Focus on Career Path (fellowship versus generalist)

To all those you have started the residency this year, congratulations! To all those who dream of pursuing residency in the US, its just as matter of time as this is something to consider when you begin your PGY1 year. In the first few months of starting your residency, identify the goals and ask yourself this question – what are you planning to get out of this residency? The sooner you delve into this issue the better prepare you will be when it comes to deciding your next plan of action.

1. Do you want to continue being a generalist?
2. Do you want to become a specialist?

Most IMG friendly specialties like internal medicine, family medicine, psychiatry and pediatrics offer very good generalist options.

Residency	Generalist career
Internal Medicine	Internist
	Hospitalist
Family Medicine	Family Physician
Psychiatry	General psychiatrist
Pediatrics	Gen. Pediatrician

If you have decided to pursue being a generalist then you can rest easy in the first year and start looking for jobs at the end of the second year. If you are seriously considering doing specialization, the sadly you will have to be proactive from the first few months of your internship. This is important because some fellowships like Gastroenterology, cardiology, allergy-immunology etc. are very competitive and to have a decent chance of getting these fellowships you have to work hard.

List of potential fellowships for IMG friendly specialties (from American Board of Medical Specialties)

Residency	Specialist career
Internal Medicine	Adolescent Medicine, Advanced Heart Failure and Transplant Cardiology, Cardiovascular Disease, Clinical Cardiac Electrophysiology, Critical Care Medicine, Endocrinology, Diabetes and Metabolism, Gastroenterology, Geriatric Medicine, Hematology, Hospice and Palliative Medicine, Infectious Disease Interventional Cardiology, Medical Oncology, Nephrology, Pulmonary Disease, Rheumatology, Sleep Medicine, Sports Medicine, Transplant Hepatology, Allergy, Asthma and Immunology.
Family Medicine	Adolescent Medicine, Geriatric Medicine, Hospice and Palliative Medicine, Sleep Medicine, Sports Medicine
Psychiatry	Addiction Psychiatry, Child and Adolescent Psychiatry, Forensic Psychiatry, Geriatric Psychiatry, Psychosomatic Medicine
Pediatrics	Adolescent Medicine, Child Abuse Pediatrics, Developmental-Behavioral Pediatrics, Hospice and Palliative Medicine, Medical Toxicology, Neonatal-Perinatal Medicine, Neurodevelopmental Disabilities, Pediatric Cardiology, Pediatric Critical Care Medicine, Pediatric Emergency Medicine, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology-Oncology, Pediatric infectious Diseases, Pediatric Nephrology, Pediatric Pulmonology, Pediatric Rheumatology, Pediatric Transplant Hepatology, Sleep Medicine, Sports Medicine

Tips on improving the chances for fellowship after residency

1. Get in touch with faculty who are specialists in the field
2. Work with them on wards
3. Chose to do elective months in the subject
4. Work with fellows in the field to write up interesting cases – submit case reports to journals or national meetings
5. Work on research in the fields
6. Keep in constant touch with the dept. heads and important professors so you can get their letter of recommendation for fellowship.

Some other fields that are not so IMG friendly are also replete with fellowship opportunities

Residency	Specialist career
Neurology	Brain Injury Medicine, Clinical Neurophysiology, Epilepsy, Neurodevelopmental Disabilities, Neuromuscular Medicine, Pain Medicine, Sleep Medicine, Vascular Neurology
Radiology	Neuroradiology, Nuclear Radiology, Pediatric Radiology, Vascular and Interventional Radiology
Pathology	Blood Banking/Transfusion Medicine, Clinical Informatics, Cytopathology, Dermatopathology, Neuropathology, Chemical Pathology, Forensic Pathology, Hematology Pathology, Medical Microbiology, Molecular Genetic Pathology, Pediatric Pathology.
Anesthesiology	Critical Care Medicine, Hospice and Palliative Medicine, Pain Medicine, Pediatric Anesthesiology, Sleep Medicine

Thus, overall, decide what you want to do at the end of your 3 years of residency. If you are not decided until the middle of the 3^rd year, it is too late to begin the legwork for getting into fellowship. In addition, if you want to be a generalist and continue working in the primary field, even then waiting too long will reduce your negotiating power with the future employers. If you wish to be in touch and get the latest posts and updates, join me on Facebook or follow me on Twitter.