Career balance and fellowship goals

[cicero23]

For those of you deciding on a fellowship, how did/do you know it's the right decision if you have other career interests?

I'm a IM PGY2 resident and trying to plan out how to use the rest of my residency to prepare me for practice. I was initially dead set on heme/onc but, coming off on a hemeonc rotation, I have been more serious about deciding on primary care. I would appreciate it if someone could help me think out my career plans to see if they are feasible and I don't have any serious misunderstandings.

My career goals are shifting and I wish to now include student education and public policy (see myself getting involved in lobbying/advocacy, likely politics in the distant future). It's important to me to incorporate these things into my career to some extent (likely light involvement early on, but prefer to get involved early in my career). Other things that are important to me are working only outpatient with 4.5-5 clinical days/wk with none/infrequent weekends or holidays. I hope to work no more than 45ish hrs/wk so I have some time to allocate to my other career interests. In terms of salary, I would be happy at around ~200-230k/yr starting, though goal would be to be at 300k at some point in my career. My family fully funded my spoiled self so I have no debts. I plan to settle down around in the suburbs of philly. Browsing online, I see job opportunities are endless (mostly for PCP, less for onc but they exist)

While reading more into heme onc vs pcp, I feel like working as a PCP would give me the flexibility i need to incorporate these interests and would allow me to start on my career earlier. Intellectually, i would be happy doing either. I'm afraid that since I have these other interests I would like to incorporate into my career, I wouldn't be able to become a good oncologist as the field is rapidly evolving and I would have a hard time keeping up with all the literature. I also feel like it would be a waste of time doing a fellowship if in the end I want to spend increasingly more time in the education and advocacy aspects of medicine.

Is this a wise decision? I have some onc projects I'll finish (a case report, review, and outcome research project) to fall back on if I decide to switch back to onc, but at this point I kind of want to stop the hustle of getting into fellowship and use the rest of my residency focusing on where i see myself as above.

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[FrkyBgStok]

I am in pediatrics so it doesn't directly apply because 1) almost all peds fellowships are 3 years, 2) most peds fellowships pay less than general pediatricians, 3) even the ones pay more are half of what the high paying fellowships coming out of IM pay, and 4) peds is low paying in general and draws more of the "follow your heart" type of people.

I asked a developmental pediatrician (one of those that pays less) how he and his wife reconciled making less money for more training time and he gave me excellent advice. He said, "fellowship is for those that can't imagine a life in general peds." he went on to discuss how money didn't matter because he knew that he was doing what he wanted. this always stuck with me and I tried to force myself to like general peds and I couldn't do it. I did fellowship because that is exactly how I felt. I couldn't get out of general peds fast enough.

 

[QuizzicalApe]

For those of you deciding on a fellowship, how did/do you know it's the right decision if you have other career interests?

I'm a IM PGY2 resident and trying to plan out how to use the rest of my residency to prepare me for practice. I was initially dead set on heme/onc but, coming off on a hemeonc rotation, I have been more serious about deciding on primary care. I would appreciate it if someone could help me think out my career plans to see if they are feasible and I don't have any serious misunderstandings.

My career goals are shifting and I wish to now include student education and public policy (see myself getting involved in lobbying/advocacy, likely politics in the distant future). It's important to me to incorporate these things into my career to some extent (likely light involvement early on, but prefer to get involved early in my career). Other things that are important to me are working only outpatient with 4.5-5 clinical days/wk with none/infrequent weekends or holidays. I hope to work no more than 45ish hrs/wk so I have some time to allocate to my other career interests. In terms of salary, I would be happy at around ~200-230k/yr starting, though goal would be to be at 300k at some point in my career. My family fully funded my spoiled self so I have no debts. I plan to settle down around in the suburbs of philly. Browsing online, I see job opportunities are endless (mostly for PCP, less for onc but they exist)

While reading more into heme onc vs pcp, I feel like working as a PCP would give me the flexibility i need to incorporate these interests and would allow me to start on my career earlier. Intellectually, i would be happy doing either. I'm afraid that since I have these other interests I would like to incorporate into my career, I wouldn't be able to become a good oncologist as the field is rapidly evolving and I would have a hard time keeping up with all the literature. I also feel like it would be a waste of time doing a fellowship if in the end I want to spend increasingly more time in the education and advocacy aspects of medicine.

Is this a wise decision? I have some onc projects I'll finish (a case report, review, and outcome research project) to fall back on if I decide to switch back to onc, but at this point I kind of want to stop the hustle of getting into fellowship and use the rest of my residency focusing on where i see myself as above.

I went into residency trying to decide if I wanted to do Heme/Onc or Primary Care. What I liked about both was the close, longitudinal relationships you could form and the outpatient life. During residency, my clinic burned me out on the idea of primary care (which is unfair to primary care because residency clinic is not a great exemplar of the field). I was lucky in that my residency had a good set-up for outpatient heme/onc rotations. Many residents only get to see the inpatient aspect of heme/onc, which tends to be dramatically ill malignant heme patients or a solid tumor service which often just ends up being a normal IM service in people that happen to have tumors, punctuated occasionally by neutropenic fevers and sick de novo small cell patients.

The rapidly changing field of oncology can be intimidating, but through a combination of national guidelines, occasional conferences, skimming emails, and leafing through high impact journals (with referrals to subspecialists picking up remaining slack), even a generalist like myself can keep up reasonably well.

Education and policy are things you could incorporate into any specialty, so I'd say make sure you got a representative exposure to heme/onc (outpatient clinics) and, assuming that, go with your heart. If you like primary care as well and don't have debt to speak of it sounds like you're not going to be able to make a bad call here and will end up doing well either way.