Fellowship advice for the current job market

[doctor313]

Just curious what everyone's thoughts are on fellowship planning for the current job market.

I am an AP/CP resident from a mid-tier residency program with a GI path fellowship lined up at a larger, "upper mid-tier" institution. I'm OK with doing academics and/or private practice in the future.

Do you think I should plan on doing a 2nd fellowship after GI path (like surg path?) in order to be more competitive in the job market (such as for jobs that may require general sign-out)? I'm interested in living in only 2-3 major cities in the USA long-term, but don't really mind taking my first job anywhere to get a few years under my belt before settling down.

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[SunBakedTrash]

Unless you're highly interested in additional specialization, just apply for a job. If you really are flexible (at least initially), that sign-out experience would be more worthwhile than carrying slides back and forth between your attending's office and wherever they make you sit.

 

[D1b()4]

One fellowship is enough, especially if you are flexible with your first job. There is no guarantee that two fellowships will make you more competitive than one.

 

[Med Director New England]

I would take a job if you find a good one where you want to live. Only do a second fellowship if you can’t land the job.

 

[doctor313]

I agree with what has been advised, but I guess the question I'm really trying to ask is should I go through the process of applying for and securing a second fellowship now as a backup in case I don't find a job? Or is that not really going to be necessary given anecdotal improvements in the job market?

 

[KeratinPearls]

I agree with what has been advised, but I guess the question I'm really trying to ask is should I go through the process of applying for and securing a second fellowship now as a backup in case I don't find a job? Or is that not really going to be necessary given anecdotal improvements in the job market?

You can always apply for the second surgpath fellowship and drop it if you find a job. People drop fellowships all the time. I would start sending out CVs early on like Oct-Nov of your first fellowship year. People are able to secure jobs early on.

The thing is if you go anywhere for your first job, the few years you spend at this job, if a partnership track position, will count towards the years to becoming partner. Thus, if you leave, then you’ve just lost the time used towards becoming partner.

Unless your first job has no partnership track then that’s ok (like a corporate lab position, a VA job, a community hospital based non partnership salary position, or an academic job).

You should be able to find a position “somewhere” with a GI fellowship. You might be able to land a job in your desired area but that depends on what becomes available and sometimes luck plays a role or who you know. If you aren’t able to find a job in your desired area just make sure that your first job will set you up for the second job, meaning you don’t want to sign out only GI path for a few years and then go looking for a general path community job later on when you haven’t seen gen surgpath for a few years. You can still maybe find a gen path job but why set yourself up for an employer to think “hey this guys been only looking at GI path for a few years. I wonder how his gen surgpath skills are?”

Oh btw how dare you say improvement in the job market is anecdotal! There’s data out there dammit!

 

[LADoc00]

Current job market is a like Stephen King nightmare wrapped in a John Carpenter horror flick from the 70s.

VA VA VA.

Go to some job where the federal government can print money if needed to pay you something so the very least you can eat and get fresh clean water.

Private practice as we knew it is pretty much on COVID life support, Im sure nurses make a TikTok video everytime a pathology group dies just like their RL COVID patients.

 

[WEBB PINKERTON]

Wilderness Medicine fellowship is what I would do.

Then go rural.

 

[gbwillner]

Wilderness Medicine fellowship is what I would do.

Then go rural.

Every time you talk about this I think of that terrible Sean Connery movie where he's a medical researcher looking for a cure to cancer living in the Amazon jungle.

 

[doctor313]

Good advice so far, thank you all for the input!

Anecdotal is what I've heard... If you've got data, please share a link! So far I've just heard anecdotally that there is data somewhere

 

[WEBB PINKERTON]

Every time you talk about this I think of that terrible Sean Connery movie where he's a medical researcher looking for a cure to cancer living in the Amazon jungle.

I haven't seen that movie. I assume it is medicine man.

Medicine Man (film) - Wikipedia

en.wikipedia.org

I do have a movie recommendation.... Brewster McCloud. Watched that and The Omega Man the other night. Great double feature.

 

[deleted314957]

Just curious what everyone's thoughts are on fellowship planning for the current job market.

I am an AP/CP resident from a mid-tier residency program with a GI path fellowship lined up at a larger, "upper mid-tier" institution. I'm OK with doing academics and/or private practice in the future.

Do you think I should plan on doing a 2nd fellowship after GI path (like surg path?) in order to be more competitive in the job market (such as for jobs that may require general sign-out)? I'm interested in living in only 2-3 major cities in the USA long-term, but don't really mind taking my first job anywhere to get a few years under my belt before settling down.

I am stunned. You are still only a resident and you believe “general sign-out” is too plebeian for you or somehow less than desirable. I suggest you learn “general sign-out” before you fancy yourself a pathologist.


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[doctor313]

I am stunned. You are still only a resident and you believe “general sign-out” is too plebeian for you or somehow less than desirable. I suggest you learn “general sign-out” before you fancy yourself a pathologist.


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On the contrary, I would love to do general signout. My primary concern is that I would not be marketable for such jobs after only doing a GI path fellowship. It's understandable, because I think most of us coming out of AP/CP training only have been on surgical pathology 15-16 months during training. And now, with the predominance of subspecialized rotations during training, you might only be on a given subspecialty 2-3 months for your whole training (once every 1-2 years...). With the various CP rotations mixed in throughout training, it's hard to keep even basic / common things straight! That's why I can see that an additional year of just doing surgical pathology, perhaps at an institution that has an actual general signout service (albeit not a "big name program") might be a good way to make myself more marketable for general signout practices, especially if I already have a year dedicated to GI under my belt to give me an area of "expertise."

Or do you think I could pull it off with just a GI fellowship (and thus save myself another year of lost attending salary!)? That is the question...

 

[deleted314957]

On the contrary, I would love to do general signout. My primary concern is that I would not be marketable for such jobs after only doing a GI path fellowship. It's understandable, because I think most of us coming out of AP/CP training only have been on surgical pathology 15-16 months during training. And now, with the predominance of subspecialized rotations during training, you might only be on a given subspecialty 2-3 months for your whole training (once every 1-2 years...). With the various CP rotations mixed in throughout training, it's hard to keep even basic / common things straight! That's why I can see that an additional year of just doing surgical pathology, perhaps at an institution that has an actual general signout service (albeit not a "big name program") might be a good way to make myself more marketable for general signout practices, especially if I already have a year dedicated to GI under my belt to give me an area of "expertise."

Or do you think I could pull it off with just a GI fellowship (and thus save myself another year of lost attending salary!)? That is the question...

Hell yes! Just look at and continue to read about other stuff, go to the resident “unknown” conferences, etc while you concentrate on gi. Gi ain’t very hard. It sure as hell does not need one year of exclusive, intensive training. and you don’t have a board exam to worry about.


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[y2k_free_radical]

Every time you talk about this I think of that terrible Sean Connery movie where he's a medical researcher looking for a cure to cancer living in the Amazon jungle.

I liked that movie

 

[Guest8]

On the contrary, I would love to do general signout. My primary concern is that I would not be marketable for such jobs after only doing a GI path fellowship. It's understandable, because I think most of us coming out of AP/CP training only have been on surgical pathology 15-16 months during training. And now, with the predominance of subspecialized rotations during training, you might only be on a given subspecialty 2-3 months for your whole training (once every 1-2 years...). With the various CP rotations mixed in throughout training, it's hard to keep even basic / common things straight! That's why I can see that an additional year of just doing surgical pathology, perhaps at an institution that has an actual general signout service (albeit not a "big name program") might be a good way to make myself more marketable for general signout practices, especially if I already have a year dedicated to GI under my belt to give me an area of "expertise."

Or do you think I could pull it off with just a GI fellowship (and thus save myself another year of lost attending salary!)? That is the question...

You don't need a surg path fellowship to do general sign out. Your residency training is what prepares you for general sign out, not another fellowship. Your GI fellowship simply gives you added training in GI and makes you marketable for groups looking for someone with additional GI expertise. You'll keep learning a lot as an attending. You don't need to waste another year in fellowship. I did a dermpath fellowship only and I still do general sign out as well. I promise that no matter how many fellowships you do you'll still learn new things out in practice. Embrace it. Show cases around frequently. Ask others for opinions and consensus. And when in doubt, send it out.

 

[octopusprime]

I haven't seen that movie. I assume it is medicine man.

Medicine Man (film) - Wikipedia

en.wikipedia.org

I do have a movie recommendation.... Brewster McCloud. Watched that and The Omega Man the other night. Great double feature.

awesome movie, imo.
" I found a cure for the plague of the 20th century, and now I've lost it! !" [use loud booming Sean Connery voice]

 

[octopusprime]

... I'm interested in living in only 2-3 major cities in the USA long-term...

To me this is your biggest hurdle.
Is it for family?
Or a need for a social life with more options?
Something else?

 

[doctor313]

You don't need a surg path fellowship to do general sign out. Your residency training is what prepares you for general sign out, not another fellowship. Your GI fellowship simply gives you added training in GI and makes you marketable for groups looking for someone with additional GI expertise. You'll keep learning a lot as an attending. You don't need to waste another year in fellowship. I did a dermpath fellowship only and I still do general sign out as well. I promise that no matter how many fellowships you do you'll still learn new things out in practice. Embrace it. Show cases around frequently. Ask others for opinions and consensus. And when in doubt, send it out.

Thank you for your advice.

 

[doctor313]

To me this is your biggest hurdle.
Is it for family?
Or a need for a social life with more options?
Something else?

Yes to all three. Again, I wouldn't mind taking a job for 1-2 years elsewhere while continuing to look for something in a more desirable location. Better than doing another 1 of year fellowship and still needing to find a job, I figure.

One other piece of advice I've received is to just apply for a 2nd fellowship to have it as a backup, and drop it if I find a job. It makes sense, but I feel like it's kind of a disingenuous thing to do at the expense of your would-be fellowship director.

 

[gbwillner]

awesome movie, imo.
" I found a cure for the plague of the 20th century, and now I've lost it! !" [use loud booming Sean Connery voice]

This quote is literally the only memorable thing from this movie.

 

[SunBakedTrash]

Yes to all three. Again, I wouldn't mind taking a job for 1-2 years elsewhere while continuing to look for something in a more desirable location. Better than doing another 1 of year fellowship and still needing to find a job, I figure.

One other piece of advice I've received is to just apply for a 2nd fellowship to have it as a backup, and drop it if I find a job. It makes sense, but I feel like it's kind of a disingenuous thing to do at the expense of your would-be fellowship director.

It’s a burned bridge, no doubt, and some people will hold it against you. If you can’t get a job, you could find an open fellowship. There are no shortages of those anywhere, especially if you would be willing to settle for non-acgme surg path type stuff.

 

[octopusprime]

Yes to all three. Again, I wouldn't mind taking a job for 1-2 years elsewhere while continuing to look for something in a more desirable location. Better than doing another 1 of year fellowship and still needing to find a job, I figure.

One other piece of advice I've received is to just apply for a 2nd fellowship to have it as a backup, and drop it if I find a job. It makes sense, but I feel like it's kind of a disingenuous thing to do at the expense of your would-be fellowship director.

If you're looking for jobs only in those 3 cities, yes I'd apply for a fellowship as a backup. If, as you've expressed openness to, you're willing to do something somewhere else for S/O experience, I'd just apply for a job and not bother with the fellowship--lost years of revenue might not mean much now but they will when you're approaching retirement.

But something to keep in mind...

I'd stick with an academic jr attending position or large lab / employee outfit...don't waste your and our time interviewing, learning the LIS/IT, having others accommodate you into the call & vacation schedule, getting to know clinicians, et al, only to bail after you find something "better" after a year or two. We've been burned by people doing that in the past... it's arguably more disingenuous to private groups in that regard than it is disingenuous to academic institutions when you bail just prior to fellowship [and that's why we only hire local people, which is coincidentally also why people never hear about those 99th percentile gigs]. Just FWIW.

 

[doctor313]

If you're looking for jobs only in those 3 cities, yes I'd apply for a fellowship as a backup. If, as you've expressed openness to, you're willing to do something somewhere else for S/O experience, I'd just apply for a job and not bother with the fellowship--lost years of revenue might not mean much now but they will when you're approaching retirement.

But something to keep in mind...

I'd stick with an academic jr attending position or large lab / employee outfit...don't waste your and our time interviewing, learning the LIS/IT, having others accommodate you into the call & vacation schedule, getting to know clinicians, et al, only to bail after you find something "better" after a year or two. We've been burned by people doing that in the past... it's arguably more disingenuous to private groups in that regard than it is disingenuous to academic institutions when you bail just prior to fellowship [and that's why we only hire local people, which is coincidentally also why people never hear about those 99th percentile gigs]. Just FWIW.

THANK YOU. That is really, really helpful information. This makes me more strongly consider securing a 2nd surg path fellowship in a location of interest, especially if it might help me land a job like you've described in that area, since neither my current nor next institution are in my preferred geographic location(s). And it makes sense, as you said, that it would be less impactful to bail last minute on a fellowship / certain jobs compared to other jobs, also a factor I didn't consider before. Thanks again for sharing your insight!

 

[yaah]

My group has a bunch of us who do general pathology plus something specialized and only 2 people have surg path fellowships. Eveyrone else has a subspecialty fellowship and/or heme or cyto. And we all sign out general path (which is everything not in a high-volume subspecialty but also includes high volume specialized stuff).

 

[doctor313]

My group has a bunch of us who do general pathology plus something specialized and only 2 people have surg path fellowships. Eveyrone else has a subspecialty fellowship and/or heme or cyto. And we all sign out general path (which is everything not in a high-volume subspecialty but also includes high volume specialized stuff).

Thanks for sharing - that's good to know. What do you all think of doing a second sub-specialty fellowship after GI compared to doing a general surg path fellowship?

 

[deleted314957]

Thanks for sharing - that's good to know. What do you all think of doing a second sub-specialty fellowship after GI compared to doing a general surg path fellowship?

There is another choice. Do WHATEVER you can to get experience/job of pretty much any kind. You will find yourself far, far more employable (unless you are a jackass).
Give THAT a try.


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[intern_for_life]

Is the job market really that bad? It seems like most fellows were able to find jobs paying $200k to $250k per year. Is there anyone here who couldn't land a job paying at least 150K a year? I know this is lower relative to some other fields in medicine but also not bad considering it's similar to primary care money without the added stress of patient care.

 

[SunBakedTrash]

Is the job market really that bad? It seems like most fellows were able to find jobs paying $200k to $250k per year. Is there anyone here who couldn't land a job paying at least 150K a year? I know this is lower relative to some other fields in medicine but also not bad considering it's similar to primary care money without the added stress of patient care.

Yes, it is bad and it has all the stresses of pathology that you are forced to deal with which includes care for the patient and the consequences of making mistakes. This is not about being greedy, this is about settling for far lower than any pathologist (or physician) should be forced to settle for due to the gross mismanagement of this specialty.

 

[KeratinPearls]

Is the job market really that bad? It seems like most fellows were able to find jobs paying $200k to $250k per year. Is there anyone here who couldn't land a job paying at least 150K a year? I know this is lower relative to some other fields in medicine but also not bad considering it's similar to primary care money without the added stress of patient care.

It’s ok since everyone gets jobs. If you are geographically restricted it may suck. You can’t just suddenly leave Your job and Expect to get another job quickly. A friend who trained in the US And is currently in Canada wanted to Return to the us for work but couldn’t find a job near the city she was interested in. With Covid it’s probably going to get worse if it isn’t already.

Agree with mismanagement of the field. We need to be like the dermatologists. They protect their field well. The field has flourished for years. If you are a foreign grad it’ll be difficult to match in derm. The opposite is true for pathology. If you are a foreign grad it’s easy. You just have to say you love Pathology and show some experience. It’s really sad in a way.

Funny thing is Derm seems to be competitive in other countries as well. I know in another country in Asia you have to have connections to get into derm. Also path is similar in other countries where it’s a NoN-competitive field.