letmeinwillya

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Currently PGY-1 in IM, don't know if I would do the fellowship or which specialty. What would you tell your resident-self for those who have gone through the fellowship application process?

Any gotchas to watch out for? If one knows at the start of PGY-1 that he/she will be applying for Fellowship what should they be doing through the residency to make them a strong candidate?

Is the process just as hectic or dare I say painful as the residency application process? How can one increase their chances of getting accepted at a fellowship? I've lot more questions but I would appreciate your input and get this conversation going.
 

ThoracicGuy

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Currently PGY-1 in IM, don't know if I would do the fellowship or which specialty. What would you tell your resident-self for those who have gone through the fellowship application process?

Any gotchas to watch out for? If one knows at the start of PGY-1 that he/she will be applying for Fellowship what should they be doing through the residency to make them a strong candidate?

Is the process just as hectic or dare I say painful as the residency application process? How can one increase their chances of getting accepted at a fellowship? I've lot more questions but I would appreciate your input and get this conversation going.
Do well in residency and fellowships will be easier to achieve (within reason...).
 
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letmeinwillya

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Thanks for the advice, I would want to do well in residency of course! I'm looking to know the mechanics of the process as well as the must-do kind of things. So in other words, if someone handed me a calendar of things to do and by the time I'm ready to apply I would have done those things. Like poster presentations and what not!

Is it fair to say that Fellowship solely rests on residency and what happens during residency. All the track record in med school and other experiences prior to residency are considered during the residency selection process. So how far into a resident's career will the Fellowship selection committees look..is it pretty much how the residency went and the candidate has interest in a given specialty..is that it? or gotta create personal statement, ERAS application the whole shebang!!
 

AdmiralChz

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In general, fellowship applications and interviews are much more relaxed and almost enjoyable. It had a completely different feel for me from residency applications. Programs also know you have the very real option to not pursue a fellowship and just go get a job, so they are more accommodating and friendly. my friends in IM who just went through this corroborate this.

For fellowship applications, much like residency it's all about what you've done recently. Medical school is barely a factor. In training exams can be important, especially in competitive specialties. I will say in many fields LORs can mean a lot more since the relative communities tend to be much smaller -it's not infrequent to have a letter writer call a PD directly if you're a solid candidate. Just some overall thoughts from the gallery.
 
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letmeinwillya

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Thanks Admiral! It's a relief to know that it's not as crazy as the residency process. One thing I find would be challenging is the schedule. During residency I applied to as many programs as I could and had the time to attend far away places on short notices and was generally available on a moment's notice for the interviews. If a residency is applying during PGY-2, the number of places where one applies and then attending the interviews would be limited by how much time one could take off from current residency program.

I know it would be program specific but would love to know how others have dealt with this. Do you tell the PD that I'm planning to apply for fellowship but don't know which one at the time and let me attend the interviews at will as they come? Sounds less likely that residency program will say go to interviews whenever on short notice.
 

AdmiralChz

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Talk to some of your upper level residents about what they had to do to get time off for interviewing. Or ask your PD. It can be difficult for sure so the physical number of interviews you can go on will likely be less (12 residency interviews, 7 fellowship including home program). Some places allow you to use meeting leave for interviews (we had 5 days), but some of my friends had to use vacation time. Some rotations are more interview friendly like ER/ICU where you might be able to cluster shifts together to have a few days off in a row.

Programs know this so usually schedule you out quite a bit in advance so you can let your program know. I had at least a 6 week notice I believe.
 

QofQuimica

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I worked for two years after residency before applying for fellowship (applying now to start next summer), so that made my schedule more flexible for interviews than it would have been if I had applied as a resident. Two things you can do to make scheduling interviews possible are to let your chiefs know you'll be applying before they make your PGY3 schedule so that they can try to schedule you on easier rotations during interview season, and/or try to get your PGY3 vacation time scheduled during interview season. But as Admiral said, you may not need to go so crazy applying all over the place for fellowship, especially if you're doing a fellowship that isn't very competitive. I applied to a couple dozen residency programs, but only to three fellowship programs. The stakes are just a lot lower at this stage of the game because I'm already a board certified attending, and I'm willing to risk not matching anywhere for fellowship over having to move somewhere I don't want to go.

As for what you can do to be a better applicant, it depends on what kind of fellowship you want to do. Try to talk to current fellows in your subspecialty about what they did to improve their apps. Also, if your hospital has a training program in your subspecialty, make an appointment with the PD to go over your app. But I agree with TG that the most important thing for you to do is to be a good resident and develop a good base in IM.
 
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letmeinwillya

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Hi Q,
Thanks for your the helpful post. Good luck with your application for Fellowship! In your opinion, does the "gap" make any difference when applying for fellowships? In case of residency applications, this was a big deal and one better have a explanation for it.

Now if one works after the residency say in a primary care setting or as a hospitalist for a year or two then applies for fellowship in IM sub specialty, is having worked after residency a liability or an asset? Is such a candidate stronger than say someone who hasn't worked at all and applied for fellowship during residency?

Thanks again for your time!
 

IlDestriero

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I worked for a few years as an attending before I went back to a fellowship. When you're kicking ass and taking names every day already, have documented leadership, are already board certified, etc., it's hard to compete when you're "just a resident". ;) Though this was in anesthesia so the fellowship isn't entirely different than what I'd be doing in the fellowship as opposed to how general IM and a subspecialty might be.
The only questions you'll need answers for are why did you wait, and how do you feel you'll be able to handle being a trainee again and being supervised.
I think it helped me get the fellowship I wanted and the attending experience gave me a leg up in scoring a great job coming out of fellowship.


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QofQuimica

Seriously, dude, I think you're overreacting....
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Hi Q,
Thanks for your the helpful post. Good luck with your application for Fellowship! In your opinion, does the "gap" make any difference when applying for fellowships? In case of residency applications, this was a big deal and one better have a explanation for it.

Now if one works after the residency say in a primary care setting or as a hospitalist for a year or two then applies for fellowship in IM sub specialty, is having worked after residency a liability or an asset? Is such a candidate stronger than say someone who hasn't worked at all and applied for fellowship during residency?

Thanks again for your time!
It's different applying for fellowship than for residency in many cases, simply because it's more of a buyer's market. You don't need to do a fellowship to practice medicine, but your MD or DO is essentially useless without a residency. That puts a much greater premium on getting a residency, because unlike a fellowship, completing a residency is not optional. But once you finish your residency, you always have the option to continue on doing general internal medicine, and plenty of people spend their entire career as a hospitalist or PCP. Of course, there are some popular subspecialties like cards or GI that are relatively competitive, and maybe for those, time off after residency might be an issue. But the subspecialty I'm applying in actually has more slots than applicants, so no, the programs don't want to shut out an eligible applicant who spent some time in general practice. At one program where I interviewed, they told me they had trained someone in their 50s who had been out practicing for a couple of decades. Compared to that, my three years out doesn't seem so crazy!

I'm sure it also matters what you do during your time out of training. If you spent that time doing something nonmedical and then suddenly wanted to jump back into medicine, that might be an issue. Whereas, if you spend the time working in a clinical setting along with getting BC, that obviously doesn't make people concerned that you can't hack the fellowship clinically the same way it might if, say, you'd taken a few years off to sail around the world or something.

In addition, fellowship PDs know that someone who is leaving FT practice as an attending to go back for training is sincerely interested in doing the fellowship. You don't make a change like this unless you're serious about the subspecialty. I'm leaving a good tenure track academic position to take a fellowship that will pay me about 20% as much (not including moonlighting, of course). And afterward, I can expect to make less money as a subspecialist than I currently do. So yes, people do ask me why the wait, but no one questions my interest or sincerity. And actually, I haven't been asked if I'd mind taking orders again as a trainee, either. Maybe it's because I was a nontrad (started med school at age 31), or maybe it's because the fellowship is a bit less hierarchical. I don't know.

I think if you know what you want to do by next year, it makes sense in many cases to go ahead and apply straight out of residency. There's no doubt that it's harder for a lot of people to go back to training (especially financially) after they've been out for a while. But if you don't know for sure, or if it's financially not feasible for you to go straight into fellowship training, it probably won't hurt you to practice general medicine for a year or two before you apply. And as IlDestriero suggested, it may even help you in some cases.
 
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