Even if you're only a first-year, life after medical school is looming. Within four short years, you'll be faced with a critical decision — do you enter primary care or do you choose to specialize before launching your practice?
Prior to making your choice, you should know what to expect at every level of medical training. Understanding the expectations, challenges and benefits of residency and fellowship can be vital to maximizing and successfully completing your education.
Residency
In the United States, life after medical school begins with residency, a three-to-five-year training period in either primary care or a medical specialty. Residency must be completed before you can earn board certification or even practice medicine. Start researching programs with the American Medical Association's (AMA) comprehensive database during your second medical school year.
What to expect
The first year of residency is devoted to gaining experience by practicing in different areas of medicine throughout the hospital. Throughout the remaining years, you can expect to focus on specialties and subspecialties as well as developing proficiency in practice with less supervision. According to Medscape, the average resident salary in 2019 is $61,200.
Choosing one
Much more goes into choosing the right residency for your life after medical school than simply picking one in the specialty of your choice. For example, you'll want to consider location when selecting a program, including whether you'd prefer an urban or rural environment, a warm or cold climate or a family-friendly region. In addition, resources from the Association of American Medical Colleges (AAMC) can help you identify a residency that matches with your personality, professional goals and values. Prioritize your choices with the AAMC's Rank Order List.
Challenges
Even after you find the right residency, transitioning to the next phase of medical training does present stumbling blocks. A 2018 AMA survey reports that residents struggle with work-life balance, time pressures, fear of failure or serious mistakes, mastering clinical skills, debt and stress.
Fellowship
The next phase of life after medical school — for those who wish to specialize further — is the two-to-three-year fellowship. If you opt for this route you will develop expertise in a subspecialty. For example, you could focus on high-risk obstetrics, neuroradiology or pediatric rheumatology. Researching programs during your second residency year ensures that you move seamlessly into your fellowship.
What to expect
A fellowship gives you the opportunity to develop your own practice style as you assume greater responsibility for treating patients. The training received during a fellowship enhances what you learned during residency. The American College of Physicians recommends pursuing as much ambulatory and community experience as you can because it more accurately reflects the patient population you will ultimately serve. In terms of your salary, you'll likely earn more than you did as a resident, but not by much.
Choosing One
Unlike residency, a fellowship isn't required. But if you're passionate about a niche area of medicine, a fellowship will help you develop expertise. Apply the same selection criteria you did to your residency, but look for programs that also align with your clinical and research interests. The AMA suggests finding a mentor during your second residency year who can guide you and introduce you to others in your desired subspecialty.
Challenges
Even though you're homing in on a specific passion, you'll still face obstacles during a fellowship. Fellows often have trouble identifying mentors early. Ask your residency program director or senior fellows for recommendations. It might also be difficult to push yourself outside your comfort zone to tackle research projects or take on complex patients. Accept the challenges because you'll have a solid support system. But be careful not to overcommit. The drive to succeed can often lead you to take on too much, which could hinder your performance.
Active practice
After your education is complete, you'll enter practice either in a private or hospital setting. At this point, you've reached the culminating stage of your life after medical school.
What to expect
In this career phase, you'll be responsible for diagnosing, treating and managing patients without supervision. If you opt for private practice, you'll have greater autonomy and more authority over the staff in your clinic. You'll also likely have the option to pursue a partnership path, and your revenue will be controlled by your patient volume. As a hospital-employed physician, you'll have a predictable income, a steady patient base and a built-in referral network.
Choosing one
Deciding whether you want to pursue private practice or hospital employment depends largely on your comfort with risk and your desire for stability and control.
Challenges
The same challenges characterizing today's healthcare environment are still likely to be around when you start practicing. As Medical Economics notes, these issues range widely, from burnout and electronic medical record difficulties to reimbursement changes and quality measure requirements. Hospital-employed physicians must also grapple with more institutional rules, limited control over staff and less say about compensation.
Although your journey to becoming a doctor starts with your choice of medical school, every decision in your life after medical school ultimately determines the outcome of your career as a doctor. Understanding the importance and role of each stepping stone can help you realize your goals.
