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cardsbound

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Dec 18, 2008
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Down to earth question here - seems like as a community we obsess to no end on how to get into the best residency so that we can get into the best cards fellowship at UCSF/MGH/BWH/Hopkins/etc. . .

My simple question is, is it worth it? I mean, what is the light at the end of the tunnel? Junior faculty with a starting salary barely six figures? Just to endure the politics of academia so that in another 7-10 yrs I can make tenure and be earning half of my colleagues who did "lesser" fellowships and went into PP? Do these fellowships open up any other doors besides a long career of being stuck in the lab and underpaid until you retire?

Help me understand why I struggle to do all of this when my non-medicine peers only seem to keep advancing in their careers. I love research and the academic setting, but there's only so much I can take.

I mean, I know i should just keep my head down and be grateful to have the "privilege" of being in academia but . . . .
 

dragonfly99

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May 15, 2008
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Nobody can answer that question for you.
For me, the answer to that was "no". I want to practice cardiology and I wanted to do fellowship somewhere I liked. I will be able to do that where I matched, and I don't care that it wasn't MGH/Hopkins/Mass General. If those places offer what you want, then I say go for it. For me, the politics in academia (which you mentioned) is problematic, and it's been enough to make me reconsider an academic career (though not abandon all thoughts of one). However, I am realistic in knowing that there are political games played in large private practices, VA hospitals, etc. as well. If you want to avoid the politics then be your own boss, but that carries considerable financial risks. There is also hospital politics to deal with, and you'll need hospital privileges to practice cardiology. So I guess you pick your poison (high powered academics vs. private practice) and you drink it. For me, I'm thinking more "low powered academics" with clinical research...LOL!

p.s. You sound depressed? Lab experiments not going well?
 

cardsbound

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Dec 18, 2008
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p.s. You sound depressed? Lab experiments not going well?
No, quite the opposite actually. I'm just at a transition point in my career where I have a lot of options, and I also have a lot of time to reflect on my choices (maybe not the best thing :laugh:). Sometimes I feel like I am being funneled into this academic system along with others, and nobody is asking these questions. I mean everyone seems to base their actions/decisions with super focus and competitiveness to getting these fellowships, but nobody seems to care why? I think there is a sort of naivety and denial out there, a hope that things sort of just work out well if you do x, y, and z.

Sorry, but as a scientist, I need proof and evidence.

So people out there, especialy fellows who have graduated, was it worth it? Do you have job opportunities you dreamed of?
 
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dragonfly99

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May 15, 2008
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Well not everybody does "x, y and z" just because someone tells them it is the thing to do.

I don't think there are many attending cardiologists on here.

If you want to do bench research and academic practice then I think going to one of those "top" programs is helpful. If you do not then what matters most is to have good clinical training...if you are interviewing at some suburban cardiology practice where they stay busy cathing people, then what they will care about is your experience in the cath lab and interventional fellowship, not whether you did fellowship at Duke vs. U of North Carolina (well bad example b/c N. Carolina is also well thought of...). That is my strong impression but I'm not an attending yet so take it with a grain of salt.
 

Myostatin

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Cardsbound, I think most of us struggle with this throughout residency/fellowship training. Its especially hard when you see your friends from undergrad who chose different paths, who didn't have to work nearly as hard, and often with less talent, easily raking in tripple+ our PGYX salaries.

I think up until choosing a residency, one is well served by going to the "most prestigious" place one can - for the sake of keeping doors open. At the point of choosing fellowship though it should be a question to ask before going through the process - bottom line is that you're right - there really is no point in struggling to land a highly regarded academic fellowship if you really want to do private practice in a small town and make lots of money.

This is the same decision that people in all fields go through - academics at a low salary in exchange for respect and the ability to (in theory) pursue whatever interests you. Often its even starker a contrast (i.e. economics professor vs hedge fund manager) But there are lots of hidden perks - if you're good at it and lucky, you can change the world and make a fortune doing research - all you need is one marketable idea. Then there's opportunities s/a expert witnessing, later jumping into industry, etc.... Many of the top executives / R&D people in pharma are recruitied from the upper tier of academics.

I guess it all comes down to whether or not you would be happy being a clinical machine, grinding through clinical volume as efficiently as possible.
 

tibor75

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Starting faculty iwth low 6 figures? I guess that depends upon your definition of low. I think $190,000 out of fellowship at an academic institution, non-interventional, is pretty good. Sure, if you wnat to do lots of research, you won't get paid. It makes sense - nobody will pay you to think and not see patients.

The idea that PP docs have it made is a joke. AT my fellowship, I worked with academic docs and with PP docs. It was no question which group worked harder. Almost all the academic guys are home by 6 PM. The private practice guys are seeing bogus CP or tachycardia consults at 8 PM because they were in teh office all day. Sure, the pay is great as is the vacation time, but it's not like they don't work for it.

I agree that getting the "BEST" fellowship may not be the best for you. The best fellowships are 4 years long, because they rope you into doing a year of research. Go to a 3 year fellowship instead.
 

lemonade02

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Sep 24, 2007
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great thread..if you are applying for a fellowship and know 100% that you will be going into private practice with the highest bidder, is it appropriate to say these are your career goals when interviewing at non-high powered academic programs? i feel like people would appreciate the honesty and the candor...but does anyone really like to hear the truth straight up like that? is it better just to lie and say you're interested in academics?
 

tibor75

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great thread..if you are applying for a fellowship and know 100% that you will be going into private practice with the highest bidder, is it appropriate to say these are your career goals when interviewing at non-high powered academic programs? i feel like people would appreciate the honesty and the candor...but does anyone really like to hear the truth straight up like that? is it better just to lie and say you're interested in academics?
Yes it's better to lie. But just say you are undecided and that is why you're going to an academic program - to keep your options open. Most of the fellows at even academic programs go into private practice, so it's not like you're alone.
 

Myostatin

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At non-academic programs, I wouldn't try to stretch the truth too much - if you haven't done a ton of research and can't back up why you want an academic career, they're not going to believe you even if you say you're interested in academics - at such programs you would be better served by talking about an interest in clinical medicine and perhaps teaching.

At academmic programs, you won't be considered seriosuly unless you can make a convincing argument that you're interested in academics long term...
 
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