fellowship options and market

[nymedstudent874]

thanks

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[DoctwoB]

IMO you should only do a fellowship if you have a specific goal in mind that requires a fellowship, like being an academic oncologist. You can do more then you think as a generalist if you had good training. In my experience generalists and female are highest in demand, onc and recon probably the most saturated. That being said as an oncologist many will take a general job and build a more oncology focused practice over time which is very feasible. Also all of my friends doing onc and recon have ultimately found good jobs they’re happy with, you may just have less ability to pick your location compared to general.

Im a generalist and I work in a metro with 2 academic centers within 30 min and still do a fair number of majors. Not as many as a full time oncologist, of course, but probably about 2 prostate/partials/pyeloplasties etc. a month, in addition to plenty of stone, bph, female and some recon. I have no regrets about skipping fellowship and when that rare RPLND or level 3 caval thrombus or micro TESE comes along I’ll send it to the academic center with no regrets. Most other things I’ll handle myself.

 

[DoctwoB]

With stipends during residency, I’ve heard of that but only seen it for rural, hard to recruit places. So if that happens to be where you want to go then great. Just know that most are structured as loans that are forgiven if you are at the practice for a certain period of time, which also usually means a tax burden as the loan forgiveness is treated as taxable income. Signing bonuses (I got one for 10k) are much more common.

 

[cpants]

There are 2 reasons to do a fellowship:
1. You need additional training to get the skills to do what you want to do in practice (most would need more training to focus on recon or female for example)
2. Fellowship is required to get the job you want (ie. academic or in some cases major city job)

If you don't need additional training to do what you want to do, don't invest the time and money to do fellowship.

In my opinion, you shouldn't need a fellowship just to do robotics, but I understand that the training may not be strong enough at a lot of programs. General urology and female are definitely the most in demand. If you have any interest in female, I would take a hard look at that because you will be extremely marketable.

I would try to avoid any forgivable loans if possible. Signing bonus or stipends are cool, but it shouldn't be tied to you being required to stay somewhere for years. What if your first job is terrible? It happens.

 

[xDNA]

Is the demand for female due to continuously increasing patient load or just not enough FPMRS? I would think its the former since FPMRS is shared between OB/Gyn and Urology.

I read in an older thread that FPMRS doesn't increase the salary of Urologist significantly, so Residency + 2 or 3yrs for FPMRS isn't very appealing to a lot of people.

 

[cpants]

Is the demand for female due to continuously increasing patient load or just not enough FPMRS? I would think its the former since FPMRS is shared between OB/Gyn and Urology.

I read in an older thread that FPMRS doesn't increase the salary of Urologist significantly, so Residency + 2 or 3yrs for FPMRS isn't very appealing to a lot of people.

I would say shortage of FPRMS trained individuals. I don't think any fellowships really increase your income. Cranking it doing general urology is probably the best way to make a lot. Certainly female can be lucrative if you set up efficiencies to do a lot of in office procedures and urodynamics.

 

[nymedstudent874]

Thanks for the advice @cpants and @DoctwoB definitely things to think about. How did you both go about researching location? Ideally I'd like to practice ~45-60 min from a major NE city so I benefit both the patients there as well as not but I imagine those jobs are harder to come by.

 

[DoctwoB]

Thanks for the advice @cpants and @DoctwoB definitely things to think about. How did you both go about researching location? Ideally I'd like to practice ~45-60 min from a major NE city so I benefit both the patients there as well as not but I imagine those jobs are harder to come by.

You’d be surprised. Finding the midtown Manhattan job might be tough (or pay very poorly). Finding a job an hour outside the city is pretty easy, especially for a generalist. I didn’t look in the market personally but know a few that didn’t have much trouble landing jobs in the area. I can’t tell you how many recruiting emails I get about that job 1 hour from city X with 4 unused robots and 800k earning potential. Sure some of these are BS, but clearly the demand is there.

Be flexible about the city (ie more then Boston and NYC) and it gets even easier. Lots of jobs in/outside the upstate cities like Syracuse, Buffalo.

 

[cpants]

Agree with @DoctwoB that an hour outside of a NE city should be easy for a generalist, especially if that city doesn't have to be Boston or NY. I'm about 90 min outside Boston in a nice area and it's very difficult to recruit anyone. The supply is just very low. If you're looking for a good gig in New England, hit me up.

 

[RinShanKaiHo]

Can someone comment on saturation and job prospect for male infertility <1hr or so around major NE cities? Is it the same fellowship as the IPP folks or it's somewhat different?

 

[cpants]

Can someone comment on saturation and job prospect for male infertility <1hr or so around major NE cities? Is it the same fellowship as the IPP folks or it's somewhat different?

If you are willing to do some general urology also, you shouldn't have a problem finding a gig. Most practices would be glad to get someone with the impotence skill set. Just be prepared that you are going to be doing a lot of hormonal work and impotence work and not a lot of infertility pretty much wherever you go.

The issue is that while male factor infertility is not that rare, most of them will not require urological or surgical intervention. Still possible to build a fun surgical practice doing vasectomies, vasovasostomies, implants, etc along with some general.

Fellowship is Impotence and Infertility together.

 

[sadpucker]

If you are willing to do some general urology also, you shouldn't have a problem finding a gig. Most practices would be glad to get someone with the impotence skill set. Just be prepared that you are going to be doing a lot of hormonal work and impotence work and not a lot of infertility pretty much wherever you go.

The issue is that while male factor infertility is not that rare, most of them will not require urological or surgical intervention. Still possible to build a fun surgical practice doing vasectomies, vasovasostomies, implants, etc along with some general.

Fellowship is Impotence and Infertility together.

Thanks for the info! How good is compensation for infertility + IPPs? I would imagine a good amount of the procedures are elective and generate good cash flow? Let's say a pp folk 1 hr out of city like DC or Philly, does infertility + IPP with some general uro

 

[cpants]

Thanks for the info! How good is compensation for infertility + IPPs? I would imagine a good amount of the procedures are elective and generate good cash flow? Let's say a pp folk 1 hr out of city like DC or Philly, does infertility + IPP with some general uro

IPP reimbursement is fairly good. It is usually paid by insurance, not a cash-only procedure. Good money for doing vasovasostomy and any infertility procedures which are generally cash payment. In most cases I don't think the income potential is much different than that of any other type of urologist. Exception would be if you build a big infertility practice in PP -- but again, unlikely that this is possible for most.

 

[mestielest]

(I'm not from the US) Agree with @cpants and I suppose you can make a good deal with general urology + some self-specialization. One "off-the-record" advantage is you can also refer problematic patients to an academic center

 

[DoctwoB]

IPP reimbursement is fairly good. It is usually paid by insurance, not a cash-only procedure. Good money for doing vasovasostomy and any infertility procedures which are generally cash payment. In most cases I don't think the income potential is much different than that of any other type of urologist. Exception would be if you build a big infertility practice in PP -- but again, unlikely that this is possible for most.

This is also an area where how you are reimbursed is essential. If you work for a group/hospital and your salary is RVU based, vasovasostomies and infertility procedures actually reimburse very poorly because the RVUs/hour is quite low. If you are paid based on collections they are lucrative as they are cash pay and usually quite pricey.

 

[Lebron's hairline]

Can someone comment about the job market for PP in the CA bay area? I'd like to head back there someday after residency.

 

[DoctwoB]

Can someone comment about the job market for PP in the CA bay area? I'd like to head back there someday after residency.

There are jobs, but it depends on your timing. The main employers are Stanford, UCSF, Kaiser, Palo Alto medical foundation (PAMF), and the county health care systems. There is also some decent size private groups in SF and east bay like golden gate urology. They have all been hiring recently, though it has slowed down of late. There will be more retirements and openings, it will just depend on hiring at the time you are looking at