Fellowships After Only 5 Years of GS

[filter07]

I'm like to get a rough idea of how much research is required for a fellowship match. It seems like most people do some research, and most are going into fellowships these days. Does this mean that virtually everyone has to do research?

Fellowships like peds, plastics, oncology probably require one or more years of research. But what about less competitive fields?

I know there are less competitive fellowships out there, like trauma/CC and CT. Are the top fellowships in these fields attainable after 5 years, or do they require extra years of research too?

Is it feasible to match into fellowships of moderate competitiveness after doing some research during the clinical years? (Not doing as much as a full year or two in the lab.)

What about other fellowships like vascular, transplant, MIS, gen. thoracic, colorectal, endocrine?

I'm interested in CT, vascular, MIS, and GI. Coming from a solid program, and with decent ABSITE scores, would it be possible to match at a east/west coast fellowship after only 5 years?

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[maverick_pkg]

yeah wanna know this as well

 

[Winged Scapula]

It is entirely possible to match into moderately competitive fellowships without doing any research; all you have to do is look at most community programs that send people to surgical fellowships - they traditionally don't have any formal lab time, nor do most do any research during residency.

Pediatric Surgery, PRS and the like generally do "require" research if only because of the few number of spots and the stellar applicants. And it is true that many surgery programs send people to fellowships and many residents do research - however, also consider the truth that not all residents who do research do so to become more competitive. Frankly, some just want some time off from clinical residency and to have a bit of a normal life. At my residency you could always tell who had been in the lab - they were in shape, tanned, and looked rested!

Competitiveness of fellowships not only hinges on the field but the location as well; so while Trauma may not be competitive, it is more so at the "biggies" - Baltimore Shock, Miami, UT Memphis, USC, Houston, etc. Anecdotally, I know someone from a community program who matched at Baltimore Shock without any research - he insisted it was due to connections (his PD was friends with the PD there), but who knows. At any rate, anything is possible, but its best to assume that these are the more competitive locations in a relatively non-competitive field.

Same goes for CT - while it is one of the least competitive surgical fellowships these days, applications have risen, although the quality of the applicants has not. At any rate, competition at a place like the DeBakey fellowship will be keen and may require some relevant research, but there are dozens of fellowships in CT around the country which didn't fill and are likely much less competitive.

Without going into details of all the fields you've listed, which may very well change in the next few years, YES it is possible to match into those fields without research. Bear in mind that doing any relevant research during your clinical surgery residency is hard - you don't have enough time and resources unless you're doing something like a chart review. If you can sacrifice the time and find the resources, that's fine, I wouldn't discourage you, but consider that what comes out of the sacrifice may not be worth it.

 

[dynx]

I'm like to get a rough idea of how much research is required for a fellowship match. It seems like most people do some research, and most are going into fellowships these days. Does this mean that virtually everyone has to do research?

Fellowships like peds, plastics, oncology probably require one or more years of research. But what about less competitive fields?

I know there are less competitive fellowships out there, like trauma/CC and CT. Are the top fellowships in these fields attainable after 5 years, or do they require extra years of research too?

Is it feasible to match into fellowships of moderate competitiveness after doing some research during the clinical years? (Not doing as much as a full year or two in the lab.)

What about other fellowships like vascular, transplant, MIS, gen. thoracic, colorectal, endocrine?

I'm interested in CT, vascular, MIS, and GI. Coming from a solid program, and with decent ABSITE scores, would it be possible to match at a east/west coast fellowship after only 5 years?

Keep in mind this is coming from a 4th year med student but from what I've seen on the interview trail:

Peds, SurgOnc and Plastics: you're right that you really need research to come out after five years. I only saw one example of a guy going to peds after a residency in a 5 year program that was out of Cottage in CA and the guy did a critical care fellowship and THEN peds at the same institution that he did his CC fellowship in. So I suppose its an outside possibility if you take it that step-wise route but in reality you're pretty much toast. Plastics I didn't take a real close look at but one of the mini-Mayos has put people directly into a plastics residency after only 5 years so it can be done.

Transplant: Don't know, didn't see too much about this.

Vascular: I have seen it done. Again, Cottage (only one of 2 five year programs on my list) put someone in vascular at Stanford not to long ago

CT: I wonder this myself. Several people have told me you can walk out the door, trip and fall into a CT fellowship these days. The real question is if that will still be true 5 years from now and also if going for a less "prestigious" fellowship institution will hurt your allready dismal job prospects....who knows.

Endocrine: Not sure. I have limited exposure but from what I've seen only a few fellowships exist at big time research oriented places...UCSF and now UCLA come to mind. So my guess is that you need some research for these.

Truama, CC, MIS, Colorectal : Yes, certainly 5 years is plenty.

So thats about what I think. Maybe Dr. Cox can hit us up with an answer as I was kinda wondering how little research I can do and still be competative.

 

[Winged Scapula]

Peds, SurgOnc and Plastics: you're right that you really need research to come out after five years. I only saw one example of a guy going to peds after a residency in a 5 year program that was out of Cottage in CA and the guy did a critical care fellowship and THEN peds at the same institution that he did his CC fellowship in. So I suppose its an outside possibility if you take it that step-wise route but in reality you're pretty much toast. Plastics I didn't take a real close look at but one of the mini-Mayos has put people directly into a plastics residency after only 5 years so it can be done.

We're all colored by our experiences. Cottage is a well-regarded community program with lots of high functioning residents, so I would not be suprised that someone from there matched. I too have seen people from community programs without research match into PRS but that was a few years ago and since its become so popular, that route is becoming less and less possible. Its a small field, so connections are key - but one hoping to get into PRS these days (and who knows what it will be like in 4 years) should expect to have to do some research. Same goes for Peds and SurgOnc (again, at most places, for most people).

Transplant: Don't know, didn't see too much about this.

Not very competitive, but some of that has to do with the competition for jobs post-fellowship. Its a very research oriented field, though...so most fellows have done years in the lab. If you are only looking to do renal transplants and work closely with a community transplant surgeon (you can find them at community programs, albeit usually ones with residencies), it could be possible.

Vascular: I have seen it done. Again, Cottage (only one of 2 five year programs on my list) put someone in vascular at Stanford not to long ago

Again, Cottage is a special case and Vascular is not too popular (except with those that LOVE it). So its possible to do without research, at most places.

Endocrine: Not sure. I have limited exposure but from what I've seen only a few fellowships exist at big time research oriented places...UCSF and now UCLA come to mind. So my guess is that you need some research for these.

Few programs, but lots of turf wars once you finish, so tends to be a small group that apply. But agree with above - most are at research oriented institutions (Columbia has one as well).

Truama, CC, MIS, Colorectal : Yes, certainly 5 years is plenty.

In most cases this is true. As I mentioned in my post above, there are some competitive programs for Trauma, Colorectal brings Lahey and Cleveland Clinic to mind, and MIS is getting more competitive. But overall, especially with Trauma and CC you don't have to have any research years.

Maybe Dr. Cox can hit us up with an answer as I was kinda wondering how little research I can do and still be competative.

 

[DoctaJay]

So as a general surgeon, you won't be taking out any tumors unless you have a fellowship in surgical oncology? I'm really not feeling the idea of doing a 7 years residency.

 

[Winged Scapula]

So as a general surgeon, you won't be taking out any tumors unless you have a fellowship in surgical oncology? I'm really not feeling the idea of doing a 7 years residency.

Not at all. Most oncologic surgery done in the community (ie, breast, colon, skin, etc.) is done by general surgeons without surgical oncology training/fellowship.

If you want to work at an academic medical center and do Whipples, melanoma, esophagectomies and some of the more advanced colorectal stuff, you probably need to be fellowship trained. That said, it all depends on what you can get privileges for (ie, I've seen a general surgeon in the community do a Whipple as well as esophagectomies).

Do you want to call yourself a Surgical Oncologist? Do a fellowship. If you want to do the cases and accept the possibly of having your practice environment limited (ie, if you were to try and do the cases in a community with lots of surgical oncologists, you would have a tough time), then you don't need a fellowship.

Same is true for lots of fellowships...

most MIS stuff is done by general surgeons especially as the residencies are doing lots more training
most colorectal cases are done by general surgeons, even advanced cases like APRs/LARs
most endocrine/thyroid is done by general surgeons and ENTs
most critical care is done by general surgeons without additional critical care fellowship training; same is true for trauma call, especially at non Level 1 centers

 

[uclacrewdude]

Not at all. Most oncologic surgery done in the community (ie, breast, colon, skin, etc.) is done by general surgeons without surgical oncology training/fellowship.

If you want to work at an academic medical center and do Whipples, melanoma, esophagectomies and some of the more advanced colorectal stuff, you probably need to be fellowship trained. That said, it all depends on what you can get privileges for (ie, I've seen a general surgeon in the community do a Whipple as well as esophagectomies).

Do you want to call yourself a Surgical Oncologist? Do a fellowship. If you want to do the cases and accept the possibly of having your practice environment limited (ie, if you were to try and do the cases in a community with lots of surgical oncologists, you would have a tough time), then you don't need a fellowship.

Same is true for lots of fellowships...

most MIS stuff is done by general surgeons especially as the residencies are doing lots more training
most colorectal cases are done by general surgeons, even advanced cases like APRs/LARs
most endocrine/thyroid is done by general surgeons and ENTs
most critical care is done by general surgeons without additional critical care fellowship training; same is true for trauma call, especially at non Level 1 centers

is that tantamount to saying that the only reason to do a critical care fellowship -- other than being able to take care of your pts who wind up in the SICU, and i imagine that responsibility would be heavily variable depending on where you wind up -- is to do trauma at a level 1 facility?

ill be at a place which sends out more general surgeons than fellows, so im trying to get an idea how much ill need to develop my app these next 5 yrs.

 

[Winged Scapula]

is that tantamount to saying that the only reason to do a critical care fellowship -- other than being able to take care of your pts who wind up in the SICU, and i imagine that responsibility would be heavily variable depending on where you wind up -- is to do trauma at a level 1 facility?

ill be at a place which sends out more general surgeons than fellows, so im trying to get an idea how much ill need to develop my app these next 5 yrs.

I think that would be a bit of an overstatement. While most trauma fellowships these days include critical care (allowing you to sit for the CC boards) and are probably required at most trauma centers, critical care (which can be a stand-alone fellowship), can be a useful tool for those who either don't get enough during their surgical residency or those who forsee a future taking care of critically ill patients (ie, CT surg, Surg Onc, etc.).

If your program gives you a fair bit of critical care rotations and you will be either practicing in a field which has few patients in need of this level of care OR practice in an environment (which you don't know about now) where critical care management is done by consultants (ie, closed ICUs or those managed by someone other than the primary team), then a critical care fellowship would probably be overkill - unless of course, its something you enjoy, IMHO.

 

[NDESTRUKT]

Or if one wants to be an intensivist, you can do a critical care fellowship and manage patients in the SICU (if for some reason they decided not to operate as much anymore) - am I right Dr. Cox?

 

[Winged Scapula]

Or if one wants to be an intensivist, you can do a critical care fellowship and manage patients in the SICU (if for some reason they decided not to operate as much anymore) - am I right Dr. Cox?

Sure. You'll have to find the right environment that would let you "just" do ICU care and not take gen surg or trauma call, but it is definitely possible and you'd still get to do procedures (bronchs, trachs, PEGs, lines, etc.)

 

[Doc Ivy]

KC, thanks for all the great info (as always)

a few questions for Dr Cox, and everyone else:

1) You mentioned Santa Barbara Cottage as a strong community program. I just matched categorical GS to Swedish Medical Center in Seattle, so I'm excited to be living it up Grey's Anatomy style in a couple of months. Have you heard anything about this program in terms of fellowship matching.


2) I am interested in CC but not the trauma surgeon lifestyle, is CC and accredited fellowship? Do they use ERAS? How many places offer it?

3) I am interested in hepatobiliary, not surg onc per se. Do you think I would need to take time off for research? How many places offer this type of training?

Thanks!

 

[Winged Scapula]

KC, thanks for all the great info (as always)

a few questions for Dr Cox, and everyone else:

1) You mentioned Santa Barbara Cottage as a strong community program. I just matched categorical GS to Swedish Medical Center in Seattle, so I'm excited to be living it up Grey's Anatomy style in a couple of months. Have you heard anything about this program in terms of fellowship matching.

Congrats - Swedish is a very well recognized program that is purported to turn out good surgeons. I don't have any data about their fellowship matching, but given the rep of Swedish, I would imagine that it would be pretty good for those who desire further training.

2) I am interested in CC but not the trauma surgeon lifestyle, is CC and accredited fellowship? Do they use ERAS? How many places offer it?

There are Surgical Critical Care fellowships which do not include Trauma; you can find info about these on the NRMP web site (don't know if they use ERAS): http://www.nrmp.org/fellow/match_name/surg_crit_care/about.html It looks like most take independent applications rather than use ERAS. There is no board for Trauma, but there is for Critical Care (hence, why many Trauma programs also include crit care), so you can be BE/BC after finishing the fellowship and any other prerequisites: https://home.absurgery.org/default.jsp?certsccce

3) I am interested in hepatobiliary, not surg onc per se. Do you think I would need to take time off for research? How many places offer this type of training?

Thanks!

I don't know how competitive HPB is...you'd have to talk to some people in the field. Most programs that offer fellowships (like Sloan, Wash U, U of Chicago) do so independently, without the NRMP. Check their websites or Google for info on HPB fellowships.

 

[Doc Ivy]

Thanks a bunch!

 

[Rook16]

so, given that research is helpful for surgonc, peds, prs...does the research have to be in that particular area. For example, you do 1-2 years of basic/translational research in surg onc during residency, pubs etc., and you then decide after leaving the lab that plastics or peds is for you. Does the research experience lose all/part of its value when applying for unrelated fellowship? appreciate input.

 

[geekgirl]

so, given that research is helpful for surgonc, peds, prs...does the research have to be in that particular area. For example, you do 1-2 years of basic/translational research in surg onc during residency, pubs etc., and you then decide after leaving the lab that plastics or peds is for you. Does the research experience lose all/part of its value when applying for unrelated fellowship? appreciate input.

optimally your research is in the appropriate field. but that is not mandatory. the research years mostly teach you how to think/act/write in a scientific manner. if they are directly applicable to what you are doing - great. if not, try and establish what skills, techniques, etc apply to the new field. you will realize many basic things translate from field to field. but be prepared to answer how research in "A" will facilitate your career in "B". if you have a reasonable response, most people will take it as such.

i have experience in a related but very different field from what i intend to pursue. but there is a thread of logic connecting the two. and many similar techniques and ways of thinking. it's never been a stretch to sell it to my new audience.

 

[eastcoastyall]

Call me jaded, but the research experience in residency isn't about learning how to write papers or think scientifically. Its to kiss enough @## so that you get the right level of letter from the right person. In the competitive fields (for example peds with 30% match if I remember correctly), the already present faculty can gain free labor for their labs. I'm not sure that it really matters if you learn anything in those years at all.

 

[boston]

Call me jaded, but the research experience in residency isn't about learning how to write papers or think scientifically. Its to kiss enough @## so that you get the right level of letter from the right person. In the competitive fields (for example peds with 30% match if I remember correctly), the already present faculty can gain free labor for their labs. I'm not sure that it really matters if you learn anything in those years at all.

not sure you should speak for everyone here. in our lab, i plan my own experiments, write the manuscripts, and meet on a weekly basis with my PI who sets the overall direction. we learn how to think and write scientifically. some of my fellow residents in other labs are writing grants. one is getting a phd. others preceding me have done phd level basic science research, publishing in journals like cancer gene therapy, annals of surgical oncology, PNAS, journal of virology, etc. they have presented at national meetings like ACS and SSO.

 

[NDESTRUKT]

So my intern told me today that colorectal wasn't hard to get. He said that it's a great lifestyle and that a lot of people apply but that there are so many programs out there if you apply to enough you'll get in. Is that true?

 

[Winged Scapula]

So my intern told me today that colorectal wasn't hard to get. He said that it's a great lifestyle and that a lot of people apply but that there are so many programs out there if you apply to enough you'll get in. Is that true?

Well, since there are more applicants than positions, I wouldn't necessarily say that your intern is correct. The match rate is 80% according to the NRMP:

http://www.nrmp.org/fellow/match_name/colon/stats.html

Cases are mostly elective and the lifestyle can be good if you don't take general surgery call.