Author Topic: To specialize or not  (Read 1710 times)

affordablehousing

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To specialize or not
« on: June 16, 2017, 11:43:47 AM »
OK, asking the community for some advice here as we prepare for our next life decision. Wife and I live in a low cost of living region where I work remotely, and wife is finishing her last year of medical residency. She is very interested in a sub-specialty that would take a 3 year fellowship, and involve us moving to a very high cost of living area, while she earns a nominal salary, and then allows her to make roughly 75% upon completion of what she would make if she just got a job as a generalist. The intangible payoff is the extra satisfaction of working on more interesting medical situations. I don't want to downplay it, but she would also enjoy particularly the environment of being a generalist.

On the face of it, this is an appalling proposition, exacerbated by the prospect that when my wife enters the workforce fir the first time, she would be almost 40. I'd like to support her career satisfaction above all, but finding the costs pretty significant in this situation. I don't want her hung up on 3 years, when she wants to work for 20.

I'm wondering if there's any medical spouses out there who might have stories to tell.
« Last Edit: June 16, 2017, 03:35:25 PM by affordablehousing »

boarder42

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Re: spousal argument
« Reply #1 on: June 16, 2017, 02:28:50 PM »
Change the title of your thread and I bet you get more traffic you're looking for

BlueHouse

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Re: spousal argument
« Reply #2 on: June 16, 2017, 02:40:29 PM »
You are very fortunate to have a job that makes it so that you can support your wife without any hardship to yourself.   So support her 100%. This is what she wants to be. That is so much more important than how long someone wants to work or how many zeroes they have after their name.

RyanAtTanagra

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Re: spousal argument
« Reply #3 on: June 16, 2017, 02:43:47 PM »
I don't have ANY zeros after my name! :-(  How many is respectable?

affordablehousing

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Re: To specialize or not
« Reply #4 on: June 16, 2017, 03:42:14 PM »
thanks@boarder42, took your suggestion.

for Blue House, should have clarified she's identified pluses and minuses to both paths of specialty versus generalist. I'm not trying to persuade her to do something she doesn't like, and I think that is the issue. The fact that one path returns a lot more and saves three years of misery just adds some significance to the decision and is giving her a harder time trying to decide what she'd like.

Happiness is #1, and I realize how fortunate we are, just wondering if any half medical couples had any thoughts having seen the impacts of their decision to pursue a fellowship or not.

hops

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Re: spousal argument
« Reply #5 on: June 16, 2017, 04:39:30 PM »
You are very fortunate to have a job that makes it so that you can support your wife without any hardship to yourself.   So support her 100%. This is what she wants to be. That is so much more important than how long someone wants to work or how many zeroes they have after their name.

My fiancee's decision to pursue fellowship was essentially made before we met, because she had known since med school that she wanted a subspecialty. So even though we discussed it as a couple and she gave me veto power once it was obvious we planned to marry, using it wasn't an option because I was unwilling to stand in the way of that dream. We were lucky and she was given early admittance into her home program, sparing us the headache of having to uproot our lives. It's indeed fantastic that you have a portable job, that puts you in a much better position than most in your situation.

The only way to make this decision is for her to keep doing some serious soul-searching about how much she might regret passing up the fellowship. Honestly, if it had been up to me I would've preferred my SO to skip it. Her debt creates a lot of stress and it's hard for me to deal with the poor pay in light of the crazy workload and the amount of time we miss out on together. But it's a temporary situation and the time invested is (hopefully) a drop in the bucket compared to the rest of her career.

Gone_fishing

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Re: To specialize or not
« Reply #6 on: June 16, 2017, 05:38:16 PM »
I am the medical spouse (primary care) and have some observations and thoughts that you might want to consider in your decision making:

1.  Money is generally not an important consideration in general, if you are a doctor.  Even as a fellow there is a fairly average salary.  Working conditions for a physician can really suck if you are not in the right job, so all other factors for happiness should come first because the income difference will feel inconsequential.  My first job out of residency, I took a job with a good package and hated it.  I lasted 3 months.  I went to another job and took a huge paycut in addition to moving to a higher cost of living area.  I didn't notice the difference in pay.  Part of it was because at higher pay, a lot more gets taken out in taxes anyway.  Mostly it was because I enjoyed my job a lot more. 

2.  I chose not to specialize and have not regretted it.  Some reasons are:  it is easy to find primary care jobs.  There are a million clinics hiring all around me that I can bike to.  I can change jobs without moving.  I can move almost anywhere and get a job quickly, even in another country.  I can chose almost any work schedule I want.  part time, per diem, locum tenens, no call, etc.  I love the flexibility.   My friends who have specialized have a much smaller pool of jobs to choose from.  Some have commuted over 2 hours a day to get to the closest job they could find, and some have moved to other states or cities.  Some have had to fly to another state (paid for by the employer) every week to run a specialty clinic there.  There is a high likelihood that with a specialization in something other than cardiology, most jobs will be in HCOL areas near academic centers, or in very rural areas. 

3.  You don't have to do fellowship right after residency.  Some people will go back later in life to subspecialize. I know many people who have done this when they have retired, or when their children are grown. At my hospital there is a cardiologist and a rheumatologist who worked in internal medicine for the hospital for most of their career, then did fellowships and came back as specialists.  So if you aren't sure, this is an option.

4. You can still practice as a generalist even if you do a fellowship.  You can also moonlight in primary care at higher attending pay during fellowship to boost income during fellowship.

5.  If you subspecialize, you may have to maintain two board certifications, which is a PITA.

6.  If I really wanted to make money I should have become a plumber or gone into finance.  Med school and residency are not good for finances or early retirement.  But in the end it's about doing what you love and I have no regrets, and either do my friends who have specialized.

7.  One good thing about residency/fellowship is that you are so busy that you don't have time to spend money, and generally the hospital will give you food to eat and scrubs to wear since you practically live there anyway.  So that helps the food and clothing budget.

Hope this helps some!

affordablehousing

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Re: To specialize or not
« Reply #7 on: June 19, 2017, 11:11:43 AM »
Thanks @gone fishing. My wife is still struggling with the simple question of what would she prefer on a pure happiness basis. Our good friend did two residencies, and two fellowships, and started the second round at 41 with a 6 month old, so I know it can be done.

I've advocated, if she truly can't make up her mind, to consider applying to fellowship after a year, and give herself some time to think about whether she'd like it better, after working for a bit as a generalist. I worry that part of the drive to become a sub-specialist, is that it may seem to her more prestigious, which is not always equal to more enjoyable.

Thanks for the advice. I know this is a very fortunate decision she gets to make.