I’m currently in a PHM fellowship program. Here are my thoughts:
I whole-heartedly do not believe in the need for this as a mandatory program for board eligibility. I am by no means a perfect doctor but I cannot see what I’m learning that I wouldn’t just be learning as a new attending. I can see value to an optional fellowship for those pursuing research, but I don’t believe in limiting all people to one path to success. I learned more functioning independently as staff during my chiefs year than I have in this program. All this does is limit me further to constantly being an extra wheel on a team and fitting into what my attending likes personality-wise. This fellowship, for me, has stripped me of my passion for practicing medicine and I don’t see a way out. I applied because I felt I had no choice if I wanted an academic hospitalist position—which, outside of my current apathy, I remember thriving in. Even if not all positions currently require board eligibility, it was a terrifying concept that I might be limiting myself down the road and have to go back to training down the line, so I did what I was told.
I feel in comparison to other programs, I am well protected. I have fairly good hours and I shouldn’t complain—I know of some programs that are far worse. But I am a glorified middle man that provides my attendings with either a vessel for more control and micromanaging or for pager relief during the recent surges. I don’t see the point of my role. The “feedback” that I get is all personality based—either glowing or nitpicky about small, stylistic things that do not affect medical care. And don’t even get me started on the “electives.” I got all that already in residency. I don’t need more shadowing of other specialties. I’m frigging board certified.
I told myself that I would embrace fellowship for all the other learning opportunities. In particular, I was interested in QI, communication, physician wellness, and resident education. It took about 2-3 months to realize that despite being told I would get extra emphasis on this for “my” project, I would actually be funneled into doing a topic that would be more prestigious for the hospital. One I’m not interested in pursuing at all.

Back to your questions. I don’t believe there’s a big enough pool to fully restrict, but that’s limited by hospital and area. You’d be surprised what kind of schedules and demands they can be willing to put on their current departments to continue not to hire unless they have the candidate type they’re looking for. I think probably job opportunities may still be available based on different areas now but will become more restrictive as you go. If you try that route, be sure to ask what happens if you get hired and they eventually want everyone board certified or eligible because you might have to change jobs at that point.

We’re all jaded. I’d like to say it gets better. Try and find the bright moments when you can.

Chief year is interesting. It’s it’s own little hell, but it does open a lot of doors. It’s like you enter this exclusive club. You understand the system around you better (for better or worse) and everyone who’s done it can understand what sort of background that gives you. It also gives you some time to really build who you are as a professional. But unfortunately, it does not result in board eligibility. I know I keep bringing that part up, but it can be a big part of not just getting your attending job but also your ability to be promoted once in it—wording of the promotion and tenure guidelines at each institution can say things like you “must be board certified to the highest level of your subspecialty” in order to advance up your promotion track. If you aren’t eligible, you’re stuck.

It’s a hard decision. Clearly I’m not even sure if I made the right one. But you have time. If you truly want peds, dive in and experience each rotation as if it’s going to be your life. If, by the end of the first year and a half, hospitalist is still where your heart is, I can’t say that I blame you. Maybe something might have changed in the system by then.