Inquire within. Reflect on the past clinical experiences you have had. What cases/clinical questions excite you? Do you like getting paged about incoming traumas? Where do you feel that time just flies by? Are you in the intensive care unit? In a clinic? Coming off cardiopulmonary bypass? Do you like just being in the operating room? Combine this information with your geographic preferences. If it is your desire to practice in a rural area where there are little in the way of specialists, you will be doing everything and must feel comfortable in doing so. Whereas in more medically populated areas of the country, you may not have the option of “doing everything” without subspecialty training. Cardiac fellowship training may be requested even for a single valve case in an otherwise healthy individual. Reflect on the clinical experiences that made you feel alive and combine this with culture of the area you would like to practice.
Veer away from the beaten path. As a resident, you will receive a lot of advice and hear many different cautionary tales. Most of your class may swing heavily towards fellowship or private practice. Do not look at the majority as a tacit implication to follow the pack. Do not pursue fellowship on the basis that it will pay more, or it will confer more job stability. When you do what you love, you carry an enthusiasm, a levity to your work that your colleagues and patients will feel. It will drive opportunities your way that others, who are just doing the motions, will not have. You will be more resilient and will burn bright instead of burning out.
Envision your ideal day down to the smallest detail. Would you like a clinic setting or an operating room, an intensive care unit? A large hospital or local one? Who do you like serving? Children? Pregnant women? Across the age spectrum? What does your ideal workday look like? Every type of case has a cadence- some are relaxed like an ambulatory GI suite, others are more regimented, like that of a neurosurgery or cardiac room. Who do you like working with? Working with a urologist is different than with an obstetrician.
The choice to pursue fellowship is a question of what types of problems do you like to solve? Keeping in mind where you want to practice and how much you want to hone your interests will provide clarity if pursuing a fellowship is right for you. Recognize that you may not use your fellowship. The job opportunity you select may include little time in the area where you did fellowship training. Whichever path you chose, this is a journey of self-discovery, there are no mistakes. Do a deep DIVE, make your decision, and enjoy the ride.
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