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keeping attending job while completing 1 year fellowship?

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  • Avatar rbc001 
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    My husband (Pulm/CC attending) is looking to apply for a 1-year sleep medicine fellowship.  What we’re trying to figure out is…  can he keep his attending job while in fellowship, ie is this kosher with the ACGME?  His current employer is OK with this arrangement.  He will be able to follow the work hour rules ( ex. <80 hrs/wk)…  I would think his attending job could just be viewed as “External moonlighting”, but not sure. Has anybody done anything similar or have any words of wisdom?  What we don’t want is to grind out a hard year, and then find out we broke some buried ACGME rule.  Thanks!

    #229583 Reply
    Avatar Panscan 
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    More about if the fellowship is OK with it. I mean he’s going to push 80 alone in fellowship probably. How is he going to work more and still meet the reqs? (not that anyone actually cares about it).

    #229598 Reply
    q-school q-school 
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    i don’t know the mechanics but i do know several people who kept their job and returned to same practice after 6 mo or year of additional training.   they continued to be paid something while they did the fellowship.

    #229599 Reply
    Avatar bean1970 
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    is the fellowship at the same place he is currently working?  who is funding the fellowship (ie is it coming from CMS dollars)? i think (it might take me a while to find my powerpoint i went to on GME funding issues i stashed away)  that is the hitch in this issue as there are rules about collecting CMS dollars as a GME trainee and billing in the same institution.    if the fellowship is funding out of private dollars or he works in a place that doesn’t collect CMS funding for trainees, then i think you could be clear…. and otherwise yes ACGME will care about duty hours between each position as they would be combined for work done for each….

    i had a resident that prior to starting residency was working for the institution as a researcher and we had to ensure she was off the payroll before the residency program could actually pay her because of the CMS issue….and as far as i know she wasn’t billing but there was a hitch as well….  bottom line if you are at the same institution you may want to sort this out…..

    #229605 Reply
    Avatar rbc001 
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    The fellowship will be a different place than where he holds his attending job. I’m not sure of the funding for the fellowship – he’s meeting with the director soon and we will ask that question. Worst case he could just continue taking his attending paycheck and not take the fellowship paycheck, as it will be smaller anyways… right?

    And the fellowship is actually a pretty easy one as far as hours go. He will work 40hrs/wk or less, so staying under that #80 should be pretty easy

    #229723 Reply
    fatlittlepig fatlittlepig 
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    LOL, that sounds absolutely miserable why would you encourage someone to do this. BTW a 40 hr work week is full time.

    #229735 Reply
    Liked by Zaphod
    CordMcNally CordMcNally 
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    I don’t see how it is any different than moonlighting in residency or fellowship. I mean, it sounds awful to have both jobs. Maybe he’ll learn how important sleep is during that fellowship and try to get more of it.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #229770 Reply
    Liked by Zaphod
    Avatar Kamban 
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    Maybe he’ll learn how important sleep is during that fellowship and try to get more of it.

    Click to expand…

    Hopefully that sleep fellowship should help him?

    #229781 Reply
    Liked by Peds, CordMcNally
    Avatar Radonlake 
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    I would also say maybe he can do some attending stuff as moonlighting but for anyone else (other than the person wanting to work this) to say full time fellowship + full time attending is “easy” because he can stay under 80 hours is somewhat concerning, particularly since it seems to be a two different places so there is likely additional commute and part of the fellowship activities are at night.

    To me, it sounds like a family loving husband is trying everything to keep his family afloat by doing something crazy like trying to work attending + fellowship. And it maybe possible, and it is laudible he wants to try – but I would not regard it “easy”.  And hopefully the family appreciates it.

    Everyone else regards a 40hr a week a full time job, interesting how in medicine the jobs become “easy” just as long as they stay below 80hrs/week 😉

    #229804 Reply
    Avatar southernerdoc 
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    Splash Refinancing Bonus

    I would love to complete a fellowship, but would also need to work at least part-time.  I’ve given up on the idea for now though.

    #229817 Reply
    fatlittlepig fatlittlepig 
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    The fellowship will be a different place than where he holds his attending job. I’m not sure of the funding for the fellowship – he’s meeting with the director soon and we will ask that question. Worst case he could just continue taking his attending paycheck and not take the fellowship paycheck, as it will be smaller anyways… right?

    And the fellowship is actually a pretty easy one as far as hours go. He will work 40hrs/wk or less, so staying under that #80 should be pretty easy

    Click to expand…

    sorry this is a stupid idea..

    #229848 Reply
    Avatar rbc001 
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    So in regards to lifestyle… I probably portrayed the year more heinous than it actually will be. We vetted the longterm pros/cons and lifestyle ramifications with close family, friends and respected colleagues.

    I was attempting to ask – under the WORST circumstances would his schedule violate any ACGME rules. Thanks for those who answered that question.

    #229855 Reply
    fatlittlepig fatlittlepig 
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    doing a fellowship and working as a critical care physician are mutually exclusive, that plan makes no sense.

    #229858 Reply
    Avatar Radonlake 
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    The fellowship institution should be able to give you a rundown of their rules. ACGME duty hour rules not only give a total max but also have other stipulations as off time between shifts and total lengths of shifts/consecutive work hours. As several others pointed out, funding may be a problem and needs to be discussed too.

    Sorry if we sound critical of your vetted plans but unless his attending job is fully aware of the fellowship and supportive and they want to make it work by allowing him to tailor his shifts around the fellowship,  I cannot see how you can avoid getting in ACGME duty hour problems or problems at his attending job. Even moonlighting fellows and residents usually get in trouble with the ACGME rules. And for sure working 40 hours in addition to the fellowship seems to violate the spirit of a fellowship which should let you immerse into whatever you are learning. This raises the suspicion that particular fellowship must be so “easy” and “undemanding” that it may not be worth the whole effort (other than for getting a certificate?). Only your husband can probably answer these questions. It sounds though all your questions care about it that he can keep both jobs and at least an attending salary coming in but I may be reading that wrong.

    #229870 Reply

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