Since I have today off, I thought I’d take a few minutes to write about my decision to pursue a medical subspecialty fellowship.  Ever since I can remember, I’ve wanted to grow up and become an exceptional physician, with emphasis on the clinical track.  I find the earliest physicians, like Hippocrates, fascinating in the sense that they utilized observation as their basis for formulating diagnoses and treatment of patients.

Currently, I’m approximately four months away from completing my PGY-2 year.  What does this ultimately mean?  If I want to continue training directly from residency, now is the time to begin thinking about and putting together application materials for a potential 2018 GI fellowship appointment.  General Internal Medicine is a fantastic field, one that I feel proud to be a member of.  However, my desire to sub-specialize takes into account numerous facets.  I concluded that I needed a well thought-out “Pros vs Cons” chart to help compartmentalize my feelings with respect to either route.  Here’s a summary of my findings for and against each.

Fellowship (GI)

Hospitalist

Pro Con Pro Con
  • Half of my day doing procedures, other half doing medicine.
  • I enjoy the consultant role
  • I want to be an expert diagnostician within a particular medical field.
  • Grandpa had Celiac disease, I can be an expert in an area like that to help others.
  • Have both hospital and office hours
  • Less note writing, more specific
  • GI blends moderately stressful clinical situations with interesting medical -clinical problems.
  • Ability to follow patients long-term
  • I genuinely enjoy gastroenterology as a topic.
  • Additional 3-4 years training (initial loss of $660K**)
  • Will delay “establishing roots” and paying back student loans.
  • Competitive – may not match
  • Application process/cost ($$, getting letters of rec., etc.)
  • Need to really push to produce more publications.
  • Schedule will be more intense (on call shifts)
  • Make ~$225K+ salary right out of residency.
  • Done with formal training
  • Settle down with my wife immediately after finishing residency (house, establish roots).
  • Be the “QB” of the medical world
  • Take care of a wide range of acute patients
  • Schedule – one week on (12 hours/day), one week off
  • Social work
  • Social work
  • Social work – SNF/ALF/LTAC/other placement issues.
  • Very large patient load
  • Consider hospital’s expectations – length of stay, quotas.
  • Fielding a lot of pages – basically on 24/7 the days I’m working, when problems arise.
  • Fewer procedures
  • No long-term follow up; will go to their outpatient doctors.

** Assuming a Hospitalist salary of $225,000 and Fellow salary of $60,000/year, this is the amount of money I would “lose out on,” or not get, because of additional training required to specialize (“opportunity cost”).

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