From the type of medicine one practices, to the setting in which one does it, a career working as a physician can take on many forms.
For medical students composing their Match rankings ahead of the Feb. 21 deadline, looking at the world of possibilities available during a post-residency career is an obvious consideration. That being said, some physicians advise applicants not to look too far ahead.
“When I was making my rank list for residency programs, the best piece of advice I received was that the goal of your residency program should be to create a board-certified strong clinician in whatever specialty you’ve decided to apply into,” said Matthew Lecuyer, MD, a pediatric emergency medicine fellow at Brown University. “That’s really resonated with me throughout my rank list decision.”
Interviews are a key resource
While Dr. Lecuyer was confident he wanted to pursue a career in pediatric medicine, he was unsure of what that career would look like beyond residency. He used his residency interviews to examine the options available, interviewing at a broad spectrum of programs—smaller pediatric programs and programs based in large freestanding children’s hospitals.
From that experience he determined the he would thrive in a tertiary or quaternary care center, and he composed his rank list to reflect that. He matched with Northwestern University’s Feinberg School of Medicine, allowing him to work at the Ann & Robert H. Lurie Children’s Hospital of Chicago.
“At the time I was making my residency rank list, I wasn’t quite sure what I wanted to do,” he said. “So I wanted a program that would offer a breadth of options at the end of it. Over the course of my training, I ended up falling in love with pediatric emergency medicine and decided to pursue that for fellowship.”
For those who have a better idea of what they want to do in their post residency career, one method to find the right program is to look at what recent graduates have gone on to do.
“What your focus should be when you’re looking at programs is: Does this program create the type of physician I want to be?” he said. “Every program has its own personality in that some programs create physician educators. Some create physician researchers. So applicants can see what opportunities they have and think about them when they are making their rank list.”
Offering flexibility for your future
As a fourth-year medical student at Thomas Jefferson University in Philadelphia, Tina Shah, MD, MPH, thought that either a master’s of public health degree or fellowship could be in her future. (She ended up doing both.) Finding a program that would be flexible with those goals played a factor in her Match rankings.
“I did a health policy elective [in medical school],” said Dr. Shah, who decided to stay at Thomas Jefferson for her residency. “All of it told me that I needed to understand the health system more. When I was starting to look for residency, I was already starting to ask questions about if there was a good school of public health wherever the university was or if they were open to me taking a year off during residency.”
Factoring in a fellowship
About 10,000 physicians applied for fellowships in 2016, according to the National Resident Matching Program, meaning roughly 20 percent to 30 percent of residents seek out those opportunities after completing residency training. Both Drs. LeCuyer and Shah were among those who took that path, but neither came in to their residency entirely sure of what subspecialty they would focus on.
“If you don’t go with an open mind and experience the entirety of a rotation, you’ll never really know if that’s what lights your fire,” he said. “I went into every rotation thinking ‘I want to learn as much about this field as I can in this four-week block, and live the experience and see if this is what I want to do with the rest of my life.’
“Over the course of my training, I ended up falling in love with pediatric emergency medicine and decided to pursue that for fellowship.”
For those who do know the type of fellowship program they want to enter after residency, Dr. Shah, who completed a pulmonary and critical care fellowship at University of Chicago, believes that should factor into their Match rankings.
“If you’re a med student and you already know which fellowship you want, maybe you have a leg up,” she said. “Even while you’re searching for residencies, you might want to see what the caliber of the fellowship program is at that hospital—thinking that you may stay there. Also, you’re looking at how well residents match in that particular specialty for fellowship."