Advice on future direction after not matching

[RSBNKCBY]

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Hi everyone,

Another I did not match into fellowship post. Looking for some objective feedback and future direction. Of note, I am going to be getting feedback from my IM PD and H/O PD.

As for my app:
-USMD from an academic (lower-mid tier) program with in-house fellowship.
-Board scores: Step 1 below average, Step 2CK average, Step 3 slightly below average.
-Research: Worked in research for 5 years before med school, plus projects in residency (1 first author review pub to decent journal) that are ongoing and interesting to talk about; amounts to 10 published pieces including 3 decent manuscripts.
-LOR: Research mentor (H/O attending), Home PD H/O letter, H/O Hospitalist, and IM PD. I've heard nothing but positive things, but of course will never know. All of these people I worked clinically with for >4 weeks.
-Extras: Did the whole academic thing, being on committees and other non-research projects etc.
-Red flags: None that I am aware of.

I applied to ~50 programs, all of which were academic throughout the US. I got 4 IVs, including home program. The other 3 programs were not in my region and overall I felt decently confident. They didn't feel like reaches and seemed to be on my level of competitiveness. I did 1 mock interview and they had nothing but good things to say; typically I do well in interviews so I don't feel like I totally shat the bed.

I recognize many here talk about the negatives of an academic career, but having seen it already from the research side I felt like I wanted in. In hindsight I wish I had applied to community programs and just overall more programs. There were regions or states I didn't apply to because I couldn't see myself living there. Because what I have identified throughout this awful past week is that I can't imagine myself doing anything else except being an oncologist.

So that leaves me with how to go about next steps. I can't identify weaknesses on my app (besides step scores which I will never be able to change) and doesn't seem like a bunch of research would change a ton outside of burning out my interest in academic medicine further. Hospitalist seems like the easiest outcome because you can do it at your home program and the transition is minimal. I truly just don't enjoy inpatient medicine overall. My home H/O program took zero in-house applicants this cycle so I'm curious how they would look at me just 6 months later. There's of course all the non-accredited fellowships, onco-hospitalist, adjacent fellowships (Geriatrics, ID, palliative care) as options.

Any feedback or suggestions moving forward is appreciated.

 

[randomhemoncpd]

Happy to review - you can DM me. I am the PD of an academic program.

 

[HemeOncHopeful19]

Hm I thought I posted this earlier maybe it got deleted but… you should REALLY be asking to meet with your home program PD and/or APDs to ask for feedback.

 

[gutonc]

Happy to review - you can DM me. I am the PD of an academic program.

Hm I thought I posted this earlier maybe it got deleted but… you should REALLY be asking to meet with your home program PD and/or APDs to ask for feedback.

I think you definitely need somebody with more information than we (or you) have here to help you post-mortem this. What you've told us is of a stock average application that should have gotten you something. The <10% yield on interviews leads me to believe that there's a hidden red flag in your application. Only someone who can see the whole app (your home program, if you're lucky and applied to their program, @randomhemoncpd) and give you insight on it.

As for what to do now, I wouldn't try to get into a geri or ID fellowship unless you really want to do that. Onc hospitalist or one of the non-accredited fellowships is the best way to move forward for next year.

 

[MifflinDunder]

I wouldn't do any 1-year fellowship because you'll reapply for heme/onc 1-2 months into it. Look into onc hospitalists positions at institutions that often take them into their heme onc fellowship (e.g. UAMS does this every year) and apply broadly next time.

 

[RSBNKCBY]

Appreciate all in the input. I'm looking into onc hospitalist positions.

Hm I thought I posted this earlier maybe it got deleted but… you should REALLY be asking to meet with your home program PD and/or APDs to ask for feedback.

Unfortunately my home PD did not give me much feedback. They noted I have roughly the same or more research than their typical applicant. They also said some programs may still use filters for # of research.

The <10% yield on interviews leads me to believe that there's a hidden red flag in your application

I honestly wish there was a red flag, at least It would give me a direction on how to change my application. Currently I'm just being told it's getting more competitive and people slip through the cracks.

Is it worth reaching out to PDs I interviewed with to get feedback?

 

[gutonc]

Appreciate all in the input. I'm looking into onc hospitalist positions.


Unfortunately my home PD did not give me much feedback. They noted I have roughly the same or more research than their typical applicant. They also said some programs may still use filters for # of research.


I honestly wish there was a red flag, at least It would give me a direction on how to change my application. Currently I'm just being told it's getting more competitive and people slip through the cracks.

Is it worth reaching out to PDs I interviewed with to get feedback?

Maybe (probably) I'm just too far out from the process, but I still think the yield on interview invites is too low to explain just with "more competitive". But with there being essentially no "barrier to entry" for apps and interviews anymore, maybe that is the new reality. It might also help explain @randomhemoncpd's note in another thread that the median number of ranks/spot to fill is increasing over the last few years.

 

[MifflinDunder]

Appreciate all in the input. I'm looking into onc hospitalist positions.


Unfortunately my home PD did not give me much feedback. They noted I have roughly the same or more research than their typical applicant. They also said some programs may still use filters for # of research.


I honestly wish there was a red flag, at least It would give me a direction on how to change my application. Currently I'm just being told it's getting more competitive and people slip through the cracks.

Is it worth reaching out to PDs I interviewed with to get feedback?

You can. Some PDs will genuinely point out what could've gone wrong.

Did you have any ASCO or ASH abstracts? That's the research currency to match. I also had some fillers to get the # of research items up so I don't get dinged either way.

 

[randomhemoncpd]

Appreciate all in the input. I'm looking into onc hospitalist positions.


Unfortunately my home PD did not give me much feedback. They noted I have roughly the same or more research than their typical applicant. They also said some programs may still use filters for # of research.


I honestly wish there was a red flag, at least It would give me a direction on how to change my application. Currently I'm just being told it's getting more competitive and people slip through the cracks.

Is it worth reaching out to PDs I interviewed with to get feedback?

Honestly 4 interviews puts you at a below average chance to match. Probably best to get an unbiased review from places that elected not to interview you to see if that could be amended.

Also - don't bother getting a LOR from a H/O hospitalist. Those are not worth anything. You need LOR from hematologists / oncologists that have some pull and/or reputation and who can go to bat for you. It also wouldn't hurt to make sure that none of the LOR you have include anything negative or are lukewarm - those really hurt too.

 

[whoknows2012]

Maybe (probably) I'm just too far out from the process, but I still think the yield on interview invites is too low to explain just with "more competitive". But with there being essentially no "barrier to entry" for apps and interviews anymore, maybe that is the new reality. It might also help explain @randomhemoncpd's note in another thread that the median number of ranks/spot to fill is increasing over the last few years.

I agree. I think that explanation of people falling through the cracks make sense if you get a lot of interviews and don’t match (or you’re a poor interviewing which both doesn’t apply here and obviously does not seem to be the case). OTOH if I had to pick something based on what you provided that stood out it would be your research and how you described prior research and current research. Did you have any ash/asco/aacr/eha/esmo abstracts? Are any of your pubs besides the review from residency?

 

[whoknows2012]

You can. Some PDs will genuinely point out what could've gone wrong.

Did you have any ASCO or ASH abstracts? That's the research currency to match. I also had some fillers to get the # of research items up so I don't get dinged either way.

Yea I just asked the same thing. When I was reviewing apps I was unswayed by numbers. If a person had 1-2 abstracts that were impactful that was enough. Also felt that some applicants (again this may not be OP) who had prior research experience rested on their laurels and didn’t produce much in residency. Just to be clear-I don’t make the rules or the review criteria as we have to figure out a way to filter out applicants, but such is the case when we get 600 applications for 90-100 interviews and 6-8 spots

 

[Ubba]

There's of course all the non-accredited fellowships, onco-hospitalist, adjacent fellowships (Geriatrics, ID, palliative care) as options.

Geri, ID, and Palliative Care have nothing to do with Heme/Onc. I don't understand why doing one of these fellowships is supposed to boost applicant favorability.

Best bang for your buck is to work as a Heme/Onc hospitalist for the next year or two, so that - if you don't match - at least you won't have sustained a terrible opportunity cost.

 

[bobow98]

I think a palliative care fellowship is actually adverse to what we do in oncology - at least modern day "hospital branded" palliative care which is what you'll be doing a lot of during that training.

I place minimal to negative stock in someone trying to get to oncology via an extra year as a palliative care fellow. I'd rather you do onco-hospitalist and focus on the actual clinical care and medical decision making of the field.

That said, I have learned great things from the palliative care folks at some of the institutions I have trained at. I have taken some lessons to heart and still employ some of the techniques learned from them regularly.

I know some people will argue against my argument and that is perfectly fine.

 

[RSBNKCBY]

Did you have any ASCO or ASH abstracts?

Did you have any ash/asco/aacr/eha/esmo abstracts? Are any of your pubs besides the review from residency?

Prior to residency: Many ASCO abstracts and attended conferences for subspecialty of ASCO.
During residency: 1 ASH abstract accepted as publication but not to attend. I had 1 high-impact journal paper in translational research during residency. Currently have a project that I plan to submit to ASCO in the Spring to attend and some of the data was presented at a local Oncology conference. Several ongoing projects that I talked about on interviews.

Honestly I'm not sure how the research game works. Plenty of applicants or fellows I have spoken to had little or no research. Of course they generally came from top-tier institutions, so go figure that is their 'ace'.

I place minimal to negative stock in someone trying to get to oncology via an extra year as a palliative care fellow.

I was always told unless your heart is in palliative care, either as a career, or a bridge to return back to your career, then you shouldn't pursue palliative care as a fellowship.

Best bang for your buck is to work as a Heme/Onc hospitalist for the next year or two, so that - if you don't match - at least you won't have sustained a terrible opportunity cost.

That is what I'm leaning towards. It just sounds like most of these positions don't have much built-in mentorship so you're kind of starting over and desperately trying to connect with the Hem/Onc division for scholarly projects.

 

[Ubba]

That is what I'm leaning towards. It just sounds like most of these positions don't have much built-in mentorship so you're kind of starting over and desperately trying to connect with the Hem/Onc division for scholarly projects.

If you work at a center where the Heme/Onc service is primary, you will be working closely with heavy-hitters every day. Develop good relationships and you'll get letters from known names, which will probably carry at least as much weight as several mid-tier pubs.

 

[ayjaystudent]

Yea I just asked the same thing. When I was reviewing apps I was unswayed by numbers. If a person had 1-2 abstracts that were impactful that was enough.

Hi. What counts as "impactful" in your opinion?

 

[whoknows2012]

Hi. What counts as "impactful" in your opinion?

1st author, ash asco aacr esmo eha. Also something you can talk about . Better if actually a poster and not pub online only but that’s harder to discern for most people reviewing

 

[randomhemoncpd]

1st author, ash asco aacr esmo eha. Also something you can talk about . Better if actually a poster and not pub online only but that’s harder to discern for most people reviewing

100%. And it’s pretty easy to tell in an interview whether someone knows their research or not.