I think I am not going to fellowship...

[Hospitalist12345]

I matched cards earlier this cycle but It happened... I found out I can actually tolerate being a hospitalist/nocturnist. I love the time off and being able to moonlight when I want. Everyone told me not to do a gap year because I wouldn't want to go back to fellowship and it happened....

Reasons why I don't want to go to cards fellowship anymore:

1) I matched cards at a COVID heavy stricken area-- family and I don't want this exposure, especially moving to a new place without much family support. I don't want my spouse to have to shelter in place at home all the time in a new city.

2)The program was low on my rank list and I was never super thrilled with it. It does not have the best of reputations. It is also filled with a lot of IMGs (nothing wrong with that in itself)---> but being one of the few AMG there I honestly don't feel like I belong or fit in.

3) I actually enjoy being a hospitalist and don't want to move out of my hometown

4) My spouse will be 10 x happier if I don't move.

5) I am no longer thrilled about being a cardiologist. People just shat on being a hospitalist so much that I convinced myself that I love cards when I didn't really in retrospect.

Am I crazy for making the decision I am about to make? I really hope I don't regret this 5 or 10 years down the road.

I hate myself for taking up a spot and causing stress to the program... so I expect some negative comments and I am sorry. I hope someone is able to snag this who went unmatched.

---

Members don't see this ad.

 

[Elixir6]

You should do what makes you happy, but it's a shame you came to this realization only after matching.

Most of the above reasons are good ones, particularly enjoying hospitalist, not being thrilled about cards, wanting to stay in home town and spouse being happy (the last two are most important I think). I don't agree with the COVID reasoning much but that's just me, and also if you didn't want to go to a program you shouldn't have ranked it, but that's in the past now. Also realize that hospitalist may pay or look different in the future (probably pay less), though you could say that about any specialty.

Obviously you should go forward with the realization that you will not be able to go into any NRMP matching program easily ever again. I'm sure someone here will mention the exact policy, but you should look that up.

You should do it ASAP though because July is coming.

 

[studentdocftw]

Go with what makes you happy. If you are content doing shift work and working as a nocturnist, go for it. Just make sure you are certain this is what you want..because you wont participate in a match ever again.

 

[GastriqueGraffin]

As long as you don’t have a midlife crisis later as a result of your decision then I think you’re making the right one based on your post.

 

[shouldigomd]

It is easy to fall into the trap of satisfying others / ego than your own happiness. Do what is right for you.

 

[NYknicks44]

Good for you man. Do what is right for you and your family.

Don’t worry about the fellowship program. Almost every program has a research fellow or medicine chief that can start tomorrow.

The thing about regrets is that it is hard not to have them. No matter what you decision you make, you will think about the path you didn’t choose. That’s life

 

[throwaway1000000]

Based your post, your dislike for hospital medicine and liking for cardiology seems to be from a "prestige" standpoint.
There are tons of hospitalists that are well respected and frankly geniuses. Whatever you become is dependent on you.
Financially, unless you would have gone into interventional cardiology, you probably will be better off as well especially if you can moonlight. Losing about a million dollars during the 4 years of fellowship.

 

[rokshana]

make sure it really is what you want and not just the reluctance to move...cards is only 3 years and if you were to do a sub-fellowship, you could always find some place closer to home.

realize that you most likely will burn the bridge to Cardiology if you break your NRMP contract...and may even not be able to re apply to anything in the NRMP for a different fellowship of a few years.

 

[deleted980918]

Lifestyle wise you are probably making the right decision to stay factor in location, family and spouse happiness. Financially, I think it would be hard to argue against that over a course of a career, cardiology wins esp if you do private practice or IC. Academically speaking, sounds like you can tolerate hospital medicine but you aren’t as excited about cardiology as you were. As far as COVID, I actually think you are safer being a card fellow than a hospitalist at this point. And like someone mentioned above, even the worst program will find someone fill in your spot and I’m pretty sure you are already getting PMs from unmatched candidates asking you for details.

 

[Hospitalist12345]

Thank you everyone for the replies.

The problem is I am not 100% sure and I don’t know if I am going to regret this 5 or 10 years later. It feels like I am giving up something that is prized or valuable.

 

[throwaway1000000]

Lifestyle wise you are probably making the right decision to stay factor in location, family and spouse happiness. Financially, I think it would be hard to argue against that over a course of a career, cardiology wins esp if you do private practice or IC. Academically speaking, sounds like you can tolerate hospital medicine but you aren’t as excited about cardiology as you were. As far as COVID, I actually think you are safer being a card fellow than a hospitalist at this point. And like someone mentioned above, even the worst program will find someone fill in your spot and I’m pretty sure you are already getting PMs from unmatched candidates asking you for details.

Curious, what is the pay difference between general cardiologist and hospitalist, especially if they do locums? 250k + 50k in locums as a hospitalist vs 350k-400k as a general cardiologist?
Also have to catch up with almost 3 extra years of lost income as a hospitalist during the cardiology fellowship (750k-900k).

 

[drimo786]

Curious, what is the pay difference between general cardiologist and hospitalist, especially if they do locums? 250k + 50k in locums as a hospitalist vs 350k-400k as a general cardiologist?
Also have to catch up with almost 3 extra years of lost income as a hospitalist during the cardiology fellowship (750k-900k).

your numbers seem roughly about right. 200-350 for hosp +/- locums (50-100k+), 300-500 for cards, about 750-1mill lost in the 3 years of fellowsihp

 

[CCM-MD]

The opportunity cost of doing a fellowship is even higher than mentioned if you account for the time value of money.

 

[rokshana]

your numbers seem roughly about right. 200-350 for hosp +/- locums (50-100k+), 300-500 for cards, about 750-1mill lost in the 3 years of fellowsihp

its 3 years vs 20 + years in practice...the amount will easily be recouped with even a general cardiologist's salary and even easier if he subspecializes -EP or interventional potentials make $1 million/year.

the other is, how long term in sustainability is hospitalist work...sure there are career hospitalists that have been doing it for >10 years, but hospital medicine is relatively new and many, if not most hospitalist are doing hospitalist work as a temporary thing until they do fellowship. Depending on where you practice and the model, hospitalist work is rough...fine for the single 30 yo, but the 50 or 60 yo with family? It cam be wearing.

I've done hospitalist work after residency and fellowship and am currently doing surge protection, but would have to say been out now 9 years, it is harder to do the 7on/7off 12 hour nights...10 years from now? doubt it...

as a cardiologist, in the beginning you can work a lot, make lots of money and then in the later part of your career, can be part time, clinic only, etc and still make a decent amount of money or retire early wi5th a decent retirement.

To the OP,Not doing the fellowship, limits your options...doing the 3 years, then at least you have the option to say, you would rather do hospital medicine instead...

you should probably start the fellowship and if after a year, you really feel cardiology is not for you, then you can always leave...no NRMP violation, and you may make that decision knowing that you really don't want to do cards and not have regrets in 5,10 years with the shoulda, coulda, wouldas...

 

[Hospitalist12345]

its 3 years vs 20 + years in practice...the amount will easily be recouped with even a general cardiologist's salary and even easier if he subspecializes -EP or interventional potentials make $1 million/year.

the other is, how long term in sustainability is hospitalist work...sure there are career hospitalists that have been doing it for >10 years, but hospital medicine is relatively new and many, if not most hospitalist are doing hospitalist work as a temporary thing until they do fellowship. Depending on where you practice and the model, hospitalist work is rough...fine for the single 30 yo, but the 50 or 60 yo with family? It cam be wearing.

I've done hospitalist work after residency and fellowship and am currently doing surge protection, but would have to say been out now 9 years, it is harder to do the 7on/7off 12 hour nights...10 years from now? doubt it...

as a cardiologist, in the beginning you can work a lot, make lots of money and then in the later part of your career, can be part time, clinic only, etc and still make a decent amount of money or retire early wi5th a decent retirement.

To the OP,Not doing the fellowship, limits your options...doing the 3 years, then at least you have the option to say, you would rather do hospital medicine instead...

you should probably start the fellowship and if after a year, you really feel cardiology is not for you, then you can always leave...no NRMP violation, and you may make that decision knowing that you really don't want to do cards and not have regrets in 5,10 years with the shoulda, coulda, wouldas...

thanks for this perspective. Maybe it would better to see if I actually like it first....

does it matter if I have the NRMP violation or not?

 

[rokshana]

thanks for this perspective. Maybe it would better to see if I actually like it first....

does it matter if I have the NRMP violation or not?

only if you want to participate in the match process again.

 

[gutonc]

thanks for this perspective. Maybe it would better to see if I actually like it first....

does it matter if I have the NRMP violation or not?

If you were 100% certain about this (or even 95%), I'd bail on Cards and not think twice. But you're not...seems like it's a toin coss for you right now. And you really don't know how this is going to play out short or long-term.

The one think that is certain is, if you bail on your fellowship now, you're not EVER getting into cardiology again and will have a difficult if not impossible time getting into another sub-specialty in the future.

 

[tantacles]

Curious, what is the pay difference between general cardiologist and hospitalist, especially if they do locums? 250k + 50k in locums as a hospitalist vs 350k-400k as a general cardiologist?
Also have to catch up with almost 3 extra years of lost income as a hospitalist during the cardiology fellowship (750k-900k).

It's totally dependent on location. Full time with no moonlighting at all, I've seen offers from $140,000 in the northeast to $280,000 in SF and heard of (though haven't experienced myself) offers in the mid 300k's in remote areas in the midwest. Cardiology pay varies as well based on region, academic, etc. It's just impossible to generalize.

 

[xoggyux]

The oldest question in the book. Did anyone tell you to do what you like and forget the rest?
This is something that you will be doing for the next 30 years... so it better be something that you enjoy and not somebody else's dream.
Stop trying to min/max and optimize everything, all of these numbers being thrown here are complete non-sense because nobody knows what is going to be the job market for the next 30years. Look at the coronavirus going around, plenty of opthalmologists and dermatologists that are having a hard time. Even the cardiologists are wondering where are all the MIs and if it will ever return back to "normal". The same way, you cannot predict what kind of legislation regarding healthcare will come as a result of whats going on... or even in the long term what is going to happen in terms goverment-sponsored-type healthcare.
All of that is to say, that what gives more $$ might not give more $$ tomorrow. And it is not like you are comparing doctor vs janitor either. Once you factor in the opportunity cost of those 3+ years of fellowship the math becomes far more blurry and more dependent on what/when you save vs what you actually make.
All of that to say...
Only 3 factors should come into 99% of the decision.
1. - Do what you like
2. - Don't do something that you don't like
3. - Have the support of your family.

3 might be the most important but it is rarely the dealbreaker, usually you can come to compromise, it is just a few years, it is not like you going 10 years into the jungle.
GL

 

[MyTachyBradyHeart]

I matched cards earlier this cycle but It happened... I found out I can actually tolerate being a hospitalist/nocturnist. I love the time off and being able to moonlight when I want. Everyone told me not to do a gap year because I wouldn't want to go back to fellowship and it happened....

Reasons why I don't want to go to cards fellowship anymore:

1) I matched cards at a COVID heavy stricken area-- family and I don't want this exposure, especially moving to a new place without much family support. I don't want my spouse to have to shelter in place at home all the time in a new city.

2)The program was low on my rank list and I was never super thrilled with it. It does not have the best of reputations. It is also filled with a lot of IMGs (nothing wrong with that in itself)---> but being one of the few AMG there I honestly don't feel like I belong or fit in.

3) I actually enjoy being a hospitalist and don't want to move out of my hometown

4) My spouse will be 10 x happier if I don't move.

5) I am no longer thrilled about being a cardiologist. People just shat on being a hospitalist so much that I convinced myself that I love cards when I didn't really in retrospect.

Am I crazy for making the decision I am about to make? I really hope I don't regret this 5 or 10 years down the road.

I hate myself for taking up a spot and causing stress to the program... so I expect some negative comments and I am sorry. I hope someone is able to snag this who went unmatched.

Hate to break it to you, but regret is part of life and you can’t avoid it. The key is to live with it and be ok with whatever decision you made.

With that being said, it sounds like fellowship may not be the right option for you. Mainly because of 4). Covid is here to stay and will be a part of training and practice going forward. I second that being a cardiologist offers more protection; most hospitals will allow for tele consults on covid+ patients unless it’s something you need to do bedside... in which case you gown up and go see the patient because you’re a doctor and that’s your responsibility. In terms of program being low on your rank list, it is still a cardiology fellowship and you can get great training and make the most of it, if you have the right attitude (which you may or may not have). Finally, job description will change in the future and there is no guarantee you’ll like being a hospitality or cardiologist 10 years from now.

That leaves #4, which is that (hopefully) your spouse will be with you and support you no matter what decision you make. Therefore, instead of posting on sdn, the most important thing you should be doing right now is talking to him/her, specifically “if we move to new city and I end up hating fellowship,” what would happen.

 

[bobow98]

Cardiology is really hard. Your calls are hard. Managing CCU as primary and floor patients on the same day is the stuff we all did as residents and all swore we'd never do again. The guys I knew who wanted cardiology were into that stuff, and if you're not really into that like a surgeon is into operating, that could be a long career of frustration.
If you don't mind shift work and want flexibility, hospitalist is the way to go based on what I'm seeing. But make sure you're doing it for YOU and not your spouse alone, to stave off future resentment on your part. good luck!

 

[cookiegrub]

I matched cards earlier this cycle but It happened... I found out I can actually tolerate being a hospitalist/nocturnist. I love the time off and being able to moonlight when I want. Everyone told me not to do a gap year because I wouldn't want to go back to fellowship and it happened....

Reasons why I don't want to go to cards fellowship anymore:

1) I matched cards at a COVID heavy stricken area-- family and I don't want this exposure, especially moving to a new place without much family support. I don't want my spouse to have to shelter in place at home all the time in a new city.

2)The program was low on my rank list and I was never super thrilled with it. It does not have the best of reputations. It is also filled with a lot of IMGs (nothing wrong with that in itself)---> but being one of the few AMG there I honestly don't feel like I belong or fit in.

3) I actually enjoy being a hospitalist and don't want to move out of my hometown

4) My spouse will be 10 x happier if I don't move.

5) I am no longer thrilled about being a cardiologist. People just shat on being a hospitalist so much that I convinced myself that I love cards when I didn't really in retrospect.

Am I crazy for making the decision I am about to make? I really hope I don't regret this 5 or 10 years down the road.

I hate myself for taking up a spot and causing stress to the program... so I expect some negative comments and I am sorry. I hope someone is able to snag this who went unmatched.

I'm not in a residency yet but the benefits you highlighted for hospitalist is definitely why I have been considering the same for myself as I contemplate residency programs with fellowship. Of course we may not be same in personality, but when I worked with hospitalists, the lounge where dictations are done felt so warm and just right. The camaradrie of having hospitalists vent together but also discuss exciting cases made me amused and to date I haven't found this level of comfort. It's crazy to see how COVID is changing big lifetime decisions in a moments notice and I don't think you should guilt yourself too much on this topic if you don't feel right. I for one have started to appreciate that medicine isn't a game where we show whose ego is bigger because every new chapter we begin in training always carry a steep learning curve. Nothing wrong with that but the older one gets, I believe the more restless we become to settle and find our niche. Seems like you found yours which is really refreshing to hear for someone who is contemplating 3 more years of training vs 7-8 years.

 

[miatadoc]

Thank you everyone for the replies.

The problem is I am not 100% sure and I don’t know if I am going to regret this 5 or 10 years later. It feels like I am giving up something that is prized or valuable.

Dear OP,
What did you end up deciding? How are you feeling? I am in a similar position to you.

 

[NewYorkDoctors]

You have a golden ticket that others would sell their souls for . Think long and hard .

General cards is one subspecialty that you can fairly easily get office space , get one secretary , get an echo / vascular ultrasound and stress test machine and start off doing everything yourself to print money . Then you expand and get partners and techs and print more money .

Yes it’s not only about money . But the hospitalist gravy train will not run as long as the private practice cardiology gravy train I suspect

The pure private practice cardiologists in the nyc area that own their practice and have high referral volume (just move in next to pcps) al make well over a million . No seriously .

 

[yeasports]

its 3 years vs 20 + years in practice...the amount will easily be recouped with even a general cardiologist's salary and even easier if he subspecializes -EP or interventional potentials make $1 million/year.

the other is, how long term in sustainability is hospitalist work...sure there are career hospitalists that have been doing it for >10 years, but hospital medicine is relatively new and many, if not most hospitalist are doing hospitalist work as a temporary thing until they do fellowship. Depending on where you practice and the model, hospitalist work is rough...fine for the single 30 yo, but the 50 or 60 yo with family? It cam be wearing.

I've done hospitalist work after residency and fellowship and am currently doing surge protection, but would have to say been out now 9 years, it is harder to do the 7on/7off 12 hour nights...10 years from now? doubt it...

as a cardiologist, in the beginning you can work a lot, make lots of money and then in the later part of your career, can be part time, clinic only, etc and still make a decent amount of money or retire early wi5th a decent retirement.

To the OP,Not doing the fellowship, limits your options...doing the 3 years, then at least you have the option to say, you would rather do hospital medicine instead...

you should probably start the fellowship and if after a year, you really feel cardiology is not for you, then you can always leave...no NRMP violation, and you may make that decision knowing that you really don't want to do cards and not have regrets in 5,10 years with the shoulda, coulda, wouldas...

Op, this is good advice. If you are questioning regret it is because you probably will.
Why not give it a chance, you may be surprised and really like it despite your negative views of the program.
I did my residency specifically to apply to primary care sports med as I am guessing you did im for cards. I did not drop down very low on my rank list but I did not get my first pick. I was bummed, but I wound up exactly were I needed to be! I loved my program and would not change it for anything. I would bet you could learn quite a bit from the diversity from your new program and maybe this is what you need. That being said in a year if you hate it you can quit and not have regret later in life.

 

[Kaustikos]

its 3 years vs 20 + years in practice...the amount will easily be recouped with even a general cardiologist's salary and even easier if he subspecializes -EP or interventional potentials make $1 million/year.

the other is, how long term in sustainability is hospitalist work...sure there are career hospitalists that have been doing it for >10 years, but hospital medicine is relatively new and many, if not most hospitalist are doing hospitalist work as a temporary thing until they do fellowship. Depending on where you practice and the model, hospitalist work is rough...fine for the single 30 yo, but the 50 or 60 yo with family? It cam be wearing.

I've done hospitalist work after residency and fellowship and am currently doing surge protection, but would have to say been out now 9 years, it is harder to do the 7on/7off 12 hour nights...10 years from now? doubt it...

as a cardiologist, in the beginning you can work a lot, make lots of money and then in the later part of your career, can be part time, clinic only, etc and still make a decent amount of money or retire early wi5th a decent retirement.

To the OP,Not doing the fellowship, limits your options...doing the 3 years, then at least you have the option to say, you would rather do hospital medicine instead...

you should probably start the fellowship and if after a year, you really feel cardiology is not for you, then you can always leave...no NRMP violation, and you may make that decision knowing that you really don't want to do cards and not have regrets in 5,10 years with the shoulda, coulda, wouldas...

Thank you. You can always go back to Hospitalist if you don't like Cards, but you're never going to have the chance to go Cards if you do this. I agree that at least trying the program out before quitting would be way better than just saying no. You might be surprised.

 

[NotAProgDirector]

The OP asked this question in 2020. They are long past making this decision

 

[Kaustikos]

The OP asked this question in 2020. They are long past making this decision

I'm an idiot. I'm allowed at least 1 stupid comment per year.

 

[NewYorkDoctors]

The OP asked this question in 2020. They are long past making this decision

I hope this individual at stayed in cards . I do see a handful of cardiologists who also do primary care and admissions under themselves and advertise accordingly .