Choosing your fellowship: How do you find the right fit?

Choosing a medical specialty is a pivotal decision that will shape the rest of your professional life—and very likely your personal life, too. But how do you decide which fellowship is right for you?

Maybe you're a physician trainee who always knew you wanted to be a cardiologist, a gastroenterologist, or other specialist. Or, perhaps you decided in residency while assigned to a specific rotation. But for many, the big decision still looms.

Consider your long-term goals

When choosing a fellowship, it's essential to look down the road to consider how you want to spend your time.

What is your passion?

There is a saying that goes, “Specialists know more and more about less and less.” As a medical specialist, you will be expected to dedicate years of training and focus your future career on a limited scope, so make sure it is something you are incredibly passionate about.

Ask yourself: Am I ready to give up the other components of this specialty to narrow my concentration? For example, if you are doing your residency in OB/GYN and want to do a fellowship in maternal-fetal medicine, are you willing to risk giving up the “GYN” of your specialty? 

Do you want to pursue academics?

Many academic centers have specialized clinics that focus on a specific disease, and you will be expected to be an expert in that disease. You may even be required to have published work relating to the specialized disease. 

You will want to choose a program that already has an established clinic for the disease process of your choosing. For example, if you want to focus your career in interventional pulmonology, make sure your fellowship program offers extensive training in relevant procedures at a specialized pulmonology clinic. 

Will you be intellectually stimulated?

Do you find reading the clinical material pertaining to your specialty interesting? Do you find your specialty challenging?

Physicians generally like to be challenged and medicine is a lifelong learning process. Maybe you want to be in a specialty where you are constantly seeing a wide variety of disorders and new symptom presentations on a weekly basis? 

Consider your personality type 

Certain specialties may attract certain personalities. For example, an individual who chooses to go into critical care may enjoy adrenaline and a fast-paced environment, whereas a foot and ankle surgeon may be competitive, precise, detailed, and extremely "type A."

A gastroenterologist may be a bit more laid back with a good sense of humor (they have to deal with feces a lot!) whereas a palliative care fellow may be very empathetic.

You must not hate the 'suck'

In general, you may love 99% of a chosen speciality, but what about the 1% that is not so great? For example, gastroenterologists generally do not love treating irritable bowel syndrome and cardiologists often fret over “atypical chest pain” but it is part of the reality of being in that specialty.

Think about the worst part of your chosen specialty and consider whether you can tolerate it, will hate it, or will actually enjoy it. If you do not know the worst part of your desired specialty, then ask the fellows and specialists in that field. Poll as many people as possible, you may be surprised you will get similar answers. 

Seek advice from a handful of people who have been in your position and completed your desired fellowship. 

Ask them about their decision-making process, if they regret their decision, and what they believe are the pros and cons of fellowship in their specialty. 

In addition, ask fellow residents and program directors which fellowships programs are highly recommended in your desired subspecialty—and why. The more advice you receive from people you trust, the more real-life information you will have to help you make your final decision.