There are probably endless blog posts, social media outcries and self-help guides for the new Fellow Physician – an optional step in medical training that is NOT required, by the way; something to not be forgotten… The transition through medical training I’ve always found cumbersome, as I’m sure many others do. The first installment of being a medical student and the anxiety to attempt learning all the things while not knowing really what direction you’ll be going – we all probably wanted to be a surgeon, but few of us are. The second installment of progressing to residency and being actually called a ‘Doctor’ increasingly with more and more responsibility; yet, still not with full fledged autonomous expectations most of the time, even at the end. Then the third installment of Attendinghood and making the decisions and living with those consequences when the safety net of education isn’t below you. Yet, the choose-your-own-ending chapter to move on to a quasi-second and a half installment to go to Fellowship is a curious place to be, especially for someone like me that worked as an attending for 3 years prior to being back in the training arena – I went backwards in some regards and far upwards in others.
While I have many thoughts on the concept of working between installments of education in our lives, a thought i’m very passionate about and advocate for for so many reasons of real world experiential gain, I write this not to address that path. Instead, I wanted to share some of my thoughts for any onlookers about truthful and honest things that went through my head at different points in the process: 1) Deciding if i should go to Fellowship in the first place vs. the alternative options, 2) The questions to ask on the interview trail, and 3) What I looked for in ranking a program as well as what I looked for when I started. Obviously, my perspective is focused on the world of Pediatric Subspecialty medicine, but I feel some of the concepts can be extrapolated to other fields based on one’s passions and personal life goals.
Before The Interview Process
What are my interested in doing and why? Do I love a field of medicine so much that I can’t live without it? What will I give up with the time it will take me to go that direction? Will the “life-hours” as one of my mentors asked me, add up and make me wish I had gone another way? Is the salary going to justify the lifestyle and the loan situation, or do I care? What is my long-term plan and where do I want to be?
And, after my exploration of locum tenens specifically: What does the job market look like down the road? With changes in the health care landscape including big data, artificial intelligence, systemic protocols and oversight, where will I be and at what time will I lose my Autonomy? What if i want to leave medicine… Will going to fellowship help me with this or pigeon-hole me? Are my going to be working my life away for a loss of gain and a loss of autonomy? What life style is important to me?
Maybe somewhat existential questions, but in my few years prior to returning to fellowship, I spent a long time contemplating my meaning in the first place. It is important to stop and take a second to breathe and explore, since, as doctors we are all hardwired to go go go and commit to a lengthy path we don’t know we’re entangled in too deeply, until it’s too late.
For the Interview Trail
I will never forget hearing about the cafeterias and the access to free coffee and the number of gyms that a program had when I looked at Residency Programs. I didn’t care then and I care even less now after taking a few years to actually work. The questions I asked this time around looking into Fellowship were what mattered at deeper levels to me. Some superficial things can add up, and I suppose if someone can’t survive without designated parking, it can become quite a hassle, but I encourage thoughts into the serious factors of life versus the small talk. EVERY place will have it’s pros and cons, but deciding what those really are for oneself is very important.
What is the training environment like? Where do your graduates go? Is there faculty support, or is the faculty supportive? Don’t tell me about the food, tell me about the benefits?
And, after my exploration of locum tenens and discussion with multiple facilities and recruiters specifically: What skills can you offer me to bolster my CV/resume for the future job market? What this program offer me if I fall apart completely and am in dire straight for whatever life reason may happen?
After the Interview
For fellowship it’s always important to consider mentorship. It has such a larger role than it did for me as a resident or medical student where I was able to stumble through like a lone wolf and somehow make it out in one piece. But, with the emphasis on fellowship to create a super expert and specialist in a particular field means to create a Leader and this is brought on by innovative research and coordination of multidisciplinary teams for multifactorial problems and holistic care. When I made my rank list, I took into consideration the place I was moving to, the balance of life I was looking towards, and the kind of physician they sought to create. My process focused on the steps that come AFTER fellowship is over, the life I know so well as a Locum Tenens and the ability to create my own path. Do NOT rank prestige over people, but do rank the unknown over the known. I sought out a new adventure as I always have as The Nomadic Pediatrician. And, if it doesn’t work out, everything is temporary, isn’t it?
Trust your instinct, keep your humility, know that you know something, and re-remember that you could be the smartest person in the room, but that won’t ever supplant experience. In the end, as my philosophy is for all things, you will end up exactly where you need to be. Getting there is never obvious, sometimes not easy, and always worth it.
Not a single damn part of me regrets the choices I’ve made. I have lived what I consider a mostly full life and one experiences has begotten the next. What a journey each new day has brought, and only by perseverance to never stop going.
The Nomadic Pediatrician 