3 Options In Case Your Dr Spouse Does Not Match Into A Fellowship

I hear you’re trying to match into fellowship…

Are you nuts??? Wasn’t residency torture enough??

Just kidding.

We were the same 😝

After residency, my husband applied for GI fellowship. Sadly, we didn’t have a straight-forward experience getting into one. Instead of rejoicing we opened up the Match email to find out where we were going, we felt the pit in our stomachs and the horror in our eyes when it said:

“You did not match.”

If this is you, I’m sure your thoughts are racing like ours did. You’re asking yourself these questions:

  • What did we do wrong?
  • How could this have happened?
  • Were all those years of sacrifice not enough?

I completely feel you. Because I’ve been where you are.

As you are thinking of all the Plan Bs and where to go from here, your #1 fear is that your DrSpouse “settles” and doesn’t enjoy their career for the rest of their life.

First, don’t flip out!! You didn’t get this far in life to hit a brick wall!

Look at all you’ve both been through so far. Behind every success that you have had, there were moments of doubt, sleep deprivation, total mess, and even defeat.

This is no different.

You CAN overcome this and match into a fellowship in the near future!

What Happened To My Husband

Let me share with you our personal story. At the end of internal medicine residency, my husband became interested in gastroenterology. Normally a person would decide to do a fellowship pretty early in their training.

Deciding during medical school or intern year? Reasonable. ✔️

Deciding the last year of residency (like my husband did)? NOT reasonable. ❌

(I KNOW that he takes TIME to make major decisions. I’m not upset with him, but it was hard not to be upset with the situation.)

The problem is that GI is very competitive. According to NRMP, in 2017 the year that my husband applied, there were 194 GI programs in the U.S. Of 758 applicants, only 489 matched. This made it the  M O S T  competitive fellowship of internal medicine, moreso than even cardiology or nephrology.

To be a strong candidate, he needed to have published strong GI-specific research. Well, by the time he applied to GI programs, his CV didn’t have any of that.

When he was rejected from a GI match, neither of us slept a wink that night.

As dawn came, we came up with several ideas and brought them to his Program Director and mentors for him to consider.

And then it was time to knuckle down with a plan…

What My Husband Decided To Do

It was ultimately up to my husband to determine what he wanted to do and how he was doing to do it. He had my support no matter where he would take us.

He decided to do an extra year of sub-fellowship in Clinical Nutrition and spend all his free time doing GI-specific research. And I supported him in that. It meant I had more to shoulder at home, and he had more to do at work.

Going forward with that plan, we came up with a battle motto for our family:

“GI OR DIE!!”

Fast forward a year later, he DID eventually match into GI and nobody died 😝

If you are going through the same thing, this success story can be yours. That fear and anxiety can go away.

I’ll share everything we’ve discovered during this difficult time of our medical journey and how he was able to match into a competitive fellowship.

3 Options To Take In Case Your Dr Spouse Does Not Match Into A Competitive Fellowship

1. Do A Sub-Fellowship

Doing a sub-fellowship is a great strategy. Examples of sub fellowships are Critical Care, Clinical Nutrition, and Hepatology.

These fellowships don’t have to be accredited.

Pros: If that institution has an in-house fellowship program, they would have a leg up as an internal candidate.

Drawback: Your DrSpouse’s salary will be similar to when they were a resident. It’s a big sacrifice to be making training salary when they COULD be making several times more as an attending.

2. Work As An Attending And Do Research

Working as an attending is another strategy. If your DrSpouse does this, they should choose an employer with the following criteria:

  • Has an in-house fellowship. (Internal candidates typically get preference over external ones.)
  • Have a reasonable chance of matching there (i.e. not super competitive).

Tip: If your DrSpouse is IMG (international medical graduate), shoot for a program that has a record of alums of the fellowship program who were also IMGs.

Pros: The attending they do research for will see your DrSpouse’s performance and vouch for them with the PD through a letter of recommendation and phone calls.

Drawback: Most PDs like to ensure that candidates still have a training mindset. They tend to avoid candidates who have been attendings for several years. We see that the longer a person is out of training, the less likely they are to match.

3. Pursue Unique Opportunities Designed To Prepare For Fellowship

There are programs that are specifically designed for those who didn’t match and are preparing for fellowship.

They’re rare and hard to find, though.

One program I know of that combines hospitalist work with a mentor doing research is NYU’s Hospitalist Scholars Program. Another is the VA Quality Scholars Fellowship Program that also offers research.

So those are two programs to Google and bookmark right now 😀

Pros: These programs specifically makes sure you get research opportunities, especially if your DrSpouse is painfully shy and not the kind to seek these opportunities out on their own.

Drawback: Not every PD is familiar with these unique programs. Having this type of experience might make your DrSpouse look super interesting, or they might be looked over by those who prefer fellows with more traditional backgrounds.

Which One Of These Strategies Is Best?

Each specialty and program is different. I can’t give exact advice, only guidelines for each strategy.

My best advice is to have your DrSpouse ask their PD for guidance for their situation.

Let’s Review

  1. Do a sub-fellowship. (The one was what my husband did.)
  2. Work as an attending and do research.
  3. Pursue unique work opportunities designed to prepare for fellowship.

In Summary

If your DrSpouse doesn’t match the first time, it is not a dead-end!

Every success story you hear has many untold moments of doubt, sleep deprivation, total mess, and even defeat.

You will have a success story.

The road will require a detour and tons of sacrifices will be required. But when you work hard together, you are sure to climb any mountain.

Then you can smile when that email finally says:

“Congratulations, you have matched.”

I’m a hugger. I am hugging and supporting you, friend ❤️

To your strong medical family,

Theresa

Your Turn

What helped your DrSpouse strengthen his CV for fellowship?