Concerns before entering fellowship, any help would be appreciated

[JerseyDoc]

Hello all,

My current situation has left me in a real predicament and has been torturing me the past few months. I'm currently in my last year of Internal Medicine residency, and scheduled to start a Pulm/CC fellowship at my home institution this upcoming July. I enjoyed my CCM rotations 1st and 2nd year, and always thought about going into that field, but never applied for the fellowship...the plan was to be a medicine hospitalist or maybe go to the outpatient setting and do primary care.

After the match, the Pulm/CCM dept approached me about a fellowship spot to start as early as this July. I grappled over it for a few weeks to a month, and ultimately took the position. I figured CCM would allow me to practice Internal Medicine on steroids, without having to deal with all the social BS, less arguments with the ED regarding admissions etc, while Pulmonary would provide me an escape from the hospital and regular hours.

Since that time unfortunately all I have been doing is going back and forth regarding my decision to take the spot. Many have stated that there is not much demand for Pulmonary outpatient and my life will end up being primarily in the ICU, which sounds horrible. Too stressful, and I fear it will give me less time with my family. I'm not worried about the fellowship itself (actually a fairly relaxed fellowship since there are 9 fellows total), but more so about my schedule and lifestyle after fellowship. It has driven me crazy, I havent been able to focus at work, and also havent been able to fully enjoy my time off at home with my family. My poor wife has had to hear about my indecisions every day for the last 2+ months.

What are everyone's thoughts? Would it be possible to work primarily Pulmonary outpatient, or does that not even exist? I would be open to combining that with IM Primary Care if needed. If that's what I end up doing, I'm not sure a 3 year fellowship is worth it.

CONS for going through fellowship:

-Potential for having very limited outpatient work, forced to do much more inpatient than I expected

-Potentially worse lifestyle

-Higher stress job

-3 more years as a trainee when I could have been an attending


PROS for going through fellowship :

-Much more pure medicine, much less of the social issues/scut work of IM

-Higher income potential

-Not a horrible schedule during fellowship

-Even if I dont end up practicing Pulm/CCM, I will have additional certifications that I would think make me more competitive for IM hospitalist or even outpatient jobs. It also gives me flexibility later in life incase I'm not happy in Internal Medicine or things get worse for generalists.

My question to all of you, if I do ultimately decide to not go through with my plans for fellowship, what would be the best way to do it? It was a spot created for myself - they had funding for the spot, but for whatever reason, were prepared to let that spot go unfilled. In other words, its not like I stole that spot from someone through the match. I've been a strong resident, and well liked by everyone throughout the institution. It would kill me if my lasting impression before leaving residency is of someone so indecisive and screwing over a fellowship program.

Everyone's thoughts will be very much appreciated, thank you so much in advance.

---

Members don't see this ad.

 

[Hernandez]

CONS for going through fellowship:

-Potential for having very limited outpatient work, forced to do much more inpatient than I expected

-Potentially worse lifestyle

-Higher stress job

-3 more years as a trainee when I could have been an attending

Whoever told to that out pt pulm isn't in much demand is WRONG. The problems I saw is I wanted a nice mix of in-pt/out pt and many places are looking for either/or. There is plenty of opportunities to set up a pulm-cc training and go into any type of practice you want.

Only worse lifestyle if you set it up as such.

Then don't so CC as primary, only as consultant

Lets say that I expect my loss of income from fellowship to pay for itself in less than 2 years.

 

[bigkahunaburger]

"Many have stated that there is not much demand for Pulmonary outpatient and my life will end up being primarily in the ICU, which sounds horrible."

Hey genius, the fellowship is pulm/CRITICAL CARE, what did you think this career entailed? To me this career is what medicine is about, thinking through pathophysiology to save lives, if you don't like it move on and become a hospitalist.

 

[Hernandez]

"Many have stated that there is not much demand for Pulmonary outpatient and my life will end up being primarily in the ICU, which sounds horrible."

Hey genius, the fellowship is pulm/CRITICAL CARE, what did you think this career entailed? To me this career is what medicine is about, thinking through pathophysiology to save lives, if you don't like it move on and become a hospitalist.

 

[bronx43]

"Many have stated that there is not much demand for Pulmonary outpatient and my life will end up being primarily in the ICU, which sounds horrible."

Hey genius, the fellowship is pulm/CRITICAL CARE, what did you think this career entailed? To me this career is what medicine is about, thinking through pathophysiology to save lives, if you don't like it move on and become a hospitalist.

Hey genius, the fellowship is pulm/critical care, not pulm/CRITICAL CARE. The OP said he didn't want his life to be "primarily in the ICU," which is totally understandable even if you love the critical care aspect. Most attendings I know start out CC heavy but taper into an outpatient heavy ratio later on in their careers.

 

[Bostonredsox]

Hey geniuses'......there are still pure CC and pure pulm fellowships around. Not many. But there their. If you really hate CC, take a 1 year pulm slot. Might be you to get a job though. Most grps take ICU call for the local hospital if you want bronch privileges in tht hospital.v my advice, unless your pure CC bound, and to some extent even in that regard, do the pulm/CC 3 years and look for a job in a big grp of 10+ docs. Your ICU responsibilities will be much less frequent in a bigger grp.

 

[Hernandez]

If you really hate CC, take a 1 year pulm slot.

They have those?

 

[dotcb]

You don't sound that into either pulm or CC. 3 years is a lot of time to be working hard, (temporarily) losing income, and doing things you're not into.

Talk to pulmonologists, your family, and weigh it over.

If you're not that into it, do medicine for 1-2 years and see if you're happy or want something more.

 

[VentdependenT]

They have those?

Hell if I know. I would rather do a 1yr sleep fellowship.

 

[Hernandez]

Hell if I know. I would rather do a 1yr sleep fellowship.

They don't have 1 year pulm fellowships. Sleep? God, might as well prescribe me Provigil now.

 

[Bostonredsox]

They don't have 1 year pulm fellowships. Sleep? God, might as well prescribe me Provigil now.

Yeah was my mistake, the pure pulm fellowships are 2 years and the CC year is the third year. However you can only do that single year of CC after or combined with the 2 years of pulm or after another fellowship (cards, GI, etc). What I meant to say was there are a few (21 per FREIDA search) pure pulmonary fellowships out there. But the job market i presume is smaller. most groups probably have a certain % of local MICU coverage responsibility and I am sure they want all the partners to be able to split this time, cept maybe the senior most who have 'retired' from being a part of the MICU rotation.

21 Pulm fellowships.....20-25 CC fellowships.....130+ pulm/cc fellowships...see what they are getting at..

And Vent I just noticed your signature...did you do a full gas residency and then come back and do 2 years of IM before starting this pulm/cc fellowship? Your criizazy man. I should have gone gas4+CC1. that would have been my ticket to happiness in retrospect.

 

[VentdependenT]

Happiness depends on your state of mind, not your job bro. But doing what you want in terms of a job is helpful! yes I did 3.8 gas, 3yr IM, now 3 pulm/cc. Yes I am crazy.

 

[Bostonredsox]

Happiness depends on your state of mind, not your job bro. But doing what you want in terms of a job is helpful! yes I did 3.8 gas, 3yr IM, now 3 pulm/cc. Yes I am crazy.

3 IM? You didnt have enough MICU and cardio months to make up for atleast 6 months of IM? Thats the shaft

 

[bigkahunaburger]

haha yeah I was little over the top with my post, I was a little hammered from st patty celebrations. And this f'ing 20degree weather is getting old, definitely can't fault someone for not wanting to be pinned down in the ICU for the majority of their career.

 

[ihearttriangles]

Happiness depends on your state of mind, not your job bro. But doing what you want in terms of a job is helpful! yes I did 3.8 gas, 3yr IM, now 3 pulm/cc. Yes I am crazy.

Noob question but, how exactly does one do 3.8 years of something?

 

[tartesos]

Happiness depends on your state of mind, not your job bro. But doing what you want in terms of a job is helpful! yes I did 3.8 gas, 3yr IM, now 3 pulm/cc. Yes I am crazy.

Cool bro!!
And I thought I had it bad!
Makes me glad to see in not alone!
( 3 y Im, 2 y ID and I'm starting Pulm/Ccm July 1st).
I'm not alone!! I'll show this to my wife! Lol

 

[tartesos]

Hello all,

My current situation has left me in a real predicament and has been torturing me the past few months. I'm currently in my last year of Internal Medicine residency, and scheduled to start a Pulm/CC fellowship at my home institution this upcoming July. I enjoyed my CCM rotations 1st and 2nd year, and always thought about going into that field, but never applied for the fellowship...the plan was to be a medicine hospitalist or maybe go to the outpatient setting and do primary care.

After the match, the Pulm/CCM dept approached me about a fellowship spot to start as early as this July. I grappled over it for a few weeks to a month, and ultimately took the position. I figured CCM would allow me to practice Internal Medicine on steroids, without having to deal with all the social BS, less arguments with the ED regarding admissions etc, while Pulmonary would provide me an escape from the hospital and regular hours.

Since that time unfortunately all I have been doing is going back and forth regarding my decision to take the spot. Many have stated that there is not much demand for Pulmonary outpatient and my life will end up being primarily in the ICU, which sounds horrible. Too stressful, and I fear it will give me less time with my family. I'm not worried about the fellowship itself (actually a fairly relaxed fellowship since there are 9 fellows total), but more so about my schedule and lifestyle after fellowship. It has driven me crazy, I havent been able to focus at work, and also havent been able to fully enjoy my time off at home with my family. My poor wife has had to hear about my indecisions every day for the last 2+ months.

What are everyone's thoughts? Would it be possible to work primarily Pulmonary outpatient, or does that not even exist? I would be open to combining that with IM Primary Care if needed. If that's what I end up doing, I'm not sure a 3 year fellowship is worth it.

CONS for going through fellowship:

-Potential for having very limited outpatient work, forced to do much more inpatient than I expected

-Potentially worse lifestyle

-Higher stress job

-3 more years as a trainee when I could have been an attending


PROS for going through fellowship :

-Much more pure medicine, much less of the social issues/scut work of IM

-Higher income potential

-Not a horrible schedule during fellowship

-Even if I dont end up practicing Pulm/CCM, I will have additional certifications that I would think make me more competitive for IM hospitalist or even outpatient jobs. It also gives me flexibility later in life incase I'm not happy in Internal Medicine or things get worse for generalists.

My question to all of you, if I do ultimately decide to not go through with my plans for fellowship, what would be the best way to do it? It was a spot created for myself - they had funding for the spot, but for whatever reason, were prepared to let that spot go unfilled. In other words, its not like I stole that spot from someone through the match. I've been a strong resident, and well liked by everyone throughout the institution. It would kill me if my lasting impression before leaving residency is of someone so indecisive and screwing over a fellowship program.

Everyone's thoughts will be very much appreciated, thank you so much in advance.

If you are going in for the wrong reasons you will be miserable no matter what, so think about it.
If you like Pulm/Ccm, I'm pretty sure you will find the right balance for you wherever you go look for a job. ( sown groups have people that like more icu than op clinics etc) or you can sell yourself 70 op 30 ip from the start.
I would love to give you my clinic time for icu time if we were on the same group and there are many people like me.

Forget about money, about your family or programs expectations for a moment, be selfish and think about what you want and will make you happy... 3 y is a lot of time to loose if you are not convinced this is what YOU want.
Forget about a job, its a high demand field and will still be by the time you finish.

Think about it long and hard, some alcohol while you are at it might help as well( it does to me!).

Good luck!

 

[slippers82]

JerseyDoc, good luck with your decision! Trust your instincts. Don't do something you were "forced" into doing, especially if you're not 100% set on it. PCCM fellowship will be very demanding and life afterwards doesn't get much easier either.

Ironically enough, I just received an email today from my IM PD today about a PCCM first-year fellow spot that just opened up and the program is looking to fill it ASAP. Coincidence? I think not.

As for me, I didn't think I was quite ready just yet to enter fellowship (money wise, family, research, etc.) right after IM graduation. So I'm actually taking the year "off" to make bank as a hospitalist, travel, do research, pay off loans, upgrade a few things, and apply to PCCM programs. I'm pretty stoked and happy about my decision. Other pulm fellows I've talked to who also took the year "off" to work/travel/play were very happy too.

Best of luck with your decision! Hope to meet some of you out there on the interview trail, too

 

[t2013]

JerseyDoc,

I feel bad for you because I am in a somewhat similar situation except a year behind you and without the job offer. I have become involved with and made several contacts with my residency's pulm/ccm group, who have expressed interest in me staying on. Now I feel bad because I am getting cold feet about doing pulm/ccm straight out of residency. I too have gone back and forth and again about trying the hospitalist and/or outpatient PC life for a while to see what I could be missing out on, as there is such a vast amount of practice options, most of them different from your typical academic center. I have driven my wife crazy and have also lost some sleep and ability to enjoy my time off thinking about it. I felt like if I were to do pulm/ccm I may as well apply ASAP and start it sooner rather than later to get it over with and then move on and practice. In the end, I decided to not let this pressure get to me and I am going to do the hospitalist gig for a while to better understand the business of medicine and also give me time to see what will happen with Obamacare and other changes coming down the pipeline.

My advice to you is have an honest conversation with the people that offered you the position and seek to delay or decline it. They cannot fault you if you are honest and explain to them why you need more time to be sure of what you are getting in to. It sounds from your post that you do not feel that enthusiastic about doing pulm/ccm, at least for now, otherwise you wouldn't be having such a hard time with the decision. If you truly loved pulmonary more than the other options at your disposal I think you would not be going through what you are going through.

I have felt enormous peace in deciding to delay applying and take the time to better understand what I will be getting myself into with pulm/ccm. The truth is pulmonary isn't that competitive as evidenced by the fact that they had to offer you a position (as has been the case elsewhere) after the match. You can always return. I suggest strongly you consider delaying this fellowship until you are more aware of what a long term future in pulm is like, are more educated and emotionally ready, and do not have the same anxiety you are now experiencing.

I hope this helps, good luck with whatever decision you make. The good news is that no matter what the decision is you will always have a great job in great demand, which is not the case for other docs.