Applying to neonatology a few years out of residency

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Mar 2, 2021
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Hi, everyone. Very long time lurker. I finished residency two years back and I think I will apply to neonatology fellowship this cycle. I have been practicing rural pediatrics which has been fun , helped me pay back my loans, and has been an adventure, but I'm looking for a new challenge and loved the nicu during residency. I'm getting a little nervous applying as I don't feel like I have a lot of resources due to being out of training, so I thought I would run some questions by all of you. Thank you in advance!

For context, I have no 'red flags': US MD, step scores >250 on all three, did residency at a large tertiary program at a "top ten" children's hospital (whatever that means), passed boards on first attempt. I think the two biggest things that will affect my application are research (basically none) and letters of recommendation. I think I did really well in residency, got great feedback, was a strong resident, always worked hard got along great with everyone etc.., but I wasn't on any leadership roles and didn't really get to know any faculty well so I'm pretty sure my LORs will be very vanilla.

1) How many programs do most people apply to? I was thinking about applying to about 10 programs. Honestly, what I'm looking for in a program is great clinical training in a nice location on the western part of the US. Is it like med school/residency where you apply to a mix of programs? How do you know which programs are more competitive than others?

2) Who do you recommend I get LORs from. I assume one has to be my PD and the other two can be open. I was thinking about my continuity clinic preceptor and maybe one of the attendings I worked with (if he remembers me enough). Should I get one from my current boss in my job right now. That might be an awkward ask even though we get along great... I don't think I know any neonatologists well enough to write me one, will this be a big deal?

3) I know research is a big part of fellowship training -- I have some interests, but certainly no track record of research accomplishments. I assume I can't do anything about it, but are some programs more 'research heavy' than others?

4) Anyone have any idea if interviews will be virtual or real life. Virtual would save me so much time and money!

5) What is the general perception of applicants who took time in between residency and fellowship? Should I answer to this in my personal statement?

6) I think ERAS requires you to have a MSPE (from medical school) and a medical school transcript. This makes me laugh a little bit as I now precept third year medical students and fill in those same comments and I wonder what they wrote about me back then! But anyways, do I just request this from my medical school and will they send it directly to ERAS?

7) Does it matter how big a program I train at in terms of clinical skills, future job opportunities or is the perception that all fellowship grads are equally trained

8) Any other tips or advice from someone going back into training. It scares me a little bit taking the pay cut and increase in workload; but every step has gotten better so far, so hopefully fellowship will be challenging and fulfilling

thank you all again!

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1. Depends on you, your flexibility, etc. 10 is a reasonable number for a strong applicant. Assuming everything is on line this year, perhaps a few more not because you need to, but just to get a sense of what's out there.

2. Whoever knows you best. The PD needs to be one, the others more recent contacts. It's okay without a neo. What matters the MOST is being able to tell a good story about why you're doing this now.

3. Yes, you'll figure this out in the process. It's not a matter of more research heavy but also lab vs clinical research.

4. I haven't heard a final answer on this, but I think the expectation is virtual. It'll be whatever residency does so keep an eye on that.

5. It needs to be in there. We like applicants who've been in practice, that's seen as a plus

6. I suppose so. Don't really know but that seems likely

7. Complex answer, but yes, it does matter to some degree. You don't have to be at the "biggest" clinical program, but be wary of ones that may be too small, have very limited cardiac time, severe BPD, etc.

8. Enjoy! I've known lots who've done it and I don't really think there's much regrets. If you can survive the paycut and being back to being a "grunt" again with all that means, it's worth it.
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thank you so much for such a helpful reply. I have been reading your advice since I was a third year med student and you are always so thoughtful; I really appreciate it.
I didn't have much confidence in myself and applied to 15 although all of my mentors told me no more than 10. I got 13 interviews and went on 10, ranked 10. My program is doing all virtual interviews again this year.