Fellowship where you did residency: worth it?

[peppy]

What are your opinions about doing fellowship at the same program where you did your general adult residency? In particular, I am wondering about fellowships such as Addiction, Geriatric Psych, and Psychosomatic Medicine where a fellowship doesn't have any financial bonus but is more for the educational value/academic boost. Is it a "waste" to worth with the same people you already worked with during residency? Or is it helpful to stay where people already know and like you?

I have mixed emotions about what to do since there are a number of "practical" reasons to stay at my residency program for fellowship (including a spouse who doesn't want to move for a couple more years), but the fellowship at my residency isn't particularly strong in one specific area of the subspecialty that I have a particular interest in. It's not at all a bad fellowship (some of the faculty for the fellowship are fairly prominent in their areas of interest), but if I could disregard the "practical" concerns, it would probably not be my first choice just because of where my interests are. Any opinions from others who have been through this decision?

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[OldPsychDoc]

What are your opinions about doing fellowship at the same program where you did your general adult residency? In particular, I am wondering about fellowships such as Addiction, Geriatric Psych, and Psychosomatic Medicine where a fellowship doesn't have any financial bonus but is more for the educational value/academic boost. Is it a "waste" to worth with the same people you already worked with during residency? Or is it helpful to stay where people already know and like you?

I have mixed emotions about what to do since there are a number of "practical" reasons to stay at my residency program for fellowship (including a spouse who doesn't want to move for a couple more years), but the fellowship at my residency isn't particularly strong in one specific area of the subspecialty that I have a particular interest in. It's not at all a bad fellowship (some of the faculty for the fellowship are fairly prominent in their areas of interest), but if I could disregard the "practical" concerns, it would probably not be my first choice just because of where my interests are. Any opinions from others who have been through this decision?

Speaking as one who did this very thing (in Addiction), primarily to deepen my clinical experience and confidence, I can endorse that it certainly doesn't hurt you (except for the notorious opportunity cost issue). Chances are you haven't worked extensively and intensively with those sub-specialty faculty already, and there will be some gems to be mined there. Staying at a middle-of-the-road fellowship for personal and comfort reasons may not launch you to prominence in the same way that doing a research fellowship at Columbia or Psychosomatics at Mass General would, but most of us aren't looking for that anyway, and it will still be more than sufficient to introduce you to the field.

 

[whopper]

Going to a new place for fellowship is a mixed bag. You will have to make adjustments and reestablish your street cred to staff members and doctors in that new system but you will make new connections, might want to settle in that new area, and be in an education setting where you can learn some new things possibly not taught in residency.

Staying in the same location also can have it's problems.

A problem I noticed with where I did residency was my former PD, who was incredibly talented, was seen as the top mentor by most of the residents, and many of them stayed with the program as attendings creating a type of "intellectual incest" as academics often call it. It's for this same reason that several academic institutions will not take their own graduates, encouraging them to go elsewhere. (This doesn't occur much in medicine but does occur in other fields quite often). Further, this mentality spread throughout the entire bottom of the state. While this certainly shows you how good a teacher this former PD was, it's better in the long run to have learned from alternative points of view as well. This PD encouraged that as well but I think he was in a league so far above his fellow faculty that he stood out as a beacon of light.

I recall several instances where attendings, when asked why they chose a med, almost verbatim quoted the former PD who had the same reasoning and they were basing it from what they learned from him. Hardly any of these attendings went to other institutions.

Several fellowships part of the same residency will remove you from the same settings you were in as a resident, possibly removing the intellectual incest aspect. For example, at U of Cincinnati, the forensic fellows do not work at the university hospital at all except when evaluating people for involuntary commitment (amounts to about 2-3 hours a week), and most of the attendings the fellows work with have no clinical duties with them as medstudents or residents. The institution is also big enough for a resident to get multiple opinions of very high worth.

Several fellows and attendings I've seen that work at the location where they graduated tell me they feel as if they are not treated as attendings, stating that former teachers and staff members tend to see these people as somewhere between a resident and attending in terms of status. Oh yeah, they'll still follow orders and such but they'll always see you as the greenhorn to some degree.

Fellowship are for those that take psychiatry

 

[SeniorWrangler]

As a fellow, you'll be more independent and should be able to collaborate more with specific attendings. You don't say what you want to do post-fellowship, that matters a lot. You should talk to current fellows and the attendings you like and very specifically talk about what you want to do, after residency you should be more proactive and not just be a generic fellow.

You should also ask how the institution feels about hiring its own trainees -- mine does this all the time and I now work alongside former residents that I supervised. It's not really weird, but I know other institutions work differently and won't take you seriously.

 

[whopper]

From what I've seen, fellowships will almost always take their own grads over others because those graduates are known quantities. Whenever you take a new person, it doesn't matter what it says on paper, the person could be someone terrible.