How many years post-residency can you practice before entering fellowship?

[IrishTwins]

So, I know that, technically, the answer to this question is "any number of years."

But I would like to get a little more insight, as I am in a bit of a unique situation. I have been offered a scholarship from my school that will pay for all tuition + living expenses, if I agree to practice primary care for four years, in the state, following residency. I'm just 1 week into my first year at school. I'd love to take the scholarship, but I do have a pretty high level of interest in some subspecialties of internal med.

If I take this scholarship, and go into internal medicine (my area of interest) ... how accessible will fellowships be to me after being in practice for 4 years post-residency? If it helps, I'm specifically interested (for now!) in Endocrinology, Rheumatology and Infectious Disease.

Thanks in advance.

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[Winged Scapula]

Must you complete that payback immediately after residency or can you do it after fellowship?

If the latter is an option, perhaps what would work best would be to pay back your 4 years while still doing a considerable amount of care within your fellowship area (ie, there are plenty of PCPs with interest in or a heavy patient load of specific diagnoses even without benefit of fellowship).

The biggest issue with these scholarships is that you really have no idea whether you are truly interested in internal medicine, primary care, etc. I say this as someone who was going to be an internal medicine specialist herself.

 

[michaelrack]

If I take this scholarship, and go into internal medicine (my area of interest) ... how accessible will fellowships be to me after being in practice for 4 years post-residency? If it helps, I'm specifically interested (for now!) in Endocrinology, Rheumatology and Infectious Disease.

.

This is just an educated guess, but I think you still would be able to get an IM fellowship after 4 years, especially in Infectious disease. GI, pulm, or cards would be a different story.
If I was in your shoes, I would take the scholarship. (if you can do the payback after fellowship as suggested by WS, that would be the best option).

 

[NotAProgDirector]

I'll agree with this. At present, ID and Endo are two of the least competitive fields, and would happily take someone after practicing for 4 years. Rheum is slightly more competitive but still a very reasonable option. GI, Cards, and Heme/onc would be a more difficult path. Could this all change by the time it mattered for you? Of course. GI used to be uncompetitive, with open spots every year. Things change.

Another question to think about is whether you'd be willing to go back to a fellow salary after working for 4 years.

No matter what you do, look at the contract carefully. Specifically, what "counts" as primary care, and what happens if you change your mind.

 

[punkedoutriffs]

I say this as someone who is going to be an internal medicine specialist herself.

Lolwut?

 

[jerseytrash]

I'll agree with this. At present, ID and Endo are two of the least competitive fields, and would happily take someone after practicing for 4 years. Rheum is slightly more competitive but still a very reasonable option. GI, Cards, and Heme/onc would be a more difficult path. Could this all change by the time it mattered for you? Of course. GI used to be uncompetitive, with open spots every year. Things change.

Another question to think about is whether you'd be willing to go back to a fellow salary after working for 4 years.

No matter what you do, look at the contract carefully. Specifically, what "counts" as primary care, and what happens if you change your mind.

anecdotally i've heard that if you wait longer after finishing residency that some fellowship programs do look down upon it for whatever reason (if you were to say do a couple years as a hospitalist before applying for fellowship) - specifically in H/O, cards, GI

 

[Raryn]

Lolwut?

Only thing I could guess was that she meant "was", not "is". That is, she wanted to be an internist before she fell in love with surgery.

 

[IrishTwins]

Must you complete that payback immediately after residency or can you do it after fellowship?

If the latter is an option, perhaps what would work best would be to pay back your 4 years while still doing a considerable amount of care within your fellowship area (ie, there are plenty of PCPs with interest in or a heavy patient load of specific diagnoses even without benefit of fellowship).

The biggest issue with these scholarships is that you really have no idea whether you are truly interested in internal medicine, primary care, etc. I say this as someone who is going to be an internal medicine specialist herself.

Thanks for all the feedback on this.

 

[ThoracicGuy]

Unless you are absolutely set on primary care, I'd say pass on it. It limits your options significantly and as others have said, the further out from training you are, the harder it will be to get much in the way of fellowships. Also, consider that you may experience a speciality that you've never had much intereaction with before and find a better love there (say anesthesia, urology, etc) and wouldn't be covered by this. Yes, its a nice savings, but it has a cost.

 

[michaelrack]

If you don't take the scholarship now but later on decide you want to do primary care (or decide that the subspecialty you want to pursue will make it possible to defer fellowship for 4 years) , what are your chances of qualifying for their "retroactive" scholarship?

 

[cartoondoc]

As you said, the answer is technically any time. But fellowships are more reluctant to take you more than a year or two out. Plus it is VERY hard to go back to being a fellow after being an attending with autonomy and high salary.

 

[IrishTwins]

If you don't take the scholarship now but later on decide you want to do primary care (or decide that the subspecialty you want to pursue will make it possible to defer fellowship for 4 years) , what are your chances of qualifying for their "retroactive" scholarship?

The answer to that has been fairly ambiguous so far. It seems like it is relatively common for this to happen, but by no means guaranteed, as you will take a backseat in priority to the lower year students.

 

[IrishTwins]

As you said, the answer is technically any time. But fellowships are more reluctant to take you more than a year or two out. Plus it is VERY hard to go back to being a fellow after being an attending with autonomy and high salary.

That's my biggest concern ... argh.

 

[Winged Scapula]

Lolwut?

Only thing I could guess was that she meant "was", not "is". That is, she wanted to be an internist before she fell in love with surgery.

This.

Siri sometimes has a wee bit of trouble understanding me.

 

[Winged Scapula]

Here is the link to the scholarship info. http://www.kumc.edu/Documents/student services/KMSL-InformationSheet.pdf

It is required to begin repayment immediately after completion of residency or within 9 months at the most (and that's only if you choose to work at the school, or a VA, etc...)

So, no go for that option. 🙁 My loans will go from 55K to 5K for this year if I take the scholarship, and I am really leaning toward doing it. I just want to know that I'll still have options if I take it.

Thanks for all the feedback on this.

Is this a ONE TIME savings of $50K or yearly (ie, $200K over the course of medical school)?

 

[IrishTwins]

Is this a ONE TIME savings of $50K or yearly (ie, $200K over the course of medical school)?

It would be every year of school, sorry if I made that confusing!