Fellowship or Quit Medicine?

[mdapply]

I went to a solid mid tier med school (MD) and residency. Slightly above average on all steps. Worked hard, did well, and got good recommendations from faculty. Considered fellowship but wasn't passionate about anything so decided against it. Honestly do not really like being a doctor in general and have felt this way since late M3 year. I have more interest in business/alternative careers. My "plan" during residency was do hospitalist for a few years, save $$, then go non clinical. Can always fall back on hospitalist.

After a year of doing community hospitalist I find that I don't like it (which I expected). But I unexpectedly kind of have this desire to do fellowship. My reasons to pursue fellowship are more to escape gen med than genuine interest in the field. I'm seeking less BS, more focus so I don't deal with so many problems, better schedule (fewer weekends), more respect. I feel like I would like it better than hospitalist, but I do not have genuine interest in the field. Heme onc or rheum would be my choices. Could not handle PCP so not really an option.

So I have positioned myself to get back into an academic center, do research, then apply next year to start a fellowship in 2021.

But I find that I am still uncertain. Would I come out of a fellowship just as indifferent about being a doctor?

Doing something more business oriented would be less stable/more risk/less guarantee of success from the safety net of medicine. Though I know a few doctors who have been successful and are willing to help me.

What would you do? Anyone gone to fellowship to escape gen med and think that is a "good enough" reason to do it? The idea of being a hospitalist forever kind of makes me cringe.

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[deleted980918]

I would continues to work as a hospitalist and treat it as a job and not a passion. Then I would do something on the side for interest, i.e. business, restaurant or whatever interests you.

 

[kehlsh]

Just quit

 

[rokshana]

I went to a solid mid tier med school (MD) and residency. Slightly above average on all steps. Worked hard, did well, and got good recommendations from faculty. Considered fellowship but wasn't passionate about anything so decided against it. Honestly do not really like being a doctor in general and have felt this way since late M3 year. I have more interest in business/alternative careers. My "plan" during residency was do hospitalist for a few years, save $$, then go non clinical. Can always fall back on hospitalist.

After a year of doing community hospitalist I find that I don't like it (which I expected). But I unexpectedly kind of have this desire to do fellowship. My reasons to pursue fellowship are more to escape gen med than genuine interest in the field. I'm seeking less BS, more focus so I don't deal with so many problems, better schedule (fewer weekends), more respect. I feel like I would like it better than hospitalist, but I do not have genuine interest in the field. Heme onc or rheum would be my choices. Could not handle PCP so not really an option.

So I have positioned myself to get back into an academic center, do research, then apply next year to start a fellowship in 2021.

But I find that I am still uncertain. Would I come out of a fellowship just as indifferent about being a doctor?

Doing something more business oriented would be less stable/more risk/less guarantee of success from the safety net of medicine. Though I know a few doctors who have been successful and are willing to help me.

What would you do? Anyone gone to fellowship to escape gen med and think that is a "good enough" reason to do it? The idea of being a hospitalist forever kind of makes me cringe.

Doesn’t sounds like spending another 2-3 years doing something you have little interest in makes sense...

Have you looked for non clinical jobs? There are those that have gone into tech or administration or something completely non medical...remember a M3 that quit school to become a stock broker...cuz he said he was better at that...

Medical writing? Pharmaceutical work?
Saw Epocrates was looking for a physician...you never know!

 

[fasteddie911]

What's you financial situation look like? Hospitalist can be nothing more than a job, nothing says you need to love your job, plenty people don't like their jobs. You can work hard, save, and move on to something else. Going fellowship you could very well end up in the same place with 3yrs down the drain and behind the ball financially. Could also be a bad position. Lots of variability out there, maybe you can find something you can at least tolerate or maybe even like.

 

[ewax]

dropoutclub.com

nice job website for MDs who want to do something outside of medicine.

 

[mdapply]

Thanks for the replies. Financial situation is very good. I have extensively explored non clinical jobs and have even been offered one. The possibility of doing fellowship is really the main thing holding me back since going non-clinical would essentially close that door. I'm worried the grass isn't greener in the non-clinical world and I would like a specialty more.

 

[bronx43]

Thanks for the replies. Financial situation is very good. I have extensively explored non clinical jobs and have even been offered one. The possibility of doing fellowship is really the main thing holding me back since going non-clinical would essentially close that door. I'm worried the grass isn't greener in the non-clinical world and I would like a specialty more.

What fellowship are you considering? Some may provide a way into non clinical jobs.

 

[mdapply]

@bronx43 Heme Onc or rheum but leaning more toward heme onc. I have thought about the fact that a fellowship would also open up more nonclinical jobs (most specifically pharma). Of course there is the possibility of not matching but from people I have talked to I should at least have a decent shot.

 

[bronx43]

@bronx43 Heme Onc or rheum but leaning more toward heme onc. I have thought about the fact that a fellowship would also open up more nonclinical jobs (most specifically pharma). Of course there is the possibility of not matching but from people I have talked to I should at least have a decent shot.

Onc would be easiest into pharma and non clinical jobs overall. But the question is if that opportunity cost is worth it. Hard to say honestly. Maybe you can find a chill program and moonlight on the side.

 

[mdapply]

@bronx43 Yes the opportunity cost is huge. My earning potential would be higher, but would still take many years to make up the lost income. Probably would never make up the money in something like rheum. Would definitely make sense if I knew I would like it.

At my IM program a good number of my classmates openly admitted they were doing fellowship to avoid gen med, not for genuine interest in the field. I would think this is common across the nation. I always thought that wasn't a good enough reason, but it's starting to make sense.

 

[GastriqueGraffin]

dropoutclub.com

nice job website for MDs who want to do something outside of medicine.

The domain is for sale. Guess they couldn’t afford to keep it open after their decision to go to medical school and then drop out without completing residency.

 

[mdapply]

@GastriqueGraffin They actually just changed the name to DOCjobs several months ago. It is still around. I'm very familiar with the site and subscribe to new job postings haha

 

[DrMetal]

@bronx43 Heme Onc or rheum but leaning more toward heme onc. I have thought about the fact that a fellowship would also open up more nonclinical jobs (most specifically pharma). Of course there is the possibility of not matching but from people I have talked to I should at least have a decent shot.

So, you don't like being a doctor but you want to go into the subspecialty that deals with some of the sickest patients out there, in some of the most dire circumstances? Please don't. I commend you for your honesty, but that sounds like a recipe for disaster.

And you'll probably have to actually practice in heme/Onc for a while seeing hundreds if not thousands of patients, before you can realistically go into pharma and advise on clinical trials, or whatever have you. Most companies like having a practicing physician (or someone who has practiced a lot) on their boards, you need the street cred.

 

[cards67]

A bunch of co-residents who did fellowship to avoid gen med usually at least like the subspecialty of choice, not necessarily loved it though. Certainly the opportunity cost is a concern. I went into cards, but if I didn't have a pretty strong interest in it I probably would've stayed gen med. One thing to think about are job opportunities. Gen med you can find a job pretty much anywhere in all kinds of setups, PP, employed, weekends, part-time, locums, housecalls, nursing homes, etc. For something like hem-onc, your options may be more limited. For me, jobs are pretty competitive in desirable areas, lower pay, often restricted to a few PP groups or hospitals, whereas gen med jobs in these same areas are plentiful with pay maybe only 50k less or so.

 

[wjs010]

If you don’t mind, what are you making as a hospitalist? And is this base or have you also moonlighted?

 

[ExplodingUlcers]

Having worked an office gig before med school, I can certainly say that a non clinical gig is the same **** but a different toilet.

Whenever you deal with anything in business, It's honestly just about the bottom line. You are a cog in a machine that must generate income for an organization and if you don't then bye Felicia.

Another thing is that you need to make sure you're covering your a$$ because when **** hits the fan, make no mistake that no one will stick out their neck for you, even if you did everything correctly. Trust no one! Any slight hiccup and you can easily be the scapegoat depending on the situation.

You'll always have someone to answer to in the corporate chain of command who doesn't have the faintest idea of what's going on in (see the Peter Principle).

I guess all these things are true in medicine too. From a hospital's perspective, a physician is essentially a depreciating asset that makes them money and if they're not documenting everything correctly, the hospital can't bill for the service, opens themselves up for liability or leaves money on the table.

That's why I said it's literally the same **** but different toilet. Just pick which toilet you want to be in and try to keep your head above it.

 

[deleted480308]

Interest is overrated, line up the next thing before you jump ship

 

[IMreshopeful]

Having worked an office gig before med school, I can certainly say that a non clinical gig is the same **** but a different toilet.

Whenever you deal with anything in business, It's honestly just about the bottom line. You are a cog in a machine that must generate income for an organization and if you don't then bye Felicia.

Another thing is that you need to make sure you're covering your a$$ because when **** hits the fan, make no mistake that no one will stick out their neck for you, even if you did everything correctly. Trust no one! Any slight hiccup and you can easily be the scapegoat depending on the situation.

You'll always have someone to answer to in the corporate chain of command who doesn't have the faintest idea of what's going on in (see the Peter Principle).

I guess all these things are true in medicine too. From a hospital's perspective, a physician is essentially a depreciating asset that makes them money and if they're not documenting everything correctly, the hospital can't bill for the service, opens themselves up for liability or leaves money on the table.

That's why I said it's literally the same **** but different toilet. Just pick which toilet you want to be in and try to keep your head above it.

The other dirty secret... you don’t have to work for anyone as a physician

If you’re enterprising, good with people, and have grit you can open up a practice (certainly in gen Med). You can be beholden to nobody but yourself. And I think it’s relatively easy compared to other professions where starting a business can be a horrendous loss

 

[mdapply]

@sb247 What do you mean?

 

[deleted480308]

@sb247 What do you mean?

I mean being excited/interested in your work is not at all necessary. It’s a first world problem.

So have your next means of providing for your finances arranged before you bail on a perfectly fine job

 

[GastriqueGraffin]

I mean being excited/interested in your work is not at all necessary. It’s a first world problem.

So have your next means of providing for your finances arranged before you bail on a perfectly fine job

There is definitely a lot of truth to that but medicine is not a job, it’s a career and arguably a lifestyle. Being a doc that is checked out because of lack of interest (which is a frequent cause of burnout) is not the same as being as being a teenager checked out working a summer job at a store. But I do agree that you should have something lined up before leaving a perfectly fine job.

 

[mdapply]

I mean being excited/interested in your work is not at all necessary. It’s a first world problem.

So have your next means of providing for your finances arranged before you bail on a perfectly fine job

There is definitely a lot of truth to that but medicine is not a job, it’s a career and arguably a lifestyle. Being a doc that is checked out because of lack of interest (which is a frequent cause of burnout) is not the same as being as being a teenager checked out working a summer job at a store. But I do agree that you should have something lined up before leaving a perfectly fine job.

@sb247 @GastriqueGraffin I agree that being excited/interested is not necessary. I just don't see being a hospitalist or PCP as a sustainable job long term for me. I think many people who have worked in these settings would agree. It's a "fine" job in that it pays relatively well and is stable and in high demand. Although we all worked hard, I do realize I am lucky that I have the ability to make a stable, high salary with lots of flexibility.

I guess I could rephrase my initial question and ask if you would pursue something non clinical or go to a fellowship at this point early in my career? I don't think I would be "jumping ship" if I did something non clinical as I would likely moonlight once or twice a month and maintain licenses and board certification. Could always go back to full time medicine. Not much would be lost since medicine is something of a "dead end" job since you don't typically make a significantly different salary with 1 year of experience vs 10 + years experience as an employed physician.

 

[Dusn]

How close are you to reaching FI (financial independence)? What's your net worth vs your annual spending? What's your current income? I would definitely do the non clinical career over fellowship based on what you've said but typically the non-clinical career will pay far less.

 

[DoubleBogey]

Become an Epic/EMR physician trainer - I’ve seen multiple physicians who don’t practice anymore d/t your exact feelings. Start a company and get your levels/certifications, provide consulting guidance - partly clinical but no pt interaction and you get to see how certain healthcare systems run.

 

[deleted547631]

Thanks for the replies. Financial situation is very good. I have extensively explored non clinical jobs and have even been offered one. The possibility of doing fellowship is really the main thing holding me back since going non-clinical would essentially close that door. I'm worried the grass isn't greener in the non-clinical world and I would like a specialty more.

If money is good and you're close to being financially independent or are already there then would you consider opening an 'ideal' or concierge practice? It could be refreshing to be your own boss.

 

[GastriqueGraffin]

Become an Epic/EMR physician trainer - I’ve seen multiple physicians who don’t practice anymore d/t your exact feelings. Start a company and get your levels/certifications, provide consulting guidance - partly clinical but no pt interaction and you get to see how certain healthcare systems run.

That sounds depressing AF

 

[xoggyux]

In my experience, when people have not made up their mind for a single specific specialty, it is because they have alternate motives and not because they like the specialty. I think that's a poor way to make a career, potentially lifelong decision especially if you putting 2-5 years of your life, high income on the line without guaranteed payoff (aka. will you enjoy it?). I suggest you pinpoint the actual reason why you are considering it, otherwise nobody will give you good advice.
If you don't like medicine, you don't need to be ashamed of it, and you don't need to quit right now. Many people find out that they don't like medicine but it is too late to turn the train around, family, peer pressure, loans, etc... So if you don't like medicine, the first step is to recognize it and my suggestion would be to stop investing your time and sweat in medicine and branch out slowly as soon as possible. Keep in mind, that once you have been away from clinical for a while, it might be difficult to return so plan your strategy very well.

 

[DoubleBogey]

That sounds depressing AF

I wouldn’t personally do it, but the physicians I’ve seen doing it appear happy/content for what it’s worth

 

[GastriqueGraffin]

I wouldn’t personally do it, but the physicians I’ve seen doing it appear happy/content for what it’s worth

They spent years learning the art and science of medicine only to work basically as IT/billers for an EMR and they are happy about it?

 

[DoubleBogey]

They spent years learning the art and science of medicine only to work basically as IT/billers for an EMR and they are happy about it?

Yes, because maybe some physicians want to make a physician salary by not seeing patients...more common than you think.

 

[1Cor1557]

I mean being excited/interested in your work is not at all necessary. It’s a first world problem.

So have your next means of providing for your finances arranged before you bail on a perfectly fine job

Yes! Yea man, tons of us did fellowship just to get away from gen med.
There is no better feeling in the world than being to say "c/w ppi, see pcp for other 12 problems " or "rest of care per primary".
Who has immigrant parents? Who here hasn't heard from them that
"You like what you do, not do what you like!"