In primary care, we often describe ourselves as “jack-of-all-trades” clinicians — experts in breadth and advocates for the patient as a whole person. Yet for many of us, there comes a point when we crave more depth, new purpose, or a different kind of impact. That’s where primary care fellowships can open doors.
Whether you’re a resident contemplating what’s next or a seasoned clinician feeling the pull toward growth, post-residency fellowships in fields like geriatrics, palliative care, and addiction medicine (just to name a few) can offer a transformational year, one that reshapes how you think about patients, systems, and your own career.
Primary care fellowships are typically one-year post-residency programs that allow family physicians, internists, or pediatricians to specialize in a focused area, often deepening their ability to care for complex, underserved, or interdisciplinary populations. These programs are about more than adding credentials; they’re about learning new ways to practice medicine that align with evolving patient needs.
For Dr. Mallory McClester Brown, a family physician and geriatrician, her calling was clear early on: “I found I loved something not many did, and what a beautiful service to give.” Geriatrics training emphasizes the principles we all aspire to — patient-centered care, shared decision-making, and teamwork — but applies them to some of medicine’s most nuanced situations.
Fellows rotate through inpatient and outpatient geriatrics, palliative care, psychiatry, rehabilitation, and community-based programs such as the Program of All-inclusive Care for the Elderly (PACE) and long-term care. The mantra is “start low and go slow,” but the philosophy is anything but slow-moving: it’s about calibrating medicine to match each patient’s unique goals, values, and capacities.
This field also teaches humility: knowing when not to treat, weighing the function and quality of life, and guiding patients and families through the end of life. “It’s a privilege to walk people through the final chapter of their journey,” Dr. McClester Brown says. “That’s the most fulfilling part of my work.”
If geriatrics is the art of nuanced medicine, palliative care is the practice of meaning-making in medicine. Dr. Alyssa Tilley, a Med-Peds physician and palliative care specialist, describes how fellowship training deepened her ability to hold space for suffering while maintaining medical precision.
Palliative care fellowships immerse physicians in interdisciplinary care, working alongside nurses, social workers, chaplains, and therapists to align treatment plans with patients' values. Fellows learn to navigate difficult conversations, address symptom management, and support families through uncertainty.
The experience transforms not only clinical skills but emotional resilience. Many fellows find themselves more grounded, more attuned to their own humanity, and more aware of systemic inequities in who gets compassionate care. As one reflection put it, “This field isn’t just about end-of-life care — it’s about life care.”
When I completed my addiction medicine fellowship, it reshaped how I understood health, suffering, and recovery. Like geriatrics and palliative care, addiction medicine sits at the intersection of biology, psychology, and social context.
That year taught me the power of harm reduction, the centrality of trauma-informed care, and the joy of helping patients reclaim dignity through accessible, treatment-first care. It also broadened my professional world, connecting me with mentors, policy leaders, and interprofessional teams across public health and family medicine.
For many of us, these fellowships reawaken our sense of purpose. They remind us that medicine is about restoring agency, fostering connection, and addressing inequities.
Graduates of primary care fellowships often describe ripple effects far beyond clinical expertise. Some take on new leadership roles in education, quality improvement, or public health. Others find renewed joy in patient care through smaller panels, more time per visit, or deeper continuity. And while the “delayed paycheck” of another year of training can feel daunting, most fellows echo the same sentiment: the professional and personal returns are immeasurable.
If you’re considering a fellowship, start by shadowing, rotating, or reaching out. Many programs welcome early learners through acting internships or resident electives. Online resources, such as the ACGME fellowship directories, can help identify accredited programs.
Ask yourself: What kind of patient stories do I want to spend my life hearing? What problems in medicine do I still want to help solve?
Primary care fellowships are a doorway into the kind of medicine many of us imagined when we first started out. If you love getting to know your patients deeply, value shared decision-making, enjoy solving complex problems, and thrive in team-based care, then maybe it’s time to unlock your next chapter.
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