hospitalist vs fellowship - pls weigh in

[lipstikisntfood]

Long-story short: I'm a 2nd yr IM resident in the throes of indecision. I have applied for and received several interview invites for one of the less competitive and less well-paying but, in my opinion, more interesting specialties. However, I have a lot of ambivalence re: going forward on the fellowship track rather than just getting a hospitalist job right out of residency (don't think I can stomach primary care for a variety of reasons).

Fellowship pros:
- really interesting medicine
- ultimately a more sustainable lifestyle than hospitalist (I think)
- money isn't everything

Fellowship cons / hospitalist pros
- my family could really use more $, and fellowship means 2 more years of student loan debt accumulating like nobody's business
- 7 on / 7 off isn't really a bad lifestyle, even if you work like a maniac while you're on
- SO SICK of being a trainee - ready to make bad and good decisions on my own!

At this point, I feel like I should just interview everywhere I'm invited in case I regret the missed fellowship opportunity later. But my list of cons is starting to seem more and more like it outweighs the pros.

Is there something I'm missing? Any insights from the crowd? Weigh in and help a girl out, PLEASE! Serious replies greatly appreciated.

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[jdh71]

Long-story short: I'm a 2nd yr IM resident in the throes of indecision. I have applied for and received several interview invites for one of the less competitive and less well-paying but, in my opinion, more interesting specialties. However, I have a lot of ambivalence re: going forward on the fellowship track rather than just getting a hospitalist job right out of residency (don't think I can stomach primary care for a variety of reasons).

Fellowship pros:
- really interesting medicine
- ultimately a more sustainable lifestyle than hospitalist (I think)
- money isn't everything

Fellowship cons / hospitalist pros
- my family could really use more $, and fellowship means 2 more years of student loan debt accumulating like nobody's business
- 7 on / 7 off isn't really a bad lifestyle, even if you work like a maniac while you're on
- SO SICK of being a trainee - ready to make bad and good decisions on my own!

At this point, I feel like I should just interview everywhere I'm invited in case I regret the missed fellowship opportunity later. But my list of cons is starting to seem more and more like it outweighs the pros.

Is there something I'm missing? Any insights from the crowd? Weigh in and help a girl out, PLEASE! Serious replies greatly appreciated.

How important is job satisfaction for you? Because most hospitalists don't have it Money is good and time off is nice so they keep doing it, but most don't care for it too much. All the stuff that annoys you about medicine wards as a resident hasn't gone away, only now the buck stops with you . . . so I think with the right gig - right hospitalist group, right location, right patient population, good social workers at the right hospital - you could probably make a decent go of it, might even like it, but it's beginning to look more and more like that is the exception not the rule, especially for more desirable markets, like the coastal cities everyone loves to much.

A subspecialty will likely allow you to tailor your practice much more effectively and if you're smart for at least the same amount of (base) money and less hours.

Going from hospitalist deciding you don't like it, to applying for a fellowship is preferable than doing a fellowship and then deciding you don't like it and going back to hospitalist medicine.

While this is kind of a crapy thing to do, you could always scrap the application for this year. Apply as a third year, so that way you could work as a hospitalist for a year, and if you don't like it, simply not show up to fellowship. This would screw you for the NRMP for the forseable future and the program that you matched into, so you'd need to make sure you KNEW, but at least you'd have the experience to make an informed decision.

 

[WorkaholicsAnon]

Let me give you this piece of advice.

It's ok to be undecided. It's also ok to not segue right into fellowship after residency. Not only is it "ok", I highly recommend it! Take a break, introspect, try a bunch of different settings.

I feel like for a lot of us, it's been a nonstop route from grade school through to the end of residency. It was never "ok" to just take time off, chill, think...it was always go go go. This was in fact the expectation. It was also always about being evaluated, judged, worrying about competition. I also feel that because of this, it's hard for residents to know the reality of how attending life is in various settings outside of academia. I remember even when i rotated through a private primary care practice as a resident, there was always the stress of wondering whether I was being useful or whether i slowed things down, or how the logistics functioned at that particular office. When you are in charge of your own practice, that stress is not there. You can set things up however you want to.

It's been more than a year since I've been out of residency. I too was very undecided on what path i wanted to take with my training, up to my very last day of residency and in the subsequent months even. Not because nothing sounded good, but because i like mostly everything in clinical medicine (with the exception of onc and perhaps CCM for emotional reasons, even though I the material). I also like research, which did ultimately help me make my decision, but that's beside the point.

So, the past year or so i've been doing research and moonlighting. It allowed me to take a step back, reflect. Gave me some flexibility to study for boards (there was of course the increased pressure to pass them the first time around if I was going to apply for fellowship), and to pursue some extracurricular interests i'd been putting off for the past few years, become a normal, healthy, well rested, relaxed person again.

Being a hospitalist is indeed a whole new world (and yes maybe i just ended up at a good place), but i've found it much much more collaborative and friendly than residency was. My shifts are always very very busy though (I do the new admissions from the ED and new consults on the floors) and i could see myself getting burnt out doing that every single day (I dont get weeks off at a time though because I still have my day job, so the vacation time could potentially make up for it). When I'm on though, I enjoy it a lot. I do have the fun part of the job though and I dont need to deal with the dispo issues so that could change some perspectives.

since I want to keep research as part of my career (this was a realization that my year off has solidified for me), a fellowship is really the only way to do it (a career as a hospitalist or primary care physician really does not have room for bench research, which is my preference). I still like most areas of internal medicine, so essentially I ended up choosing a relatively multidisciplinary, analytical field for fellowship (endocrine), which I very much enjoyed as a resident and in which i have a specific research interest.

Anyway, to make my original point, there is no race to the finish line. Take your time making your decision about how you want to build your career. There are so many possibilities in our field, so many different sorts of lifestyles, so many combinations, there is a niche for everyone and there is always a way to make your career what you want it to be, at least I think so.

 

[drbhooks]

I am a third year resident and I was in your shoes last year. In order to decide, you are going to have to take a step back and do some reflective thinking and soul searching. I agree with the other posters that you have time and you don't have to jump into anything right now. I was indecisive about whether to do hospitalist medicine or fellowship. I was interested in competitive fellowship at my institution (cardiology or pulmonary/critical care) however I wanted to branch out and apply outside of my institution and I didn't think I would have a strong shot since my resume is not the strongest (not a lot of research or publications). Also my husband lives and works in another state. I decided not to apply to fellowship this year and do an academic or private hospitalist position for 2-3 years. For me, it provides me with the opportunity to become established in an area I wanted to settle down in and start a family.

It was a tough situation but like you, I was tired of being a trainee. I also wanted to be out on my own and see what it was like. Academic hospitalist positions do not pay as well but I am interested in hospitalist medicine because it is multifaceted: you have the ability to teach (which I love), do research, and clinical work. I am also interested in obtaining my MPH as well.

As I am doing my electives this year, I am enjoying doing some of the subspecialities and I might consider to do endocrinology instead of cardio or pulmonary/critical care medicine. I think being a hospitalist will allow me to decide what I am interested in and give me more time to decide my career path or goals.

There is no rush to decide on fellowship; many of the fellows I work with were out in practice for awhile and then decided to go into fellowship. I think it is a wise move. I think sometimes our ideas of what a particular subspecialty will be like is different than it appears so I think it is good to obtain some perspective and experience under your belt before you make that decision. Furthermore with the current economic situation, I would like to pay off some of my loans and be in a more stable position financially before I start fellowship (buy a house, pay off debt, etc).

Good luck...whatever decision you make will be the right one. Besides you always have the right to change your mind. Life is about options and what you enjoy and makes you happy.

 

[cgk]

I am a third year resident and I was in your shoes last year. In order to decide, you are going to have to take a step back and do some reflective thinking and soul searching. I agree with the other posters that you have time and you don't have to jump into anything right now. I was indecisive about whether to do hospitalist medicine or fellowship. I was interested in competitive fellowship at my institution (cardiology or pulmonary/critical care) however I wanted to branch out and apply outside of my institution and I didn't think I would have a strong shot since my resume is not the strongest (not a lot of research or publications). Also my husband lives and works in another state. I decided not to apply to fellowship this year and do an academic or private hospitalist position for 2-3 years. For me, it provides me with the opportunity to become established in an area I wanted to settle down in and start a family.

It was a tough situation but like you, I was tired of being a trainee. I also wanted to be out on my own and see what it was like. Academic hospitalist positions do not pay as well but I am interested in hospitalist medicine because it is multifaceted: you have the ability to teach (which I love), do research, and clinical work. I am also interested in obtaining my MPH as well.

As I am doing my electives this year, I am enjoying doing some of the subspecialities and I might consider to do endocrinology instead of cardio or pulmonary/critical care medicine. I think being a hospitalist will allow me to decide what I am interested in and give me more time to decide my career path or goals.

There is no rush to decide on fellowship; many of the fellows I work with were out in practice for awhile and then decided to go into fellowship. I think it is a wise move. I think sometimes our ideas of what a particular subspecialty will be like is different than it appears so I think it is good to obtain some perspective and experience under your belt before you make that decision. Furthermore with the current economic situation, I would like to pay off some of my loans and be in a more stable position financially before I start fellowship (buy a house, pay off debt, etc).

Good luck...whatever decision you make will be the right one. Besides you always have the right to change your mind. Life is about options and what you enjoy and makes you happy.

Doesn't the liklihood of matching into a competitve fellowship diminish the further out from the completion of your IM residency you wait to apply?

 

[docscience]

Doesn't the liklihood of matching into a competitve fellowship diminish the further out from the completion of your IM residency you wait to apply?

bump

 

[gutonc]

Doesn't the liklihood of matching into a competitve fellowship diminish the further out from the completion of your IM residency you wait to apply?

Sort of, sometimes, kinda, maybe...or not.

A year or two probably won't make a huge difference for an otherwise solid applicant. Longer than that can make things tougher.

Cards would be much harder than Pulm/CC (which while becoming more popular is still not very competitive) unless one spent some time doing research during that period of time.

 

[Ouloplastics]

Sort of, sometimes, kinda, maybe...or not.

A year or two probably won't make a huge difference for an otherwise solid applicant. Longer than that can make things tougher.

Cards would be much harder than Pulm/CC (which while becoming more popular is still not very competitive) unless one spent some time doing research during that period of time.

I agree with the above poster. PCCM actually easier to get if you are a hospitalist for 2-3 years with ICU exposure in a semi-academic to academic hospital as many hospitalists cover ICU as fulltime attending

 

[mig26x]

Im a Hospitalist in a 7on/7off schedule and I couldnt have asked for anything better. Not everyone wants to do fellowship and not everyone wants to stay as an internist (including hospitalist in that category).

I decided for hospitalist for a couple of reasons: I wanted to own the patient, I wanted to call the last shots (doesnt happen 100% of the time), I couldnt resist the temptation of education for another 2-3 years.

You have to look deep inside and see what you want. We cannot decide for you. I had my reasons not to pursue fellowship but at the same time I liked the idea of been a hospitalist therefore my desicion was a pretty easy one.

Sit down, think about it. Only you and your significant other (if there's one) can make that desicion.

 

[tartesos]

im currently a PGY-3 on a busy community hospital... i had( and still do) the same doubts...
after a lot of thinking, grieving and debate with my fiance, i decided to go for fellowship, if it came through( im an IMG, from a community hospital, so odds were against me, my only "plus" was not needing a visa, no research and only 1 case report published) i would do it immediately, and started looking for jobs at the same time just in case...
in the end, i definitely wanted to do a felowship... i got my position in ID( not $$ making nor competitive but it is what i wanted), and i am now happy and worried about things to come, 2 more years of training and hard work, sacrifices and no money= debt, and i keep getting wonderful offers that make my jaw drop for the amount of money....
in the end it is just what you want and is best for you, and what are your goals.
i love what ill do, but sometimes i wonder what if i couldve taken a year off to rest and make some payments...

 

[chubbykid]

im currently a PGY-3 on a busy community hospital... i had( and still do) the same doubts...
after a lot of thinking, grieving and debate with my fiance, i decided to go for fellowship, if it came through( im an IMG, from a community hospital, so odds were against me, my only "plus" was not needing a visa, no research and only 1 case report published) i would do it immediately, and started looking for jobs at the same time just in case...
in the end, i definitely wanted to do a felowship... i got my position in ID( not $$ making nor competitive but it is what i wanted), and i am now happy and worried about things to come, 2 more years of training and hard work, sacrifices and no money= debt, and i keep getting wonderful offers that make my jaw drop for the amount of money....

what's like the average and maximum salaries you've been offered? i hope it's something i can look forward to as i'm just starting residency.

 

[Ouloplastics]

im currently a PGY-3 on a busy community hospital... i had( and still do) the same doubts...
after a lot of thinking, grieving and debate with my fiance, i decided to go for fellowship, if it came through( im an IMG, from a community hospital, so odds were against me, my only "plus" was not needing a visa, no research and only 1 case report published) i would do it immediately, and started looking for jobs at the same time just in case...
in the end, i definitely wanted to do a felowship... i got my position in ID( not $$ making nor competitive but it is what i wanted), and i am now happy and worried about things to come, 2 more years of training and hard work, sacrifices and no money= debt, and i keep getting wonderful offers that make my jaw drop for the amount of money....
in the end it is just what you want and is best for you, and what are your goals.
i love what ill do, but sometimes i wonder what if i couldve taken a year off to rest and make some payments...

I have read in many reports ID earn less than hospitalists unless you have a NIH grant or so.

 

[Ouloplastics]

what's like the average and maximum salaries you've been offered? i hope it's something i can look forward to as i'm just starting residency.

I am an hospitalist for 4 years, want to go back to fellowship, I am an IMG. I might go back to PCCM. the average salary for hospitalist after 4 years of experience is $225K

 

[jdh71]

PCCM actually easier to get if you are a hospitalist for 2-3 years with ICU exposure in a semi-academic to academic hospital as many hospitalists cover ICU as fulltime attending

This is simply not true.

 

[LennonMcCartney]

Hey guys, I'm an IMG and PGY-1 at a community hospital. I am torn between fellowship and primary care as well. I love GI/Cards but don't love the idea of busting it to obtain one of those fellowships. So I am left with deciding between Geriatrics and Primary care, both of which are fields I love as well.

Would doing Geriatrics offer me any increase in Pay to that of a PCP? Does one even need to do a Geriatrics fellowship to to actually practice Geriatric medicine?

I am being offered a chance to get myself into a top university Geriatrics program when residency is finished if i choose to accept it. My questions is this, is doing Geriatrics even worth doing as a fellowship?

 

[staup]

This is simply not true.

I would say that it could, possibly, if you went to an academic place and did research/projects at the same time, but it will not increase your chances just by showing up at an academic hospital, and definitely not at a run of the mill community hospital.

I am currently a hospitalist and I would advise those considering a hospitalist career to examine it carefully. There are tons of jobs out there, and they are all different. There are jobs in rural community hospitals where the pay may be very high and you are basically the doc for everything (admissions, codes, icu) to dayfloaters/nightfloat positions where you basically only admit and crosscover to academic places where you only run and precept resident teams to everything in between. The term "hospitalist" is a misnomer if you are assuming all positions are the same.

I think it can be a rewarding career at the right job. You have to know yourself and what you want out of your career. If you are just looking for the highest paying job out of residency, it probably won't be a good one, and you probably will burn out.

I must say the higher pay, basically no call and increased time off is very nice. It can be hell if you are doing something you don't want to do though as most jobs can get very busy.

 

[ZDoggMD]

I would say that it could, possibly, if you went to an academic place and did research/projects at the same time, but it will not increase your chances just by showing up at an academic hospital, and definitely not at a run of the mill community hospital.

I am currently a hospitalist and I would advise those considering a hospitalist career to examine it carefully. There are tons of jobs out there, and they are all different. There are jobs in rural community hospitals where the pay may be very high and you are basically the doc for everything (admissions, codes, icu) to dayfloaters/nightfloat positions where you basically only admit and crosscover to academic places where you only run and precept resident teams to everything in between. The term "hospitalist" is a misnomer if you are assuming all positions are the same.

I think it can be a rewarding career at the right job. You have to know yourself and what you want out of your career. If you are just looking for the highest paying job out of residency, it probably won't be a good one, and you probably will burn out.

I must say the higher pay, basically no call and increased time off is very nice. It can be hell if you are doing something you don't want to do though as most jobs can get very busy.

I couldn't agree with this advice more, the jobs are very different and the key is to finding the niche in hospital medicine that works for you. Otherwise, you end up making videos like this:

[YOUTUBE]jfieCuBrMyE[/YOUTUBE]

 

[staup]

funny. really enjoyed that.


One other thing I would say is that hospital medicine is now and the way of the future. There are a ton of community and a lot of good academic hospitals that don't have organized hospitalist divisions or sections yet, but they will, it's inevitable.

While there will always be terrible jobs out there, most places will have to evolve to minimize the attending scutwork on non teaching services. It just has to as the specialty gets more popular.

As a generalist, it offers the opportunity to get involved in research from many different angles, especially quality of care and patient safety which is very hot right now. And for those looking to bridge into admin work, as hospitalists get more and more involved with how the hospital actually runs, it offers an amazing transition possibility.

Finally, as I have seen mentioned on this board before, it may seem crazy to do a fellowship in hospital medicine (especially when residency is essentially mostly hospitalist training), but the specialty is wide open right now, with leadership positions being created everywhere. Experience matters immensely, but if you were looking for someone to head your division/section/group/whatever, would you want the guy with the same experience and no fellowship or the fellowship?

It's not the answer for everyone, but for those not sure on a specialty and shying away from primary care, it may be a decent one.

 

[tartesos]

what's like the average and maximum salaries you've been offered? i hope it's something i can look forward to as i'm just starting residency.

sorry i came in soooo late for this, but life is moving on and not gettin much time
the highest offer ive had has been 7on 7 off for 300K in the middle of nowhere in Kansas ( no oun intended).
if you are not geographically fixated on the east coast or a big big metro city, the avg salary you will get will be 200+( 240 in Mississippi and louisiana for example, plus production.)
and it all depends on how much are you willing to work, what you will be willing to do( ICU, vents? procedures? im confortable with all of those things, but some are not) and what type of practice you want( all i listed was for hospitalist).

hope that helps

 

[tartesos]

I have read in many reports ID earn less than hospitalists unless you have a NIH grant or so.

yes. they do make more money, but have a longer schedulle and more work/ responsibilities and less possibilities as OP to make money at the same time(IE: ID consults in a hospital and private practice, or 8-5 consults and private practice, own your own practice and do IM/ID same time... endless possibilities) in the end it all depends on how much you want to work and where you are( the farthest away from a big metro the better $) and what hospital you are in
some statistics are to plain to explain the whole picture as it is...

hope that helped you and you can ask me for

 

[tartesos]

that was very much funnier than placebo!!!
will intubate for food!!
ROFLMAO!!!

 

[tartesos]

Hey guys, I'm an IMG and PGY-1 at a community hospital. I am torn between fellowship and primary care as well. I love GI/Cards but don't love the idea of busting it to obtain one of those fellowships. So I am left with deciding between Geriatrics and Primary care, both of which are fields I love as well.

Would doing Geriatrics offer me any increase in Pay to that of a PCP? Does one even need to do a Geriatrics fellowship to to actually practice Geriatric medicine?

I am being offered a chance to get myself into a top university Geriatrics program when residency is finished if i choose to accept it. My questions is this, is doing Geriatrics even worth doing as a fellowship?

if you like geriatrics then yes!! it is totally worth doing it!
if you are doing it only for the money... not so good, you could spend that year of fellowship making money of finding what you really love.
as i have heard, as a geriatrician you can bill as an internist and geriatrician at the same time( if your patient is elder of course).
and you will be in high demand, every year as america gets older!!
but if it is only for the money, it will be a waste of time...

 

[Reductio]

Holy Crap! ZDoggMD is on the SDN!!!

 

[dragonfly99]

the only advice I have is that I think doing a hospitalist year will not help you for cards or GI, which are competitive. If you apply during 3rd year you can do 1 hospitalist year in between residency and fellowship, and it won't necessarily hurt you for all cards or GI programs. Some programs, I observed while on the interview trail, prefer a "fresh" graduate and may even view applications from 3rd year residents with some suspicion (thinking that if the applicants was any good, he would have matched to cards as a PGY2...I personally think it's dumb but that's the way it seemed). I think if you are this undecided, then it would be better to wait a year...you can still apply to most fellowships as a PGY3 and do fine. You don't want to end up committed to something you don't want to do. There are several people in my cards fellowship who did a year of hospitalist in between IM and cards fellowship, and they were able to do things like buy a car, save money, etc. and I feel like they have less financial stress than me.

I agree w/a lot of the comments above...there is a lot of variation from job to job in "hospitalist" jobs. I think you can expect to probably work harder than most residents in most IM programs do, but you will be earning way more money. The social and dispo issues, etc. will not go away. All the headaches from wards medicine will still be there.

 

[ZDoggMD]

Holy Crap! ZDoggMD is on the SDN!!!

Ha! This is the only place where I am even vaguely understood!

 

[Silent Cool]

hi all,

just a quick question about hospitalist/fellowship: do you know or have you heard of anyone who has worked as a hospitalist for a number of years and then gone back to do a fellowship?

thanx
sc

 

[Elixir86]

hi all,

just a quick question about hospitalist/fellowship: do you know or have you heard of anyone who has worked as a hospitalist for a number of years and then gone back to do a fellowship?

thanx
sc

Yes. ("number of years" = 10+)

 

[pagandoc]

guess I am biased as I am currently applying to fellowship after being out for 1 year. But I do agree that being out for the year did help me realize my interest lie in pulmonary and critical care with possibly interventional pulmonology. The private setting also made me realize I want my long term career to be in the academic setting. Again I agree with most who mentioned that a year in the community might help have a better view of what your priorities are. Hopefully in 2013 I'll be going back to fellowship.

 

[Silent Cool]

Yes. ("number of years" = 10+)

Hey Elixir,

What field die the person (or you) go into? Is there any bias against hospitalists who have practiced for, say, 5+ years vs. fresh grads? I'm thinking of perhaps working for 3-5 years after IM, and then going back and doing a fellowship. Are some subspecialties more or less open to this?

Thanks for your opinion.
sc

 

[Silent Cool]

guess I am biased as I am currently applying to fellowship after being out for 1 year. But I do agree that being out for the year did help me realize my interest lie in pulmonary and critical care with possibly interventional pulmonology. The private setting also made me realize I want my long term career to be in the academic setting. Again I agree with most who mentioned that a year in the community might help have a better view of what your priorities are. Hopefully in 2013 I'll be going back to fellowship.

Hey Pagan,

What about practicing for more than a year--would this be helpful or hurtful for an internist interested in fellowship?

thanx
sc

 

[jonmadden]

You can always lie to the program too and make up some financial or child issue as screwing yourself for life hardly seems worth it for them.

If youre a bad at thinking and selling a lie Im the king of fake excuses. PM me and I'll give you one you can use later of needed.

And dont take it for granted, many people are horrible at making excuses and you automatically know they are lying. Its an art I've mastered. Like hundreds for just being 5 minutes late to a meeting just to practice

 

[pagandoc]

Not sure if over all it's helpful to be honest, especially with the burn out. I guess the only advantage is that you become more financially secure prior to fellowship.

 

[caffeine37]

Does it matter if you work at a community vs academic place if you're planning on going back for fellowship?