quitting fellowship

[rokshana]

I don’t hate it. My fear is dealing with the stress and the people co fellows, attendings, leadership, PD etc. I don’t mind the patients really, not that they would never annoy me but the big issue is the people in the program.
I am going to try my best to learn. Not sure if I can do much about feeling incompetent when I am treated that way.

What makes you think you won’t have to deal with this as a hospitalist? In many places, hospitalists are the dumping ground for everyone.

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[CatFactorial]

Do you think it is a pretty bad sign that I already feel this way? My co fellows are all smart and good and have it together which makes me question my decision more. If I am the lousy one that means I am not that qualified. Just feels wrong.

First few weeks of heme/onc fellowship, like many others I was new to the institution, don’t know anything, anxious, etc.

Talking to my cofellows about it later apparently, I came across as super confident to the point of intimidating, which is really quite silly based on how i really felt.

Your self-perception may not square with how others see you.

 

[Raha44]

First few weeks of heme/onc fellowship, like many others I was new to the institution, don’t know anything, anxious, etc.

Talking to my cofellows about it later apparently, I came across as super confident to the point of intimidating, which is really quite silly based on how i really felt.

Your self-perception may not square with how others see you.

It is cool how you all talked about it later. I don’t see that happening with my cofellows

 

[rokshana]

It is cool how you all talked about it later. I don’t see that happening with my cofellows

But you have only known them for 2 weeks…

 

[collegestud2013]

Cards can be similar to hospital medicine if you want it to be, only you’re paid more. Give it 6 mo.

Maybe for some of cards subspecialists like interventional or EP, but harder to say sure how much general cardiology really comes out ahead of IM/FM hospitalist once all factors considered. Namely, the higher pay comes mostly from longer work hours (usually 55-60 hrs week as an attending from what I hear, which ends up being a lot more work than the typica 7-on/7off hospitalist) and the higher RVUs that are generated as result. The hourly pay for employed general cardiology comes out only slightly higher than employed hospitalist. Once you factor in the 3 year training time, and the high tax brackets physicians are in, the post-tax money may only be slightly more with the break even point later in career.

And yes there are cardiology hospitalist jobs out there if you like shift work and don't want to deal with the hassles of running an outpatient practice. These are jobs are even better at facilities where patients are admitted under IM/FM hospitalist service, with cardiology just being a consultant (and thus not having to deal with most of the discharge/dispo issues).

Also others mentioned, fellowship and residency training is often very different than attending life.

Also, IM/FM hospitalist job market is starting to get saturated. There are less cardiologists out there and hence the job market may not saturated as easily.

 

[HemeOncHopeful19]

Don’t give up your golden goose for 6m to 1y imo.

If you still end up quitting you are out a year of being a hospitalist and maybe (100-150k given the time it would take to find and credential at a hospitalist job)

On the other hand if you quit now then you miss out on 30 years of being a Cardiologist and probably a few million.

 

[Señor S]

Couple more thoughts:

1. My understanding is that most fellowships are fairly frontloaded and the first year is the worst. And as others have said the first few months are probably going to be the worst part of that, especially in a new environment. You may find yourself a year from now on a "research" block thinking "Hey, this isn't so bad."

2. If you finish your Cardiology training and decide you want to be a hospitalist, you still can. The reverse is not true.

3. All other things being equal Cardiologists will come out far ahead of hospitalists financially, don't let anybody tell you otherwise.

 

[dozitgetchahi]

This is so true. Fellows don't realize how much bull**** they get shielded from by attendings. Now that I'm out in the real world, I wish I could go back to the fellow workload even though at the time we all thought we were the hardest working group in the hospital and the attendings just sat around doing nothing.

I don’t know. I worked pretty damn hard as a fellow, and a lot of the stuff I had to do was either scut work or aspects of my specialty I detested dealing with. Now, as an attending, I do “more work” but it’s the kind of work I like doing. Plus, I can set up the clinic my way, I have staff that specifically work to help me accomplish things (including scribes!), and I’m not personally handling any scut work - none of which were true in fellowship. So even though the volume of work is “bigger”, I think it’s actually much easier to deal with (and much more pleasant).

Also, in academia, the attendings really are dumping work on trainees.

 

[Raha44]

Maybe for some of cards subspecialists like interventional or EP, but harder to say sure how much general cardiology really comes out ahead of IM/FM hospitalist once all factors considered. Namely, the higher pay comes mostly from longer work hours (usually 55-60 hrs week as an attending from what I hear, which ends up being a lot more work than the typica 7-on/7off hospitalist) and the higher RVUs that are generated as result. The hourly pay for employed general cardiology comes out only slightly higher than employed hospitalist. Once you factor in the 3 year training time, and the high tax brackets physicians are in, the post-tax money may only be slightly more with the break even point later in career.

And yes there are cardiology hospitalist jobs out there if you like shift work and don't want to deal with the hassles of running an outpatient practice. These are jobs are even better at facilities where patients are admitted under IM/FM hospitalist service, with cardiology just being a consultant (and thus not having to deal with most of the discharge/dispo issues).

Also others mentioned, fellowship and residency training is often very different than attending life.

Also, IM/FM hospitalist job market is starting to get saturated. There are less cardiologists out there and hence the job market may not saturated as easily.

All good points. Problem is I really didn’t do it because I thought I’ll make more money. I won’t do a super fellowship. I wanted to specialize and do research in academia but questioning everything now.

 

[Raha44]

Don’t give up your golden goose for 6m to 1y imo.

If you still end up quitting you are out a year of being a hospitalist and maybe (100-150k given the time it would take to find and credential at a hospitalist job)

On the other hand if you quit now then you miss out on 30 years of being a Cardiologist and probably a few million.

I totally get the financial part and everyone talks about it. I want to be able to work as a physician and not ruin my professional career because quitting the fellowship. I am already credentialed for somewhere I moonlighted.

 

[Raha44]

Couple more thoughts:

1. My understanding is that most fellowships are fairly frontloaded and the first year is the worst. And as others have said the first few months are probably going to be the worst part of that, especially in a new environment. You may find yourself a year from now on a "research" block thinking "Hey, this isn't so bad."

2. If you finish your Cardiology training and decide you want to be a hospitalist, you still can. The reverse is not true.

3. All other things being equal Cardiologists will come out far ahead of hospitalists financially, don't let anybody tell you otherwise.

I agree with you 100%. Yeah the first year will be tough and I anticipated it will be, didn’t think about every challenge I will face. I think I was so focused on the match and finishing training that I ignored that part.
I’m gonna try and give it a few months. Who knows maybe they will let me go before I end up quitting.

 

[CCM-MD]

Don’t quit. Give it time.

It’s not unusual to feel this way in a new location/institution/department/specialty. Think of it like adjustment disorder. You might have similar feelings starting as a brand new attending in a new place. I

 

[SXMMD]

Thank you for your advice.
I am concerned about the workload and stress which feels like torture. I feel overwhelmed already by the expectations.
I agree that I should wait a bit before making the decision so will give a few weeks unless something bad happens or I make a bad mistake.
I am not on a visa which is a big relief. I am credentialed in another hospital in a different city for moonlighting. I am thinking of going back there and see if they will take me.

agree with others here- sounds like your concerns aren't about cardiology as much as self doubt and a tough environment.

Training will give you confidence. Completion of training will get you out of that environment- it's temporary.

If you like the work, stick with it. You can always do straight IM if you so choose, but your cardiology pedigree will open tons of doors. As an attending you will have MUCH more control over your work life, certainly moreso as a specialist than a hospitalist.

 

[Splenda88]

Since you will be moonlighting as hospitalist, give it time. If you like hospital medicine, you can quit in a few months or at the the completion of PGY4.

Hospital medicine is hit or miss. Some people like myself like it, others can't see themselves doing it.

I have a friend who is a PGY5 that is still having doubt about continuing cardiology fellowship. He has been moonlighting as a hospitalist and like it a lot.

 

[Splenda88]

Maybe for some of cards subspecialists like interventional or EP, but harder to say sure how much general cardiology really comes out ahead of IM/FM hospitalist once all factors considered. Namely, the higher pay comes mostly from longer work hours (usually 55-60 hrs week as an attending from what I hear, which ends up being a lot more work than the typica 7-on/7off hospitalist) and the higher RVUs that are generated as result. The hourly pay for employed general cardiology comes out only slightly higher than employed hospitalist. Once you factor in the 3 year training time, and the high tax brackets physicians are in, the post-tax money may only be slightly more with the break even point later in career.

And yes there are cardiology hospitalist jobs out there if you like shift work and don't want to deal with the hassles of running an outpatient practice. These are jobs are even better at facilities where patients are admitted under IM/FM hospitalist service, with cardiology just being a consultant (and thus not having to deal with most of the discharge/dispo issues).

Also others mentioned, fellowship and residency training is often very different than attending life.

Also, IM/FM hospitalist job market is starting to get saturated. There are less cardiologists out there and hence the job market may not saturated as easily.

I am not sure that IM/FM hospital medicine (HM) is really getting saturated with the # of calls I am getting everyday. If it is, there must something attractive about HM. I will say that again, the most attractive thing about HM is flexibility.

 

[Raha44]

Since you will be moonlighting as hospitalist, give it time. If you like hospital medicine, you can quit in a few months or at the the completion of PGY4.

Hospital medicine is hit or miss. Some people like myself like it, others can't see themselves doing it.

I have a friend who is a PGY5 that is still having doubt about continuing cardiology fellowship. He has been moonlighting as a hospitalist and like it a lot.

PGY-5 and still has doubts? He is almost done! He has to survive another year that’s it! Third year is a breeze!

 

[Splenda88]

PGY-5 and still has doubts? He is almost done! He has to survive another year that’s it! Third year is a breeze!

He just started PGY5, so he has close to 2 more years to go.

 

[ReviewOfSystems]

I wanted to do cardiology too. Love the field, still do, did research, shawowing, everything. But the personalities and lifestyle I just couldn't get with. Hospitalist made more sense and still does. Glad I chose it and didn't do fellowship. I just follow the cardiology cases more closely and get my fill that way.

 

[cgk]

I wanted to do cardiology too. Love the field, still do, did research, shawowing, everything. But the personalities and lifestyle I just couldn't get with. Hospitalist made more sense and still does. Glad I chose it and didn't do fellowship. I just follow the cardiology cases more closely and get my fill that way.

Can you elaborate a bit more regarding the lifestyle ?

 

[Splenda88]

My friend who is PGY5 has the same issues w/ cardiology lifestyle. He also said the lifestyle for inventional is even worse than non invasive cardio.

He has been moonlighting at a couple of places where he can round and leave around 1-2pm. There is no rounding and leave at 1-2pm in cardiology. You have to see all the BS elevated trop consults that the hospitalists call you for.

Outpatient is always a grind for every specialty because you have to see so many patients to keep the lights on.

Hospital medicine (HM) has its issues. Wei deal with social BS that most other physicians don't deal with. However, lifestyle-wise, there are not many jobs in medicine that beat HM.

 

[ReviewOfSystems]

Can you elaborate a bit more regarding the lifestyle ?

I mean, you dont need me to tell you. Look at the life of any cardiology attending, academic or private. They may be raking in the cash, but for what? Long hours, stressful cases, between those consults plenty of sinus tach and trop one point above normal consults, always busy and on call (yes even when not scheduled if you are someones cardiologist, you are getting called), and the literature changes by the minute so you have to keep up with it on top of that. Thats what I can name off the top of my head. It sucks! Contrast that with a hospitalist: shift work, half the month off, can have very easy days, the work gets to be mundane after a while (which is nice, despite what the make you believe in residency), scale up on shifts if you want more $, and can acutally enjoy the money and life otuside of work.

 

[collegestud2013]

Can you elaborate a bit more regarding the lifestyle ?

Typical full time cardiologist works 55-60 hrs per week, unless it's a vacation week. They usually have both inpatient and outpatient responsibilities, and rotate in overnight call with their colleagues (and they get called a lot more by the ED and hospitalists than most other specialties). That's a lot more work than the typical FM/IM hospitalist, and hence higher RVUs and higher pay. Though on a per hour basis, generally cardiologists on average make only slightly more than FM/IM hospitalist, despite having 3 more years of training.

Cardiology hospitalist might be the way to go for some people if you prefer just shift work. Though there would likely still be overnight call responsibilities from home since very few hospitalist have a dedicated cardiology nocturnist.

 

[Miles Gloriosus]

Typical full time cardiologist works 55-60 hrs per week, unless it's a vacation week. They usually have both inpatient and outpatient responsibilities, and rotate in overnight call with their colleagues (and they get called a lot more by the ED and hospitalists than most other specialties). That's a lot more work than the typical FM/IM hospitalist, and hence higher RVUs and higher pay. Though on a per hour basis, generally cardiologists on average make only slightly more than FM/IM hospitalist, despite having 3 more years of training.

Cardiology hospitalist might be the way to go for some people if you prefer just shift work. Though there would likely still be overnight call responsibilities from home since very few hospitalist have a dedicated cardiology nocturnist.

i think you forgot the terrible lifestyle of reading echos from home 9-5.

 

[Splenda88]

Typical full time cardiologist works 55-60 hrs per week, unless it's a vacation week. They usually have both inpatient and outpatient responsibilities, and rotate in overnight call with their colleagues (and they get called a lot more by the ED and hospitalists than most other specialties). That's a lot more work than the typical FM/IM hospitalist, and hence higher RVUs and higher pay. Though on a per hour basis, generally cardiologists on average make only slightly more than FM/IM hospitalist, despite having 3 more years of training.

Cardiology hospitalist might be the way to go for some people if you prefer just shift work. Though there would likely still be overnight call responsibilities from home since very few hospitalist have a dedicated cardiology nocturnist.

I work ~65 hrs every other week for 350k/yr. I can request schedule changes anyway I want to if I make the request 2 months in advance. For instance, I requested to work beginning and the and of this month so I can get 2 wks in between to travel. No problem/issue.

I don't know if there are many perfect jobs in medicine, bu when it comes to lifestyle and $/hr, HM medicine is not that bad.

 

[Splenda88]

i think you forgot the terrible lifestyle of reading echos from home 9-5.

This actually would be a nice gig.

The cardiologist who is taking consults and round on floor at my shop also reads the echo.

 

[collegestud2013]

This actually would be a nice gig.

The cardiologist who is taking consults and round on floor at my shop also reads the echo.

Not sure such a full time job would exist outside of large academic institutions. Would probably need a lot of volume to justify one person just doing cardiac imaging full time, which you usually only get at academic medical centers or large health systems. And would probably come with a significant pay cut if they were only working 40 hrs. In PP, would be unusual for the partners to let only one person work 9-5 and get out of rotating through the night/weekend pool.

 

[Raha44]

I wanted to post an update! So now 6 weeks into fellowship, I feel the sane way. I am dreading the upcoming calls and I was told that by an attending that she is worried about me being able to handle them, that my pace is slow, etc.
she plans on talking to my PD. I was honest and told her that I am trying to get better but that I understand where she is coming from and that I am also nervous.
I am really trying my best, maybe I am just not fit and not smart enough.
Should I still go on?

 

[Splenda88]

I wanted to post an update! So now 6 weeks into fellowship, I feel the sane way. I am dreading the upcoming calls and I was told that by an attending that she is worried about me being able to handle them, that my pace is slow, etc.
she plans on talking to my PD. I was honest and told her that I am trying to get better but that I understand where she is coming from and that I am also nervous.
I am really trying my best, maybe I am just not fit and not smart enough.
Should I still go on?

It's not healthy. I think you should get out.

Hospital medicine is not as bad as some people portray it. I actually think it has one of the better lifestyle specialty in medicine based on my conversation with other physicians.

Find a round-and-go hospital medicine job, make 300k/yr and call it a day.

 

[Raha44]

It's not healthy. I think you should get out.

Hospital medicine is not as bad as some people portray it. I actually think it has one of the better lifestyle specialty in medicine based on my conversation with other physicians.

Find a round-and-go hospital medicine job, make 300k/yr and call it a day.

Thanks! I keep thinking that it is not worth it to torture myself like this.

 

[HemeOncHopeful19]

I wanted to post an update! So now 6 weeks into fellowship, I feel the sane way. I am dreading the upcoming calls and I was told that by an attending that she is worried about me being able to handle them, that my pace is slow, etc.
she plans on talking to my PD. I was honest and told her that I am trying to get better but that I understand where she is coming from and that I am also nervous.
I am really trying my best, maybe I am just not fit and not smart enough.
Should I still go on?

You’re definitely smart enough.

It’s not like it takes more intelligence to be a Cardiologist or Oncologist than it does to be an Internist (which you are)… it just takes more years of specific study of those fields. Now that I’ve completed subspecialty training there are definitely things I am relatively clueless about that the PCP/Hospitalist is much better/smarter at.

That being said if you aren’t happy and especially if your program is going to put you under the microscope then it may not be worth it, but that’s something you have to decide I think.

 

[Raha44]

Yeah they are definitely going to put me under the microscope now. PD is calling me to talk so for sure it will be different for me after this and I also feel uncomfortable and insecure in the program.
I don’t think I cannot be a cardiologist, I think maybe a smaller and less competitive program would have been a better fit. I am also considering transferring.

 

[rokshana]

Yeah they are definitely going to put me under the microscope now. PD is calling me to talk so for sure it will be different for me after this and I also feel uncomfortable and insecure in the program.
I don’t think I cannot be a cardiologist, I think maybe a smaller and less competitive program would have been a better fit. I am also considering transferring.

It’s only been 6 weeks…you have had what? 1 rotation?
Go hear what your PD says… you can always leave, but realize you will not likely be able to transfer since you will need your PDs support for that.

 

[anonperson]

I wanted to post an update! So now 6 weeks into fellowship, I feel the sane way. I am dreading the upcoming calls and I was told that by an attending that she is worried about me being able to handle them, that my pace is slow, etc.
she plans on talking to my PD. I was honest and told her that I am trying to get better but that I understand where she is coming from and that I am also nervous.
I am really trying my best, maybe I am just not fit and not smart enough.
Should I still go on?

Are you actually reading/studying?

What exactly are you messing up on?

 

[90sportsfan]

Yeah they are definitely going to put me under the microscope now. PD is calling me to talk so for sure it will be different for me after this and I also feel uncomfortable and insecure in the program.
I don’t think I cannot be a cardiologist, I think maybe a smaller and less competitive program would have been a better fit. I am also considering transferring.

Yeah, just reading this thread you’ve gone from thinking you wat to quit fellowship to become a hospitalist, to now saying you don’t think you cannot be a cardiologist…so it seems like it may be more mental at this point. It seems like you have at least come to the realization that you do want to be a cardiologist, so its good you didn’t quit outright. It sounds like the program itself is the challenge and that you are under the microscope, which makes for a stressful situation. It’s probably good you are talking with the PD so that you can develop a game plan for improving. It’s never good to develop a reputation and be under the spotlight, but if you show improvement, you should end up ok. I would be open to feedback and figure out how to best improve (talk to attendings, is there daily reading/studying you can do to help, etc).

 

[CCM-MD]

You can always become a hospitalist. If you quit, you will essentially close the doors to your subspecialty forever. It is highly likely you will regret quitting after a few years as a hospitalist.

 

[Splenda88]

You can always become a hospitalist. If you quit, you will essentially close the doors to your subspecialty forever. It is highly likely you will regret quitting after a few years as a hospitalist.

Hmm.. this is coming from a hospitalist on steroid aka CCM.

 

[CCM-MD]

Hmm.. this is coming from a hospitalist on steroid aka CCM.

Call it whatever you like. It’s way better than being a hospitalist. At least I’m not leading a crusade to convince everyone on this board that it’s the best gig in the world, like you are, for hospital medicine.

 

[Splenda88]

Call it whatever you like. It’s way better than being a hospitalist. At least I’m not leading a crusade to convince everyone on this board that it’s the best gig in the world, like you are, for hospital medicine.

Yeah, you are right.

 

[rokshana]

Yeah, you are right.

Well you have to admit, you are a bit of a cheerleader…been there, done that and I’m glad I’m an endocrinologist…10 years ago hospitalist was doable… now? Hard to sustain that life.

 

[Splenda88]

Well you have to admit, you are a bit of a cheerleader…been there, done that and I’m glad I’m an endocrinologist…10 years ago hospitalist was doable… now? Hard to sustain that life.

I am. I happen to like my job. I work with people who have been doing for over 10 years that are actually more gung ho than me.

 

[Ubba]

You need to make a definitive decision and soon. Either commit to hitting the books and review courses immediately like you're back in M1 and memorizing Pathoma, FA, etc., or get out and embrace the positives of generalist medicine, be it inpatient or outpatient. Yes, there are negatives, but there are also plenty of negatives to being a specialist with whom the buck stops. If you focus on the positives more than the negatives, in a sense, your decision will be correct no matter what. But you must decide and plan to live cheerfully with your decision.

 

[rokshana]

I am. I happen to like my job. I work with people who have been doing for over 10 years that are actually more gung ho than me.

Which just shows you that the are different options… one is not the end all be all specialty.

 

[dozitgetchahi]

Sounds like a nasty place. If they’re already going to put you under a microscope 6 weeks in, that seems a bit crazy to me. The big consideration I would have is whether you should get out before they put you on some sort of probation that will have to be reported on license apps, credentialing etc for the rest of your career. If this PD talk seems to be leading in that direction, I’d get out.

 

[dozitgetchahi]

Well you have to admit, you are a bit of a cheerleader…been there, done that and I’m glad I’m an endocrinologist…10 years ago hospitalist was doable… now? Hard to sustain that life.

I agree, I think I’d be miserable as a hospitalist. (Rheum now.)

 

[Splenda88]

I agree, I think I’d be miserable as a hospitalist. (Rheum now.)

I just happen to be ok with my job. The stuffs that bother some hospitalist (eg,. social issues, surgical specialties dumping on you, OB calling you to fix a postpartum elevated BP etc...), don't bother me that much.

I got there today at 7:15 am today and I am already home before 4pm drinking cognac. I just like the flexibility, and the $$$ is not bad either.

Maybe my job is different from most other HM jobs because 70%+ of the people I work with seem to be ok with the job.

 

[Raha44]

Sounds like a nasty place. If they’re already going to put you under a microscope 6 weeks in, that seems a bit crazy to me. The big consideration I would have is whether you should get out before they put you on some sort of probation that will have to be reported on license apps, credentialing etc for the rest of your career. If this PD talk seems to be leading in that direction, I’d get out.

Good point! If I leave myself, then I won’t have to go through that right?

 

[mulberry]

Can you elaborate a bit more regarding the lifestyle ?

I mean, you dont need me to tell you. Look at the life of any cardiology attending, academic or private. They may be raking in the cash, but for what? Long hours, stressful cases, between those consults plenty of sinus tach and trop one point above normal consults, always busy and on call (yes even when not scheduled if you are someones cardiologist, you are getting called), and the literature changes by the minute so you have to keep up with it on top of that. Thats what I can name off the top of my head. It sucks! Contrast that with a hospitalist: shift work, half the month off, can have very easy days, the work gets to be mundane after a while (which is nice, despite what the make you believe in residency), scale up on shifts if you want more $, and can acutally enjoy the money and life otuside of work.

No ACGME protected work hours during fellowship so you work as long as they need you. It is more taxing and harder than a tough IM residency. Frequent long calls. Q2-4 24 hour shifts often lasting longer than 24 hours. STEMI call? Yeah no thanks lol

 

[NotAProgDirector]

No ACGME protected work hours during fellowship so you work as long as they need you. It is more taxing and harder than a tough IM residency. Frequent long calls. Q2-4 24 hour shifts often lasting longer than 24 hours. STEMI call? Yeah no thanks lol

Perhaps I am misunderstanding, but ACGME work hours apply to all fellowships exactly the same as residency. Unless you're referring to a non-ACGME fellowship. Or work after training?

 

[Drrrrrr. Celty]

Perhaps I am misunderstanding, but ACGME work hours apply to all fellowships exactly the same as residency. Unless you're referring to a non-ACGME fellowship. Or work after training?

Mine follows ACGME work hours. That being said being on home call afterwork for >24 weeks out of the year plus working a lot more weekends is certainly more of a battering than residency ever was.

 

[HemeOncHopeful19]

Perhaps I am misunderstanding, but ACGME work hours apply to all fellowships exactly the same as residency. Unless you're referring to a non-ACGME fellowship. Or work after training?

Probably referring to “home call”