CHESTThought Leader Blog10 Things I Wish I Knew at the End of Fellowship

10 Things I Wish I Knew at the End of Fellowship

By: Fiore Mastroianni, MD

This post is part of our Life as a Fellow blog post series, which features “fellow life lessons” from current trainees in leadership with CHEST.

1. Practice what you need.
Have you run ICU rounds without the attending’s input yet? Did you do an EBUS start to finish without the attending touching the scope? Do you feel like you need to spend another week or two in asthma clinic because your new position is 50% airways disease clinic? Do those things now! Third year fellows’ schedules often have a lot of research and elective time; fashion those months to meet your future needs, whatever they may be.

2. Find all of your documents.
Credentialing offices will want every document you ever had. One hospital held up my packet because I did not list my high school graduation year. Gather your medical school and residency diplomas, state licenses, DEA certificate, board certifications, social security card, passport, and more. Take a photo of each document, and store it on your desktop for easy access later. Replacing those things takes time and is frustrating, so start the process now before you realize you lost your social security card during your last move and your passport expired in 2019.

3. Maintain your own procedure log.
Future jobs may want a list of your procedures. Often, summary totals are not enough, so keep your own running spreadsheet with the facility, date, and procedure done (no identifying information). This can be expanded when you are an attending, making future credentialing processes much easier. You will probably lose access to your fellowship procedure logger after you graduate, so do it now.

4. Shop for life/disability insurance now.
Life and disability insurance may be important depending on your own personal family and financial situation. It is hard to think about your own death or significant disability, but you need to consider those financially dependent on you and what would happen if your income disappeared. Many insurance companies have trainee discounts up to 6 months after graduation. Rates are partially based on age and health status—you are not getting any younger! Your GME office likely has an agent who is familiar with the discounts and can get you some quotes.

5. Start budgeting for your new salary.
You may be interested in buying a house, a car, or moving after fellowship. See what your expenses are right now, and look a year or two into the future to estimate how much you will be able to save and what new expenses you will have. I wanted to purchase a house after my wife finished fellowship, and we ended up having a second child. These were within our budget because we thought of them early on and focused on saving for them. Some banks offer financial planning services, loan refinancing, retirement help, and additional benefits at no to little cost.

6. Ask your new employer for things before you sign your contract.
As a fellow, you get the schedule you get and the expectation is you will do the work even if it means staying late, working most weekends, and missing holidays. I was surprised how many requests I could make and how many fewer weekends I had to work as an attending. Things like licensing fees, boards fees, prep courses, and conference trips will likely be more easily reimbursed when you become an attending. Want different parking? A laptop? A TEE probe? Loan assistance? Maybe your new place will pony up—but only if you ask! Don’t rush to sign the first contract you get; you may be willing to negotiate more.

7. Make an educational portfolio.
You likely have a variety of talks, slides, and papers saved from fellowship. Some may be on shared drives or websites you will soon lose access to. Make a folder of your presentations, important reference papers, and conferences now. These can be the foundation of your future resident and fellow education and will allow you to have a few talks in your pocket if you are asked to give a noon conference soon after you start.

8. Apply for things.
Is there anything you can do as a fellow you can’t do after? Look for academic awards/competitions at your institution, local or professional society grants or prizes, and other educational discounts. Have you considered applying to CHEST’s trainee work group?

9. Plan for the critical care boards (usually in November).
Will you need to request significant time off to study, take a review course, or get a question bank? The exam is in the fall, but you will probably have more time over the summer months to dedicate to board prep. Remember to request the day of your boards off and be especially careful if you work nights that your sleep schedule will be good for you in the days before. Register early to avoid the late fee, and lock in a testing center close to home.

10. Have a lawyer review your employment contract.
You’re a doctor, not a contract lawyer. Ask your attorney about what can happen to your pay, one party ending the contract early, and noncompete clauses. Most likely, everything will work out great in your new position, but if it does not, you need to know your options if you decide you want to break the contract, have a pay dispute, or want to change your duties. Some rules are state-specific, so you may want to consult with an attorney in the state of your new position.



Fiore Mastroianni, MD

Fiore Mastroianni, MD

Dr. Mastroianni is an assistant professor of medicine at NYU Long Island School of Medicine. He is interested in ultrasound education and is a lifelong Long Islander. You can reach him on Twitter at @FioreSono.