Home CHEST Thought Leaders Fellowship: It’s Lonely at the Top

Fellowship: It’s Lonely at the Top

By: Meredith Greer, MD

Meredith Greer, MDThis post is a part of our Life as a Fellow blog post series. This series includes "fellow life lessons" from current trainees in leadership with CHEST.




People tell you lots of things to prepare you for fellowship: the hours are long, you’ve got to be self-motivated, be sure to get a good mentor, the list goes on—but one thing that nobody seems to pass along from year to year is how lonely it is once you’re finally at the top. Of course, I don’t mean at the top of everything. In fact, you end up in this sort of weird purgatory in between the residents and the attendings, boarded in a specialty that you’re not practicing and not yet boarded in the specialty in which you’re expected to be an expert. At first, I thought this might just be a phenomenon true to pulmonary/critical care or related to the size of the program or brought on by leaving one’s home institution. Yet, the more I was open in discussing my loneliness with my friends from residency and fellowship, the more I realized the feeling was universal. Everyone I spoke to had, at one point or another in fellowship, found themselves alone.

On polling these friends, I came across three common reasons for this loneliness:

  1. New city, new institution, new people
  2. Feeling alone in your thoughts, differentials, and medical decision making
  3. Living in limbo—no longer a resident, not yet an attending

So, I want to acknowledge, here and now, that if you’re feeling this way—you are not alone! We are all right there with you, or at least have been in recent years, and want to remedy the situation by giving you some simple advice.

First and foremost, be friends with your co-fellows. It may be a small group of people, and you may think you have nothing in common outside of the hospital, but you’re all going through the same things at work. Make a group text and put your thoughts and feelings out there. Share your questions about cases and patient care—this way, if you’re not on the same service or even at the same hospital, you’ll feel more like you’re making decisions with a team rather than on your own.

With regards to feeling in limbo, just bridge the gap. It is okay to be friends with residents and attendings; they’re people too! Maintaining the medical hierarchy while building friendships is possible and can make fellowship a lot more pleasant. In particular, the junior faculty can be very helpful. They were in your place just a few years ago and remember well what you are going through. Ask to get a coffee, a beer, or a bite to eat. In my experience they’re always more than happy to help.

Nobody told me that fellowship would be lonely. But now I know. It may feel like a “you problem” in the beginning, but really it’s just a part of the process. Everyone has either been through it already or will go through it at some point in their career. Now that it’s out in the open, help us pass it on, so that first-year fellows and future fellows to come know what to expect and know that in their loneliness, they are in fact, not alone.