A Guide to Fellowship Applications: Don't Forget to Feel Lucky

September 4, 2014

We’re checking back in with our newest CHEST blogger, Dr. Rohit Devnani. Dr. Devnani recently began his fellowship in pulmonary and critical care medicine, and we’ve asked for a sneak peek into his journey.

By Rohit Devnani, MD, @RoRo_Nani

Recruitment season is among us. We have barely begun on our own paths, yet soon, groups of future pulmonary/critical care fellows will be asking us for directions. I can already imagine being paged about needing to intubate a patient while some overly enthusiastic applicant is grilling me with meaningless questions like, how many PFTs do you read?

I’m sorry—that was mean. I already broke the rules from my last post (summarized in one sentence: don’t be a jerk). I’m also just kidding.

Even though interview season is fun, it can be very demanding on the applicants. A friend of mine is being burdened by having to fly to southern California on, count it, TWO separate occasions. Sucks to be her, right? 

But really, it is stressful. Programs send out invitations to interview with two options for interview dates: both Thursdays. So the applicants have to find someone to cover their inpatient service on the second Thursday (because the first one filled up). Well, actually, they should also probably ask somebody to cover them on Wednesday so they can attend the pre-interview dinner. No flight home after 3 pm? Better get someone to cover Friday clinic, even though we all know that nobody wants to cover Friday primary care clinic. Three interviews later and the chiefs are calling the applicant into their office because he/she took too many days off and now can’t graduate.  

Dear applicants, 

Breathe.

Everything will be fine. I promise. Here is my guide to the pulmonary/critical care application process, how I ended up in this position, and a look into the training program at Indiana University. Let’s start with a fitting anecdote. Forewarning, this will make you feel worse before you feel better. 

“Oh man, are you guys feeling depressed?” This is what one of the senior fellows asked us last week after he learned that Gabe, our program director, gave us his talk on careers after fellowship. Why has this talk traditionally been such a downer? Well, the short version went something like this: If you want to be a clinician-educator, there are no jobs. If you want to be a community practitioner, there are no jobs (at least right now in Indianapolis). If you want to be a researcher at an academic center, great, there are jobs for you! Except you have to bust your ass to fund yourself by writing grants, you have to give up on the idea of seeing patients ever, oh, and statistically speaking, the majority of you won’t work hard enough to accomplish meaningful scholarly work anyway.

Well, $*@!^&. 

That was a reality check. So why didn’t I feel like crap?

“Remember, 99% of people would love to be in your shoes.”

That was Gabe’s first slide. That was Gabe’s most important slide.

No matter what happens, at the end of our 3 years of fellowship, we will be pulmonary and critical care doctors. The same goes for the applicants. Aside from the unlucky few that don’t match this cycle, no matter where you end up, all will be pulmonary and critical care physicians by the end of your training.

My friend and co-fellow, Erin, is in the middle of her first week of call. The second night she had to come in to the hospital and stayed from 2 am through the next working day.  When I checked in with her to ask how she was doing, she said, “It’s really great to realize, despite how much it sucks to work like this, that I am doing what I love.” This is an equalizing truth irrespective of being at a top ten program in Los Angeles or some unheard of program in some unheard of city. 

But how to you get into a top ten program? Well, first you have to want to go to that program. The most important things are that you know what you want to do, what you don't want to do, and just as important, when you don't know what you want or don't want to do. Confused yet? Good, then you are with me. Let’s break it down.

Know what you want to do. Interested in clinical work in pulmonary hypertension? UCSD has an incredible set-up for that, whereas it’s not a focus of the program at Rush. What about ICU research? The University of Chicago puts all fellows on an NIH training grant, whereas Stanford’s NIH grant is geared toward research in pulmonary translational work. Is practical experience important to you? IU and USC are both affiliated with county hospitals where the volume and variety of patients and procedures are unparalleled, whereas at other programs, the fellows felt they did not get much experience in things like airway management.  

Know what you don’t want to do. Don’t want to do basic science research? Then you won’t be happy at a program that traditionally produces basic science researchers, even if it is a top ten university. Less interested in clinical work? Programs that have protected research time will be better suited for you. Not interested in working that hard? Go into cardiology (just kidding). 

Are any of you freaking out because you don’t actually know what you want to do? Chill. Sure you do. You know that you want to be a pulmonary and critical care physician. You will match at a place dedicated to helping you achieve that goal.

For me, that program was Indiana University. I did not have a 5-year plan. I had a research interest in medical ethics, but I wanted to be at a program that put clinical work first.  IU is a “fellow-driven program,” meaning that the majority of the work falls to the fellows. These responsibilities range from resident-level work, such as putting in lines, to attending level work, such as running rounds. After rotating at a county hospital, a VA hospital, a University hospital, and a gargantuan community ICU hospital, the fellows at IU graduate as rockstar clinicians. Joe Smith is the senior fellow on service at the county hospital with Erin and myself. After witnessing his calm, thoroughness, and patience, I knew that this place trains great people. 

The other reason I ended up at IU is to work with a mentor named Alexia Torke, who has done some great work studying surrogate decision-making in the hospital. I couldn’t predict this at the time, but I came up with a 5-year plan within the first month of fellowship, and I committed to developing a research career in this realm of family communication in the ICU. Indiana was one of the few programs on my interview trail that seemed genuinely excited about developing a fellow on this particular career path.

The bottom line is, I believe in the match. After all the blood, sweat, and tears poured into your resume, the stress of traveling around the country, and the terror of finalizing that rank list, you will match at a place eager to develop you into the doctor you want to become. You will become a pulmonary and critical care physician. 

Remember, 99% of people would love to be in your shoes.