When do physicians normally do a fellowship?

[Mark Greene]

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Ok, so I know what fellowships are and that you have to complete your residency before starting one. My question is this: is it possible to spend a few years after residency practicing medicine more generally before starting a fellowship, or do you have to go directly into the fellowship you want to do post-residency? is it normal to practice generally before starting a fellowship?

For example, I'm thinking of doing a health services corps scholarship, which requires 4 years of payback post-residency. after doing those four years, could I go back and start a fellowship in a sub-specialty that I'm interested in? thanks.

 

[JCTWP46]

I would imagine the norm is to do a fellowship right after residency is finished. However, I do know that it is definitely possible to practice a few years and go back for a fellowship. I specifically know a physician who did EM, practiced a few years, and then decided he wanted to go into a sports med fellowship. He didn't intentionally wait but decided he didn't particularly like EM.

 

[Praefectus]

As long as you can still get good rec letters...

 

[Winged Scapula]

You can do one after a few years in practice if you wish, but as noted above, right upon the completion of residency is most common.

The LORs is not the big problem. Leaving a well paying job for a fellowship salary/hours is.

 

[gyngyn]

Ok, so I know what fellowships are and that you have to complete your residency before starting one. My question is this: is it possible to spend a few years after residency practicing medicine more generally before starting a fellowship, or do you have to go directly into the fellowship you want to do post-residency? is it normal to practice generally before starting a fellowship?

For example, I'm thinking of doing a health services corps scholarship, which requires 4 years of payback post-residency. after doing those four years, could I go back and start a fellowship in a sub-specialty that I'm interested in? thanks.

Anyone who completes the required residency may apply for a fellowship. Those with an NHSC scholarship (or any other obligation) may certainly apply for a fellowship upon completion of their service. In reality, relatively few do. I found that after my service it was a hard pill to swallow the prospect of taking instruction from those with less experience (admittedly my own issue and not theirs!). It is certainly an option, though.

 

[MedPR]

Anyone who completes the required residency may apply for a fellowship. Those with an NHSC scholarship (or any other obligation) may certainly apply for a fellowship upon completion of their service. In reality, relatively few do. I found that after my service it was a hard pill to swallow the prospect of taking instruction from those with less experience (admittedly my own issue and not theirs!). It is certainly an option, though.

How does salary work for fellows?


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[deleted480308]

How does salary work for fellows?


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Generally a continuation of the pgy pay schedule

 

[gyngyn]

Generally a continuation of the pgy pay schedule

Correct. But moonlighting is a lot easier in fellowship than in residency!

 

[MedPR]

Generally a continuation of the pgy pay schedule

I see. So if you take 2 docs, one an IM and one an Ortho, and they both start a fellowship after 10 years in practice, the Ortho is gonna get screwed way more than the IM in terms of paycut?

 

[gyngyn]

I see. So if you take 2 docs, one an IM and one an Ortho, and they both start a fellowship after 10 years in practice, the Ortho is gonna get screwed way more than the IM in terms of paycut?

Although I've never seen an established internist (or orthopedist) enter fellowship after 10 years, I am confident that such a opportunity would not be considered "getting screwed" by either!

 

[Winged Scapula]

Although I've never seen an established internist (or orthopedist) enter fellowship after 10 years, I am confident that such a opportunity would not be considered "getting screwed" by either!

I would disagree, or perhaps just point out that the question that is being asked is, "if an internist and orthopod decide to leave practice after 10 years to do a relevant subspecialty, won't the orthopod have more of an income drop during fellowship than the internist?"

The answer is absolutely, in almost all cases, yes. The average Orthopedic surgeon makes substantially more than the average Internist. Leaving practice, 1 year or 10 years after residency training, will mean that your income will be substantially lower as a fellow.

Now, the Internist will be paid as a PGY-4 (or 5 if he did a Chief year) and the Orthopod as a PGY-6 but the differences between those salaries is not nearly as significant as the difference between their salaries as a practicing physician. THIS is why leaving practice to go back and do a fellowship is not common; most people after a few years in practice have a house, nice car, and other fancy things that they couldn't afford on a fellows salary, even with moonlighting.

FYI: not all fellowships allow moonlighting, or have restrictions on them. I was only allowed to moonlight on Saturdays, for no more than 24 hours, and of course, only on weekends when I wasn't on call for Surg Onc.

 

[gyngyn]

I would disagree, or perhaps just point out that the question that is being asked is, "if an internist and orthopod decide to leave practice after 10 years to do a relevant subspecialty, won't the orthopod have more of an income drop during fellowship than the internist?"

The answer is absolutely, in almost all cases, yes. The average Orthopedic surgeon makes substantially more than the average Internist. Leaving practice, 1 year or 10 years after residency training, will mean that your income will be substantially lower as a fellow.

Now, the Internist will be paid as a PGY-4 (or 5 if he did a Chief year) and the Orthopod as a PGY-6 but the differences between those salaries is not nearly as significant as the difference between their salaries as a practicing physician. THIS is why leaving practice to go back and do a fellowship is not common; most people after a few years in practice have a house, nice car, and other fancy things that they couldn't afford on a fellows salary, even with moonlighting.

FYI: not all fellowships allow moonlighting, or have restrictions on them. I was only allowed to moonlight on Saturdays, for no more than 24 hours, and of course, only on weekends when I wasn't on call for Surg Onc.

The differential in pay is undeniable for these two specialties and therefore a disruption a larger income stream would be expected for the orthopedist. Neither, in my view is getting "screwed," because fellowship is a step in professional development that is both an honor and one that may potentially improve their professional stature as well as their income!

 

[Winged Scapula]

Neither, in my view is getting "screwed," because fellowship is a step in professional development that is both an honor and one that may potentially improve their professional stature as well as their income!

I understand that (and agree with you - there is no doubt that my fellowship brought me increased prestige/stature/income). However, the poster you were responding to was talking about being "screwed" in terms of money, not prestige/honor.

 

[gyngyn]

I understand that (and agree with you - there is no doubt that my fellowship brought me increased prestige/stature/income). However, the poster you were responding to was talking about being "screwed" in terms of money, not prestige/honor.

Ahhh. Here I am, a gynecologist and I misunderstood "screwed!"

 

[MedPR]

Ahhh. Here I am, a gynecologist and I misunderstood "screwed!"

Haha yea I shouldve worded it better. I was just making sure that fellowship pay isn't based on specialty, but instead is pretty universal.

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[Winged Scapula]

Ahhh. Here I am, a gynecologist and I misunderstood "screwed!"

ha ha...👍

 

[Sophocles]

Ahhh. Here I am, a gynecologist and I misunderstood "screwed!"

 

[mvenus929]

I believe in some specialties, you actually apply for fellowship 2 years before you start (though I think this is becoming less common), so people who are in 3-year residency programs who don't know what they want to do after they graduate may apply for residencies after their second year (rather than their first), and spend their gap year working as a hospitalist or something similar.

 

[Winged Scapula]

I believe in some specialties, you actually apply for fellowship 2 years before you start (though I think this is becoming less common), so people who are in 3-year residency programs who don't know what they want to do after they graduate may apply for residencies after their second year (rather than their first), and spend their gap year working as a hospitalist or something similar.

That is true. There are some surgical specialties for which you apply during your 4th clinical year.

 

[mindyopenner]

Ok, so I know what fellowships are and that you have to complete your residency before starting one. My question is this: is it possible to spend a few years after residency practicing medicine more generally before starting a fellowship, or do you have to go directly into the fellowship you want to do post-residency? is it normal to practice generally before starting a fellowship?

For example, I'm thinking of doing a health services corps scholarship, which requires 4 years of payback post-residency. after doing those four years, could I go back and start a fellowship in a sub-specialty that I'm interested in? thanks.

Probably 90% of fellows enroll after residency, and match to their spot (or accept a spot) during residency. Many residents know what fellowship they will do during their final year of residency. Fellows are paid slightly more than residents. This varies from place to place, but the information is easy to find. There is normally a PGY (postgraduate year) pay scale at each teaching institution.

There are many people who do fellowship after going into practice, but it is unusual to have many years of practice. There is at least a 2-3 fold difference between the salary of a practicing physician and a fellow. For some specialties, it may be as much as 12 fold.

Some people do what is called a "pre-residency fellowship". This is normally time spent doing research to improve the chances of getting into a residency or to complete a project. It is in some ways similar to a post doc that PhD graduates do.