Going back to fellowship after being in the attending world...

[Pouletdelune]

I'm sure anyone who read the topic of this was thinking.... yikes! Why would you want to do that?

The reason is very simple... I'm following what makes me happy.

I've been working as a Peds ER attending for a number of years after making the switching from general/Adult EM (without completing a PEM fellowship), and after 3+ years of doing primarily Peds EM (with the odd adult shift tossed in) I've come to realize that I really, really, really love taking care of the incredibly sick kids that I come across. One of the frustrations for me in the EM world is having the pressures (wait times, admin, etc.) to take care of a lot of the "not sick" when I really want to focus on my sick asthmatic two rooms down. I also miss seeing my patients come out of that acute "stabilization" phase to getting better/worse and the challenges that come with that. I've always been the attending/resident in my group that people say "we really want you there when there's a sick kid". (I should have realized this all sooner, but hindsight is bliss...)

So, despite the "perks" of the attending world, I'm going to make the jump back into the training environment. However, since this isn't something that happens every day, I'm having a hard time finding good advice on things that, if I was still in residency, would be relatively straightforward. I've dug around on these forums, asked a few colleagues (some of which actually support this decision!), and stressed out a fair amount, but here's my top questions...

1. How much bias is there for attendings coming back to the fellowship world? Are we considered valuable from an experience standpoint, or a liability due to potential bad habits and the "oh they'll just leave after a year when they're tired of being an intern again"?

2. Letters of recommendation. I'm far enough out of residency to have re-MOC'ed, which makes letters difficult. In addition to that, I was primarily in the EM world, so my EM program director (I completed a combined EM/Peds residency) knows me better than my old peds PD. Should I get a letter from one of them, and is it best from the EM PD who knows me better than the peds PD did?

3. Another on letters. I am lucky to work in a facility that has a PICU, and I am on good working terms with the PICU docs; would one of them be a good letter source (my thoughts are yes)? For my third letter, I was planning on getting a third letter from one of the other Peds EM docs that I have worked with for 3 years.

4. Academic upkeep. I know that PICU is a "heavy academic" specialty and that previous research/academic experience is important. During med school and residency I published, but I have been in the community environment ever since. I have been giving lectures to my group (mostly adult/general EM; I am one of 5 peds EM docs) on pediatric topics, have worked in protocol writing/QA/QI, and am finishing up a master's degree. Will this be enough to offset my time out of the academic world?

Many thanks to all that read and respond, even if it is with connections to the local funny farm

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[SurfingDoctor]

I'm sure anyone who read the topic of this was thinking.... yikes! Why would you want to do that?

The reason is very simple... I'm following what makes me happy.

I've been working as a Peds ER attending for a number of years after making the switching from general/Adult EM (without completing a PEM fellowship), and after 3+ years of doing primarily Peds EM (with the odd adult shift tossed in) I've come to realize that I really, really, really love taking care of the incredibly sick kids that I come across. One of the frustrations for me in the EM world is having the pressures (wait times, admin, etc.) to take care of a lot of the "not sick" when I really want to focus on my sick asthmatic two rooms down. I also miss seeing my patients come out of that acute "stabilization" phase to getting better/worse and the challenges that come with that. I've always been the attending/resident in my group that people say "we really want you there when there's a sick kid". (I should have realized this all sooner, but hindsight is bliss...)

So, despite the "perks" of the attending world, I'm going to make the jump back into the training environment. However, since this isn't something that happens every day, I'm having a hard time finding good advice on things that, if I was still in residency, would be relatively straightforward. I've dug around on these forums, asked a few colleagues (some of which actually support this decision!), and stressed out a fair amount, but here's my top questions...

1. How much bias is there for attendings coming back to the fellowship world? Are we considered valuable from an experience standpoint, or a liability due to potential bad habits and the "oh they'll just leave after a year when they're tired of being an intern again"?

2. Letters of recommendation. I'm far enough out of residency to have re-MOC'ed, which makes letters difficult. In addition to that, I was primarily in the EM world, so my EM program director (I completed a combined EM/Peds residency) knows me better than my old peds PD. Should I get a letter from one of them, and is it best from the EM PD who knows me better than the peds PD did?

3. Another on letters. I am lucky to work in a facility that has a PICU, and I am on good working terms with the PICU docs; would one of them be a good letter source (my thoughts are yes)? For my third letter, I was planning on getting a third letter from one of the other Peds EM docs that I have worked with for 3 years.

4. Academic upkeep. I know that PICU is a "heavy academic" specialty and that previous research/academic experience is important. During med school and residency I published, but I have been in the community environment ever since. I have been giving lectures to my group (mostly adult/general EM; I am one of 5 peds EM docs) on pediatric topics, have worked in protocol writing/QA/QI, and am finishing up a master's degree. Will this be enough to offset my time out of the academic world?

Many thanks to all that read and respond, even if it is with connections to the local funny farm

1. We have people who have been independent practice who have come back into fellowship training. It certainly isn't common, but it happens. You said you did a EM/Peds residency, so I assume you are Pediatric Board Certified and not only EM? The only bias I could see would be from research heavy programs since you are likely going to be later in your career and not pursue research, thus the whole scholarly project hard might be a hard sell, but maybe not. If you can tell them exactly what kind of intensivist you want to be, that should be sufficient.

2. You definitely should get a residency letter, probably your pediatric PD just to get a sense of what kind of trainee you were. Otherwise, colleague letters should be fine. If any of those colleages are PICU people, all the better. You just want letters that speak to your character. Probably the most important letter would be from your supervisor (just like a job application).

3. See 2.

4. See 1. Yes, pediatric subspecialties in general are academic heavy. Like I mentioned above, because you are further along in your career, this part may introduce some bias toward your application, but maybe not. Likely program specific. Either way, I think if you are sincere and have a clear goal of what kind of intensivist you want to be... ie maybe back in a community/private practice PICU but you really want to learn the intricacies of PDSA cycles or learn about cost analysis so you can apply it to your future practice. As long as you don't go in and say "I want to learn to genotype mice" because no one is going to believe you, but if you have a clear plan of what you want to learn outside of the clinical stuff, you'll be fine. You have to realize that most applicants coming out of residency have not published or done abstracts (or done very few) so there aren't expectations that applicants have 20 publications in NEJM and Nature.