3. Are you academically inclined?
In my opinion, it’s incredibly unfair to ask so early in the decision process if you are interested in pursuing private practice or an academic career. People change, and opportunities present themselves in ways that change professional trajectories. But it’s a decision that must be made.
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Explore This IssueAugust 2019
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You should take a self-inventory to see if you fit into the shoes of a clinician, researcher or teacher. Talking to your staff physicians in a frank and respectful manner can help you make this tough decision. Reach out to your local rheumatology society or other contacts to find rheumatologists in private practice to talk with. Remember, there’s a whole universe of options, and you can enter industry, government or journalism, too.
In short, your list of programs should match whatever your heart desires. If you seek basic science research, perhaps going to a larger institution with more resources, support and contacts would be advisable. If you seek private practice, programs with electives set in the community may be higher on your list.
4. Who will help you on your career path?
Fellowship programs often have flashy websites that detail what faculty members are doing. Study those websites closely. They provide clues about who can help in your career development. But these websites often don’t mention a lot about the fellow physicians, which is a pity, because that represents real information that can make or break a decision to apply to a program. Who are the current fellows? What are they doing? Where did fellow graduates go? The success of your fellowship depends on your predecessors. If you’re seeking a career path that has already been traveled by another, your challenges become far less foreboding. Resources and mentors may be available to help you in your development, as they have been for previous fellows.
The productivity of fellows can be a good proxy for gauging institutional support. Scholarly work is rarely, if ever, done in isolation; rather, it requires an entire ecosystem of support and mentorship. Robust records of scholarship by fellows may indicate fertile ground for future academic growth. Involvement in ACR activities, institutional awards and leadership positions may suggest fellows have the support to achieve their highest potential.
5. How do you want to grow?
This is possibly the biggest and most difficult question to answer. Many people have ideas about what they want to do in fellowship and why. They have elaborate visions of research activities or clinical practice, some of which actually do happen. Others have a rough sketch of their future plans. Few are able to detail exactly how they want to become a rheumatologist.
Are you interested in greater autonomy and exploration? Certainly, some programs have a hands-off educational philosophy and encourage electives and free time for individual pursuits. Do you require greater structure? Indeed, some trainees need greater direction within a supportive learning environment. More didactic conferences, greater supervision in clinics, dedicated mentorship committees and detailed curricula may be signs of such an environment.
There’s only one way to help answer this question: a detailed self-examination of how you have been learning during residency and medical school. Because our own self-perceptions are often not reflective of reality, asking others, including colleagues and mentors, is absolutely necessary. The other caveat is that fellowship is totally different from residency, and the lessons from the past may not be as applicable to the future as you may think.