So how much does this really matter when it comes to fellowship spots, especially for something like cards. Do fellowship programs really care? I ask because I am stuck between two programs for #2 and #3 choices (my #1 is a University program. Of course all programs are going to tell you that they match everyone into their desired fellowship choice. Any thoughts?

what I have heard: reputation matters for competitive subspecialties and there's more of a chance you could work with big names at university programs...it would probably be easier for you to get this sort of fellowship if you went to the university program.

what I have heard: reputation matters for competitive subspecialties and there's more of a chance you could work with big names at university programs...it would probably be easier for you to get this sort of fellowship if you went to the university program.

Agreed. For the very competitive subspecialities, coming from a good university program with some research and strong letters of rec from known people in the field will help significantly. This is not to say that those coming from a community program won't be able to match, but they have to find other avenues to get their application to stand out. Many of the residents from the community IM program across town did subspecialty rotations at my university program just so they could get better letters of rec.

If you're in an university affiliated program, you can still be a competitive applicant for subspecialty fellowships if you form connections with academic faculty from the university and get letters of support from them.