How to Get Into Fellowship After Residency

September 12, 2022
Fellowship is an exciting next step in your training after residency. Not everyone needs to do a fellowship (and many people don’t), but the advantage of further subspecialty training is the additional expertise that will set you apart from your colleagues. In this article, we’ll explain the different types of fellowships, how to apply to these programs, and what you can do now and in the future to make yourself competitive for a position.

What are the different types of fellowships?

The type of residency you do influences the different fellowship options that would be available to you. Many surgical fellowships like transplant surgery, pediatric surgery, or surgical oncology require you to complete training in general surgery. In addition, fellowships in cardiology, gastroenterology, or infectious diseases require you to complete a pediatrics or internal medicine residency.

That said, sometimes fellowship programs will accept residents from different paths. For example, hand surgeons may have training in orthopedics or plastic surgery, while dermatopathologists may have done dermatology or pathology residencies.

Another important distinction is whether the subspecialty is ACGME accredited, as some fellowship programs are not accredited. For example, trainees in internal medicine may pursue an addiction medicine or medical education fellowship after residency. These are still valuable to gain expertise in a discipline, but they may have different curriculum structures or application processes.

Finally, you may notice an option for a so-called “fast-track” residency to a fellowship position or an integrated residency. A fast-track resident usually has a background or interest in research and completes a shortened residency—usually two years of internal medicine or pediatrics—to apply for a fellowship earlier. If you match, you then would do a longer fellowship with more time allotted to engage in research.

Alternatively, an integrated residency combines residency and fellowship training from the beginning. It usually applies to surgical subspecialties, and examples include cardiothoracic surgery and vascular surgery. It’s possible to match into and complete a general surgery residency before becoming a fellow in these fields. The integrated path is usually shorter, however, and does not require a separate fellowship application. Because you apply for these positions as a medical student, you have to identify an interest in these subspecialties earlier.

How do I apply for fellowships?

Most residents apply for a fellowship at the beginning of their last year of residency. Overall, the process is similar to the residency application process as it uses the Electronic Residency Application Service (ERAS). The application requires letters of recommendation, a personal statement, a summary of your research and work experiences, and your United States Medical Licensing Exam (USMLE) transcripts for Step 1, Step 2 CK, and Step 3. Fellowship programs receive these materials and will then send out invitations for fellowship interviews.

Most interviews happen one to two months later and have largely converted to a virtual format due to COVID-19. You should note that sometimes scheduling interviews may be more challenging as a resident than it was as a medical student. As a result, you will need to time them when you’re free from clinical responsibilities.

What does the matching process look like for fellowships?

After you finish your interviews, you will generate a rank order list (ROL) of programs in order of preference. The same National Resident Matching Program (NRMP) that matched you to your residency program will match you to a fellowship. An important point is that the matching process is much less standardized for fellowship than it is for residency. You may have to use the SF match instead of ERAS and NRMP if you are applying into some programs like ophthalmologic and dermatologic subspecialties. Furthermore, some subspecialties may process applications well in advance of the start date, so you might have to apply a year or more before you are scheduled to finish your meds-peds residency program.

You should be aware that some fellowships—particularly those that are not ACGME accredited—may not use a centralized application service. Instead, you or a mentor on your behalf may communicate directly with fellowship program directors who would then consider interviewing you and offering a position outside of any matching process. The takeaway is that you should research the specifics of how to secure a fellowship position in your preferred field early on—and really as soon as you identify your interest—to be ready when it’s time to apply.

How can I make myself competitive for a fellowship position?

The review of fellowship applications is holistic but, of course, focuses on your performance as a resident. You can make yourself competitive by focusing on your training, showing dedication to patient care, and growing into the best doctor you can be. Your references and evaluations are key components of your application, most importantly that of your residency program director who is the most qualified to speak to the strengths you would bring to a fellowship program.

Research is another crucial component of your application, especially if you are applying for a more competitive fellowship. You should focus on quality over quantity. Take projects through to completion and publish your work rather than starting many smaller research projects that go unfinished. Beyond research, you should also get involved in meaningful work and volunteer experiences aligned with your intended field. It’s better to devote your time to a few impactful, longitudinal pursuits that would best showcase enthusiasm for your work.

A common question is how important USMLE board scores and specifically Step 3 are in your fellowship application. Fellowship programs will review your entire USMLE transcript, but the importance of these scores varies widely between programs. If you didn’t reach your goal score on Step 2 CK, you can use Step 3 to show improvement. However, these scores are only a part of your application and are evaluated in context with your other documents.

Set yourself up for success during residency

The most important takeaway is that you shouldn’t excessively stress through residency about applying for a fellowship. Residency is your opportunity to learn and grow, so take advantage of this experience to develop your skills. Focus on providing the greatest possible care to your patients, and with a little bit of planning, success will follow when it’s time to apply for a position.

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By Michael Stephens, MD

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