Fellowship Competitiveness

[Detective SnowBucket]

Recently accepted to MD school and starting to think about program strengths/weakness/exposure at my school and then went to thinking about fellowships. I realized I know next to nothing about fellowship competitiveness. Is it more competitive than med school? Is there a huge range in competitiveness between different fields (not accounting for program prestige) eg: is a ortho spine fellowship harder to land than a nephrology fellowship? Why doesn't everyone do a fellowship, is it a question of opportunity cost?

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[whoknows2012]

Recently accepted to MD school and starting to think about program strengths/weakness/exposure at my school and then went to thinking about fellowships. I realized I know next to nothing about fellowship competitiveness. Is it more competitive than med school? Is there a huge range in competitiveness between different fields (not accounting for program prestige) eg: is a ortho spine fellowship harder to land than a nephrology fellowship? Why doesn't everyone do a fellowship, is it a question of opportunity cost?

While the question is totally reasonable it wholly depends on what fellowship you’re talking about. Certain fellowships, like renal as you brought up, are never very competitive. Others like GI are quite competitive. In my opinion unless your some superstar, medical school was easily the toughest to get into IMO. Once you get in, you have a lot more control, in my assessment, on your future. Also to your question, yes competitiveness varies by field.

Why doesn’t everyone do fellowship? Well it depends first on what you want to do. Fellowships also increase your training length. I’m finishing hem/Onc as a PGY7 (did a chief year) right now. That’s a REALLY long time to be training, and yet, others, like let’s say EP, or certain surgical sub specialties train for even longer. There’s potentially some opportunity cost with training longer for lower paying fields for example. But there are also people who want to be general surgeons or do primary care etc. Others like myself could only see themselves doing one thing (for me it’s leukemia).

 

[aldol16]

It's entirely dependent on field and whether you even want to do fellowship. Fellowship competitiveness doesn't really matter to you if you don't want to do fellowship in the first place right? Various factors go into that decision. Maybe you want to be a generalist in whatever specialty you go into (if that makes sense) and not further subspecialize. You might be limiting your opportunities in academic medicine but maybe your dream is to go into private practice in Minnesota. If that was your goal, you shouldn't be caring about fellowship match but rather how well a program places its residents into private positions.

It's useless to compare one field's fellowship to that of another field in terms of competitiveness. That's comparing apples to oranges. Within a field, fellowship competitive can also vary just like how residency competitiveness can vary.

 

[libertyyne]

It is too early to be thinking of fellowship competitiveness. Fellowship competitive and field competitiveness tends to fluctuate based on how many spots are available and what reimbursement looks like.

Go to the best/cheapest school you can.
Figure out what you want to do
Work hard
Match at the best program you can

Fellowship will naturally come after all of that.

 

[AnatomyGrey12]

Huge range and pointless to think about now.

 

[spartan25]

It’s important to get into the best medical school in order to get into the best residency in order to get into the best fellowship in order to get the best tenured track in order to become professor in order to get into the best nursing home once you’re all done

 

[longhaul3]

I agree with those above who say forget about it for now. Fellowship is a means to the job you want once you decide on that.

Even within the same field, many fellowships are more competitive than others. In small surgical fields, including spine, fellowships are usually with 1-2 attendings, like a true apprenticeship. Within the field, those fellowships are well known, and while you could do the same subspecialty fellowship with anyone, the big names are the only ones that really matter.

There are also different kinds of spine fellowships that focus more on certain things than others (like MIS vs. deformity) based on the attending who takes the fellows, and you have to figure out what you want to do for a career when you choose your fellowship.

 

[7331poas]

It is too early to be thinking of fellowship competitiveness. Fellowship competitive and field competitiveness tends to fluctuate based on how many spots are available and what reimbursement looks like.

Go to the best/cheapest school you can.
Figure out what you want to do
Work hard
Match at the best program you can

Fellowship will naturally come after all of that.

The equation is not so simple. People often have to balance their chances of attaining fellowship with their need to stay within a region or how well they like the program.

 

[libertyyne]

The equation is not so simple. People often have to balance their chances of attaining fellowship with their need to stay within a region or how well they like the program.

Yes, but those are personal decisions for reasons other than career prospects.

 

[7331poas]

Yes, but those are personal decisions for reasons other than career prospects.

True, but I may put aside my personal decisions to go to residency over another if they significantly impact my career prospects.

 

[libertyyne]

True, but I may put aside my personal decisions to go to residency over another if they significantly impact my career prospects.

Then i am unsure why you brought it up to begin with. Everyone has other factors in their life compared to career that impact them when they make decisions. This thread and conversation was about none of those. Merely, the pathway and competitiveness of fellowships.

 

[7331poas]

Then i am unsure why you brought it up to begin with. Everyone has other factors in their life compared to career that impact them when they make decisions. This thread and conversation was about none of those. Merely, the pathway and competitiveness of fellowships.

My point is that if a fellowship is competitive and I wish to enter that fellowship, I may be more inclined to forgo my personal priorities and elect to enter a "better" residency in a worse location. I think that dilemma makes it important to think about how competitive different fellowships are long before applying to a residency.

 

[Angus Avagadro]

My point is that if a fellowship is competitive and I wish to enter that fellowship, I may be more inclined to forgo my personal priorities and elect to enter a "better" residency in a worse location. I think that dilemma makes it important to think about how competitive different fellowships are long before applying to a residency.

You are really jumping the gun. Competetive specialties and later fellowships aren't your biggest concern right now, unless you can be in the top 10% of your med school class. You will find that many of your classmates are scary smart. Secondly, to.be a candidate for competetive specialties, you need a competetive app. This will require publications, ECs, board,scores, class rank etc. If you are in the middle of your med school class, you are in a group of very smart people, but probably not matching IM at Brighams.. Dont get ahead of yourself. Work hard in med school, get the best board scores you can, and play the match game well. Set realistic goals and you will be fine. Good luck and best wishes!

 

[nimbus]

It’s important to get into the best medical school in order to get into the best residency in order to get into the best fellowship in order to get the best tenured track in order to become professor in order to get into the best nursing home once you’re all done

I have mine picked out. Just puttin’ it out there to make myself accountable.

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[Mass Effect]

Recently accepted to MD school and starting to think about program strengths/weakness/exposure at my school and then went to thinking about fellowships. I realized I know next to nothing about fellowship competitiveness. Is it more competitive than med school? Is there a huge range in competitiveness between different fields (not accounting for program prestige) eg: is a ortho spine fellowship harder to land than a nephrology fellowship? Why doesn't everyone do a fellowship, is it a question of opportunity cost?

You're way too early in the process to even worry about this right now. As an entering MS-1, you likely have no idea which direction you're going.

But to answer your question, it's all specialty/institution dependent. Some fellowships are more competitive than others. Some fellowships that aren't competitive at, say, Rush, are competitive at MGH. There is no blanket answer to this. As to why some don't do fellowship, there are a number of reasons -- to some people, they'd much rather be an IM hospitalist than a nephrologist so it makes no sense to do any kind of fellowship after IM residency. Some just want to do family practice so why would they do a fellowship? Some go into derm and just want to practice derm so why do a fellowship? For others, they don't want the extra year or two of lost attending salary. After med school and 3+ years of residency, they're ready to start working and don't want to waste time in a fellowship that (in some fields) won't make any difference in terms of job opportunities, their own professional goals, or salary.

 

[Detective SnowBucket]

You're way too early in the process to even worry about this right now. As an entering MS-1, you likely have no idea which direction you're going.

But to answer your question, it's all specialty/institution dependent. Some fellowships are more competitive than others. Some fellowships that aren't competitive at, say, Rush, are competitive at MGH. There is no blanket answer to this. As to why some don't do fellowship, there are a number of reasons -- to some people, they'd much rather be an IM hospitalist than a nephrologist so it makes no sense to do any kind of fellowship after IM residency. Some just want to do family practice so why would they do a fellowship? Some go into derm and just want to practice derm so why do a fellowship? For others, they don't want the extra year or two of lost attending salary. After med school and 3+ years of residency, they're ready to start working and don't want to waste time in a fellowship that (in some fields) won't make any difference in terms of job opportunities, their own professional goals, or salary.

The point about opportunity cost (losing that year/2 of attending pay) was my initial suspicion. However, I just googled the spine fellowship length and it seems to be 1 year across the board. For the difference in salary (just ortho: ~$480,000/yr vs. spine fellow ~$750,000/yr) that is a huge difference (? IMHO?) and would justify a fellowship because - without running the numbers - it looks like you could make that lost year of salary back quickly and be able to cover student loan interest for that 'lost' year.

Though, I DO NOT imagine most fellowships fall into this category. Thoughts?

 

[libertyyne]

The point about opportunity cost (losing that year/2 of attending pay) was my initial suspicion. However, I just googled the spine fellowship length and it seems to be 1 year across the board. For the difference in salary (just ortho: ~$480,000/yr vs. spine fellow ~$750,000/yr) that is a huge difference (? IMHO?) and would justify a fellowship because - without running the numbers - it looks like you could make that lost year of salary back quickly and be able to cover student loan interest for that 'lost' year.

Though, I DO NOT imagine most fellowships fall into this category. Thoughts?

I think the point is , you can have long term goals, But realistically the best way to achieve them is to have short term goals that keep those doors open. All the number running and cost analysis wont mean squat if you end up with 200 on step 1, or get poor clinical rotation comments , etc.

The other aspect is that things change, interests change, competitiveness of specialties and fellowships change over time. You will change. Even the income numbers you are quoiting may change. So mapping out fellowship paths when you havent even passed an m1 exam yet is premature to say the least, and counterproductive.

Do well in school, do well on boards, match into a good program with a track record of placing people into fellowship and things will fall into place.


That being said, not everyone does fellowship is because not everyone is interested in doing fellowship, the income potential may not be very different at the end of the day, It may actually reduce job prospects / salary if you are too subspecialized .

 

[7331poas]

You are really jumping the gun. Competetive specialties and later fellowships aren't your biggest concern right now, unless you can be in the top 10% of your med school class. You will find that many of your classmates are scary smart. Secondly, to.be a candidate for competetive specialties, you need a competetive app. This will require publications, ECs, board,scores, class rank etc. If you are in the middle of your med school class, you are in a group of very smart people, but probably not matching IM at Brighams.. Dont get ahead of yourself. Work hard in med school, get the best board scores you can, and play the match game well. Set realistic goals and you will be fine. Good luck and best wishes!

I disagree with this. To match cardiology you don't need to be at MGH. You just need to be at a decent program. But as a residency applicant, it's important to know how competitive the cardiology match is and what qualifies as "decent" before deciding to move to the no-name community program next to your sick grandma's house.

I don't think it's too early to think about these things during M3/4.

 

[Angus Avagadro]

I disagree with this. To match cardiology you don't need to be at MGH. You just need to be at a decent program. But as a residency applicant, it's important to know how competitive the cardiology match is and what qualifies as "decent" before deciding to move to the no-name community program next to your sick grandma's house.

I don't think it's too early to think about these things during M3/4.

I dont necessarily disagree, OP was worrying about competetive residencies and fellowships before he/she has spent one day in med school. To get a competetive residency, you need a competetive app. The gist of what I'm saying.

 

[7331poas]

I dont necessarily disagree, OP was worrying about competetive residencies and fellowships before he/she has spent one day in med school. To get a competetive residency, you need a competetive app. The gist of what I'm saying.

Ok sure, but im sure others are interested in seeing the question answered who aren't medical school matriculants.

 

[deleted915325]

Yeah, there’s nothing wrong with asking questions about fellowship early in your career. It’s called being proactive. Thinking about how fellowships work as an M1 will not make you get bad grades lol. There’s a reason schools have “careers in medicine” seminars. It’s so you can a better idea of what you want to do and the path you need to take to get there.

I’m only an M2 though so I don’t have any answers for you

 

[longhaul3]

The point about opportunity cost (losing that year/2 of attending pay) was my initial suspicion. However, I just googled the spine fellowship length and it seems to be 1 year across the board. For the difference in salary (just ortho: ~$480,000/yr vs. spine fellow ~$750,000/yr) that is a huge difference (? IMHO?) and would justify a fellowship because - without running the numbers - it looks like you could make that lost year of salary back quickly and be able to cover student loan interest for that 'lost' year.

Though, I DO NOT imagine most fellowships fall into this category. Thoughts?

You're missing the point a little bit. Doing a spine fellowship won't increase your salary as a general orthopedic or neurosurgeon. It will allow you to start a career in complex or minimally invasive spine surgery, which comes with the higher average salary. So if you want to be a spine surgeon, go for it. If you don't, just spending a year doing it will not increase your salary by 50%.

The cost/benefit is more than just the extra year vs. higher salary. It's your career path.

 

[Detective SnowBucket]

You're missing the point a little bit. Doing a spine fellowship won't increase your salary as a general orthopedic or neurosurgeon. It will allow you to start a career in complex or minimally invasive spine surgery, which comes with the higher average salary. So if you want to be a spine surgeon, go for it. If you don't, just spending a year doing it will not increase your salary by 50%.

The cost/benefit is more than just the extra year vs. higher salary. It's your career path.

hmm yes, so you're saying that if you take the extra training then don't go into the exact field it'll have been a waste financially. I can't disagree?