should I pursue a fellowship or just keep on being a hospitalist?

[lighteningyang]

I am an international medical graduate. I finished internal medicine training 3 years ago in a community hospital on a J visa. I had been planning to do pulmonary and critical care since the beginning of the residency. I liked the comprehensiveness of inpatient general internal medicine and I felt critical care was a fortified version of inpatient medicine.

I did not do research during residency. I did several posters; I did two pulmonary consults elective rotations and two MICU electives at three different tertiary centers in east Mass. I planned to do chief resident but eventually gave up because of visa issues. It has been harder and harder to get exchange scholar visa-related documents from my home country. Back then, my partner was preparing for a residency application, so I decided to do a hospitalist job as a transition, finish J1 waiver and get a green card. Maybe doing research and even an MPH degree.

I have been working as an academic hospitalist for 3.5 years. I did medical student didactic teaching, attended a critical care ultrasound course, became a member of the resident selection committee interviewing incoming residents. I also got into a decent MPH-epidemiology program this year and started learning data analysis, R programming and epidemiologic methods. As for the green card goes, because I am from a country where there is a significant backlog of green card applicants, I still have not got it, but it looks promising so far and I might be able to get it in a couple of years.

Now I am at crossroads to decide whether I should keep on pursuing a fellowship or just keep on being a hospitalist. Overall, I do not dislike hospitalist work. The group I am working with is quite decent. I have opportunities to teach residents 3-4 months out of a year. On non-teaching services, we on average see 14-15 patients usually manageable. The downside is the salary is not the greatest, 210K base and we must do two months of nights every year. There is part of me that wants to learn more and be an expert. Also, I still have a mentality from my home country. That is, general inpatient internal medicine is not that well respected. I fear one-day mid-level providers will take away hospitalist opportunities.

With the new year coming, I will be 35 years old. It does not seem that I am getting closer to my goal of fellowship. If I apply in 2022, which I do not feel I am exactly ready because of MPH class also no green card, I will start a fellowship in 2023 and graduate when I am on my way to 40 years old. I am an anxious person; I am not sure if staying around sick dying patients all the time is good for my mental health. At one point I am thinking about doing hemonc since my partner is doing rad-onc residency. My current plan is to do an MPH thesis related to lung cancer so that maybe I can apply pulmonary and hemonc at the time and see how it goes.

I know it is going to be a highly individualized decision and finally will be up to me. Still, not sure if anyone had or is having a similar internal debate as I do. Any suggestions, perspectives are appreciated. Happy holidays.

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[pulguy]

It's depend how you really want to do PCCM. I saw people who keep trying like crazy and go through unmatched, research and publications before they got the fellowship.

If you are hesitated, I think you should ask yourself again that you really want to do it or not. Just my 2 cents

 

[lighteningyang]

It's depend how you really want to do PCCM. I saw people who keep trying like crazy and go through unmatched, research and publications before they got the fellowship.

If you are hesitated, I think you should ask yourself again that you really want to do it or not. Jut my 2 cents

Thanks for your reply. Very to the point. I do need some serious self-reflection.

 

[Forgottenhopes]

Thanks for your reply. Very to the point. I do need some serious self-reflection.

Age shouldn’t be just the determining factor. I like you am an IMG, and a very old graduate at that, (lets say ppl from my class are PDs and APDs in their chosen specialties now) I had initially matched in 2010 in a big University program, but was denied a visa and had to stay back in my country, I ended finishing my training there, and trained as a pulmonologist (no critical care); then in 2019 I managed to match again, but this time as I was an old graduate managed to match in a very small community program on a H1 (fellowship suicide), everyone advised me not to apply for fellowship until I get a GC, as with an H1 from an unknown program I wouldn't match well, if I match in the first place.
I applied this year and interviewed at very good places, and managed to match at my 4th choice, a mid tier University program.,even my top choices ranked me (one pd, reached out to me afterwards, but a little lower given I was on H1 and my residency program is unknown), When I finish my PCCM fellowship I will be 42.
Point of the whole diatribe was age (40) would still be young, as someone said what really depends is how bad do you want it?

 

[Benzo4every1]

our hospitalists make 280k and don't do nights. do pccm if you truly love it, not for the money reason though

 

[Mehena]

With the new year coming, I will be 35 years old. It does not seem that I am getting closer to my goal of fellowship. If I apply in 2022, which I do not feel I am exactly ready because of MPH class also no green card, I will start a fellowship in 2023 and graduate when I am on my way to 40 years old. I am an anxious person; I am not sure if staying around sick dying patients all the time is good for my mental health. At one point I am thinking about doing hemonc since my partner is doing rad-onc residency. My current plan is to do an MPH thesis related to lung cancer so that maybe I can apply pulmonary and hemonc at the time and see how it goes.

In 2014, approximately 30% of hem-onc fellows were age 35 plus and with 6% above age 40. American medical school applicants & matriculants are becoming older & older, thus the current fellowship age cohort is certainly to show older fellowship matriculants. So, don't read too much into the ageism. As long as you're debt free from medical school loans( possible being FMG) & your family (partner) situation allow, then your age shouldn't be a major determining factor.

 

[lighteningyang]

Age shouldn’t be just the determining factor. I like you am an IMG, and a very old graduate at that, (lets say ppl from my class are PDs and APDs in their chosen specialties now) I had initially matched in 2010 in a big University program, but was denied a visa and had to stay back in my country, I ended finishing my training there, and trained as a pulmonologist (no critical care); then in 2019 I managed to match again, but this time as I was an old graduate managed to match in a very small community program on a H1 (fellowship suicide), everyone advised me not to apply for fellowship until I get a GC, as with an H1 from an unknown program I wouldn't match well, if I match in the first place.
I applied this year and interviewed at very good places, and managed to match at my 4th choice, a mid tier University program.,even my top choices ranked me (one pd, reached out to me afterwards, but a little lower given I was on H1 and my residency program is unknown), When I finish my PCCM fellowship I will be 42.
Point of the whole diatribe was age (40) would still be young, as someone said what really depends is how bad do you want it?

Thanks so much for sharing. That is inspiring!

 

[tartesos]

Go for a fellowship if you love it and can’t see yourself not doing it( speaking from experience).
Age and salary is just a number.