Second Fellowship

[glialman]

Hey everyone,

I'm seeking out advice as I'm currently a second year heme/onc fellow and have had the chance to do a recent elective in immunodeficiencies and really enjoyed it. I plan on working with an allergist over the next month but am interested in possibly applying to a allergy fellowship after I finish my heme/onc one. I am wondering how competitive I may be as I'm coming to this conclusion late. I was a 240/260 on Step 1/2 and I'm currently at an academic place and went to a top 50 med school, medicine residency, and heme/onc fellowship all at academic institutions. I have little research and no research within A/I.

Have people done a second fellowship before? I couldn't find much on it on any previous threads here. I was wondering if anyone had any thoughts on competitiveness or experience with anyone having done this. Thank you!

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[hotsaws]

Current fellow here.

I can't speak to the details on getting extended GME funding for a second fellowship. I imagine that could be a hurdle but I am clueless about the details.

Your step scores and credentials should help you be competitive. Are you particularly interested in clinical immunology? There's a paucity of that in allergy fellows. Many up-sell there interest in immuno but most just go on to practice predominantly allergy. Even at academic institutions, there's usually one faculty that is particularly immuno heavy (and the other faculty are happy to let that person be the immuno person). A heme/onc background would seemingly prepare you well to be a clinical immunologist, especially with things like BMT or just the way immunologists tend to take on this pseudo-PCP role for their patients. If you're really into immuno, sell that hard on your app and interviews.

 

[glialman]

Thanks for your reply.

Yeah, the immuno material is what I find interesting. Will definitely make that a focus.

I think the funding issue is there if you do a second residency and not for a second fellowship.

Does anyone have any experience or thoughts?

According to this atleast all fellows count as a 0.5 FTE


All training (including fellowships) beyond the IRP:
• For all other training that is beyond the IRP, including fellowships, a resident is counted by the hospital as 0.5 FTE.17

https://aamc-black.global.ssl.fastly.net/production/media/filer_public/64/77/6477adae-c4c6-4e0e-8c6f-adcdabf2bdec/dgme_-_medicare_gme_payments_what_you_need_to_know_-_20190430.pdf

 

[Raryn]

Current fellow here.

I can't speak to the details on getting extended GME funding for a second fellowship. I imagine that could be a hurdle but I am clueless about the details.

Your step scores and credentials should help you be competitive. Are you particularly interested in clinical immunology? There's a paucity of that in allergy fellows. Many up-sell there interest in immuno but most just go on to practice predominantly allergy. Even at academic institutions, there's usually one faculty that is particularly immuno heavy (and the other faculty are happy to let that person be the immuno person). A heme/onc background would seemingly prepare you well to be a clinical immunologist, especially with things like BMT or just the way immunologists tend to take on this pseudo-PCP role for their patients. If you're really into immuno, sell that hard on your app and interviews.

GME funding for a second fellowship is the same as for a first fellowship best I can tell. Everyone has reduced funding once they're done with their primary residency - that is, fellows get less CMS money to the institution across the board.

 

[mnbhk123]

Hello, Im looking to connect with someone who has done allergy/immunology AND ID fellowships.

 

[hotsaws]

Hello, Im looking to connect with someone who has done allergy/immunology AND ID fellowships.

Well...that's gotta be a rare find. Why would someone do A/I and then ID? Maybe could see someone doing ID and then escaping to A/I but we're pretty happy on the A/I side. There are combined rheum and A/I fellowships. The rheum part overlaps well with the clinical immunology side of things but not that practical unless you're practicing at an academic medical center with a very specific niche.

 

[mnbhk123]

Well...that's gotta be a rare find. Why would someone do A/I and then ID? Maybe could see someone doing ID and then escaping to A/I but we're pretty happy on the A/I side. There are combined rheum and A/I fellowships. The rheum part overlaps well with the clinical immunology side of things but not that practical unless you're practicing at an academic medical center with a very specific niche.

I am currently an ID fellow, looking to do a second fellowship in AI. Just wondering if that expands the scope of practice.

 

[NewYorkDoctors]

I am currently an ID fellow, looking to do a second fellowship in AI. Just wondering if that expands the scope of practice.

It certainly expands the scope of private practice . More specialties more patient volume.

Alternatively you could become an NIH / NIAID researcher with those fields - which is probably what these multiple sub specialties are really for .

 

[mnbhk123]

It certainly expands the scope of private practice . More specialties more patient volume.

Alternatively you could become an NIH / NIAID researcher with those fields - which is probably what these multiple sub specialties are really for .

That's helpful. Thanks!

 

[hotsaws]

If you do an A/I fellowship after ID, it should just be because you want to practice A/I. I don't see how it would really expand your scope. The two specialties don't really mix in PP, at least not in any practical way. You have to keep in mind that every specialty has a certain practice structure that drives revenue. If you're in an A/I practice, you want to be seeing allergic patients that you're skin testing, PFTing, ITing, etc. That's how the practice runs and drives revenue. Your medical assistants are trained in that flavor of practice in order to be efficient. You also have to consider referral base as well.

If you wanted to pursue some kind of niche research field, I don't think an A/I fellowship really helps that. Like if you wanna do drug allergy stuff, just use the ID background for that. You don't need an entire A/I fellowship for that.

Im curious, how do you see the two fields mixing in some way that expands your practice or benefits you?

 

[dozitgetchahi]

If you do an A/I fellowship after ID, it should just be because you want to practice A/I. I don't see how it would really expand your scope. The two specialties don't really mix in PP, at least not in any practical way. You have to keep in mind that every specialty has a certain practice structure that drives revenue. If you're in an A/I practice, you want to be seeing allergic patients that you're skin testing, PFTing, ITing, etc. That's how the practice runs and drives revenue. Your medical assistants are trained in that flavor of practice in order to be efficient. You also have to consider referral base as well.

If you wanted to pursue some kind of niche research field, I don't think an A/I fellowship really helps that. Like if you wanna do drug allergy stuff, just use the ID background for that. You don't need an entire A/I fellowship for that.

Im curious, how do you see the two fields mixing in some way that expands your practice or benefits you?

The other issue is that the specialties are basically polar opposites in terms of practice environments. As I understand it, A/I (like rheumatology often is nowadays) is basically outpatient while ID is heavily inpatient. Most ID docs I’ve worked with as a resident spend the bulk of their time rounding in hospitals and have maybe one (or one half) day of clinic weekly. Not sure how this overlaps with A/I in any productive fashion. In fact, I’m not even sure how well rheum and A/I would gel together from a billing standpoint although at least both specialties are in an outpatient environment and both are in high demand. Even if you hung a shingle as a “rheum and A/I doctor” you would probably be rapidly inundated with rheumatology referrals, almost to the exclusion of A/I.

 

[hotsaws]

The other issue is that the specialties are basically polar opposites in terms of practice environments. As I understand it, A/I (like rheumatology often is nowadays) is basically outpatient while ID is heavily inpatient. Most ID docs I’ve worked with as a resident spend the bulk of their time rounding in hospitals and have maybe one (or one half) day of clinic weekly. Not sure how this overlaps with A/I in any productive fashion. In fact, I’m not even sure how well rheum and A/I would gel together from a billing standpoint although at least both specialties are in an outpatient environment and both are in high demand. Even if you hung a shingle as a “rheum and A/I doctor” you would probably be rapidly inundated with rheumatology referrals, almost to the exclusion of A/I.

That sounds like a twilight zone nightmare. I prefer to avoid all things rheum, even the overlapping portion of the rheum/AI Venn diagram. We get those referrals where people start talking about fevers this and joint pain that and I'm like "ohhhh you must have meant to see the angry immune system guy...I'm more of the apathetic/absent immune system guy."

Not meant at all to be a slam on rheum, much love for the rheum docs.

 

[dozitgetchahi]

That sounds like a twilight zone nightmare. I prefer to avoid all things rheum, even the overlapping portion of the rheum/AI Venn diagram. We get those referrals where people start talking about fevers this and joint pain that and I'm like "ohhhh you must have meant to see the angry immune system guy...I'm more of the apathetic/absent immune system guy."

Not meant at all to be a slam on rheum, much love for the rheum docs.

Yeah, we get the opposite end of that spectrum too - the patients who show up and think symptoms are occurring because of some vague “food allergy” or who think their lupus is related to some sort of allergic rhinitis or something. I usually just look at them funny.

It’s funny - as a rheumatologist I generally dislike the A/I overlap portion of the rheumatology spectrum too.

 

[hotsaws]

Yeah, we get the opposite end of that spectrum too - the patients who show up and think symptoms are occurring because of some vague “food allergy” or who think their lupus is related to some sort of allergic rhinitis or something. I usually just look at them funny.

It’s funny - as a rheumatologist I generally dislike the A/I overlap portion of the rheumatology spectrum too.

And then we both get to share in the craziness when a patient thinks they have lupus (Definitely don't have lupus) and food allergy (definitely don't have food allergies) driving their chronic miserableness.

 

[dawrhino]

Hello, Im looking to connect with someone who has done allergy/immunology AND ID fellowships.

check Dr Calabrese at Cleveland Clinic - he combined both fields and also rheumatology

 

[NewYorkDoctors]

In general, the only reason why one should seek out dual "parallel" subspecialties (outside of the common CCM combination or the super-subspecialist like Cardiology-EP or Renal-HTN , or Pulm/CCM/Sleep) would be for

1) You have very specific research interests and are on track to becoming Professor of Medicine at a very distinguished research institution and want to be a leader in the field. The dual training would give you more clout so to say. It might be a way that distinguishes you in the pack to get that specific top research job in the first place.

2) You own your own private practice and will be the boss and will hire partners that overlap individual subspecialties. This way you can cross cover and pick and choose which patients you want to see. This is probably less common than #1.

3) Money and debt are not a problem and you want to be very learned in the fields you are interested in. This usually goes hand in hand with #1.

Otherwise you will end up seeing more of one than the other and your employer may not even want you to see bot hsubspecialties.