Neonatology fellowship 2023

[Anyknown]

Hi I wanted to make a thread for current applicants who are applying for fellowship this year. My question is what are the main things in program to look for to assess how good a program is for neonatology.

Also please add and ask more questions as relevant.

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[oldbearprofessor]

The two keys are clinical experiences and research breadth and expectations. Take a critical look at volume, exposure to ECMO and cardiac and number of VLBW infants each year. Research can be harder to assess but see how many neonatologists are doing clinical or basic science research, are funded, etc. This takes some investigation by the applicant beyond what you'll find on a website.

 

[Stitch]

I agree with OBP as usual. 🙂

I'm PICU but I think it's important for NICU fellows to have good exposure/experience with both cardiac patients and ECMO. It's best to see and manage as much as possible because that will enable you to take any job out there. Specifically I would ask whether ECMO is done in the NICU or if it transfers to PICU. If they transfer to PICU do the neonatologists and fellows follow the child there after transfer.

Same with cardiac. Most post op hearts go to PICU/PCICU but you'll want those patients in NICU for pre op management, and then back in the NICU once they are stable after surgery. The cardiac physiology is very important to learn and understand.

Another way to ask this question more broadly is by asking the program what types of cases get transferred out, or 'what don't you do here?'

 

[ghostbaby]

I’ve heard that there’s a growing trend towards neonates who need ECMO or cardiac surgery, being cared for in the PICU (or at least in the CICU which is either connected or closer to the PICU)… especially in the top academic centers.

Is there such a correlation with prestige of the academic center; if so, are there any centers with exceptions to this?

 

[SurfingDoctor]

I’ve heard that there’s a growing trend towards neonates who need ECMO or cardiac surgery, being cared for in the PICU (or at least in the CICU which is either connected or closer to the PICU)… especially in the top academic centers.

Is there such a correlation with prestige of the academic center; if so, are there any centers with exceptions to this?

Not to hijack this thread but…

Prestige according to whom?

 

[ghostbaby]

Not to hijack this thread but…

Prestige according to whom?

I would say according to a combination of US News and Doximity.

For example, I know neonates who need ECMO are managed in the PICU (“med-surg unit”) at Boston Children’s.

 

[wickedprophet]

I’ve heard that there’s a growing trend towards neonates who need ECMO or cardiac surgery, being cared for in the PICU (or at least in the CICU which is either connected or closer to the PICU)… especially in the top academic centers.

Is there such a correlation with prestige of the academic center; if so, are there any centers with exceptions to this?

I would say this is NICU-dependent rather than institution-dependent. I’m sure some of the higher-ranked Neonatology programs (i.e. based on US News) will see more ECMO or cardiac babies in the NICU.

 

[SurfingDoctor]

I would say according to a combination of US News and Doximity.

For example, I know neonates who need ECMO are managed in the PICU (“med-surg unit”) at Boston Children’s.

They don’t do that by prestige. Boston Childrens NICU is ranked 7, whatever that means. There is no ranking for PICUs anywhere.

There has been a trend to more NICU patients receiving pre-op CHD care in the CVICU… mostly so the cardiologists and surgeons don’t have to walk elsewhere. Maybe there is actual data on outcomes that supports this trend… but I highly doubt it. My experience in my own group has been mostly… “we did it because we could and we have to take care of them afterwards so why not”

 

[BabyDrKing]

Applying this cycle as well and have a few questions. How do fellowship programs view applicants who are a bit removed from residency training? I graduated residency in 2021 and have a year left of my active duty service obligation in the Navy. I tried to address this as well as an additional interruption in training between PGY1 and PGY2 due to service commitments in my personal statement but it’s not an uncommon path for the Navy.

Given interviews are likely to be virtual again resulting in people applying a bit more broadly, what would be a good number of programs to apply to? I know in the past I’ve seen +/- 10 but I’m probably going to apply to double that number to increase my chances.

What do programs use to screen/filter applicants? Step scores? Residency evaluations? My Step 1 score is mediocre (low 2XXs) but Step 2/3 were both significantly improved and I passed the boards this past October.

 

[Stitch]

Applying this cycle as well and have a few questions. How do fellowship programs view applicants who are a bit removed from residency training? I graduated residency in 2021 and have a year left of my active duty service obligation in the Navy. I tried to address this as well as an additional interruption in training between PGY1 and PGY2 due to service commitments in my personal statement but it’s not an uncommon path for the Navy.

Given interviews are likely to be virtual again resulting in people applying a bit more broadly, what would be a good number of programs to apply to? I know in the past I’ve seen +/- 10 but I’m probably going to apply to double that number to increase my chances.

What do programs use to screen/filter applicants? Step scores? Residency evaluations? My Step 1 score is mediocre (low 2XXs) but Step 2/3 were both significantly improved and I passed the boards this past October.

I can only comment on the first part here, people will be very understanding of military service and obligations. I practiced for three years after residency before doing fellowship and that was also fine (I would argue it was beneficial since I got confident in myself and knowledge). I think I applied to something like 9 or 10 programs, but it's hard to do much more because the interview season is shorter. Decide how big of a program you want and try to narrow done some geographic locations to start with.

 

[Oso]

Applying this cycle as well and have a few questions. How do fellowship programs view applicants who are a bit removed from residency training? I graduated residency in 2021 and have a year left of my active duty service obligation in the Navy. I tried to address this as well as an additional interruption in training between PGY1 and PGY2 due to service commitments in my personal statement but it’s not an uncommon path for the Navy.

Given interviews are likely to be virtual again resulting in people applying a bit more broadly, what would be a good number of programs to apply to? I know in the past I’ve seen +/- 10 but I’m probably going to apply to double that number to increase my chances.

What do programs use to screen/filter applicants? Step scores? Residency evaluations? My Step 1 score is mediocre (low 2XXs) but Step 2/3 were both significantly improved and I passed the boards this past October.

I think you should be fine as long as you were doing something legitimate during those gaps in training , which sounds like you were.

I don’t think the step 1 will matter much to at all given that you did well on subsequent steps and having passed Peds boards already will look great.

Things that will matter more will be letters of recommendation and research experience.

Generally speaking, I would recommend applying to 15-20 programs with a goal of ranking 10-15 programs.

I applied in 2020-21 virtually and everyone kept telling me what a mess it would be virtually and that everyone would be keeping their home applicants and that I needed to interview at a ton of places. So, I applied to 21 or 22 programs, got 19 interviews, did 18, ranked 18, matched #3. In retrospect it was super overkill and interviewing at 10-15 would have been plenty and much more manageable. YMMV.

 

[BabyDrKing]

Appreciate the responses. 15-20 programs seems like a reasonable number while staying in the general geographic region I'm interested in. I unfortunately don't have any publications, a few podium presentations from QI projects I've done. I feel strongly about my letters of recommendation though, my residency PD, 2 Neonatologists, one a former fellowship PD, one the NICU director, and both know me very well. Just gonna cross my fingers and pray. 🤔

 

[takeonme]

Despite having the rest of my app complete and trying to be as diligent as possible when reminding my letter writers, I have 2 letters that have not been uploaded. The processing time for my other letters has been taking roughly 6-7 days. Does anyone have any insight for what option is better when submitting:

1. Submit the complete app late when letters are uploaded? *how late is generally acceptable still?
2. Submit an incomplete app and send the LOR once it is done processing? *will you automatically be placed into an incomplete pile that gets looked at even later (compared to submitting a complete file late)?
3. Submit a different type of letter that does not necessarily fulfill their requirements and send the LOR once it is done processing? *will the program disregard your app early on for not following directions?

 

[Bloy]

Despite having the rest of my app complete and trying to be as diligent as possible when reminding my letter writers, I have 2 letters that have not been uploaded. The processing time for my other letters has been taking roughly 6-7 days. Does anyone have any insight for what option is better when submitting:

1. Submit the complete app late when letters are uploaded? *how late is generally acceptable still?
2. Submit an incomplete app and send the LOR once it is done processing? *will you automatically be placed into an incomplete pile that gets looked at even later (compared to submitting a complete file late)?
3. Submit a different type of letter that does not necessarily fulfill their requirements and send the LOR once it is done processing? *will the program disregard your app early on for not following directions?

I'm in the same boat and interested in advice. I'm planning on waiting to submit until whenever everything finishes processing in the next day or so.

 

[HemeOncHopeful19]

Submit now.

There are no piles. Everytime the PD logs into ERAS their list is dynamically updated.

If they filter based on number of LORs you will show up immediately after your LORs are in. If they don’t filter on LORs you’ll be seen immediately. There is zero advantage to sending in your app later.

 

[Anyknown]

What states should I target during the interviews where by I have better chance of getting Nicu waiver job. Once I am done with fellowship. I am on J1 visa.

 

[Bloy]

Submit now.

There are no piles. Everytime the PD logs into ERAS their list is dynamically updated.

If they filter based on number of LORs you will show up immediately after your LORs are in. If they don’t filter on LORs you’ll be seen immediately. There is zero advantage to sending in your app later.

Thank you for the advice! I'm on NICU right now and was chatting with one of the fellows and they also strongly recommended submitting so I was able to submit on time.