Residency

Thinking about a fellowship? 5 things to consider

Making the decision to pursue postgraduate training isn’t easy. Get advice from current fellows about the factors you should weigh before you follow the fellowship path.

“A fellow is an interesting balance of independence and responsibility,” said Aaron Kithcart, MD, a cardiovascular disease fellow at Brigham and Women's Hospital. “You’re given more freedom to practice your own style of medicine, but that comes with the responsibility of truly taking ownership of your patients.”

Hear what fellows recommend you consider before making your decision:

Prioritize your clinical and research interests

If you want to work in a primary care clinic, a fellowship program might draw you away from that path. But if you want to do specialized procedures, then specialty training may be right for you. “Your research interests are also important because most academic fellowships will include at least some research time,” Dr. Kithcart said. “Making that personal differentiation between private practice and academic medicine is important because that will help narrow your search for programs.”  

Some fellows don’t fully realize what they’re signing up for. “Does the resident understand the time commitment?” asked Surendra Varma, MD, executive associate dean for graduate medical education and resident affairs at the Texas Tech University Health Science College.

Find your passion

"Ask yourself: Am I ready to give up the other components of this specialty to narrow my concentration?” said Nicole Lee, MD, a maternal fetal medicine fellow at the University of Mississippi Medical Center. “If so, stick with it and be focused.” For Dr. Lee, a fellowship was the perfect choice. “I love ob-gyn, but I really wanted to be an expert in high-risk obstetrics,” she said. “I’m finally able to focus my skills on what I really want to do.”  

For Tina Shah, MD, chair of the AMA Resident and Fellow Section and a pulmonary and critical care fellow at the University of Chicago, she felt at home in the intensive care unit. “I thought it made sense to specialize because I really care about it,” she said. “But although it can be rewarding, the experience is much more arduous than residency. You want to make sure you spend this time on something you care about.”

Talk to a mentor

Dr. Lee recommends finding a mentor in your second year of residency to help you determine your next steps. “A mentor can make all the difference,” she said. “A mentor can help you find or develop research projects, introduce you to others in the subspecialty and write a letter of recommendation. They can also provide feedback to your interviewers.”

Consider your desired lifestyle

Geography and future income should play a role in your decision. For example, if you want to live in a more rural area, it may be more difficult to use your subspecialty training. “Sometimes you make more money because you’re a specialist,” said Dr. Shah. “Other times, it doesn’t necessarily mean you will have an associated pay increase. You have to weigh the opportunity cost.” And make sure to consider your family’s needs as well. Dr. Varma emphasized the importance of discussions with family, such as a spouse or significant other, as one of the top things a future fellow needs to take into consideration.

Start early

Fellowship programs tend to be smaller than residency programs, so it’s important to find a good fit. “Start early by talking to colleagues and program directors, go to specialty national meetings and do your research online,” Dr. Kithcart said. “If you’re really interested in a program, communicate that regularly to the program director, and they’ll remember you when it comes time to finalize their rank list.”

Dr. Lee also recommended getting an early start. “If you’re interested in a fellowship, express your interest early on to a staff member in the subspecialty, your program director and your chairman,” she said. “That way, they can support you doing elective and away rotations during your third year of residency, as well as put you in touch with others that might be able to help you.”

The 2014 fellowship appointment year was the largest in the history of the National Resident Matching Program’s (NRMP) Specialties Matching Service, encompassing 3,552 programs within 55 specialties offering more than 8,200 fellowship positions. Nearly 9,300 applicants participated in at least one of the fellowship matches, with 77.9 percent obtaining a position, according to the NRMP. The number of applicants to fellowships has roughly tripled since the early 2000s, which can cause potential fellows some worry.

“People might try to tell you [the fellowship match] is too competitive or it’s not worth the time,” said Dr. Lee. “But if you want to do it, just work hard and excel during your residency training and apply. If you don’t match, you can always re-apply or work as a generalist.”

Check out the AMA Resident and Fellow Section’s list of vacant fellowship positions if you’re interested.

Tell us: Which considerations played the largest roles in your decision to follow the fellowship path or not?  How did you decide whether or not to pursue a fellowship?