Entering fellowship after doing loan forgiveness work?

[Rumalum]

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As I increasingly have heart attacks about the ballooning interest on my out-of-state loans, I am thinking about strategies for paying off these loans. I don't think I can trust PSLF being an option once my time comes around, so I was thinking about taking advantage of the 50k/yr payment from the NHSC and then using the higher salary that comes from working in a rural area to quickly pay my loans down to a more reasonable number (2-3 years working?). I also wonder if you can apply for NHSC and state loan forgiveness programs simultaneously (e.g. Minnesota has a 25k/yr loan forgiveness program).

Afterwards, I would like to pick up my career and go back to do a fellowship. I was wondering if my competitiveness as an applicant would decrease doing this, however. Would an academic specialty like heme/onc prefer other candidates who have not been away from research and academic medicine for 2-3 years?

 

[studentathlete5]

I'm interested to hear some responses to this as well..

 

[FBurnaby]

I third the interest...particularly if rural PC --> peds cardiology fellowship can be done.

 

[Promethean]

I've known people who had been attendings for a while before going back for a peds surgical fellowship. It can be done. You will want to do everything possible to keep your CV sharp, I'm sure. Write up those case reports to get some publications, maybe do a little clinical research in your area of interest, if you can get something together. But I have a hard time imagining how an accomplished attending with a few years of solo experience wouldn't be competitive with a freshly graduated resident, if they tried even just a little.

 

[mvenus929]

It's not uncommon for surgery people to take a couple of years off before going to Peds fellowship, but peds is not surgery.

That said, I've seen several fellows and attendings (including a cardiology attending) who worked as general pediatricians before going back to fellowship. I don't think it's unheard of, if a little uncommon. I'm personally planning on taking a year off in order to pay off one of my smaller (non-PSLF) loan, but that means I'll be applying right after residency graduation.

 

[FrkyBgStok]

i don't really have any experience to base this post on, but i just had a very similar conversation with my peds advisor before i graduated. he said he was on a rural scholarship and went into peds thinking the rural job would be awesome like family med and get to do everything, but the reality is that on the inpatient side of things, rural hospitals aren't comfortable with taking kids, aren't set up to do procedures on kids, and plain don't admit. on the outpatient side, if you don't have a bunch of other pediatricians, you are basically going in and stealing all the healthy patients, so they don't want you. so in short, both the inpatient and outpatient rural areas don't want you there. he ended up paying back his rural scholarship because he couldn't find a good situation. for me, it was excellent advice and really opened my eyes to the fact that rural peds often isn't like envisioned. so unless you have an actual rural plan, i would rethink that idea.

 

[NurWollen]

i don't really have any experience to base this post on, but i just had a very similar conversation with my peds advisor before i graduated. he said he was on a rural scholarship and went into peds thinking the rural job would be awesome like family med and get to do everything, but the reality is that on the inpatient side of things, rural hospitals aren't comfortable with taking kids, aren't set up to do procedures on kids, and plain don't admit. on the outpatient side, if you don't have a bunch of other pediatricians, you are basically going in and stealing all the healthy patients, so they don't want you. so in short, both the inpatient and outpatient rural areas don't want you there. he ended up paying back his rural scholarship because he couldn't find a good situation. for me, it was excellent advice and really opened my eyes to the fact that rural peds often isn't like envisioned. so unless you have an actual rural plan, i would rethink that idea.

Would I be right in thinking that there has been a trend over the last 10-20 years towards pediatric inpatient services consolidating around larger hospitals with designated pediatric inpatient units? Perhaps due in part towards the trend away from community pediatricians admitted at whatever hospital and towards pediatric hospitalists?

Maybe in this case, OP's best bet would be to go work and a small to medium sized community somewhere in middle America, large enough to have advanced pediatric services but not large enough to be over saturated with physicians.

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