Fellowship

[augmel]

someone mentioned a little while ago a rumor that peds fellowships might be shortened to two years in an effort to draw more people. this seems reasonable, especially for specialties such as ER and ID. three more years for ER? that seems ridiculous to me. does anyone have any info on this or a different perspective? i just don't understand why IM fellowships should be shorter than peds even with more conditions to treat in general.

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[augmel]

pulmonology too. do they treat anything other than CF and severe asthma, maybe some neonatal development stuff? IM learns several more diseases in two years.

 

[augmel]

bump

 

[HiFi]

well of my 36 month fellowship, I spent 13 months on the clinical service and the rest on research months.
The way a few of my friends structured their schedule, they actrually only did ONE clinical month in their final year.

of course we still took 3 or 4 night calls on our research month, but it's not the same.

therefore, yes fellowships could be shortened if the research component was shortened.

it would depend on the type of career one wanted. if you wanted a career in bench research, then no the fellowship could not be shortened. you are already doing very little clinical time as it is.

of course, diffrent fellowships offer more or less time on the cliniaal service I am sure.

in terms of shortening the fellowships to attract more applicants : SCREW THAT!!!!!!!!!!!!
people that want to do something can do the full freaking three years like I did.
I DO NOT want the job market going to hell just because all of a sudden a bunch of people that decided they could stomach 2 years of fellowship ( but not 3 ) and went into my field.

no thanks.
3 year fellowships will never be shortened ( IMO ) and they shouldn't be

 

[augmel]

thanks for replying HIFI.
i can appreciate the annoyance of those who get screwed when the requirements get changed for a specialty (see pathology.) but i still can't see why the boards require 2 years of research when people that want academics will do research whether it is a fellowship or not, and it does little for the careers of the majority of physicians that go on to practice in the community. especially since there is a shortage of peds subspecialists right now. and DOUBLE especially since the corresponding IM fellowships only take 2 years. all it does is select for younger docs with less responsibilities to go into these specialties. maybe a few more people go into academics due to the exposure to research, but i doubt it changes that much. it seems like they just throw another year on for the hell of it anymore. cards is getting ridiculous. spend 1/2 your life getting educated to work for 1/3 of it.
aaahh. i feel better now.

 

[HiFi]

Originally posted by augmel
thanks for replying HIFI.
i can appreciate the annoyance of those who get screwed when the requirements get changed for a specialty (see pathology.) but i still can't see why the boards require 2 years of research when people that want academics will do research whether it is a fellowship or not, and it does little for the careers of the majority of physicians that go on to practice in the community. especially since there is a shortage of peds subspecialists right now. and DOUBLE especially since the corresponding IM fellowships only take 2 years. all it does is select for younger docs with less responsibilities to go into these specialties. maybe a few more people go into academics due to the exposure to research, but i doubt it changes that much. it seems like they just throw another year on for the hell of it anymore. cards is getting ridiculous. spend 1/2 your life getting educated to work for 1/3 of it.
aaahh. i feel better now.

because boards are filled with academic people who only see the world as protected research time and of course, what insane person would ever want to do a non-academic job!!!

The people making the rules are the people that think research time is precious. That's the problem

In hindsight, I did enjoy some of my research time. I learned to think critically and to become a fanatic about practicing evidence based medicine, so in the long run, it worked out OK for me....but I think I could have done with a few more months on clinical service and a few less months in the lab....

actually I picked really easy research projects so on my research months I only worked about 1/2 day per week ( shhhhh, don't tell )
The rest of the time I was at the gym, playing my flight simulator, or hanging out at the county NICU and putting in PICC lines for the junior fellows that were weak with vascular access skils

 

[augmel]

I hadn't thought of that. Of course the boards are made up of academics. Makes more sense now.

Now that 1/2 day research life does sound pretty good. And I can see from the one research project I am involved in that it does improve critical thinking. I just hate to think what it will be like to finish 3 years of residency and think about another three years of poverty in an expensive city vs. actually having money to get a house and perhaps even have a savings acount!

 

[HiFi]

well look at your extra 3 years this way :

I hated doing general peds, and couldn't wait to start my fellowship.
The idea of doing what I really really liked every day, and taking care of really really sick and unusual patients was a huge plus.
fellowship went really fast. I loved 95% of it.
The learning curve was almost vertical!

I can't possibly imagine working as an office based pediatrician, looking at ear drums and diaper rash, and writing ritalin scripts ( all for a salary about 1/2 to 1/3 what I am making now that I am out of fellowship...... ( I am not saying that a career in pediatrics is a bad job , just that it wasn't for me, any more than I could see myself doing IM or surgery. Thanks but no thanks )

Fellowship time is a lot of fun.
If your goal is not a career in research, then try to pick quick and easy projects that will generate multiple abstracts ( which equals multiple trips to meetings !...which are good excuses to party on your programs tab )

I would run multiple assays on the same tracheal aspirates, and write up each one seperately. I presented at a lot of meetings which are a great place to meet fellows from other programs, and meet the people that are writing the textbooks.

My message to you is that your career in medicine is a journey with no destination. See the big picture.
If you love one particular area, then doing the fellowship is a great time. Yes, it's more of a hardship working for 40K/yr, but some places allow you to moonlight so you can make a bit more.
General peds pays for crap! You aren't going to be rich on 100 grand a year. ( even though the demon-crats will call you rich ).
IF you do a subspecialty that pays twice as much, you'll quickly catch up.
Making a lot more money, AND doing something that you enjoy makes all the difference.

Medicine is a lot of work, but as the saying goes, " a man that loves his job, never works a day in his life"

 

[Gator05]

I think this brings up an interesting conundrum. As an MSIII, exposure to peds is pretty much in the realm of the general pediatrician. Since neonatology, critical care, etc are so different from normal peds, how are students ever supposed to find out about these subspecialties?

One of the neo fellows at our institution stated that if he had to do it all over again, he would go into private practice for a few years to clear up his debts and make some money before returning to his fellowship. Not sure how common this is, but seems to make sense if concerned about finances.

 

[HiFi]

it's too hard to go back to making 40 thousand dollars a year after you have been working for 6 figures. There are people that do it, but I cannot comprehend life in poverty after a few years of decent money.

also as I said before, 100-120000 a year as a new hire general pediatrician is good money, but it doesn't go as far as you would think, especially if you are paying off debts.

every person I ever knew that "went to work for a few years", never did a fellowship.

How are you supposed to get exposure to subspecialties?
Sure it can be tough but during a good peds rotation as a 3rd year, you ought to be able ( or required to ) take at least one short call in the level 3 NICU...or with the peds cardiologists, pulm, etc.

IMO, medical school in 3rd year ought to be about learning fthe basics, and as 4th year it ought to be a "buffet" where you can try out various career options.

Unfortunetaly, the eperience that peds residents in the NICU is getting watered down. I have noticed residents consulting me for things that I feel pgy-2 and 3 ought to be able to handle. It's a matter of lack of time in the care of newborns.