Leaving subspecialty after fellowship

[Terumo]

Hello everyone!

I am coming up on the final year of my cardiology fellowship and have recently had a lot of second thoughts about remaining in this field. My doubts come from many sources (realizing I like the subject more than the field, poor personality match, went into fellowship because I felt pressured to chase prestige/$ against my better judgement, realizing I hate most cardiology procedures, burnout from being in a very malignant though well-regarded program). I've done well in fellowship and plan to finish so as not to burn my bridges/screw over my co-fellows. That said, I'm wondering has anyone ever finished an IM subspecialty fellowship (esp competitive inpatient heavy such has cardiology/GI) and then gone back to hospital medicine/primary care afterwards? While this might just be my burnout talking, the thought of going straight into cardiology practice post fellowship just fills me with absolute dread, and I've found myself soft-pedaling my job search as a result. I actually was a hospitalist prior to fellowship and have a good idea of the pros/cons, and am well aware that leaving cardiology at this point will make it quite difficult to return to the field. Financial cost to this decision is not an issue, fortunately.

I'm also aware that I've had a great opportunity to train in this field that I might be throwing away, and all I can say is that recent difficult life events have dramatically changed my perspective on medicine in recent years. If I could go back in time I would have never done any fellowship at all (maybe palliative). Obviously this is a personal decision I need to make for myself, but I would love to hear from anyone who's ever been in similar shoes.



Thank you in advance!

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[Bobblehead]

Don't take a job right away?

Work some locum for a while perhaps while getting your cardiology boards done. You'll be more employable in case you change your mind.

You can always do a mix of IM and cards practice eventually and find somewhere that needs a cardiologist that won't require more than reading EKGs and echos for procedures.

 

[dozitgetchahi]

Hello everyone!

I am coming up on the final year of my cardiology fellowship and have recently had a lot of second thoughts about remaining in this field. My doubts come from many sources (realizing I like the subject more than the field, poor personality match, went into fellowship because I felt pressured to chase prestige/$ against my better judgement, realizing I hate most cardiology procedures, burnout from being in a very malignant though well-regarded program). I've done well in fellowship and plan to finish so as not to burn my bridges/screw over my co-fellows. That said, I'm wondering has anyone ever finished an IM subspecialty fellowship (esp competitive inpatient heavy such has cardiology/GI) and then gone back to hospital medicine/primary care afterwards? While this might just be my burnout talking, the thought of going straight into cardiology practice post fellowship just fills me with absolute dread, and I've found myself soft-pedaling my job search as a result. I actually was a hospitalist prior to fellowship and have a good idea of the pros/cons, and am well aware that leaving cardiology at this point will make it quite difficult to return to the field. Financial cost to this decision is not an issue, fortunately.

I'm also aware that I've had a great opportunity to train in this field that I might be throwing away, and all I can say is that recent difficult life events have dramatically changed my perspective on medicine in recent years. If I could go back in time I would have never done any fellowship at all (maybe palliative). Obviously this is a personal decision I need to make for myself, but I would love to hear from anyone who's ever been in similar shoes.



Thank you in advance!

Lots of people bail out of nephrology and become hospitalists. That said - remember that training doesn’t necessarily reflect the reality of day to day practice in a given specialty. For instance, my rheumatology fellowship was really hardcore-we did lots and lots of inpatient time and had huge censuses when we rounded, and we were expected to do tons of research and other academic crap too - and by the end I felt rather burned out. Now that I’m out, however, I work a purely outpatient private practice job that I really love. There is so much BS in training, and you are asked to do so much stupid **** that attending doctors in real life don’t have to deal with. When you get out, you may be able to set up a much more pleasant life for yourself.

 

[IMGASMD]

I think it can be very location dependent too. If you end up in a smaller town, you can be the town doctor and cardiologist. Worked at a small hospital before, the guy pretty much choose whatever procedure he wants to do. No interventional cath, no problem. Only reads TTE or EKG. If there are NOTHING you like to do within cards, then it’s a different story. Like the other poster said, private practice is very different than academic medicine. You CAN pick and choose things that YOU want to do or comfortable to be doing.
Also are you really looking forward to general medicine? You’re out of practice foe 3 if not more years.

 

[dozitgetchahi]

Which reiterates what I’ve always said: residency and fellowship are, by-and-large,
a scam. The further I get along in training the more I realized how utterly useless most of my day to day is and how it isn’t reflective of what my life will actually be like.

There’s some truth to this - but also a lot of what I learned in fellowship was very useful.

For instance: my rheumatology fellowship really emphasized rare, exotic, bizarre disease and weird presentations of common disease (this was a “name brand” institution we all would recognize). But when I got out, I found I was actually underprepared for the bread and butter - I basically had to teach myself an approach to RA and psoriatic arthritis etc, which is the bulk of what I see any given day! Nevertheless, I learned that fairly quickly and do that very well-but because I saw so much vasculitis and unusual scleroderma and dermatomyositis etc I’m able to handle all of that too. So it all worked out.

But I still think they could have changed the fellowship to be a bit more useful to the general rheumatologist.

I also think that way too much of GME consists of doing pointless scut work and other things to make attendings’ lives easier. I didn’t have to deal with that much of it as a resident, but my fellowship featured a surprising amount of scut work that in retrospect was a complete waste of time. Now, my office staff always does the secretarial things (chasing old records, faxing, scheduling patients, calling patients to bug them to do their labs, etc) that my fellowship attendings thought was so important to have the fellows doing all the time. Really underscores how much of GME is just being cheap labor for other people.

 

[Kaustikos]

Hello everyone!

I am coming up on the final year of my cardiology fellowship and have recently had a lot of second thoughts about remaining in this field. My doubts come from many sources (realizing I like the subject more than the field, poor personality match, went into fellowship because I felt pressured to chase prestige/$ against my better judgement, realizing I hate most cardiology procedures, burnout from being in a very malignant though well-regarded program). I've done well in fellowship and plan to finish so as not to burn my bridges/screw over my co-fellows. That said, I'm wondering has anyone ever finished an IM subspecialty fellowship (esp competitive inpatient heavy such has cardiology/GI) and then gone back to hospital medicine/primary care afterwards? While this might just be my burnout talking, the thought of going straight into cardiology practice post fellowship just fills me with absolute dread, and I've found myself soft-pedaling my job search as a result. I actually was a hospitalist prior to fellowship and have a good idea of the pros/cons, and am well aware that leaving cardiology at this point will make it quite difficult to return to the field. Financial cost to this decision is not an issue, fortunately.

I'm also aware that I've had a great opportunity to train in this field that I might be throwing away, and all I can say is that recent difficult life events have dramatically changed my perspective on medicine in recent years. If I could go back in time I would have never done any fellowship at all (maybe palliative). Obviously this is a personal decision I need to make for myself, but I would love to hear from anyone who's ever been in similar shoes.



Thank you in advance!

Yes, you can. Someone mentioned you can do Locums for Hospitalist while getting ready for boards and see how it's like or be full time Hospitalist. Nice thing is their schedule tends to be two weeks out of the month. The other nice thing is your background in Cardiology will make your life easier inpatient as you'll have an easier time dealing with patients.
Similar to ID world; working as a hospitalist means you can deal with most infections and not have to wait/call ID for most of them.
So, if you're not sure, definitely try Hospitalist and see how it works.
Also, It's better to get the Fellowship over with early on than not do it and regret it. So, you're definitely doing the smart thing finishing it.

 

[nik1990s]

a few cardiologists I know do mostly outpatient while occasionally covering the inpatient service for a few weeks. If you don't enjoy the inpatient component, you can likely find a place where you will do mostly outpatient/preventative cards

 

[dazedundco]

If you don't mind working as a primary care doctor, what deters you from doing outpatient cards? less headache.

 

[NITRAS]

Also, I know a few cardiologists who padded their patient panel with lots of PCP stuff.

 

[cards67]

Certainly there are specialist who've gone back to gen med, haven't heard that for cardiologists though. But I know a few, especially older PP guys, who are their patients pcp and I've heard some do pcp work because there's just not enough cardiac business. But I'd have to question what your issue with cardiology is and how you think hospitalist/pcp will solve it? I agree with others that training was nothing like real world practice. I'm not talking about just the scut stuff either, but gen cards can often be heavily outpatient (which isn't emphasized in fellowship) w/ lots of bread and butter stuff and longitudinal care. It's hard to tell if your feelings are more about your training program than cardiology itself.

 

[deleted980918]

Most of the PP cardiology practice in NYC and LI area do IM/PCP

 

[collegestud2013]

Hello everyone!

I am coming up on the final year of my cardiology fellowship and have recently had a lot of second thoughts about remaining in this field. My doubts come from many sources (realizing I like the subject more than the field, poor personality match, went into fellowship because I felt pressured to chase prestige/$ against my better judgement, realizing I hate most cardiology procedures, burnout from being in a very malignant though well-regarded program). I've done well in fellowship and plan to finish so as not to burn my bridges/screw over my co-fellows. That said, I'm wondering has anyone ever finished an IM subspecialty fellowship (esp competitive inpatient heavy such has cardiology/GI) and then gone back to hospital medicine/primary care afterwards? While this might just be my burnout talking, the thought of going straight into cardiology practice post fellowship just fills me with absolute dread, and I've found myself soft-pedaling my job search as a result. I actually was a hospitalist prior to fellowship and have a good idea of the pros/cons, and am well aware that leaving cardiology at this point will make it quite difficult to return to the field. Financial cost to this decision is not an issue, fortunately.

I'm also aware that I've had a great opportunity to train in this field that I might be throwing away, and all I can say is that recent difficult life events have dramatically changed my perspective on medicine in recent years. If I could go back in time I would have never done any fellowship at all (maybe palliative). Obviously this is a personal decision I need to make for myself, but I would love to hear from anyone who's ever been in similar shoes.



Thank you in advance!

As others have said it seems the main issue might be your fellowship program (which you think is malignant) and not all of cardiology. If you can find the job within cardiology that fits your lifestyle and interests within cardiology you don't have to leave cardiology altogether. For example if you like inpatient work you can be a cardiology hospitalist and not have to deal with the challenges that come with running an outpatient practice. If you like outpatient work you can be 100% outpatient. You'll probably still get paid more per hour doing cardiology work than general IM so you if you value work-life balance you could make similar to a IM hospitalist while working less hours.

Sure you can go back to being a general IM hospitalist or PCP but it shouldn't be your fulltime role after having done a cardiology fellowship; the only potential exception to this is if you're geographically restricted and can't find a suitable cardiology job within your geographic area but can find a primary care or hospitalist job. If you were a hospitalist previously and doing something inpatient heavy like cardiology going back to hospitalist shouldn't be an issue; if you wanted to to primary care and haven't done it since residency that may be harder to pick back up but still obviously doable.

 

[timpview]

Cardiology sucks and you have every reason to regret your decision (especially if you don’t need the money). Though unless you’re 100% sure you will be happier as a Hospitslist or general IM than I would at least give it 2-3 more years as an attd before calling it quits.

Find an employed gig as a general cardiologist with a hospital system that doesn’t like to spend money or be productive (kaiser) in a big group where call is watered down (some can be less than q10) and you might find a job you can tolerate.

 

[Terumo]

Thanks to everyone for their replies! They've definitely given me some food for thought. I agree it's pretty hard to separate my thoughts about cardiology as a field versus my experience during fellowship as I don't really have direct experience outside of training. I had briefly considered taking a hiatus or locums work, though I can't say I know anyone who's done that immediately after finishing fellowship which makes me think it's somehow taboo. Overall I think I agree that it's better not to definitively leave the field until I've actually tried the real-world experience--and get some distance from my training. I'll have to chew on this for a bit, but I really appreciate everyone's perspective!

 

[Splenda88]

Cardiology sucks and you have every reason to regret your decision (especially if you don’t need the money). Though unless you’re 100% sure you will be happier as a Hospitslist or general IM than I would at least give it 2-3 more years as an attd before calling it quits.

Find an employed gig as a general cardiologist with a hospital system that doesn’t like to spend money or be productive (kaiser) in a big group where call is watered down (some can be less than q10) and you might find a job you can tolerate.

If someone is not going to do interventional, I dont think doing a cardiology fellowship worth it.

People are quick to consult cardio for anything...

 

[ROBINHO]

If you are considering primary care then you can do outpatient cardiologist.
If you are ok with hospitalist then look into cardiology hospitalist jobs.