Sub-specializing

[dented]

Does anyone know whether after you sub-specialize or do a fellowship you can go back and work generally in your field? This has probably been discussed before on this forum but I cant find any info through a search.

 

For instance: Do a 5 year general surgery residency, do a 1 year trauma fellowship, work on a trauma team for a bit, and then go back to being a general surgeon?

 

Thanks

[thebouque]

Does anyone know whether after you sub-specialize or do a fellowship you can go back and work generally in your field? This has probably been discussed before on this forum but I cant find any info through a search.

 

For instance: Do a 5 year general surgery residency, do a 1 year trauma fellowship, work on a trauma team for a bit, and then go back to being a general surgeon?

 

Thanks

 

You can as long as there are jobs offerings. I know a geriatric psychiatrist who practiced for many years (at least 12) and he just switched to general psychiatry.

Also, in many cases, you don't only practice in your subspecialty field. For eg, a pulmonologist who has a subspecialty in pulmonary oncology can also take care of the general pulmonary ward, resp fonction tests etc. In some cases, there is just not enough work in your subspecialty to invest 100% of your time into it. You'll have to work in the ''general'' specialty as well. If I'm not mistaken, our forum admin Ian Wong said that he has an msk imaging fellowship but only spends a small % of his time reading msk and he has to be very versatile.

 

Bottom line: subspecializing doesn't necessarily mean lack of variety, and it doesn't mean that you can't go back to your specialty either.

[A-Stark]

In the case of surgery more specifically, there aren't that many centres with enough volume in trauma that you could practice it exclusively (not in Canada anyway), so you'd likely be able to keep up an elective practice alongside it.

[dented]

Thanks for the responses. It's nice to know that one can keep variety within the specialty and isn't limited in scope within the specialty because of more training.

[Ian Wong]

For radiology, it's really tough to do 100% of a subspecialty, unless you are at a large academic center. I did a fellowship in MSK imaging after my radiology residency, but the vast majority of my work is general radiology, as there is not enough work to warrant doing 100% full-time MSK. As well, were I do to that, I'd start to lose my general skills over time (ie. neuro, mammo, OB, etc).

 

I think in clinical specialties, it may be a little different. Certainly, if you did a cardiology fellowship, I would think that in a large city you'd probably be doing 100% cardiology, and after a decade or two, going back into general internal medicine might be difficult (not sure how many cardiologists would even want to do that).

 

Ultimately, it would depend whether you are able to secure a job where you can do both your subspecialty as well as the more general work within your specialty. I suspect you can probably find or create a job that would allow this, as long as you are flexible about where you live.

 

Ian

[moo]

It really depends on a couple of things: one is if you feel comfortable doing it, and two is if there is demand for you (jobs).

 

For some specialties, especially in internal med, as Ian said, you are not likely to do general internal if you are a cardiologist. However, I have seen some subspecialists in internal med do GIM on the teaching service.

 

Most surgeons, even if they've subspecialized will still do some general surgery work. I worked with a guy in med school who did 75% bariatric surgery but also did general surgery call. And this was in a major academic center in the third largest city in the US. Thus, even in a teaching institution, people will still want to do general work.

[thebouque]

A cardiologist who did a fellowship in interventional or electrophysiology and works in a large center will still do general cardiology and won't be limited to IC or electro. However, it is right to assume that this cardiologist won't come back to GIM.

[rmorelan]

Even the interventionist radiologists here in London do general radiology work. Kind of surprised me as the interventionist route seemed a bit of big break from the rest of radiology, but there you go!