What is life like during a fellowship?

[estradiol9]

I know that residency can be brutal but what about fellowships? How much do people work in cardiology, gastroenterology, endocrinology, etc fellowships?

How much do doctors get paid during residency and fellowship?

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[Raryn]

I know that residency can be brutal but what about fellowships? How much do people work in cardiology, gastroenterology, endocrinology, etc fellowships?

How much do doctors get paid during residency and fellowship?

It really really varies from fellowship to fellowship. First year of a fellowship like cards or GI is pretty much just as bad as your intern year.

Pay-wise, residents all start between 45 and 50 thousand a year varying depending on geography and it generally goes up by $1500 or so yearly. So a PGY1 resident (i.e. an intern) might start at say, $47,000 and be earning $50,000 by PGY3. Fellowship is generally treated as an extension of your residency, so if you were to do a cardiology fellowship after IM, you'd simply start as a PGY4 (since you already had 3 years of IM training). So a first year fellow coming out of a 3 year residency would earn on the order of $52-55k.

Note: This doesn't include any pay you might get via moonlighting. Now, resident moonlighting experiences are generally limited, but depending on the program people often can supplement their income by 50% in the last year to year and a half. On the other hand, a fellow is also a board eligible (or even board certified) physician in their primary specialty, so they can earn a hell of a lot when moonlighting if they're willing to put in the time. This is within the limits of duty hour restrictions of course, because any time moonlighting still counts towards your 80hrs/week.

 

[Law2Doc]

It really really varies from fellowship to fellowship. First year of a fellowship like cards or GI is pretty much just as bad as your intern year.

Pay-wise, residents all start between 45 and 50 thousand a year varying depending on geography and it generally goes up by $1500 or so yearly. So a PGY1 resident (i.e. an intern) might start at say, $47,000 and be earning $50,000 by PGY3. Fellowship is generally treated as an extension of your residency, so if you were to do a cardiology fellowship after IM, you'd simply start as a PGY4 (since you already had 3 years of IM training). So a first year fellow coming out of a 3 year residency would earn on the order of $52-55k.

Note: This doesn't include any pay you might get via moonlighting. Now, resident moonlighting experiences are generally limited, but depending on the program people often can supplement their income by 50% in the last year to year and a half. On the other hand, a fellow is also a board eligible (or even board certified) physician in their primary specialty, so they can earn a hell of a lot when moonlighting if they're willing to put in the time. This is within the limits of duty hour restrictions of course, because any time moonlighting still counts towards your 80hrs/week.

I'm not sure I'd equate fellowship with an extension of residency, at least not in most fields. In many cases the fellowship salary will actually be a step down from what you were earning in the last year of residency. And your hours generally will go up, as fellows are the workhorses of programs that utilize them. They take a lot of call and supervise the residents so the attending don't have to. Moonlighting is available, but limited as hours are already high. And you are going to be using some of your "spare time" in job search efforts. Many fellowships are not ACGME accredited, so the 80 hour work week may not be applicable.

 

[IMSingular]

40 hour week is a myth. If you are professional or exempt employee you have to put in some where between 60-80 hours/week. If you are not an exempt employee you have to hold on to two jobs to make a living.

 

[BigRedBeta]

I'm not sure I'd equate fellowship with an extension of residency, at least not in most fields. In many cases the fellowship salary will actually be a step down from what you were earning in the last year of residency.

Not sure where you're getting this. Every place I've ever seen, fellows simply insert at their appropriate PGY salary based on the institution's house officer payscale. As a first year peds critical care fellow, I'll be making the same salary as the 4th year general surgery resident. If I had subjected myself to a chief year, I would have entered at the PGY-5 level. Granted I do know people who have taken significant pay cuts entering fellowships, but within the same institution, the salary is the same dependent only experience level.

As far as the work load, especially with the new work hour rules for interns, fellowship, especially the first year will definitely be the most rigorous year of training. However the variability between specialties is significant. For example, many peds fields will have nothing but home call...however they will frequently be on call for a week or more at time, taking phone calls from the ER, or residents taking care of patients on the floor. As a PICU fellow, all my call will be in-house, with many programs front loading call into the first year meaning there's likely 9 or 10 months of q4 call. There are people on either side of the fence as far as which is harder (personally, when I leave the hospital, I prefer to be done with my responsibilities, rather than have to deal with continual calls at any or all times). Now if you're a fellow in something that's mostly outpatient in nature, like say endo or rheum, then there's probably limited amount of disruption. But at my children's hospital, our neuro and heme/onc fellows get called throughout the night all the time.

 

[Law2Doc]

Not sure where you're getting this. Every place I've ever seen, fellows simply insert at their appropriate PGY salary based on the institution's house officer payscale...

Multiple fellows I work with all have claimed to be earning several thousand dollars a year less than they did in their last year of residency, and I have no reason to doubt them. Every hospital system handles it differently, but it's certainly not a global rule that everyone just advances to the next PGY level, and even where they do, the pay for PGY is not uniform across all hospitals/ geographic regions. Most people don't stay within the same institution for fellowship. Many faculty will strongly advise going elsewhere for fellowship both because there is more to learn from a whole new set of attendings, as well as the fact that it benefits your training if t he people you are working with don't still see you is just continuing your residency.

 

[Raryn]

Multiple fellows I work with all have claimed to be earning several thousand dollars a year less than they did in their last year of residency, and I have no reason to doubt them. Every hospital system handles it differently, but it's certainly not a global rule that everyone just advances to the next PGY level, and even where they do, the pay for PGY is not uniform across all hospitals/ geographic regions. Most people don't stay within the same institution for fellowship. Many faculty will strongly advise going elsewhere for fellowship both because there is more to learn from a whole new set of attendings, as well as the fact that it benefits your training if t he people you are working with don't still see you is just continuing your residency.

I haven't seen a single hospital system that doesn't simply plug fellows into the next PGY on the pay scale. Now, it's entirely possible that you work at an institution with a low pay scale, so that the fellows that you personally work with had to take a pay cut (relative to their old system) to be there. On average though, the pay for a PGY4 cards fellow will be ~$1500-2000 more than a graduating PGY3 internal medicine resident. (Half will be more than that, half will be less than that, usual statistical mumbo jumbo applies)

The benefits of doing fellowship at your home institution really vary from program to program. Some people already have research projects set up they want to continue in fellowship or they plan on remaining at the institution for their career. The skills you gain in a fellowship (at least in medicine) are substantially different enough from the skills you gained as a IM resident that having a new set of attendings to learn from is a pretty meaningless distinction. Same might not be true for surgical fellowships, which pretty much are (focused) extensions of residency these days.

Edit: The only exception I just thought of is a few non-ACGME accredited fellowships (such as various ones out of Radiology) where the fellows are often also treated as junior faculty members. Then they earn ~$100k a year. But outside of those specific cases, I can't think of a situation where they weren't simply plugged into the appropriate year on the payscale the institution uses.

 

[45408]

Multiple fellows I work with all have claimed to be earning several thousand dollars a year less than they did in their last year of residency, and I have no reason to doubt them. Every hospital system handles it differently, but it's certainly not a global rule that everyone just advances to the next PGY level, and even where they do, the pay for PGY is not uniform across all hospitals/ geographic regions. Most people don't stay within the same institution for fellowship. Many faculty will strongly advise going elsewhere for fellowship both because there is more to learn from a whole new set of attendings, as well as the fact that it benefits your training if t he people you are working with don't still see you is just continuing your residency.

Unless you've heard differently, the PGY-4 fellow at any given institution is making more than the PGY-3 resident. That's all we're saying here. Of course you can find another place that pays you less.

 

[oldbearprofessor]

Many faculty will strongly advise going elsewhere for fellowship both because there is more to learn from a whole new set of attendings, as well as the fact that it benefits your training if t he people you are working with don't still see you is just continuing your residency.

This is especially true if they don't like you.

In my place, if we like a resident we strongly recommend they stay because not only does it obviously benefit us to have our strongest residents stay for fellowship but because we know that the training and experiences of a fellow are very different from that of a resident such that there is no real concern for too much overlap.

Virtually all pediatric fellowships are ACGME and all pay at a higher level than residency at the same institution. Of note is that some final year residents MAY have more moonlighting opportunities than clinically busy first year fellows but that changes quickly at most places.

 

[estradiol9]

I have an interest in endo.. In all seriousness, is an endo fellow work load really the same as an IM resident?

 

[Law2Doc]

This is especially true if they don't like you.
....

Actually the opposite. the folks I've know who were advised to do fellowship elsewhere actually were the ones hired back as faculty a year later. The point is that you learn a lot seeing how they do things elsewhere, working with others in the field, and bring back more to the table. Working as a fellow at a place that just thinks of you as the senior senior resident isn't always the ideal.

 

[Law2Doc]

I have an interest in endo.. In all seriousness, is an endo fellow work load really the same as an IM resident?

As a premed you probably shouldn't be focused on subspecialty fellowships. A lot will change for you in the at least 7 years between now and then.

 

[mipp0]

As a premed you probably shouldn't be focused on subspecialty fellowships. A lot will change for you in the at least 7 years between now and then.

Change...for the better mister?

 

[Law2Doc]

Change...for the better mister?

Could go either way. The majority of people change their minds at least once regarding desired specialty during med school, once they get exposed to more things on rotations. Some things you think you will hate you end up liking and vice versa. Some things you realize you simply don't have the numbers for. Relationship status and family changes make lifestyle decisions more or less important. And then even if you go down the IM route, you have a few more years of mind changing as you mull subspecialties. So it's borderline silly to fixate on specialties before med school, let alone subspecialties. Best to go into med school with an open mind and a willingness to work extra hard to try and keep doors open.

 

[oldbearprofessor]

Actually the opposite. the folks I've know who were advised to do fellowship elsewhere actually were the ones hired back as faculty a year later. The point is that you learn a lot seeing how they do things elsewhere, working with others in the field, and bring back more to the table. Working as a fellow at a place that just thinks of you as the senior senior resident isn't always the ideal.

With all due respect, speaking related to pediatric fellowships, which are 3 years in length, I disagree. I have never suggested that a good resident leave to do their fellowship elsewhere just for broader experience, etc. Nor is it my personal experience that my colleagues in any pediatric specialty at my institution or most others make such a suggestion either. Often we compete for good residents with the "home" institution and vice-versa. Again, I can only speak for pediatrics, but my experience in this area is longstanding and involves many residents and subspecialty areas.

More philosophically, I also disagree with the sentiment that it's best to go away for a while, etc., but that's just my personal perception of the differences, in pediatrics, between residency and fellowship training.

 

[Raryn]

With all due respect, speaking related to pediatric fellowships, which are 3 years in length, I disagree. I have never suggested that a good resident leave to do their fellowship elsewhere just for broader experience, etc. Nor is it my personal experience that my colleagues in any pediatric specialty at my institution or most others make such a suggestion either. Often we compete for good residents with the "home" institution and vice-versa. Again, I can only speak for pediatrics, but my experience in this area is longstanding and involves many residents and subspecialty areas.

More philosophically, I also disagree with the sentiment that it's best to go away for a while, etc., but that's just my personal perception of the differences, in pediatrics, between residency and fellowship training.

I'm fairly certain Law2Doc has to be talking about (non-acute care or peds) surgical fellowships. Or (a slim chance) that he's talking about (non-IR) radiology ones. Nowhere else is a fellowship simply an extension of the training you were getting as a senior resident. (oversimplification in many cases, but generally holds for the above)

 

[Socrates25]

I have an interest in endo.. In all seriousness, is an endo fellow work load really the same as an IM resident?

tough to say, depends on the clinical volume of the program, depends on the number of co-fellows to share the load. Some fellowship programs are based at programs where faculty expect the fellows to do everything; others are based at places where faculty is used to doing a lot of the work on their own, and they simply use fellows as sort of "extra" help.

I will say that anecdotally I think a lot of fellows enjoy their time more than residency, even if their work is much harder and a higher volume. There's some truth to the old saying "if you love what you do, you'll never work a day in your life." Fellows get to concentrate on the organ system that they love, instead of being responsible for everything that walks in the door.

 

[Socrates25]

I agree with OBP; from what I've seen on the pediatrics side, fellowship programs want to hold onto their best residents so they can take advantage of their talents.

 

[oldbearprofessor]

I'm fairly certain Law2Doc has to be talking about (non-acute care or peds) surgical fellowships. Or (a slim chance) that he's talking about (non-IR) radiology ones. Nowhere else is a fellowship simply an extension of the training you were getting as a senior resident. (oversimplification in many cases, but generally holds for the above)

I recognized that, but the statement was generalized and this is pre-allo, where some might understand the view to be all-inclusive of fields.

I should point out that another reason that programs like to keep their best (pediatric) residents for fellowship is that it is a good chance to begin their research on a fundable pathway. Final year fellows can begin writing K08 and similar grants based on what they've done. Programs like to keep those folks around and not risk losing them elsewhere or having to start from scratch. Often that is unavoidable, but if a resident is very good, we look to the long-term picture of keeping them on for faculty so we think about research bridging fellowship and starting faculty.

 

[Law2Doc]

... Again, I can only speak for pediatrics...

More philosophically, I also disagree with the sentiment ...., but that's just my personal perception....

your specialty and sentiment are very definitely not shared by all specialties (perhaps not even the majority). What's good for the program and what's good for the resident aren't always the same thing, but a lot of programs in other specialties are secure enough with what they have to offer that a superstar can often be lured back after fellowship. All I can tell you is there are some very definite reasons folks may benefit from doing fellowships elsewhere, and many programs that are adamant that folks do so before they are welcomed back as faculty.

 

[Law2Doc]

... Nowhere else is a fellowship simply an extension of the training you were getting as a senior resident. (oversimplification in many cases, but generally holds for the above)

I'm not saying it's a continuation of training. (I actually disputed that point above). I'm saying that the attendings who taught you as a resident are still going to look at you the same way if you just stay on another year. It's the same idea as the paralegal who goes to law school and then goes back to the firm they previously worked for -- they will forever be thought of as "the paralegal who went to law school" not a lawyer. You don't want to do this. Break the taint by doing fellowship elsewhere. You can then come back later and be regarded as a fellow professional, not a trainee. I'm sure there are places that are better and worse regarding how they regard home grown fellows, but as a general rule it's probably not the ideal in most fields.