by Shamar Young, R4, University of Florida-Gainesville
Shamar is a freshly minted matched IR fellow. He will begin his IR fellowship at the University of Minnesota in the summer of 2015.
If you are contemplating pursuing a career in interventional radiology (IR) my first piece of advice is to do it! IR is an amazing field! Unfortunately, before you can enjoy a long satisfying career as an IR doc there is the small matter of obtaining a fellowship. There is no sugar coating it, IR fellowships have become very competitive and appear to becoming increasingly so yearly. For the 2014 IR Fellowship match, there were 275 applicants for 219 fellowship spots, with 59 applicants going unmatched (about 1 in 5 applicants). So, having just gone through this process I am happy to share a few thoughts to try and help you through this stressful time.
The first step in the IR fellowship application process is deciding where you want to apply. Given the personal nature of these decisions I will only make a few very broad comments. In deciding where to apply you must decide what is most important to you in a fellowship year. Common priorities include location, breadth of training, and program prestige. Once you have decided what is most important it is time to do a little homework. This can be easy, especially if your program has faculty who are well versed in the various programs, or fairly hard if you don’t have a faculty member or upper level resident to guide you. If you find yourself in the latter position you can look for general information on forums like Aunt Minnie. However, much on these blogs should be taken with a grain of salt. If at all available, reaching out to someone who has been through the process recently would be of great value, even if it’s someone you have never met before.
The natural next question is how many programs should I apply to? This again is a difficult question to answer. I would first start with how confident you feel that you have a spot at your home institution waiting for you. If this is the case, then applying to a limited number of programs that really interest you is a reasonable approach. If you are not confident in a position at your home institution or you don’t have a home fellowship, your goal, in my opinion, should be to receive and take 10-15 interviews. How many applications you send out in order to receive these interviews is definitely hard to gauge. However, in general you should try to take an honest look at your application, including your medical school data (grades, step scores, etc), current residency program’s reputation, and resume (such as publications) and evaluate the programs to which you are applying. For instance, if you have a very strong application but are only applying to the top programs in the country I would recommend applying to 20-30 programs. If your application is slightly less competitive and you are applying to these same programs I would add another 20-30. In the end it does not cost you anything other than time to apply, so I would advocate to over rather than under shoot the target.
Once you have identified your fellowship targets the real work begins. The first thing to do is ask for letters of recommendation, as it is common for faculty to take awhile getting these to you. When deciding who to ask for a letter it is important to consider your audience. If you have a faculty member who is well known nationally, his/her letter is a very important for you to obtain. While others may know you better at the end of the day your target audience tends to be more trusting of letters from people they know or have heard of. That being said it is also important to make sure the letter will be favorable, and if you are not sure, just ask. I also felt that programs appreciated the personal touch of addressing the letters to their program director by name. So include the program director’s name as well as the mailing address when presenting your letter writers with information.
Unfortunately, the current system we work in requires you to visit the website of every program you are interested in and track down exactly what they want. This annoyance is amplified by the fact that many websites either don’t provide this information or make it difficult to find, forcing you to send an email or call the program secretary to find out. It can be painful so do yourself a favor and scan copies of the commonly asked for documents (medical school transcripts, USMLE scores, Dean’s letter, etc). This will not only allow you to print the documents anytime and anywhere, but also allow you to email copies when necessary. Why would you need to email copies after you already mailed them? Sadly it is quite common for parts of your application (or the whole thing) to somehow go missing. For this reason it is imperative to follow up with programs you have sent applications to in order to ensure yours is complete.
In keeping up with the completion of your application you will also communicate with the program secretary, a very important person. The secretary will be your lifeline–letting you know if your application is complete and also, in some cases, giving you clues as to if/when an interview invite may be extended. However, they are extremely busy so DO NOT ANNOY THEM. Trust me you do not want to be that irritating person. Also, if you have the misguided thought that you are somehow above these over worked people at least have the common sense to hide it. They often have much more leverage than you would expect, and also a keen eye for the overconfident or condescending.
As interviews begin that fantastic feeling of promise mixed with anxiety starts. I know you can all interview well or else you wouldn’t be where you are today. However, here are a few reinforcing thoughts. When going to an interview know something about the program. For instance, if the program you interview at invented a technique then spend a few minutes boning up on it. Similarly, especially if they send you a list of who will be interviewing you (a fairly common practice), do a quick Pub Med search so you have an idea of what topics may come up. While I believe strongly that you should present your strongest side, DO NOT LIE. If you have no interest in pursuing a research career don’t pretend that is your goal, however, that is very different from having a flippant attitude towards research when interviewing at a research heavy program. If you’re interested in such a program, but not in being an academic Interventional Radiologist, just be honest. The majority of fellows at those programs go into private practice anyway, so show up to the interview having some knowledge and enthusiasm about their research while not over stating your future plans. One last thought about your interview; absolutely assume every single person you come into contact with has some, however limited, influence over your ranking. So be polite, interested, and responsive towards everyone that you meet no matter how limited that contact is.
Remember while at the interview it is not only your job to impress them, but also to figure out if you would enjoy training there for a year. Just as it is hard for them to ascertain if you are a good fit in a 6 hour interview day, it is hard for you to gauge the same. As the interview season progresses you will learn some tricks to figure this out sooner rather than later, but here are a few thoughts to get you started. First almost every program will show you how many and the variety of procedures they performed in the past as an estimation of what to expect. When looking at these numbers make sure you know the date range. Some programs will show you there ablation numbers over the last 3 years, an important fact to consider. Time with the fellows is also key. Most will be happy and positive, but also provide you with the disadvantages as they see them. Keep in mind the average fellow relates to you as an applicant as well, and is generally your ally. Most are pleased with their choice and just want to help you make a similarly good decision. I did not encounter an institution that hid their fellows from me, so if they do I would consider this a big red flag.
After you have completed your interview it is always a good idea to send an email to those you met thanking them for their time and giving specific examples of what you liked about their program. Commonly, they will send something back acknowledging your email but I wouldn’t read too much into any response or lack thereof. After you have completed all your interviews it is important to communicate with your top programs. I advocate sending a letter or email to the program director letting them know you have finished interviewing and hold them in high regard. It is important to again be honest, meaning if you tell a program you are ranking them number one, do that. If you are really interested in a program but think they may end up two or three on your rank list just say you loved them and they will be ranked highly. It is essential to let your top programs know they are at the top because at the end of the day they have many qualified applicants but also know from experience it is better to have fellows who really want to be there. If you have a person at your program who knows someone at one of your top places having them make a call or send an email is helpful. I personally had trouble with this because it seems kind of sleaze somehow, however I was assured that this is not how it is perceived by those who matter and others will certainly be taking this advantage.
The last thing to do is sit back and try to relax. Once match day rolls around life will be great. Even if you don’t get your top choice just remember that you could have been one of those that didn’t match at all. If you are one of those that don’t match you still have two options. Find something to do for a year and reapply, or do diagnostic radiology. The few I have met in this position did reapply and found a spot in IR. At the end of the day a one year detour for thirty years of career satisfaction is not that bad of a trade.