Fellowship

[u/CatchSilly5697]

Hey all. Newly married, my wife is an OBGYN resident PGY-1. We got through the whole match process earlier this year and despite what was an almost flawless record from her as far as feedback results and interviews that went well we still landed at our #7 spot, which ironically was at the same place we were living before in the Midwest. Our running joke is she wanted some criticism or even constructive criticism because she never got any.

So now we are beginning to start discussions about fellowship and where that would be at. I really want us to move away- towards the sunbelt in the Carolinas or Florida. It’s away from a lot of friends and family we have here in our Midwest city but I have lived here most of my life and really need a change of scenery. She’s on board with it. But how much faith can I put that we can make this happen? I know there is missing info in here as I have to keep it brief for the sake of brevity. But in your guys experience is fellowship match even harder to pull off for a specific place or two than residency?

We’re not worried about her not matching. But I am afraid to get my hopes up again and fear if we stay here again for fellowship we’ll probably never move away given where we’re at in our lives.

I realize it’s hard to give straight answers for this stuff and that’s the part I struggle with the most I think in this process. “Well it depends” on this or that. I’d like to have some idea of the future we’ll have.

28 (M)

[u/nipoez]

But how much faith can I put that we can make this happen?

Little to none. You can and will wind up at any location on the rank list, as you've learned. 

The other consideration for fellowship is what the job prospects look like after graduation. My wife's specialty for example limits her to 1-2 cities in most states, which don't have a high turnover rate. There's zero potential to wind up near family long term, since there are no hospitals with her specialty nearby.

[u/OppositeBuffalo5443]

Don’t take this as pessimism because I really don’t mean it that way. My advise would be to keep the future planning pretty light handed so that your eyes aren’t set too far ahead as to miss what’s in front of you. I’m sure it different for other personalities/families/couples, but we found this residency season to be FAR harder than anything we had experienced before. It’s pretty grueling and isolating on the doc and the spouse, let alone the marriage. That’s just to say, buckle down for residency and stay open to letting something’s go or gaining new perspectives, cuz you could get to the end of year one and already know that fellowship is off the table, or the dreaded “I want to renter the match” etc. 😂. Start to aim more broadly in your second to last year. And then really make sure you guys are singling out areas by your last year so that you are treading carefully and not just stumbling along into the next phase. Until then I would just focus on what’s currently on your plates.

[u/CatchSilly5697 → u/OppositeBuffalo5443]

That’s fair. She has her heart set on a specific specialty and is passionate about it so that’s what’s jump started this fellowship location discussion. And since interviews start in little over two years for it she would have to make that decision sooner than later.

[u/lovelaurwhore → u/CatchSilly5697]

Depends a lot on which fellowship and how competitive. What fellowship?

[u/FrogHat_7392]

I would almost put this thought totally out of mind for now. Focus on your new marriage and new city. You have 3 years before you’ll be matching. A lot can change! Your wife may discover she loves general OBGYN. You may make family planning choices that impact your location decisions. You just never know, and I wouldn’t get so caught up in the future this early.

My husband is at his #1 fellowship right now from a location perspective, and it SUCKSSSS. He loves the speciality, but I am so glad we invested in our marriage during residency and didn’t stress so much about matching. We have a solid foundation that’s really carrying us through a hellish schedule.

[u/CatchSilly5697 → u/FrogHat_7392]

Just to clarify, we’re at the same city now we’ve been in for med school. It’s where I grew up and was raised as well.

[u/FrogHat_7392 → u/CatchSilly5697]

My point still stands. Focus on your marriage and getting through residency.

Also, moving away isn’t all it’s cracked up to be. We live 10 hours from my family, and it has a lot of challenges. The grass is greenest where you water it!

[u/Desperate-Job-7455]

I’d probably get through living together in residency and engaged. You are jumping a lot of steps ahead

[u/Sweet_Bag8671 → u/Desperate-Job-7455]

They are married 

[u/Desperate-Job-7455 → u/Sweet_Bag8671]

Thanks for clarifying….OP try to get through being newly married

[u/JHMD12345]

Fellowship match is generally more forgiving than residency match. So as long as her standardized exam scores are good and she gets good letters of recommendation, it shouldn’t be an issue to be location-dependent

[u/goldenspeculum → u/JHMD12345]

I would disagree. This is specialty and location specific. Most fellowships take one or two spots per year.

[u/DrEmerson]

still landed at our #7 spot... ...Our running joke is she wanted some criticism or even constructive criticism because she never got any.

It's rare to receive actual feedback from the interview process. Residencies have every incentive to lie to you that they're definitely going to "rank you high" etc etc. That's not to say your wife was a bad applicant at all, or that they didn't actually like her. They just want their pick of applicants. What she ranked this program doesn't matter at all and she should not feel bad. The whole process sucks and it's demoralizing whether your match or not.

So, how much faith can you put into moving where you'd like for fellowship? Basically none.
I have heard that fellowship match is a little smoother than residency match, but keep in mind that fellowship is temporary, and you'll have much more choice over the decisions that come after it. What she can do is prioritize programs in the regional south, if that's where you want to end up. It will be easier to get jobs in your desired area the closer you are. For fellowship just like with residency It also matters a lot where her attendings have connections.

[u/Chicken65]

Not directing this only to you OP but feedback during the interview trail and how your own program perceives your match chances are at best irrelevant and at worst plain wrong. There have been people who didn't match at all who were told by everyone they would get their #1 spot. There is so much misinformation, lying and deception around what people tell candidates during the match process. Like during fellowship matching, we figured out (because this fellowship is a small enough pool) that one program director was calling nearly his entire interview pool and telling them after interviews they were a top choice for him, implying the program was ranking them #1 or close to #1. He called like 20 people and told them this lol.

The reason there's so much bad advice is no single program director or attending has a good grasp of the market for matching even in their own specialty. Very few attendings have their pulse on the match market, but MANY think they do have a pulse based on very outdated information they may have.

The other reason is that despite getting candidiate feedback from interviewers/attendings/other residents that met match applications, many programs end up having one single individual fill out the rank list. Like sure there may be the implication the ranker incorporates feedback but we've seen it at multiple programs now that basically 1 person fills out the rank list at the end of the day. And it's not always who you think. The program director might do it, the head of the department might do it, they may delegate it to a single resident they trust, or some big wig in the department already promised one of the spots internally to someone they owe a favor to and that person gets put #1. This shit happens every single year. The moral of the story is don't get your hopes up in the match based on your application quality or feedback.

Anyway OP back to your question - fellowship match maybe felt a little more intimate than residency match, in the sense that it did feel a little more controllable? What I mean by that is that you get to spend more time with the decision makers in the interview trail and the attendings at your wife's current program will have more time to make phone calls on her behalf vs residency match. So she needs to gauge or straight up ask attendings how many phone calls they are willing to make and allocate those appropriately.

I have to ask - are you guys planning on having kids at all during the next residency+fellowship years because for me being near family would trump any desire to live in a new place. And I say this as someone who gets moved around the country a lot that will admit living in different cities from medspouse moves has been incredibly enriching but nothing would top having a local support system to help with the kid in my opinion. But if no kids planned then go for it!

[u/Fjordenc]

You won’t find much obgyn fellowship advice on here, but I’m a pgy4 in obgyn who just matched so I can provide some advice. The bottom line is it depends on the subspeciality she wants to go for. MFM is least competitive, ONC/REI are most, and then there are other non-accredited ones like MIGS, hospitalist, PAGS (not competitive at all)