letters

[bonedoc16]

When applying for fellowship how important is it that your letters of rec be from attendings in your subspecialty? For instance if you are applying to spine and you only worked with one spine attending it would be unrealistic to get letters from 4 spine attendings right? Any thoughts?

[LongBoard]

I just went through the fellowship match process and it seems like getting a fellowship is based much more on recommendations (i.e. someone that the fellowship director knows vouching for your abilities) since there are no grades, boards, etc. People who have fellowships are much more likely to know people within their subspecialty, so it obviously helps to have letters from those people. However, if you only have one spine attending then there's not much you can do unless there is a well known private guy near your program you can get to know fairly quickly. If you are applying to spine, a friend who recently matched in spine claims it is one of the less competitive fellowships to get, although I'm sure the top ones are always competitive. Bottom line is, yes it would be better to have letters from 4 spine guys, but because you won't it shouldn't stop you from applying or make you go into something you won't like as much out of fear. Getting a fellowship is much easier than getting a residency.

[wnlevine]

Fellowship is much more about your actual abilities (as opposed to residency selection which is all about "potential abilities") so you need your mentors to be able to advocate on your behalf. That means usually your chairman and residency director (if they are different) and as many people in that subspecialty as possible. If you only have one spine person who can advocate on your behalf that's the best you can do but make sure that your other supporters can really go to bat for you as best as possible.

For those of you who are still in your junior resident years remember that if you plan on competing for the most competitive fellowships (in any subspecialty) getting involved with research early is very important so that your CV doesn't look the same as the one that helped you match into orthopaedic surgery.

Keys to matching in the best fellowship are:
1) Decide what you really want out of fellowship - mentorship, hands-on experience, academic career, private practice career, geograhical issues, etc...
2) Research and academic success (publications, presentations, etc...) if competing for top fellowships is in your future
3) Support from your Department Chairman
4) Support from your Residency Director
5) Support from as many subspecialty attendings as you can get

good luck - hope this answers your questions -

wnl