Open Spots - Beating the Crowd

Beating the Crowd

Congratulations on choosing your specialty, or sub-specialty as the case may be. It’s not easy and you may not be 100% sure about it but the reality was best described by my wise Jewish grandma: “You love what you know, and your grandfather knew coffee.” That holds true for you as well, except the coffee part (maybe). Once you commit yourself and begin the process of becoming a maven in that field, you will love it – and if you can’t get past it then suck it up and know your stuff anywa because there's plenty of competition out there.

Now, it’s time to stand out from the crowd. There’s not much as a resident that gives you an edge. Unfortunately, you can’t put on your resume that you did the most admissions or always got the NG tube to go down on the first push. It’s a shame but the hardest working, most functional residents are rarely the ones who end up with the premium fellowships. And there’s three reasons for this: research, research, research. It sucks right? Welcome to fellowship.

Fact: The top academic centers of the world are not looking to train great clinicians, they are looking to bring money and prestige to their institution. And research grants bring both. Thus, the better job you can do of convincing them that you may be that person to bring them money and prestige, the better chance you have of training at a Harvard or UCSF-type place

So what are you doing about it?

Have you approached the program director of your future fellowship at your institution and told him or her that you are interested? If not get to it. Half the battle of matching is getting noticed and no better way to get noticed than to walk right up, introduce yourself confidently, and say that you hope to do a fellowship in that field. Honest, straightforward, and it’ll get you noticed. More importantly, when it come time to ask for a letter, or better yet a phone call, it’s not the first time you have expressed interest in the field.

You can follow up that declaration with an inquiry about ongoing research and how you can get involved. If s/he knows of any, you’re golden but at the very least the program director knows that you want to be in that field and may think of you in the future (and therefore, not think of someone else).

If your institution’s program director has not been helpful with research (or, you don’t have that fellowship at your institution) it’s time to canvass the fellows. All fellows might not be doing research but they usually know who is, and whether they might be looking for some help. If they are of no help, ask them if there is a good attending that might be of some help or an online resource that is available to them.

Here’s the most important rule: Anything is possible if you want it bad enough. You may have to do things that do not seem common at your hospital or think outside the box a bit. Scour the Internet; call a hundred places; write obsequious letters – whatever it takes.

If there is no research going on at your hospital in what you want to do, force the issue! Find research elsewhere and present it to your program director and beg, plead, scream, and cry to get an external elective there. Whatever it takes! There is always a way and the Internet happens to be about the best resource out there. Find what you want to do and get it done.

If you notice a disturbing trend of not matching in a particular field form your hospital, DO NOT BE A LEMMING! Don’t do what all the others before you did. Think outside the box a little and come up with a sure-fired way of getting an “in” somewhere. If you have seen all of the cardiology applicants fail from your place then think of another way to approach it. Perhaps acknowledge the likelihood that you will not match first time around and plan accordingly. Do a non-accredited fellowship in ECHO or CHF in order to do some research and get a foot in the door at another place.

The bottom line is competitive fellowships (and residencies, too, for that matter) require forethought, planning, and hard work. Depending on where you are applying from, they may also require some creativity and patience. Do not be discouraged, do not follow the pack, and remember that anything is possible if you want it bad enough.

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