Fellowship/"Assistant Professor"

[McPoyle]

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Hey all, quick (likely ignorant) question.

How does compensation work for surgical fellows? When I look at programs website it seems that their charts only go to PGY7... however I'm interested in surg onc or HBP which in all likelihood may mean I could potentially be upwards of PGY10. Some places say something along the lines of "...fellows act as assistant professors of surgery" and at least at my institution residents on the general service can staff a patient with say an endocrine fellow?

So, with that said, is compensation different for surgical fellows, or is it still basically a residents salary with more responsibility but maybe slightly better hours?

Thanks in advance.

 

[ESU_MD]

If its a real Acgme accredited fellowship like vasc, plastics ,etc. Then they can get away paying you pgy6 salary. The so-called unaccredited fellowships will often be able to pay more since they can bill for your services since it is not a true fellowship officially.

In the cardiac world, superfellows in transplant, vats/thoracic, aortic, etc. Usually make >$100k. Same is mostly true for the general surgery stuff like endo or surgonc

The surg onc guys may be screwing their fellows by becoming accredited, since now they wont be able to bill as attendings/1st assists.

 

[ajlmd]

ACGME accredited fellowships (colorectal, vascular, plastics)- you are a PGY-6 + resident and are paid as such. Usually a little more than a PGY-5 though significiantly above $60,000 for a PGY-6 would be unusual. You may or may not have to have a full medical license in that state (it depends on the program)

Bonus- usually more structured standards on what the fellowship must meet to remain accredited, the protection that comes by still technically being a resident. You come out with the ability to obtain board-certification in the specialty.

May or may not be able to moonlight, which can mean significantly more $


ACGME non-accredited fellowships include minimally invasive, transplant, hepatobiliary, surg onc (though not for long)- you are technically a "fellow" and not a PGY-6 resident. You usually will be employed as a "clinical instructor" and functionally can often behave as junior faculty. I don't know of any places that would employ a fellow as an assistant professor and give them the salary associated with such.

The pay may be slightly higher ($60-70K), if at all. Often nonaccredited fellowships get funding from industry (Ethicon, Covidien, etc) so your salary will be a portion of that money.

It depends widely on the program, though in some places you may function as an attending at times (taking independent call within the group, being able to independently staff cases). Billing may also be different within the department for cases you participate.

+/- the ability to take call (and get paid for it) as well as moonlight

Positives- a year or more of experience in the field, a certificate from that institution upon the completing the fellowship that you are trained in that subspecialty

Negatives- less structure on what the fellowship has to provide. There are no boards for these specialties so when you finish you not eligible for any board certification beyond general surgery.

 

[Winged Scapula]

I think we need to clarify "Non-Accredited".

The ACGME is not the only body to accredit fellowships. For example, the SSO (Society of Surgical Oncology) accredits its own fellowships for Surg Onc and Breast. These are not accredited by ACGME but they are not "non-accredited".

So there are:

ACGME accredited fellowships
Specialty accredited fellowships (ie, SSO)
Non-accredited fellowships (these are generally the ones to avoid)

Fellowships that are not accredited by the ACGME do not need to follow ACGME rules. Salaries do not need to follow the PGY format (but often do), nor do they need to adhere to work hour regulations (but often do). The industry funded ones are often the highest paid.

I was in an SSO accredited program, paid as a PGY-6, allowed to moonlight but
had faculty responsibilities (call, rounding, etc.) on Surg Onc (if not the salary...LOL).

 

[toxic-megacolon]

I'm interested in surg onc or HBP which in all likelihood may mean I could potentially be upwards of PGY10.
Thanks in advance.

You can do HPB in 6 years if you do a little research during your residency. PGY10 is for pediatric cardiac surgeons and other such nonsense.

 

[ajlmd]

I think making the distinction between ACGME and specialty accredited fellowships versus non-accredited is a good point that I did not clarify.

Watch out for when you are looking- though you may get a great clinical experience at an altogether non-accredited program it is widely variable and not guaranteed. You may end up with excellent skills at the end but won't have much to show for it.

 

[Buzz Me]

Some fellowships will count lab time as a PGY year as well. So you may start your accredited fellowship as a PGY-7 or PGY-8, and be paid as such.

 

[igap]

Be aware that the "attending" status conferred on fellows at some programs is not necessarily a good thing.

I know programs in my field that give their fellows "attending" status, simply to cover call. For example, a program may cover a busy county hospital, and since the ED is very busy there and reimbursement is poor, guess who will be the one covering call there, and staffing all of the washouts, debridements, and other junk cases? The fellow with "attending" privileges. This happens at some of the country's most prestigious programs so beware.

My opinion only of course, but I don't think you should be picking a fellowship based on how much money you will earn during that year. I recommend picking the program that you think will give you the best training. Save the $$ thinking for negotiating your practice after training.

 

[McPoyle]

Be aware that the "attending" status conferred on fellows at some programs is not necessarily a good thing.

I know programs in my field that give their fellows "attending" status, simply to cover call. For example, a program may cover a busy county hospital, and since the ED is very busy there and reimbursement is poor, guess who will be the one covering call there, and staffing all of the washouts, debridements, and other junk cases? The fellow with "attending" privileges. This happens at some of the country's most prestigious programs so beware.

My opinion only of course, but I don't think you should be picking a fellowship based on how much money you will earn during that year. I recommend picking the program that you think will give you the best training. Save the $$ thinking for negotiating your practice after training.

Oh no, I wasn't really factoring fellowship salary into my career plans, simply a curiosity I noticed and wasn't sure how it worked. Thanks for the heads up regarding some of the pitfalls to the position though.

 

[Buzz Me]

I recommend picking the program that you think will give you the best training. Save the $$ thinking for negotiating your practice after training.

Exactly.