Final Thoughts from the Fellowship Application Process

And with the dawning of a new year, I’m another year closer to becoming a full-fledged pathologist. Exciting and yet daunting at the same time as I have only 1.5 years and my AP/CP boards left before I start my fellowships! So, I thought I’d leave some final words on what I learned during the fellowship application process for those who have yet to go through it.

The earlier you decide on your choice of fellowship(s), the better you can prepare by presenting and publishing research in your area of interest, spending extra rotation time and study in areas related to your interest, and networking within your academic subspecialty organizations. I would say for the first half of first year, concentrate on your rotations especially surgical pathology and grossing technique. But at the latest by the second half of your first year, start honing in on what you think you’d eventually like to do and working toward that goal. Most residency programs are amenable if you ask them to adjust your schedule so you can rotate early through subspecialties of possible interest during your second or early third year. Don’t forget to ask for lighter rotation months and less/no call duties during peak interview season (Oct-Jan).

If you can, do an elective during your second or early third year in your subspecialty of interest at your dream program(s) before fellowship decisions are made and fund it through grants such as the one offered by ASCP (1/16/14 deadline; application here). I found that often, positions were already promised or eventually went to internal candidates or external candidates who had done an elective prior to their interview. Scheduling for elective rotations takes foresight, time and effort (eg – state medical license can take months), and an available rotation spot during your desired month, so start the process early!

Research early to create your application list. Only you will know the number you feel comfortable applying to which depends on your personal situation (eg – subspecialty competitiveness). I found that attending conferences and listening to speakers in my content area of interest helped me to decide which programs I may like. I’m also very active in CAP and ASCP and the physicians I work with in these roles, pointed me toward programs where the culture might be a good fit for me as they were role models of the type of people that I would like to work with. Of course, I also applied to top programs that I knew or that my attendings advised me were good.

Then check with programs about the opening date for application submissions if it is not posted on their website. I found that frequently, these were not hard deadlines. Since we don’t have a match, decisions are rolling (eg – I got promised an offer during my interview day and have friends who also had similar experiences). Once again, the early bird may catch the worm, and not because they are necessarily the best bird, but the first bird that a program likes. While some programs have a schedule for decisions, I found that just as many made offers as soon as they found someone they liked.

Make sure that personal statements are no longer than one page, shorter is better. You can follow this format: 1) how and why you fell in love with that subspecialty, 2) what you bring to the table especially for the program, and 3) what you want out of your fellowship and why that program is the best to accomplish those goals. Ask multiple people in your subspecialty or more senior residents to give you feedback on your personal statement/CV and for letters of recommendations very early – give a deadline earlier than you need so that you can have them ready by the time you want to submit.

I applied mostly to programs that had both hematopathology and molecular pathology fellowships and stated in my cover letter that I wanted to do both consecutively at the same place (but that it wasn’t a deal breaker). I received invites at almost all but decided to interview at a select number. For the ones where I interviewed for both fellowships (ARUP, Hopkins, MD Anderson, UPMC, Houston Methodist), it was usually the program looking for the fellow first who made the arrangements with the other fellowship. ARUP had interviews over 2 days (paid expenses except airfare) but the others all worked it out so that half a day was interviewing for hematopathology and the other MGP. Receiving an offer from one did not necessarily mean that I would automatically get one from the other. Scheduling both on the same day, also made things a little more difficult.

Respond to invitations quickly because this process is truly rolling. I was often given a limited choice of date(s). One place gave me only one date for an interview that I couldn’t make. Rescheduling can result in losing an interview because programs interview less people over fewer dates than they did for residency and will schedule someone else if you can’t make it. Some programs told me they were interviewing 2-3 per position while others said 5-10.

Be courteous and prompt, send your “thank you” email/note early and no later than by the next day. You can have a basic “thank you” email template ready to go that you can personalize so that you can send it even while waiting at the airport to go to your next interview. And be honest. I found that being upfront made it easier for programs to extend me a counteroffer when I mentioned that I had to make a decision soon on another offer. Once you’ve accepted a position, keep in touch with your program to hit fellowship running! I hope to do a PGY4 research elective in order to submit abstracts for conferences that occur soon after I start my fellowship and to familiarize myself with the EMR and clinical workflow in both fellowship areas.

And finally, be true to yourself about your goals, realistic possibilities, and most importantly, the program characteristics that will make you most happy. When I was applying to college, academic prestige and idealism were important, and for medical school, proximity to my aging parents. But now, what I find most important is the fit of the program. I want to be happy and feel like it is my home. I want to be at a place that hires their alumni and goes out of their way to help them find jobs. I want to be around role models working in areas that I want to as an attending: advocacy, medical education, and research…and of course, foremost, clinical diagnostic excellence…and who I feel will continue to support me as colleagues in the future. For me, fellowship isn’t just the time to merely refine my clinical expertise or learn things that I didn’t get to during my residency. It was more like interviewing for a job rather than for school admissions, making decisions with a more immediate goal of what I want to accomplish after and no longer “down the road”, and most importantly, building toward my future.

And I’m happy to say that I did get multiple offers from great programs and accepted at the place I felt the best fit. It was my last interview in mid-December, so you never know. I can say that having served in positions with CAP actually helped me because I already felt at home with 2 of my interviewers with whom I serve on a CAP Council (we just had a meeting 4 days prior) and one of the current fellows who I also met through being involved with CAP. So, networking, even when it isn’t deliberate or conscious as it was in this case, can help. In case you’re wondering, I’ll be completing hematopathology (2016-2018) and molecular genetic pathology (2018-2019) fellowships at Houston Methodist and also hope to participate in research at the Houston Methodist Research Institute.

-Betty Chung, DO, MPH, MA is a third year resident physician at Rutgers – Robert Wood Johnson University Hospital in New Brunswick, NJ.