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Nowadays multiple fellowships seem to be the norm, what will make a good choice for second fellowship after heme?
Second Fellowship After Heme
- Thread starter DRBrothers
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I see more than one fellowship as a soft red flag. I get that they are sometimes necessary for a competitive fellowship or to line up with a spouse’s training/job, but for the most part they are a waste of time because you can’t and shouldn’t be an “expert” in everything. I would work hard in residency to be competent, do the heme fellowship and then apply for jobs like your life depended on it. You’ll make more money, be happier and not have to be a pgy-7 with all the other clowns who are too scared or unqualified to sign out gallbladders and colon polyps.
to begrudgingly answer your question, molecular first and possibly cyto or derm after that. If you went to a good residency, surg path shouldn’t be necessary.
to begrudgingly answer your question, molecular first and possibly cyto or derm after that. If you went to a good residency, surg path shouldn’t be necessary.
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Some places training is subpar and not adequate thus the reason for two fellowships. Most people I know have done two. I don’t think it is a red flag for me. I know people who have done heme and surgpath and couldn’t even tell what a mesothelial cell was on a pleural fluid cytology.
People on here make it seem like you’re special ed if you do two fellowships. If you want to do two then go for it. It’ll stick with you and help you the rest of your career.
If you feel ready to hit the ground running in private practice with one fellowship then go for it. You will never feel ready but based on how good your training is, there is a “comfort level” where one feels like they know when to sign out a case versus when to seek help.
From listening to a few pathologists on here and on social media, grads aren’t ready to signout independently after 4 years of residency.
Three fellowships would be a red flag to me though.
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I know some people who ended up doing a second or even third year of fellowship simply because they couldn’t find a job. They needed a paycheck while they continued to search and that is the best they could do. They actually got good training and would’ve been fine (and better off) getting out and starting their career after just one fellowship but simply couldn’t find anything despite casting a pretty wide net. It is absurd that the oversupply was ever allowed to get to this point.
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Fellowship application is normally 2 years in advance. That means if you haven't had a job offer in your third or fourth year of residency, you need to have your second fellowship secured. Am I right? What to do if you get a job offer during your first fellowship?
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Take the job and tell your second fellowship you would like to withdraw. It happens all the time.
You should come to Canada to work. There is a huge shortfall of hemepath, you can get hired almost anywhere, because the geniuses at academic centers decided to convert all the APCP residencies into AP only.
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I would absolutely take the job and tell the second fellowship you aren’t coming. If you turn down a job (even a mediocre one) to spend another year in training, then can’t find a job after the additional fellowship year, you will really be screwed. A signed offer letter several years in advance of a start date is not enforceable. Some program directors will be pissed, and you can try to let them know as soon as possible so they aren’t scrambling at the 11th hour, but the truth is that they played a hand in creating this mess so they shouldn’t get much sympathy from you or anyone else. Most program directors couldn’t care less whether you have a family to support and are unemployed after June 30.
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I have no doubt this happens but nearly all the cases of 2+ fellowships I have seen are people who stack them starting in PGY2 year without ever applying for jobs until the last fellowship year. Sometimes its someone with a planned hyperspecialized career path in academics (heme/molecular, forensics/peds, transfusion/hla) but often its some clueless weirdo with little social skill or diagnostic talent bouncing between uncompetitive fellowships, thinking some community group is going to pay them for their diagnostic expertise in fine needle aspiration of cardiac sarcomas.
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How many of you feel confident enough to apply for a job in PG4?
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Likely no one feels confident enough to apply for a job in their last year of residency. Because almost no one will hire you straight out of residency any more, not with the fellowship arms race out there.
I didn’t formally apply for anything at that point, but I was working to lay the groundwork by the beginning of my pgy-3 year. I was sending out letters with my CV (to any practices I could find within about a 10 state area), making cold calls, going to some state and local society meetings etc, trying to make some kind of connection with any private group that might eventually lead to a job. Of course it was all pointless as I had nothing until late in my fellowship year when I finally managed to land a third rate corporate lab job. Private practice jobs were about as easy to find as a live dodo bird.
The best thing you can do, if you are a pathology resident wanting a job, is to either do forensics or switch fields if it isn’t too late. Some fields, like radiology, are pretty competitive and those programs will view you as flawed just because you are a resident wanting to switch fields- even if you had a good medical school record, board scores etc that would’ve gotten you in as a 4th year med student.. same for most of the surgical specialties. However, a medicine residency (followed by a cards or GI fellowship) or something like anesthesia would be very do-able, especially if you are A US grad. I’ve heard that as many as 10% of residents switch fields at some point during their training, and you would have many, many more options in any of those fields. For example, my best friend from medical school went into anesthesia and got a partnership track job in his first choice location on the west coast, straight out of training. He started at 350k, made partner in 2 years, and is now at well over 500k. His practice treated him very fairly- once his 2 years were up he was treated as an equal partner, the same as everyone else. In contrast, I am close to mid career in pathology, in private practice, and will likely never even make what he was making his first year out. The job market in pathology is horrendous, we have zero leverage in any negotiations and employers can basically treat us like dogs. You also may have to move long distance- not just within a state or to a neighboring state- but to an entirely different region of the country.
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I felt confident to practice after PGY-4. My residency wasn’t anything special but I worked my A off, felt comfortable with CP, and knew that I wasn’t expected to be Juan Rosai. You have to be comfortable knowing what you don’t know and asking for help. Everyone makes and will always make mistakes, but you have to learn from them and learn how to handle them.
I didn’t look for jobs much until fellowship because I knew no one would hire me. When I looked for jobs, almost all were academic and I ended up moving to a place I never thought I would end up. Be very cautious about pathology if you are geographically limited.
I didn’t look for jobs much until fellowship because I knew no one would hire me. When I looked for jobs, almost all were academic and I ended up moving to a place I never thought I would end up. Be very cautious about pathology if you are geographically limited.
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Agree be very careful about pathology if you are geographically limited. Sometimes jobs can pop up if you are in the right place at the right time. I put a lot of effort searching online for jobs and got one where I wanted to live. I got lucky.
Even if you are not geographically limited, the odds are still against you because of all the other factors that have been discussed. And most people, even if they are not “geographically limited” per se, still have a lot of areas where they’d rather not live (even if they are willing to in a worst case scenario).
If you buy a lottery ticket, yes there’s a slim chance you could win, but that doesn’t mean it’s a great idea to spend your paycheck on lottery tickets. Going into pathology, at this point, is kind of like dumping your life savings into the powerball. Yes there is a chance you could hit the right numbers, but it is far more likely that you’ll end up destroying your future instead.
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What if I don’t even want to do any fellowship?
I seriously feel I can do the job well without one.
I seriously feel I can do the job well without one.
D
deleted314957
Go for it. If you have an in/ can get a job screw the fellowship. Those are just a prolongation of being a student and having no (real) responsibility. Lots of folks have done it.
I don’t see any problem with someone who is well trained in residency taking a job without doing a fellowship, other than the extreme difficulty in actually finding a job in that situation. But if you can actually find one- absolutely. It is the norm in almost every other specialty except path. I suspect that, if pathology had a normal job market, the most common number of fellowships for new pathologists coming out would be either zero or one, and the people doing 2 or 3 would be a small minority.
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It will be hard to find something because you will be in competition with people with 2-3 fellowships. I personally would look favorably on your application if you applied to my shop but not sure most people would agree. My advice would be to look rural. Not outside a major city rural but like true middle of nowhere (Alaska, Amish country Pennsylvania, etc). Be real and show that you aren’t arrogant or too weak for fellowship. Explain that you want to be a generalist and feel that a year of independent practice would be more beneficial to you than a year of concentrated academic BS. Also make it clear that you plan to stick around longterm.
Once you work for a few years, no one will give a crap that you didn’t waste a year in fellowship.
Good luck.
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I've heard of a couple instances of people doing this, but they were well connected to their future employers in residency. If you can prove you're of solid value, you have your foot in the door. Once you have a 2-3 years in practice I doubt it would be an issue.
