The Fellowship Transition

I am 31 years old, yet here I find myself again at the bottom of a proverbial totem pole just trying to keep my head above water. It’s October 1st tomorrow, which means I’ve just completed the first three months of my fellowship training, a time period of experiencing pretty much every emotion one can have during a transition. I write posts like these for anyone early on in a healthcare career (or any career that requires what feels like endless years of training) to remind them that it never ends. IT. NEVER. ENDS. And I don’t mean that in a negative way— not at all. When I say “it” I’m referring to the inevitable growing pains and steep learning curves that arrive abruptly and at multiple stops along this road.

To be completely truthful, I never want “it” to end. I hope I’m 64 years old with no plans for retirement and thinking to myself, “in what way can I learn more and be challenged?” “In what way can I feel uncomfortable and excited at the prospect of learning a new skill or new subject?” Thinking back to so many pivotal time periods of growth, and it was in those times I was as equally as happy as I was scared. The transition from the comforts of medicine residency to the new challenges of fellowship is no different. I am so happy to be here but still scared at the responsibility that will one day be on my shoulders as a GI attending. Looking back on the past three months, it’s been so thrilling to recognize all that I’ve become more comfortably managing, and small pieces of knowledge that are now instinctive. It will only grow from here.

(Except tell me and all my co-fellows, we totally care!)

(Except tell me and all my co-fellows, we totally care!)

In regards to my fellowship environment, I couldn’t be luckier. Staying at the same hospital where I did residency has it’s major perks (and let’s be honest, some drawbacks.. a completely fresh start is always nice too.) I know pretty much everyone in the hospital, and I didn’t have to navigate a new EMR or jump through hoops just to figure out how to park my car. The last day of residency and the first day of fellowship were only delineated by changing the department name that’s embroidered on the side of my white coat. On top of all the comforts in familiarity, my co-fellows and attendings are quite possibly the most supportive group of people and I knew instantly I could go to any of them with a problem. I wouldn’t be judged or mocked, but I would be helped instantly. A while ago I wrote a blog post on unfortunate/inhumane situations in which healthcare providers had to show up to work (read HERE if you’re interested). I was so touched when one of the current GI fellows wrote to me saying how the entire department had helped them when a personal issue had arisen, no questions asked and completely supportive. This is not the status quo everywhere, and I’m so thankful that this is the culture here. Even better, my 1st year co-fellows turned out to be the most down to earth people (with a good sense of humor) that picturing three years with them by my side made everything feel “right.” I do hope that none of them mind my over-sharing on social media regarding work. If you’re reading this— just know that I love you! I love walking into the fellows room and whatever shade of poop I’m talking about, I’ve got at least eight other people who are intrigued by what I’m saying :-P

On top of all that goodness, our call schedule makes me feel like a normal person for the first time since 2015. I get weekends, SO many weekends completely off! None of this “grey weekend” business that ruined all my plans to frolic aimlessly up and down the east coast as a resident, but REAL weekends. We work one weekend a month, and while you really are put to WORK when you’re on (5pm Friday through 7am Monday you’re the only fellow with both the GI and liver pagers.. and rounding on both services) I would pick this a thousand times over so I may cherish the rest of my wide open Saturdays and Sundays. Of course, we also take home call during the week, too. Sometimes it’s quiet, sometimes I’m jolted awake every hour to address an active issue either from the emergency department or up on the floors. The grogginess the next day can be pretty painful, and I’m sure as the year goes on the real fatigue will kick in, but so far it’s been completely manageable.

In regards to daily work flow, that too has been variable but overall reasonable. Certain days I’m in early and leave pretty late (maybe 6:45am in, 8:30pm out) but most days it’s more like 7am-5:30pm. Some days I’m buried in new consults and the frustration boils at my surface, other days I’m walking around the GI suite looking for more procedures to fill my free time. I’ve learned to hear about and complete every consult graciously. When you’re 6 new consults deep, hearing about the 7th one for a benign reason that could be easily addressed outpatient, it’s natural to attempt talking my way out of it. But the truth is, the time/energy spent in trying to fight it could have easily been used to complete it and move on. Everyone in the hospital is just trying to do their job, and there is no use in complaining/arguing. (Ok, but I could get better about the complaining part.) The hardest part of the week in regards to time management is our clinic days. On Wednesdays for the entire morning, we are seeing outpatients while simultaneously getting paged with new consults. We have to triage over the phone and learn to recognize what needs to be addressed emergently without physically seeing the patient. We learn the skill of racing around the hospital right after clinic (so very hungry, because clinic makes a person ravenous apparently) to see all the consults we’ve just been paged about for the last 5 hours.

Side note- The perks of being a consultant: not having to address discharge dates with care management, not being responsible for pain med regimens, & not putting in orders. IT’S LEGIT

The hardest part so far? Fighting my never-ending insecurities. The inferiority complex kicks in so strong when you have the least experience in the room, back to feeling like a know-nothing medical student or intern again. Sometimes I hope that feeling never goes away, because it really is what motivates me, but some days I long for feeling like the most confident, knowledgable person in the room. What keeps me up at night is getting a call at 2am regarding a sick patient, with uncertainty about what my next step should be. Internal dialogue ranges from “woww I really don’t want to wake my attending” to “yeahhh… I’m going to call them, but let me first read every word of the guidelines in regards to this issue.”

In the midst of all this desire to learn everything about GI and get down to really learning all the nitty-gritty of my career, I had to take internal medicine boards. After long days of knowing nothing and trying to perfect my work flow, I was expected to study for a board certification? Sure, I had been studying before fellowship started, but was disappointed with how much focused time I could devote to my test preparation during those first 6 weeks of training. That creeping feeling came back— the one where no matter what you’re doing, you feel like you should be doing something else. Being completely honest (do I know how to keep embarrassing emotions to myself? Nah…) I walked out of that test and burst into tears. I walked out feeling like the dumbest person in the world, 100% certain I failed. I tortured myself for WEEKS after with so much wasted energy going into trying to remember questions on the test and look up if I got the answer right (inevitably remembering allllll the ones I got wrong.) I wasted so much headspace, and the time of others, just COMPLAINING about how I’m so certain I failed. I still don’t know the results of my test (for all I know maybe I did fail) but it took me over a month to find peace with that. It took me a month of self-inflicted torture to remember that it’s just ONE test, your life is NOT over even if you do fail, and there are so many bigger, more important things to cry over. I allowed one exam to completely consume me and overshadow all the beautiful experiences to be had during this transition period. I really do regret that, and I’m writing this to apologize to myself and remind anyone reading this to save your tears/anxiety for the things that really, truly matter (and nope, that thing is never an exam.)

But back to the good stuff. You guys. SCOPING IS SO MUCH FUN. I could be on the absolute opposite end of the hospital but when the endoscopy fellow texts me from the GI suite saying, “your patient is coming back, are you around to do this EGD?” You better believe I am sprinting, showing up to that room out of breath ready to put gloves on. During residency I was never the person obsessed with doing procedures (even though they are SUPER fun), mostly because I got so easily annoyed with sterile fields. Doing procedures would take away from the efficiency of my workflow on the floors, and other than paracenteses, I knew I wouldn’t be using any of those skills in GI. But endoscopy?? I’d stay late any day to do them. It’s like glorified video games for the super nerd and I’m INTO IT. Count me in. For all of them. I’m there :-)

There was a tiny little voice in the back of my head before starting fellowship that questioned if I made the right decision. How nice it would be, to have all my training complete and finally start working that “real” job with a real salary. While I absolutely love internal medicine for the knowledge base it provided during training, there was no general internist career path that appealed to me. Three more years of being a “PGY” seems pretty daunting but every day I show up knowing I’m exactly where I’m supposed to be— the ultimate blend of procedures to do, patients to see, papers to read, and presentations to speak. Can I see myself at 64 years old happy with what I’m doing and excited for what’s to come in the field of GI? ABSOLUTELY. And I think that’s how you know if it’s right. When the exhilaration of a new and shiny career wears away, will you still look forward to the mundane parts of your job, but still feel like there’s more to explore? If so, go for it. Go with your gut (PUN TOTALLY INTENDED!)


Shanny DO