Does the Fellowship Application Process Work?

This is an article that I wrote for the ASCP, featured in Pathology Today. I am republishing it on this blog space in hope of getting your input with the permission of the American Society of Clinical Pathology. It can also be found at http://www.ascp.org/AboutUs/Newsroom/pathologytodaynews.aspx

Does the Fellowship Application Process Work?
Spring has arrived and the end of the academic year is in sight. For many, this time of the year will bring a heightened level of anxiety about their professional future. For seniors, the reality of starting a career nears. Boards are only months away and contracts for fellowships and jobs have been signed (we hope). For juniors, it's the time to start thinking about fellowships. Yes, even if you feel like it is too early, it's probably not. Much anxiety about our career paths is now displaced down the resident hierarchy to junior residents - they are the ones now forced to make lasting career decisions which have traditionally been made later in training. The primary reason for this is the advancement of application deadlines and interviews for fellowships by one year because of the change in our length of training. In the five-year training program of the past, a decision to do a fellowship could be postponed until the third or even fourth year of training. Now, residents who are in a four-year AP/CP program begin making that decision at the end of their second year. Because of this, residents have to begin thinking about fellowships very early in their training with only a year's worth of experience. Most agree that this is very difficult given the little exposure that pathology receives in the final two years of medical school and the limited exposure that residents get to pathology subspecialties in
the first year of training. This problem will likely be compounded by a higher level of competition for fellowship positions. In the past three years, we have witnessed a steady increase in the percentage of residents seeking fellowship training, and there has been an increase in the number of graduating residents per year (see my January column). Because of this, many residents now feel that they have to apply to multiple programs to increase their chances of getting a position. Unfortunately, this creates a problem. Individual programs have customized schedules for interviewing and selecting residents for their fellowship positions. There is no centralized or monitored application process like the National Residency Match Program (NRMP). Therefore, a considerable amount of variation exists in the timing of application deadlines and interview dates among programs. This creates an environment which ultimately rewards programs who interview early and, more importantly, limits resident options. For example, a resident may apply to two programs that have significantly differing interview schedules (let's say 2 months apart). After the resident interviews with Program A, he or she may be offered a position and asked to give a final decision within a reasonable time frame (2-4 weeks). This is great, right? Well, not quite. Unfortunately, their next interview (with Program B) is not for another two months, forcing them to either take the fellowship position with Program A without interviewing at Program B or declining the position at Program A and hoping that Program B offers them a position. I'd bet most residents would choose the former of the two options. Therefore, the program that interviews later is indirectly penalized, creating an incentive to begin the interview process earlier.
Intuitively, it is best for residents and programs to delay the fellowship decision to allow residents a better opportunity to learn more about pathology. Counterintuitively, we have shortened this time frame. To rectify this, changes will need to be made to the application and interview process. It's obvious that we cannot change the length of pathology training (at least not immediately); therefore, efforts should be made to remove the incentive for programs to interview early. The direction of this effort needs to be openly discussed between the parties involved: residents and programs. Could we or should we convert to a 'match' system? Are there other ways to provide structure to the interview
process as a whole? This will be a subject that your ASCP Resident Council will address within the next couple of months. I need to hear your opinions and learn more about your experience with the fellowship application process. We are your voice. Collectively, we can find a solution.