These are good questions.
Fellowship is probably the thing I grappled about most -- more so than residency and definitely more than employment, perhaps. I think anyone applying for fellowship needs to think not only about what s/he wants to do with his/her career but also about what potential options need to be in place should there be a change.
I always ask this of residents applying for our fellowship:
1. Why do you want to do neurotology? There's no right or wrong answer, but are you doing it because you feel like you need more otology training, you want to learn more advanced neurotology or you aspire to do academics or work in a tertiary center?
2. What are your academic goals? Are you interested in basic science or translational research, and how much of your future career will be devoted to the two?
3. How do you see yourself as a teacher? (This attempts to highlight how they will work and teach residents and what they will do beyond.)
4. Tell me your 5 and 10 year goals.
5. What innovations do you think are on the horizon for neurotology?
I also try to get a sense of what clinical experience they have had in residency (were they in the OR all the time or did they actually see patients in clinic). I see what residents know about E&M and CPT. I try to learn about struggles they had with co-workers and attendings as well as with nursing staff and technicians. I ask them about leadership dilemmas and scenarios that would require them to struggle with ethical decisions.
That's part of what my interview is like with fellows.
Being in an academic setting means different things to different people, so I really try to peel back they layers of a common answer when someone says they want to go into academics. Are they going into academics for the big cases, the teaching or the research -- and how much of all three. Any answer is valid, and I don't berate an applicant for any choice; it's getting a sense of the applicant's fit for our program and what he or she will do beyond. The "beyond" part is very important to us; how is this future physician going to represent us?
All the programs that you've listed are great. Really, they are. Most programs that will hire you for a "real job" will be looking for the best fit. Frankly, some just want a warm body that does neurotology. That's something that you can tease out before the interview and during the interview. I interviewed at 5 places, and when I narrowed it down to two places, I went to those two places twice for interviews. The first interview is to assess compatibility typically. Can we work with you; are you a good person? Do we have common goals? Do I know your fellowship directors, and what have they said about you. Keep in mind, that when interviewing residents for our fellowship, I almost always know at least one of the neurotologists personally (and in many cases very well). I always call or email in these cases. Believe it or not, sometimes we are so close that a colleague will sink an applicant when I ask him or her about the resident. The personal communication is that vital many times. So, yes, sometimes success in getting a fellowship is all about who you know.
The second interview tends to me more about getting to know other people you might work with (neurosurgeons, radiation oncologists, business admins, etc.) and hooking up with real estate agents, etc.
What are employers looking for? It's simple. They're looking for an applicant than can do the job described, and that's to be a neurotologist. The finer details of this widely vary. So, you want to seek a fellowship that gives you the broadest experiential learning and networking potential. A fellowship program that gives you numbers and variety of cases...a fellowship that gives you research time...a fellowship that puts you on the podium at national meetings...a fellowship in which the director invites you back to local meetings as a faculty member (that's really one of the most flattering statements about performance). There's no real formula. Every program has different needs, but many programs are looking for applicants who are neurotology -- not otology -- trained. Those that can and will sit for the boards and have done a two year fellowship. Some programs make no distinction between 1 and 2 year fellowships, but others really care about the 2 year fellowship-trained individual, the board-certified nature of the applicant, and the prestige.
In terms of prestige, if there are fewer spots available than applicants, prestige will play a role. If there are more spots than applicants, prestige doesn't matter. Nevertheless, you could be a House fellow with dozens of papers, but if you can't get along with faculty on the interview or just rub them the wrong way, it isn't going to matter. The higher up you go in the academic chain, the more it matters that you "fit."
I'd be happy to answer any more direct questions.
