After four years of medical school and three or more years of residency, most physicians are eager to begin practicing. More specifically, they are eager to earn the compensation of a fully trained, practicing physician. However, an increasing number of physicians finishing residencies are opting to pursue a physician fellowship, allowing them to further specialize their training.
According to data from the National Resident Matching Program, 2021 saw more fellowship programs, applications, and appointments than any year since 1993, when the Specialties Matching Services began recording the data. There has been a steady increase since 2001, however, as we dive deeper into a critical physician shortage, will subspecialization be an asset or a detriment?
For some physicians, a fellowship is a non-negotiable requirement of the specialty they have chosen to pursue. However, for others, a fellowship is a way to acquire additional training in a specific area of the field in which they are already trained to practice. It is these physicians who, as they enter their last year of residency, often reach out to the physician recruiters at Jackson Physician Search to gauge their employment options while they consider the pros and cons of extending their training with a physician fellowship.
To help them evaluate the ROI on such an important decision, the physician recruiters at JPS advise them to consider the following four questions.
Will This Fellowship Make Me More Employable?
Jackson Physician Search works with organizations all over the country that are seeking physicians to meet the community demand in their area. As a result, our physician recruiters have a clear view of which types of physicians are most in demand. It obviously varies by location, but as we dive deeper into a physician shortage, more organizations are seeking physicians who can take on a broad case mix and perform a wider range of services.
“The biggest need right now is for physicians who can be flexible and provide a wide scope of practice,” says Director of Recruiting, Katie Moeller. “Sometimes a subspecialization can actually make a candidate less attractive.”
As an example, consider a Family Medicine resident who has spent an additional year training in a Sports Medicine fellowship. Perhaps they are hoping to work primarily with athletes or even find employment with a professional sports team. The reality is, these jobs are few and far between, so this physician has essentially limited their employment options. Even if they are willing to work in a broader practice setting, the fellowship may signal to an employer that the candidate’s ultimate goal is to focus on sports as much as possible, and therefore, perhaps not the best long-term fit.
“I would never say, ‘Don’t pursue a fellowship,’” Katie continues, “But physicians need to do some research and be clear about how it may impact their employability and, of course, their income.”
Will This Fellowship Increase My Income Potential?
There’s no doubt, certain specialties earn significantly higher compensation than others. The latest compensation data from Doximity shows specialized surgeons, gastroenterologists, cardiologists, oncologists etc. can earn two to three times as much as their primary care or general surgery counterparts. Obviously, the opportunity cost of those additional 3+ years of training is more than covered by the high compensation commanded by those specialties.
On the other hand, some fellowships provide a subspecialization that is not as likely to increase income. Consider an internal medicine resident applying to a one-year geriatrics fellowship. The resident knows the population is aging and demand for geriatric medicine will be high. She thinks it is likely to increase her attractiveness as a candidate, but will it increase her income?
The Doximity report indicates geriatrics commands an average compensation slightly below that of an internist or family medicine physician. Looking at this hypothetical situation solely through the lens of income maximization, the physician has sacrificed a year in which they could have earned the compensation of a practicing internist in exchange for training in a field that, on average, pays slightly less than general internal medicine.
Do I Feel Called to Pursue This Type of Medicine?
Income and employability aside, many physicians truly feel called to pursue a specific type of medicine that requires one or more fellowships. If a Pediatric resident who survived childhood cancer feels called to spend their career working with other children fighting cancer, they should certainly pursue a pediatric hematology-oncology fellowship.
Though not always so personal, many medical students and residents feel drawn to pursue a certain scope of practice. This feeling is not to be ignored; however, it shouldn’t trump all other considerations. Physicians should seek advice from a mentor in the field to learn more about the reality of practicing in whatever specialty or subspecialty they are considering. They should also consult with a physician recruiter regarding their job prospects and the types of settings and locations available to those trained in that subspecialization.
Can I Become an Expert in This Area While on the Job?
As discussed, some specialties require a lengthy fellowship, however, if the goal is merely to learn more about a specific area of interest, it may be wiser to find a mentor or practice setting that will allow you to continue your training while on the job. In the case of the internist considering geriatrics, they might be better served finding a practice with a significant population of geriatric patients. In the physician interview process, he should make his interest in this subspecialty known and inquire about finding a mentor within the practice. Similarly, a family medicine resident who wants to incorporate obstetrics into their practice doesn’t always need a fellowship. Rather, they could accept a job with a practice that employs experienced OBGYNs or FM-OBs who are willing (or even eager) to be mentors. By pursuing on-the-job training, these physicians can earn full compensation right out of residency even as they continue their training on a specific area of interest.
Exploring these four questions, and researching to find answers where applicable, can help residents make an informed decision about fellowships. Other points to consider are your personal needs with respect to more years in training, student loan deferment, and the geographical and lifestyle implications of a career in your chosen specialty.
Ultimately, only you can answer the question of whether or not to pursue a fellowship. As always, the Jackson Physician Search recruiters are here to talk with you about your options. Contact a Jackson Physician Search Recruitment Specialist today or download the Physician Job Search Playbook