American College of Physicians: Internal Medicine — Doctors for Adults ®


Tips to find a fellowship in a competitive market

Fewer subspecialty slots may mean a tough search. Here are some ways to make the process successful.

From the July/August 2000 ACP-ASIM Observer, copyright 2000 by the American College of Physicians-American Society of Internal Medicine.

By Ingrid Palmer

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Talk to educators about the market for subspecialty fellowships, and you'll hear one word to describe the competition: intense. As the number of subspecialty training slots has shrunk, residents pursuing fellowships have responded by getting aggressive with the application process.

This year, for example, the infectious disease program at the University of Massachusetts received three to four applications for every available slot. The gastroenterology fellowship program at the University of Colorado received more than 300 applications for its three open slots and interviewed only 10% of candidates. And some residents report that their colleagues pursuing fellowships in competitive fields like cardiology are applying to 50 or 60 programs.

Why has the competition for subspecialty fellowships become so fierce? Many training programs trimmed their slots in the 1990s after experts predicted a shortage of generalists and an oversupply of subspecialists. A few years later, budget cuts from the Balanced Budget Act of 1997 curtailed many hospitals' training programs by slashing funding for some fellowship positions. At the same time, some technically oriented subspecialties began requiring fellows to complete more training, cutting even deeper into money earmarked for fellowship training.

The result is that housestaff who want to subspecialize, particularly in hypercompetitive fields like cardiology, have their work cut out for them. Educators say that now more than ever, finding a fellowship requires more than a deep desire and a good resume--it can take months of planning and perseverance. Here are some strategies to help you get the fellowship you want.

  • Start early. Getting an early start is more important than ever when it comes to finding a subspecialty fellowship. Because many subspecialty programs are training fewer people each year, the available slots tend to be snatched up quickly.

Dennis J. Ahnen, MD, director of the gastroenterology program at the University of Colorado, said that he had already filled his positions for July 2001 by last March--and that he was already receiving applications for 2002. "Some programs will be finished choosing applicants for 2002 by the end of this year," he said.

Though you want to get a jump on the competition, some educators warn that applying too early can actually hurt your prospects. If your curriculum vitae is a little on the light side, they say, you should probably hold off on sending out early applications.

  • Research your options. To find a program that matches your interests and goals, plan on doing some serious research. Start by getting a list of fellowship programs from the AMA's FREIDA Online, which provides information and program contacts for accredited programs nationwide. (Go to You should also visit the Accreditation Council of Graduate Medical Education's Web site (, which lists fellowship programs by subspecialty and by state.
  • Get some experience. Once you've identified a program you're interested in, try to do an on-site rotation at the facility early in your second year. "Internal candidates always have an advantage. People who've come to visit and spent a month training are known," Dr. Ahnen said, "so they're more likely to get a break. It's hard for program directors and residents to evaluate somebody when they just see them for a day."

Another way to enhance your exposure is to participate in volunteer work. You'll earn positive recognition by doing "over and above what is required," said Eric B. Milbrandt, ACP–ASIM Associate and Chair of the College's Council of Associates.

Get recognition for your experience by getting referrals from physicians you have worked with. If you have worked with a well-known physician in a subspecialty or a physician who knows the fellowship director where you are applying, ask for a recommendation.

  • Publish. Another way to gain recognition is to publish. "Many fellowship programs look for students who have published," explained Dr. Milbrandt, "because it shows academic initiative, which is pretty important to fellowship directors." The articles don't have to be groundbreaking cases; a simple case review published in a small journal will do. The important thing is to gain the research experience and to have your name on the study as a lead author.
  • Apply to enough programs. Educators say that residents should apply to at least five or 10 different fellowship programs. If you're going into highly competitive subspecialties like cardiology or gastroenterology, consider boosting that number to 10 or 15 programs. To cover all the bases, Dr. Milbrandt suggested using a shotgun approach and applying to "several programs you have a good shot at matching into and at least a few long shots."
  • Use the Match. Some fellowships participate in a Match program similar to the one that you probably used to find your residency. For information on which fellowship programs participate in a Match, go to the National Resident Matching Program's Web site at

While the Match makes applying for a fellowship easier, you must sign an agreement stating that you will abide by the results. With this in mind, you should use the Match to apply only to programs that you really want to enter.

Another downside of many subspecialty Matches is that not all programs participate. For instance, only half of the nation's pulmonary fellowship programs participate in the Match, which can be frustrating if you want to apply to some programs in the Match and some outside of the Match.

Michael C. Ott, ACP– Associate, who recently entered a pulmondary fellowship at the Mayo Clinic in Jacksonville, Fla. noted, "If a program is outside of the Match, it may make an offer but want an answer before the Match" occurs, thereby putting you in a difficult situation.

  • Prepare for interviews. Educators say that while residency interviews are often intimidating, fellowship interviews tend to be more intimate and personal because of the comparatively small numbers of applicants. "Programs are looking for two to six fellows," Dr. Ott explained.

Because the personal aspect of a fellowship interview is so important, you want to make the best impression possible. Here are a few things to avoid:

  • Don't arrange an interview immediately after you've been on call. You want to be sharp and well-rested.
  • Don't whine. "We've all gone through residency, we know it's hard," said Margaret M. Johnson, MD, director of the pulmonary disease fellowship at the Mayo Graduate School of Medicine in Jacksonville, Fla. "Don't bother telling me it's hard."
  • Don't bad-mouth other candidates or programs. You'll be perceived as having a negative attitude and being unpleasant to work with.

Be prepared with answers to the standard questions: Why do you want to join our program? What is your motivation for going into this subspecialty? What are your strengths/weaknesses? What are your long-term goals?

Also be prepared to ask some questions of your own. Asking insightful questions shows the program director that you are interested and enthusiastic. It is perfectly acceptable to write down a list of questions and bring them to the interview with you. You can ask about the program's philosophy, schedule, teaching style and opportunities for future growth.

Research the program and the doctors before you arrive and know who you're interviewing with and what their interests are. Dr. Johnson recommended looking at what people in the division had published because "it gives you something to talk about and it can save you from making some faux pas."

You should also be prepared to discuss your research experience, according to Dr. Johnson. "I'm looking for people who understand what they've done and can talk about it," she said. "We had one candidate who had quite a number of projects listed on his curriculum vitae, and yet when you asked him about them in-depth, he couldn't tell you anything. That's a real negative in my mind."

Finally, be cooperative. Directors want to be sure you will fit in well with the other physicians on staff and the organization as a whole. "One thing that sets people apart is their ability to be part of the health care team," Dr. Johnson said. "All things being equal in terms of the resident's intellectual and patient care abilities, I'm looking at her ability to play well with others in the sandbox."

Resident resources

For more tips on finding a fellowship program and other career information for residents, see the Career Resource Center on ACP-ASIM Online at

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