FELLOWSHIP : TO DO OR NOT TO DO?

TO DO OR NOT TO DO? - Dr MANOJ KHATRI

WHAT IS A FELLOWSHIP ?

Fellowship for doctors is an additional period of training after completion of a specialty-training program, which is now called “residency” in various parts of the world. A typical fellowship is 1 to 2 years during which one undergoes focused training in a particular area within a specialty and develops expertise in the management of a certain patient population.

WHAT ARE THE PROS AND CONS OF PURSUING A FELLOWSHIP ?

After 4 to 5 years of medical school, 1 year of housemanship, 1 or more years of non-trainee MOship (medical officer), and at least 3 to 6 years of residency, more years to remain as a trainee may sound daunting and unattractive. A fellow’s life is definitely not easy. One is expected to be the first point of contact for referrals to the sub-specialty. This will translate into dealing with complex or urgent cases and most likely the need to be on duty after office hours. In addition to clinical work, research output and scholarly activities are also standard requirements for most programs that a fellow needs to excel on. Salary during fellowship is usually very basic if there is any. Most people will need support from his/her home institution, which comes with waiting time and period of service obligation. Most if not all fellowships are only available in distant places/ states, which may be difficult for those with family and young children.

On the other side, there are certainly benefits in pursuing fellowship. After fellowship training, one should be able to offer expert level of care to a certain patient population and to perform certain specialized procedures independently. A sub-specialist is allowed to focus his/her time in one specific area of interest in clinical work and research so there is a potential to be a knowledge expert or even an opinion leader. The compensation for sub-specialist is generally higher than generalist according to published reports, although the opportunity cost from the additional training should be considered.

WHAT ARE THE CONSIDERATIONS BEFORE COMMITTING TO A FELLOWSHIP ?

As discussed above, fellowship training has pros and cons. It may not be suitable for everyone and is dependent on one’s overall professional and personal goals. It is also a major career and life decision that should not be taken lightly. It is essential to think through the following questions before committing to a fellowship.

• Do you have a strong passion or deep interest in a particular subspecialty?

• If you think you are, have you had enough exposure in this subspecialty to know what it is really like?

• Are you satisfied clinically to care primarily for patients with problems within a particular subspecialty?

• Are you interested and comfortable in performing procedures in some subspecialties?

• Will the particular fellowship program help you achieve your goals?

• Are you comfortable with the lifestyle and financial compensation of a particular subspecialty?

WHAT SHOULD YOU DO TO PREPARE YOURSELF FOR A FELLOWSHIP ?

After careful consideration of your professional and personal goals, long-term professional satisfaction, financial liability, and family considerations, do act early if you are thinking of pursuing fellowship training. Gain as much exposure as possible in your subspecialty of interest to avoid any uninformed decisions. Find a mentor who can inspire you to go further in the subspecialty, help you develop research projects and introduce you to others in the specialty. Go for specialty conferences and do your research on which are the reputable fellowship programs that fit your goals.

SHOULD I DO A FELLOWSHIP ?

If provided with an opportunity, I will always and always do fellowship – it will allow me much needed exposure in the subspecialty of my choice. The fellowship will allow me to make independent decision for better patient care and outcome. The fellowship will provide me with the much-needed window into what will be lying ahead for me in future. It will also allow me to explore certain key topics in greater details and an appropriate platform for research. To be completely independent physician or surgeon, one definitely need to take the path of fellowship and I believe there is no short cut into one’s clinical or academic career without prior fellowship.

WHY RETINA OR UVEITIS FELLOWSHIP ?

I will like to use this opportunity to throw insight into why I ventured into retina and uveitis fellowship – I really enjoy challenges and the mere thought of salvaging one’s vision by tamponading the most important layer of the eye gives me greatest joy and sense of fulfilment at the end of the day. Retina fellowship strengthens a surgeon mentally and allows him to be in total control of patients vision (and to a certain extent life) – likewise clearing the inflammation and infection from eyes is again a tough enduring task but witnessing the smile back on patients and his family is the most important goal in life of a uveitis specialist. On similar lines, is the need of the hour is to train people globally on the work/ specialization related to Ocular trauma. It is indeed a very challenging work to give the optimal outcomes both anatomically and visually for a severely traumatized eye and even more daunting task is to manage the patient at the point of contact along with the hyper anxious attenders/relatives.

VRSI (Vitreo Retinal society of India) and USI (Uveitis Society of India) are taking huge strides forward in shaping the future of the upcoming trained Vitreo Retinal and Uveitis specialists in India and they will have a very bright future ahead for Clinical work, Academics and Research and the opportunities galore will widen further.

So, folks don’t think twice and make up your mind and get into the fellowship programme of your choice and dedicate yourself for the best to bestest patient care!! As the future lies in the expertise delivered by the super specialists…

All the very best!!!

DR MANOJ KHATRI MBBS, DO, DNB, FICO (UK), FLVPEI, FMRF, FRCS (GLASG, UK), FAICO, FIAMS is the Principal Consultant Ophthalmologist and Vitreo-Retinal Surgeon Founder and Managing Director, EYDOX EYE HOSPITAL, Chennai. Senior Consultant Ophthalmologist and Chief of Rajan Retina Foundation at Rajan Eye Care Hospital, Chennai. Senior Consultant Ophthalmologist at Apollo Hospitals, Westminster Healthcare, Chennai.

A well-trained actively practicing Ophthalmologist in both anterior and posterior segment of the Eye over a decade. His academic achievements comprises of a Vitreo-Retina fellowship (short term) from the prestigious L V Prasad Eye Institute, Hyderabad followed by a Clinical and Research fellowship in Vitreo-Retina and Uveitis from the esteemed Sankara Nethralaya, Chennai. Dr Khatri has published several papers in peer reviewed scientific journals, presented widely nationally and internationally at various scientific forums. He is on board as a Principal investigator and Co-investigator of various drug trials in Ophthalmology. He is assiduously engaged as a DNB (Diplomate Of National Board in Ophthalmology) teaching cum thesis guide. Principal areas of interest include – Cataract and Vitreo-Retinal Surgeries as well as Uveitis/Ocular trauma and Neuro-ophthalmology. His special interests rests in - Retinopathy of prematurity, Diabetic retinopathy and challenging Vitreo-Retinal surgeries.

He can be contacted at drmanojkhatri@gmail.com