Neurology Nuts and Bolts: Constructing Your Career, Taking a Gap Year: Between Residency and Fellowship

Transcript

[MUSIC] Welcome to the Neurology Nuts and Bolts podcast all about constructing your career in neurology.

I'm your host Sarah Schaefer from the Yale School of Medicine.

Today, as part of the types of career series, we will be speaking about taking a gap year between residency and fellowship with Christian Omlong, Movement Disorders Fellow at Columbia, and Paul Sanmartin, ICU EEG Fellow at Yale.

Thank you for joining us, Christian and Paul.

Well, hi.

Thanks for having us.

All right.

So let's start with you, Paul.

When did you decide to take a gap year between residency and fellowship, and why did you make that decision?

Oh, well, you know, I was in a way, I was forced to do it because I'm under a visa and I need to work with an X amount of years.

And right after I finished neurology, I needed to renew my visa, but the only way I could do it is by working.

So I took initially what I thought it was going to be a couple of years and then ended up being three years, and that's how it happened.

So before joining neurology, I knew that such thing will happen.

And that's because you had done residency, a second residency in internal medicine previously, so you had reached the extent of your training that was allowed under your visa.

Is that correct?

That's correct.

I did a full medicine residency before neurology, so my normal visa will allow you to study for six years, and that's the reason why I had to to switch to to work.

What about you, Christian?

When did you decide to take a year off and why did you make that decision?

Yeah.

So at some point in residency, I made the decision.

I just felt like that residency was pretty hard.

And then I wanted to have some time in between training to get some more experience, have some more time for my family.

And then I think during my third year of residency, I made the decision that I would like to spend a year as a new hospitalist.

Actually, with reduced time, I only had like 50% contract to work part-time during that one year.

All right.

So you're going into my next question.

So why don't you finish answering that one, which is what did you end up doing during that year off?

During that year, I worked as a new hospitalist at Yale, which was great, actually, because I trained at Yale.

So it was like a small community hospital.

I was working for one week, then I was one week off.

And then the second half of the year, I was actually completely off.

I just moonlighted, worked in clinic with some of our movement resource attendings at Yale.

It was like, it was a very great time because I had a lot of opportunities to design my schedule the way I wanted it and to explore things, specialties, also like non-medical stuff that I didn't have time for doing residency.

And also, it was great to have that opportunity to work as a new hospitalist.

I felt like when I started my first week, I remember it was like, I realized, oh, there's so much I don't know.

And there's so much more that I have to learn.

And the great part about being, doing it at a hospital that was affiliated with my residency or the institution where I did residency, was that I was very, it was very easy for me to stay in touch with my previous, my old attendings and the view too.

Like, you know, like, whenever I had questions, whenever I had concerns, I was able to reach out to get input.

So in a way, I was paid as an attending, but I was kind of a fellow.

I would say like a new hospitalist fellow.

So I think there was a, there was something that I didn't actually anticipate, but it was a tremendous learning opportunity that still helps me now when doing move-in disorders.

Well, I have to say that that experience of relying on your old colleagues to help you as a new attending doesn't matter if you're right out of residency or if you've done a fellowship, I definitely had the same experience and was texting a lot of people and calling a lot of people my first few months as an attending.

So, so, yeah, it sounds pretty, pretty familiar.

What did you end up doing, Paul?

So I went for, to work as a new hospital, the same as Christian.

I worked there for three years.

I was in Hartford Hospital, which was affiliated to Yukon.

I was part of the residency program as well.

And, and you know, I can, I'd love the time, time over there.

I mean, and I had the same experience as Christian.

I remember the first couple of weeks were tough.

And I remember reaching to all my mentors and, and attendings at Yale because, you know, you always have questions.

And one of the great things about working is that sometimes you don't know what you, sometimes you don't know what you know, and also you don't know what you don't know sometimes.

It's a very interesting experience.

So, I was lucky enough that I kept good relationships with who were my attendings at the, at the Yale, and I was calling them frequently, I would say, and learning not only from there, but also from the new residents, from the new attending that I met, the new institution.

So that's what I did.

And I had the same spiritual as Christian, seven days on, seven days off.

You never get tired with that schedule.

I enjoyed it.

It sounds like you both just wanted a little bit time to be human as well, which is something that, that's, that some people in medicine maybe need to learn that lesson.

It doesn't work to be, to be a normal person.

Absolutely.

I mean, listen, the thing is, if you think about it, in theory, you finish residency on June 30, and then you start fellowship on July 1.

There's not a lot of space in between to explore in your life.

And, and sure, like for some people, fellowship can be more relaxed or can be less stressful than residency, but it doesn't have to be like, I think in many ways it's like a very decisive step in your medical career.

So I think it's nice to have just a moment to breathe and read just like two things that you hadn't been able to do before.

I, for example, I spent some, I love traveling, so I spend some, a lot of time traveling to whenever I could.

I'm German, I was able to go back to Germany to spend a month with my family, which is, which you couldn't do if you have, if you do residency or fellowship.

And when you got back into the training circuit and when you were off interviewing for fellowships, you know, I think, I think some people might wonder if taking these gap years could be a black mark on their application, if that would raise some eyebrows from fellowship directors.

What were both of your experiences with that?

I have to say it was not so, because I'm doing a movement disorder, so I interviewed right at the end of P124 at the end, because it's very late in the, for neurology fellowships.

And I didn't have actually any comments whatsoever.

Whenever I said, you know, I would like to stay for a year as a new hospitalist, no one had any concerns or was giving me any hard time, asking critical questions.

I actually, like a lot of people encouraged me to do so.

And honestly, at the end, I understood why it's not, I wouldn't say it's a gap or like a loss, it's just, it's part of your training.

Again, I can say that I really solidified my, my general neurology knowledge a lot.

It's just, it's so much different when you see patients as an attending compared to as a trainee.

And I think that reinforces you to, to sharpen your knowledge, to read, be really on top of what you do, to double check, to double check every decision that you make.

And I think it just made me better neurologist.

And I suspect maybe that's why I didn't get any questions about it, to be honest with you.

And Paul, what was your experience?

Well, you know, when, when I applied, I, my experience was great.

I mean, when I was applying for fellowship, I only applied to one place, to be honest, I went back to where I trained.

And no, there were, there were very, very supportive.

And then when I started the training, like Christian, I completely agree with what a Christian said.

It's, it's different to see a patient as a trainee, to see a patient as an attending.

You're, as an attending, you're able to see the full feature where as a trainee and we evolve when, when through these, you have to be focusing on things like documentation, the teacher summary, you know, things that probably are not pure medicine.

But we're not going to be able to do that.

So coming back, I could see the difference, even the people with whom I have worked a few years after I go, they saw the difference.

So on my applying process, I never, never thought that people were concerned about my training or concerned about this gap that I agree with Christian.

It's not even, it's not a gap.

I mean, it's, it's basically invaluable time of learning and teaching and neurology.

So I don't consider it as a gap.

I imagine not just learning neurology, but becoming a more confident and more independently, a naturally independent practitioner, which, you know, as a fellow, I'm sure would be looked at as, as a benefit.

Yes, oh, definitely.

Yes, you are, you're independent, you know, it's, it's, it's something unique, something that you will experience once you step out of either residence, your fellowship.

It's great.

I think there are also two other aspects.

One is that no matter what you do, even if you have, if you're super subspecialized, you only see movement as well as Parkinson's in my case, you know, the patient is, you know, as a human being is complex, has like different, different conditions and is going to have general and logic questions too, or problems.

So it's, or just like medical issues.

And of course, if it's more complex to you, we have to, it's an expert consultation and refer the patient.

But if it's simple, I think it's also beneficial for the patient in the way of powerful, powerful for you to be able to, to address like, at least minor issues.

So the patient doesn't have to see like 10 different specialists.

The other aspect is, it's, I think it's hard to find after fellowship a position in academic, let's say you do a certain fellowship.

I think it's very hard to find a position where you only see patients of that subspecialty.

In many cases, I believe you see at least portion of general logic patients, or you spend some time in the inpatient service, regardless of your specialty.

I honestly think that at that point, when you, when you're finishing a fellowship and you're applying for a faculty position, that experience of having worked as an in-house specialist is actually advantageous.

It might be beneficial for your application because that's very valuable experience that comes in handy when you start working as an attending, regardless of like your position.

I could absolutely see that I've Dix-Hallpike'd and Epley'd people in my Parkinson's clinic and, you know, given triptans for headaches and diagnosed neuromuscular conditions and all kinds of things.

So I could absolutely see that.

Now, one thing that I did want to ask you guys about is that obviously, you know, you go from a residency salary to a attending salary, and often that's double or more what you might be making in residency.

And then back to a fellowship trainee salary, how did you sort of approach that roller coaster financially?

Paul?

Well, you know, in my case, Sarah, I'm a little on my own.

I'm single.

I really didn't have any problems adapting to the new salary either to go to have the salary attending or coming back to have the federal attending.

So I didn't have any issues.

But I know what I remember telling people that I was going to do this, that was the first question, how are you going to deal with this?

But I really, I really have no issues at all.

What about you, Christian?

So in my case, it's a little bit special because, as I said, I work part-time.

I take me only work for half a year, then the other half of the year did, you know, whatever I wanted to do.

So the benefit of that was that I had half of the attending salary, which was exactly the salary that I had as a resident and later as a fellow.

So it was like, there's no difference whatsoever, which I liked.

So I had the same salary.

I worked much less.

And we could just enjoy life and do a lot of interesting stuff in medicine too.

Also, like, in preparation of my fellowship that I couldn't have done otherwise.

Yeah.

So in terms of, and then I was actually, the nice part was that I was able to moonlight as an attending, which is much better than moonlighting as a resident.

But overall, my salary was like more or less the same, I would say.

And as you guys have gone out into the world, have you talked to other people who have done this and did they have different reasons than you?

I could imagine some people might have family planning type reasons or reasons related to a spouse's job.

And do you have any other insights from other people you've spoken to?

You know, it's interesting that you say it, I think, Paul is the only one that I know that I can think of right now that has done that.

Otherwise, most people just most people I know, you know, finished residency and went straight to fellowship, which I, you know, which makes sense.

So I don't, I don't, I don't, Paul, do you know anyone else?

I know.

So, you know, I did medicine for us in neurology.

And I know a lot of the specialty medicine people who for several reasons visa issues, research or family planning, like you mentioned, Sarah, they've been working for years.

I actually have one of my best, one of my best friends is he's attending of somebody who was our co-resident in medicine.

So she spent six years working and then she joined a pulmonary critical care program in New Jersey.

And actually, my friend who is who is actually, we were all co-resident is for attending.

So I know us, I work, well, at least five or six people.

And their experience, interestingly, is always very good.

And they all tell you that they say the same thing that after working for some time, we develop that experience.

And sometimes after residency, you're not ready, you're not really ready on your own.

You're not sure what to do next.

And actually those years of working and time off, like Christian said, really guides you in a way to, to, to a final specialty.

So all those people that I know, they, they're happy with their final decision.

Great.

So what advice would you have for anybody who might be listening and, and considering this pathway for themselves?

Paul, you want to start?

Sure.

Good.

I mean, it's always good to have a break.

Being and attending not only carries more responsibilities, but also you have more time for yourself, for your family.

And medicine is a tough world and it takes years for training.

And don't be disencouraged by anything.

I mean, during that time, you will learn a lot, you'll be able to practice independently.

And the first few weeks are going to be interesting.

But you always have your mentors, people who train you at your different institutions who will back you up.

I think if you do it, you will not regret it.

And as I always say, you know, this is not a gap.

I mean, it's a time of knowledge.

It's a time of, it's an invaluable time that you can actually use.

A time of growth.

Correct.

In many, many, not only neurology as a person, but I do, I do photography and the only time of I travel the world taking pictures.

And I have seven days that I have to come back, be in neurology again and then travel again.

So it is really those three years were among the best three years of my life.

Christian?

Yeah, I just, I absolutely agree with Paul.

I think it would encourage anyone or everyone to consider it as an option.

I wouldn't see it as a gap year.

I think it's an extension of your training in a way.

It can help you make, make it a better clinician and maybe like a more holistic human being because you're, you have some more time, maybe hopefully to focus on other aspects of life and of yourself.

That's giving you more, you know, just a bit more of knowledge and wisdom in a way, maybe, for the, for the next steps and for the future.

Yeah, I would encourage anyone to or everyone to rethink about it.

Well, you guys have certainly made me want to go back in time and to a gap year or two.

Oh, well, it's too late now.

Well, thank you both for sharing your wisdom, your, your gained knowledge and wisdom with, with me and our listeners.

I appreciate your time.

Thank you so much for having us.

Thanks so much for having us.

Neurology, Nuts and Bolts podcast was created and produced by myself, Sarah Schaefer.

This podcast is not recorded as an official podcast of any institution or organization.

The podcast is unfunded.

Opinions are those of the individual participants.

Music by Audrey Nath, artwork by Shivani Ghoshal.

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