Pathway for mid-career physicians?

[txcawa84]

Hello all,

I am an interventional radiologist a few years out of training, currently working in a community hospital setting.

A significant part of my practice has involved helping to provide end-of-life care for patients with cancer and end-stage liver disease. I've had longitudinal care relationships with these patients and their families as I have provided serial paras/thoras, pleurX placements, kyphoplasties & spinal met ablations, palliative locoregional treatments for hepatic malignancies, etc.

As I progress through my career I find myself drawn more and more to these relationships and less and less to many of the other daily aspects of my job. I've started looking into hospice and palliative care fellowships and wanted to get opinions from those who went back to do a fellowship mid-career as to how they investigated the field while in practice and how they approached going back to do a fellowship.

Thanks in advance!

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[Tizoc]

The other fellow I worked with was a hospitalist for 10 years before switching to HPM. He enjoyed goals of care discussions a lot. In addition, his hospitalist group was looking to start an affiliated palliative medicine group. He wanted to lead it, so he decided to get certified. Since he started looking for positions after the match, he went around cold calling programs with openings, especially in the local area, until he found ours.

You said, "as I progress through my career I find myself drawn more and more to these relationships and less and less to many of the other daily aspects of my job," and I think that was true of him as well. I would argue that the desire to be a part of this field is emphasized more than other specialties. If that shines through in your personal statement and interview, I doubt you'd have a problem getting a fellowship.

Funnily enough, all the fellows that came after me were career changers too (FM, Pain, Anesthesia), so there might be programs that prefer the veterans over us fresh out of residency types.

 

[wxf]

Hello txcawa84,
Similar situation, anesthesia/CCM now in process of applying to palliative care fellowships.
Not the norm, but not unusual either.
The University of Colorado Anschutz Medical Campus is offering an online option (Healthcare Education & Research Innovation Solutions) for training those currently in practice.
All the best.

 

[turkeyjerky]

So how does one go about applying for a fellowship when they're several years into community practice. Do you set up a "rotation" with a local HPM group? Who writes the LORs? I'm assuming you would get one from your residency program, but what about the others--coworkers, medical directors?

 

[SourceOfDenial]

HPM as a field is very friendly towards people joining for fray, and going from IR to HPM would be a switch that would surely excite fellowships.

Definitely look for places that have taken mid career folks or take fellows outside of IM. If they are excited to learn from you, that’s a good sign.

 

[the argus]

Hello txcawa84,
Similar situation, anesthesia/CCM now in process of applying to palliative care fellowships.
Not the norm, but not unusual either.
The University of Colorado Anschutz Medical Campus is offering an online option (Healthcare Education & Research Innovation Solutions) for training those currently in practice.
All the best.

deleted for correctness

 

[CCM-MD]

It should be pointed out that this online option certainly does not qualify you to become boarded-certified in palliative care, and hence would not actually lead you to be able to practice palliative medicine at most institutions. This type of certificate might be useful for a social worker or midlevel provider.

Palliative fellowships are not particularly competitive, many people actually use them as CV boosters to get into more competitive fellowships (pulm crit, heme onc). In this years match only 85% of palliative positions filled, with 43 programs going unfilled.

Mid-career physicians with a compelling story as to why they want to do palliative medicine, who are able to relocate for the 1 year fellowship, should be able to secure a fellowship position leading to board-certification without spending >$8000 on a certificate that is largely meaningless for a physician.

I believe it does allow you to become board certified in palliative care:

"This program has been approved by the Accreditation Counsel for Graduate Medical Education (ACGME), American Board of Internal Medicine (ABIM), American Board of Family Medicine (ABFM) and other supporting Boards as a 5-year demonstration projects. Fellows who successful complete the CB HPM Fellowship will be eligible to take the HPM Board exam."

Fellowship | Palliative Care | Graduate School

www.cuanschutz.edu

 

[the argus]

I believe it does allow you to become board certified in palliative care:

"This program has been approved by the Accreditation Counsel for Graduate Medical Education (ACGME), American Board of Internal Medicine (ABIM), American Board of Family Medicine (ABFM) and other supporting Boards as a 5-year demonstration projects. Fellows who successful complete the CB HPM Fellowship will be eligible to take the HPM Board exam."

Fellowship | Palliative Care | Graduate School

www.cuanschutz.edu

Shoot, I stand corrected. I didn't dive deep enough apparently, only found the certificate and masters programs. That's quite a departure from the traditional fellowship model leading to board certification.

 

[dadaddadaBATMAN]

Shoot, I stand corrected. I didn't dive deep enough apparently, only found the certificate and masters programs. That's quite a departure from the traditional fellowship model leading to board certification.

Although not my field, this may come from the fact that until recently palliative seems to have followed more of an on the job or apprenticeship model. I think the board certified/acgme fellowship/match participation only started about 15 years ago for this field.

Happy to be corrected by anyone who knows more though

 

[wxf]

So how does one go about applying for a fellowship when they're several years into community practice. Do you set up a "rotation" with a local HPM group? Who writes the LORs? I'm assuming you would get one from your residency program, but what about the others--coworkers, medical directors?

I went through ERAS, including my Dean's Letter (from a long time ago) and national board scores (from a long time ago).
I approached several colleagues, explained the reasoning behind my motivation for palliative care and asked if they would be able to write me a letter of support. The ERAS system is pretty straightforward, much better than the old days of filling out individual applications for each program.

 

[rachelle04]

So how does one go about applying for a fellowship when they're several years into community practice. Do you set up a "rotation" with a local HPM group? Who writes the LORs? I'm assuming you would get one from your residency program, but what about the others--coworkers, medical directors?

I'm currently applying for fellowship in HPM. I finished residency 8 years ago. I have worked part-time in out patient primary care/urgent care. You are required to have a letter from your program director. It was unclear if it was to be the current PD or the one from when you were in residency. However, I had maintained contact with my PD, who is long retired, and he kindly wrote a letter for me. One letter was from my current supervisor whom is also the chief medical officer for my practice. The third letter was from a HPM physician who I rotated with for a HPM rotation as a resident and whom I spent a couple hours a week with over the past year participating in interdisciplinary team meetings with the hospice she works for. We shall see if my application is good enough to get into a fellowship.