fellowship after primary care

[frogger41]

i have been in private practice for 8 years now. i started with the intention of just getting some experience after residency before committing, then had a few kids and time got away from me.

i am not at a point where i feel i have to apply now or give up on heme/onc. and kicking myself for not going straight through after residency, since it all seems so much harder with a family.

so, my questions are about quality of life i guess. right now my hours and lifestyle are not perfect but very manageable, not much more that 40 per week (i am part time). but i am not satisfied taking care of the worried well and feeling as a generalist that i dont have in depth knowledge in any subject. I'm scared to be honest though of resenting the time commitment of fellowship. not scared of the pay cut, but time away from my kids and if that is worth it. and scared i will make the sacrifice then it wont live up to expectations. also wanting to do less clinical work and more science, so would want to do academic (my interest is heme) and know there are no guarantees after fellowship i will be able to do that and academics has its own frustrations.

i don't see myself in primary care forever. i thought about just leaving clincial practice and trying for a pharma job. i probably sound not committed enough, but at this point in my life am old enough to be realistic/practical....

thanks for reading. feel free to rip apart or offer advice

---

Members don't see this ad.

 

[DoctorDontStop]

Quality of life will vary by fellowship program, but generally speaking, the 1st 18 months of fellowship can be tough You may adapt well given your experienced as an independently practicing physician. I'd say apply and see what interviews you get, you can find out from other fellows during interviews about quality of life, career trajectory, etc.

 

[lafamilia]

If you’re only interested in Heme, there are 2 year fellowships albeit fewer spots compared to Heme/Onc. I’m not sure what the job market is for Hematology only positions, though my co resident (also interested in doing the 2 year path) says he’s seen a slight increase in opportunities compared to last year. Granted this is in the Midwest and most of the jobs were associated with an academic institution like you alluded to in your post.

 

[gutonc]

Agree that the first 12-18 months, depending on the fellowship, will be rough. Some are akin to intern year workload, with the caveat that much more of it is outpatient and has less of a time commitment.

If you are thinking about a career in academic medicine though, keep in mind that the time commitment attendant in that career is going to dwarf your time in fellowship. When I was still on that treadmill, I would routinely do a full 9-10 hours a day in clinic or the lab and then put in another 3-4 hours at night. Being clinical/admin now, my "pajama time" has dropped to under an hour 3 or 4 days a week at the most.

Honestly, do what makes you happy...unless it's a 2y single board fellowship...don't do that. The time will go quickly and if you are happier as a hem/onc than a PCP, then do fellowship.

 

[frogger41]

Agree that the first 12-18 months, depending on the fellowship, will be rough. Some are akin to intern year workload, with the caveat that much more of it is outpatient and has less of a time commitment.

If you are thinking about a career in academic medicine though, keep in mind that the time commitment attendant in that career is going to dwarf your time in fellowship. When I was still on that treadmill, I would routinely do a full 9-10 hours a day in clinic or the lab and then put in another 3-4 hours at night. Being clinical/admin now, my "pajama time" has dropped to under an hour 3 or 4 days a week at the most.

Honestly, do what makes you happy...unless it's a 2y single board fellowship...don't do that. The time will go quickly and if you are happier as a hem/onc than a PCP, then

 

[frogger41]

how often was your clinic? some of the draw for me would be protected research time rather than constant patient care with a full clinic each day. i was under the impression that many in academic practice had 2 half days of clinic a week and a set numbed of weeks per year on service. can anyone else speak to this? i dont want to go in uninformed. thank you

 

[futureapppsy2]

how often was your clinic? some of the draw for me would be protected research time rather than constant patient care with a full clinic each day. i was under the impression that many in academic practice had 2 half days of clinic a week and a set numbed of weeks per year on service. can anyone else speak to this? i dont want to go in uninformed. thank you

Can't speak the clinic/wards piece, but research will eat all the time you have and then some if you want a true academic career--there's always something more to do--another manuscript to write, revise, or proof, another grant application to work on, another IRB to track, another set of data to analyze, another peer review to do... it can very easily become endless.

 

[gutonc]

how often was your clinic? some of the draw for me would be protected research time rather than constant patient care with a full clinic each day. i was under the impression that many in academic practice had 2 half days of clinic a week and a set numbed of weeks per year on service. can anyone else speak to this? i dont want to go in uninformed. thank you

Your balance of clinical and protected research time will be dictated by your ability to fund the latter. So if you can figure out a way to fund 80% research time, then you'll only have 1 full day of clinic a week. You'll likely be seeing 20-25 patients during that "day" though, so it's not going to be a vacation.

And you're going to be working twice as hard in the lab as you are in the clinic. For realsies. If that's what you want to do, then by all means go for it. But know what you're getting yourself into.

 

[frogger41]

Your balance of clinical and protected research time will be dictated by your ability to fund the latter. So if you can figure out a way to fund 80% research time, then you'll only have 1 full day of clinic a week. You'll likely be seeing 20-25 patients during that "day" though, so it's not going to be a vacation.

And you're going to be working twice as hard in the lab as you are in the clinic. For realsies. If that's what you want to do, then by all means go for it. But know what you're getting yourself into.

thanks. not afraid of hard work but value quality of life. appreciate the honest answers

 

[gutonc]

thanks. not afraid of hard work but value quality of life. appreciate the honest answers

QOL is going to take a hit during fellowship for sure. But that's temporary. And if you don't particularly like the work you do now, that (IMO at least) is a QOL hit as well.

 

[frogger41]

QOL is going to take a hit during fellowship for sure. But that's temporary. And if you don't particularly like the work you do now, that (IMO at least) is a QOL hit as well.

can you tell me more about the lab piece in academics? i was envisioning being involved in clinical trials, quality, possibly survivorship research. i assume lab means basic science. are more clinical research tracts realsitic? if i want to be academic (heme/bmt) does that sound right or unrealistic?

 

[frogger41]

I’m at the end of my first year of heme/onc fellowship after 6 years as a primary care clinician/educator/administrator, interested in malignant hematology. First year has been challenging - maybe more for my spouse and kids than for me - but I’ve really enjoyed the substance of the work and the learning curve has been steep but rewarding. Happy to talk more about my experience - PM me if interested.

i would absolutely love to talk more. will PM you

 

[KRMC]

i have been in private practice for 8 years now. i started with the intention of just getting some experience after residency before committing, then had a few kids and time got away from me.

i am not at a point where i feel i have to apply now or give up on heme/onc. and kicking myself for not going straight through after residency, since it all seems so much harder with a family.

so, my questions are about quality of life i guess. right now my hours and lifestyle are not perfect but very manageable, not much more that 40 per week (i am part time). but i am not satisfied taking care of the worried well and feeling as a generalist that i dont have in depth knowledge in any subject. I'm scared to be honest though of resenting the time commitment of fellowship. not scared of the pay cut, but time away from my kids and if that is worth it. and scared i will make the sacrifice then it wont live up to expectations. also wanting to do less clinical work and more science, so would want to do academic (my interest is heme) and know there are no guarantees after fellowship i will be able to do that and academics has its own frustrations.

i don't see myself in primary care forever. i thought about just leaving clincial practice and trying for a pharma job. i probably sound not committed enough, but at this point in my life am old enough to be realistic/practical....

thanks for reading. feel free to rip apart or offer advice

I have 2 young kids and also went back to fellowship after being in primary care for 5 years. It’s definitely doable. I’m sure it’s variable between fellowships, but I’m at a large academic center and I still feel like I can keep up with the pace. Feel free to PM me!

 

[CatFactorial]

Lab based research for a non MSTP without a track record (meaning, previous grants and 1st author basic science papers) is daunting. Not saying it can't be done, but very challenging. You will be in the lab when you are not in the clinic/wards. Much easier to do clinical research as there is much more clinical overlap.