Medical Fellowship in the USA
Applying to Fellowship
Applying for fellowship is a process that is overall usually less stressful than prior applications to medical school or residency--remember, regardless of whether you enter your sub-speciality fellowship of choice, you will still be licensed to practice in your speciality!
Requirements
Please verify with each program individually with each program their specific requirements, these are only broad outlines:
Enrolled in a Residency Program
Most fellowship programs will require you to be enrolled in an accredited residency program at the time of application, or to have completed such a program. For example, any residency program in Canada would be a valid option.
Specialty Certification
At the time of application, most fellowship program will not require you to have completed your a specialty accreditation (since most will still be in residency and will not have completed such an accreditation at the time of applying). Some fellowship programs may require you to submit subsequent proof of completion of a Royal College speciality certification, but this is actually rare from my experience.
USMLE
From my experience, proof of completion of medical school in Canada and being enrolled in a provincial college of physicians as a resident or in independent practice is sufficient for most fellowship programs and USA-specific licensure is not required for Canadian Resident physicians. This may vary for other countries and by program, so please check accordingly.
Citizenship
US citizenship or permanent resident status is NOT a requirement to undergoing fellowship in the USA.
Timeline
Ideally, one would apply to fellowship early, but this is not something that is always possible given that many residents are so busy with the quotidian tasks of residency that they don't have time to think about which subspecialty they would like to choose, let alone the specific fellowship program in which they would like to do this. Fortunately, many subspecialty fellowship programs in the USA have switched to a "matching" system, à la CARMS, which pushes the deadline for applications towards the end of residency rather than in the middle of it. The list of fellowships selecting candidates through a matching system are listed on the National Resident Matching Program (https://www.nrmp.org/fellowship-applicants/participating-fellowships/).
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If your program is not listed, that means you have to apply to each program’s institution separately. Most fellowships applications are NOT done through a matching system. This can lead to some complications, say if you are asked to make a decision on your 2nd or 3rd program of choice before you knew before your 1st-choice program will offer you a position. Here are a few suggestions on how to help you navigate this potentially fraught situation:
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Make your own ranking: What would be your first choice, second choice, and so on. Should you be in a situation where, for instance, a non-first choice program asked you to make a commitment, I would be honest with your first choice program, explain the situation to them, and if they are reasonable, they will understand that you would likely rather be in a program of your second-choice rather than your first choice program, and if they truly want you in their program, may be able to offer you a spot earlier than anticipated if they know that you already had other offers. Personally, I think being transparent is often the best way to address these challenging situation and avoid leaving any bitter taste to programs who may have been disappointed that you did not join them or worse felt that you were dishonest with them--remember that at this level of sub-specialization, you are often dealing with a small inter-connected community.
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Apply early: The biggest concern of most fellowship program is to have a vacant spot (think about it, that means a lot more work to do for the attending physicians). I applied to my program in October two years before my starting date (that is in my penultimate year of residency, which in my case was the fourth out of five years of residency).
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Manifest interest to the program early on: An ideal venue to let your interest in applying to a given fellowship be known is when you do your elective there. I even managed to squeeze in in-person interviews when I was there.
This is a highly tentative timeline you may want to consider, although, as always, you should discuss this with colleagues who have gone through the process more recently to establish a timeline that is based on a plurality of experiences and opinions:
Elective Rotations (optional)
Many find it helpful to do an elective in a prospective fellowship program, so that they can "test the waters" before committing to 1-2 years of your professional lives to a specific program. This may also increase your chances of being selected for the program of your choice if you can make a good first impression and show your interest before interviews. Of note, most will usually do their rotation as an "observership" given that there are usually several ramifications in terms of liability insurance that confront the resident physician wishing to do a bona fide medical elective rotation in the USA. That being said, depending of your subspecialty of interest, you may still be given a reasonable amount of clinical responsibilities despite your rotation having the "observership" moniker. Regardless, my advice would be not to get too discouraged if you find yourself given a more passive role than you are used during your rotation: take this opportunity to observe the interactions between the fellows and all members of the program, ask questions, make yourself as useful as you can, be a positive addition to the team rather than a hindrance, and just enjoy being back in a more "medical student" role for a few days or weeks. The timing of the elective will dependent on when your application to the program is due, but obviously, if you plan on doing such an elective, you should really aim to have this done before the application. Some program may even offer you to do an interview on-site while you are doing an elective there, although with the advent of COVID and the more widespread of virtual interviews this is less common than it used to.
Letters of Reference
Those who applied to CARMS will remember the painful process of asking for letters of reference and fretting to until confirmation had been received of the successful arrival of such letters. To avoid being caught empty handed at the application deadline, make sure you ask you referees early, and remind them often.
Interviews
You will be contacted by the programs you apply to for interviews. This is almost always done virtually now, but some programs may offer you an in-person interview, especially if you are already on-site doing an elective.
Application
Non-Matching programs: Generally speaking, the earlier the better, with most program starting to consider applications in the fall two years preceding the start of a putative fellowship (e.g., for a fellowship program that starts in July 2024, you would consider applying in the fall of 2022). As always, consult the individual programs website or contact them to have a good sense of their timelines.
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Match-participating programs: please consult the NRMP website for details, but usually they deadline for applications for programs that match is later than non-match participating programs, somewhere in the Spring of the year preceding the start of your fellowship (e.g., For a fellowship with a planned start date in July 2024, the matching would take place in the Spring of 2023). Of note, the timeline of application for match-participating programs can be broken down further into ranking, downloading of documents, and "match day". See the following link for details: https://www.nrmp.org/match-calendars/fellowship-calendars/