Let me preface this by saying I'm trying to offer sincere advice and not trying to be mean, at all.
1) Most ER fellowships, to me, are a total waste.
Critical care is interesting because critical patients are what we love. On the other hand, do you want to be the ICU doc that inherts 17 ventilated pateints on Monday morning and has to figure out how much Jevity to give in the tube feeds and figure out sodium deficits and all the other minutia that goes into being an ICU doc. I like codes and resucitation and putting in lines/tubes, but the slow meticulous management of ICU patients is generally not what ER doctors like- though you maybe the exception. There are ICU/ER hybrid models but there are very few of those and I think there would probably be more than enough people wanting to do that.
I'm not sure what a palliative care fellowship teaches you. I'm not sure what an ER doctor with a palliative care fellowship can offer a patient that a plain old ER doctor can't (especially if you are in a hurry to see the next 5 patients that have not been seen yet).
I really wanted to do a peds fellowship coming out of residency. I'm glad I didn't. It would have been flushing money down the toilet. First, in most ERs, the ER doc gets paid more than the peds ER doc. Second, I already see a bunch of sick kids. In fact, in my shop, we have peds hospitalists that staff the ER in the evening. If there's a very sick kid (imminent intubation) or a trauma, I'm seeing it, not them. Point being, I'm already very competent seeing sick kids and I think doing a fellowship would only make me marginally better than just getting ongoing community experience. Third, I think a Peds ER fellowship really only helps you if you work in a Pediatric Academic Center where you will be more comfortable with weird/genetic diseases that we typically don't get in a standard ER. Those families typically know that they have to go to THEIR hospital to get specialized treatment.
Ultrasound-schmultrasound. Just kidding. Though, I think it's been discussed on this forum that in most community settings, it's hard to make doing a bedside ultrasound make financial sense. I'm actively looking for good ultrasound courses to take to get better at very limited/specific exams (see related thread), but 1-2 yrs seems like overkill.
Now some people say that if you do a fellowship you can get your foot in the door of an academic program. I guess that makes sense. BUT, you know those little glossy fliers you get in the mail advertising job offers- but sometimes they don't tell you exactly which hospital they're hiring for? So I got one the other day, and I'm like 80% sure it's for the University of Chicago Hospitals. U of C! Like, Peter "I wrote the book" Rosen was program director there! And they're just like sending out job ads trying to hire faculty. Also, there are new residency programs popping up every year (too many, in my opinion, but that's another issue). I don't think you need a fellowship to do academic medicine because it is still moderately wide open- as long as you're not married to a single location.
2) It sounds like you are not trying to get into a field that you are passionate about as much as you are trying to get away from a job that you don't like. If that's the case, a fellowship is not the answer- a new job is. What is wearing you down about your current job? Is it the structure? Are you with a Mega-Group? Are you seeing 4.5 pts/hr? Are the patients in that part of town hard to deal with?
If the powers above are trying to make you prioritize anything over good patient care, I think you should consider voting with your feet. There is such a strong demand for ER doctors right now (outside of a few tight markets) that you should be able to find a job easily. You can find a hospital employed position or a nice smallish group. There are good groups out there that want to provide excellent patient care, I promise.
It sounds like you have had some financial setbacks. I guess it's hard to give advice without knowing details, but I think there's a temptation to make a lot of money all at once and tell yourself you will relax after that. It works for some people, but it's not worth it if you hate your job/life/the care you provide.
3) I've been reading your posts for a long time, Gringa, and have gained a lot from your comments over the years. Thanks!
