Taking Time Off Between Residency and Fellowship

[MedicineForLife 777]

So I'm considering doing a fellowship after residency in IM. I figure the usual route is for people to go straight into a fellowship after completion of residency. But, do people take some time off in between and work for a while or take the time to have a family, etc? If so, how common is it and does it affect your chances of getting into a competitive fellowship? Thanks in advance for any responses!

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[gofor]

I've heard mixed stuff. Plus, you need specifics. If you have good credentials -- scores, academic med school, residency -- you'll prob get a less competitive fellowship if you show some previous exposure or research or passion for it. If you want cards/gi/possibly even heme-onc -- well, that's going to depend upon your resume -- good scores, research, recs, degrees? -- well, yes, you should be ok. They might even like your experience. If not, it can be tougher. Some places might not like having to train someone who tasted things outside the system for a bit. Vague answer, but you need to be more specific on your question also.

 

[LukeWhite]

I'm currently in the midst of my "year off" between residency and fellowship, doing a hospitalist year in my hometown. I love it, for several reasons:

--Private practice medicine is dramatically different from residency. Everything down to the physical exam differs in really surprisingly specific ways, mainly because of Medicare regulations. There's also a lot more exposure to other specialties. I feel as if this has been a fourth (very well-paid) year of residency in terms of continuing my education. Learning how to be a useful consultant is something that doesn't really get taught in residency.

--It's going to be way easier to move and get settled for fellowship having had a year to save money and to prepare. My cross-country move is infinitely easier with money in the bank, and having saved a fair chunk of my salary this year for retirement will ease the sense of panic that accompanies not finishing training until one's mid-thirties.

--I've had a year to publish papers I didn't have time for in residency and to build administrative contacts that will help with job negotiation after fellowship. The salary differential between my hospitalist work and the pulm/ccm I'll be doing after fellowship is probably $150,000 but with some foresight you can make this up during an off year by convincing your employer to pay top dollar for you when you're done with fellowship.

--Time with family. Ten years of training from medical school through fellowship is a lot...to take a year sabbatical to live near family has been very worthwhile.

Caveats:

--If you're applying for fellowship, I would take no more than a year off. I would have had a very hard time applying this year without the institutional support of my residency. Letters of recommendation were hard enough to get when I was bothering the writers every day during rotations. From five states away it would be impossible.

--Make sure you can get in the year you apply. A round of interviews without a match is probably going to be repeated unless you do something big to remediate whatever kept you from ranking the first time...a hospitalist year will probably not be enough.

All in all I'm very glad I took an extra year. Not only for the off year, which has been incredibly useful from a family, educational, and financial perspective, but also because my application was much stronger as a senior resident. I matched much better than I would have had I applied as PGY2.

 

[indiamacbean]

A number of people in my residency are taking a year of prior to fellowship. The majority are doing academic hospital medicine and some are doing private practice. Virtually all of us are very pleased we are taking a year off. I think that you do need to have a good answer during your fellowship application process about why you are taking a year off and what you plan to do with the year. This was a question that came up during my interviews for fellowship. All in all I think it is a winning move. I also agree with what LukeWhite said.

 

[Top Gun]

So I'm considering doing a fellowship after residency in IM. I figure the usual route is for people to go straight into a fellowship after completion of residency. But, do people take some time off in between and work for a while or take the time to have a family, etc? If so, how common is it and does it affect your chances of getting into a competitive fellowship? Thanks in advance for any responses!

I graduated from residency about 4 months ago, and am practicing in my hometown right now, with plans to apply for fellowship next year. I'm hoping that having some actual experience before starting fellowship might turn out to be an advantage, although I'm not really sure. I plan on applying for nephrology and heme/onc, which are probably about middle-of the-road competitive.

 

[FutureDoctorrrr]

I'm currently in the midst of my "year off" between residency and fellowship, doing a hospitalist year in my hometown. I love it, for several reasons:

--Private practice medicine is dramatically different from residency. Everything down to the physical exam differs in really surprisingly specific ways, mainly because of Medicare regulations. There's also a lot more exposure to other specialties. I feel as if this has been a fourth (very well-paid) year of residency in terms of continuing my education. Learning how to be a useful consultant is something that doesn't really get taught in residency.

--It's going to be way easier to move and get settled for fellowship having had a year to save money and to prepare. My cross-country move is infinitely easier with money in the bank, and having saved a fair chunk of my salary this year for retirement will ease the sense of panic that accompanies not finishing training until one's mid-thirties.

--I've had a year to publish papers I didn't have time for in residency and to build administrative contacts that will help with job negotiation after fellowship. The salary differential between my hospitalist work and the pulm/ccm I'll be doing after fellowship is probably $150,000 but with some foresight you can make this up during an off year by convincing your employer to pay top dollar for you when you're done with fellowship.

--Time with family. Ten years of training from medical school through fellowship is a lot...to take a year sabbatical to live near family has been very worthwhile.

Caveats:

--If you're applying for fellowship, I would take no more than a year off. I would have had a very hard time applying this year without the institutional support of my residency. Letters of recommendation were hard enough to get when I was bothering the writers every day during rotations. From five states away it would be impossible.

--Make sure you can get in the year you apply. A round of interviews without a match is probably going to be repeated unless you do something big to remediate whatever kept you from ranking the first time...a hospitalist year will probably not be enough.

All in all I'm very glad I took an extra year. Not only for the off year, which has been incredibly useful from a family, educational, and financial perspective, but also because my application was much stronger as a senior resident. I matched much better than I would have had I applied as PGY2.

Hi,
Thanks for this informational post. I just got done with my 1st yr of medical school.
I want to do IM. I have a follow-up question to the post above. I was planning on spending 2-3 yrs as a hospitalist in a university hospital before applying for a nephrology fellowship.
Is there no way of doing so? I really want to pay off my loans before starting the fellowship. I also want to work for 2-3 yrs in order to give myself time to have an honest answer to whether I really care about being a nephrologist or am I just wanting to do so because all my friends want to be specialists.

Your comments are much appreciated.

 

[Instatewaiter]

Hi,
Thanks for this informational post. I just got done with my 1st yr of medical school.
I want to do IM. I have a follow-up question to the post above. I was planning on spending 2-3 yrs as a hospitalist in a university hospital before applying for a nephrology fellowship.
Is there no way of doing so? I really want to pay off my loans before starting the fellowship. I also want to work for 2-3 yrs in order to give myself time to have an honest answer to whether I really care about being a nephrologist or am I just wanting to do so because all my friends want to be specialists.

Your comments are much appreciated.

There are a few problems with taking time off, especially more than a year.

First, some say that time off is seen as a weakness because it is hard to parse out who didn't match and who just wanted to take time off. I am not so sure how true this is but have heard of it from a few respected posters on this board. I do know of two people from my residency who matched to incredible fellowships after taking a year off.

More importantly, once you are more than a year out gettings letters is difficult. There basically are no grades in residency and it is hard for a fellowship to parse out who is a great candidate. The letters help them do this. On top of that, being close to residency (ie in residency) you program director/head of the dept you are interested in can make calls for you. The latter is very important and probably won't be available or meaningful if you are 3 years out of residency.

Now, this is more important for competitive fellowships like GI, cards and heme/onc. Nephrology is very uncompetitive. If you have a pulse, you can match into nephrology, especially if you are a US citizen coming from an academic IM program (where most US med students end up).

So in the end, I don't think you won't be able to match but taking more than a year off (and some would even say taking a year off) will really limit your chances and limit where you can match.

 

[LoudBark]

There are a few problems with taking time off, especially more than a year.

First, some say that time off is seen as a weakness because it is hard to parse out who didn't match and who just wanted to take time off. I am not so sure how true this is but have heard of it from a few respected posters on this board. I do know of two people from my residency who matched to incredible fellowships after taking a year off.

More importantly, once you are more than a year out gettings letters is difficult. There basically are no grades in residency and it is hard for a fellowship to parse out who is a great candidate. The letters help them do this. On top of that, being close to residency (ie in residency) you program director/head of the dept you are interested in can make calls for you. The latter is very important and probably won't be available or meaningful if you are 3 years out of residency.

Now, this is more important for competitive fellowships like GI, cards and heme/onc. Nephrology is very uncompetitive. If you have a pulse, you can match into nephrology, especially if you are a US citizen coming from an academic IM program (where most US med students end up).

So in the end, I don't think you won't be able to match but taking more than a year off (and some would even say taking a year off) will really limit your chances and limit where you can match.

Program directors and academic lifers definitely look down on anyone applying to fellowship who is more than one at most two years out of residency.

They have a lot of concerns, some real, some not so real but still concerning in their own mind.

They are worried that you may not adjust to the life and atmosphere as a fellow. Fellowship is much different from working in the real world. They worry you won't mesh well with working under an attending. You are used to working on your own and not having to answer to anyone. They worry you may butt heads with the attendings. You may just want to do things your own way like you do in private practice and not want to have to present patients with attendings and take their advice and certainly not their criticism. They worry that you may not work well with others if you have been on your own.

They worry you won't get adjusted to the certainly longer and worse work hours. You will have to take call from home and then present and round on patients in the morning. Will you get sick of getting that mundane call from the ER at 2am? Those right out of residency are used to the lifestyle and don't know any different.

They have this fear (real or imagined) that since the income is so much different you may one day decide to say screw it all, just quit and go back to being a hospitalist or whatever you were doing after getting frustrated.

Part of what a fellowship director is looking for is that good team player who can fit in and be part of the group. They think that working alone in private practice outside of academics will sour you and you won't work well with others.

The rare exception is the case of someone who stays in academics and does research before starting fellowship. The academians really, really look down on the private practice docs that want to return to fellowship.

 

[gutonc]

Program directors and academic lifers definitely look down on anyone applying to fellowship who is more than one at most two years out of residency.

They have a lot of concerns, some real, some not so real but still concerning in their own mind.

The one I hear the most from my colleagues but that you didn't mention is "why did s/he work as a hospitalist/PCP/locums? Probably didn't match the first time around. What have they done to improve their app since? Nothing. No thanks."