OBGYN - Fellowship After Residency?

[HanSpecial]

Hi All,

My fiancee is a OBGYN resident and is considering a Minimally Invasive Gynecology Surgery (MIGS) fellowship after her 4th year. I read a study on the salaries of MIGS graduates published by the Journal of Minimally Invasive Gynecology and the findings were quite surprising. Essentially, a 2 fellowship in MIGS does not result in any increase in starting salary when compared to Generalist OB/GYN. (https://www.aagl.org/wp-content/uploads/2015/03/PIIS1553465014017622.pdf)

So I am trying to understand why anyone would take on the additional risk of doing a 2 year fellowship when there seems to be no financial incentive. Is it possible that MIGS graduates have less workload in their careers? The study does not provide data about workload throughout a generalist vs. MIGS graduates' career but I'm curious if any out there have some anecdotal evidence? I imagine that you're also (probably) more marketable with this specialty?

Any feedback would be appreciated!

[ACN]

All of the following are possibilities (Maybe you should just ask her?)

• Her personal interests in the fellowship


• Marketability in larger markets


• Different patient population mix / payer mix

 

The same holds true in many surgical sub-specialties, where it takes X number of years after fellowship before seeing any "financial" benefit.

[Dicast]

The addition of a fellowship for many people is about specific career/life goals and desired practice circumstances.  I've asked my wife more than one time why she decided to do a combined emergency medicine/internal medicine residency and then follow it with a toxicology fellowship.  She will have been in residency/fellowship for 7 years by the time she finishes.  She would have made more money if she'd done just emergency medicine (3 years) but I don't think she would have been as happy as she is now.

Practicing medicine just for the money is a quick way to burn out and have issues with depression.  Spending 2 years in order to do what you like is small in terms of mental health for the next 20-30 years.

[Zaphod]

HanSpecial wrote:

Hi All,

My fiancee is a OBGYN resident and is considering a Minimally Invasive Gynecology Surgery (MIGS) fellowship after her 4th year. I read a study on the salaries of MIGS graduates published by the Journal of Minimally Invasive Gynecology and the findings were quite surprising. Essentially, a 2 fellowship in MIGS does not result in any increase in starting salary when compared to Generalist OB/GYN. (https://www.aagl.org/wp-content/uploads/2015/03/PIIS1553465014017622.pdf)

So I am trying to understand why anyone would take on the additional risk of doing a 2 year fellowship when there seems to be no financial incentive. Is it possible that MIGS graduates have less workload in their careers? The study does not provide data about workload throughout a generalist vs. MIGS graduates’ career but I’m curious if any out there have some anecdotal evidence? I imagine that you’re also (probably) more marketable with this specialty?

Any feedback would be appreciated!

Click to expand...

Plastic surgery did a similar study, showing that all a fellowship did was reduce the lifetime amount of money you made, increased student loan principal, etc....You can make a ton of money with a bare bones degree or hardly anything with the most advanced training in your field. Obviously, for some fields there is a big difference, but often just because you did a fellowship doesnt mean those patients will be coming your way or where you end up working has them either.

There are lots of fellowship trained docs doing all kinds of things related and unrelated to their additional training, its not like just because you do an XYZ fellowship you can choose from only XYZ type positions, or they exist in locations you want, etc..etc...

If she does it it should be because she really values the training and feels its necessary to be the best she can be.

One of my partners is a dentist, omfs, and craniofacial trained. All he does now is breast/body, absolutely no bearing.

[The White Coat Investor]

HanSpecial wrote:

Hi All,

My fiancee is a OBGYN resident and is considering a Minimally Invasive Gynecology Surgery (MIGS) fellowship after her 4th year. I read a study on the salaries of MIGS graduates published by the Journal of Minimally Invasive Gynecology and the findings were quite surprising. Essentially, a 2 fellowship in MIGS does not result in any increase in starting salary when compared to Generalist OB/GYN. (https://www.aagl.org/wp-content/uploads/2015/03/PIIS1553465014017622.pdf)

So I am trying to understand why anyone would take on the additional risk of doing a 2 year fellowship when there seems to be no financial incentive. Is it possible that MIGS graduates have less workload in their careers? The study does not provide data about workload throughout a generalist vs. MIGS graduates’ career but I’m curious if any out there have some anecdotal evidence? I imagine that you’re also (probably) more marketable with this specialty?

Any feedback would be appreciated!

Click to expand...

Welcome to medicine. Pediatric specialists often don't get paid more than generalists despite 2-3 years of additional training. Most EM fellowships result in less pay than just seeing patients in the pit. There's no rhyme or reason to it. It just comes from the fact that medicine isn't a true market due to government intervention.

[VagabondMD]

While the starting salary may not be more, her marketability may be greater, and she might find a job where she is doing what she likes doing a greater percentage of the time. My (radiology) practice would not consider hiring someone who is not fellowship-trained, but that is not the case across all specialties and practices. It may be the trend in OB/Gyn in the future...or not.

[MrsIMDoc]

I chose to do a geriatric fellowship after internal medicine where I will absolutely make less money when I graduate.  However, I wanted to do the fellowship because I wanted to learn more.  I find my geriatric patients more rewarding and I enjoy my time more.  However, I definitely lost a year of attending level internal medicine salary during the fellowship and geriatric specific positions pay less in general.  For me it was worth it, but many people might say it is not because you could do everything I will do in my upcoming geriatric position without the fellowship.

[jhwkr542]

Less OB call, perhaps? I don't know all the OB/gyn practice setups but I know several colleagues hate the OB call.

[Hatton]

I am an Ob/Gyn. I think this person intends to never do OB. Most of the risk and lifestyle dissatisfaction comes from ob. Ob can be rewarding but it is costly from an insurance perspective and a personal one. Most General ob/gyns do minimally invasive surgery so this fellowship would only be marketable in a larger community or university setting. I am not surprised by the salary findings. Most of the money in Ob/gyn comes from the Ob practice. Most docs consider themselves to be semi retired when they do just gyn. In my community there are general Ob/gyns, gyn oncologists, urogynecologists, infertility, and maternal fetal medicine. I guess all specialties are really subdividing like this.

[thedudeabides]

My wife did a MIGS fellowship mainly to buy time while I finished residency. It hasn't made a difference in terms of salary....she still practices as a general ob/gyn, but she is much more marketable with that skill set.

She was also a much more confident surgeon coming out of fellowship...many ob/gyn residencies are OB heavy, light on surgery.

She hasn't regretted doing the fellowship at all.

[YYjames]

because it's not about money all the time. Majority of doctors I have met and the ones in my field chose fellowships NOT for money but rather interest in the field. That is permenant memory/satisfaction.

Money comes money goes.