Thursday, March 7, 2013

Financing Fellowship

What else did I do while I was grounded? I crunched numbers! Lots and lots of numbers, mostly for tax purposes. But it also allowed me to finish a post I have been meaning to write. Win Win!

A reader asked a question a few months ago about the costs associated with fellowship. I looked at the date I started this post and it was in July. I guess it has been more than a few months - can you tell I wasn't really excited about knowing exactly how much this adventure costs? I didn't forget her question, but was waiting until all the bills rolled in. Well, it looks like the bills are still coming and I am afraid this blog post is going to go stale before it is all said and done. So before it is too late:

Fellowship is not cheap! In fact, it is rather expensive especially when you consider how much a fellow makes (about $60K), the income potential they lose by another year of training, and the interest that accumulates for an additional year on your student loans.

In our case fellowship was especially burdensome because at the same time some of these expenses were being paid we were losing money on the house we were selling. Houses aren't always wise investments when you are in training. It's a gamble. So it felt really expensive! You might recall some of my we are running out of money posts from this time last year.

I believe our calculations border on the low side for one reason and one reason only: he applied to three programs. His first choice had interviews first, and his first choice took him before the other programs even scheduled their initial interviews. The early bird gets the worm. Had there been multiple interviews the associated costs would be higher.

The process for obtaining a fellowship is different for each specialty. For us there was no match, no silly algorithm. It was much more like looking for your first job. They like you, you like them, they send you an offer, it's done.

These costs may pertain to you even if you don't do a fellowship. They may occur during your last year of residency as you prepare to practice and in some contracts these fees may be paid for you. Maybe not.

Here is a breakdown of our fellowship related expenses:

Travel for interview(s): $756.00
Prep docs/books for test: $311.00
Licensing application: $1,002.00
Misc. licensing fees: $136.00
DEA (for Rx): waived (how, I don't know)
PHY Registration: $844.84
Total Fellowship Acquisition costs: $3,049.84

And then these are the associated costs with fellowship that really hurt. These are the expenses that are usually covered by your new employer if you are heading out into the world as a practicing physician/surgeon. Since you are technically obtaining further training you pick up the tab. All of it. And I don't (didn't) like it one bit! Perhaps some fellowships allow moving allowances, but don't count on.

Depending on the distance you have to move, how much stuff you have, and what method of transportation you use this amount can vary widely. We traveled light and cheap. 

Moving: $3822.24 (PODS - 1,000 miles, 2.5 months storage, 1 16x8 box)
House Hunting: $1,963.00 airfare/hotel/rental car/food 5 days for 2 - more or less depending on duration.
Deposits/Set up: $1,805.00
Total Fellowship Moving associated costs: $7,590.24

Another expense to factor in is your grocery bill the first month that you move is going to be quite larger than previous ones. Think of all the things you couldn't bring with you. It isn't cheap to stock a new pantry and buy perishables that are typically replaced as they run out, not all at the same time. Chances are good you didn't pack those few rolls of toilet paper or paper towels, half used cleaning supplies, etc. You could easily add an extra $200.00 to your grocery budget that month and maybe the next one too.

Fellowships are not typically in Low Cost of Living (COL) areas. More often than not, they are located in High COL areas. That means everything will typically be more expenses (housing, utilities, groceries, gas, etc).

Some costs you would incur in you last year of residency anyway and aren't unique to a fellowship. In particular I am thinking of professional conferences and boards. In our residency program they had an expense account for conferences. In fellowship it is our dime. They must think we are going to get a good job and can afford to travel all over the country!

During fellowship year there have been trips to Chicago, Las Vegas, Phoenix, Austin, and Tampa (or was it Orlando).  Some have been taken already, others are coming up. I estimate the total to be $2,500 in hotel, airfare, transportation, food, registration fees. But then again, we aren't really done yet. There are four more months and something exciting is sure to come up.

He travels alone, sadly. Every time he leaves I wish I were going with him. If you plan on attending conferences with your spouse, or as a family, and making a vacation of it I will be jealous. I am waiting for a really good conference.... that's what I keep telling myself.

And then there are more tests. His board exam happened to be combined with a conference, but the cost to sit for the written exam was $1,500. It's one test you hope you only have to take once. Some specialties can be board certified in several areas. That's more exams and more fees. Cha-Ching.

I took this picture of his board application/fees and about died when I saw all of the amounts. I believe this is the first picture that I have ever posted on this blog! It's that good.

It seems that the closer you get to becoming that "real-paycheck-earning" doctor that the cost of little things get more expensive. Can't wait to pay for the oral boards this summer:-)

If you are headed off to a fellowship, or have a specialty that demands one, or your spouse/so just wants to do one (because you never know when you might wish you had it and this is the only time to get it) you probably want to save about $15,000 to $20,000 . Of course you don't have to have all that money right as you begin fellowship, but some of it you will certainly spend before you get there. Some will be spent in the first month, and the rest will come in starts and spurts. Just know what you are dealing with so you can make adjustments in your budget if needs be before and during fellowship or make decisions about other financing options. Maybe you will use a sign-on bonus or stipend to pay for them before you ever have the pay the bill. Maybe not.

I think the expense of the endeavor is one of the factors that makes a fellowship so discouraging and bordering on depressing. On the bright side we have friends who have secured jobs with stipends before fellowship began so the pain wasn't as great. And if you secure a job early in your fellowship, or just before you are about you sell your belongings at an auction, you are good. The longer it takes to get a job, the more expensive it feels. Sometimes you don't have much control over the "when" you get a job. It so frustrating. I would have preferred to have had the job before we started fellowship. If only everything went according to my plans:-)

This is just one more "investment" that gets made in pursuit of medicine. Thinking of it in those terms helps the medicine go down. So does a little ice cream and chocolate. And then when it pays-off you can breath a sigh of relief that you may actually live long enough to see a return and it was money well spent.

Is your spouse/so considering a fellowship for his specialty? Don't let this scare you away - we survived, or at least plan on it!



  1. Thanks for sharing this! We are hoping that starting a family later in residency and me maintaining a high paying job till he becomes an attending - that this will drive down costs. Doesn't look like theres any avoiding them! :(

  2. I feel your pain. My cost for my oral boards this year is going to run me approximately $5,000 when you factor in the exam fee, prep course, air fare and hotel. AWESOME!!

  3. It just never stops... Thanks for sharing. Always helps to have a heads up for future expenses. I really liked that you included moving costs!!

  4. Oh my gosh this makes me sad. My hubby will be starting to apply for fellowship this fall (we'll find out where we're going in Nov & he'll start July 2014). His fellowship is 3 years long & IS a match. He's gonna mostly interview here in the midwest, but still will be a lot of travel etc. 15-20K can be like half of a fellow's take-home pay! Yuck.

  5. UGH AMEN! We spent SO much money interviewing for fellowships- I posted about it awhile back. We had to do a match so Jeff went on as many interviews as possible which = lots of travel expenses! Don't even get me started on board fees. I also wish we could have signed a contract by now- one of his classmates already has and is receiving a nice stipend every month.

  6. All very true, BUT, it will all change very soon!!! :)
    Hang in there!

  7. Thank you for sharing this! Totally going to reshare it with the hubby when he gets home from call.

  8. This is a great post - thanks! It's always great reading real life experiences regarding the financial aspect of things. Everyone's is a little different but in the end it all adds up to about the same. Appreciate the insight :) xo

  9. Yes, I definitely remember The Ray Doc's fellowship years. Hang in there - and great post!

    Ray Doc Wife


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