Post-Graduate Training: Residency vs Fellowship

One of the benefits of earning your PharmD is the wide range of career paths open to you after graduation. You could work in the inpatient or outpatient settings, the pharmaceutical industry, or as a retail pharmacist. There are of course many other paths you could take like becoming a medical writer, getting a Ph.D., or working for a pharmacy benefit manager. Today we'll be talking about some of the differences between residencies and industry fellowships, two of the most popular post-graduate training programs for PharmDs. To clarify, this article is not referring to academic fellowships, which will be covered in later posts. We'll focus on a few areas like salary, hours, types of work, and retention, but other areas will be explored in upcoming posts.

Salary: You're not supposed to talk about salary in public, which I find ridiculous. It's not supposed to matter, and I agree that this should not prevent you from pursuing post-graduate training altogether. However, coming out of pharmacy school you likely have student debt to pay off, and how on Earth can you make budgeting plans if you don't know what kind of money you'll be making? What if you're prioritizing other things in life like buying a house, having children, or taking care of family members? In all of these cases, salary matters. For residents and fellows, salaries are very comparable with fellowships typically offering slightly more money on average. Fellowships tend to offer somewhere around $50,000 annually, which is pretty standard across fellowship programs. Residents will typically make somewhere between $38,000 and $50,000 annually. I have seen fellowships offer up to $67,000 and residencies up to $60,000, so this is obviously program-specific. If you're pursuing a residency, you can likely find the estimated stipends for programs of interest on the ASHP Residency Directory. One thing to consider is how long you will be locked in at this salary. Fellowships are typically 1 or 2 years long, while residencies typically last 1 year with the option of pursuing a PGY2, which would tack on an additional year. For both residencies and fellowships, you typically see a small pay raise from one year to the next, but it's pretty negligible and not guaranteed. Either way, you'll be making a fraction of a standard pharmacist's salary while completing your post-graduate training, so keep this in mind when it comes to things like loan repayments.

Hours: This is a highly variable area. In my experience, fellows will typically work fewer and more consistent hours. You can read my Day in the Life of a Post-Doctoral Pharmacy Fellow (COVID-19) post which goes through a typical day for me specifically during the pandemic. You'll see that fellows are more likely to be on a standard 9-5 schedule Monday through Friday. This can change, especially during busy times like upcoming congresses and clinical trial submissions where your hours may be increased and occasionally include a weekend. Residents work a wide variety of hours which depends on a lot of variables. Just to provide an example, 12 days on 2 days off is a pretty common schedule for a resident which involves working Monday through Friday and every other weekend. A lot of this will depend on the staffing requirements in place for any individual residency. Other things to consider are holidays and vacation time. This too is highly variable, but many of the pharmaceutical companies with fellowship programs take off all federal holidays. Additionally, many of them will give you extra days off around Thanksgiving and often the entire period between Christmas Eve and New Years Day. Residents are more likely to rotate holidays just like most hospital employees, but again this varies between programs.

Types of work: There is a huge variety of residency program types and even more fellowships. Therefore, the type of work you do is incredibly variable. Generally speaking, residencies will focus on direct patient care and clinical skills, while fellowships will have no direct patient care at all. This is where the decision of residency vs fellowship is often made. If you want to work with patients or respond to codes, then residency is obviously the better option. If you want to work in marketing or clinical trials, then fellowship is probably the better option. As I mentioned, fellowships are extremely variable and there are a lot of different types. You can work in regulatory affairs, medical information, field medical, marketing, pharmacology, clinical development, commercial, economics, and much more! There will likely be a series coming soon that does a deep dive into each of the main functional areas available to industry fellows. For now, my advice is to see what you enjoy in school and go from there. I loved research, presenting, writing papers, and doing literature searches. On the other hand, I never looked forward to writing a SOAP note, going through patients' charts, or rounding. I wasn't bad at these tasks, but I certainly didn't enjoy them. Don't pursue a path because someone expects you to, and instead follow what you like!

Retention: Completing a post-graduate training program can open a lot of doors for you, and it certainly enhances your chances of landing a competitive position. This is definitely the case for both residencies and fellowships. One thing to consider is a program's willingness to retain its trainees once the program is finished. In general, you are much more likely to be offered a full-time position by a fellowship program than you are by a residency. This doesn't mean that residents never stay on with their program, but it's much less likely. I'm also not implying that residents struggle to find work after their program ends. However, many fellowship programs claim that 100% of their past fellows were offered a position when their training concluded and retention rates ultimately come down to whether a former fellow wants to stay on board. This is not the case for all fellowships, but when comparing fellowships to residencies in the aggregate, there is a clear distinction.

When it comes to picking a path for post-graduate training, I highly suggest following what you actually enjoy. Personally, I was struggling to choose between pursuing a residency, Ph.D., or an industry fellowship. In the end, I went with what I enjoyed and haven't looked back! If you love working with patients, then narrow down your choices accordingly and save yourself some stress. Don't make the same mistakes as me and waste time contemplating a path that you know you would hate. Instead, be honest with yourself. These are life-altering decisions, so make them for the right reasons!