What I wish I knew in residency about fellowship Match

For physicians who know they want to pursue fellowship training, the Match may feel mysterious—and crucial.

But AMA member David J. Savage, MD, PhD, said residents should remind themselves of exactly how far they have already come.

“It's a privilege to get to be a physician,” he said. “And the fact that you've put in all these years of hard work to finish a residency should not be overlooked.”

Dr. Savage, now an assistant professor of medical oncology at the University of New Mexico’s Comprehensive Cancer Center in Albuquerque, pursued a hematology/oncology fellowship in 2020 for a July 2021 start. In an interview with the AMA, he talked about the yearlong process of applying for the fellowship Match and what he wishes he had known at the time.

His advice runs the gamut, from how to get great letters of reference to dealing with rejection if the Match doesn’t go as you’ve hoped.

In January the year of his fellowship Match, Dr. Savage began updating his CV, drafting a personal statement and assembling his letters of recommendation.

He identified faculty members who knew him well and who he was confident could meet his deadline. Then he asked if they would be comfortable writing a strong letter of recommendation. Dr. Savage suggested ways he could help, offering to send them his CV, his personal statement, talking points and even draft letters.

“I let the letter-writers guide me. Many of them actually took me up on the offer of a draft letter, which was great because then I was able to put the things that really stood out to me about my interactions with that person and that were memorable to me in the letter,” he said. 

David J. Savage, MD, PhD

From there, Dr. Savage asked his recommenders to make any desired changes and put it on their own letterhead. He gave them a hard deadline of about a month before his own deadline to submit.

“That way, if there were stragglers, it wasn't going to hold up my application,” he said.

With fellowship training, program directors want to see that applicants have done some scholarship in their field. Dr. Savage said it’s not enough to “have shadowed or worked in a clinic.” Find a way to show your commitment.

“That could be a presentation in a national conference, it could be something that you've gotten published with a mentor, and that then translates to a mentor letter of support,” he said.

Once you’ve published, request a letter of recommendation from the person who mentored you on the project. Not doing so could send the wrong message, Dr. Savage warned.

“It actually would stand out as a red flag to have a lot of stuff on your CV with somebody who's a medical oncologist and not have a letter from them,” he said.

When it comes to crafting a personal statement, make sure to let your top choices know of your strong interest, and be clear when you have important considerations such as geographic limitations. For Dr. Savage, that meant telling some programs that he had to stay in the area for family reasons.

“I emphatically put that in the personal statement because I wanted to make it crystal clear that I wasn't just a free agent looking at places all over the country,” he said. Program directors “try to prioritize people who have these very specific geographic constraints and they're not just applying to San Diego to be by the ocean.”

In residency applications, Dr. Savage said there’s some understanding that you may not have your entire career mapped out yet. But by the time you are applying for fellowship training, the expectation is that you will have clear goals. Your personal statement should detail them and explain how the fellowship program will help you reach that aim.

Don’t try to read fellowship program directors’ minds about what you believe they will want, he said. It is better to take a more straightforward approach. 

“When you're an applicant—especially when you're applying to university programs—you probably have the narrow idea that the university programs want somebody who's a little bit cookie-cutter, somebody who's done a lot of research, wants to do more research and wants an academic” career, he said. But as someone who is now reviewing fellowship applications himself, Dr. Savage said “we put a lot of value in somebody knowing themselves so well to know where they thought they would want to be in three years.”

You also don’t want to wind up in a program that’s not your best fit.

“I've seen that mismatch happen where people end up at the big university, and then when the rubber hits the road and they start working,” the person thinks: “I just want to do private practice, and this place wants me to publish X number of things to graduate and go to all these conferences. And I hate research. Why did I do this to myself?”

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Good practice for both residency and fellowship program applications is to have all materials assembled well ahead of the deadline and upload them as early as possible, ideally on the first day.

“What some programs do is they download all the apps on a single day. Maybe they'll wait until a week after the apps become available, and they'll download everything that's available. And they might not refresh their download after that,” Dr. Savage said. “You might miss out on opportunities at certain programs if you don't have your app in on day one.”

The process of interviewing for fellowship training turned out to be far less expensive than Dr. Savage’s residency interviews, when he spent at least $10,000 traveling across the country. He also had to take a lot of time off for multiday trips.

“When I interviewed for residency, it was a very in-person, costly process,” he said. “So, when I was in this new postpandemic or midpandemic process of applying to fellowships virtually, it was a dream.”

While some fellowship programs have kept the virtual interview format, others have gone back entirely to in-person interviewing, Dr. Savage noted, specifically naming neurosurgery as one specialty where residents should expect to visit for interviews, at least for some programs.

There are some programs, however, that provide an optional “second look” in-person visit that takes place after program directors have already submitted their rankings but before applicants make their final list.

“That way, people didn't feel pressured to come out just because they thought it would change their position,” he said.

Perhaps the most crucial piece of advice Dr. Savage has for residents applying to fellowship programs is to keep it all in perspective.

“Whether you match or you don't, usually anywhere from six to 12 months after you do go through the Match, most people are going to finish a residency and they're going to be a board-eligible physician in a field that they did a residency for,” he said.

“In a few cases, I've seen people get down and mired in sadness when either they don't match to the place [fellowship program] their heart was set on or they don't match, period. Whereas, when you're applying to match in residency and you don't match, that really limits your ability to do things because you have a medical degree and you can't practice,” Dr. Savage said. 

“With fellowship, it's different in that way. Because if you don't match, you know you're still going to graduate and be a graduate” of an Accreditation Council for Graduate Medical Education residency program, he noted. “You can sit for your boards. You can get gainful employment as a physician, and you can get compensated well for it. And I've always recommended applicants not lose that forest by focusing on the trees of the fellowship. 

“It's hard to appreciate at the time,” he said, of missing out on your dream fellowship Match, “but it's not the end of the world.”