is a salary or based on work done, or a combination. Some people might like being paid under that model, but that was not for me.

 

[deleted1070955]

Thanks for the opinions. I'm in a cognitive specialty--endo.

Avg. MGMA data suggests the speciality's starting salary is a bit better than GIM. I would prefer an academic career to develop a fairly narrow area of interest, but that won't be as much of an option if the private world offers a reasonable amount more income to make up for the years of lost savings from loan payback and now fellowship.

In 5 years and going forward, I think I'd be far happier as a specialist, but the next 22 months with over half the time in the VA system is another story. The conversations I had with the program and former fellows did not bring out the proportion of time spent in the VA, typical hours in house for each rotation were undersold despite me being blunt that I needed to know in order to adequately balance things with my family if I could make fellowship work, and of course covid has led to some changes for the worse.

I think I have to figure out how to streamline my workflow, become more efficient, minimize the time I have to be outside of the house during the hours my kids would be home (doing the chart review and stuff from home before going in each morning; leaving clinic/hospital and doing notes from home once the kids are asleep as much as possible (I hate leaving work undone, particularly inpatient stuff), and sucking it up that I'll have to sacrifice more sleep and personal pursuits as well right now.

I work with extremely nice cofellows and the division is remarkably supportive (the same cannot be said from those outside the division at the VA).

I just haven't figured out how to put my head down, figure out how to make the adjustments and implement them, and stop considering the alternatives.

I can probably leave off some of the nonessential stuff, but I also want to be engaged in the aspects of the field that appeal aside from day-to-day patient care--more so since I'll probably be in private practice and not have much opportunity for that stuff in the future.

 

[rokshana]

Thanks for the opinions. I'm in a cognitive specialty--endo.

Avg. MGMA data suggests the speciality's starting salary is a bit better than GIM. I would prefer an academic career to develop a fairly narrow area of interest, but that won't be as much of an option if the private world offers a reasonable amount more income to make up for the years of lost savings from loan payback and now fellowship.

In 5 years and going forward, I think I'd be far happier as a specialist, but the next 22 months with over half the time in the VA system is another story. The conversations I had with the program and former fellows did not bring out the proportion of time spent in the VA, typical hours in house for each rotation were undersold despite me being blunt that I needed to know in order to adequately balance things with my family if I could make fellowship work, and of course covid has led to some changes for the worse.

I think I have to figure out how to streamline my workflow, become more efficient, minimize the time I have to be outside of the house during the hours my kids would be home (doing the chart review and stuff from home before going in each morning; leaving clinic/hospital and doing notes from home once the kids are asleep as much as possible (I hate leaving work undone, particularly inpatient stuff), and sucking it up that I'll have to sacrifice more sleep and personal pursuits as well right now.

I work with extremely nice cofellows and the division is remarkably supportive (the same cannot be said from those outside the division at the VA).

I just haven't figured out how to put my head down, figure out how to make the adjustments and implement them, and stop considering the alternatives.

I can probably leave off some of the nonessential stuff, but I also want to be engaged in the aspects of the field that appeal aside from day-to-day patient care--more so since I'll probably be in private practice and not have much opportunity for that stuff in the future.

first year can be more stacked with input consults so is more time consuming, but overall, i don't recall working over the 80 hours as a fellow. When you have clinic months, you will usually have the weekends off and leave when clinic is done. I'm surprised the VA is taking up so much time (though i did VA for residency and not in fellowship) since they tend to end earlier than other clinics. But i hope you didn't do an Endo fellowship thinking that it was an easier fellowship than other, more procedural based specialties.

you will become more efficient as the months go along...try to remember what it was like to be an intern in july...being a fellow in july is really no different...the learning curve is steep.

and as it has been said here before, people generally don't go into Endo for money but interest in the specialty and in the grand scheme of things, 2 years is not a long time, but only you can decide if you and your family are willing to make the sacrifices to do those 2 years.

 

[Chemist0157]

Thanks for the opinions. I'm in a cognitive specialty--endo.

Avg. MGMA data suggests the speciality's starting salary is a bit better than GIM. I would prefer an academic career to develop a fairly narrow area of interest, but that won't be as much of an option if the private world offers a reasonable amount more income to make up for the years of lost savings from loan payback and now fellowship.

In 5 years and going forward, I think I'd be far happier as a specialist, but the next 22 months with over half the time in the VA system is another story. The conversations I had with the program and former fellows did not bring out the proportion of time spent in the VA, typical hours in house for each rotation were undersold despite me being blunt that I needed to know in order to adequately balance things with my family if I could make fellowship work, and of course covid has led to some changes for the worse.

I think I have to figure out how to streamline my workflow, become more efficient, minimize the time I have to be outside of the house during the hours my kids would be home (doing the chart review and stuff from home before going in each morning; leaving clinic/hospital and doing notes from home once the kids are asleep as much as possible (I hate leaving work undone, particularly inpatient stuff), and sucking it up that I'll have to sacrifice more sleep and personal pursuits as well right now.

I work with extremely nice cofellows and the division is remarkably supportive (the same cannot be said from those outside the division at the VA).

I just haven't figured out how to put my head down, figure out how to make the adjustments and implement them, and stop considering the alternatives.

I can probably leave off some of the nonessential stuff, but I also want to be engaged in the aspects of the field that appeal aside from day-to-day patient care--more so since I'll probably be in private practice and not have much opportunity for that stuff in the future.

I would think back to what you have done thus far and how you very likely and regularly became more efficient as time went on. I believe you will find yourself speeding up with time. Sound like you may end up pursuing private practice if you are looking for better income, but I would weigh your options as quality of life, better interest in work, etc may sway you elsewhere. You'll get a better feel of what is important to you. Sounds like time away from family is the worst thing right now so consider that.

 

[Renal_Prometheus]

@imthere and @suboptimal are you talking about Nephrology fellowship ? Are we all assuming because it is the most miserable fellowship in IM?

The Three Most Valuable Specialists In Your Hospital

From reading the title of this post, you’re probably thinking that I am going to list some surgical specialties, interventional cardiology, or gastroenterology since these specialties bring in fina…

hospitalmedicaldirector.com

This guy thinks Nephrology and ID are in bear market and doing it now when it is less competitive is a good investment. Any thoughts on that?

I think you should focus your time trying to get into a more competitive specialty. Trying to take the easy shortcut and hoping things turn your way, you are bound to be disappointed.