- i'm absurdly over being a trainee
Understandable but there are a few considerations to be aware about. As a fellow, you are often treated by attendings with far more respect and collegiality than as a resident. A lot of that resident angst you really don't deal with as a fellow. I enjoyed fellowship year probably the most of any year of my radiology career. It was super chill. Which leads me to my next point:
First year attendinghood is no walk in the park. As chill fellowship was, being a newbie attending was really unpleasant at times. That adjustment to finally signing cases, building speed, etc... And that's beyond troubles of a joining a big, onsite PP like it sounds like you won't be doing. I had to drive all over town, gladhand and kiss ass like no one's business and go back to reading all this **** I avoided during fellowship year. I personally wouldn't recommend people be in a rush to get to year 1 attendinghood.
- opportunity cost of fellowship year
- make hay while sun shines - job market is red hot rn - reimbursement will probably continue to decline
- i'm bullish on AI and think our lifespan as human rads is probably in the 10-20 year range, so even just one extra year of attending salary may be more impactful than one would think
As many people have said, the opportunity cost can be fairly minimized with some external moonlighting. The job market is red hot now, but many groups would just as well hire you now (while a resident) for two years later. You could get the job now and go do fellowship anyway.
I wouldn't price in reimbursement declines into your math; that just is what it is. Same thing with AI. No one can predict with any certainty when AI will start costing radiologists jobs.
- flexibility of tele - i can live wherever
- i hate procedures
I think this will limit your career earnings as much as anything. The better tele gigs will get you up in the range of low $30's/wRVU. The crappy ones will be mid-high $20's/wRVU. Flip side, a PP group will solid contracts can be anywhere from $40's-50's/wRVU. A buddy of mine signed for a small PP in the Midwest to make in $60's-$70's/wRVU. You will give up a considerable amount in your career going the pure tele path.
- i enjoy reading ED / acute / inpt studies more than outpt exams
Most young rads coming out of training prefer more acute stuff. It gets old. I'm a few years out of training and I'm starting to find the call case mix pretty mind numbing. Slogging through a ton of negatives with the occasional positive stroke or appy.
I'd say probably >80% of the people in my section with more than 20 years in radiology have switched to/lean heavy OP preference now. I didn't understand it at the beginning, but it makes alot of sense to me now. Chill days.... are nice. A "miss" on an outpatient degen spine MRI usually doesn't cause dire consequences. Flip side: when you pound high-acuity cases and you miss something, you open yourself up to a lot of liability. Even beyond liability, the first couple of misses I had where the patient had a bad outcome, I took that really hard.
Side point: I derive a lot of professional satisfaction from being fellowship trained and good at my sub-specialty.
Basically, go to fellowship.