Is it worth doing a fellowship?

[leacott]

Im about to be a CA-3 and interviewing for pain fellowship. My wife is a DO student applying for residency this fall, shes interested in anesthesia. Should I forgo this year and apply for a job or do the fellowship if I match. Theres a chance that we may match at different locations. I can always apply for fellowship im a few years but it will be nice to get it out of the way now.

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[dabears505]

I think cardiac or peds is worth it. Only the dinosaurs are doing cardiac without a fellowship these days. Same with complex peds.

 

[1halfMVsquared]

I say do the fellowship if you are really interested in pain. It is tough to come back to fellowship after being out in practice for a few years. Also, you can email the fellowship/residency directors to see if they could couples match you and your wife to the same program.

 

[leacott]

I think cardiac or peds is worth it. Only the dinosaurs are doing cardiac without a fellowship these days. Same with complex peds.

Hmmm so no to pain? Thing is, you don't really need a fellowship to do peds or cardiac. Most people just choose not to do it

 

[ucladoc2b]

I think cardiac or peds is worth it. Only the dinosaurs are doing cardiac without a fellowship these days. Same with complex peds.

Pretty much this. If you really like pain and want to make it your career, you have to do the fellowship. But it does come with about a $400-600k price tag. Not to mention one more year as a trainee (once you graduate you’ll see that life is much better).

Most places require advanced TEE certification for cardiac panels. So you are most likely stuck doing the fellowship if you really want to do cardiac. However, these same patients also end up in the general ORs frequently, so if you just like big cases, there are other avenues.

At least at my shop, I personally (as a generalist) can do peds cases 12 months and above. But if you like sick neonates, you have to do the fellowship.

Critical care is ok if you like the ICU.

The rest really aren’t worth it. Especially in this job market.

 

[buccsmf1]

If you start practicing theres close to a zero precent chance youll go back to fellowship later. After a couple of years youll be around 500k+ per year with 8-10 weeks of vacation. only an idiot would give that up to be a trainee making 70k with 3-4 weeks vacay.

Im a DO, and youre wife likely wont exactly have her choice of matching wherever she wants. youll likely be long distance for a year. thats a presonal question youll have to answer, if youre ok with a year apart.

the job market is so hot right now that you'll have zero issue getting a solid job wherever she matches

my vote would be get a job in the town your wife matches, your life will be 100x better.

 

[leacott]

I say do the fellowship if you are really interested in pain. It is tough to come back to fellowship after being out in practice for a few years. Also, you can email the fellowship/residency directors to see if they could couples match you and your wife to the same program.

Can they really couples match us? Pain match is in October and residency match in March. Is this really a thing?

 

[buccsmf1]

Hmmm so no to pain? Thing is, you don't really need a fellowship to do peds or cardiac. Most people just choose not to do it

That depends. It my shop you can't do any cardiac without a fellowship. You can do any peds case youre comfortable with, but we have peds on call 24/7, so i generally punt anything under 12 months to the peds guys.

 

[1halfMVsquared]

Can they really couples match us? Pain match is in October and residency match in March. Is this really a thing?

Doesn't hurt to try. A colleague of mine was able to get an out-of-match spot for his significant other when he was applying for cardiac (she matched anesthesia).

 

[Gern Blansten]

Can they really couples match us? Pain match is in October and residency match in March. Is this really a thing?

No, it is not a thing. If you are both very competitive candidates and the programs you want also want you, it can happen, but certainly not a couples match guarantee type of thing and I would guess chances of being successful at achieving it are low.

 

[dannyboy1]

You can also match pain in October, then of your fiancé doesn’t match close to your fellowship just give it up and get a job. A bit of a $hitty thing to do but it works….

 

[leacott]

You can also match pain in October, then of your fiancé doesn’t match close to your fellowship just give it up and get a job. A bit of a $hitty thing to do but it works….

Lol that's some horrible advice

 

[dannyboy1]

Lol that's some horrible advice

Is it though ? Dude is on the fence about the value of a fellowship anyway. Let him get one and if he decides fellowship is not for him (maybe because his wife won’t be nearby, or maybe he just loses interest) inform the fellowship in March that you won’t be showing up in July. Fellowship is a JOB. If the job doesn’t work for you, then it doesn’t work for you…

 

[vector2]

Is it though ? Dude is on the fence about the value of a fellowship anyway. Let him get one and if he decides fellowship is not for him (maybe because his wife won’t be nearby, or maybe he just loses interest) inform the fellowship in March that you won’t be showing up in July. Fellowship is a JOB. If the job doesn’t work for you, then it doesn’t work for you…

One signs a contract to enter the match. Entering into a contract in bad faith with the future intention to purposefully void it is not only unethical but can also have unintended consequences, both for future fellowship applications or even job applications. Anesthesia is sometimes a small world.

 

[kidthor]

If you want to be a pain doctor then do a pain fellowship. If not, sounds like you want to be a generalist as your alternate plan.

 

[Status Sciaticus]

One signs a contract to enter the match. Entering into a contract in bad faith with the future intention to purposefully void it is not only unethical but can also have unintended consequences, both for future fellowship applications or even job applications. Anesthesia is sometimes a small world.

No it doesnt. Unless you are specifically applying to a program where you dropped your fellowship spot. Stuff comes up all the time. Parents get sick or die, applicants have health issues or personal conflicts come up. Expecting nothing to happen in the 9 months after match in someone's life is a bit naive. OP isnt gong into the match with the express intention of dropping a spot to screw over the program, but the option to drop out post match is not a punitive one. The spot will fill outside the match anyway.

 

[vector2]

No it doesnt. Unless you are specifically applying to a program where you dropped your fellowship spot. Stuff comes up all the time. Parents get sick or die, applicants have health issues or personal conflicts come up. Expecting nothing to happen in the 9 months after match in someone's life is a bit naive. OP isnt gong into the match with the express intention of dropping a spot to screw over the program, but the option to drop out post match is not a punitive one. The spot will fill outside the match anyway.

Uh, you're mentioning unexpected life events that potentially qualify for an official match waiver. People are suggesting to OP to premeditate a plan to violate the terms of a match contract (what @dannyboy1 himself called a "$hitty thing to do") because his wife isn't a strong candidate and thus they might have to suck it up and do long distance for a year.

What's naive is thinking that that's on the same level as your dad dying.

 

[dannyboy1]

Uh, you're mentioning unexpected life events that potentially qualify for an official match waiver. People are suggesting to OP to premeditate a plan to violate the terms of a match contract (what @dannyboy1 himself called a "$hitty thing to do") because his wife isn't a strong candidate and thus they might have to suck it up and do long distance for a year.

What's naive is thinking that that's on the same level as your dad dying.

Meh. The program will find someone else. People back out of fellowships all the time. Fellows are fully trained attendings and have options, especially in this job market. Maybe if the fellowship offered more than 75k per year they would not have people back out as much. Just saying…

 

[Status Sciaticus]

Uh, you're mentioning unexpected life events that potentially qualify for an official match waiver. People are suggesting to OP to premeditate a plan to violate the terms of a match contract (what @dannyboy1 himself called a "$hitty thing to do") because his wife isn't a strong candidate and thus they might have to suck it up and do long distance for a year.

What's naive is thinking that that's on the same level as your dad dying.

what people suggest OP do, and what OPs intentions are going into the match are not necessarily the same. He/she is simply asking if he should apply for fellowship based on the chances his partner will end up in the same location as him/her.

Again, this is a job, not something more than that. People quit all the time right?

Yeah my examples were a bit on the extreme end. But if I learned that a program was malignant or that the program was hiding something that I learned after the fact or that they intentionally misrepresented themselves (non-waiver conditions), I would consider dropping them as well. Its like an employer saying that youre only going to be doing 2 calls/month, but then get dragged into doing 8 calls/month. Would you stay in that job?

 

[Gern Blansten]

Yeah my examples were a bit on the extreme end. But if I learned that a program was malignant or that the program was hiding something that I learned after the fact or that they intentionally misrepresented themselves (non-waiver conditions), I would consider dropping them as well. Its like an employer saying that youre only going to be doing 2 calls/month, but then get dragged into doing 8 calls/month. Would you stay in that job?

Except none of those scenarios are representative of what the original question was asking.
I don’t disagree with what you’re saying if you think a position was misrepresented or if a fellow is actually being mistreated.
But this is about advocating that some be half way committed to completing the fellowship during the application process. It’s not fair to the program or the other fellows to have someone who is misrepresenting themselves any more than it would be for the program to misrepresent themselves. The couple needs to resolve their issue prior to going through the process. If they cannot do the distance relationship for a year during the training, that needs to be resolved on the front end and then they can wait and do the fellowship later if he is truly committed.
The training program should not have to deal with the consequences of the couple’s uncertainty. Sure, life happens sometimes and people have to back out for legitimate reasons. This scenario is not a legitimate one in my opinion because one party was not acting in good faith from the outset (in this fictional scenario).
This is about just being a decent person. The other thing to consider is the missed opportunity of the person who really wanted to match there but could not because someone else took a spot, when they were only 50:50 on whether they even wanted it. Kind of like spitting on the last slice of pizza just so it will still be there in case you’re still hungry after you finish your share.

 

[Status Sciaticus]

Except none of those scenarios are representative of what the original question was asking.
I don’t disagree with what you’re saying if you think a position was misrepresented or if a fellow is actually being mistreated.
But this is about advocating that some be half way committed to completing the fellowship during the application process. It’s not fair to the program or the other fellows to have someone who is misrepresenting themselves any more than it would be for the program to misrepresent themselves. The couple needs to resolve their issue prior to going through the process. If they cannot do the distance relationship for a year during the training, that needs to be resolved on the front end and then they can wait and do the fellowship later if he is truly committed.
The training program should not have to deal with the consequences of the couple’s uncertainty. Sure, life happens sometimes and people have to back out for legitimate reasons. This scenario is not a legitimate one in my opinion because one party was not acting in good faith from the outset (in this fictional scenario).
This is about just being a decent person. The other thing to consider is the missed opportunity of the person who really wanted to match there but could not because someone else took a spot, when they were only 50:50 on whether they even wanted it. Kind of like spitting on the last slice of pizza just so it will still be there in case you’re still hungry after you finish your share.

you bring up a fair point as well.
In the grand scheme of things, 1 year long distance isnt a drastic thing if OPs long term plan is pain. I would say just get the fellowship done instead of coming back to do it after being an attending.

 

[dannyboy1]

Except none of those scenarios are representative of what the original question was asking.
I don’t disagree with what you’re saying if you think a position was misrepresented or if a fellow is actually being mistreated.
But this is about advocating that some be half way committed to completing the fellowship during the application process. It’s not fair to the program or the other fellows to have someone who is misrepresenting themselves any more than it would be for the program to misrepresent themselves. The couple needs to resolve their issue prior to going through the process. If they cannot do the distance relationship for a year during the training, that needs to be resolved on the front end and then they can wait and do the fellowship later if he is truly committed.
The training program should not have to deal with the consequences of the couple’s uncertainty. Sure, life happens sometimes and people have to back out for legitimate reasons. This scenario is not a legitimate one in my opinion because one party was not acting in good faith from the outset (in this fictional scenario).
This is about just being a decent person. The other thing to consider is the missed opportunity of the person who really wanted to match there but could not because someone else took a spot, when they were only 50:50 on whether they even wanted it. Kind of like spitting on the last slice of pizza just so it will still be there in case you’re still hungry after you finish your share.

This type of thinking only happens in medicine. Particularly among medical students and residents. OP is not sure of what he wants to do so he is applying for a JOB to keep his options open. He is not obligated not to apply so someone else can have the spot. The program will have to deal with a fellow backing out. It’s happened before and will happen again. I have no doubt the fellowship program will easily fill the spot out of match with someone else. As you move forward in your career you need to look out for YOURSELF because no one else will. Guarantee the large academic institution at which the fellowship is based will be just fine regardless.

 

[Gern Blansten]

This type of thinking only happens in medicine. Particularly among medical students and residents. OP is not sure of what he wants to do so he is applying for a JOB to keep his options open. He is not obligated not to apply so someone else can have the spot. The program will have to deal with a fellow backing out. It’s happened before and will happen again. I have no doubt the fellowship program will easily fill the spot out of match with someone else. As you move forward in your career you need to look out for YOURSELF because no one else will. Guarantee the large academic institution at which the fellowship is based will be just fine regardless.

I respect your opinion, though I disagree with it 100%.
You do need to be an advocate for yourself, but what you are describing is not what I consider the "professional" way to do it.
The NRMP addresses this issue as follows:

• Rank and match with integrity
  Applicants should create rank order lists based on their true preferences, the characteristics of the programs interviewed, and the perceived alignment of the applicant’s capabilities and interests with program mission, aims, and eligibility. Applicants must respect the binding nature of a match commitment and be prepared to honor the commitment if a match occurs with any program placed on a rank order list.

The SF match says the following:

Binding Commitment
Both the program and the applicant formally commit to accepting a position with any one of the rank choices listed. Both parties are bound by the results of the match. However, an applicant’s actual entry into the training program (and continuation in it) is contingent upon satisfactory completion of the prerequisite training, any special requirements the program may have stated explicitly for all applicants and satisfactory performance during training.

Prior to the existence of the matching systems, an applicant was interviewed and may be offered a spot that day, take it or leave it. This may be their very first interview on the trail and they now have to make a decision to take the spot or lose a chance at that program. Some programs interviewed very early and filled their spots this way. Many students felt that they never had a chance to get the program that they really wanted because they had the offer in hand and the old "bird in the hand" adage applied. The matching process has its downsides, but is better for the applicants than the previous system, IMHO. However, for it to work, there needs to be some degree of commitment to the system by both parties at the outset. That commitment is built into the process during registration for the match.

If the applicant wants to "keep options open," then the way to do that is register, apply, and interview for the positions. If, by the rank order list deadline, they are not committed, then they have the option at that point to back out of the match and leave their rank order list blank. The program nor the other applicants are not adversely affected by this and the applicant has upheld their commitment they made when they registered for the process. Once they turn in that rank list, it is my opinion that they should be committed unless there are extreme extenuating circumstances that change their situation.

 

[nimbus]

I respect your opinion, though I disagree with it 100%.
You do need to be an advocate for yourself, but what you are describing is not what I consider the "professional" way to do it.
The NRMP addresses this issue as follows:

• Rank and match with integrity
  Applicants should create rank order lists based on their true preferences, the characteristics of the programs interviewed, and the perceived alignment of the applicant’s capabilities and interests with program mission, aims, and eligibility. Applicants must respect the binding nature of a match commitment and be prepared to honor the commitment if a match occurs with any program placed on a rank order list.

The SF match says the following:

Binding Commitment
Both the program and the applicant formally commit to accepting a position with any one of the rank choices listed. Both parties are bound by the results of the match. However, an applicant’s actual entry into the training program (and continuation in it) is contingent upon satisfactory completion of the prerequisite training, any special requirements the program may have stated explicitly for all applicants and satisfactory performance during training.

Prior to the existence of the matching systems, an applicant was interviewed and may be offered a spot that day, take it or leave it. This may be their very first interview on the trail and they now have to make a decision to take the spot or lose a chance at that program. Some programs interviewed very early and filled their spots this way. Many students felt that they never had a chance to get the program that they really wanted because they had the offer in hand and the old "bird in the hand" adage applied. The matching process has its downsides, but is better for the applicants than the previous system, IMHO. However, for it to work, there needs to be some degree of commitment to the system by both parties at the outset. That commitment is built into the process during registration for the match.

If the applicant wants to "keep options open," then the way to do that is register, apply, and interview for the positions. If, by the rank order list deadline, they are not committed, then they have the option at that point to back out of the match and leave their rank order list blank. The program nor the other applicants are not adversely affected by this and the applicant has upheld their commitment they made when they registered for the process. Once they turn in that rank list, it is my opinion that they should be committed unless there are extreme extenuating circumstances that change their situation.

I think that if backing out of commitments becomes normalized, it is the applicants who will eventually pay the price. Given the dearth of GME spots, the programs have the power. After an applicant matches at a program, what will stop the program from saying, “just kidding, we found somebody better.” Right now, the residency market is the opposite of the attending job market.

 

[TheLoneWolf]

Meh. The program will find someone else. People back out of fellowships all the time. Fellows are fully trained attendings and have options, especially in this job market. Maybe if the fellowship offered more than 75k per year they would not have people back out as much. Just saying…

Can I just pause and ask where does fellowship pay 70-75 000? I did a pain fellowship and it paid about 55.

 

[Hork Bajir]

Match issues aside, I don’t understand how a resident reaches the end of their residency and doesn’t know whether or not they want to do pain. Deciding about peds, cardiac, even ICU, I understand… But pain is a totally different job, almost to the point of being a separate specialty (TBH it’s never made sense to me why you have to do anesthesia residency first, it ought to be its own separate residency).

Do you want to do anesthesia, or do you want to work in a pain clinic? Your career is long, fellowship is just one year. You’ve come this far. Given that the two career paths you’re considering are radically different, choose the one where you’ll be excited to get out of bed and go to work in 20 years

 

[nimbus]

Can I just pause and ask where does fellowship pay 70-75 000? I did a pain fellowship and it paid about 55.

Interns at Stanford/UCSF get about $80k. PGY-5’s are over $100k.

 

[Justice4all]

Housing is ridiculous in those locations . Even with a housing stipend at Stanford, hard to afford

 

[Angus Avagadro]

Im about to be a CA-3 and interviewing for pain fellowship. My wife is a DO student applying for residency this fall, shes interested in anesthesia. Should I forgo this year and apply for a job or do the fellowship if I match. Theres a chance that we may match at different locations. I can always apply for fellowship im a few years but it will be nice to get it out of the way now.

Who says you will find a job where your wife is doing her residency? My wife matched her residency in her city of choice. The anesthesia job market for me was tight. No jobs within an hour of her residency. I had to re enlist and do a fellowship, which ultimately opened doors for me for employment in the area. Another thing to consider.

 

[nimbus]

Housing is ridiculous in those locations . Even with a housing stipend at Stanford, hard to afford

I was just answering the question posed by @TheLoneWolf. Agree it’s not a lot of money in those locations.

 

[NICMAN]

The pain market is a bit tighter than the generalist market. I would say that for me and my values I would rather stay with my wife and support her in her intern year rather than be away. If you are on the fence then a happy and long-lasting marriage will pay far greater dividends in terms of life satisfaction than almost anything else.