Hey, can you expand on this a bit? What was that fellowship year like? Were you able to work at all as an EM doc? Difficult to go back as an older doc so far away from residency? I've often thought that Palliative Care would be the most rewarding way to end a medicine career but have never felt like I could go back to fellowship. What was the experience like and can you expand on how long you planned for it? Did you shadow before you went to fellowship? Did you need any letters and if so how did you get them? Was Palliative very competitive? Can you do palliative part time coming out of fellowship or are you pretty much committed to the first few years as full time?
Sure. Fellowship year was busy - compounded by the fact that I have a family (including two middle schoolers) and I had been 0.7 FTE (0.5ish clinical and 0.2ish administrative) in the ED for years. So having a M-F job was a switch. I had 8 full weekends over the course of the year (significantly fewer than what I did in the ED, even at part time), and carried a pager overnight a handful of times. Rotations included inpatient palliative consults, inpatient palliative primary palliative service (end of life patients where we are the primary team), hospice (a mix of home visits and time at our respite house/inpatient hospice facility), pediatrics, electives (comprehensive pain, acute pain, heme onc, rad onc), and rural rotations.
I applied to only one program (my local program), given I wasn’t going to move or commute due to family obligations. I wouldn’t say that it felt difficult to go back, per se. I was more grateful for a year to be a learner again. That feels so rare in mid-life.
I started thinking about palliative in 2018 or 2019 or so. I took a course on developing conversational skills for serious illness conversations, and that was my gateway. I did shadow a palliative doctor for a day some time around then. Then the pandemic happened, and I got involved in some fun EM-adjacent activities (summer camp doctor, cruise ship doctor) so I put off applying. I then started taking courses to TEACH the aforementioned serious illness conversations training for clinicians in my health network. So I spent a fair amount of time with folks in our palliative department, and they knew me/of me as I went through the application cycle.
As to whether it’s competitive - I can’t really say. I’m grateful I matched to the one program to which I applied, but I know there were at least three of us hoping for one of the two spots at my program that year. If you cast a broader net, I think your chances are better. I will say there are more than a few local EM docs asking to shadow us for a day and see what we’re about. Interest is growing.
You do need letters for the fellowship application. I think I had one from my ED director, one from my assistant ED director, one from a hospitalist, and one from an ED social worker/case manager. Palliative is a very interdisciplinary specialty, so the latter felt important to include.
I know some people moonlight in the ED during palliative fellowship, but between the fellowship demands, family/home demands, and just wanting to have some free time, I didn’t do it at all.
So now I’m out of fellowship and just getting my feet wet as a palliative attending. I’m listed as a per diem physician at my old ED, but I don’t feel the pull to return. I think the longer I’m away, the harder it will be to go back. If I were a betting woman, I’d say I’m done.
Currently I’m 0.75 FTE - 0.7 clinical, and 0.05 teaching. On the clinical side, this equates to about two weeks a month on average. My first few weeks I was assigned to ICU and it was rough. I thought “I’ve got this, I was a fellow here, I have some agency now as an attending, and I’m an ED doc - I’ll be so efficient.” We’re a nascent program, and I guess I didn’t appreciate how much politics and other services’ unfamiliarity with palliative care/what we do plays into my day. For instance, it’s a real challenge trying to establish ourselves in the SICU while not stepping on toes and yet still trying to reign in surgeons during family meetings. I also do a lot of palliation of moral distress on the part of the clinical team. It’s fascinating work, but it’s time intensive. My hours are supposed to be 8:30-5:30, but these first few weeks have had much longer days - especially when charting is factored in. I’m hopeful to become more efficient with time, and learning how to set boundaries as a consultant (in a program that is, as I’ve said, nascent and trying to grow).
TL;DR - good life decision. Feels sustainable until the end of my career. Challenges me in new ways. My particular environment might be more demanding than others.
