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Jun 5, 2020
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Hello,

I am a (soon to be) PGY2 at an upper-mid tier large academic program (AP/CP).
I am an AMG from a reputable medical school.

I want to do general, community practice pathology. I do not want to do a fellowship.
I entered the field anticipating that I would need to do a fellowship, but really I would rather not.
The notion of not completing a fellowship seems to be pretty taboo at my program.

My wife is also a physician and if I do not do a fellowship, we will enter the job market at the same time.
We are geographically flexible.

Would like to hear other people's thoughts.
 
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Sep 8, 2019
48
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Status
Attending Physician
Hello,

I am a (soon to be) PGY2 at an upper-mid tier large academic program (AP/CP).
I am an AMG from a reputable medical school.

I want to do general, community practice pathology. I do not want to do a fellowship.
I entered the field anticipating that I would need to do a fellowship, but really I would rather not.
The notion of not completing a fellowship seems to be pretty taboo at my program.

My wife is also a physician and if I do not do a fellowship, we will enter the job market at the same time.
We are geographically flexible.

Would like to hear other people's thoughts.
While i commend you for asking this and wish the pendulum would swing back to residency actually preparing you for practice, this is not the norm. Despite competency, the other issue is who will hire you without a fellowship or experience? It’s pretty much required at this point. Rare jobs nay come up, but we’re talking a handful per year in the most rural areas imaginable (think Amish country).
 
Jun 5, 2020
4
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Resident [Any Field]
While i commend you for asking this and wish the pendulum would swing back to residency actually preparing you for practice, this is not the norm. Despite competency, the other issue is who will hire you without a fellowship or experience? It’s pretty much required at this point. Rare jobs nay come up, but we’re talking a handful per year in the most rural areas imaginable (think Amish country).
Appreciate the feedback.

For what it is worth, I am from a relatively small town and having a lot of land would be awesome.
I considered switching specialties, but at this point it is probably better to stay the course. But then I remember the sunk cost fallacy...

I have considered bringing this up to my program administrators and faculty mentors, but have not pulled the trigger yet.
 

mikesheree

Lifetime Donor
10+ Year Member
Feb 27, 2010
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Appreciate the feedback.

For what it is worth, I am from a relatively small town and having a lot of land would be awesome.
I considered switching specialties, but at this point it is probably better to stay the course. But then I remember the sunk cost fallacy...

I have considered bringing this up to my program administrators and faculty mentors, but have not pulled the trigger yet.
If you can get a job without a fellowship in an area you and S.O. like, RUN, do not walk or pass go. You take that job. And your “faculty”, who are oh-so concerned about your further enslavement/fellowship can stick it where the sun don’t shine.


Sent from my iPad using Tapatalk
 

SoDakMLS

Good luck on the Path!
7+ Year Member
Mar 6, 2011
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It *CAN* happen. Three graduates from my program (two different class years) basically caught wind of a private group in a rural area (main population center ~50,000 a good 2 hours from anything bigger) of 3 pathologists who were ready to retire. So all three signed on without doing fellowships and the partners are phasing into retirement. Our program is reputable. The one who graduated with my class to join this group basically scrounged up every piece of glass he could 4th year and "hot seated" them--i.e. looking at the cases, deciding what he would call them, recorded it, and went back later to see how the case was signed out. I'm sure it was better in the long run than the "studying" people typically do for boards while on senior elective. They do most everything, except perhaps Neuro and I think all the Hemepath gets sent out. He asks me some CP-related questions (due to my fellowship choice) from time to time.

But if I were you, I'd apply to a fellowship 3rd year like everyone else. These 3 got lucky and were in the right place at the right time and willing to go where most wouldn't.
 

SetecAstronomy

2+ Year Member
Sep 29, 2016
27
15
Status
Attending Physician
The only 2 people I've known to avoid fellowship were in my MSTP (MD/PhD) program and were basically primarily research scientists first, and pathologists second. If you hustle and schmooze now, you might, MIGHT be able to pull it off, ie slap your name on as medical director somewhere and take on the liability. As SoDakMLS said, you might want to hedge and apply for a fellowship.
 

Euchromatin

10+ Year Member
Oct 15, 2009
339
41
Status
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Agree with prior posters that if you happen to get lucky and find a halfway decent job that will hire you without a fellowship, certainly take it. But I would definitely have a fellowship spot lined up as a backup.
 
Jun 5, 2020
4
0
Status
Resident [Any Field]
It *CAN* happen. Three graduates from my program (two different class years) basically caught wind of a private group in a rural area (main population center ~50,000 a good 2 hours from anything bigger) of 3 pathologists who were ready to retire. So all three signed on without doing fellowships and the partners are phasing into retirement. Our program is reputable. The one who graduated with my class to join this group basically scrounged up every piece of glass he could 4th year and "hot seated" them--i.e. looking at the cases, deciding what he would call them, recorded it, and went back later to see how the case was signed out. I'm sure it was better in the long run than the "studying" people typically do for boards while on senior elective. They do most everything, except perhaps Neuro and I think all the Hemepath gets sent out. He asks me some CP-related questions (due to my fellowship choice) from time to time.

But if I were you, I'd apply to a fellowship 3rd year like everyone else. These 3 got lucky and were in the right place at the right time and willing to go where most wouldn't.
That is quite the story. Good for them!

Appreciate all of the feedback and agree with the general consensus that I should hedge by having a fellowship lined up. But I will continue to keep my ear to the ground. Maybe I will get lucky...
 

mark-ER

Senior Member
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15+ Year Member
Apr 26, 2004
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Agree, it can happen, but unlikely. I know 2 people (out of 100+) who were trainees around the same time as me in the late 2000 / early 2010s who succeeded. Required both luck and skill (both, but I'd value former more than the latter).
 

octopusprime

2+ Year Member
May 6, 2016
285
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If you're a 2nd year and don't have a gig lined up yet, chances are one of these rando luck-of-the-draw "no fellowship needed" jobs isn't going to just fall into your lap. And if it does, you're not necessarily going to want it just because they don't require a fellowship.

I'd look at your vs your spouse's income potential as well--who wins out? Hate to say one of your careers trumps the other, but could make all the difference in the world.

If she's primary care / GP chances are she could work anywhere while you do fellowship. If she's peds cardiothoracic surgery, problem solved.

In general, better to play the 'long haul' game vs taking whatever scraps you can find. Secure a fellowship.
 
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