Hi Q,
Thanks for your the helpful post. Good luck with your application for Fellowship! In your opinion, does the "gap" make any difference when applying for fellowships? In case of residency applications, this was a big deal and one better have a explanation for it.
Now if one works after the residency say in a primary care setting or as a hospitalist for a year or two then applies for fellowship in IM sub specialty, is having worked after residency a liability or an asset? Is such a candidate stronger than say someone who hasn't worked at all and applied for fellowship during residency?
Thanks again for your time!
It's different applying for fellowship than for residency in many cases, simply because it's more of a buyer's market. You don't need to do a fellowship to practice medicine, but your MD or DO is essentially useless without a residency. That puts a much greater premium on getting a residency, because unlike a fellowship, completing a residency is not optional. But once you finish your residency, you always have the option to continue on doing general internal medicine, and plenty of people spend their entire career as a hospitalist or PCP. Of course, there are some popular subspecialties like cards or GI that are relatively competitive, and maybe for those, time off after residency might be an issue. But the subspecialty I'm applying in actually has more slots than applicants, so no, the programs don't want to shut out an eligible applicant who spent some time in general practice. At one program where I interviewed, they told me they had trained someone in their 50s who had been out practicing for a couple of decades. Compared to that, my three years out doesn't seem so crazy!
I'm sure it also matters what you do during your time out of training. If you spent that time doing something nonmedical and then suddenly wanted to jump back into medicine, that might be an issue. Whereas, if you spend the time working in a clinical setting along with getting BC, that obviously doesn't make people concerned that you can't hack the fellowship clinically the same way it might if, say, you'd taken a few years off to sail around the world or something.
In addition, fellowship PDs know that someone who is leaving FT practice as an attending to go back for training is sincerely interested in doing the fellowship. You don't make a change like this unless you're serious about the subspecialty. I'm leaving a good tenure track academic position to take a fellowship that will pay me about 20% as much (not including moonlighting, of course). And afterward, I can expect to make less money as a subspecialist than I currently do. So yes, people do ask me why the wait, but no one questions my interest or sincerity. And actually, I haven't been asked if I'd mind taking orders again as a trainee, either. Maybe it's because I was a nontrad (started med school at age 31), or maybe it's because the fellowship is a bit less hierarchical. I don't know.
I think if you know what you want to do by next year, it makes sense in many cases to go ahead and apply straight out of residency. There's no doubt that it's harder for a lot of people to go back to training (especially financially) after they've been out for a while. But if you don't know for sure, or if it's financially not feasible for you to go straight into fellowship training, it probably won't hurt you to practice general medicine for a year or two before you apply. And as IlDestriero suggested, it may even help you in some cases.
Though this was in anesthesia so the fellowship isn't entirely different than what I'd be doing in the fellowship as opposed to how general IM and a subspecialty might be.
