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Besides doing very well and impressing your attendings during medical school and residency, there are other things that you can do to help you obtain your fellowship of choice. For the most competitive fellowships, research in the respective field is almost considered a pre-requisite by many attending physicians. Besides the summer in between their first and second year of medical school, many medical students take off years during medical school to pursue research. It is also possible to do research electives during your fourth year of medical school, as well as during your internship year and during your residency in general. Some internal medicine residency programs have a research requirement. It is generally considered a requirement that internists train at University programs in order to be considered competitive for fellowships as well. Generally, it is better to train at a main University hospital rather then a private affiliated University hospital as well as the training is often regarded as superior (oftentimes rightfully so). Becoming a chief resident in internal medicine can help your application if a program has not already accepted you yet as well. It is not necessary to do your residency at a place different then your medical school in order to be competitive for fellowships.

What is "fast-tracking?"

Fast tracking, or short tracking, is an option that some residents do who are interested in pursuing academic medicine in a certain subspecialty. People who fast track complete their IM residency in 2 years, instead of 3 years, and then start their fellowship after their second year. The catch to it is that they have an extra year of research added on to their fellowship, so it does not save them any overall time. Advantages of fast tracking include: the ability to pursue a more in-depth research project as a fellow in order to jump-start one's academic career; and less overall clinical training time (some may view this as a disadvantage). A major disadvantage is that in order to fast track, the resident must pretty much know which subspecialty they want to pursue before they even start residency, because they will have to apply for fellowships early in their intern year, and they will not have enough time to adequately explore most subspecialties. Most people who fast-track have MD/PhD's or have already done extensive research in their intended subspecialty. In order to short track, you must get permission from your residency program, then apply and get accepted to a fellowship program as a short-tracker. You do not have to stay at the same institution as your residency in order to short track, although that is the most common way to do it.

When and how do I apply for subspecialty fellowships?

If you are looking to start your fellowship immediately after residency, and are not planning on fast tracking, you will need to apply during your second year of residency to secure a spot for after your third year. Many people, however, do not know which specialty they want to pursue by then, so it is becoming increasingly more common for people to apply during their 3rd year of residency or even later. By applying later, IM graduates will have to take 1 or more years off between residency and fellowship. Many IM grads will take that time and work as hospitalists in order to line their pocketbooks with a little more cash. Applying while working as a hospitalist is fairly easy to do: because the hospitalist schedule is so flexible, applicants find it very easy to attend multiple interviews. In my own fellowship interview process, about half of the applicants I was interviewing with had already finished their residencies and were working as hospitalists.

Each subspecialty has its own application process and deadlines, so it is best to check with the individual programs you are interested in. In general, some fellowship programs operate through the NRMP match, and some operate more like normal job interviews, where they offer or deny positions after each interview. The specialties that participate in the Match are: Cardiology, Pulmonary/Critical Care, Infectious Disease, and Rheumatology. See the NRMP fellowship match website http://www.nrmp.org/fellow/index.html for more information.

Generally for the programs that participate in the Match, applicants submit their applications in November/December, interview in March/April, submit their rank lists in May, and match at the end of June. Keep in mind that you match to a program more than a year before your start date, so you must plan ahead. The rest of the specialties do not participate in the Match, and use their own timeline.

Out of these, GI has the earliest timeline. Typically, applicants submit their application in August-September, interview September-November, and hear about their acceptances/rejections while they are interviewing. So most people accepted into GI know where they will be more than 18 months before the start of their fellowship. The timeline of the other subspecialties is generally: submit application October/November; interview and hear about offers December-February.

I want more information on the specific subspecialties!

The subspecialty fellowships are so different from each other that all of them deserve their own section. Below, each specialty will have a brief overview and links to relevant threads to provide more information.

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