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Is fellowship worth it? (married to high income spouse)

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  • Is fellowship worth it? (married to high income spouse)

    Currently a resident in a surgical field contemplating fellowship. My spouse recently finished training. He is a high income earner (over $500k yearly, we expect him to be close to 7 figures at some point), we have about $2M net worth and no debt. We have one child but would like more eventually. I am trying to figure out whether it is worth it financially to practice full time given our tax burden. Bluntly put, is another W2 worth it?

    I enjoy what I do but could probably find other things I like more with less call and more independence (such as entrepreneurial endeavors). I am deciding between the following A) pursue fellowship and maximize my ability to handle tough cases, do complicated surgeries and build a busy clinical practice (eventual earning potential likely $200-600k depending on business model) B) pursue fellowship and work part time, splitting time between work, kids, entrepreneurship and investments/family duties C) pursue the latter option (part time work/kids/entrepreneurship) without fellowship as a generalist. What would you do? Is fellowship worth it?

  • #2
    Depends what your current residency is. General surgery followed by a surgical subspecialty? Or peds followed by a surgical fellowship?

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    • #3
      Thank you so much for your reply! For the sake of remaining anonymous, I am in a surgical specialty (so something like ortho vs plastics vs ophthalmology).

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      • #4
        Depends on the income and lifestyle options available to you without the fellowship vs. with it. If the fellowship would not increase these by much, then it probably would not pay.
        If one member of the family makes 500k to 1M, and the other makes 200-600k then of course it is worth working. Your tax bracket maxes out and you get to keep all of the after tax income.

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        • #5
          maybe not..

          imo it’s all often an all-in type commitment which to me wouldn’t be worth it in your situation (fellowship, taking all tough cases, call, flying to meetings, chasing the best job regardless of location) ... unless if that is just how you are wired

          otherwise you can still be a competent doc who can help a lot of people but have a life.. or just do something rude

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          • #6
            If the fellowship is only 1 year, then do it. Practice that part time. You never know what can happen to your marriage (although it may be possible to do a late fellowship if life leads you that way). If you are ophtho, maybe don't do peds.

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            • #7
              Originally posted by Brains428
              . If you are ophtho, maybe don't do peds.
              How dare you....

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              • #8
                I think it depends on what the fellowship is and how difficult it is going to be.

                Before I started fellowship, I was told it would be the funnest year of training because you get to simply learn and not be bogged down by some of the negatives that attendinghood carries (I should qualify this with the fact that I did a very cushy fellowship. I'm sure this might not be the same for a hardcore surgical fellowship)

                I still look back at that year very fondly even though my income and networth were both puny.

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                • #9
                  I think a "wasted" fellowship is better than never having done it & pondering "what if...?" down the road. Once you graduate, you will never have the chance to do a fellowship. Doing it now will be a minor inconvenience for a lifetime of additional opportunities. That you aren't required to pursue if it doesn't end up suiting you.

                  I say go for it.
                  "Oh look another bajillion point declin-Ooooh!!! A coupon for pizza!!!!" <--- This is what everyone's IPS should be. ✓✓✓

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                  • #10
                    Originally posted by spindlecell View Post
                    Currently a resident in a surgical field contemplating fellowship. My spouse recently finished training. He is a high income earner (over $500k yearly, we expect him to be close to 7 figures at some point), we have about $2M net worth and no debt. We have one child but would like more eventually. I am trying to figure out whether it is worth it financially to practice full time given our tax burden. Bluntly put, is another W2 worth it?

                    I enjoy what I do but could probably find other things I like more with less call and more independence (such as entrepreneurial endeavors). I am deciding between the following A) pursue fellowship and maximize my ability to handle tough cases, do complicated surgeries and build a busy clinical practice (eventual earning potential likely $200-600k depending on business model) B) pursue fellowship and work part time, splitting time between work, kids, entrepreneurship and investments/family duties C) pursue the latter option (part time work/kids/entrepreneurship) without fellowship as a generalist. What would you do? Is fellowship worth it?
                    You should work if you'd like to work. We decided to do a fellowship because it allowed for jobs/careers which were not available without.

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                    • #11
                      Originally posted by adventure View Post
                      You should work if you'd like to work. We decided to do a fellowship because it allowed for jobs/careers which were not available without.
                      Just a word of caution.
                      •Do a fellowship and part time is a very idealistic plan.
                      •Recently finished fellowship and have a $2m NW is an unusual but great place to be.
                      •Regardless of the residency, there will be substantial competition for fellowships and getting started in practicing your specialty. The interesting complicated cases and building your brand and referral base takes dedication. No one will “give you” the patient flow in a surgical specialty. Once practicing, case volumes matter and competition will continue.
                      •Fellowship (or two) should probably be based on what type of skills and how hard you want work in developing your skills and practice. The kicker is “part time “ the competition for the generalist things are the fellowship trained physicians as well . They will do those too.
                      •If you are set on part time from the start, only do the fellowship if you want to have those opportunities in the future. Part time is going to be difficult from a career satisfaction standpoint straight out of residency.

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                      • #12
                        You don’t need money. Do what you want.

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