Interview trail Impressions Part -1
Since I still am interviewing, and the ROL deadline is only in Sept, I am going to post only a generic impression in this segment. I will post a more detailed impression of individual programs in part 2 in September after I have matched (playing it safe
).
The Era of Great Personalities is Over, Move On:
The field has been heavily influenced by giants from Fahn to Delong to Jancovic, but remember they are all stepping down or about to step down. After interacting with fellows in such "big name" places, my impression is that these stalwarts are now almost namesake, and a one-to-one apprenticeship has become meaningless both because of the hyperspecialization that has engulfed the field and because these first generation giants are cutting back their clinic times everywhere. So, my aim this season was to look for second or third generation clinicians who are potentially going to grow into the next Fahn or next Delong.
But there is a catch here. There are already such upcoming stars, but due to the fragmentation of the field, they are not the "all-rounders" you would expect. Most centers with 4-5 Attendings, have someone doing exclusively DBS, someone running an HD clinic and someone helming the Ataxia clinic/research and so forth. Frucht, Factor, Bressman, Louis, Jinnah, Okun, Litvan, Mari, Ramdani, Stover, Walker, Mills, Espay, Changizi, are all examples of such a generation. They all have their niche areas of interests. Which means, you may need more than one mentor.
The Fellowship Is What You Make Out of It:
The absence of ACGME regulations means, only those programs that have a certain clinical volume can expect to stay in the game of offering fellowships. In that sense Movement Disorders is a blessed field. Any place is a good place to match. So what is the difference?
First year of the fellowship is pretty standard everywhere. Clinically intensive. Anywhere between 2-3 half day clinics a week, with OR time, rotations among Ataxia clinics, HD clinics, Tourette clinics etc. If you are keen on building a solid clinical base (especially intending to go into private/hospital practice), look for two types of diversity -- (1) number of hyperspecialized clinics within the division and (2) ethnic/age diversity among your patients. Some big metro programs and big referral centers have a particular advantage in the latter; they get all kinds of referrals, even international referrals, and sometimes faculty consultation from outside USA even (yes, truly global!). I am impressed by such things, being an international graduate with work experience from two other countries.
Most programs this year have been tactful enough to say to their candidates that the second year is built around the fellow's needs. That said, there are programs that haven't woken up from their twentieth century slumber and wants the second year to be absolutely a research endeavor. I prefer the former, with an opportunity for clinical subspecialization and research on the side. Many programs would suggest taking Masters courses for research training (Grant writing, Statistics etc). If you have a clear idea as to what you want out of this career, you are lucky in that you can straightaway tell the program to design the second year around your needs. Programs seem to like people with a plan - even if an overly ambitious or unrealistically optimistic one! Many fellows I met on the trail seemed to have had dithered and postponed making this decision until late in their first year, and programs seem to have taken note of this. I could read between the lines from many directors that they want you to not make that mistake. So plan your career ahead.
Subspecialization Is the Future:
Any program will train you in the basics of PD, manage Atypical Parkinsonisms, manage HD, tinker with DBS programming, play with meds for basic psychiatric issues common to our group of pts, and teach you BoNT injections for dystonia. So if you are set for private practice in a non academic center, choose your program based on the city you want to live or the proximity to your partner's workplace or whatever that is. But if you are planning to establish an academic career (any teaching center not necessarily a research center), and want to be do something very specific like DBS, or Gait or Tremor, then find a program that has a suitable mentor for you. Unfortunately this means interviewing at many places to find that person who will inspire you. Or go to conferences and figure out who is who and if they are approachable or offer such mentorship. This also will mean that you can not be very picky about the city your training center is located.
That is it for now. Part -2 on specific interview experience, will be updated later in September.
