Are any FM fellowships worth it?

[Captain DO]

A FM doc I worked with said the majority of his practice was geriatrics. He did not do a geriatrics fellowship. If he did, it didn't seem like it would change anything. So, what would be the benefit of doing a geriatrics fellowship?

Do any of the FM fellowships significantly help you salary wise? Increased privileges? etc?

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[primadonna22274]

I'm struggling with this a bit. We do a LOT of geriatrics in my FM residency and I enjoy it tremendously. I am an NHSC loan repayment recipient and my obligation does allow for a one year geriatrics fellowship, but other than the credential and additional board certification and beefing up my CV, I'm not sure what else that extra year will gain for my practice. I would like to hear from seasoned folks on this one.

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[Doctor4Life1769]

I think the fellowships that add an added qualification like sports, Geri, sleep Med, etc may be "worthwhile" if you plan to incorporate into your practice only. There's at least a board certification process.

 

[styphon]

Depends on what you are after

AIDS fellowship would be great if you want to work in an HIV clinic (I doubt there would be much change in salary)
OB fellowship is great if you want to do c/s (plus it likely adds to your salary)
Sports is great if you want to be part of an Ortho group (this also likely adds to salary)

 

[Doctor4Life1769]

Depends on what you are after

AIDS fellowship would be great if you want to work in an HIV clinic (I doubt there would be much change in salary)
OB fellowship is great if you want to do c/s (plus it likely adds to your salary)
Sports is great if you want to be part of an Ortho group (this also likely adds to salary)

OB also adds to that malpractice insurance

 

[pusher]

A FM doc I worked with said the majority of his practice was geriatrics. He did not do a geriatrics fellowship. If he did, it didn't seem like it would change anything. So, what would be the benefit of doing a geriatrics fellowship?

I think the fellowships that add an added qualification like sports, Geri, sleep Med, etc may be "worthwhile" if you plan to incorporate into your practice only. There's at least a board certification process.

Occupational medicine is also worth to consider. I think, it can be done as a fellowship. The Lifestyle is better than other primary care specialties and job opportunities are good.

 

[Promethean]

As FM, your scope is wide. What you can do is limited more by geography and availability of specialists than by hard boundaries on scope of practice. So, you *can* build whatever kind of practice you want without a fellowship, assuming you can find an employer that is on board (or else do private practice) and a patient base to support it. (Can doesn't mean should.)

In some cases, fellowship training could mean more money, but possibly not enough to balance out the opportunity cost of lower income during the fellowship. At least, it could take some time to see a return on the investment. If you are going for academic medicine or want to break into a competitive regional market, it may indeed be beneficial to have a fellowship on your CV.

I think that beyond economics, there is the question of confidence and competence. If I were going to do a subspecialty, I'd want to know that the services I could provide were where they needed to be from the gate. If I intended to see exclusively geriatric patients after finishing a residency where elders were less than half of the patients I cared for, I don't think it would be unreasonable to spend a year becoming the very best geriatrician I could be before I set out on my own. That would give me confidence that the patients who opted to see me, rather than a more general FM doctor, would be getting something of particular value for making that choice.

Once someone has been in practice for a few years, I don't think that this reason would matter so much as for when they are just starting out as an attending. After enough clinical experience, the fellowship you did a decade earlier may really just be a feather for your cap and a modest salary bump.

 

[letsdoit]

I did HPM fellowship and my practice is hybrid FM/HPM. I think that the fellowship was worth it. But then again, I am not measuring worth based on money. I am mesuring worth based on practice satisfaction.

 

[Leonardsean]

I looked into addiction medicine fellowships, and1 of the questions I was asked was, "Is your residency ACGME accredited?" So even though there are no official "prejudices" against DO's there may still be bias against AOA prorgams...this will (hopefully) go away with the ACGME merger, but for right now it's still a thing.

--Sean

 

[galactus]

I did HPM fellowship and my practice is hybrid FM/HPM. I think that the fellowship was worth it. But then again, I am not measuring worth based on money. I am mesuring worth based on practice satisfaction.

Practice satisfaction is key! I practice a hybrid FM/SM model with some inpatient, and it's great! For me doing that extra year for fellowship was worth it, but to teach their own.

 

[yunsenb]

Practice satisfaction is key! I practice a hybrid FM/SM model with some inpatient, and it's great! For me doing that extra year for fellowship was worth it, but to teach their own.

Does your sports practice procedures mainly consist of US guided injections, or do you routinely perform other procedures as well?

 

[galactus]

Does your sports practice procedures mainly consist of US guided injections, or do you routinely perform other procedures as well?

For my sports medicine clinic? Blind injections, US guided injections, US diagnostic, casting, concussion evaluation, minor MSK manipulations, etc. Aka your typical sports practice. Game coverage wise - reducing dislocations, suturing, placing IV's, (just within the past month!)
I still do primary care, so your general FM office procedures I still do.

 

[septoplasty]

Practice satisfaction is key! I practice a hybrid FM/SM model with some inpatient, and it's great! For me doing that extra year for fellowship was worth it, but to teach their own.

Dude, are they hiring in your group?

That sounds like what I want haha.

Jk, but real talk, that's a sweet job!

 

[galactus]

Dude, are they hiring in your group?

That sounds like what I want haha.

Jk, but real talk, that's a sweet job!

Lol yeah I like it so far. I’m in academics so I enjoy the variety. I teach MSK exams to the med students and hopefully soon I’ll be teaching some MSK US, since the med school is now incorporating US into the 1st year curriculum. Fun times!

 

[KeikoTanaka]

Practice satisfaction is key! I practice a hybrid FM/SM model with some inpatient, and it's great! For me doing that extra year for fellowship was worth it, but to teach their own.

I came to the FM forums specifically to ask about this type of model! This is entirely what I’m interested in doing in the future. I’m soon to be a 1st year DO student in July. I am working at a orthopedics office now as a scribe until school starts and I’m living with my bf and his family. My bf was also accepted to medical school and his mother is the head orthopedist at the practice im working at. They both seem to be skeptical in that I wouldn’t be able to “fund” the SM side of my practice and it wouldn’t be useful unless it’s the only thing I did. They say I won’t get referrals for MSK pathologies because no PCP would send their patients to another PCP in fear of losing patients. Also they said and that if I still kept my FM practice, I couldn’t work with an orthopedist part time in fear of costing the orthopedist money if I worked with their practice cuz then PCPs won’t refer patients to that orthopedist in also fear of losing their patients to a PCP/SM doc. Also they’re saying having an X-ray tech, buying all the cortisone injection materials, the US machine, everything would be too much time and money to be able to do all of it on top of just seeing patients. Are their fears legitimate? To be honest I love variety so if doing SM in house only increases my salary marginally, I really don’t care, as long as I can offer more comprehensive care to my patients and do what I love, that’s what I want! But do you think I could really use this model and be an effective physician on both fronts?

 

[VA Hopeful Dr]

Some yes, some no.

Sports - Definitely worth it as you usually get training in lots of procedural stuff that the rest of us don't really do.

Geri - Meh. The only thing that I've seen geriatricians do really differently than the rest of us are more complete functional assessments (which doesn't reimburse well for the time it takes and PT can do just fine) and having a better idea of local aging resources but that's easy to pick up.

Hospital - If you have a really strong inpatient in residency, this might be overkill but that's less and less common these days.

Addiction - I think this is a good one - most of us don't get all that much experience in actually treating addiction in residency.

Hospice - Similar to hospital. We had an attending who ran the local Hospice House so we got great experience but that might not be the norm.

 

[septoplasty]

I came to the FM forums specifically to ask about this type of model! This is entirely what I’m interested in doing in the future. I’m soon to be a 1st year DO student in July. I am working at a orthopedics office now as a scribe until school starts and I’m living with my bf and his family. My bf was also accepted to medical school and his mother is the head orthopedist at the practice im working at. They both seem to be skeptical in that I wouldn’t be able to “fund” the SM side of my practice and it wouldn’t be useful unless it’s the only thing I did. They say I won’t get referrals for MSK pathologies because no PCP would send their patients to another PCP in fear of losing patients. Also they said and that if I still kept my FM practice, I couldn’t work with an orthopedist part time in fear of costing the orthopedist money if I worked with their practice cuz then PCPs won’t refer patients to that orthopedist in also fear of losing their patients to a PCP/SM doc. Also they’re saying having an X-ray tech, buying all the cortisone injection materials, the US machine, everything would be too much time and money to be able to do all of it on top of just seeing patients. Are their fears legitimate? To be honest I love variety so if doing SM in house only increases my salary marginally, I really don’t care, as long as I can offer more comprehensive care to my patients and do what I love, that’s what I want! But do you think I could really use this model and be an effective physician on both fronts?

So correct me if I'm wrong, you want to do outpatient FM (Primary Care) along with SM?

If so, that's the model that most common way to practice the hybrid mix. To be honest, full primary care sports med (only non-op orthopedics, etc.), jobs are harder to come by.

1. Funding your SM side is a key component as to why the above "Sole SM" sports for PC don't exist, the lack of patients to start up with. This is why alot (I would say 90%+) are FM/SM, as to build your SM practice, but funding not only your position, but your salary.
2. PCP's fearful of losing their MSK/SM patients? Heck no. TBH, most PCP's I know, along with the ones I trained, don't really want to do what SM trained docs do. Procedures are a biggie. If a PCP refers their patient to you, its done for a Ortho/SM reason (which you can deem operative/non-op), you aren't getting the referral from another PCP to manage their patient's DM. Thus their fear doesn't have a basis.
3. The cost of injections and xray isn't that much, honestly, majority of PCP offices I know have both. The U/S is a different factor, those start at a $100k+ (multi-probes, etc.), this might be hard to justify as a part time SM doc, as you need the patient volume to justify the cost (but again, this is where your ortho colleagues come in, they refer to you to do the injection therapies that are technically limited by palpation guided, or require imaging for proper guidance (but don't want fluoro, which is losing its grip), thus justifying the cost.

4. Thus, its possible. You'll have to work for it/design your practice etc.

Based on timing of things, you're atleast 8 years out from any of this, and by than, the market might be tougher (who knows?), as SM has picked up as of late.

 

[KeikoTanaka]

So correct me if I'm wrong, you want to do outpatient FM (Primary Care) along with SM?

If so, that's the model that most common way to practice the hybrid mix. To be honest, full primary care sports med (only non-op orthopedics, etc.), jobs are harder to come by.

1. Funding your SM side is a key component as to why the above "Sole SM" sports for PC don't exist, the lack of patients to start up with. This is why alot (I would say 90%+) are FM/SM, as to build your SM practice, but funding not only your position, but your salary.
2. PCP's fearful of losing their MSK/SM patients? Heck no. TBH, most PCP's I know, along with the ones I trained, don't really want to do what SM trained docs do. Procedures are a biggie. If a PCP refers their patient to you, its done for a Ortho/SM reason (which you can deem operative/non-op), you aren't getting the referral from another PCP to manage their patient's DM. Thus their fear doesn't have a basis.
3. The cost of injections and xray isn't that much, honestly, majority of PCP offices I know have both. The U/S is a different factor, those start at a $100k+ (multi-probes, etc.), this might be hard to justify as a part time SM doc, as you need the patient volume to justify the cost (but again, this is where your ortho colleagues come in, they refer to you to do the injection therapies that are technically limited by palpation guided, or require imaging for proper guidance (but don't want fluoro, which is losing its grip), thus justifying the cost.

4. Thus, its possible. You'll have to work for it/design your practice etc.

Based on timing of things, you're atleast 8 years out from any of this, and by than, the market might be tougher (who knows?), as SM has picked up as of late.

Thanks so much for your input, this was very educational and reassuring. I imagine living in a rural to suburban area so I don’t know what competition will be like at that time in 8 years, I just know I hate cities with a burning passion. I didn’t think I would have a problem with all this but his mom definitely was like “no no that PCP would lose their patient to you because you’re a sweet and charismatic guy who can now offer both of these services, and may be more convenient for them” etc etc which I suppose would only work if their PCP really sucked... so like survival of the fittest?

 

[Freezeout]

Thanks so much for your input, this was very educational and reassuring. I imagine living in a rural to suburban area so I don’t know what competition will be like at that time in 8 years, I just know I hate cities with a burning passion. I didn’t think I would have a problem with all this but his mom definitely was like “no no that PCP would lose their patient to you because you’re a sweet and charismatic guy who can now offer both of these services, and may be more convenient for them” etc etc which I suppose would only work if their PCP really sucked... so like survival of the fittest?

For what it’s worth I just signed a contract to do FM/SM hybrid when I finish with fellowship. Luckily the system I’m going to has an ortho surgeon who doesn’t do surgery anymore, but he has way more volume than he can see/wants to see. I’m going to take some of his load and they already bought him an ultrasound so it just kinda worked out. They currently have 6 week waiting periods for pcp appts so I’m going to help out there as well. No game coverage, which was critical for me in my search. The job you want definitely exists. Just gotta find it. A lot of places I interviewed weren’t looking for sports but when I explained what from my fellowship training I wanted to be doing they were very open to it.

 

[galactus]

Thanks so much for your input, this was very educational and reassuring. I imagine living in a rural to suburban area so I don’t know what competition will be like at that time in 8 years, I just know I hate cities with a burning passion. I didn’t think I would have a problem with all this but his mom definitely was like “no no that PCP would lose their patient to you because you’re a sweet and charismatic guy who can now offer both of these services, and may be more convenient for them” etc etc which I suppose would only work if their PCP really sucked... so like survival of the fittest?

I'll be real. If they are seeing me in my SM clinic, I defer all primary care issues to their PCP. I keep my FM and SM clinics separate. In my FM clinic, I do some SM, but for more focus I ask my patients to see me in the sports medicine clinic.

Being sports medicine trained isn't a burden, it's an additional skill set to your primary speciality (FM). I'm in academics, so 2 days a week i do FM, 2 days a week i'm in the orthopedics department, and 1 day a week I'm at the med school teaching physical exam. For the monthly FM clerkship didactics I give the MSK lectures and an ultrasound workshop. I originally signed on to be in the FM department, but once word came out that a FM/SM came to the school, ortho ASKED me to start doing clinic in their department.

I don't feel like i'm intruding on either ortho nor my FM colleagues. My FM colleagues refer to me for MSK issues, and ortho clinic triages patients to me. I share game coverage "call" with my SM ortho colleagues (esp with all those college basketball games!) It's a great dynamic. In regards to having an ultrasound, I use it in the FM clinic, but I share it. It includes a TVUS probe for ALSO and for our FM/OB faculty. It was worth it to be department if they bought it for more than just MSK.

Long story short the practice you envision does work. I'm living it lol.

 

[KeikoTanaka]

I'll be real. If they are seeing me in my SM clinic, I defer all primary care issues to their PCP. I keep my FM and SM clinics separate. In my FM clinic, I do some SM, but for more focus I ask my patients to see me in the sports medicine clinic.

Being sports medicine trained isn't a burden, it's an additional skill set to your primary speciality (FM). I'm in academics, so 2 days a week i do FM, 2 days a week i'm in the orthopedics department, and 1 day a week I'm at the med school teaching physical exam. For the monthly FM clerkship didactics I give the MSK lectures and an ultrasound workshop. I originally signed on to be in the FM department, but once word came out that a FM/SM came to the school, ortho ASKED me to start doing clinic in their department.

I don't feel like i'm intruding on either ortho nor my FM colleagues. My FM colleagues refer to me for MSK issues, and ortho clinic triages patients to me. I share game coverage "call" with my SM ortho colleagues (esp with all those college basketball games!) It's a great dynamic. In regards to having an ultrasound, I use it in the FM clinic, but I share it. It includes a TVUS probe for ALSO and for our FM/OB faculty. It was worth it to be department if they bought it for more than just MSK.

Long story short the practice you envision does work. I'm living it lol.

Awesome, what you do is the dream! I never thought about working in academics. Seems like a great balance of doing what you love. Thanks for your input!