Fellowship Advice

[snowbird900]

I've been very interested in PCCM since my first rotation in the ICU. I was also interested in cardiology. Due to personal reasons and some not so great advice I received early in my residency I ultimately chose to pursue cardiology (advice being the job market for CC isn't the greatest and there is a high burn out rate while cardiology offered more job stability and security especially if I wanted to move around. I would also be more likely to match cardiology because of there were more spots). Luckily did not match cardiology; I think part of me knew I wanted PCCM more and I subconsciously sabotaged my chances by only ranking <4 programs (despite 9 IV), all of which being reaches.
Now amidst this COVID pandemic and the more and more time I spend in the ICU (due to staffing shortages, I am finishing my 3rd straight month in the ICU and could easily finish the year here without an issue) it has become very apparent that this is what I want to do.
Since I learned this a little late and already committed to a year in a academic institution (with a strong PCCM fellowship) I would not be applying until 2021-2022 cycle. Full disclosure I do have 2 red flags on my application; 1) failed a course 1st year of med school that was successfully remediated (no other academic issues during medical school and actually would always get great feedback from professors/attendings on medical knowledge) and 2) Step 1 is <220. All other steps >230. All passed on first attempt, including CS.
These two are linked and stem from a rough 2-3 months where I lost several people close to me. In retrospect, should've taken the time off I was offered but was adamant that I graduate on time. It's not something I delve into on any application because really I don't think anyone wants to read yet another sob story, but will openly discuss on interviews if asked about it. Everything else on my application places me in the middle of the curve (a few PCCM publications/posters and awards) and good references (PCCM faculty at my home program does like me and have mentioned they were disappointed I chose the cardiology path).
That being said; would I honestly have a shot if I applied? I am American and an American medical grad from a low tier medical school and low-middle tier residency program. There is a long-standing PCCM fellowship associated with my residency, however I was hoping to go elsewhere for different exposure (and would like to go somewhere academic since I ultimately want more of an academic practice - even with the paycut and regional restrictions). I am not tied to any specific geographic area and will apply widely when the time comes. I was even thinking of pursuing an MPH and a sleep fellowship prior to applying to boost my application, in addition to continuing my research involvement.
My questions are 1) do I stand a shot with the above red flags? 2) does a hospitalist year followed by a sleep fellowship and an MPH help or would it hinder my application given that I am putting more time between graduation from residency and the start of fellowship? 3) am I really fighting an uphill battle here and should I maybe look into hospitalist positions where I get to do some ICU coverage as well? (not sure how I feel about not being fully trained to run an ICU but still stepping into that role) and I will be missing out on the pulm aspect as well.
Any advice, especially from selection committee members, would really be appreciated.

---

Members don't see this ad.

 

[Bobblehead]

I'm not sure med school transcripts or step scores ever factored very highly into our decision making process. I would only do a sleep fellowship if you plan to have sleep as part of your practice after fellowship. The MPH couldn't hurt but normally it's cheaper to get your fellowship to pay for it than having you foot the tuition yourself. Normally I would recommend you do a few weeks in a sleep rotation, see some patients and read some studies to get a feel for whether it's tolerable but right now due to covid virtually all sleep testing is suspended. If you do end up doing sleep you are more marketable in the end but realize that if you join a pulmonary group without a strong sleep presence already established you will be doing a lot of sleep, if not all of it.

 

[snowbird900]

I'm not sure med school transcripts or step scores ever factored very highly into our decision making process. I would only do a sleep fellowship if you plan to have sleep as part of your practice after fellowship. The MPH couldn't hurt but normally it's cheaper to get your fellowship to pay for it than having you foot the tuition yourself. Normally I would recommend you do a few weeks in a sleep rotation, see some patients and read some studies to get a feel for whether it's tolerable but right now due to covid virtually all sleep testing is suspended. If you do end up doing sleep you are more marketable in the end but realize that if you join a pulmonary group without a strong sleep presence already established you will be doing a lot of sleep, if not all of it.

Thank-you for the response. As part of my pulm rotation in residency, I did get some exposure to sleep medicine and I could see myself doing it in supplement to an academic PCCM practice; personally I really enjoy the pathology/tx of ILD and see myself building a practice mostly around that. Realistically, I know PCCM is getting more and more competitive every year and with two major red flags on my application, I was hoping to use a sleep medicine fellowship 1) to really emphasize my commitment to the field (especially since I have a lot of cards research and not as much PCCM; though I intend on working on that over the next year or two before I apply) and 2) to make myself more marketable to any group I may join down the line. I worry a lot of programs will just automatically filter me out based on my step 1 score, but to those programs that will actually review my application, I do want to make it clear to the committee that I may have not made the right decision initially, but I am dedicated to this and to prove that those red flags really were just situational and not part of any trend (a point that I believe my letters will also highlight when commenting on my clinical skills and knowledge).

 

[snowbird900]

Anyone with any further input?

 

[shouldigomd]

I agree, I doubt your failed course during med school will factor in much and your step score is just a screening tool. I would say the 9 interviews you got for cardiology (arguably more competitive than pulm/crit) is a decent indicator that you have a shot even with that step 1.

If I were in your shoes I would try and do a chief year if possible or secure a hospitalist position and make contacts / do research. Then apply very broadly... I would do the hospitalist position at the place that would allow you the most connections / research opportunities rather than "ICU" exposure.

 

[snowbird900]

Thanks

I agree, I doubt your failed course during med school will factor in much and your step score is just a screening tool. I would say the 9 interviews you got for cardiology (arguably more competitive than pulm/crit) is a decent indicator that you have a shot even with that step 1.

If I were in your shoes I would try and do a chief year if possible or secure a hospitalist position and make contacts / do research. Then apply very broadly... I would do the hospitalist position at the place that would allow you the most connections / research opportunities rather than "ICU" exposure.

Thanks for the input. A lot of the cardiology IVs came from the connections made through research, networking at conferences and through other med ed events; things I spent 2 years aggressively chasing. I am not sure whether I'll have that freedom/support as a hospitalist to cultivate these same connections which makes me think I may not be as lucky when it comes to PCCM. Though my home institution likes me, it is a smaller program which doesn't have as much of a name/presence outside of the state so unlikely to really be able to cultivate connections that way. I just want to figure out the best way to approach this (whether through MPH or sleep fellowship or both) to best place me in a position of success down the line. Luckily, the place I am signing with is an academic powerhouse with a strong PCCM fellowship and I plan to get involved with faculty early, I am hoping to make some connections through this avenue. I don't know if I really have an interest in pursuing an MPH but I am willing to do it as a means to an end if it means I'll be a stronger candidate in the end.

 

[shouldigomd]

Thanks


Thanks for the input. A lot of the cardiology IVs came from the connections made through research, networking at conferences and through other med ed events; things I spent 2 years aggressively chasing. I am not sure whether I'll have that freedom/support as a hospitalist to cultivate these same connections which makes me think I may not be as lucky when it comes to PCCM. Though my home institution likes me, it is a smaller program which doesn't have as much of a name/presence outside of the state so unlikely to really be able to cultivate connections that way. I just want to figure out the best way to approach this (whether through MPH or sleep fellowship or both) to best place me in a position of success down the line. Luckily, the place I am signing with is an academic powerhouse with a strong PCCM fellowship and I plan to get involved with faculty early, I am hoping to make some connections through this avenue. I don't know if I really have an interest in pursuing an MPH but I am willing to do it as a means to an end if it means I'll be a stronger candidate in the end.

Thats what I would do. A hospitalist year while devoting myself to research, connections and buffing the resume. MPH = useless.

 

[CriticalCareDoc7]

Go do a sleep year and back door your way in to the Pccm fellowship. We took our 2 sleep fellows.

 

[snowbird900]

Go do a sleep year and back door your way in to the Pccm fellowship. We took our 2 sleep fellows.

I hear this isn't as easy as it once was. Not that I'm looking for easy, but I'm really more interested in the ILD aspect of pulm than sleep or general pulm and ultimately would like to have more of an ILD clinic base when not in the unit. I was told sleep won't significantly help my application much which is why I didn't really pursue it and looked into alternatives like a masters that could maybe help separate my application from the rest. Are you involved in the fellow selection process? Do you generally view it as a bonus or was it mostly because you worked with your sleep fellows and could vouch for their work ethic and capabilities? Did your sleep fellows have an interest in sleep to begin with? I know it makes you more marketable, and if it'll help now and in the future, I don't mind delving down that path (given I can find a spot).

 

[CriticalCareDoc7]

I would do sleep at the PCCM institution you want to match in. Our 2 sleep fellows impressed the department faculty, other fellows, and had a bunch face time with the PCCM PD. It was a no brainer to take them.

 

[pccmforlifer]

When I was reading your intro paragraph, I thought to myself that this could literally be me. I have almost identical stats in terms of scores, med school, residency. What made me stand out as a candidate (12 interviews with lots of interest from my interviewers on the trail for the 20-21 cycle) are my strong LoRs, 4 co-author publications, and 6 poster/abstracts at national/international conferences. One of my letter writers is an associate program director for a PCCM fellowship which held a lot of weight. A couple of programs asked me about med school experiences, but you just have to defend yourself and back it up in the interview. They like to see your growth in residency and post-residency. So in short, if you have strong LoRs and show your interest in PCCM by doing research, then you will be all set.