Peace with not doing fellowship

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I'm about to start PGY2, and I'm still trying to come to terms with what I want to do with my life. It sort of is hitting me that I can't really put off making a decision any longer.

I really think I would be happy as a hospitalist. I like general medicine. I don't find procedures that interesting. I am having a hard time coming to terms with that decision though. I had originally planned on doing fellowship. I worked pretty hard as a medical student and did well, and I'm in a decent program where I have the opportunity to do any fellowship I could want. It is really hard to just "throw that away" if you will and become a hospitalist. It feels like I'd be wasting all that work and dedication.

Maybe it's really weird to think that way, I don't know.

The hospitalist pay and not having to put off living my life for another 3 years is pretty appealing.

Anyone go through similar feelings? What did you decide? Did you regret your decision?

Everyone I ask around here is like "you should do fellowship! Don't do hospitalist!" Including our hospitalist attendings...

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I thought @InvestingDoc had a helpful perspective:
I'm very happy with what I make but its all relative. I've found that the medscape average is pretty spot on for my location in Texas (Austin). The average in my neck of the woods seems to be about $260k. If you pick up extra calls or work a little harder than the average this is easily pushed above 300k. Some of my partners work many extra shifts and make over 400k/year. Many of my colleagues are directors at hospice groups or SNF's and bring in extra cash on the side. One person does expert witness on the side, another has a vitamin nutritional supplement business, another person owns a coffee shop, while another doc has a side business flipping houses. The 14 days off a month can lead to plenty of time for side gigs.

Before medical school I was installing air conditioning ducts and plumbing in houses making $6-7 an hour so my salary seems sweet as hell. It helps that I love general medicine and I actually enjoy the work. If I hated general medicine then my mind would definitely change.

Don't be a hospitalist just for the money. I've been with my current group about a year and have seen 5 people quit since joining who realized that hospital medicine is not for them and changed their mind to go back to fellowship. They were absolutely miserable every day at work and looked depressed. Seems like the pay was definitely not worth it for them. Trust me, dealing with dispo for homeless patients, patients who are 95 years old and want to have a hour long meeting to discuss goals of care, or administration texting you daily pushing for you to get patients out will wear you down if you don't love general medicine.
 
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If you are not passionate, definitely don't do rheum/ID/nephro just to do a fellowship.

Allergy is a sneaky one to think about if you like outpatient work.

You also do not have as much time off as you think.

The scourge of seven on/seven off

I think being a hospitalist is fine, but just make sure its what you want to do for the next 30-35 years, not just the next 5.
 
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Last year I had a slightly similar conundrum. Heavy onc background and interested in onc. However I also like GIM and hospitalist medicine, and I think I could make use of the schedule (I have an MBA so have thought about administrative stuff).


Ultimately (or at least 10-20 years from now) I think I'd regret being not being an oncologist more than not going the hospitalist route. Hence I am satisfied with my decision to apply for onc fellowship now.

A friend of mine in my year, on the other hand, has a phd in onc and molecular bio stuff and was all set for fellowship but is going full steam ahead for hospitalist/general internal medicine due to more robust interest in the field.

If you don't have anything that you'd regret doing more and like the hospitalist career, go for it.
 
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I think you should only consider fellowship if you have a strong interest in that field, if not and if you like hospitalist medicine, then it's not a bad gig. For hospitalist work, I know people who started off at $200k at an academic center in a very desirable city, up to $300k+ in less desirable areas. Throw moonlighting on top of that that and you can make a decent amount, keep expenses low and you can save a lot, pay off loans and maybe even retire early. It can be very flexible, you can find work pretty much anywhere you want, you can do part-time or move to outpatient medicine if you want to cut back. You can even do fellowship (at least the less competitive ones) a few years out if you wish.

You're not throwing anything away by not doing fellowship. Assuming you're coming from a good IM program with good training, you've already gained plenty and are pretty valuable already. I'm not sure where you're training, but sometimes those in the ivory tower (big name academic programs) can have a narrow and limited view of things in the "real world" or outside their bubble. There's big name programs where general medicine is more encouraged. I think it would be good to think about what you want out of your life/career, where you see yourself in 10+ years, whether it's being retired, doing medical missions, teaching, being a subspecialist, etc.
 
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Thanks for the advice! There are several fellowships I think I'd enjoy a lot, so it's not for lack of passion. There is the trade-off of another 3 years though. A lot to think about.
 
If you are not passionate, definitely don't do rheum/ID/nephro just to do a fellowship.

Allergy is a sneaky one to think about if you like outpatient work.

You also do not have as much time off as you think.

The scourge of seven on/seven off

I think being a hospitalist is fine, but just make sure its what you want to do for the next 30-35 years, not just the next 5.
Not sure why allergy is a "sneaky one to think about," but rheum is clustered with ID and neph. I had an open spot waiting for me in allergy at my home institution but picked rheumatology instead. The lifestyle and income potential is not much different but the job market and the growth of the field weighs HEAVILY in favor of rheumatology.

To OP, I agree with the rest of the people here. If you like GIM and can see yourself being a hospitalist for the next 30 years, do it. I think you would have a pretty good idea after 6 months of HM. I knew after 1 month that it wasn't for me. I'm more than happy with my fellowship decision. But, a lot of my hospitalist buddies wouldn't trade it for the world. If you end up hating hospital medicine, you can always apply to fellowship after 1 year. Most programs won't care if you took a gap year to be a hospitalist, since it's getting more and more popular of a route.
 
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Not sure why allergy is a "sneaky one to think about," but rheum is clustered with ID and neph. I had an open spot waiting for me in allergy at my home institution but picked rheumatology instead. The lifestyle and income potential is not much different but the job market and the growth of the field weighs HEAVILY in favor of rheumatology.

To OP, I agree with the rest of the people here. If you like GIM and can see yourself being a hospitalist for the next 30 years, do it. I think you would have a pretty good idea after 6 months of HM. I knew after 1 month that it wasn't for me. I'm more than happy with my fellowship decision. But, a lot of my hospitalist buddies wouldn't trade it for the world. If you end up hating hospital medicine, you can always apply to fellowship after 1 year. Most programs won't care if you took a gap year to be a hospitalist, since it's getting more and more popular of a route.

Ah good old Bronx, I see that you're still talking about allergy. I also thought about doing rheum vs allergy and I am SO GLAD I chose allergy. I don't know about MGMA standards for rheum, but I'm in the 50-75% percentile in terms of income for allergy, working 4 days a week in a decent size city. No inpatient call ever.

No regrets.
 
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Ah good old Bronx, I see that you're still talking about allergy. I also thought about doing rheum vs allergy and I am SO GLAD I chose allergy. I don't know about MGMA standards for rheum, but I'm in the 50-75% percentile in terms of income for allergy, working 4 days a week in a decent size city. No inpatient call ever.

No regrets.
That's great. Your point? I didn't bring up allergy. Just responded to a post. I'm saying the two fields are similar in lifestyle (outpt without call) and income ($250k coming out of fellowship with much higher potential once established). Difference is the job market for rheum, which will only improve with our severe workforce shortage. Our graduating fellows can basically close their eyes, point at the map, and get a job there.
 
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That's great. Your point? I didn't bring up allergy. Just responded to a post. I'm saying the two fields are similar in lifestyle (outpt without call) and income ($250k coming out of fellowship with much higher potential once established). Difference is the job market for rheum, which will only improve with our severe workforce shortage. Our graduating fellows can basically close their eyes, point at the map, and get a job there.

I agree the rheum market is better, but I got a job offer as well in any place I wanted to go to after fellowship; SF, southern Cal, Seattle, etc. The starting offers were variable (200k to 250k) but the potential income were similar; 300-500k+.

In the end, I chose an area where the wife/boss was happy (near her hometown).

To the original poster, I would only do a fellowship if you're interested in it. No reason to do a fellowship just because. I did it because I knew I had some interest in allergy and couldn't stand hospitalist or primary care.
 
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I agree the rheum market is better, but I got a job offer as well in any place I wanted to go to after fellowship; SF, southern Cal, Seattle, etc. The starting offers were variable (200k to 250k) but the potential income were similar; 300-500k+.

In the end, I chose an area where the wife/boss was happy (near her hometown).

To the original poster, I would only do a fellowship if you're interested in it. No reason to do a fellowship just because. I did it because I knew I had some interest in allergy and couldn't stand hospitalist or primary care.
Just out of curiosity, did you go with an employed position, single specialty, or multi specialty?
 
Just out of curiosity, did you go with an employed position, single specialty, or multi specialty?

Large multi-specialty group; sucked me in with the benefits and guaranteed income initially
 
It doesn't matter what you could do if you wanted - it matters that you do what you enjoy and are best at, the thing where you can make the impact you want to. Competitive fellowships are so because there are more than enough people who want to do them and chances are someone about as good as you would take the fellowship you might take, if you don't apply. But the world needs generalists and its not sure that someone as good as you will take that GIM spot if you don't. Bon courage.
 
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I agree the rheum market is better, but I got a job offer as well in any place I wanted to go to after fellowship; SF, southern Cal, Seattle, etc. The starting offers were variable (200k to 250k) but the potential income were similar; 300-500k+.

In the end, I chose an area where the wife/boss was happy (near her hometown).

To the original poster, I would only do a fellowship if you're interested in it. No reason to do a fellowship just because. I did it because I knew I had some interest in allergy and couldn't stand hospitalist or primary care.
I didn't know Rheum can make that much :wow:
 
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I bet most aren't making 500k unless they're hustling like crazy.
who knows. I heard stories of Hospitalists who bill for $1.2 Mil one year. legendary lol
 
I didn't know Rheum can make that much :wow:
I'm an allergist not a rheumatologist. Let me tell you young superstars out there, physicians like most people will not divulge how much they make. I don't know how much rheumatologists makes but most of my allergy private practice friends are making the top end of that and more. Academics is a whole another world. However, we're facing cuts and uncertainties in pay every year. We will see how it turns out in the next 3-5 years.
 
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who knows. I heard stories of Hospitalists who bill for $1.2 Mil one year. legendary lol

no idea how much he makes, but I rotated at a hospital where a hospitalist bragged about how he rounded on 50+ a day and hadn't taken a day off in three years. quantity > quality... he had nice watches :laugh:
 
I was in the exact same position as you a few years ago. I didn't want to put off my life for 3 more years, I wanted to be done. I decided to be a hospitalist, told everyone that's what I was going to do, convinced myself I would be happy. Until I started seeing all my friends apply for fellowship and go on interviews. Then the panic of what have I done set in. I realized I was kidding myself, and I didn't want to be a hospitalist. So I applied way late for fellowship that year and got a spot. I have never regretted it. After interacting with hospitalists as a consultant, I would quit medicine if I had to do that work. It's nice to be a consultant, answer a specific question, and sign off. If you like being a hospitalist, there's nothing wrong with not doing a fellowship, just make sure you're being honest with yourself. I definitely wasn't.
 
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no idea how much he makes, but I rotated at a hospital where a hospitalist bragged about how he rounded on 50+ a day and hadn't taken a day off in three years. quantity > quality... he had nice watches :laugh:
YEAH these guys always brag about seeing 60+ patients a day. A DAY/ please that's just bull**** lol. I bet they all cut corner and do some shady stuffs to squeeze in those 60 PLUS notes a day. Crazy greedy bastards lol
 
I'm an allergist not a rheumatologist. Let me tell you young superstars out there, physicians like most people will not divulge how much they make. I don't know how much rheumatologists makes but most of my allergy private practice friends are making the top end of that and more. Academics is a whole another world. However, we're facing cuts and uncertainties in pay every year. We will see how it turns out in the next 3-5 years.
OH that makes more sense. I did hear about Allergist make lots of money with cush lifestyle. Not Rheum. Maybe the supply and demand law applies here. And I see way more Rheum fellowship spots then Allergy fellowship spots.
 
Rheum is actually getting more competitive and people are easily signing for 250-270K for 36 hours work schedules!

And last year Rheum had only like 4-5 spots left from match
 
OH that makes more sense. I did hear about Allergist make lots of money with cush lifestyle. Not Rheum. Maybe the supply and demand law applies here. And I see way more Rheum fellowship spots then Allergy fellowship spots.
Huh? You do realize that rheumatology has a significantly better job market than AI and that supply and demand is actually very much in favor of rheum? Not only are we predicting a mass retirement exodus of older rheumatologists, but we have seen one of the lowest increases in fellowship spots in the past 5 years compared to other specialties. Furthermore, the reason there are more rheumatology fellowship spots than allergy is due to the fact that we are basically sports medicine lite as well as anything autoimmune. You can easily fill up your schedule with 30 OA/tendonitis/CTS/bursitis patients a day, and not even see a single SLE or vasculitis patient.
 
no idea how much he makes, but I rotated at a hospital where a hospitalist bragged about how he rounded on 50+ a day and hadn't taken a day off in three years. quantity > quality... he had nice watches :laugh:
So, basically he's a terrible doctor. The problem with hospital medicine is that it's one of the few specialties where you really should NOT chase volume, because you're supposed to oversee a patient's entire hospitalization. Sure, you can pan-consult, but each subspecialist is only seeing their own part of the problem, and if something slips through the cracks, there can be bad outcomes. When I was a hospitalist, I did not feel comfortable when my census exceeded 16-17, because no matter how good you think you are, you just can't provide the same care to 20 patients as you can to 15.
 
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OH that makes more sense. I did hear about Allergist make lots of money with cush lifestyle. Not Rheum. Maybe the supply and demand law applies here. And I see way more Rheum fellowship spots then Allergy fellowship spots.

I can tell you from an allergy perspective, I get a significant amount of my income on allergy shot serum renewals/new starts. I also do a lot of "procedures"; food/drug challenges, skin tests, spirometry, rhinoscopies, and about to start food desensitization program which maybe cash only since it's currently not FDA approved.

If supply and demand dictated compensation in medicine then family physicians and geriatricians would probably be making 800k a year. Unfortunately, its still all about procedures.
 
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Huh? You do realize that rheumatology has a significantly better job market than AI and that supply and demand is actually very much in favor of rheum? Not only are we predicting a mass retirement exodus of older rheumatologists, but we have seen one of the lowest increases in fellowship spots in the past 5 years compared to other specialties. Furthermore, the reason there are more rheumatology fellowship spots than allergy is due to the fact that we are basically sports medicine lite as well as anything autoimmune. You can easily fill up your schedule with 30 OA/tendonitis/CTS/bursitis patients a day, and not even see a single SLE or vasculitis patient.

I remember deciding between rheum and allergy and comparing what I would rather see on a daily basis. Chronic musculoskeletal pain or chronic rhinitis. That was a no brainer for me. However, I like healthier patients in general.
 
I remember deciding between rheum and allergy and comparing what I would rather see on a daily basis. Chronic musculoskeletal pain or chronic rhinitis. That was a no brainer for me. However, I like healthier patients in general.
I don't see chronic musculoskeletal pain. I look for things I can intervene upon. If those don't exist, then I punt to the PCP or pain specialist. Like I said, you can build a practice with well controlled inflammatory arthritis, and each visit can take 5 minutes.
 
I don't see chronic musculoskeletal pain. I look for things I can intervene upon. If those don't exist, then I punt to the PCP or pain specialist. Like I said, you can build a practice with well controlled inflammatory arthritis, and each visit can take 5 minutes.

You should be able to see over 100 pts a day and make 1 mil per year! I think you made a good choice doing rheum.
 
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