Last minute fellowship openings?

[Dr Doak]

I am a pgy3 with a job lined up post graduation in July. They, like most places, are cutting hours with volumes down. I was thinking it may not be a bad time to scramble into a fellowship... anyone heard of any openings?

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[KGflyboy]

I am a pgy3 with a job lined up post graduation in July. They, like most places, are cutting hours with volumes down. I was thinking it may not be a bad time to scramble into a fellowship... anyone heard of any openings?

I don't know anything about open fellowships, but I'm curious if you thought about how this will impact your future employer if you back out of your job at the last minute.

 

[HoosierdaddyO]

I mean you think his future employer cares when they had to cut back on his hours and his salary?! No one cares about you... it’s all about the money for these hospital systems lol. I say if you are out of the time frame that you could negate the contract and you want to do a fellowship!! Then go for it!!

 

[Porfirio]

I think there was a UCLA or something toxic fellowship that was looking for a last minute fellow on EMDOCS Facebook group.

 

[coachB]

I think there was a UCLA or something toxic fellowship that was looking for a last minute fellow on EMDOCS Facebook group.

I believe what you are referring to is UCSD that has an opening for tox. One of their current fellows posted on the Facebook group.

 

[RainbowOtterz]

I believe what you are referring to is UCSD that has an opening for tox. One of their current fellows posted on the Facebook group.

Correct, UCSD is down 1 of their 2 fellows due to unforeseen circumstances. If you are interested I would email the PD Alicia Minns ([email protected]) and CC the Program Coordinator Mae ([email protected]). More information about the two-year fellowship can be found at Medical Toxicology Fellowship - UC San Diego Dept. of Emergency Medicine.

 

[ShockIndex]

I do not think that UMich filled their IM/CCM spot this upcoming year that is open to EPs. I’m not sure that they are trying to fill it given the fiscal environment and interested parties may want to do their due diligence as to why they didn’t fill.

 

[KarlPilkington]

I'd be careful when it comes to scrambling into a fellowship. If you were set to go into community practice and hadn't really considered doing a fellowship then I wonder how happy you'd be doing all the requirements of the fellowship for the next 1-2 years. If you were on the fence about doing a particular fellowship then going down that road may give you some financial stability but I'd be hesitant to do a fellowship just to avoid taking a job with reduced hours.

 

[namethatsmell]

If you find a fellowship that meaningfully allows you to diversify your work options outside of the ED afterwards, then it's not a bad idea to jump on it. Provided that said field truly interests you.

 

[Fox800]

I was on the fence when I wasn't finding jobs to my liking. Was considering scrambling into an anesthesiology CCM spot. One of my mentors (EM/CCM) gave me some sage advice...

If you aren't 100% on a fellowship, don't do it. Work for 2 years. Do locums and make good money. After that, decide if you really want to do a fellowship. See what the real world is like.

 

[TheComebacKid]

If you aren't 100% on a fellowship, don't do it. Work for 2 years. Do locums and make good money. After that, decide if you really want to do a fellowship. See what the real world is like.

I got the opposite advice. "If you think you want to do fellowship, do it now. You will never do it again/come back to it after working in the real world."

I have found that to be at least anecdotally true.

 

[The Knife & Gun Club]

Honest question - what would happen to your EM skills doing a 2 year CCM fellowship? Sure you’d learn a ton of CCM, but I’d imagine there’d be some atrophy in your ability to do move the meat if you decided you’d rather go back to the communtiy

 

[chocomorsel]

I got the opposite advice. "If you think you want to do fellowship, do it now. You will never do it again/come back to it after working in the real world."

I have found that to be at least anecdotally true.

You can come back if you really want to. Plan well and come back with a little money in the pocket if you are really passionate about it and can’t stand your regular practice.

 

[ShockIndex]

I got the opposite advice. "If you think you want to do fellowship, do it now. You will never do it again/come back to it after working in the real world."

I have found that to be at least anecdotally true.

I spent 15 years post-residency in military, private, academic, and other governmental employment before going back to fellowship. I’m married with a kid. It took 2 years of saving bonuses and other preparation (shadowing in the ICU, CC research, etc.) before I was ready. I’d say it’s difficult and stressful but certainly not impossible.

 

[ShockIndex]

Honest question - what would happen to your EM skills doing a 2 year CCM fellowship? Sure you’d learn a ton of CCM, but I’d imagine there’d be some atrophy in your ability to do move the meat if you decided you’d rather go back to the communtiy

Don’t worry. Performing pelvic exams is like riding a bicycle...

IMHO, being able to move the meat in EM has far less to do with perishable technical skills, and everything to do with a mentality that allows one make decisions using a minimum of testing/imaging. In other words, testers are slow; people who can dispo a routine pelvic pain without an ultrasound are fast.

In theory, a CCM fellowship should make you faster at recognizing dispoing the “not sick.” Unfortunately, this is not always the case as some come out of CCM fellowship thinking everyone is critically ill. A lot of it depends on personality and critical thinking habits that were developed long before residency.

Your fellowship will be much more meaningful if you show up with 1-2 years under your belt. So, my advice for 90% of the EM residents who are entertaining a CCM fellowship is to take 1-2 years after residency to practice at a high-volume EM program to solidify your clinical skills. More than 2-3 years is doable as I’ve proven but probably overkill. Preferably, your hiatus would be at a busy community shop (>75K) with some academic ties so that you can shadow in the academic ICU. Live like a resident, payoff some debt, and build a nest egg. Keep in mind that there is a 10-18 month hiatus between accepting a CCM fellowship and the start date depending on the pathway you choose. So, applying for a CCM fellowship as a senior guarantees a 1 year hiatus.

 

[Apollyon]

Don’t worry. Performing pelvic exams is like riding a bicycle...

When you fall off, it really hurts?

 

[deleted547339]

Honest question - what would happen to your EM skills doing a 2 year CCM fellowship? Sure you’d learn a ton of CCM, but I’d imagine there’d be some atrophy in your ability to do move the meat if you decided you’d rather go back to the communtiy

Its not that hard to come back. I was a little nervous my first few shifts back, but it came back pretty quick. I find that I’m a lot more confident in my decisions due to a deeper understanding of physiology and pathology. It may have been different had I gone to a fellowship that was not multidisciplinary, but when you spend time in all the different icus, you don’t miss much. Only thing I was really rusty on was ortho - turns out you just need to keep pulling. I still don’t know much about rashes or kids, but I know plenty to say that a rash or febrile illness isn’t going to kill you. FWIW, I was in the bottom 20% or so for speed my first few months but am now typically in the 2nd quintile.

 

[TheComebacKid]

Honest question - what would happen to your EM skills doing a 2 year CCM fellowship? Sure you’d learn a ton of CCM, but I’d imagine there’d be some atrophy in your ability to do move the meat if you decided you’d rather go back to the communtiy

In residency, the EM/CCM faculty were universally my favorite to work with in the ED (large cohort of dual trained people at my program).

That said, their approach to medicine was very different compared to the straight EM trained person. Not in a bad way. But resuscitations were much more well orchestrated and detail oriented. Nobody, ever, left the ED without central access and an arterial line. Vent management was definitely more nuanced. Everyone got bedside echos and volume status assessment. Sometimes we sent labs such as ScVO2s, and lots of lactates... god don't even get me started on the lactates.

You contrast this to some of our straight EM trained folk... codes are often called sooner. Some of my attendings will find as many reasons as possible to not put in a central line or arterial line and leave it up to the ICU. At our community site, the nurses don't even know how to set up an arterial line in the ED (I had to do it myself once).

the EM/CCM folks will sometimes let the waiting room pile up with non emergent BS complaints... and really spent time with the residents teaching them to hone in on their skills with the sicker patients. It's not that couldn't move the meat faster, it's just that many of them, didn't really care to. Especially in academic settings where the incentives are a little different than a high volume community shop.

Regardless, they were universally the most well respected faculty in my program, with good reason. If it wasn't for 2 years, plus already going to a 4 year program, plus the fact that I hate rounds, nutrition, electrolytes and physical therapy, I would have definitely considered it more. The 2 year fellowship at my program seemed BRUTAL and the fellows were universally miserable.

 

[deleted547339]

In residency, the EM/CCM faculty were universally my favorite to work with in the ED (large cohort of dual trained people at my program).

That said, their approach to medicine was very different compared to the straight EM trained person. Not in a bad way. But resuscitations were much more well orchestrated and detail oriented. Nobody, ever, left the ED without central access and an arterial line. Vent management was definitely more nuanced. Everyone got bedside echos and volume status assessment. Sometimes we sent labs such as ScVO2s, and lots of lactates... god don't even get me started on the lactates.

You contrast this to some of our straight EM trained folk... codes are often called sooner. Some of my attendings will find as many reasons as possible to not put in a central line or arterial line and leave it up to the ICU. At our community site, the nurses don't even know how to set up an arterial line in the ED (I had to do it myself once).

the EM/CCM folks will sometimes let the waiting room pile up with non emergent BS complaints... and really spent time with the residents teaching them to hone in on their skills with the sicker patients. It's not that couldn't move the meat faster, it's just that many of them, didn't really care to. Especially in academic settings where the incentives are a little different than a high volume community shop.

Regardless, they were universally the most well respected faculty in my program, with good reason. If it wasn't for 2 years, plus already going to a 4 year program, plus the fact that I hate rounds, nutrition, electrolytes and physical therapy, I would have definitely considered it more.

That’s funny. I almost never order lactates.

 

[Groove]

I am a pgy3 with a job lined up post graduation in July. They, like most places, are cutting hours with volumes down. I was thinking it may not be a bad time to scramble into a fellowship... anyone heard of any openings?

Work a few years, get your boards and re-assess. Fellowships are relatively meaningless for a career in the community. Most fellowships completely take over your career. Pain, CCM, etc.. It's not that those guys couldn't do both, but most by and large end up committing most of their time to the fellowship career. I think it's really pre-mature to jump into a fellowship track as nothing more than an insurance policy against a potential turbulent job market in bread and butter EM.