Radiology FellowshipAn Unofficial Guide

by John Towle, MD

4th Year Radiology Resident

Outline• Intro/Background

• 2015 A3CR2 survey

• ACGME vs Non-ACGME Fellowships

• Research

• Applications & Interviewing

• The NRMP Match

• Discussion

Intro• Why do a fellowship?

• How many residents are pursuing fellowship?

• What fellowships are available?

• How does one decide on a subspecialty?

• How does one decide on a specific program?

Why Do a Fellowship?

• As with all of medicine, there is too much information to master

• Competitive advantage (or competitive leveling?)

• Weathering a poor job market

• ABR board changes (i.e. prepare for the new DR certifying exam)

What Percent Pursue Fellowship?

• A 1999 survey revealed 80% of fourth year radiology residents accepted fellowship offers

• In 2005, an ACR study revealed 87% of radiology residents planned to enter fellowship

• In 2009, 95% of radiology residents intended to pursue fellowship

• The 2015 A3CR2 annual chief resident survey revealed 96% of respondents planned to enter fellowship

Historical Perspective

Sunshine JH, et al. Diagnostic radiologists’ subspecialization and the new final board examination. AJR 2008; 191:1293-1301

http://www.diagnosticimaging.com/double-fellowship-new-standard-radiology

What Fellowships are Available?• MSK

• Neuro

• Breast

• Women’s Imaging

• Body/Abdominal

• MR

• VIR

• Nucs

• Peds

• Cardiothoracic

• Emergency

• Informatics

Choosing a Subspecialty• Area of strong personal interest (“What I love doing”)

• Intellectual curiosity

• Lifestyle (call vs. no call)

• Procedures/patient contact

• Job market (employability)

• Financial compensation

Choosing a Subspecialty

Arnold RW, et al. Factors influencing subspecialty choice among radiology residents: A case study of pediatric radiology. J Am Coll Radiol 2009; 6:635-642.

Choosing a Program• Regional preferences

• Reputation

• Size

• Flexibility or quality of training

• Personal recommendation

• MSK fellowship (some with spine MR, US, procedures, pain injections)

• Neuro fellowship (some with procedures/angio)

• ACGME vs non-ACGME (CAQ vs no CAQ)

ACGME vs Non ACGME

ACGME• Private, nonprofit council that evaluates and

accredits residency programs in the United States

• Established in 1981

• Accredits about 9,500 residency programs in 140 specialties and subspecialties

• Mission is to improve health care by assessing and advancing the quality of resident physicians' education through accreditation

Importance of ACGME Accreditation

•Programs must be ACGME-accredited in order to receive graduate medical education funds from the federal Center for Medicare and Medicaid Services.

•Residents must graduate from ACGME-accredited programs to be eligible to take their board certification examinations.

•Many states require completion of an ACGME-accredited residency program for physician licensure.

Fellowship Types

• ACGME accredited: Neuro, IR, Peds, Nucs have associated CAQ exams

• Mixed: MSK, abdominal, informatics (all are predominantly Non-ACGME) have ACGME defined criteria, but no CAQ exams

• Non-ACGME: Breast, chest, MRI, informatics

Breakdown of ACGME vs Non-ACGME programs

2013 data obtained from FREIDA, all ACGME programs

Subspecialty Programs Fellows

Neuro 85 270

IR 92 220

Nucs 20 17

Peds 47 87

Abd 11 39

MSK 14 29

Baker SR, Luk L, Clarkin K. The trouble with fellowships. J Am Coll Radiol 2010; 7:446–451

ACGME vs Non ACGME

Current MSK ProgramsACGME 15

Non ACGME 73

Current ABD ProgramsACGME 12

Non ACGME 35

Current MAM ProgramsACGME 0

Non ACGME 79

ACGME Fellowships

• Fully accredited by the ACGME

• Funding (e.g. your salary) comes from the GME office (Medicare)

• Tied to formal subspecialty CAQ exams offered by the ABR (or ABNM)

Non-ACGME Fellowships• Not accredited by the ACGME

• Funding (e.g. your salary) comes from the radiology department

• Potential drawbacks - education/service balance concerns, limited benefits, limited research time, more call, read part time as staff radiologist, limited formal recourse for fellowship program issues

• Potential advantages - more flexible, can be tailored to the strengths of the program and individual, more opportunity for electives, more moonlighting opportunities

2015 A3CR2 Fellowship survey information

Applications

Imperfect Process• Only neuro and IR go through a formal match process via

the NRMP website

• Not Good - There is lack of application uniformity in all other fellowship subspecialties

• Bad - Interview dates have crept into summer of R3 year, resulting in insufficient time for residents to make an informed decision regarding a subspeciality

• And Ugly - Programs interviewing candidates in excess of positions, candidates interviewing for filled positions, time limited acceptance offers, etc…

A Little History...• In 2003, there was a push to have all radiology

fellowships go through a match-like process. This effort failed, with over 28% of applicants taking positions outside the match.

• Reasons sited included excess positions over applicants, nonuniform program participation, nonuniform application process, lack of awareness by programs of match deadline

Yablon CM, et al. Radiology fellowship with a focus on musculoskeletal imaging: Current challenges and future directions. AJR 2013; 200:379-382

Application Timeline

• Research

• Applications

• Interviews

• Offers vs Match

Application Timeline

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

MSK, Breast Applications

Due

Start MSK, Breast

Interviews

Body, Peds Applications Due

• Neuro, IR Applications Due • Start Body, Peds Interviews

Start Neuro, IR Interviews

NRMP Match Opens

NRMP Match Results

*Specific program dates may differ. Go directly to the program websites for exact application deadline information.

Program Research

• MSK - SSR (skeletalrad.org)

• Neuro - ASNR (asnr.org)

• VIR - SIR (sirweb.org)

• Breast - SBI (sbi-online.org)

• Nucs - SNMMI (snmmi.org)

• Chest - STR (thoracicrad.org)

• Peds - SPR (pedrad.org)

• Body/GU - SAR (abdominalradiology.org, scbtmr.org)

• Emergency - ASER (erad.org)

• Imaging informatics - SIIM (siim.org)

• Talk to current 4th years and fellows • Find lists of all current fellowships (by subspecialty)

• ACR Beyond Residency

• RSNA Fellowship connect

• ACGME

• NRMP - get match data from prior years

• AMA’s FREIDA online

ACGME Website

FREIDA Online

Program Websites

Message Boards

Application Requirements

• Curriculum Vitae (CV)

• USMLE transcript

• Personal statement

• 3 Letters of Recommendations (one from the Program Director required)

Interviews

• Time off for interviewing, Program Directors are generally granting between 5 to 10 days.

• Interviews are not as well organized as for residency, you will need to be flexible.

Offers

• Many programs will extend time-limited offers.

• Tips for negotiating (?)

NRMP.org

• Main Residency Match

• Specialties Matching Service - $65 fee, unlimited number of programs

ReferencesSunshine JH, et al. Diagnostic radiologists’ subspecialization and the new final board examination. AJR 2008; 191:1293-1301

Arnold RW, et al. Factors influencing subspecialty choice among radiology residents: A case study of pediatric radiology. J Am Coll Radiol 2009; 6:635-642.

Yablon CM, et al. Radiology fellowship with a focus on musculoskeletal imaging: Current challenges and future directions. AJR 2013; 200:379-382

Baker SR, Luk L, Clarkin K. The trouble with fellowships. J Am Coll Radiol 2010; 7:446–451

Farria DM, et al. A survey of breast imaging fellowship programs: Current status of curriculum and training in the United States and Canada. J Am Coll Radiol 2014; 9:894–898

Referenceshttp://www.acr.org/Membership/Residents-and-Fellows/Resident-Resources/Beyond-Residency

http://www.diagnosticimaging.com/double-fellowship-new-standard-radiology

http://www.aur.org/a3cr2/

www.theabr.org

www.acgme.org

www.nrmp.org

freida.ama-assn.org

www.auntminnie.com

Discussion