Fellowship - “needed” for 1-2 hours within major city?

[Ophthough]

Planning to return home to within 1-2 hour commuting distance of New York City when starting life as an attending. My current program is not in the Northeast, and is not a top 10 program (cannot trade on name recognition), but seems to produce overall clinically & surgically strong grads many of whom have gone comprehensive in the past (though not in a major metro area). While I would feel confident entering the fellowship match I am not convinced that I really want to pursue a fellowship at this point, though if I had to pick a fellowship I’d pick cornea.

What do you think? Do you “need” a fellowship to get a good job in a saturated area? Just how saturated is the area within 1-2 hours of NYC?

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[Bgladney]

The "need" for a fellowship is not required for positions in the NYC. While having a fellowship under your belt will make you more attractive as a candidate and will help to further build your practice, it is NOT an absolute.

 

[Dusn]

A cornea fellowship is the least useful fellowship in my opinion. There just isn't that much cornea pathology and most comprehensive docs feel comfortable with most cornea stuff... It's a rare day when I see a patient who needs a corneal corneal transplant, DSEK, DMEK... phaco machines use less and less energy and PBK is very rare.

Second, you want a fellowship that will give you a skill set that will make you useful and valuable to your practice - not just for getting hired but, even after that, so that they don't want to lose you. That'll give you leverage in future negotiations for partnership, hire pay, etc. If the practice owner can just take over your patients if you leave and do everything you can do then you'll have no leverage.

 

[dantt]

Glaucoma will probably be most marketable in a major metropolitan area. Unfortunately, plastics retina neuro peds are not so synergistic with anterior segment surgery. If you pursue that training you will stop getting cataract referrals and be stuck doing that specialty.

 

[DrQuakerJack]

I feel like I'm in the same boat. If I could script my perfect practice, it would be a little of a lot of different fields (cataract, MIGS, tubes, refractive, PRP/injections, ptosis). I am getting good training in residency but not quite enough to feel comfortable to do this alone and feel that I could easily master these skills with just a little extra training/oversight.

Is it reasonable to find a suburban or semi-rural practice where you could perfect all these skills?

I worry about joining a big city group with comp since you just rely so heavily on one skill set - cataracts.

 

[dantt]

I think it would be reasonably easy to find a semirural place where you could practice true comprehensive. I dont think you will be able to do it as efficiently as a subspecialist or necessarily as well as a subspecialist but you will be able to take care of your patients and they will appreciate you. The suburbs are full of subspecialists as well.

 

[Bgladney]

Outside of the metro areas you can practice pretty much whatever you would like. Most groups that I work with are happy to work with someone for the first few months out of training.