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Take Two Fellowships and Call Me in the Morning--Neurologists Describe Their Decision to Add a Second Fellowship

Published on: Jan 21, 2020


You don’t have to be a neurologist to know that medical training is both difficult and exhausting – not to mention expensive. Why then, after a decade of classroom and hands-on instruction, would someone opt for even more training, in the form of a fellowship – or two? Statistics are not plentiful on the number of fellowship double-dippers, but the anecdotal evidence suggests there has been an increase in doctors extending their training through multiple fellowship experiences. The choice itself can’t be easy. While there’s the obvious advantage of adding credentials and skills, it can come at a steep cost, both financially and personally.

Weighing the Decision

By the time you read this, Khadija Irshad, MD, will have decided whether to go forward with a second fellowship or to conclude her training for the moment in order to start practicing as a neurologist. At the time of this interview, however, she was still weighing the decision while completing a one-year stroke fellowship at Henry Ford Hospital in Detroit, MI. Her goal, which has been evolving since she arrived from Pakistan to start her residency (also at Henry Ford), is to become an academic neurohospitalist. “Eventually, I would like to be doing some training and some research, while also focusing on inpatient neurology,” she explains.

Will she need to add a neurohospital fellowship in order to achieve this objective? Although the answer may never be certain, Irshad says she would like to take the training if she can, to help her keep up with what has become a rapidly evolving field. She’s just not clear if the timing is right for her. “I’ve spoken with a couple of places that still have spots open in their programs,” she said, “but I also have a few job offers. I do have a young family, so money is a concern. A year or two in a job might help me get caught up financially. Still, the neurohospitalist fellowship is only one year, so that isn’t too long. But I’ve been in training already for five years!”

At this point, Irshad laughed as she realized she had talked herself both into and out of the second fellowship in the space of a few minutes. Whether she goes directly to this next round of training or works in the field first, she does know that she wants to feel clearer in her decision than when she chose her stroke fellowship. “I wish I’d had more guidance for that decision,” she said. “It was very last minute for me and I wasn’t fully decided. A lot of the people I was talking with weren’t aware of neurohospitalism, so I didn’t realize the variety of options.” Luckily, she says she feels more knowledgeable now, having spent the past year getting more familiar with the field.

To that end, Irshad has advice for others in the process of making the fellowship decision: “If you’re like I was and don’t know what you want, you need to start researching, even as early as PGY1. I would say to really explore new and developing areas of neurology and different roles, not just the roles we already know about. And you should definitely reach out to mentors to get advice.” In the future, Irshad hopes to see more consolidation in certain fellowship tracks, making it easier for doctors to take multiple, inter-related fellowships without having to switch locations between programs. “That would make transitions smoother for people, and keep them from having to start new applications for the second fellowship,” she noted.

Signing up for Two Fellowships at Once

As coincidence would have it, a combined fellowship track is the path laid out by one of Irshad’s colleagues, Kavit Shah, MD. Just completing his residency at Henry Ford Hospital, Shah is about to launch into a three-year training commitment at the University of Pittsburgh. The first year will result in a completed vascular neurology fellowship, to be followed immediately by a two-year fellowship in endovascular surgical neuroradiology. Shah would agree with Irshad’s advice to fully research the options, as that was the system he needed to use. “The fellowship process isn’t at all centralized like it was for residency,” he says. “It’s very program-specific. I had to do a lot of research and due diligence to figure out which programs accepted neurologists, and take it step by step to get in.”

For Shah, much of the research stemmed from the fact he had chosen a rapidly evolving field, with many of the participants coming in as radiologists or neurosurgeons. That’s one reason he’s glad to have found a two-fellowship track, to allow him to attack the training all at once. “I think my field is relatively new, and it’s very procedure-laden,” he notes. “The relative novelty and the fact that it requires an additional skill set, it just made sense logistically to get all the training done from the get-go.” When he’s finished, Shah envisions pursuing an academic career where he will work with fellows and medical students and stay actively involved in the teaching process.

In the meantime, he has some advice about making the fellowship decision, whether it’s for one or multiple training sessions. “One of the best pieces of advice I received during rotations in medical school was from an OB-GYN attending,” he said. “He told us to think about what we like to read when we choose a path because we’d be reading about it for the rest of our career. I think that holds true for choosing a fellowship. You have to be passionate about the subject matter, and you want to enjoy what you’re doing.”

Going Back Later for the Second Fellowship

If you find it difficult to imagine delaying the entrance to a well-paying career by taking fellowships, you can appreciate how much more difficult it would be to stop an already-thriving career to take the training. Bhagwan I. Moorjani MD, FAAP, FAAN, doesn’t have to imagine that scenario, because he has lived it twice. The first time he went for a fellowship, Moorjani explained, he had been in private practice only a year. When it became very clear to me that if you were in private practice and you wanted to make a difference to your patients you needed to do a fellowship.” At this point, Moorjani had already completed two residencies, for a total of six years of post-doctoral training in pediatrics and pediatric neurology, so he was not unfamiliar with the price one pays by extending education. Nevertheless, in 2001, five years after starting in practice, Moorjani took a one-year neurophysiology fellowship focused on epilepsy. Since this program also provided EMG and evoked response training, Moorjani now had a well-rounded skill set as he re-entered the workforce.

All was well for several years, with Moorjani traveling and pursuing his career, but eventually he concluded that he would need one more round of training to enable him to serve his patients as he envisioned doing. He wanted to provide a higher level of accuracy in neuroimaging than he was getting from the radiologists, most of whom weren’t deeply trained in pediatrics. In 2010, he and his wife decided to bite the bullet, curtailing the higher income and lifestyle they had been accustomed to so Moorjani could pursue a fellowship in neuroimaging at Dent Neurologic Institute in Buffalo, NY. It was a difficult and expensive year of commuting back to California to see his wife and two-year-old son, but one that Moorjani believes has paid dividends.

“I don’t regret earning 25 percent of what I was making during training, because I can better serve my patients,” he said. “I’m not making money from reading the images, but it’s better for treating the whole patient. Now I have no fear or qualms about what the radiologist is going to report, and the parents of my patients feel much better about the second opinion when I give it.”

Not long after Moorjani completed the second fellowship, he had an opportunity to purchase a practice in La Quinta, near his California home. Now 55 years old and in his seventh year of business ownership, he can appreciate how each of his training experiences has helped him build a practice and a lifestyle that he values. In providing advice for others considering one or more fellowships, he emphasizes the importance of knowing one’s life goals. “For me, it was best to be in my own practice so I could have time for my family,” he says. “So then, when I decided to go into private practice, the question was, ‘What’s the best fellowship for my goals?’”

Although Moorjani vows he is satisfied with his level of training, “I want to enjoy my life now.” He admits to being tempted by the idea of a third fellowship, this time in headache medicine. But if interrupting a career was difficult before, as a solo practitioner it’s close to impossible. Unless…. “I wish there were programs that could cater to someone in private practice,” Moorjani says. “Maybe one day a week, where I could go somewhere accredited, like UCLA, instead of going a full year in another state. I won’t do that, but if someone came up with a part-time program for two years in headache, that’s something I wouldn’t mind doing.” UCLA, are you listening?