Announcement

Collapse
No announcement yet.

To Fellowship or not to fellowship, from a financial perspective

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • lilsnappa
    replied
    Thanks for all of the fantastic advice everyone.

     

    After reading all of these responses, I believe she's been talked out of doing this fellowship.

    Leave a comment:


  • RogueDadMD
    replied
    I'll add a couple more things:

    The academic part of the job I find rewarding; the biggest drawback is salary working in an traditional academic environment (and at a place currently on the lower end of the spectrum).  There are other monetary benefits but they don't always make up for salary differences.  Some academic places actually do pay competitive salaries, though in peds (as in other specialties) you'll be able to get more going non-academic, IF you are willing to go to that job. Not every city will have high paying private jobs.

    Because of my PEM training (working in a high acuity peds ED with plenty of real trauma) and academic interests, I could likely go anywhere that needs a PEM doctor and get a job, whether purely clinical or hardcore research.  That brings a flexibility that I currently don't use but which could be valuable.

    So while a hospitalist fellowship currently is a hard sell given the job market (almost every big and small place in the country will have a job available without requiring a fellowship and she is likely to be grandfathered to have rights to take the exam in if the fellowship becomes board eligible), it is not necessarily a 100% no-go if you consider the other aspects.  The amount of salary tradeoff in the short and long term is important and your families financials also matter.  Sometimes the academic jobs are so low paying it really IS a terrible decision to take one, but that's not universal.

     

    Leave a comment:


  • RogueDadMD
    replied
    First -- have her read this article:

    Does Fellowship Pay: What Is the Long-term Financial Impact of Subspecialty Training in Pediatrics?


    http://pediatrics.aappublications.org/content/127/2/254.short

    I'm an academic pediatrician (peds EM) at a large university and medium-large children's hospital (and did peds EM fellowship).

    The short answer is in some peds fellowships you increase your lifetime income compared to no fellowship of any kind.  As a hospitalist there's currently not no financial incentive for a fellowship in most places (unless you want a job at a place that requires a fellowship).

    The longer answer...

    The setup of our hospital means that our peds hospitalist group actually fills multiple roles, including working along side me in the ED as the second/third attending in addition to the customary inpatient work they do in other parts of the hospital/hospital system.  Whenever a new one starts they also use our ED as the training ground for a few months (working nowhere else), so we are available to help with every potentially complicated patient (pros/cons and why of this is a separate discussion).

    As such as I've been working side by side with our hospitalists for several years and talk with them regularly about ED patients and inpatients.  I also am heavily invested in the "academic" side of things, working on grants, research papers, etc.

    We've just started a hospitalist fellowship and also had one of our graduating residents go elsewhere for a hospitalist fellowship and spoke with him quite a bit.  Our own hospital doesn't have a big enough program to fill our own hopsitalist spots, so people can still join the hospitalist faculty straight out of residency.  He went to a very large children's hospital that required a fellowship to get a hospitalist job, but they have a bigger program and less turnover in their group.

    Knowing many excellent hospitalists, including some that are able to replace a PEM attending at this point, I can tell you unequivocally you don't need a fellowship for the clinical work.  Given the amount of job openings around the country, you are unlikely to need one for a long time to get a job.

    Knowing many that are trying to do academic work (research, grants, etc), if she has interest in that she will need additional training.  In some places that could be on the job training as faculty, but generally you'll get better training doing it structured within a fellowship with your time protected for this type of work.  Also your job after training is likely to have more protected time for the "academic" work as opposed to a purely clinical job or trying to get an academic job without having done the extra training.  That brings with it a different type of work that you have to want to do, but in some ways brings more variety and flexibility that can make life better (or worse depending on your view of academic work).

    I could go on a lot more, but if she wants to be a pure clinician and doesn't care about academic type work or working in a free standing children's hospital, there's little point in a fellowship.  Even if she wants to go to a children's hospital, she may not need a fellowship.  The benefit of the fellowship won't be the money...

    Leave a comment:


  • HLM
    replied
    I've been pediatric hospitalist for the past 12 years and I'm in agreement with everyone else who says that doing a peds hospitalist fellowship makes no sense from a financial perspective. I'd also agree more broadly that in pediatrics, a fellowship training in any area does not necessarily translate into an eventual bigger salary except for PICU and peds GI that does a lot of procedures. Perhaps peds ER too (not necessarily paid a ton more than a pediatric hospitalist but hours are usually less for a full time FTE when compared to a hospitalist).

    There may be a time in the future where it becomes hard to find a job as a pediatric hospitalist without the fellowship, similar to what has happened in peds ER and PICU medicine which also didn't require fellowship training in the past but now does for most jobs in those fields. However, that time is still a way off into the future. The American Board of Pediatrics just made its initial approval of pediatric hospitalist medicine as a subspecialty last year and we are probably a decade or more out until all the kinks are ironed out regarding certifying the fellowships and the ABP figuring out how to certify individuals. As mentioned by many people already, people who are already working as hospitalists will be grandfathered in to take what will surely be a rip off board certification exam (don't get me started on that rant) that will eventually come for the subspecialty.

    I think the only reason to do a fellowship in peds hospital medicine might be if you have a particularly strong interest in doing QI or teaching at an academic institution because I have already seen listings for jobs at such places in which the listings state that they are looking for people with fellowship experience if they don't have longer term work experience.

    But there are so many opportunities to work as a pediatric hospitalist outside of the ivory tower that don't and won't require that fellowship. I work at hospital where we teach pediatric and family practice residents, have 3rd year medical students doing their inpatient pediatric rotation with us, and have multiple opportunities for QI and admin work and not a one of us is fellowship trained.

    From a financial perspective, it makes no sense. I've never seen or heard of a job that pays someone more as a peds hospitalist for being fellowship trained (this includes not only my own experience at two different hospitals but the experience of several other friends from residency and med school who are also peds hospitalists).

    As for clinical experience, I can't speak for current trainees, but as someone who trained in the old days prior to the residency hour restrictions (I finished residency the year before those restrictions went into place), we spent way more time taking care of sick kids on the floor, ED, PICU and NICU than any outpatient work. My first job out of residency was at a clinic and I remember feeling like a fish out of water doing well child care. Maybe that has changed and current residents have less autonomous exposure to sick kids in their training but I doubt that a fellowship will help you much with that since most of the programs really do seem geared toward QI, administrative, and teaching. Not necessarily more hands on clinical experience.

    So, to reiterate, a fellowship in peds hospitalist medicine does NOT make financial sense. It may make sense depending on where you want to work in terms of opening up doors but that could be easily investigated by talking to people at those institutions or even putting out feelers on the AAP hospitalist listserv which is open to anyone interested, not just AAP members. And you can post questions to that listserv anonymously.

    Leave a comment:


  • CM
    replied







    I agree with those saying “no” to the fellowship. I did two years of gen peds as part of my peds neuro training and started hearing about this Hospitalist fellowship nonsense last year. If someone is really interested in pediatric hospital based research and/or quality improvement I can see pursuing more training/education in these areas, but I’m pretty sure you could learn these things during your first 1-2 years as an attending (which is what all of the Peds Hospitalists have been doing for the last several years). And the fact that these fellowships are TWO YEARS is ridiculous. What is crazy to me is that current Hospitalists actually lobbied for this to get created. I hear you that there is enormous pressure to continue to seek out more and more training, but from what I have seen and experienced I can’t imagine two years of Pediatric Hospitalist training to be worth it.
    Click to expand…


    It would make sense for the hospitalists to lobby for it in a perverse sort of way. Makes their life easier by giving them and their hospital cheap labor. They dont have to do it so it benefits them without any of the drawbacks.
    Click to expand...


    .

    Leave a comment:


  • Zaphod
    replied




    I agree with those saying “no” to the fellowship. I did two years of gen peds as part of my peds neuro training and started hearing about this Hospitalist fellowship nonsense last year. If someone is really interested in pediatric hospital based research and/or quality improvement I can see pursuing more training/education in these areas, but I’m pretty sure you could learn these things during your first 1-2 years as an attending (which is what all of the Peds Hospitalists have been doing for the last several years). And the fact that these fellowships are TWO YEARS is ridiculous. What is crazy to me is that current Hospitalists actually lobbied for this to get created. I hear you that there is enormous pressure to continue to seek out more and more training, but from what I have seen and experienced I can’t imagine two years of Pediatric Hospitalist training to be worth it.
    Click to expand...


    It would make sense for the hospitalists to lobby for it in a perverse sort of way. Makes their life easier by giving them and their hospital cheap labor. They dont have to do it so it benefits them without any of the drawbacks.

    Leave a comment:


  • pedsneuro
    replied
    I agree with those saying "no" to the fellowship. I did two years of gen peds as part of my peds neuro training and started hearing about this Hospitalist fellowship nonsense last year. If someone is really interested in pediatric hospital based research and/or quality improvement I can see pursuing more training/education in these areas, but I'm pretty sure you could learn these things during your first 1-2 years as an attending (which is what all of the Peds Hospitalists have been doing for the last several years). And the fact that these fellowships are TWO YEARS is ridiculous. What is crazy to me is that current Hospitalists actually lobbied for this to get created. I hear you that there is enormous pressure to continue to seek out more and more training, but from what I have seen and experienced I can't imagine two years of Pediatric Hospitalist training to be worth it.

    Leave a comment:


  • RadMD
    replied
    Another vote for no fellowship.  It's a waste of time in this case....

    Leave a comment:


  • Zaphod
    replied




    Relatively new pediatrician here.  I think the only specialties that might come out ahead financially (when considering income lost during fellowship) are neonatology, cardiology, pediatric critical care, and pediatric EM.

     

    The pediatric fellowship system is broken in my opinion (3 year fellowships that for the equivalent adult fellowship would require only 2 years of additional training, too research-heavy).  Hospital medicine might be the most outrageous example…few of her cohort will have done the fellowship.   She’ll be eligible to grandfather if she wishes.  I don’t think she’ll have a problem getting a hospitalist job without it.

     

    I have some subspecialty interest but refuse to participate in a system that I’m increasingly convinced is focused on cheap labor, not provided the needed training in the most efficient way.

     

    If you want an academic career, you may need something to distinguish yourself (research, specialty expertise, admin experience) which are often gotten through a chief year or fellowship.  But there are other ways.

     

    Consider also, for peds, if you are a subspecialist there may only be one “game in town”.  You may be tied to working in big cities with pediatric hospitals.  And in some cities, if you are the peds GI doc, there’s only one system to work for…which can make it difficult if the work environment changes for the worse and you want to change jobs.  Peds hospital medicine and neo won’t have these issues as much as they are often practiced in general hospitals as well as full-service children’s hospitals.
    Click to expand...


    Its crazy these are 3 years. Whats really crazy are the research requirements that really do a large benefit for the institution and only sometimes for the fellow/resident (if theyre planning on academics). Worse are residencies with mandatory research years, and there were and probably still are those around. Michigan was 7 years long due to a mandatory research year, I nearly left that interview right then. That is nuts and totally just cheap labor institution prestige building. Its impossible for the majority of residents to be very research heavy, and its a huge disservice to them clinically and financially for many institutions to be moving in that direction. It is however what the incentives would predict. What a weird world.

    Leave a comment:


  • Tuxedo
    replied
    Relatively new pediatrician here.  I think the only specialties that might come out ahead financially (when considering income lost during fellowship) are neonatology, cardiology, pediatric critical care, and pediatric EM.

     

    The pediatric fellowship system is broken in my opinion (3 year fellowships that for the equivalent adult fellowship would require only 2 years of additional training, too research-heavy).  Hospital medicine might be the most outrageous example...few of her cohort will have done the fellowship.   She'll be eligible to grandfather if she wishes.  I don't think she'll have a problem getting a hospitalist job without it.

     

    I have some subspecialty interest but refuse to participate in a system that I'm increasingly convinced is focused on cheap labor, not provided the needed training in the most efficient way.

     

    If you want an academic career, you may need something to distinguish yourself (research, specialty expertise, admin experience) which are often gotten through a chief year or fellowship.  But there are other ways.

     

    Consider also, for peds, if you are a subspecialist there may only be one "game in town".  You may be tied to working in big cities with pediatric hospitals.  And in some cities, if you are the peds GI doc, there's only one system to work for...which can make it difficult if the work environment changes for the worse and you want to change jobs.  Peds hospital medicine and neo won't have these issues as much as they are often practiced in general hospitals as well as full-service children's hospitals.

    Leave a comment:


  • engerland66
    replied
    Agree with most of above. My co-residents in IM who went straight into hospitalist positions tell me it's like an extension of residency (especially with how much inpatient we had). I'm sure peds is the same. There is a similar fellowship in IM and none of them did it. Some went into community positions, others stayed at fairly prestigious academic centers. The only reason I can think of doing it in her case is if she's dead-set on an academic position and thinks it will help her climb the ranks as an academic hospitalist. However, given that peds is overall less competitive and hospitalists are ubiquitous, I doubt it will significantly help her career. I would pass and start working.

    Leave a comment:


  • ticker
    replied
    In my view, chief years are for two groups of people: 1. those who want a competitive fellowship but aren't competitive applicants.  2. those who can't say "no" to their program directors.

    I did a one year fellowship.  Financially, it will take 5-7 years to get back to neutral impact financially (impossible to say, since apart from my pay specific to the subspecialty training, I think it also allowed me to negotiate for more compensation for my "regular" specialist pay).  It also allowed a year with minimal responsibility, paid paternity leave, fun times in a city we enjoyed, etc.  We were paying for all that in lost income, but it was enjoyable.

    Two extra years for peds hospitalist training?  What on earth did they manage to not teach her in 3 years of (probably at least half inpatient) peds residency?  That is absurd.  There's a reason they let residents moonlight as hospitalists after a 12-month internship.  It ain't neurosurgery.

    Leave a comment:


  • kingsnake
    replied
    In internal medicine a cheif year is total waste of time unless you need to do it to get a certain fellowship... you a do year of chief residency in exchange for a Cards or GI fellowship spot....TWO?! years of peds hospitalist fellowship sounds like overkill...maybe ONE year max...probably just rotate on the floor an and through the ICU plus a lot of research time....typical Academia milking the residents/fellows for all they are worth.  Very cheap MD labor for them.

    My chair wanted me to stay at the U (I'm not anything special) and get paid a pittance instead of go out into practice....within 2 years I had more time off and 3x the salary of those who stayed in academics.

    Buyer beware.

    Leave a comment:


  • StarTrekDoc
    replied
    KUDOS for being net zero coming out of residency!  Sounds like non-academic track.  With that remains completely true, then get into the work force in your desired location and start her career.  The other potential large factor (or monkey wrench!) not mentioned -- kids.

    A fellowship in peds hospitalist certainly will give one exposure to that peds residency didn't compared to internal med.  My wife's children's hosp peds still was 50% outpatient compared to my 10% outpatient.  But, the fact is that she would get hands on experience year-for-year compared to fellowship and grandfathered into the position.  Would I take a person with 3 years of hands on floor experience over a freshly minted fellow?  All things equal, i'd take the experienced one with real data, real feedback from colleagues, and real experience.

    From the financial point, it's three years of real income, compounded.  Think of it as extending your savings cycle, like NOT starting saving for retirement for three years later.

     

     

    Leave a comment:


  • ENT Doc
    replied
    Zaphod's points are spot on.  Don't let her get snared by people who are clearly biased.  It may be the best thing for her (I doubt this on many levels), but as others have noted I don't see the marginal benefit of delaying the attending experience for 3 years if she wants to work in hospital pediatrics.  Her general training should be enough for that.  She should ask her program director why he/she thinks their program doesn't prepare them well enough to take care of inpatient pediatric patients.  I'd love to hear the answer.

    Leave a comment:

Working...
X