fellowship after general practise

[iatrosB]

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Does anyone know if it is possible to do a peds fellowship (cardio, GI, pulmonary...) after you are in practise as a general pediatrician? I ask this because I will probably join the military and practise as a general pediatrician then try to specialize when I get out. Is this possible? Thanks for your help.

 

[edmadison]

Does anyone know if it is possible to do a peds fellowship (cardio, GI, pulmonary...) after you are in practise as a general pediatrician? I ask this because I will probably join the military and practise as a general pediatrician then try to specialize when I get out. Is this possible? Thanks for your help.

Yes it is, and its what I plan on doing.

Ed

 

[Neuronix]

I ask this because I will probably join the military and practise as a general pediatrician then try to specialize when I get out.

Don't do it. If you're interested in specializing now, stick with your goal. Don't waste your time in the military, restricting yourself severely as to where you can do residency, practicing gen peds in the middle of nowhere for years, and being deployed in all sorts of general roles that will probably have little to nothing to do with pediatrics. It's not worth the money and it's going to be easier to persue your fellowship of interest after doing a top civilian residency and honing yourself in on some specialized area. If you want to practice generally for a few years, that's not a bad idea, but don't lock yourself in for the next 12 years of your life.

My two cents out.

 

[Homunculus]

Don't do it. If you're interested in specializing now, stick with your goal. Don't waste your time in the military, restricting yourself severely as to where you can do residency, practicing gen peds in the middle of nowhere for years, and being deployed in all sorts of general roles that will probably have little to nothing to do with pediatrics. It's not worth the money and it's going to be easier to persue your fellowship of interest after doing a top civilian residency and honing yourself in on some specialized area. If you want to practice generally for a few years, that's not a bad idea, but don't lock yourself in for the next 12 years of your life.

My two cents out.

actually the peds gig is one of the better ones if you are military.

1) your pay is closest to civilian pay of any specialty
2) you get this pay without having the hassles of setting up your own practice
4) the army had virtually every fellowship in house if you choose to do it with them
5) the residency programs in the military are actually pretty damn good

yes, you will probably get deployed at some point to do general medicine. it's not for everyone, but i didn't sign up for the peace corps, lol. and there may be a few more isolated billets, but if you talk to any pediatrician who has come from that kind of environment and they'll tell you that it's great practical training-- when to admit, what can be followed outpatient, what needs imemdiate attention, etc.

like edmadison i plan on specializing when i get out (maybe sooner depending on how i like things). i haven't narrowed down exactly what that will be, but i think spending some time as a general pediatrician will help me figure it out.

good luck

--your friendly neighborhood combat pediatrician caveman

 

[oldbearprofessor]

Greetings iatrosB;

I don't know anything about the military side of things so I'll let the others here debate that. I did want to comment about delaying the time between residency and fellowship. First of all, in the (about) 20 years since I started my fellowship I have known only a few people in the pedi specialty fields I interact with the most (neo, ID, cardio, GI, critical care) that had more than 1 year between ending residency and starting fellowship. However, all of these people did very well and I certainly don't think they were harmed by the delay at all. However, in fairness, I have known many more PL-3s who assured me they would practice general peds for a few years and then come back to do a fellowship who never did. Certainly, some of them might have been just telling me what they thought I wanted to hear 🙄 but I am fairly sure that many sincerely wanted to come back but never did it. The question is why? and How can you be prepared for the pitfalls that might make it harder to come back?

Again, ignoring the military issue (I've seen several military folks do pedi fellowships by the way), here are some ideas - I hope others will elaborate, add more, or refute them.

1. Money/moving, etc - it's hard to give up an attendings salary for a fellows salary for 3 years and the ultimate salary benefit from doing a fellowship is sometimes small - there have been several threads about this before.

2. Nightcall - Fellows in neo, cardiology and critical care pedi generally take in-house call throughout their three years of fellowship. I have heard it said that these are busy nights and fellows may easily do 50 or more calls/year 🙁 . Both "on-service months" and night-call are busy for many of the other specialties like GI, heme-onc, ID even if they don't stay in house.

3. Loss of autonomy - who wants to go from being an attending to being a fellow again and having to check out all of your sick patients with someone else?

4. Research expectations - Most fellowships expect research production and some are more heavily oriented towards basic sciences. The farther from medical school one is, the farther you might be from this. This can be overcome, but I think is a real barrier for those whose goal is clinical specialty peds rather than academics per se.

5. General peds isn't so bad afterall for many people!! Especially when faced with the problems of arranging things (including child care) related to returning to in-house call or 80 hour in-hospital weeks. I think this isn't a career change that some end up feeling as passionately about as changing for example, from engineering to medicine.

I don't mean to be discouraging here about coming back. I believe that if you honestly are aware of the challenges, then you can prepare yourself and your family and go forward, as I've seen others do. But it isn't easy to make this move - I wish the AAP and the boards (and academic institutions) would try to make it easier but I'm not sure this will happen.

Regards and best of luck

"oldbear professor"

 

[Neuronix]

I guess my point is that with the military you are signing a "contract" that goes in effect for the next twelve years of your life and severely restricts your options, especially with location. Your future interests may change or not be available in the military. If you want to serve your country, there are other ways to do so or you can join later. Don't sign your freedom away until you are in your 30s.

Then again, this is general advice for anyone considering HPSP. As the fiancee of a HPSP student, I can tell you that they care very little about your own desires, and alot less about the desires of your family. Once you sign that "contract", you're really locked into it. I put contract in quotes beause it's not like other contracts where if you break it, you're protected by civil law and you just owe some money. Instead, it's a contract for a good fraction of your life that specifies basically only that your ass is the military's and it's enforceable by a military court.

Good luck,
Eric

 

[Homunculus]

I guess my point is that with the military you are signing a "contract" that goes in effect for the next twelve years of your life and severely restricts your options, especially with location. Your future interests may change or not be available in the military. If you want to serve your country, there are other ways to do so or you can join later. Don't sign your freedom away until you are in your 30s.

Then again, this is general advice for anyone considering HPSP. As the fiancee of a HPSP student, I can tell you that they care very little about your own desires, and alot less about the desires of your family. Once you sign that "contract", you're really locked into it. I put contract in quotes beause it's not like other contracts where if you break it, you're protected by civil law and you just owe some money. Instead, it's a contract for a good fraction of your life that specifies basically only that your ass is the military's and it's enforceable by a military court.

Good luck,
Eric

all good points. 👍

i'm probably a little biased, but peds really is one of the better fields in military medicine 🙂 now if we could just get them to stop using us as FP's and ER docs, lol.

--your friendly neighborhood harriet lane carrying caveman

 

[bb622]

how hard is it to get into the navy peds fellowships and are they any good? Also with the downsizing of peds do they get to go straight through or are they ending up in GMO or ther tours?