For many, fellowship graduation is the last formal stop on a very long road that began in medical school or maybe even before. It is also the time when a young physician really discovers what they are passionate about and where their talents truly lie. Residency brings the exhilaration of finally becoming a physician, refining your skills, discovering your true interests and talents, and becoming an educator yourself. But in a fellowship program you really get to focus in on what you want to spend the rest of your career doing. The extra time is no small commitment though. Depending on the specialty and subspecialty this can mean, all told, as many as fifteen years in post-secondary education, more than one spends in school before college. It is a lot. But worth it.

Fellowship is often compared to residency as more manageable, the “easier” of the two training experiences. And, generally, there is a more predictable and less intensive schedule and greater amounts of autonomy in fellowship than in residency. But the flip side to that is a larger amount of responsibility, both in training residents and medical students as well as in conducting research. Fellowship is the time when physicians go from being one of many experts in a specialty to identifying an area of a subspecialty in which very few are. That shift requires imagination, deep thought and study, which is where that “extra” time can go. That is why the celebrations of our fellows’ graduations this month matter so much. We know how hard they have worked, how intensely they have practiced certain procedures and how beneficial their discoveries and expertise will be to the academic medical community. To all of the graduates of our fellowship programs, please know that we see you, your effort, and your and your families’ sacrifices to get you to this point. Congratulations, one and all, on this outstanding achievement.

It has been wonderful to see the photos and recaps from some of the fellows’ graduation events. The previous restrictions on these kinds of gatherings are still recent enough that the events feel special, being together again. I hope that feeling lasts for us all for much longer. For some fellows, this year’s graduation is both the first time and the last time that they have been able to participate in a social event with their division. They deserve to be celebrated. Their accomplishments are noteworthy. A back-of-the-envelope estimate from PubMed reveals that this year’s 38 fellowship graduates have published more than 5 dozen articles in peer-reviewed journals during their years of training with us. This is of course on top of seeing dozens and dozens of patients every week, providing education to medical students and residents, presenting at division Grand Rounds and at regional and national conferences. Is fellowship easier than residency? That may be arguable, but it is certainly just as busy.

And so what now? If this is the last stop on the formal training journey, now it is time for our fellowship graduates to choose where they will start to plant roots and grow their careers. I am pleased to announce that of those 38 graduates, 42% are staying at Iowa, the most of a graduating class since 2017. Typically this number hovers in the mid-30s, but one recent year that number dipped down to 22%, so it is heartening to see so many decide to stick around.

What influenced their decision? We asked some fellowship graduates who will be joining us as faculty members. Dr. Peter Farjo, an electrophysiology fellow, cited a number of reasons: “the family feel of the lab staff and faculty,” the “interesting cases” and the ability to mentor. Lastly though, he said, “my wife and I have enjoyed living in Iowa City and do not want to leave any time soon.” Dr. Farjo’s colleague in cardiovascular medicine, Dr. Lakshmi Nagarajan echoed that opinion about our community. “The cost of living,” she said, “access to amenities, educational opportunities, and opportunities for children make UIHC an ideal place to continue to stay on as faculty.” And like Dr. Farjo she cited the people here and her mentors, but she also highlighted the culture. “We have a collaborative environment at UIHC,” she said, “which encourages interdisciplinary teamwork that allows for enhanced care of the patients and continued learning/growth as individuals.” GI fellowship grad (and former Chief Resident!), Dr. Salman Ansari said he “wanted to stay because of great mentors and colleagues.” As he takes on the “challenges of being a new staff” and developing his practice, he knows he will appreciate having an “overall supportive environment available to me.” We could not be happier that you all have made this choice and will ensure that your commitment to us will be worthwhile.

Finally, one last note to highlight a leadership opportunity for faculty who want to work with fellows. The VA Quality Scholars Program has been an important training ground for those interested in quality improvement, patient safety, and health care delivery in general. Recently, Nephrology’s Dr. Melissa Swee stepped into the program leadership role after Dr. Hilary Mosher led it so ably for so long. Dr. Swee is now advertising for a Program Co-Director and the application window closes in just a couple weeks. If you are interested and meet the requirements, you should consider applying. More details are here.