A professor once told me, “Specialists know more and more about less and less.” The statement didn’t carry much weight when I heard it as a medical student. Specialization was far away, and my main goal was to understand the basics of medicine. Flash-forward to a few years later, residency was reaching its conclusion, and I found myself feeling confident with my medical knowledge; I was ready to expand on it by “knowing more” about my niche. It was time to apply for fellowship.
There was just one problem, though. I’d learned a lot, but when it came to finding a fellowship, I didn’t know quite where to begin. I imagine many others may not either.
In 2017, over 9,000 fellowship positions were offered through the National Residency Matching Program’s Fellowship Match. It’s almost certain that the thousands who applied for these positions didn’t use the same means to decide which program to target. Programs are different; sometimes subtly, sometimes vastly. Like a well-tailored suit, a perfect fit is essential. And to find that fit, you need the right tools.
In making your decision you may consider a tangle of factors, including a program’s clinical training, research training, prestige, location, etcetera. Before you let your mind race, here are two key questions that may help you more-easily navigate the process.
Where do I want to be in ten years?
This is the most important question. If you know you want a career in bench research, finding a program that has a structured research track will suit you best. If you know that you don’t want to spend countless hours in the lab, don’t waste your time in a program that requires you to spend time in a lab. I know this sounds intuitive, but it’s often not emphasized as much as it should be.
If you’re applying for a fellowship, you aren’t likely a teenager or in your early 20s -- you’re an adult who has already figured out what you like and don’t like to do. Don’t let anyone tell you that you have to do a specific type of research. Favor programs that allow you to do the work you enjoy. In the end, all fellowships required some degree scholarly activity. This is your chance to dive in, but dive into a lake that you would like to explore.
What do I want out of my training?
If your goal is private practice, it’s very likely you’ll need to be the Jack of All Trades in your subspecialty. Your future patients will depend on your ability to manage a breadth of diseases under your specialty umbrella.
If you know you’re going to into an academic career, you’ll need to find a program that lets you make a name for yourself in your desired niche. Most academic centers have very specialized clinics for specific disease processes, and you’ll be expected to have a tremendous amount of depth in that disease. Your knowledge base will have to be a mile deep. One thing to keep in mind is to favor programs that already have an established clinic/track for the disease process of your interest. For example, if you want to focus your career on interventional pulmonology, it would not be in your best interest to train at a fellowship that doesn’t do these procedures. You may be surprised, but not all large academic centers provide all the services under the sun.
More to Consider
Don’t let a program’s “prestige” be the driving factor for your selection. Many of the well-regarded fellowships earned their reputations by their excellence in research in addition to the fantastic clinical training that they provide. Just because a program is not sitting on top of a ranking list does not mean they do not provide excellent training.
The above points are subjective measures. For the more objectively-minded, there are several tools that applicants use to narrow down fellowship options. Many people flock to the U.S. News and World Report rankings of hospitals. All of the hospitals that make this list are exceptional at what they do and are great places to train. The ranking methodology is primarily driven by reputation with specialists, patient survival and measures related to quality of care. Certainly, if a hospital did well in all of these, it is very likely they provide great education as well.
Doximity’s Residency Navigator is also a useful tool. Although catered to residency, it takes into account board pass rates and metrics of research for a given program. It may not specifically focus on a particular fellowship, but it gives some insight into graduate medical education as a whole at a particular institution.
These two resources should act as nothing more than guides. The most useful resource that combines the best of subjectivity and objectivity is a trusted mentor or colleague that has done their fellowship in a program you’re interested in. These people are few and far between, so make sure you hear them out if you find one.
Fellowship is potentially the most important stage of our training. Find a program that fits you, do not conform to fit it. Keep clear eyes on the end game, and you will end up at a fantastic fellowship.
Sameer Avasarala is a clinical fellow in pulmonary and critical care medicine at the Respiratory Institute at the Cleveland Clinic and 2017-2018 Doximity Fellow.