Rethinking the 2vs1 fellowship

[dermpathlover]

It is making less and less sense to me to do two fellowships. Of course a million private groups would love to hire a DP/HP/AP/CP boarded person, but they would also love to hire a DP/AP/CP or a HP/AB/Cp boarded one also.

Unfortunately for me I most want to do derm and my spot isn't until 2009. I wish I would have kept on looking and found one for 2008. Basically my fellowship (in 2008) is just turning into a wasted year as I want to do only skin. I'll have to see how it goes.

Do most people in your programs do 0,1,or 2 fellowships? (AP/CP residents only).

---

Members don't see this ad.

 

[Matte Kudesai]

Do most people in your programs do 0,1,or 2 fellowships? (AP/CP residents only).

Recently our residents have trained in derm, GI, GU, GYN,Cyto, pediatrics, and heme. Most have done only a single fellowship. In almost every case when there was a second fellowship it has been surgical pathology.

 

[Adrian Cocot]

I personally am doing two -- GI and Cyto. I've met one other person who's done that combo. I've met people that have done Cyto/GYN, GI/Breast, and Cyto/Breast. Most of the folks are ultrasmart types that go into academics. For private practice, I don't see why two fellowships are really necessary. In my case, I'm partially doing it for personal reasons, and also because I was kinda offered a deal that I couldn't refuse.

If you're not going to use your heme, I hope your fellowship year is cushy enough for you to focus on knowing lab management and billing.

 

[yaah]

The people I know who have done two mostly do surg path + something (cyto, GI, heme, GU, derm). One I know is doing heme + pediatric. Two subspecialties is a bit overkill, although some people instead of a pure general surg path do a hybrid Breast & surg path or whatever, then a second fellowship.

Personally I don't really see much point in doing GI + cyto, you will likely either do mostly GI in your future practice or a lot of cyto, can't really do both so you will likely have to choose, in which case one of them was kind of overkill. But for people who get the fellowship they "really" want as a second one, it's kind of a necessity.

Don't forget, a lot of people who did two fellowships did it because they had to fill their credentialling year (usually with a surg path fellowship). Graduates in the last two years have not had that requirement, but that is very new, and general surg path fellowships will probably become less popular in favor of subspecialties.

 

[djmd]

Personally I don't really see much point in doing GI + cyto, you will likely either do mostly GI in your future practice or a lot of cyto, can't really do both so you will likely have to choose, in which case one of them was kind of overkill. But for people who get the fellowship they "really" want as a second one, it's kind of a necessity.

I think that academics could see more 2 fellowship people.
Plus I could see an arguement for Cyto+ andthing you see a fair amount of cyto in (more for academics), GYN, Breast (ok not a lot of FNA anymore), head & Neck... Pulm?

 

[LADoc00]

If you had no loans at all, one year is costing you about $150,000 pretax. That is the opportunity cost conservatively estimated.

If you have 200K in loans/credit card debt, then that year is costing you 200K+. Fairly big difference.

I dont think it will be wasted year as any year can be used to build connections, even if you do no real pathology.

I was in the same boat, walked away from a fairly nice fellowship opportunity that was year 6 for me and instead got a job. It worked out but I would have been a much stronger pathologist with that sixth year.

 

[CameronFrye]

I think that academics could see more 2 fellowship people.
Plus I could see an arguement for Cyto+ andthing you see a fair amount of cyto in (more for academics), GYN, Breast (ok not a lot of FNA anymore), head & Neck... Pulm?

Yeah, cyto and gyn seem to have a pretty good synergy.

 

[Napoleon1801]

Don't forget, a lot of people who did two fellowships did it because they had to fill their credentialling year (usually with a surg path fellowship). Graduates in the last two years have not had that requirement, but that is very new, and general surg path fellowships will probably become less popular in favor of subspecialties.

Forgive the ignorance, but what do you mean by 'credentialling year' and what is its purpose?

 

[yaah]

When pathology was a five year residency, residency still had the same requirements as it does now in terms of timeline. But there was a fifth year (or fourth year if you did only AP or CP) that was required to sit for the boards, most people did this as a fellowship (a non boarded fellowship, as boarded fellowships would not count as a year of residency). Usually it was surg path or a surg path subspecialty. Now that fifth year is not required so there is no credentialling year.

 

[Cabbage Head]

If you had no loans at all, one year is costing you about $150,000 pretax. That is the opportunity cost conservatively estimated.

If you have 200K in loans/credit card debt, then that year is costing you 200K+. Fairly big difference.

I dont think it will be wasted year as any year can be used to build connections, even if you do no real pathology.

I was in the same boat, walked away from a fairly nice fellowship opportunity that was year 6 for me and instead got a job. It worked out but I would have been a much stronger pathologist with that sixth year.

Wait, do you consider the immediate cost of not getting a job, or do you consider what you'll make in your last year of employment? Because even if you extend your working life by one year, it's going to be an extra year at the end of your career, where you might be making more than 150k.

 

[LADoc00]

Wait, do you consider the immediate cost of not getting a job, or do you consider what you'll make in your last year of employment? Because even if you extend your working life by one year, it's going to be an extra year at the end of your career, where you might be making more than 150k.

Good ?, you can look at it many different ways. For the most part, pathologists really slow down in the final years, maybe working 2-3 days a week or less so I took the higher number which would likely be year 1 salary.

Most docs have a salary curve in the form of what looks like a Bell Curve with a flat plateau instead of a hump.

 

[Cabbage Head]

LADoc is correct.

When considering this, you need to take into account the fact the money today is worth more than money tomorrow. Thus, you need to convert after tax income streams to present values in order to make valid comparisions.

As LADoc suggests, your decision to do a fellowship has the immediate consequence of giving up one year of salary.

While you can work an extra year, the value of that year is:
PV(Salary in year n) = S/(1+r)^n

where
PV = present value
S = salary in year n
r = interest rate (opportunity cost of funds invested otherwise)
n = years

On average, stocks have a yield of about 7%. Thus, the value of 200k received 30 years from now is:

PV(200,30,0.07) = 200/(1+ 0.07)^30

So, 200k received 30 years from now (assuming an average return of 7%) is roughly equivalent to 27k today. In other words, if given 27k today, you could turn it into 200k in 30 years so you should be indifferent between the two.

So, the overall impact (in gross dollars) is:

Loss = 150 - 27 = 123k

Interesting, makes sense.