For residents considering fellowship training, it’s crucial to believe the time investment will lead to a fulfilling career once they are in practice. But how do you achieve confidence in your decision?
Those who have been there say it’s about considering all the options, being comfortable with your future colleagues and patients, and understanding the day-to-day aspects of the job.
Dayna Isaacs, MD, MPH, a second-year hematology-oncology fellow in Northern California, said it was in residency that she found a new direction for her career.
“I initially applied to internal medicine residency thinking that I was going to be a hospitalist, and that was on all my applications and my personal statement,” said Dr. Isaacs, who also is a delegate for the AMA Resident and Fellow Section. “But during residency, I was drawn to the outpatient clinic setting. I really valued the continuity and relationship-building with patients and their families.”
Even if you have already found the right path, it’s worth taking time to consider the entirety of what your life will be like before taking the leap. Move ahead in your subspecialty fellowship journey with these three steps.
Explore the possibilities
As you progress through residency training, you will have opportunities to explore a range of subspecialties. Truly give each one a chance, said Dr. Isaacs. She, for example, found herself won over to hematology-oncology during an inpatient service in which residents had the opportunity to drive the medical management of patients on chemotherapy, immunotherapy and targeted therapy.
“I had the opportunity to spend meaningful time with that patient population, and that's what initially drew me to” the subspecialty, Dr. Isaacs said.
That is advice that resonates with James Mossner, MD, MS, a sixth-year resident in neurological surgery in Chicago who will soon be pursuing fellowship training in stereotactic and functional neurosurgery in Oregon. He recommends keeping “a very open mind” to all possibilities.
“Even if you have an idea of what you might want to do, you'll be surprised when you're actually in the throes of rounding, or in the operating room, or whatever it might be, and how different or similarly validating it could be of an experience for you,” he said.
The AMA’s Specialty Guide simplifies residents’ subspecialty-selection process, details training information and provides access to related association information. The guide is produced by FREIDA™, the AMA Residency & Fellowship Database®, which offers a streamlined experience and includes information on thousands of fellowship programs accredited by the Accreditation Council for Graduate Medical Education.
Look at who will be around you
Ask yourself: When you become a practicing physician in this subspecialty, who will you be spending much of your time with at work? Patients in clinic? Fellow researchers and colleagues? Those are the people with whom you will want to make sure you connect, say others who have been in your shoes.
For Dr. Isaacs, the key to the fit was patients, but Dr. Mossner said it was through his time with functional neurosurgeons that he realized he had found the right crowd.
“That's when I really felt like these were my people,” he said. “I really just jibed with the neurosurgeons. They were—not to be too on the nose, but—a very cerebral group of people.”
Find the lifestyle that works for you
Whether you will be working in outpatient or inpatient settings, in clinic or conducting research, it’s crucial to know what you will be getting yourself into in terms of lifestyle, said Dr. Mossner, an alternate delegate for the AMA Resident and Fellow Section.
“Seeing what the next seven years of your life is going to be like is extremely important,” he advised, referencing the length of residency training in neurological surgery, to which Dr. Mossner will be adding an eighth year of training when he does his functional neurosurgery fellowship.
Another way to explore various fields of medicine is with the AMA “Shadow Me” Specialty Series, which offers advice directly from physicians about life in their specialties.
For her part, Dr. Isaacs made sure to request hematology-oncology clinic time to “get a better assessment of what the day-to-day life as an oncologist would look like since the patients in the hospital are a lot sicker than the patients in clinic.”
She also suggested considering which subspecialties “are inpatient-heavy and which ones are outpatient-heavy as a career.” It’s about “making sure that you get to see the realistic” experience that you’ll be living.
“If someone’s interested in outpatient cardiology,” she said, they should explore “what outpatient cardiology looks like, as well. Because the coronary care unit (or CCU) might not be the most accurate depiction of day-to-day clinic life as a cardiologist, for instance.”
At the end of the day, you should be able to imagine a realistic picture of your life practicing in a given physician subspecialty—and envision enjoying the fruits of your hard work. When you’ve made the right decision, you will feel like you belong in the job.
“Everything about it [the subspecialty] just really fit what I was looking for: the research, the personalities, the spectrum of disease, the operations,” Dr. Mossner said. “It was just right.”
Find out more about the AMA Resident and Fellow Section, which gives voice to—and advocates on—issues that affect resident and fellow physicians.
