Might Have Chosen Wrong Fellowship…advice please

[anon628917]

Hi everyone,

I recently started a medicine subspeciality fellowship in a fairly competitive field at a highly regarded institution in a major city. During residency, I was torn between applying for fellowship in this field and another field (ID). Ultimately, I thought I made the right choice in applying for the field I’m in (did some research, did electives when I could, thought there was decent enough overlap with some ID, etc).

A month into fellowship and unfortunately I’m starting to feel like I chose incorrectly. I know it’s extremely early but I want to have a sense of what my options are.

At this point, I can’t tell if I’m just unhappy because of the transition from resident to fellow, the VERY high expectations (in terms of knowledge/management) and decreased support as compared to my prior experiences, not really having much advanced knowledge of the field OR if I really just don’t like the field itself, finding it not as interesting as I thought it would be, and finding I don’t appreciate certain aspects in practice that I thought I would. For the record, I have always been a high-performing medical student and resident (based on board scores, clinical grades, evaluations, and I was also selected to be a chief resident) so I could see this new experience of feeling so challenged being unusual for me, but at the same time, I do think I’m a resilient person and I do think I have a decent fund of knowledge commensurate with my training level. It’s simply too early to tell and I recognize that.

My options as I see it are to complete the fellowship and then either apply to ID or practice as a generalist OR leave fellowship after a year (full stop, I would never leave in the middle of the year, and intend on being a hardworking, motivated fellow until the day I were to potentially leave).

I know leaving after a year would (understandably) close off any chances of applying to ID- why would another fellowship take a chance on me when I left another fellowship after a year. This is unfortunate but I understand the rationale and it’s the price I have to pay for quitting. But would this be an impediment to getting a job as a generalist? The problem is I do really like my institution and so I stayed for fellowship at the same place I did my residency, so I don’t have the luxury of “going back” to where I did my residency. The Internal medicine department where I am a “known” entity and have a good reputation as a reliable, hardworking, competent Medicine resident is at the same institution where I’d now be the fellow who left training (and invariably screwed over my PD and cofellows, which will be a great source of guilt and embarrassment to me). I’m geographically limited to the city I’m in now, but the other hospitals in this city are as well-regarded (or more) as my current institution or else they’re community hospitals with less than stellar reputations for how they are to work in. However, again, I know I can’t be choosy because of potentially quitting fellowship, but the bottom line is, I would hope to be able to stay in the same city as a generalist.

The other option would be to eke it out for three years and then apply to ID (not ideal; that’s another 5 years total of house staff salary, and I come from quite modest means so this would indeed be difficult financially) or apply then to a generalist job.

Would really appreciate any advice or words of wisdom. I’ve always done my very best to do my due diligence in making decisions about my career- I have never chased prestige or money; I’m truly just trying to have a career I’ll be happy with- and I never thought I’d be in the position I am now. Thank you for your time to anyone reading.

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[MD46]

Maybe some one from ID could switch with you at your local institution? If they are not happy with ID

 

[IMGASMD]

What do YOU want?! At some point you don’t have five years to waste. I am sure some will advocate for you to stay for a few more months before you make your final decision.

On the other hand, if you’re at your home institution, shouldn’t you know the expectation before entering?! There’s any other thread about a cardiology fellow who hates his fellowship, but he’s already a second or even a third year.

I “may” stay for an year, if they let me in ID next year. If you have good relationship with your PD, maybe they can pull some strings. This kind of stuff happens.

How competitive is ID, these days? Was it all filled this year? If not, maybe reach out to other places?

TBH, you’re done. You “can” have a career the day you finished IM residency. You do have some leverage and “prestige” only count for very very little of your happiness in the grand scheme of things. If you hate your fellowship, you’re only wasting more time on your earning years.

 

[anon628917]

What do YOU want?! At some point you don’t have five years to waste. I am sure some will advocate for you to stay for a few more months before you make your final decision.

On the other hand, if you’re at your home institution, shouldn’t you know the expectation before entering?! There’s any other thread about a cardiology fellow who hates his fellowship, but he’s already a second or even a third year.

I “may” stay for an year, if they let me in ID next year. If you have good relationship with your PD, maybe they can pull some strings. This kind of stuff happens.

How competitive is ID, these days? Was it all filled this year? If not, maybe reach out to other places?

TBH, you’re done. You “can” have a career the day you finished IM residency. You do have some leverage and “prestige” only count for very very little of your happiness in the grand scheme of things. If you hate your fellowship, you’re only wasting more time on your earning years.

Thanks for your reply!

I guess my question (which I realized was not clear) is whether leaving fellowship after a year (again, I will finish the first year no matter what to minimize the disruption to my program) would “blacklist” me from getting a job as a generalist. I’d like to pursue ID fellowship but I think that’s not in the cards (and again, I understand why- a program shouldn’t be expected to give someone like me a second chance when there are others who haven’t even had a first chance). I don’t mind what kind of hospital I work at in terms of “prestige” or reputation, I just would prefer not to be relegated to choosing a very undesirable job (in terms of working conditions, not “prestige” of the institution) as a generalist, and am wondering what my odds are of being able to get an okay job as a generalist.
You make excellent points and I appreciate your time

 

[gutonc]

Thanks for your reply!

I guess my question (which I realized was not clear) is whether leaving fellowship after a year (again, I will finish the first year no matter what to minimize the disruption to my program) would “blacklist” me from getting a job as a generalist. I’d like to pursue ID fellowship but I think that’s not in the cards (and again, I understand why- a program shouldn’t be expected to give someone like me a second chance when there are others who haven’t even had a first chance). I don’t mind what kind of hospital I work at in terms of “prestige” or reputation, I just would prefer not to be relegated to choosing a very undesirable job (in terms of working conditions, not “prestige” of the institution) as a generalist, and am wondering what my odds are of being able to get an okay job as a generalist.
You make excellent points and I appreciate your time

Deciding that specialty X isn't right for you won't blacklist you in the medicine world. Maybe in the surgery world, but we're generally nicer over here.

ID is not at all competitive so you're likely to find a program in next year's match without difficulty. You'll need to explain your change of heart in your PS, but that's really easy. Similarly, if you decide to bail on a subspecialty altogether and go into PC or hospitalist medicine, literally nobody will care. They'll just be stoked to have you.

Finally, you may just be struggling with the dramatic shift in expectations from first day of residency (nobody expects you to know which end of the stethoscope goes in your ears) to the first day of fellowship (you're getting hammer paged by the ER and surgery and medicine, all of whom expect you to be the expert and have an answer for them in 15 seconds), which is totally normal. That said, if you don't see yourself practicing this specialty (which is obviously Cards, GI, Hem-Onc or PCCM) in 20 years, get out now.

 

[IMGASMD]

Op, you’ve gotten three responses so far. Noticed, noone counted you out for ID, if that’s what you want.

I went as far as, you may be able to change now, rather than later. I think it’s nice that you would stay for the year.

Maybe stay put for a few more weeks, after all it’s only the 3rd week of your fellowship. If you still feel it’s a mistake, talk to your IM PD, talk to your fellowship director. I’ve dealt with a few PDs in my career, all of them were very supportive. They all understand change of hearts, they all understand once in a while someone or something can and will disrupt schedule. They understand you have to make the best choices for yourself…. You should too. You’re the one who will have to live with all your decisions, no one else. Good luck.

 

[NonNocere]

I'm not sure if I fully understand. I don't think there is any risk of being blacklisted as a generalist if you leave a fellowship. You can always apply into the fellowship you prefer. Why don't you gently test the waters with your superiors without making any decisions yet.

 

[rokshana]

ID is not going to be hard to get… they go unfilled at a high percentage every year.
And if your current fellowship is that competitive ( I suspect pccm) then trust me there is someone chomping at the bit to take your spot… if you truly feel that your current fellowship is not what you want, tell your pd and serve out your 45 days… they will be able to find someone who will take your spot now.

 

[mszzeta]

Hi everyone,

I recently started a medicine subspeciality fellowship in a fairly competitive field at a highly regarded institution in a major city. During residency, I was torn between applying for fellowship in this field and another field (ID). Ultimately, I thought I made the right choice in applying for the field I’m in (did some research, did electives when I could, thought there was decent enough overlap with some ID, etc).

A month into fellowship and unfortunately I’m starting to feel like I chose incorrectly. I know it’s extremely early but I want to have a sense of what my options are.

At this point, I can’t tell if I’m just unhappy because of the transition from resident to fellow, the VERY high expectations (in terms of knowledge/management) and decreased support as compared to my prior experiences, not really having much advanced knowledge of the field OR if I really just don’t like the field itself, finding it not as interesting as I thought it would be, and finding I don’t appreciate certain aspects in practice that I thought I would. For the record, I have always been a high-performing medical student and resident (based on board scores, clinical grades, evaluations, and I was also selected to be a chief resident) so I could see this new experience of feeling so challenged being unusual for me, but at the same time, I do think I’m a resilient person and I do think I have a decent fund of knowledge commensurate with my training level. It’s simply too early to tell and I recognize that.

My options as I see it are to complete the fellowship and then either apply to ID or practice as a generalist OR leave fellowship after a year (full stop, I would never leave in the middle of the year, and intend on being a hardworking, motivated fellow until the day I were to potentially leave).

I know leaving after a year would (understandably) close off any chances of applying to ID- why would another fellowship take a chance on me when I left another fellowship after a year. This is unfortunate but I understand the rationale and it’s the price I have to pay for quitting. But would this be an impediment to getting a job as a generalist? The problem is I do really like my institution and so I stayed for fellowship at the same place I did my residency, so I don’t have the luxury of “going back” to where I did my residency. The Internal medicine department where I am a “known” entity and have a good reputation as a reliable, hardworking, competent Medicine resident is at the same institution where I’d now be the fellow who left training (and invariably screwed over my PD and cofellows, which will be a great source of guilt and embarrassment to me). I’m geographically limited to the city I’m in now, but the other hospitals in this city are as well-regarded (or more) as my current institution or else they’re community hospitals with less than stellar reputations for how they are to work in. However, again, I know I can’t be choosy because of potentially quitting fellowship, but the bottom line is, I would hope to be able to stay in the same city as a generalist.

The other option would be to eke it out for three years and then apply to ID (not ideal; that’s another 5 years total of house staff salary, and I come from quite modest means so this would indeed be difficult financially) or apply then to a generalist job.

Would really appreciate any advice or words of wisdom. I’ve always done my very best to do my due diligence in making decisions about my career- I have never chased prestige or money; I’m truly just trying to have a career I’ll be happy with- and I never thought I’d be in the position I am now. Thank you for your time to anyone reading.

Matching into ID is very easy and should be a walk for you even if you quit your fellowship at any time.

If you think your current specialty/fellowship is not good for you, how do you know ID would be better. Each specialty has really boring staff (ID consult for all common bacterial infection in surgery patients, etc).

There is a completely understandable steep learning curve in most subspecialty training. You will feel much more confident about patient care next year, especially given that you have been a productive learner. If you feel that you are given an unrealistically high expectation in patient care in your first month of fellowship, it is the problem of your program, not a problem from you. It should not be a reason for you to hate your subspecialty choice

 

[Kaustikos]

Deciding that specialty X isn't right for you won't blacklist you in the medicine world. Maybe in the surgery world, but we're generally nicer over here.

ID is not at all competitive so you're likely to find a program in next year's match without difficulty. You'll need to explain your change of heart in your PS, but that's really easy. Similarly, if you decide to bail on a subspecialty altogether and go into PC or hospitalist medicine, literally nobody will care. They'll just be stoked to have you.

Finally, you may just be struggling with the dramatic shift in expectations from first day of residency (nobody expects you to know which end of the stethoscope goes in your ears) to the first day of fellowship (you're getting hammer paged by the ER and surgery and medicine, all of whom expect you to be the expert and have an answer for them in 15 seconds), which is totally normal. That said, if you don't see yourself practicing this specialty (which is obviously Cards, GI, Hem-Onc or PCCM) in 20 years, get out now.

If it's actually CCM, saying you want to go into ID instead should be a breeze. Alternatively, OP should've considered ID/Crit.

I'm not sure if I fully understand. I don't think there is any risk of being blacklisted as a generalist if you leave a fellowship. You can always apply into the fellowship you prefer. Why don't you gently test the waters with your superiors without making any decisions yet.

ID is not going to be hard to get… they go unfilled at a high percentage every year.
And if your current fellowship is that competitive ( I suspect pccm) then trust me there is someone chomping at the bit to take your spot… if you truly feel that your current fellowship is not what you want, tell your pd and serve out your 45 days… they will be able to find someone who will take your spot now.

That used to be the norm. It's changed in the past couple years. I'm not saying ID is competitive but don't apply thinking "this won't be difficult, they need me". You should be able to get in if you have a good reasons why.
Regarding the last bit - if it's PCCM...I'd just stick it out. Or if it's just CCM, it's only 2 years.

Matching into ID is very easy and should be a walk for you even if you quit your fellowship at any time.

If you think your current specialty/fellowship is not good for you, how do you know ID would be better. Each specialty has really boring staff (ID consult for all common bacterial infection in surgery patients, etc).

There is a completely understandable steep learning curve in most subspecialty training. You will feel much more confident about patient care next year, especially given that you have been a productive learner. If you feel that you are given an unrealistically high expectation in patient care in your first month of fellowship, it is the problem of your program, not a problem from you. It should not be a reason for you to hate your subspecialty choice

Realistically, it depends on your limitations on where you can go. Also, whether you want to go to a prestigious fellowship or the three year program with research.

Some things to consider about ID -
As stated above; there are a LOT of boring consults. There are a lot of annoying consults. But every specialty deals with that.
Second - it's a very busy service. Don't think you're going to go in and just breeze through.
Third - Infection Control and Stewardship are part of your lifestyle. Be ready for constant pages about isolation protocols for XYZ (Especially COVID and Monkeypox). Stewardship isn't as bad but you'll have to deal with basically asking why X person is using this antibiotic for so long or what they're treating.
Fourth - it's a busy service and lower pay than a hospitalist on average. ID is actually busier than a hospitalist.

But the pros far outweigh that. But...I'm a little biased. If there's one thing I've learned from myself and other colleagues is that there's almost zero change you'll be going to a malignant/toxic program where people take advantage of you.

 

[Kaustikos]

Hi everyone,

I recently started a medicine subspeciality fellowship in a fairly competitive field at a highly regarded institution in a major city. During residency, I was torn between applying for fellowship in this field and another field (ID). Ultimately, I thought I made the right choice in applying for the field I’m in (did some research, did electives when I could, thought there was decent enough overlap with some ID, etc).

A month into fellowship and unfortunately I’m starting to feel like I chose incorrectly. I know it’s extremely early but I want to have a sense of what my options are.

At this point, I can’t tell if I’m just unhappy because of the transition from resident to fellow, the VERY high expectations (in terms of knowledge/management) and decreased support as compared to my prior experiences, not really having much advanced knowledge of the field OR if I really just don’t like the field itself, finding it not as interesting as I thought it would be, and finding I don’t appreciate certain aspects in practice that I thought I would. For the record, I have always been a high-performing medical student and resident (based on board scores, clinical grades, evaluations, and I was also selected to be a chief resident) so I could see this new experience of feeling so challenged being unusual for me, but at the same time, I do think I’m a resilient person and I do think I have a decent fund of knowledge commensurate with my training level. It’s simply too early to tell and I recognize that.

My options as I see it are to complete the fellowship and then either apply to ID or practice as a generalist OR leave fellowship after a year (full stop, I would never leave in the middle of the year, and intend on being a hardworking, motivated fellow until the day I were to potentially leave).

I know leaving after a year would (understandably) close off any chances of applying to ID- why would another fellowship take a chance on me when I left another fellowship after a year. This is unfortunate but I understand the rationale and it’s the price I have to pay for quitting. But would this be an impediment to getting a job as a generalist? The problem is I do really like my institution and so I stayed for fellowship at the same place I did my residency, so I don’t have the luxury of “going back” to where I did my residency. The Internal medicine department where I am a “known” entity and have a good reputation as a reliable, hardworking, competent Medicine resident is at the same institution where I’d now be the fellow who left training (and invariably screwed over my PD and cofellows, which will be a great source of guilt and embarrassment to me). I’m geographically limited to the city I’m in now, but the other hospitals in this city are as well-regarded (or more) as my current institution or else they’re community hospitals with less than stellar reputations for how they are to work in. However, again, I know I can’t be choosy because of potentially quitting fellowship, but the bottom line is, I would hope to be able to stay in the same city as a generalist.

The other option would be to eke it out for three years and then apply to ID (not ideal; that’s another 5 years total of house staff salary, and I come from quite modest means so this would indeed be difficult financially) or apply then to a generalist job.

Would really appreciate any advice or words of wisdom. I’ve always done my very best to do my due diligence in making decisions about my career- I have never chased prestige or money; I’m truly just trying to have a career I’ll be happy with- and I never thought I’d be in the position I am now. Thank you for your time to anyone reading.

If what everyone is saying is true and this is critical care; you're not alone. I have colleagues from my residency program who are in the same boat. They love it but they were scared and felt like idiots and everything. Even the fellows at my hospital say the same thing about how stressful the first few months are.

But, ID isn't much different. Some programs will throw you in on service for the first few months and you are going to be BUSY. And you'll feel nervous, incompetent and worried. Again, this changes as time passes. They don't expect you to be expert at ID. The Attendings want you to be more than comfortable going into a career in ID. But I feel that most other programs feel the same (Except for apparently Nephrology).

But the other benefit is being ID means you're competent not just in ID but also Dermatology, Addiction Medicine. And it makes being prepared for board exam WAY easier. Especially since a lot of the exam is ID.

But, I echo the sentiment that other's have said and keep on going and see how things are in 6 months. And good for you for stickcing with it for a year and not bailing on the program mid-way. Some people have done that (even in ID) and it's REALLY annoying and also disrespectful to your colleagues.

 

[rokshana]

That used to be the norm. It's changed in the past couple years. I'm not saying ID is competitive but don't apply thinking "this won't be difficult, they need me". You should be able to get in if you have a good reasons why.
Regarding the last bit - if it's PCCM...I'd just stick it out. Or if it's just CCM, it's only 2 years.

however that is not what the nrmp match data say...

Despite Pandemic Spotlight, Infectious Disease Not a Sought-After Specialty

Specialty has long struggled to fill fellowship training positions

www.medpagetoday.com

or even what ISDA says

ID Fellowship Match

ID Fellowship Match; Medical Specialties Matching Program;

www.idsociety.org

yes a slight uptick to 82%, and certainly not nephrology...but a person that was competitive for a competitive fellowship like say, PCCM, if they explain their change of heart and interest in ID, probably should not have too much of an issue in getting into an ID fellowship...will it be a competitive place? eh....but it's realistic that he will get something if he applies broadly and isn't too picky.

 

[Kaustikos]

however that is not what the norm match data say...

Despite Pandemic Spotlight, Infectious Disease Not a Sought-After Specialty

Specialty has long struggled to fill fellowship training positions

www.medpagetoday.com

or even what ISDA says

ID Fellowship Match

ID Fellowship Match; Medical Specialties Matching Program;

www.idsociety.org

yes a slight uptick to 82%, and certainly not nephrology...but a person that was competitive for a competitive fellowship like say, PCCM, if they explain their change of heart and interest in ID, probably should not have too much of an issue in getting into an ID fellowship...will it be a competitive place? eh....but it's realistic that he will get something if he applies broadly and isn't too picky.

I agree. I was just trying to clarify we are matching better than before.
And I agree 30000%; someone coming from critical care will DEFINITELY be competitive and not have an issue. You just have to say why you like it and I'd think someone saying "I liked critical care but only when I dealt with infections" would definitely sell well.
But, again, being restricted to a certain region can make it a bit difficult.

So, I'm not disagreeing that much.

 

[Kaustikos]

OP - come join us nerds. ID ftw!

 

[Prehealth1011]

I just got off ID. Overheard the attending talking to my fellow if they should be taking this applicant. Candidate had not done an IM residency and they were trying to figure out how his rotations were in his country based on his CV. I guess the plan is to do an IM residency after the fellowship? Is that even a thing

Not competitive. Don’t worry

 

[IMGASMD]

I just got off ID. Overheard the attending talking to my fellow if they should be taking this applicant. Candidate had not done an IM residency and they were trying to figure out how his rotations were in his country based on his CV. I guess the plan is to do an IM residency after the fellowship? Is that even a thing

Not competitive. Don’t worry

Fellowship first, ask questions later.

 

[Kaustikos]

I just got off ID. Overheard the attending talking to my fellow if they should be taking this applicant. Candidate had not done an IM residency and they were trying to figure out how his rotations were in his country based on his CV. I guess the plan is to do an IM residency after the fellowship? Is that even a thing

Not competitive. Don’t worry

Those programs are few. And they usually have to be so impressed with your resume/CV/experience that you're REALLY grasping at straws. Not sure why.

 

[Blue_sky_endo]

You should do what you love. Only live once.

That said, the beginning of fellowship is so hard. I remember people who had been doctors 4 times longer than me calling me in the middle of the night for advice. Our own department faculty had to constantly recalibrate expectations of new fellows, which just made me feel wildly inferior. There is so much you don't know you don't know until it is your job to know it. Okay to keep an idea in the back of your head of what else you want to be, but I was so burned out by the end of med school I thought a bike valet sounded like more fun that going on to residency (which is actually possibly true). Then you just escape residency and you're briefly on top of the world, and then you're suddenly a different brand of intern. It gets so much better after the first year.

 

[Gastrapathy]

It’s hard to give advice without knowing the field you’re in now.

 

[berenjena89]

Hi everyone,

I recently started a medicine subspeciality fellowship in a fairly competitive field at a highly regarded institution in a major city. During residency, I was torn between applying for fellowship in this field and another field (ID). Ultimately, I thought I made the right choice in applying for the field I’m in (did some research, did electives when I could, thought there was decent enough overlap with some ID, etc).

A month into fellowship and unfortunately I’m starting to feel like I chose incorrectly. I know it’s extremely early but I want to have a sense of what my options are.

At this point, I can’t tell if I’m just unhappy because of the transition from resident to fellow, the VERY high expectations (in terms of knowledge/management) and decreased support as compared to my prior experiences, not really having much advanced knowledge of the field OR if I really just don’t like the field itself, finding it not as interesting as I thought it would be, and finding I don’t appreciate certain aspects in practice that I thought I would. For the record, I have always been a high-performing medical student and resident (based on board scores, clinical grades, evaluations, and I was also selected to be a chief resident) so I could see this new experience of feeling so challenged being unusual for me, but at the same time, I do think I’m a resilient person and I do think I have a decent fund of knowledge commensurate with my training level. It’s simply too early to tell and I recognize that.

My options as I see it are to complete the fellowship and then either apply to ID or practice as a generalist OR leave fellowship after a year (full stop, I would never leave in the middle of the year, and intend on being a hardworking, motivated fellow until the day I were to potentially leave).

I know leaving after a year would (understandably) close off any chances of applying to ID- why would another fellowship take a chance on me when I left another fellowship after a year. This is unfortunate but I understand the rationale and it’s the price I have to pay for quitting. But would this be an impediment to getting a job as a generalist? The problem is I do really like my institution and so I stayed for fellowship at the same place I did my residency, so I don’t have the luxury of “going back” to where I did my residency. The Internal medicine department where I am a “known” entity and have a good reputation as a reliable, hardworking, competent Medicine resident is at the same institution where I’d now be the fellow who left training (and invariably screwed over my PD and cofellows, which will be a great source of guilt and embarrassment to me). I’m geographically limited to the city I’m in now, but the other hospitals in this city are as well-regarded (or more) as my current institution or else they’re community hospitals with less than stellar reputations for how they are to work in. However, again, I know I can’t be choosy because of potentially quitting fellowship, but the bottom line is, I would hope to be able to stay in the same city as a generalist.

The other option would be to eke it out for three years and then apply to ID (not ideal; that’s another 5 years total of house staff salary, and I come from quite modest means so this would indeed be difficult financially) or apply then to a generalist job.

Would really appreciate any advice or words of wisdom. I’ve always done my very best to do my due diligence in making decisions about my career- I have never chased prestige or money; I’m truly just trying to have a career I’ll be happy with- and I never thought I’d be in the position I am now. Thank you for your time to anyone reading.

Do what you hate the least. I did a fellowship but I realized did not like much, I just did it because it was a “lifestyle” specialty so I would have more time to spend doing my hobbies. and I hated it during my fellowship. I was always thinking on quitting but I decided to finish. Now as an attending I feel miserable

 

[AlbinoHawk DO]

Stop overthinking it. Quit at the 6 month mark and get a job for the next 6 months. These places don't care about you. Apply to ID. You will get in because they are desperate for bodies at some places even if it is for a month

 

[IMGASMD]

Do what you hate the least. I did a fellowship but I realized did not like much, I just did it because it was a “lifestyle” specialty so I would have more time to spend doing my hobbies. and I hated it during my fellowship. I was always thinking on quitting but I decided to finish. Now as an attending I feel miserable

The ending, took me by surprise.

 

[rokshana]

The ending, took me by surprise.

Not me…saw that coming…

 

[hotsaws]

It might be helpful if you just disclosed what field you're currently in.

The beginning of fellowship was hard and intimidating for me. I was a high performing med student and resident (high scores, AOA, intern of the year, etc etc) and was very comfortable as an IM resident (ie nights, ICU, codes, procedures, etc.) and was generally respected by attendings, colleagues, nursing and other staff. I am not trying to brag or sound douchey but just trying to give some perspective because when I started fellowship, I felt uncomfortable and out of my element. Fellowship was in A/I, btw. Fellowship started and now about 50% of my patients were pediatrics and a good portion of them are pediatric immuno which are generally complex kids with thick charts by the time they are a few months old. Immuno itself, both clinical and basic science, was dense and complex and I felt like a second year med student studying while also trying to be a fellow working. The knowledge expectations of a fellow are high from both A/I faculty and people calling consults. Like suddenly we are expected to be experts in the field. For me, it was a lot easier to know "alot" of internal medicine than it was to try and master the intricacies of a single field. Then came all the academic stuff -- constantly reading primary literature and then being expected to discuss it at a very high level, giving presentations to in house faculty and other departments, trying to develop research plans, etc. Fortunately, A/I clinically has a good lifestyle but fellowship is not a cakewalk with all the other stuff piled on top of it. I also really enjoy and appreciate my field. Very happy in practice so far and I find what I do very fulfilling. Lots of impostor syndrome during fellowship.

Anyways, you have to be happy but I think a couple months into fellowship is a bit early to pull the plug. If you do leave, you should give your PD plenty of notice. This way they have options for replacing you. They may choose to recruit an extra fellow for the incoming year to compensate the loss or something along those lines. You should also really consider what it's like to actually practice in your current field and not just fellowship stuff...same with ID. Plenty of students and trainees don't consider the long term reality of working in their field. I have lots of friends that went into various specialties for the wrong reasons only to find themselves unhappy as attendings. There are lots of factors such as lifestyle, money, job market, type of patients you see, practice setting, etc. that can all have a significant impact on your happiness. These can outweigh the love for a particular field. Not to mention the actual day to day practice of a field can be quite different than what is experienced in fellowship, especially if you are going into private practice or some super specific niche in academics.

 

[JP2740]

You can do a lot of “negative” things before ID is off the table. There’s a reason it’s so uncompetitive (is that a word?)