Pudortu

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Hey guys, EM PGY3 here getting ready to graduate at the end of June. I could use some advice regarding a job vs. fellowship situation.

I'm interested in pain and my hospital is trying to make an ACGME accredited pain fellowship through the Anesthesia dept. My assistant PD (my mentor) is currently spearheading the project with plans to try to make this fellowship a reality. Everything is currently submitted and now we are just waiting for the ACGME from what I understand. He told me that "if we get the fellowship, it's yours."

Now, last night I interviewed for a job that I really liked. I'm very geographically limited due to family and really enjoyed the people there and the compensation seems good. It seems like a place I can settle and would actually enjoy working. I went to the dinner with the group last night and they said that they will make me an offer. They said a contract is being sent to me and I have 60 days to respond. Even if I do the fellowship, this place seems like somewhere I'd like to work for.

Now my dilemma is this. How should I approach this situation?
I was going to tell my Asst. Program Director about the situation and ask him when is the earliest we will know. Unfortunately I really doubt he will. Should I ask the new job's ED Director for an extension on the contract time? Do you all think that's too much to ask for? Pain is something I'm interested in but not dying to do. A pain fellowship could be my "ER out" plan but who knows if that will even happen. If they offered me the fellowship tomorrow I would take it out of respect for my mentor, but feel it's a problem waiting until February and not hearing anything job wise with my hands tied down. I'm really looking for some solid advice on the situation and really appreciate all the help you guys have provided throughout the years. Thanks so much for everything guys.
 
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Now, last night I interviewed for a job that I really liked. I'm very geographically limited due to family and really enjoyed the people there and the compensation seems good. It seems like a place I can settle and would actually enjoy working. I went to the dinner with the group last night and they said that they will make me an offer. They said a contract is being sent to me and I have 60 days to respond. Even if I do the fellowship, this place seems like somewhere I'd like to work for.

...

Now my dilemma is this. How should I approach this situation?

...

Pain is something I'm interested in but not dying to do. A pain fellowship could be my "ER out" plan but who knows if that will even happen. If they offered me the fellowship tomorrow I would take it out of respect for my mentor...

Given the options, I'd vote for you taking the job you were offered.

Lowly PGY2 outsider's opinion. I'm all for having an out, but maybe this isn't the out you're after.
 

emd123

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I did Pain and I think it's a great option. It's worked out very well for me. PM if ?'s
 
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shopsteward

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Do you have to be your hospital's first pain fellow? Could you take the job and go back to the pain fellowship later if you wanted?

It's the "very geographically limited" that's important here. Are there other groups you could join as an anaesthesiologist? How often do those jobs in your area come up? If the answers are "no" and "less than once a year" and you don't take this job, you are either looking at moving for an anaesthesia job or going straight into pain without practising anaesthesia.
 

gutonc

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Do you have to be your hospital's first pain fellow? Could you take the job and go back to the pain fellowship later if you wanted?

It's the "very geographically limited" that's important here. Are there other groups you could join as an anaesthesiologist? How often do those jobs in your area come up? If the answers are "no" and "less than once a year" and you don't take this job, you are either looking at moving for an anaesthesia job or going straight into pain without practising anaesthesia.
You're in the EM forum. Nobody but you is talking about anesthesia.
 
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Birdstrike

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Do you have to be your hospital's first pain fellow? Could you take the job and go back to the pain fellowship later if you wanted?

It's the "very geographically limited" that's important here. Are there other groups you could join as an anaesthesiologist? How often do those jobs in your area come up? If the answers are "no" and "less than once a year" and you don't take this job, you are either looking at moving for an anaesthesia job or going straight into pain without practising anaesthesia.
http://www.abem.org/public/docs/def...elease_pain-medicine.pdf?Status=Temp&sfvrsn=4
 

dotcb

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Tell your APD the situation and the details about time constraints. If they're any good, they'll be straight with you. It also sounds like you have over 2 months to make this decision, which is quite a bit of time. Overall, I would lean toward taking the job.
 

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The problem with a pain fellowship is that you are committed to that route once you complete. It's reportedly much more difficult to balance pain with traditional EM vis-a-vis other fellowship tracks. Unless you concretely envision yourself doing pain, I see limited ROI in spending an extra year going that route. I'd take a step back and internally align your career goals & ambitions so that they aren't adversely influenced by an overzealous assistant PD who has an invested interest in putting a new recruit in his/her pet fellowship track.
 

gman33

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Do you really want to do pain?
If this is your goal, you should be applying to a whole bunch of programs and trying to find the best one.
It sounds like you are only interested because there is an opportunity which you can just fall into at your home program.
To me this suggests you don't have a strong interest.

I don't think doing a fellowship now in case you want to switch fields later is a good idea.
You need to work in that field or else the skills and knowledge will go away.

If you want to do something else in 10 years, do the fellowship at that time.

To me it sounds like you should just take the job at move on.
 

Arcan57

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** WARNING - UNIFORMED OPINION AHEAD **

It seems to me that there are two types of fellowship tracks that EM practitioners go into:

1) ED + fellowships: tox, EMS, U/S, +/- hyperbarics and crit care are all traditionally fellowships that are intended to augment existing EM knowledge and I would wager that most people that do these fellowships are working clinically in the ED

2) Instead of ED fellowships : pain, sports medicine, palliative care - primarily clinic based practices that require a high time commitment that is incompatible with pulling fulltime in the ED. Usually taken by people that are looking to transition out of working in the ED.

Academics allows some mixing due to generally lighter fulltime clinical load but out in the community this seems to be the common breakdown. Going down the "instead of ED" track is going to mean either not being able to start up your practice in your outpatient specialty or a swift decay of your ED skills if the fellowship is done right out of residency. If you don't need an escape hatch right now, it's better to wait and just budget in some savings for the hit in income you'll take transitioning to a fellowship later.
 
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How commonly do people pursue "instead of ED" fellowships several years after completing residency? I've only heard of people doing fellowships out of residency.
 

Pudortu

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Hey guys, thanks for the advice. I followed most of it and talked to my APD and have decided to sign with the group. He was very supportive and appreciated everything and totally understood where I was coming from. Thanks for all the straightforward and helpful points.
 
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Birdstrike

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** WARNING - UNIFORMED OPINION AHEAD **

It seems to me that there are two types of fellowship tracks that EM practitioners go into:

1) ED + fellowships: tox, EMS, U/S, +/- hyperbarics and crit care are all traditionally fellowships that are intended to augment existing EM knowledge and I would wager that most people that do these fellowships are working clinically in the ED

2) Instead of ED fellowships : pain, sports medicine, palliative care - primarily clinic based practices that require a high time commitment that is incompatible with pulling fulltime in the ED. Usually taken by people that are looking to transition out of working in the ED.

Academics allows some mixing due to generally lighter fulltime clinical load but out in the community this seems to be the common breakdown. Going down the "instead of ED" track is going to mean either not being able to start up your practice in your outpatient specialty or a swift decay of your ED skills if the fellowship is done right out of residency. If you don't need an escape hatch right now, it's better to wait and just budget in some savings for the hit in income you'll take transitioning to a fellowship later.
I think this is a fairly informed assessment. The only thing I'd disagree with a little bit, is that it's immensely easier to do a fellowship immediately after residency, as opposed to later. You can keep up your skills through moonlighting if desired. I think "swift decay" of skills is a little strong. (Efficiency is probably the quickest thing to go, but the quickest thing to come back once diving back in.) Also, going back to training after being out, gets harder and harder each year, as life and finances get more complicated. I did it though, and I'm very happy I did. Also, though it's harder to combine the fellowships under your "#2" with clinical work in the ED, with mega-employee groups (Kaiser-Perm, academics, etc) it definitely is possible. All of them, #2 > #1, allow you to significantly reduce your exposure to the things in EM toughest to weather over the long haul, such as circadian-crushing shift changes, soul-crushing administrative mind-games and neuron-cauterizing pace.

In residency, I thought doing an EM fellowship was a waste if time, but >10 years out, count me as "Pro-EM Fellowship" in a big way. Doing one, has made my life a lot better, and having done one, in no way prevents me from working in the ED.



#Positivity
 
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Old_Mil

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Now, last night I interviewed for a job that I really liked. I'm very geographically limited due to family and really enjoyed the people there and the compensation seems good. It seems like a place I can settle and would actually enjoy working. I went to the dinner with the group last night and they said that they will make me an offer. They said a contract is being sent to me and I have 60 days to respond. Even if I do the fellowship, this place seems like somewhere I'd like to work for

Take the job.

Pain is something I'm interested in but not dying to do. A pain fellowship could be my "ER out" plan but who knows if that will even happen. If they offered me the fellowship tomorrow I would take it out of respect for my mentor, but feel it's a problem waiting until February and not hearing anything job wise with my hands tied down. I'm really looking for some solid advice on the situation and really appreciate all the help you guys have provided throughout the years. Thanks so much for everything guys.

I do not see a field that takes the drug addicts, narcotics seekers, malingerers, and crazy middle aged women with fibromyalgia who make life hell as an EM physician and concentrates them into an office practice as any sort of rational "out" for Emergency Medicine.
 

gman33

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Take the job.



I do not see a field that takes the drug addicts, narcotics seekers, malingerers, and crazy middle aged women with fibromyalgia who make life hell as an EM physician and concentrates them into an office practice as any sort of rational "out" for Emergency Medicine.

The reason this can still be an out is that a private practice can d/c these patients from the practice.
Or just tell them to go to the ER.
All this only during 9-5 M-F.
 

Birdstrike

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The reason this can still be an out is that a private practice can d/c these patients from the practice.
Or just tell them to go to the ER.
All this only during 9-5 M-F.
...and lots of elective procedures in patients with good insurances?
 
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