Fellowship - didn't match

[docp81]

Hi everyone,

I am a 3rd year pediatric resident. I go to a relatively competetive residency program, I had top 15-20%ish board scores, I have top 5% ITE scores, I have always had great evaluations on every rotation I have had, my fellow residents all seem to like me and frequently come to me for help, and my program was hoping I would be one of their chief residents.

However, I am interested in cardiology, and so I declined their offer and proceeded to apply to several pediatric cardiology programs. I interviewed, all went well, and I was all but guarenteed a spot at my home program by the program director.

And then I didn't match.

Now I find myself slightly lost. Pediatric Cardiology was all I ever really wanted to do, and I never really considered anything else.

In the past month since the match, I decided to persue a hospitalist position. The plan is to stay in academic medicine, stay on the inpatient side of things for a few years and possibly reapply (though the thought of reapplying right now makes me slightly nauseated).

Here's the question. I have my first interview in roughly one month. I have already had a phone interview and it went well. I'm trying to decide if I should tell the hospitalist program that I am applying at that I had applied for a fellowship and didn't match. I feel that not matching has wiped away all of the good things I have done to this point and sticks out like a bright red 'X' on any application or interview. I mean, if the cardiology programs didn't want me, why would anyone?

Maybe I'm wrong... I hope I'm wrong.

-CP

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[TexasRose]

Hi everyone,

I am a 3rd year pediatric resident. I go to a relatively competetive residency program, I had top 15-20%ish board scores, I have top 5% ITE scores, I have always had great evaluations on every rotation I have had, my fellow residents all seem to like me and frequently come to me for help, and my program was hoping I would be one of their chief residents.

However, I am interested in cardiology, and so I declined their offer and proceeded to apply to several pediatric cardiology programs. I interviewed, all went well, and I was all but guarenteed a spot at my home program by the program director.

And then I didn't match.

Now I find myself slightly lost. Pediatric Cardiology was all I ever really wanted to do, and I never really considered anything else.

In the past month since the match, I decided to persue a hospitalist position. The plan is to stay in academic medicine, stay on the inpatient side of things for a few years and possibly reapply (though the thought of reapplying right now makes me slightly nauseated).

Here's the question. I have my first interview in roughly one month. I have already had a phone interview and it went well. I'm trying to decide if I should tell the hospitalist program that I am applying at that I had applied for a fellowship and didn't match. I feel that not matching has wiped away all of the good things I have done to this point and sticks out like a bright red 'X' on any application or interview. I mean, if the cardiology programs didn't want me, why would anyone?

Maybe I'm wrong... I hope I'm wrong.

-CP

Of course you're wrong. Failing to match in a highly competitive fellowship in no way negates all of the good things you have done. You are still the person who accomplished all those things and you should continue to feel good about them.

I believe Cards is the most competitive pediatric specialty and it seems like it is growing in popularity, at least at my program. If you still want to be a cardiologist, I believe you shoud apply again when you're ready.

As for telling interviewers that you didn't match, what would be the point? I can understand if you felt obligated to tell them that you would be reapplying next year and thus didn't expect to keep the hospitalist position for more than a year or two, but I don't think you're obligated to tell them about what didn't work out for you this past year.

Hang in there, I know not matching must be a tough blow. I've seen it happen to many really good folks. Most of those people took a break from the process for a little while, then re-evaluated their situation, made what changes they felt might be helpful and tried again.

You're still the same excellent person you were before the match.

 

[oldbearprofessor]

However, I am interested in cardiology, and so I declined their offer and proceeded to apply to several pediatric cardiology programs. I interviewed, all went well, and I was all but guarenteed a spot at my home program by the program director.

And then I didn't match.

Now I find myself slightly lost. Pediatric Cardiology was all I ever really wanted to do, and I never really considered anything else.


Here's the question. I have my first interview in roughly one month. I have already had a phone interview and it went well. I'm trying to decide if I should tell the hospitalist program that I am applying at that I had applied for a fellowship and didn't match. I feel that not matching has wiped away all of the good things I have done to this point and sticks out like a bright red 'X' on any application or interview. I mean, if the cardiology programs didn't want me, why would anyone?

-CP

Here are some suggestions - you may well have done some of these, but I want to cover as much as possible.

First, you should try to get a better understanding of why you didn't match, especially in your home program. If you're not comfortable talking to your cardiology PD, talk to the program director for pedi or some other cardiology attending.

Second, consider whether you want to do PICU as an alternative or even a bridge to cardiology. I realize you said that cardiology was all you'd wanted to do, but you might be able to work something out if you match into PICU and do some combination.

As far as interviews for hospitalist, I would be honest. You'll have trouble keeping it a secret as they are bound to ask you "Why this job?" and I suspect that you'll end up saying something. Better to be honest up front. It won't likely affect how they see you.

Finally decide if you are going to reapply to cardiology this year/next year. If so, as with any applicant for a position, think about what you can do to strengthen your application while doing the hospitalist job/PL-3 year. Can you do some research? Do you have a month to do an away rotation, etc. This isn't like reapplying for the match, but still, you may be able to enhance your application.

Good luck!

 

[J-Rad]

Here are some suggestions - you may well have done some of these, but I want to cover as much as possible.

First, you should try to get a better understanding of why you didn't match, especially in your home program. If you're not comfortable talking to your cardiology PD, talk to the program director for pedi or some other cardiology attending.

Second, consider whether you want to do PICU as an alternative or even a bridge to cardiology. I realize you said that cardiology was all you'd wanted to do, but you might be able to work something out if you match into PICU and do some combination.

As far as interviews for hospitalist, I would be honest. You'll have trouble keeping it a secret as they are bound to ask you "Why this job?" and I suspect that you'll end up saying something. Better to be honest up front. It won't likely affect how they see you.

Finally decide if you are going to reapply to cardiology this year/next year. If so, as with any applicant for a position, think about what you can do to strengthen your application while doing the hospitalist job/PL-3 year. Can you do some research? Do you have a month to do an away rotation, etc. This isn't like reapplying for the match, but still, you may be able to enhance your application.

Good luck!

I agree with the first piece of advice. I would also ask a few questions: did you put yourself in the scramble? There are high quality programs that stop interviewing after a certain point (on their list of potential applicants) because they know that there will be higher quality candidates in the scramble. It's too late for that now, but don't forget that in the future. Also, how broadly did you apply? Obviously, the more the better.
As for the idea of using PICU as a "bridge" to cardiology...I respectfully caution you against this. Now if you love PICU and know you can be happy as an intensivist, then by all means, consider it. But, as just a bridge to cardiology I think it may be a poor choice. On of the appeals of cardiology is the super-specialties you can go into if your choose: EP, interventional, imaging, heart failure/transplant, adult congenital, cardiac critical care (I know there is even the rare bird that is cards/neo). Aside from this you can have a predominantly outpatient practice w/ inpatient consultations, predominantly inpatient, academic, private practice. If you do a PICU fellowship and don't do a cards fellowship you've basically got PICU, hospitalist, and academic vs. private. If you do the cards fellowship afterward and you don't do cardiac critical care, you've basically wasted three years of your life. I don't know if there is a move away from this, but there are some people who trained in cardiology who are employed as intensivists, but I'm pretty sure that there are no intensivist-only trained employed as cardiologists. Both cardiology and PICU fellowships can be grueling, but my perception is that almost all PICU programs are grueling and I presume most do in-house call. In the cardiology world there is more variety in how much you may get beat on in each individual program. If you're not passionate about critical care, this may be a set up for burnout before you get to what you really love.

 

[oldbearprofessor]

If you do the cards fellowship afterward and you don't do cardiac critical care, you've basically wasted three years of your life.

Hopefully only 2 in that they could arrange a 5 year double fellowship. No guarantees, but this might be possible.

As it is, they will be spending one or two years in the hospitalist program before doing a full three yrs of cards except they won't get some opportunities that PICU or even NICU training would provide.

No one, including the OP should do a fellowship in something they would really not like, but I'm not sure there isn't a substantial cross-over interest among PICU/NICU/cards that might appeal to someone who couldn't get their first choice of these.

 

[J-Rad]

As much as I respect your opinion and experience, I still respectfully submit that I think that this is a bad idea except in the case of a true passion for PICU. As an aside, I almost did this when I had the opportunity for military funding for a PICU fellowship prior to knowing that cardiology would come up for funding the following year. It was both my intensivist mentors and cardiology mentors that advised me against going this route.
So here are the problems as I see them: if the individual were to obtain a PICU fellowship they 1) better be at one where they like the cardiology fellowship as much as the PICU fellowship because 2) the individual is now married to applying to only that [cardiology] fellowship (forget being able to apply broadly) to do an expedited 5 year combined fellowship 3) if they get into the cardiology program it would suck to be in one they don't like 4) they better be in a program in which the cardiology and PICU divisions get along well (while I'll bet most do, I doubt there are guarantees of this fact) 5) they better be in an institution that has PICU and cardiology divisions that are amenable to the combined fellowship 6) and they better be better than every cardiology candidate that comes through for the first 1+ year of interview cycles (cardiology tends to match 18 months out). When you plug all the variables into this scenario I think there is a lot that one is gambling on. And 1-2 years as a hospitalist doing inpatient general pediatrics is definitely still applicable. Inpatient pediatric cardiology has a substantial amount of general pediatrics and I think the experience would be equally as valuable to a future cardiologist as PICU experience. There are also opportunities to moonlight in some PICUs even as a boarded general pediatrician. So I definitely think the OP should think about this option, but should think long and hard about it.