To train more or practice

Should you do a fellowship? 5 questions to ask yourself

A fellowship can open doors and allow physicians to gain more focused knowledge, but pursuing a subspecialty isn’t for everyone.


After four years of medical school and three to seven years of residency, the last thing on your mind might be more training. A fellowship, however, allows physicians to focus on a particular patient population or develop further expertise on a particular organ system.

DO interest in pursuing fellowship training continues to grow. Osteopathic applicants who submitted rank order lists to the NRMP fellowship match have increased 47.3% in the past four years.

The DO talked to physicians from a variety of subspecialties about what residents should take into consideration before pursuing a fellowship. Here is what they had to say.

1. Are you passionate about a narrower focus?

Merril Krolick, DO, an interventional cardiology program director at Largo Medical Center in Largo, Florida, trains physicians for a subspecialty after they’ve completed three years in residency and another three years in a cardiology fellowship. He looks for physicians who are continually striving for excellence in their care and want to train younger physicians.

“I don’t want people to just learn and train here, I want people who are going to give back to the community,” Dr. Krolick says.

As a geriatric program director, Nicol Joseph, DO, says fellows should be willing to go the extra mile for patients to help yield better patient outcomes.

“Pursuing a fellowship is one of the best decisions I have made as a physician,” Dr. Joseph says. ” It has awarded me a lot of opportunities, helped me become a better physician and I truly enjoy my work.”

2. Will additional training help you reach your goals?

For Dr. Joseph, completing a geriatric fellowship aligned perfectly with her desire for treating the elderly. As a family medicine physician she could see geriatric patients as part of her practice, but  completing a fellowship increased her level of comfort with this patient population.

“I felt that if I was going to work with elderly patients I needed to have the additional training to do so,” Dr. Joseph says.

Before applying to a fellowship, she suggests examining whether it will help a physician reach their long-term career goals.

“If your goal is [a career in] medical education or [health care] administration, then a fellowship may be of additional benefit,” Dr. Joseph says.

3. Do you know enough about the specialty?

Jennie Kwon, DO, an assistant professor of medicine at Washington University School of Medicine in St. Louis, became interested in infectious diseases during her first microbiology lecture during medical school. Her interest in multi-drug resistant organisms further solidified during an infectious diseases rotation where she had the opportunity to take care of patients who were septic due to MDROs.

She suggests residents complete a rotation in the particular specialty they are interested in to truly understand the role of a specialist.

“That will allow you to get a sense of the daily work of the specialist,” Dr. Kwon says. “If you are very interested in a particular program, consider even doing an audition rotation at the fellowship of interest.”

4. Does the lifestyle suit you?

Dr. Krolick says physicians looking into fellowships should consider the demands of the specialty and how they would fit in with their family and home life.

“It really depends on the lifestyle you want,” Dr. Krolick says. “Are you dedicated enough to come in the middle of the night or do you want to be a general practitioner with set hours?”

For Michele Gilsenan, DO, sports medicine has allowed her to practice in a variety of settings, including colleges, school districts and even ringside for World Wrestling Entertainment.

“You’ll certainly need a flexible lifestyle when you first start out due to team coverage and unforeseen injuries that come up, but you can define your practice any way you wish,” Dr. Gilsenan says.

5. Does it make sense financially?

A fellowship can take another 1 to 3 years of training to complete, which of course pays less than a physician out of training.

“This will be one more year that someone won’t be able to start a practice or have the income of a practicing physician,” Dr. Gilsenan says. “It’s definitely something to think about.”

While some physicians want to jump straight into practice after residency, physicians who sub-specialize generally have higher incomes.

According to the 2018 Medscape Physician Compensation Report, on average specialists make $106,000 more a year than primary care physicians.

Because of the amount of debt many medical students will incur during their education, Dr. Krolick believes this should be a part of the decision on whether to pursue a fellowship.

“You need to think about when you want to be able to pay your student loans back,” Dr. Krolick says.

One comment

  1. Mary Jo Robinson

    If you have done an Osteopathic residency, does the specialty have an Osteopathic fellowship? If not, and there is NO Osteopathic pathway for fellowship Certification of added qualification or other certification in tha fellowship pathway, DO NOT Take the fellowship. This is because currently ACGME. Fellowships will NOT allow you to take certification exams unless you did the ACGME residency first. This may change, but right now….it is not possible. Also the Bureau of Osteopathic Specialists is not receptive to adding additional CAQ exams in response to new fellowship categories, unless there are enough people available to take all the exam each year. Their cut off is 40 people per year. Need to make it financially feasible you see…

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