Reneging on Fellowship

[Pomacentridae]

Hello,

I am a current PGY-4 Psychiatry resident who has accepted a position for a 1 year fellowship that is not in Child or Forensics starting in the summer of this year. I am in my very early 30s and have over 300k in loans. I now realize the time value of money and I am wondering if it was a bad decision on my part to follow through with this fellowship now that I am hearing of the offers my coresidents are getting out in the community for attending positions. I am not particularly interested in academics once I am done with my training.

On the other hand, I know it would be a huge letdown and would appear extremely unprofessional to bail on starting this fellowship since it is too late for them to find another candidate and I have already signed the contract. What should I do and can someone help assuage the feelings of anxiety I am having?

Thank you very much. Responses are greatly appreciated.

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[MacDonaldTriad]

Is this ACGME accretited? Was there a match? Even if the NRMP is involved, what would it matter if they banned you for participating in a future match? Slavery ended in 1865, yet I'm not encouraging you to not honor your contract. Maybe telling them now is better so thay can try and look for a replacment before July. I would read the contract carefully and see if it says anything punitive if you don't report to work. If it does, you eather suck it up and do it, or you get a lawyer's oppinion.

 

[Pomacentridae]

Is this ACGME accretited? Was there a match? Even if the NRMP is involved, what would it matter if they banned you for participating in a future match? Slavery ended in 1865, yet I'm not encouraging you to not honor your contract. Maybe telling them now is better so thay can try and look for a replacment before July. I would read the contract carefully and see if it says anything punitive if you don't report to work. If it does, you eather suck it up and do it, or you get a lawyer's oppinion.

There was no match process. I guess I'm ambivalent currently as to whether or not to do the fellowship but it seems kind of late to back out now.

 

[TexasPhysician]

Do they allow moonlighting? Most psych fellowships are not time intensive.

I earned more than faculty with moonlighting + fellowship.

 

[Pomacentridae]

Do they allow moonlighting? Most psych fellowships are not time intensive.

I earned more than faculty with moonlighting + fellowship.

They do allow moonlighting.If you can remember, how many moonlighting shifts a month did you do during fellowship and how much did they pay per hour?

 

[TexasPhysician]

They do allow moonlighting.If you can remember, how many moonlighting shifts a month did you do during fellowship and how much did they pay per hour?

I had a few moonlighting jobs. One paid $5k/weekend. One paid $75/night for call + $100 per patient if called in. One was outpatient M-Th 5-7pm paying about $160/hr.

I didn’t do all of these every week, but added up, it is significant.

 

[Sushirolls]

Use it as an opportunity to hone your understanding of CPT codes, billing etc. Go stroll down to where the billers are, or get their numbers and talk with them. Moonlight, stack up some cash reserves, and use this year as your time to do recon on where you want to land. Learn the business side of medicine as best possible, and then go open your own practice.

Set up a 1 month elective to round with the admin with the hospital, organization, etc and sit in on all of the meetings you possibly can. The more the better.

 

[Mass Effect]

Do the fellowship. You already committed to it and psychiatry is a small world. It sounds like it's an addiction fellowship. If you want to work in addiction (or whatever subspecialty it is), you're going to run across these people in the future and people talk. Honor your commitment.

Moonlight all the way. Fellowships in psychiatry allow plenty of time for moonlighting on the weekends. One of my friends did a forensic fellowship and did telepsych every Saturday. Another friend did in-house moonlighting over the weekend once a month, making 8K per weekend. There's money out there, even in fellowship and moonlighting will allow you to honor your commitment and not burn bridges.

For those reading, these types of questions should be asked before you sign the contract so you don't have to renege on a deal.

 

[J ROD]

Professionally not the best move but if you really do not want to do it now I would call the program and see what they say along with reading over the contract. If the fellowship has a good name, it could be a good boost to the CV.

 

[heysexylady]

Hello,

I am a current PGY-4 Psychiatry resident who has accepted a position for a 1 year fellowship that is not in Child or Forensics starting in the summer of this year. I am in my very early 30s and have over 300k in loans. I now realize the time value of money and I am wondering if it was a bad decision on my part to follow through with this fellowship now that I am hearing of the offers my coresidents are getting out in the community for attending positions. I am not particularly interested in academics once I am done with my training.

On the other hand, I know it would be a huge letdown and would appear extremely unprofessional to bail on starting this fellowship since it is too late for them to find another candidate and I have already signed the contract. What should I do and can someone help assuage the feelings of anxiety I am having?

Thank you very much. Responses are greatly appreciated.

Nothing bad will happen to you if you l let them know that you are no longer interested. You will not have to put the place in your CV nor will you need to obtain verification for the rest of your life. Just let them know now so that they can have the opportunity to find someone to fill the spot.

Professionally, this will not affect at all... It's not like yo need a reference from them and like I said before list them on your CV. In the future you can always shange your mind and do a fellowship if you desire

 

[SourceOfDenial]

Things happen, people change their minds. Maybe you’ll be persona non grata at that one institution, but unless it’s the only game in town and you’re staying put, I doubt the effect would be significant. People are overstating the effect this will have.
That being said, careers are long, you’ll have plenty of time to make money, so if it’s something you care about maybe you’ll enjoy it.

 

[Pomacentridae]

Thanks for the replies, everyone. My main concern is not earning as much money as I would be able to as an attending given my loan burden.

If I can make a comparable income with some moonlighting I wouldn't mind as much.

 

[Nudexta]

I had a similar experience. Accepted a fellowship at the end of my pgy3/beginning of pgy4. After maturing in pgy4 and moonlighting, I realized the lack of financial value for most psych fellowships. For fellowships to be valuable, they should teach you or make you do something other psychiatrists are not capable of. This can be true in GI or Cardiology, but most psychiatrist can practice Geriatircs, forensics, consults and even some child with their general experience. I dropped out and told them I can’t honor the agreement. It was one of the best desicions I have ever took!

 

[Pomacentridae]

I had a similar experience. Accepted a fellowship at the end of my pgy3/beginning of pgy4. After maturing in pgy4 and moonlighting, I realized the lack of financial value for most psych fellowships. For fellowships to be valuable, they should teach you or make you do something other psychiatrists are not capable of. This can be true in GI or Cardiology, but most psychiatrist can practice Geriatircs, forensics, consults and even some child with their general experience. I dropped out and told them I can’t honor the agreement. It was one of the best desicions I have ever took!

Hmm. Would you be able to private message me so we can discuss some things?

 

[Nudexta]

Sure

 

[finalpsychyear]

The opportunity cost to do this is massive. There must be a passion or desire to do the fellowship that goes beyond $. Fellowships rarely pays off in non procedural specialties. If you no longer have this passion/interest reasoning it is basically a 500k wasted opportunity if you factor in you'd make 300k if you worked similar hours as an attending if you count the didactic aspect vs fellowship where for simplicity let us say you made 50-60k. That 250k if invested at a modest 7% growth with no other contribution over 10 years would be nearly 500k.

The only fellowship that may have some $ for psych would have been pain but that is also dwindling in its own way and is very difficult to even get as your up against the 8 ball.

 

[Sushirolls]

C&A is worth it, too. I get a fair amount of child inquiries.

 

[finalpsychyear]

C&A is worth it, too. I get a fair amount of child inquiries.

I think any psych can do a certain amount and and level of child. To be fair though its not worth it from a $$ point. The several cases I took out of trying to be the doctor who helps out this population since child psych was 7 month wait were nightmares and took at least twice as long as an adult case plus i was also treating 3 patients for the price of 1. Unless you are in a market where your charging cash and like 500 for a 60 min intake I still find it too draining.

 

[Mass Effect]

The opportunity cost to do this is massive. There must be a passion or desire to do the fellowship that goes beyond $. Fellowships rarely pays off in non procedural specialties. If you no longer have this passion/interest reasoning it is basically a 500k wasted opportunity if you factor in you'd make 300k if you worked similar hours as an attending if you count the didactic aspect vs fellowship where for simplicity let us say you made 50-60k. That 250k if invested at a modest 7% growth with no other contribution over 10 years would be nearly 500k.

The only fellowship that may have some $ for psych would have been pain but that is also dwindling in its own way and is very difficult to even get as your up against the 8 ball.

It all depends on the sub-specialty. If someone wants to do expert witness work, you'd be much better off having the fellowship and you'd make up that 500K with the post-fellowship work. If you want to work in academics in a specific sub-specialty, you also need a fellowship. Top academic places want board-certified addiction/CL/child people running those services.

 

[Pomacentridae]

It all depends on the sub-specialty. If someone wants to do expert witness work, you'd be much better off having the fellowship and you'd make up that 500K with the post-fellowship work. If you want to work in academics in a specific sub-specialty, you also need a fellowship. Top academic places want board-certified addiction/CL/child people running those services.

What if you don't really want to work in academics?

 

[finalpsychyear]

It all depends on the sub-specialty. If someone wants to do expert witness work, you'd be much better off having the fellowship and you'd make up that 500K with the post-fellowship work. If you want to work in academics in a specific sub-specialty, you also need a fellowship. Top academic places want board-certified addiction/CL/child people running those services.

It takes time to establish yourself being an expert witness and getting the $ in forensics while requiring business skills and reputation. If you take 2 like minded people one who goes into starting a PP (adult/child) right away after residency and someone who does a 5th year in forensics and starts a side forensics private practice more often than not former comes out ahead at least in a 10 year head to head of course exceptions exist. I am seeing these PP have multiple mid levels so you have passive income opportunity through that as well.

500k would also be taxed at 15% capital gains as far as opportunity cost. You'd have to be making like 80k more right away as the forensic guy which is like 50k post tax just to break even largely due to how income and investments are taxed and i doubt your going to get that much more right away. Of course if you compare it to someone not in PP then yeah you come out ahead but that's not a fair comparison.

PP is not for everyone and I'd argue most people have no idea how much work it actually requires and most prefer the cookie cutter system that residency structured them to train in.

 

[Mass Effect]

What if you don't really want to work in academics?

If you don't want to do academics, a fellowship isn't necessary in fields like addiction and CL. In child, it may still be helpful (I know my general training had major deficits in the child portion) and for forensics, I still think it would be helpful if you want to do expert witness work.

 

[Mass Effect]

It takes time to establish yourself being an expert witness and getting the $ in forensics while requiring business skills and reputation. If you take 2 like minded people one who goes into starting a PP (adult/child) right away after residency and someone who does a 5th year in forensics and starts a side forensics private practice more often than not former comes out ahead at least in a 10 year head to head of course exceptions exist. I am seeing these PP have multiple mid levels so you have passive income opportunity through that as well.

500k would also be taxed at 15% capital gains as far as opportunity cost. You'd have to be making like 80k more right away as the forensic guy which is like 50k post tax just to break even largely due to how income and investments are taxed and i doubt your going to get that much more right away. Of course if you compare it to someone not in PP then yeah you come out ahead but that's not a fair comparison.

PP is not for everyone and I'd argue most people have no idea how much work it actually requires and most prefer the cookie cutter system that residency structured them to train in.

Yeah, that's probably correct. I'm about to make a thread about PP that I'd appreciate your input on. It's off-topic from fellowships so will start its own thread.

 

[Splenda88]

If you are not passionate about that fellowship, don't do it...

Work and make $$$ to pay down your loan. 300k+interest is a lot...

 

[Chimed]

My opinion is to do the fellowship unless there's a specific hardship such as family issues or health. You've already committed and it's a professional obligation. Sure, as others have pointed out, there's probably no legal issues that would come out of this. However, there are other issues in terms of professionalism and being true to your word. I suppose you could reach out to them and see what they say, but that could potentially backfire as well. Is there someone in the department that you could trust to give you advice about reaching out to them?

The other issue is, did you take a position from someone else? I don't mean that to be as harsh as it probably sounds in a forum, but just to add perspective about the obligation what it would mean to not honor it. In the scheme of things, 1 year is nothing. You'll probably learn a lot and it may add value that goes beyond money. It will likely make you a better psychiatrist. Having a fellowship on your CV could also benefit you down the road. You're only in your 30's and you never know what you'll want to do 10 to 20 years from now.

 

[meow1985]

Hello,

I am a current PGY-4 Psychiatry resident who has accepted a position for a 1 year fellowship that is not in Child or Forensics starting in the summer of this year. I am in my very early 30s and have over 300k in loans. I now realize the time value of money and I am wondering if it was a bad decision on my part to follow through with this fellowship now that I am hearing of the offers my coresidents are getting out in the community for attending positions. I am not particularly interested in academics once I am done with my training.

On the other hand, I know it would be a huge letdown and would appear extremely unprofessional to bail on starting this fellowship since it is too late for them to find another candidate and I have already signed the contract. What should I do and can someone help assuage the feelings of anxiety I am having?

Thank you very much. Responses are greatly appreciated.

How time-intensive is the fellowship? If finances are an issue, this can be partially offset by moonlighting.

 

[meow1985]

It sounds like the biggest concern is your loan burden and sadness/jealousy (let's call a spade a spade, shall we?) that those around you will be making 200-300K. Maybe to help yourself feel better, sit down and figure out how much your loans will appreciate in a year, and balance that against how much you may be able to make by moonlighting. That way the decision will be a more informed one, rather than driven by emotion.

A balancing thought is that many of your peers will probably use their salaries to finally start living the "attending lifestyle," and paying off *their* loans may take a back seat. Many people are short-sighted like that.

 

[Pomacentridae]

Does a fellowship distinguish you and help with obtaining more desirable jobs in major cities like NYC or DC?

 

[Chimed]

Does a fellowship distinguish you and help with obtaining more desirable jobs in major cities like NYC or DC?

All things being equal, yes, it should.

 

[TexasPhysician]

Does a fellowship distinguish you and help with obtaining more desirable jobs in major cities like NYC or DC?

Yes, even in less desirable areas.

 

[psyguru]

With a fellowship you could possibly do IMEs and expert witness work in your specialty. You wont be able to do the same variety and types of cases as a forensic psychiatrist. If you develop your expert practice right, you could easily make up for lost income within a few years. If you become prominent, you could charge a high hourly. There was one non md non-forensic psychology ptsd expert witness who is a very well published researcher. She billed more than me (non-published triple-board certified forensic MD psychiatrist) at $650 an hour. The interesting thing is she used many self-reporting checklists as you would in research and you could tell she did not have a forensics background.

 

[cleareyedguy]

The opportunity cost to do this is massive. There must be a passion or desire to do the fellowship that goes beyond $. Fellowships rarely pays off in non procedural specialties. If you no longer have this passion/interest reasoning it is basically a 500k wasted opportunity if you factor in you'd make 300k if you worked similar hours as an attending if you count the didactic aspect vs fellowship where for simplicity let us say you made 50-60k. That 250k if invested at a modest 7% growth with no other contribution over 10 years would be nearly 500k.

The only fellowship that may have some $ for psych would have been pain but that is also dwindling in its own way and is very difficult to even get as your up against the 8 ball.

In the real world, the supposed $250k difference will be a lot less, especially if the fellowship allows moonlighting and/or the person doesn't get a 300K starting job. But even if the difference is 250k, there are significant taxes and the almost universal tendency to expand one's spending to fill one's earning.

Oh, the annoyance wouldn't just be to the fellowship director but to your own PD who presumably recommended him or her for the fellowship.

By now, the decision has presumably been made. Any decision?

 

[nexus73]

I would explain the financial concerns to the program director and see if they could help point you to some moonlighting opportunities. I’d tell the PD what your loan burden is as most probably don’t realize what you’re facing, especially if they’re 50+ years old.

 

[m2k]

Here's what I my thinking is.... you're going to work 30+ years. If you like the field of fellowship, do it. Loans can wait another year. Over lifetime of your work what difference of difference of $15 million or $14.5 million will make. I saw the math that you invest $250 and will grow to large sum till you die.