Navy Preping for fellowship

[Perrotfish]

So, I am now about 75% sure that I want to do a fellowship that the Navy does not offer, which would mean doing my time and then getting out to do the fellowship. So my question: for those of you who waited on fellowships, how did you prepare yourself during the time you served as a generalist? Did you moonlight? If you're based somewhat near an MTF (like Pendleton), does it make sense to spend a few days a month working as a trainee on applicable services? Is it possible/legal for you to continue to do resident style rotations for a couple of weeks a year? Or did you just wait it out and hope for the best? For those who did a chief year, did you think is a valuable experience relative to your years of just working in the fleet? Other thoughts?

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[HighPriest]

I recently spoke with a fellow resident who just started fellowship after separating. His case is kind of unusual, but here it is anyway:
He happened to be stationed within a few hours of the fellowship program, and so he made contact with the program director early, and let him know he was strongly interested. They ended up working on a few patients together, and ultimately he was awarded a position.
But of course, this wasn't a sub-spec that fell into any official match (head/neck endocrine), and he lucked out with the station being so close.....
That's probably not too helpful....

 

[Homunculus]

word to the wise-- if you do this be very very careful about working at a place (ODE or otherwise) that you then separate and join. an audition rotation or something for free is one thing, but if you are there consistently and being paid, the legal folks will have a **** fit. reason being, if you are being paid by an outside source while in, then transition to that slot immediately after getting out, there is the perceived opportunity for shenanigans to occur. and appearances are everything anymore, regardless of intent.

it's much ado about nothing in my opinion most of the time, but there have been incidents where people retiring had some really big unexpected hurdles placed in front of them because of this policy. it may be different for ETSing, but it would be a travesty to lose your GI bill or other benefits due to this. unless you don't want the GI benefits and just want to GTFO, in which case more power to you. just run in through JAG first, all i'm saying. if i didn't see it happen myself i wouldn't believe it, but it has happened.

--your friendly neighborhood gimme my damn GI bill caveman

 

[HighPriest]

I'm fairly sure he was never paid for anything prior to ETSing, and I'm very sure he didn't care about the GI bill.

 

[BigNavyPedsGuy]

I was in your situation: I ended up being 2+ hours away from the nearest training program and getting tons of hurdles thrown up about doing rotations. Since you aren't a trainee, you won't be covered by that institution's malpractice coverage for trainees. Since you're moonlighting/rotating you won't be covered by the Navy/Army/AF malpractice. I ended up penciling in some trips to do "observerships"

But then a job that was too good to pass up fell out of the sky and I scrapped the whole fellowship idea. The reality of staring training after having a couple of kids (and one income) and being 3 years out from training was much more daunting than I had anticipated. And the aforementioned job came along.

Good luck. I worked really hard and got nowhere.

 

[Perrotfish]

So basically my concern is that my program has somewhat limited electives and I'm worried that that, plus four years of outpatient clinic, could leave me feeling very unprepared for fellowship on the other end. Some more specific questions:

1) If I'm near a major MTF is there any way to work under the residency's training license and use my vacation to do a rotation or two when I'm coming up on fellowship? What about if I'm still attached to the MTF (like if I was doing a chief year)?

2) If I'm at smaller, more distant command can I legally work under another physician's supervision (like a surgeon or anesthesiologist) to learn a new skills despite the fact that we're both attending physicians? Is that legal?

3) A lot of my more educational electives were basically just observerships anyway. If I asked the poison control center, Peds radiology department, forensic pathologist, or a subspecialty service for the chance to do an observership as an attending, would they look at me like a total freak? If I took extra call/weekends, do you think I could carve a couple of two week blocks out of my schedule or are things too busy for that?

All theoretical of course. I'm sure there's a better than even chance that I will have kids and give up on the idea of further training before this becomes relevant (Not that having kids isn't also a good reason to lean tox and sedation)

 

[BigNavyPedsGuy]

In my experience you'll run into some challenges. I do think those things would be easier if you were working with military folks vs civilians. they understand delayed fellowships and the credentials transfer much more easily. BUT if you want to train as a civilian some face time might be nice too. There really isn't a way to work as a resident once you're not a resident. It was a surprising hitch in my plans.

In the end I was going to do an observership for about a week at my top choice and had a visit planned with my second choice. All 6 months before interview season started. I had picked up enough collaterals that I had a pretty strong resume. (I wanted Peds EM and was the Chair of our Code blue Committee and the Medical Director of our Urgent Care). My mentors from residency had also promoted to higher positions (specialty leader, Dept Head, etc) so those letters would've been good.

Also, I cold contacted several folks in the field. Explained my situation and said things like, "do you think my background might be a good fit for your program? What would you like to see in an applicant like me? What can I do in the meantime to make myself more competitive?" In general people were very receptive to that.

My advice has always been: ask everybody who might know something everything you can think to ask them.

Anyway, I say all that to say that you can do things. It just takes a lot of work. Maybe some job where you work every other week, make essentially the same as a fellowship trained doc in a location that you've dreamed about living for 15 years will fall into your lap too

I had a LOT of angsty times trying to get that together, but it'll all work out.

 

[Gastrapathy]

If NMCSD has the applicable services, how sure are you they won't train you? It doesn't have to be on the precept. Sometimes weird things happen and applying one year might make them decide to go for it the next year. I can't speak for Peds but for IM subs, doing a tour and getting out has worked out fine for the people who would have been competitive after residency.

 

[BigNavyPedsGuy]

I think the challenge is that you don't meet any of the folks that separated and did a civilian fellowship - they aren't in the Navy anymore! There could be dozens of success stories, but the only people available to us as advisors are those who stayed in. If you're interested in a fellowship the Navy doesn't train (like Peds EM in my case) then you are really kind of wandering in the wilderness on our own.

 

[Perrotfish]

Anyway, I say all that to say that you can do things. It just takes a lot of work. Maybe some job where you work every other week, make essentially the same as a fellowship trained doc in a location that you've dreamed about living for 15 years will fall into your lap too .

That's f-ing awesome. If you guys have an opening 5 years from now let me know.

 

[Homunculus]

My advice has always been: ask everybody who might know something everything you can think to ask them.

Anyway, I say all that to say that you can do things. It just takes a lot of work. Maybe some job where you work every other week, make essentially the same as a fellowship trained doc in a location that you've dreamed about living for 15 years will fall into your lap too

where is this panacea? generally? acute care clinic in a rich private pay neighborhood?

I think the challenge is that you don't meet any of the folks that separated and did a civilian fellowship - they aren't in the Navy anymore! There could be dozens of success stories, but the only people available to us as advisors are those who stayed in. If you're interested in a fellowship the Navy doesn't train (like Peds EM in my case) then you are really kind of wandering in the wilderness on our own.

can't overemphasize this enough. other than this forum it's hard to find people who get out and go on with their lives. taking career advice from a current O6 is not as useful as it once was, because all the rules and the lay of the land has changed.

--your friendly neighborhood making his own way caveman

 

[narcusprince]

So, I am now about 75% sure that I want to do a fellowship that the Navy does not offer, which would mean doing my time and then getting out to do the fellowship. So my question: for those of you who waited on fellowships, how did you prepare yourself during the time you served as a generalist? Did you moonlight? If you're based somewhat near an MTF (like Pendleton), does it make sense to spend a few days a month working as a trainee on applicable services? Is it possible/legal for you to continue to do resident style rotations for a couple of weeks a year? Or did you just wait it out and hope for the best? For those who did a chief year, did you think is a valuable experience relative to your years of just working in the fleet? Other thoughts?

Perrot I am dissapointed I for sure thought you would stick around for O-6 be a game changer.

 

[StarboardMD]

Can someone give me details on this "observership"? I'm applying for civilian residency, not fellowship, but I keep running into roadblocks to getting to spend time in the clinic here on post (now I have to request a revision to my credentials). I was slow to decide on a specialty, and now I am desperately seeking some experience (and hopefully LORs). I assumed that since I'm a licensed physician, but am neither licensed in this state nor do I have malpractice, that I wouldn't be able to go near a civilian hospital or clinic. Is this observership a legitimate thing, or was it just people willing to look the other way?

 

[BigNavyPedsGuy]

You don't need to be credentialed to stand around and watch. If you touch patients, then you have to do that junk. It was a PD's idea in my case.