Long story short, I graduated FM in 2016. Have been working as a full time hospitalist and APD (for the last year) for a 20 physician and 6 NP group since then but the urge to do a sub-IM fellowship (interventional cardio) is strong now. Would I be able to get a PGY-2 spot in IM? If so do I go through the normal match process?
Going back for a 2nd residency?
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No, at best you could get 6 months credit for pgy 1...is the urge so great that you are willing to do 8 more years of training?
I had calculated 6 years if I had got a 2nd year spot. I know a friend of mine got a 2nd year spot, but he also was a Hospitalist with the University group, guess that probably played some role. I have thought about it and I do go back and fourth to be honest.
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I would strongly consider the time committment as a factor
IM residency is hard. Being a hospitalist is not the same as going through IM training. Your FM background will help with outpatient medicine for sure but not that much with inpatient especially subspecialty services, ICU, etc
You’re aiming for cardiology, a very competitive fellowship which requires a good amount of research in residency and you have to go to a residency which has both the resources and reputation to get you into a good fellowship. Doing IM and then NOT getting fellowship especially if you’re working already as a hospitalist is a colossal waste of time and money.
Interventional cardiology is in some ways even more competitive. Although most programs have their own fellowship that they can select internal applicants for, if you apply elsewhere you often have 15-20 applicants interviewing for one spot. And there’s no match. Also requires some research interest and productivity to get interviews.
Then to top it off, fellowship training is hard. Long hours, sick patients, often with their lives in your hands. It’s lot of stress and tiredness. It can be rewarding but not for everyone.
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Is this urge worth 7 years (assuming you match cards and you understand there is a risk of not matching, and then assuming you match interventional and you understand there is a risk of not matching) and 1.4 million dollars? Don't know the answer if you can get PGY-2, but I assume not as you wouldn't have completed all PGY-1 IM requirements.
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deleted480308
I agree with the large risk of going back and then not getting cards
But I have to disagree on a FM trained hospitalist not being able to pull weight on inpatient IM rotations. OP should be crushing new residents
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Gen med sure. Depends on how good the experience was in FM residency. Some I’m sure are good. My experience is that they don’t do as much time inpatient compared to IM. Unfortunately the FM service at my shop was very weak - low acuity patients with very low threshold to consult specialists. But I meant more things like CCU, inpatient oncology, inpatient liver, MICU, etc
The main advantage is that they have experience backing them and can prob function much more efficiently
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The original post says he spent three years doing inpatient medicine since completing residency as a hospitalist.
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My god please don't do this to yourself
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ABIM only accepts 6 months credit from family medicine residency. Even if you do get into cardiology, that’s over $2M in lost income.
What kind of hospital do you work in now?
dude don't do it!!!! As someone who essentially wasted 3 years + in switching residency I gotta tell you don't do it!! It's a massive massive massive waste of time not to mention that there is no guarantee that you'll get a fellowship! you are also trying to get probably one of the most competitive IM fellowships - interventional cards. Don't do it! there's no guarantee you will get it even if you do get an IM spot. Think of all the money you will lose! not to mention the massive massive loss of life and time. I don't know how much you make but get some ancillary services, do something on the side, etc if it's just $$$. Don't spend more of your life training man. Won't you be super disappointed if you go through another 2.5- 3 years of hellish residency (and i would agree with whoever said that IM is hard ) for potentially ending up doing about the same of what you are doing now?No thanks.
I felt in my current life state (fairly young age, single no kids) that if I was going to do it it's now or never. Agreed with what you say on the risk of not getting the fellowship, it would be tough to swallow.
Haven't taken the plunge yet just wanted to get some insight from everyone here.
Small community hospital around 270 beds. Figured with the higher salary of a cardiologist it would even out 8-10 years down the road, maybe..
Just out of curiosity what did you switch from and to?
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270 beds and "small" don't go together.
let's say medium then. I was comparing it to those bigger tertiary care centers with 800+beds
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I’ll go against the grain here and support your urge. The only thing worse than spending a few years doing another residency is spending a few decades in a field you don’t like. If you can handle the extra stress - both psychological and financial - and this is truly what you want, then I say go for it.
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Just depends how much you think you'll love cards and how much you like/dislike what you're doing now.
I had a similar situation (not residency switching), and I had to think long and hard about $$$$$$/time. I decided in the end, I would always regret not trying. It was a hell of a long shot but it worked out for me.
It really comes down to what is worse for you, regretting not trying or lost income/time.
I had a similar situation (not residency switching), and I had to think long and hard about $$$$$$/time. I decided in the end, I would always regret not trying. It was a hell of a long shot but it worked out for me.
It really comes down to what is worse for you, regretting not trying or lost income/time.
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Man, I read this and the first thing I thought of was Paul Bettany playing Silas in "Da Vinci Code" where he flagellates himself with a whip throughout the whole movie.
I just find it really difficult to think this will be worth it in the long run when you factor in the enormity of personal sacrifices you're going to be forced to make. There's no way this won't wreck your finances, your personal life, your relationships, not to mention the added gray hair and will probably also knock 5-6 years off your lifespan. I would only do this if you felt somehow that this was your life's calling that you had somehow missed out on, but keep in mind....almost every specialty gets old and dull after awhile and all of us start looking at other fields wishing we could wear another pair of sneakers from time to time. That's totally normal.
I just find it really difficult to think this will be worth it in the long run when you factor in the enormity of personal sacrifices you're going to be forced to make. There's no way this won't wreck your finances, your personal life, your relationships, not to mention the added gray hair and will probably also knock 5-6 years off your lifespan. I would only do this if you felt somehow that this was your life's calling that you had somehow missed out on, but keep in mind....almost every specialty gets old and dull after awhile and all of us start looking at other fields wishing we could wear another pair of sneakers from time to time. That's totally normal.
I would invest the time you have in working more to earn more $$$ and retire or semi-retire in your mid-40s and find enjoyable stuff to do with your life.
I don't know how inpatient medicine was when you did your FM residency, inpatient IM where I am is brutal man...
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I personally don't know any place where inpatient medicine is not brutal? Even where I did prelim internship at a sleepy community hospital IM was brutal. I don't know of too mnay people who can retire by mid 40's, particularly given that many people don't graduate until 30's these days.... Not to mention - what would most people do for 40+ years?
Really... In my mind, anything below 400 beds is a small hospital...
I also said semi-retire (aka working 2-3 days/wk). Physicians can do that if they are single and use their money wisely...
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I would hope that not too many docs are single in their 40's
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I mean, it all depends on your spending.
I could retire sometime in my late 30s pretty easily if I wanted based on my current salary, debt, and net worth. Just would need to limit my spending to $40-50k/year. I had a number of advantages though with regards to timing and family assistance - even still, most physicians could do the same by their mid-40s.
I don't want to limit my long-term spending to that sum though, and most other physicians don't either.
You've saved about 2.5 million already? If so congrats. I don't think most of us have. If you retire at say 38 and live for 50 years to say 88, on 50k it would be about 2.5 million.
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Have you not read his financial advice? If anyone could retire by 40, it’s him...and that’s on an endo salary!
I would so have him as my financial advisor !
I can without hesitation say that I have not read his financial advice but I'm happy to read it if someone shows me where. I also don't really know how much endos make honestly.
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To spend an inflation adjusted 40k a year at a 3.5% withdrawal rate (which is enough for an indefinite retirement) you need about $1.2 million. $50k would be $1.5mm. I don't have that now but if I lived on $40-50k a year, I would by my mid-late 30s depending on the market. Probably 40 years old at the latest with my personal situation.
Remember that money grows, so you don't need 50 years x 50k up front...
I plan on spending more now and in retirement though.
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Median endo makes around $250k, less in academia. About the same as primary care money - the fellowship isn't worth it from a financial standpoint. Still like my life better than if I was doing primary care though.
Financial advice on SDN can be seen at the finance and investment forum ( Finance and Investment ) and the practicing physicians forum ( Practicing Physicians ). The latter requires verification of credentials.
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How do you get into the “Practicing Physicians” forum? I have no problem sending my credentials to whomever needs them but how do I even initiate the process?
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The easiest way is to get the Verified Physician badge through the process at Doctor Verification
Then you can send a message to @Winged Scapula and she'll let you into the forum (it may or may not be automatic with the verification process - it used to be but I think they brought back the human component)
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Thank you.
Yes there is a “human component” because the practicing physician forum should be limited to people who are in the last months of training or have completed training. However the badge can be obtained by anyone who has graduated medical school. We were unable to divorce the two without the “human” verification
We asked that users post in the account Desk forum and tag me.
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I think after looking at the bigger picture the time, lost money and effort for 6 years with no guarantee isn't worth it. Plus it's not like I'm not happy, I do enjoy my job (minus the social work aspect). Plus I want to retire early so that alone should give me my answer. Appreciate everyone's input.
Yes good choice! Not to mention you can always do other stuff within your field and branch out in many ways when you do get bored of your current job. Keeping relationships intact as a physician is important 🙂
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You're generalizing, big time. Tons of FM residencies have extremely good inpatient training and any FM residency prepares you to be a hospitalist.
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Then why is there a 1 yr Hospital medicine fellowship for FM?
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There's hospitalist fellowships you can do after IM too. Mind you, they're mostly focused on QI and other administrative stuff, but they still exist.
I'll disagree with both of you a bit. I think that there's a lot more heterogeneity in the focus on inpatient adult medicine in FM programs than IM programs.
In IM, we must do at least 12 months of inpatient medicine (including ICU) over the course of the 3 years - and I don't know any program that is anywhere close to the minimum. Most of us do closer to the maximum of 21 months (12 months must be outpatient including EM, and 3 months is average for vacation over 3 years - out of 36 months total).
In FM, there's a lot of other things that need to be fit in - more extensive clinic requirements, Ob requirements, peds requirements, etc. So while some programs get them enough adult inpatient experience that they are competent in the hospital, not all programs do. If I recall correctly, the FM program at the institution where I did residency averaged 7 or 8 months total inpatient adult medicine over their 3 years - including the ICU month they did on "our" service. Other programs in other parts of the country - particularly at hospitals without a concurrent IM residency - do significantly more. Hence why many urban and suburban hospitals will only consider BE/BC internists for their hospitalist groups - it's just easier than trying to vet someone who may or may not have adequate training.
@MedicineZ0Z says "tons" of FM programs have extremely good inpatient training and I have no idea what proportion is what, but certainly some do - and many don't. Just like some FM programs put out people who have the confidence to continue with Ob and many don't - even though they all theoretically meet their minimum numbers.
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No, not any FM residency. Some sure. Not all. On average much less inpatient time compared to IM. No need to get defensive.
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Yep. There's a new program in my state that just opened at an HCA hospital. 6 months of adult inpatient. Across 3 years.
They have no business being hospitalists.
While I have never wanted to do inpatient, I ended up with I think 13-14 months inpatient during my training (I did extra ICU rotations during electives because I'm an idiot). Still not nearly what you IM folks do, but we have had several residents including 2 from my class go on to do inpatient and they did fine.
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deleted480308
I think it also depends on if we’re talking closed icu, are you running vents, procedures, etc
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Can always depend on SDN to get into a pissing contest over something.
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6 feet, beat that pansy!
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Those GIM fellowships are more for becoming academic internists not more education on how to handle inpt care.
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13-15 mos seems to be standard at the cat FM program here as well for adult medicine/ICUs. It definitely varies though. I saw numerous FM programs that have way more outpatient in med school.
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Dude, we have NP hospitalists and PAs who do inpatient.
Because NP/PA are doing it, that does not mean they are good at it. There are a lot of shenanigans that happen in the healthcare industry in order for the bean counter to maximize profit.
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That's true. So maybe once you shut down all of that first, then you can turn to the problem of unprepared FM doing hospitalist work. A problem which is maybe 1/100th as bad as midlevels who have less far inpatient training than a med student.
Also, I like how we're pretending that hospitalist work is overly challenging. Unless you're managing an open ICU or have to do procedures or have minimal consultant support - then you're a secretary who can treat CHF/COPD/PNA.
