Hello! Longtime reader here! I am a third year Medicine resident at a notoriously grueling program in the southwest (which I love and would choose a thousand times over if I had to do my Match again...) on the brink of finishing my residency. I am heading into a Chief Resident year which should be a nice break - at my program we are junior faculty, paid as such but only attend for two months and have 10 months of administrative and educational work. I am mom to one lovely 9 week old baby girl. My husband is not in medicine and is currently a stay-at-home dad. I'm struggling in my decision of when and whether to pursue fellowship, and here's why...
As an intern I fell in love with critical care. I loved the fast pace, the gratification of seeing a septic shock patient turn around in hours, loved working with a big team of folks to bring someone back to health. I even liked the end of life issues and family discussions. I liked the idea that even when I had nothing in the way of medical treatments to offer I could still help the patient (and more often, the intubated/sedated patient's family) come to terms with the end of life. I did a block of Pulmonary Consult at our large tertiary referral center and found the physiology and multisystem diseases that involve the lungs very interesting as well.
I'm not sure what happened this year - if I just got tired and burned out (we have 4 ICU blocks a year, still have 30h resident call q4, minimal outpatient stuff) - but I grew tired of the same old thing in the ICU. I got annoyed when families wanted their 85 year old grandfather with two primary cancers and septic shock to be a full code. I got tired of the overdoses and alcoholics in DTs we see at our county hospital coming in night after night, their self destructive behavior the reason for thousands of our taxpayer dollars being spent to dry them out, extubate them, and discharge them to homeless shelters or broken homes to continue their substance abuse. Even some of the pulmonary sub-specialty patients started to annoy me; most of them are in and out of the hospital frequently and have been sick all their lives with congenital heart and/or lung disease and have the "sick person" mentality.
After slogging through months of call while pregnant and finally having my baby girl here with me - the thought of heading into fellowship after my Chief year makes my stomach turn. I am so tired of being a resident! The toddler inside me is stomping her feet and wants to be the BOSS already and stop having to run everything by an attending all the time. I'm tired of 80 hour work weeks. I'm exhausted.
I am considering taking a year to work as a hospitalist and consider my options. On one hand - hospital medicine pays enough for us to live comfortably, in my opinion (I did not grow up with much and neither did my husband) and the moonlighting opportunities in my area would enable me to very easily make an extra $50K by working three very easy nights a month. Scraping along on $50K as a fellow for three more years makes me feel sick...and we want more kids - it would be way easier to do that as a hospitalist than a fellow in a program with 3 or 4 fellows per year.
On the other hand - in my heart of hearts I fear general hospital medicine will not be enough for me. I want to be a specialist - someone who is consulted to assist with a sick and complicated patient. I like pulmonary medicine and while I would probably not do critical care full time or even half time, I wouldn't mind keeping a toe in the water in an academic Pulm/CC position - a few consult months, a few inpatient ICU months, etc. I can't imagine doing any other fellowship really...so if I do specialize, I think Pulm/CC is it for me. And I fear if I go the hospitalist route I will never go back to do my fellowship.
Any ideas? Is it better to do fellowship now when my kid(s) are young? Should I just gut it out a few more years and get through it? If I wait to do fellowship, my kid(s) will be older - won't they miss me more? But I can't stomach the thought of doing a fellowship now. Would love to hear the perspective of you brilliant ladies :)