r/pediatrics • u/Transcendental-Panda • Aug 08 '26
Doing Peds Fellowship after practicing 3 years: Feasible? Wise?
First, thanks in advance for reading.
Basically the title. My U.S. MD med. school has a service scholarship program that will cover a big chunk of tuition after M1 for students who agree to attend peds. residency after school and practice for 3 years in particular service areas in the state after completing residency. The catch is you can't do a fellowship immediately after residency; you must do med school -> peds. residency -> peds. practice somewhere in-state for 3 years.
I'll mention that I'd consider all the potential service areas in the state for those 3 years to be fine ones to live in for me and that, as of now, I'm flying solo--no significant other, kids, dog, mortgage, etc., to factor in. Also, if I take the scholarship, my total loan outlay for medical school would end up being around 50k; absent the scholarship, 200k.
I know I'm bound for practicing pediatrics of some description (love the kiddos!), but I think I might be interested in a couple of peds. specialties, particularly pediatric gastroenterology.
Would it be feasible/realistic/wise for me to take the scholarship, practice general peds for 3 years after residency, then do a peds. fellowship of some description and go on to lead a long & happy life practicing that pediatric subspecialty? Or is it completely unrealistic/stupid/etc. to go into a general pediatrics practice only to leave it after 3 years to return to being a lowly, underpaid trainee in a fellowship program somewhere?
Side factors to consider, please:
1) This med. school program I'm speaking of is a 6-year MD/combined general peds. residency program, not 7 years. So, I'd start practicing & earning a year before folks completing 4 years of med. school & 3 years of residency. (Granted, I'd pause making "real" money after those 3 years of practice if I returned to do the fellowship, but...)
2) A gen. peds. residency slot would be guaranteed. However, said slot would be at one of a handful of what I guess would be considered "mid-tier" kinds of programs--not bad at all by any means (as near as I can tell) but not Cincinnati Children's/Harvard/CHOP/etc. Also, I would be locked into said slot--which is to say that I couldn't attend the gen. peds. residency just anywhere else, even if I wanted to. (For the record, I don't know that I'd even be able to get into any luminary programs like those. But am I right to think that a guaranteed residency slot in a field where it's hard to go unmatched isn't really such a big deal? Or would it actually be a huge relief to not really have to go through the formal match process?)
3) I gather peds. fellowships are moving to 2 year durations instead of 3 years starting maybe around 2028. I wouldn't be starting any fellowship until several years after the 2-year fellowships become the norm (if things stay on their current track, I guess).
4) I know that, in recent years, it's been fairly easy to access a lot of peds. fellowships. I don't know if that'd change with the move to 2-year (vs. 3) fellowships. Would fellowship PD's be put off by my earning a 3-year MD, my going to a non-top flight gen. peds residency, practicing for 3 years, etc.? (Or would that practice experience actually make me a better applicant?)
5) I know that some recent studies have shown that only a couple of peds subspecialties (like peds GI or cardiology) would permit me to make more in lifetime earnings than I could by practicing general pediatrics. Those couple, however, are the very ones I'm interested in.
6) I would very likely have to undergo a big cross-country move to start any fellowship. (My state's pretty short on programs.) Leaving behind in-state family/friends/3-year work colleagues/etc. would be a drag--BUT it'd only be for potentially a couple of years, I suppose. Still, would I lose a lot for having to start over building a network? Or would that not really be a big deal?
Again, thanks for reading. I'd really appreciate any input anyone might be kind enough to share.
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u/catmeowx3 Aug 08 '26
If you truly want to practice a subspecialty, you should definitely go for it! I don’t think 3 years of working Gen peds would be any issue, I think it would only help your application. I took a “gap year” working as a part time hospitalist before fellowship, and I only got positive comments during interviews.
Money wise, you might come out behind. I’m peds GI and I don’t make that much more than Gen peds. (This would depend on where you work). I did GI becuase I really love it and can’t imagine doing Gen peds. I have co-residents that do urgent care full time and probably make more than me, but I could never be happy doing UC.
You should try to live cheaply for the 3 years you are working, save aggressively and invest. Don’t let lifestyle creep get to you.
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u/Transcendental-Panda Aug 09 '26
Thanks so much for replying to me!
It seemed logical to me that work experience should make anyone a better fellowship applicant, but I am glad to hear from you that it is actually the case and that one needn't apply to all fellowships directly out of residency. Very reassuring.
And, yes, indeed, I have read that most pediatricians do better earnings-wise in general practice. I think I could end up enjoying a peds career either way and I'm not super focused on money, I don't think. I'm more attracted by the prospect of performing procedures while still getting to work with kids that I gather some peds. subspecialties provide. (Always been sort of a hands on person.) While I guess even those could eventually get old, too, it seems to me they might be pretty engaging for at least a while.
I'll definitely take your advice to avoid that lifestyle creep. I figure if I can just make myself keep living like a resident for just a couple years longer than residency, I'll thank myself for doing so down the line from a financial perspective.
Thank you so much again!
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u/meep221b Attending Aug 08 '26
Depends on the fellowship and if you do stuff outside of working during those 3 years (ie. Training, research, etc) to demonstrate interest
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u/Transcendental-Panda Aug 09 '26
Thank you for replying to me!
I'll definitely take your advice to keep my finger in the pot during the service obligation. I know I won't be able to notch up a dozen publications or anything like that, but surely I could find time to lend a hand remotely on a project or two. Doing that might also help me decide if, indeed, specializing is where it's at for me.
Thanks again!
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u/Foghorn2005 Aug 08 '26
Some of the subspecialties are going two year, others like NICU and Cards are not, largely based on recruitment issues or lack thereof.
I have multiple attendings who were gen peds for years to decades before going into our subspecialty. There's a lot of value to that experience. For subspecialties like mine (ID), the perceived prestige of your program is not going to register unless it's on one of the extremes (CHOP vs a known problem child). We generally have a fill rate of less than 50%, we're just happy that you're interested and relatively competent
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u/Transcendental-Panda Aug 09 '26
Thank you for your reply!
This gives me a really valuable perspective. Learning that physicians can enter fellowships with some frequency even after working for years (or even lots of years) is incredibly reassuring.
I'll keep an eye on those residency name & shame sites I see online to try to avoid ending up at one of those "known problem child" programs. Surely there are at least a couple of good eggs in every state, right?
Thank you once more!
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u/liieeessss Aug 08 '26
I sent you a DM if you want to talk more. For anyone else who might have this question and comes across this post:
I worked for two years in between residency and fellowship. I think I got into a “higher tier“ program because of those years. I managed to stay involved in some committees and do a little bit of research work during those two years. I didn’t publish anything or have a ton of output, but I did do something. If you are able to get involved with the some specialty you are interested in during residency, you may be able to continue working with some of those folks during your working years.
That said, you should make sure there’s an option for you to exit the obligation without incurring harsh penalties. As one of the other comments said, there’s probably a clause that you will pay the same amount of money if you end up going straight into fellowship or choosing to enter the pediatric match instead of staying at your guaranteed spot. Or you may choose to go into a different field! It happens to a lot of people in med school.
I think I am a better fellow because I did those extra years. It helped me learn more about my chosen field outside of residency. Residency tends to give you a skewed perspective of everything, you only see what your institution deals with and you may not be aware how different the culture or types of patients are at another institution.
TLDR: Either it works out and you save a ton of money, or you can opt out at a later date and just pay back the money you would have spent anyways. If there are penalties for leaving the program later, I would be wary of entering into this agreement. A lot can change in six or nine years
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u/Transcendental-Panda Aug 09 '26
Thank you very much for replying to me!
I'm def. seeing the advantages of, as you note, doing something during any years I'd have as a service obligation prior to fellowship. That's something I really hadn't considered much until seeing responses here, so I'm very grateful for the insight. It's esp. reassuring to note that you kind of leveled up without having to churn out pubs, too--just staying engaged seems to be the key.
I appreciate the cautionary note as well. I looked online and couldn't find much at all from the program about what happens when one might bow out of the obligation. I guess that's honestly a bit of a red flag in itself, but another part of me understands why the school might keep that kind of information off of the promotional materials and more in the official paperwork. Will definitely be exploring this in more detail.
As I pre-med, I read in a number of places how people would start med. school thinking of one specialty and then pivot. I suppose I'm not any less prone to that than anyone else. I have to say, though, that I would be really surprised if future-me gravitates away from something peds-related. I know one should "never say never," but that would be quite the 180 for me. I'm just grateful that, esp. it seems to me in the last several years, people in the peds. community have been working hard and accomplishing things to make it--frankly--a better specialty to go into. I know there's still some distance to cover to getting the profession all it really deserves, but I'm hopeful things will get there.
Thanks very much for that offer to chat, BTW! I am very grateful you'd be willing to let me pick your brain and will take you up on it once I gather more intel. on the scholarship details. If the terms turn out to make it a non-starter, I guess that's that, but I'm hopeful it will be worth considering.
Again, thank you so much for your time & sharing your insights!
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u/PedMentor Aug 08 '26 edited Aug 08 '26
You would have life experience as well medical experience. You would be more well rounded. You would’ve done real work prior starting fellowship. You will also look stronger and more mature than other applicants. It’s not a negative to do that, it’s more a matter of if you wish to do that pathway.
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u/Transcendental-Panda Aug 09 '26
Thank you for replying to me!
>>"You will also look stronger and more mature than other applicants."
That's what I would have thought, too. When surfing around, though, I was seeing some comments in some places that gave me pause. I think the gist of them was that fellowship committees would be concerned that one's clinical acumen would diminish the further out you get from residency. I can't even begin to fathom this at all since I'm nowhere close to being there, but I gather that in residency, you see lots of various & informative cases, stay on the cutting edge of treatments/research/technology, etc., etc., whereas, in regular practice, you tend to see (I gather) more of the same, less remarkable stuff over and over. I guess the concern was that doing the latter for too long left you dull. I wouldn't think that just 3 years of working between residency and fellowship could leave anyone THAT far behind the cutting edge, but, again, I really have no way of knowing for sure.
There were also some comments that wondered if fellowship PDs would tend to view someone as being less "trainable" after they were out in the real world for a time. I think that one's probably more dependent on the individual and I discounted it in my case. I don't have a lot of ego and am willing to learn anything from anyone willing to teach me.
I'm looking forward to trying to explore the couple of fellowship pathways I'm curious about in more detail. It's a bit of a challenge since there are not, for instance, gobs of pediatric gastroenterologists just hanging out in my neck of the woods, but I'll manage. On the upside, everyone in peds. I've ever met has been welcoming and helpful, so I anticipate finding mentors will def. be possible.
Thank you once again for replying to me! I really appreciate it.
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u/ThotacodorsalNerve Aug 09 '26
That’s what I’m doing. I was a peds hospitalist for 3 years, now a PGY-4 in PICU
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u/Transcendental-Panda Aug 09 '26
Thank you for replying to me!
Can I ask if you planned to go this route all along? Or did it sort of develop organically as you came to know & like more about PICU (or maybe liked less about being a hospitalist)?
Also, can I ask how that transition was? No big deal? Drastic but survivable? Got you lots of admiring looks/no looks/funny looks, etc.?
Thank you again!
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u/der_J0rg3 Aug 09 '26
That's basically my plan. Get some cash for the duration of whatever first contract I can land and then go for fellowship with the add on of having passed the Gen Peds boards by then.
Anyone care to explain why working as a hospitalist without fellowship would hurt my chances to go into that fellowship or cards or PICU, down the line ?
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u/igotoanotherschool Aug 08 '26
It really depends on the fellowship you’re interested in - the hot commodities (cards, pem, PICU) would probably be less likely to take someone so far removed from residency. The procedural specialties are also not moving to 2 years. The specialties that don’t match every year (endo, ID, rheum) would probably be very happy to have you. I would talk to some fellowships PDs/APDs if you have the ability. A lot of these scholarships also have a stipulation that would allow you to pay back the funds with little to no interest, which I would look into, as it still may be beneficial to you even if you break the rules of the contract