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Less competitive for fellowships if you work for 1-2 years after residency?

Discussion in 'Surgery and Surgical Subspecialties' started by blackdiamond, Apr 10, 2007.

  1. blackdiamond

    blackdiamond 10+ Year Member

    Oct 8, 2006
    So as an applicant for competitive fellowships, does it make you more or less competitive if you choose to work as a general surgery attending for a year or two after residency? I am massively in debt and the salary I would get for those two years would help, but I don't want it to make me a less attractive applicant when I apply for fellowships. Anyone not go into fellowship due to financial contraints?
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  3. Pilot Doc

    Pilot Doc SDN Angel Moderator Emeritus 7+ Year Member

    Mar 6, 2002

    Haven't heard of anyone doing this purposefully. Problems I see in the strategy ...

    1) not many groups are interested in hiring someone for 1-2 years.
    2) Tail coverage is going to be pricey and is going to come out of your salary, whether explicitly or not. My guess is that a tail will run $25-50K.
    3) After you taste the hours, salary and professional freedom of attending-hood, you may not want to go back.

    Is your debt in student loans? If so you can simply defer it for 2 more years and not pay anything. If it's other debt, I suspect with a little looking you can find someone to restructure it so that another 2 years won't hurt you. Another option is seeing if you can sign with a group several years early in return for a stipend.
  4. blackdiamond

    blackdiamond 10+ Year Member

    Oct 8, 2006
    what is "tail coverage"?

    I don't really have any more debt than anyone else, just the usual med school loans of 220K plus an upcoming mortgage, car, etc. From an investment/business point of view, every year that you hold onto that size debt, the interest accrues to an astronomical figure. Why not lessen the load through an attending's salary for a couple years (live cheaply) before going back to getting paid squat? I did the numbers and I would benefit more in the long run. I just don't want it to hurt my fellowship chances, though.
  5. Playmakur42

    Playmakur42 7+ Year Member

    Jun 30, 2006
    I'm going to go out on a limb and say that it is an insurance policy which covers all of the patients that you operated on before you stop working as an attending and join the hospitals insurance as a fellow. Since your not actively operating on new patients, it will probably be a bit less pricey than a normal malpractice insurance policy.
  6. Amgen1

    Amgen1 New Member 10+ Year Member

    Dec 23, 2005
    depends on the fellowship. for less competitive fellowships (ie thoracic, trauma) probably won't hurt you; you should be able to get a spot somewhere (will be harder at the more comp places). for more competitive fellowships (ie peds, plastics, onc) you would need to be doing something during that time to improve your CV related to those fields
  7. Winged Scapula

    Winged Scapula Cougariffic! Staff Member Administrator Physician Faculty Lifetime Donor Classifieds Approved 15+ Year Member

    Apr 9, 2000
    hSDN Member
    That is correct...tail coverage is necessary when you switch policies or geographic regions or positions not covered by your previous policy. It would be fairly cheap for someone who didn't practice long, although estimates are often 150% of the malpractice coverage for each, if it cost you $10K your first year out (not an unreasonable estimate in some areas), then the tail would be $15K and so on, as malpractice will increase the longer you are in practice.

    Frankly, I'm with pilotdoc on this one...I think you might find it difficult to locate a group or hospital willing to take you on for just a few years...many have salary guarantees for the first couple of years, with a requirement that you pay that back if you don't stay (usually 2 years guarantee = 5 years of staying to get loan foregiveness of salary). It is expensive to bring a new candidate to town - the travel expenses they incur, contract expenses for you and the hospital/practice (reviewing the contract by an attorney), etc.

    Believe me, for those of us that have been through this...the amount of money required to start practicing, even if you are going to be a hospital employee is significant and most places will not want to invest in someone who is leaving. Besides, it really doesn't make much sense to defer fellowship for the reasons you've given, IMHO.
  8. Pilot Doc

    Pilot Doc SDN Angel Moderator Emeritus 7+ Year Member

    Mar 6, 2002
    Tail coverage has been covered...

    One option that might work is doing locums for a year or two. I still think it's a bad idea and I think locums would be a particularly hard way to start your career as a surgeon. But you could do it.

    Getting back to paying off loans early, have you consolidated your loans and at what rate? Mine are fixed at something like 3.5% and I am going to stretch that baby out as long as humanly possible. That interest rate is barely higher than inflation for one, and it's less than the return on very safe investments. Renting money for 4% and making 6% on it is the way to get rich! If you're paying 8-10% the calculus shifts somewhat, but when you consider inflation and reasonable investment return, the numbers still aren't nearly as bad as they look.

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