These programs can make a difference in your training and education. I’m planning on working at PSLF-qualified institutions during residency/fellowship, and I’m not much of a lavish spender. If some of the above sounds appealing to you, then the main consideration would be whether it's worth the opportunity cost of making a fellow's salary for a year instead of your attending salary.

I’m a 30 year old surgery PGY3 with $400K in student loans. [Editor's Note: Today's guest post is written by The Physician Philosopher (TPP), an anesthesiologist who blogs to physicians about finances and wellness. In cardiology (non-invasive) you can easily set up hours very similar to a primary care doc if functionalize things and find a good group of partners. Someone actually calculated this out for the various orthopedic subspecialties. Maybe that can translate into a higher income or more job security. I’d be pretty hesitant to separate at that point, especially if being in the military didn’t REALLY bother you.

Stimulation and satisfaction. Student Loan Refinancing & Consolidation Guide, The Physician Philosopher -- Fighting Burnout While Building Wealth, How not to owe $8,000 to the IRS at Tax Time, Refinancing Medical School Loans During Residency, 11 Financial Lessons from The Greatest Showman, The Best Path to Wealth is Offense-Defense-Offense, Refinancing Student Loans -- Best Tips From WCI Readers, Fellowship Rarely Makes Sense Financially, National Institutes of Health (NIH) Loan Repayment Program,, Fire Your Financial Advisor Online Course. I didn’t do a sub-specialty fellowship to gain a larger income, I did it to be in a position manage more complicated cases and be surrounded by people who wanted to do the same thing. Interesting article.

While many peds fellowships have poor ROI. It also didn’t hurt that the fellowship was 1 year so little lost opportunity cost there. Learn about the program here.

In academia (and private practice) the first day that you step onto the job as an attending physician you start a timeline. If you can't pay off your student loans and have a very nice life on any type of surgical subspecialist's income you have a spending problem, not an earning problem. There’s too many inherent assumptions to come up with a single valid number. Sleep medicine relates to spaceflight because sleep disturbances and altered circadian rhythms commonly affect astronauts. My skills and income have grown over time and I have no regrets. With more non-physician providers taking jobs, having a fellowship (I’m ultrasound), makes you more attractive to employers. I showed my work so you could use it or modify it as you see fit. For example, let’s say an internist makes 225,000 annually and is contemplating a 3 year fellowship that would increase their salary to 300,000 annually. The purpose of this post is to only speak towards the financial aspect. Assuming you are saving 20% as a fellow (I saved less) and first-year attending here is the difference: 20% of Fellowship salary =$60,000 x 0.2 = $12,000 You don’t delay SS if you don’t expect to make it to 70. This is a very important post. There certainly is an opportunity cost to be calculated. Yes, there are some specialties that come with significantly better incomes, but usually much worse lifestyles. Competitiveness typically falls along the same lines (Rheum is almost as competitive as cards/GI/heme-onc/pulm-crit, Endocrine is mildly competitive, nephrology just requires a pulse). Glad it worked out well for you! While certain subspecialties will direct you towards academic/ hospital positions, others will enhance your opportunities to get a better private practice job. Most of this is opportunity cost.

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