Fellowship Costs

[Sneezing]

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I'm aware of the numerous aspects that go into making the decision to apply for a fellowship. There are many variables.

If you eliminate as many variables as possible and look strictly at finances, which fellowships are worth the opportunity costs of being paid a resident salary for one more year as opposed to making a general practice attending salary? In other words, which fellowships will lead to an increased salary?

Feel free to comment on private vs academic.

This is my speculation:....... Private......... Academic
Forensics...........................Yes...............Possible
C&L...................................No...................No
Child.................................Yes..................No
Addiction...........................Yes................Possible
Geriatrics..........................Possible............No
Pain..................................Yes.................Yes
Sleep...............................Possible............Yes

 

[michaelrack]

change sleep private to yes

 

[nitemagi]

I assume we're talking straight time devoted relative to salary offers right out of fellowship. Then your assumptions are probably pretty close.

I think if you can develop a niche in something you can very much significantly raise your income potential, and a fellowship can be a place to do that, though not the only place. Plus keep in mind academia and private are mutually exclusive. Many big names stay involved in academia, build a big name, then increase their earnings based on their work and reputation.

 

[Chimed]

Change child Academics to "yes."

 

[Halverson]

For the sake of argument, I'm going to assume 3 things in making a purely financial decision regarding a fellowship:

(1) You can't get board certified in the subspecialty without doing a fellowship(*)
(2) You make 50 as a PGY-5 vs. 150 for a first year employee
(3) You're going to work in a large enough population setting where people/employees are going to have choices between the two kinds of physicians

It seems the question then becomes is it worth 100k over the course of your career in each of those fields to be subspecialty board certified? If that's the case, I would answer your grid this way:

This is my speculation:....... Private......... Academic
Forensics...........................Yes........... ....Yes
C&L...................................No.......... .........Yes
Child.................................Yes......... .........Yes
Addiction...........................No........... .....Yes
Geriatrics..........................No...... ......Yes
Pain..................................No......... ........Yes
Sleep...............................No...... ......Yes

$ in the academic setting will be at least partially tied to promotion/advancement, and without a subspecialty board certification, you're fighting an uphill battle from the get-go. In the "better" academic settings, not sure you could even get hired without it, to be honest.

Purely private practice is more complicated. I don't think you're making a fantastic career as a forensic/child shrink without that certification, so you'd have to go that route.

For the others? When I look around my community and see who's making what, the distinction isn't fellowships, it's use of midlevels, expansions into nursing homes, payer mix, contracting other providers, all that stuff. Nitemagi is 10000% correct -for money in that environment, getting a niche is critical, and a fellowship may help you establish that niche, but ultimately what $ you make from it is going to depend a lot more on the stuff I just mentioned than what your fellowship status was.

(*) That's a really tough one. If you can get board certified in a subspecialty without doing a fellowship, is there any $ advantage to the fellowship? I'd think no no matter what the setting, but would love to hear what others have to say.

 

[TexasPhysician]

It seems the question then becomes is it worth 100k over the course of your career in each of those fields to be subspecialty board certified? If that's the case, I would answer your grid this way:

This is my speculation:....... Private......... Academic
Forensics...........................Yes........... ....Yes
C&L...................................No.......... .........Yes
Child.................................Yes......... .........Yes
Addiction...........................No........... .....Yes
Geriatrics..........................No...... ......Yes
Pain..................................No......... ........Yes
Sleep...............................No...... ......Yes

$ in the academic setting will be at least partially tied to promotion/advancement, and without a subspecialty board certification, you're fighting an uphill battle from the get-go. In the "better" academic settings, not sure you could even get hired without it, to be honest.

I disagree

This is my speculation:....... Private......... Academic
Forensics...........................No........... ....Yes
C&L...................................?.......... .........Yes
Child.................................Yes......... .........Yes
Addiction...........................No........... .....Yes
Geriatrics..........................?...... ......Yes
Pain..................................Yes......... ........Yes
Sleep...............................Yes...... ......Yes

I agree that in academics it would really help to be fellowship trained for job openings.

With forensics, you don't need to be fellowship trained to take on private practice forensic work. I know tons of psych docs doing forensic work - none are fellowship trained. They all make good money.

I don't know enough about C&L salary to comment.

The catch with child making more money is the severe shortage and non-fellowship docs don't want to take on the added malpractice risk. I'm biased though because this is my future fellowship.

Addiction is like forensics. I don't need an addiction fellowship to prescribe suboxone or anything else in addiction. You could start your own rehab center without being fellowship trained. I'm very interested in addiction myself, but I don't plan on doing a fellowship.

Geriatrics I don't know enough about salary.

Interventional pain pays a lot. Psych is eligible for interventional pain fellowships just like anesthesia & PM&R, etc.

Sleep private practice can do quite well from what I've seen. One sleep doc I know sees a patient every 5-6 minutes. He doesn't have enough sleep lab beds to fill 5 days worth of patients. 1 day/week is sleep patients only and he can literally see 100/day. Probably not the best way to practice, but surely that is lucrative.