Extremely gutted over matching at a community program. How to make lemonade out of lemons?

[Latteandaprayer]

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I know I sound entitled but I’m at a T20 med school with good scores, research, and letters. Interviewed well as far as I can tell. I really wanted to match to an academic program, but I ended up matching at a community one. The reasons I still ranked it is because it has a big catchment area and close to fiancé’s family.

I feel shame mostly because my co-students matched at T20s, and my school hasn’t matched anyone below a T30 in Neuro in at least 6 years (my matched program is in the low 100s).

I really want to abandon ship right now and leave medicine but obviously that’s the ego talking. I want to go into movement or epilepsy most likely, and my matched program doesn’t have either as a fellowship option. Not a research powerhouse by any means. No one probably has even heard of it outside of the city/region it’s in.

How can I be the best fellowship applicant possible?

 

[Captain_Falcon]

Once you hit PGY2 year, ask about opportunities to do away rotations to get movement and/or epilepsy exposure. Besides that just work hard and you’ll find a fellowship no problem even without research. The only truely competitive fellowship that has more applicants than spots is NIR (to be done after either vascular or NCC fellowships)

Sorry this happened. But it happened for a reason, you get to experience a totally different environment now and that could be amazing and exactly what you needed.

 

[Latteandaprayer]

Once you hit PGY2 year, ask about opportunities to do away rotations to get movement and/or epilepsy exposure. Besides that just work hard and you’ll find a fellowship no problem even without research. The only truely competitive fellowship that has more applicants than spots is NIR (to be done after either vascular or NCC fellowships)

Sorry this happened. But it happened for a reason, you get to experience a totally different environment now and that could be amazing and exactly what you needed.

Is it good enough if the program has faculty in movement and epilepsy, or should I do aways at programs with fellowships in those?

Thanks. It stings a lot. It’s my fault though because I only fell within my top 5 but I was “so sure” that I would match at my home program (#1) at least. But that’s life and lesson learned.

 

[Captain_Falcon]

Is it good enough if the program has faculty in movement and epilepsy, or should I do aways at programs with fellowships in those?

Thanks. It stings a lot. It’s my fault though because I only fell within my top 5 but I was “so sure” that I would match at my home program (#1) at least. But that’s life and lesson learned.

If you have subspecialty staff with clinics and exposure then no need for aways at all. You’ll just want to make sure you love what fellowship you’ll apply to based on the exposure you’ll get.

 

[DrSatan]

Congratulations on matching! Good news for you is that most neurology fellowships are not competitive outside of NIR. Since you'll be in a community program, you'll probably get more outpatient exposure which is great for movement disorders. My residency did not have a movement fellowship (though did have a strong movement clinic) and I matched well in fellowship. I have not heard of anyone doing away rotations. Research is useless outside of top academic fellowships. Remember that most neurologists do not practice in academic settings and see a combination of everything.

• Carve out your interests.
• Hone your skills.
• Find your mentors.
• Remain curious.

You will do great!

 

[Latteandaprayer]

Congratulations on matching! Good news for you is that most neurology fellowships are not competitive outside of NIR. Since you'll be in a community program, you'll probably get more outpatient exposure which is great for movement disorders. My residency did not have a movement fellowship (though did have a strong movement clinic) and I matched well in fellowship. I have not heard of anyone doing away rotations. Research is useless outside of top academic fellowships. Remember that most neurologists do not practice in academic settings and see a combination of everything.

• Carve out your interests.
• Hone your skills.
• Find your mentors.
• Remain curious.

You will do great!

Is it hopeless for me to match at a top Movement (or Epilepsy etc) program? Like UCSF, Columbia, Emory caliber. I just don’t want this to define me, I want to still get the best training I can and while I may not want to be in academics, the ego is talking and I just want to feel like doors didn’t close for me.

 

[deathmerchant]

Is it hopeless for me to match at a top Movement (or Epilepsy etc) program? Like UCSF, Columbia, Emory caliber. I just don’t want this to define me, I want to still get the best training I can and while I may not want to be in academics, the ego is talking and I just want to feel like doors didn’t close for me.

Like others said, I don't think you should have any trouble matching any fellowship in Top 5-10 programs. Most neurology fellowships have unmatched positions every year, including some top programs. Fields like movement are very niche and most departments are very small, so sometimes you could Not match into a specific program for a minor reason, but in general with good letters and some research you should be good. Also, like many people I know, you might change your mind about fellowship after first 2 years.

I was in an academic program but we didn't have all the fellowships and honestly, in the subspecialties where we didn't have fellows- I learned more.

 

[DrSatan]

Is it hopeless for me to match at a top Movement (or Epilepsy etc) program? Like UCSF, Columbia, Emory caliber. I just don’t want this to define me, I want to still get the best training I can and while I may not want to be in academics, the ego is talking and I just want to feel like doors didn’t close for me.

Only you can let your residency define you. No one gives a **** where you went to residency outside of ivory towers. Defining success by academic prestige is foolish, but unfortunately we've been trained to think that way. A fellowship is only as useful as you make it.

 

[Kissmyabjj]

Aside from basic competency, you will only get out of residency what you put into it above and beyond minimum requirements. I haven’t noticed any correlation between quality of a physician and where he went into residency after five years in practice. In my opinion, most important factors how much he cares about the quality of the work he does.

 

[s5260205]

Second all of the above. Even if you are gung-ho about research, you will have the opportunity to do so through fellowship, and there are several fellowship programs that are research intensive (including NIH T32 fellowships) where fellows spend majority of time in research with goal of K-1 or even R-1 awards. Outside of opportunity for research, the "prestige" associated with ivory tower academic institutions are all nonsensical. Going to these places will not make you a better neurologist. As long as you put in the effort to learn neurology, you will be a great neurologist no matter where you train.

 

[Latteandaprayer]

Second all of the above. Even if you are gung-ho about research, you will have the opportunity to do so through fellowship, and there are several fellowship programs that are research intensive (including NIH T32 fellowships) where fellows spend majority of time in research with goal of K-1 or even R-1 awards. Outside of opportunity for research, the "prestige" associated with ivory tower academic institutions are all nonsensical. Going to these places will not make you a better neurologist. As long as you put in the effort to learn neurology, you will be a great neurologist no matter where you train.

But do you think I could still match at a place like UCSF or Columbia from a low-tier university-affiliated community program?

I know it sounds ridiculous to target these two (and the like), but I am very upset that doors could close for me and there isn’t anything I can do about it.

 

[s5260205]

But do you think I could still match at a place like UCSF or Columbia from a low-tier university-affiliated community program?

I know it sounds ridiculous to target these two (and the like), but I am very upset that doors could close for me and there isn’t anything I can do about it.

In short, yes, you should be able to match at one of these namebrand institutions without difficulty, especially as both movement disorders and epilepsy are not competitive. However, you should ask yourself why you want to do fellowship in these places first.

Fellowships at these name-brand hospitals are usually research-oriented, meaning they are there to train future physician scientists, and as a result often 2 or more year in duration for fellowship with majority of time spent in research. However, in reality, many fellows trained through these programs do not end up in research-oriented careers, some even going into private practice soon after fellowship. What is then the point of doing the extra 1 to more year of fellowship? Consider the opportunity cost of 1 or more year of attending salary. I should add that there are people in academics who are there because of "prestige", some working just as much as in private practice and getting paid pennies on the dollar in comparison.

If this is your goal, to become a physician scientist, then you should absolutely apply to these programs. However, there are many other great programs that are 1 year in duration and provide great clinical training without the research requirement. This is better suited in my opinion for majority of prospective fellows.

Don't dwell too much on the residency being "community" at this time. You should really enjoy the rest of your 4th year and be ready for the challenges residency will bring in the next 4 years. Those who are not happy in residency, either due to geographic location or other factors, tend to do more poorly.