CHESTThought Leader BlogTransitioning Out of Fellowship—So I am Finally a Doctor….

Transitioning Out of Fellowship—So I am Finally a Doctor….

By: Melissa B. Lesko, DO

This 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.

After years of striving toward my next goal, trying to make myself the best possible candidate for medical school, residency, and then fellowship, could it be that I was finally done with training?! I had always known what the next step would be, but now it was not as clear. The 30-something woman in the mirror looked back at me with mock horror when I realized that I was about to embark on the search for my first real job.   

The easiest aspect of applying for a job was completing my curriculum vitae (CV) as I had been required to update it during the course of my fellowship. Next, I started to tackle my cover letter. This was extremely challenging for me because I needed to describe the job that I was seeking. It seemed as though many of the positions were looking for someone who wanted to practice primarily pulmonary or critical care medicine, but not both. As a third-year fellow, I found it difficult to fathom abandoning any of the skillsets that I acquired throughout my training. After all, I enjoyed the complexities of pulmonary pathophysiology, caring for patients and their families in the medical intensive care unit, as well as performing bronchoscopies.    

The process of applying for a job and reviewing a contract is one that is seldom discussed in detail as a part of medical education. This exclusion is ironic given the fact that your contract can dictate the parameters of your practice. My other friends, who are already an attending, urged me to evaluate my contract for “tail” coverage and the specifics of the restrictive covenant, especially in a city like New York. Both of these terms were foreign to me. Delving into unchartered territory was becoming a theme this year, and I began educating myself about another aspect of my transition out of fellowship.

Another issue, which presented itself, was that both pulmonary and critical care medicine were becoming more subspecialized.  It seemed as though my fellowship training alone was insufficient. Even though I was just graduating, I needed a niche. Given the disconnect between the ideals that I had for my first job and the qualifications that were sought for new hires, I found that my first meeting about a potential job opportunity was less than satisfying.

At some point in the year, I found myself making an important transition. I stopped seeing myself as “just a fellow” who had the goal of obtaining a job and started to think about myself as a clinician, a future attending physician. How did I see myself practicing over the next several years? What patients did I want to care for and in what kind of environment? To help answer these questions, I made a list of interests that I had and goals that I wanted to achieve. I later realized that maybe the idea of a niche could be interchanged with having a direction. After all, it is difficult for an employer to invest in a person or in the development of his or her career, especially if its course is unclear to that individual. 

After months of thinking in circles and driving family, my close friends, and myself crazy, I gained perspective. It seemed like it happened all of a sudden and without any conscious knowledge on my part. This insight led me to accept a position focused on advanced lung disease with a nominal amount of time spent on critical care.

I had a flashback to my first day of internship. As I left my apartment that day I put on my long white coat and stared at myself in the mirror. Acutely aware of my lack of clinical knowledge and experience, I certainly did not feel like a doctor. Although now secure in my role as a physician, in a few months, I will face another difficult transition by becoming an attending physician. Yet, I am confident that I will overcome this as well. As FDR once said, “the only limit to our realization of tomorrow will be our doubt of today.”

Melissa LeskoMelissa B. Lesko, DO, is a graduate of the Philadelphia College of Osteopathic Medicine. She trained in internal medicine at St. Luke's - Roosevelt Hospital Center in New York City. She is currently ending her third year as a pulmonary and critical care medicine fellow at New York University Medical Center and will stay on as faculty following graduation.