As far as I know they are usually rolling admissions - there is no match, so it varies by program. In our program we are interviewing now for fellowship positions starting in 2012, so if you were planning to come straight from residency, you would apply as an R2. However, we will keep interviewing until we fill the slots.
For the fellowship that I did at a program in the midwest, I applied in fall the year before the fellowship started (I was in private practice instead of residency, but it would be the equivalent of applying as an R3) - however, I think they were going to be joining ERAS & due to that they were going to have to move the dates up. I suspect it varies program by program until everyone is in ERAS, so if there are programs you are interested in, it might be best to check with them.
This is based on my experience, thus far, as an applicant for the 2012-2013 fellowship year.
About 2/3 of the ACGME-approved H&PM programs have ERAS, set on the December schedule, 18 months prior to the start date, i.e., during R2 for IM. This throws off other specialties that usually apply for fellowships the beginning of their last year of residency.
Some programs are clearly, and in some cases explicitly, specialty-centric, limiting their screening process to applicants from 1 or maybe 2 specialties, despite the fact that the H&PM subspecialty is co-sponsored by 10 specialty boards.
No explicit rejections though, so far.
Familiarity and facility with ERAS appears uneven. Application review and timelines for offering interviews is also variable among programs. Initial phone interviews are fairly common.
There's no Match. It's all rolling. This creates a difficult, disempowering, anxiety-provoking and dilemma-prone situation for applicants, who may be interviewed and even receive offers from some programs, while other programs have not yet even contacted them (and, which programs conceivably might be interested in said applicant, and even offer a position after an interview whenever they actually got around to their official process).
This process needs a common set of deadlines. It needs a Match.
This process needs to get the word out to non-IM-specialty residents as to the IM-centric application timeline. I believe I am more plugged into the H&PM fellowship circuit than the average resident; I belong to AAHPM; I read H&PM blogs and get H&PM email newsletters, and I did not get the memo on this sea-change. My understanding now it that it was essentially a relatively recent, joint decision by H&PM fellowship PDs to align the process to the IM subspecialty application timeline to foster commitment to, and establish the perception of co-equal status of H&PM as a subspecialty, and to discourage applications by those who did not ultimately get into other subspecialties, which was making H&PM seem like a safe, fall-back, consolation-prize fellowship.
I'm not IM, and there is no H&PM fellowship at my institution. Information like this should not be dependent on my specialty, or my institution, or my connections. It should be transparent and widely promulgated.
The only reason I even know about the cycle and am applying now is because of this thread. I found out when I read mophead's post, confirmed it and frantically threw together an ERAS application within a week. So, I was only 2 weeks into the season. But that was not my vision, for a multiplicity of planning reasons, not the least of which is that I was just beginning my full license process, in order to moonlight, in order to finance the fellowship application process, which I can assure you ain't cheap.