Turn a Fellowship Into a Career: How to match up with the right program

The opportunity to gain more surgical experience as a facial plastics fellow was enticing to Hussein Samji, MD, MPH, as he finished his residency at Stanford University School of Medicine in Palo Alto, Calif., in 2010. But after exposure to some of the more mundane aspects of the subspecialty during screening interviews, Dr. Samji said he knew it wasn’t the career path for him.

“When I met people who would be my mentors, I thought, ‘I don’t think I could be you for the next 30 years.’ When it came time to talk about the matching and going forward in the process, I actually dropped out and said, ‘I can’t do this.’”

Luckily, one of the dozen or so programs Dr. Samji applied to was a laryngology fellowship, and when it came time to decide whether that was the best option for him, he spent a lot of time talking with his residency directors to determine if he was making the right choice.

“They said, ‘Let’s not talk about the cool stuff. What’s the stuff you hate to do?’ I had to ask myself, ‘If I saw nothing but patients with vertigo or sinus issues or hoarseness, would I be happy?’”

Fortunately, the answer was ‘yes,’ and Dr. Samji went on to complete a laryngology fellowship at Stanford last June before joining Camino Ear, Nose and Throat Clinic in San Jose, Calif. But the danger of choosing the wrong program is prevalent among residents, he said. “It’s easy to get seduced by a powerful mentor who just shows you the ‘sexy’ stuff. If you’re not willing to deal with the other aspects, you’re going to hate your job.”

Determine Career Goals First

It’s that potential danger that makes discussing career goals with appropriate faculty members at your residency institution the first and most important step in the fellowship process, said Edward J. Damrose, MD, FACS, director of the laryngology/bronchoesophagology clinical instructorship at the Stanford School of Medicine. “People interested in head and neck oncology may want to focus on academic or tertiary care institutions for fellowship training, where the case load is likely to be high. Residents interested in facial plastic surgery may have more flexibility, where location, the specialty of the mentor and the type of practice may have greater weight.”

Depending on which path you choose, three criteria are generally important in determining where to pursue a fellowship, said Devyani Lal, MD, assistant professor of otolaryngology at the Mayo Clinic in Arizona. The first consideration is the faculty, particularly the fellowship director. Is he or she an expert in the field in which you wish to subspecialize? How well do you think you could personally get along? What is the director’s past mentorship track, and how well does he or she continue to support former fellows?