Spine Fellowship Application Process

Hey guys

Have read through most of the information on spine fellowship - a lot
of good information regarding specific fellowships, and some regarding
the application process.

Seems like letters, calls and spine research are important in
getting some of the top fellowships.

My question is more regarding how the application process works.
When do you ask for letters? When should you schedule your
spine rotations your third year? How many programs do most
people apply to? Like residencies - are fellowships regional biased?
When do you start this process - beginning of PGY-4? When
should you suchedule your interviews? How does a place like
Wash U that gets 90 applications for 2-3 spots even begin to
offer interviews? What meetings/courses do people make contacts?

Reading through the Top spine fellowships thread - seems like
most places are either deformity/deg vs. trauma - is there room
for someone that wants to be involved in both? In the opinions
of the elders here - what are some of the fellowships that
prepare you for that kind of practice?

FYI - finishing my PGY-2 year, about to start PGY-3 year.
The advice is much apperciated.

Thanks.

Some answers to your inquiries:

- you should have your app and letters out by mid-july of your pgy4 year
- doesn't matter when you do spine rotation as long as you have time to generate letters from your spine attending
-# of programs very variable...i applied to 12.
- i didn't think regionalism was an issue at all
-as far as degen/deformity/trauma...tough question...I don't know of any fellowship that doesn't have a weakness. The key question you have to ask yourself is whether you want complex adult deformity to be a part of your practice. if answer is yes, list of fellowships that give you good experience in this area becomes rather short. Most programs seem to have a weakness in one area or another. My impression only, but i think emory probably is most well-rounded...and no i'm not going there for my fellowship so i can be objective. Places that offer the most well-rounded experience seem to be ones with multiple attendings who do different things. You see different approaches and philosophies. remember you can do trauma without going to a trauma-heavy program. You want an adequate exposure but don't need to get killed.

Well, I think your timing definitely depends on what your ideal fellowship is. I agree with ssaco in general that starting in the first of your fourth year is reasonable, it can be helpful to start earlier. Supposedly wash u had two of its three spots filled by the beginning of August (hearsay, but I have no reason to doubt the source). That didn't offend me since I have no interest in deformity and they do so much of it there. My point is, since the spine match doesn't exist anymore the application process has become something of a free-for-all. I applied to about 12 places and was offered spots at the first two I interviewed at within five days of the interview. Those offers come with the caveat that if you sit on the offer they will keep offering the spot to others. This has the obvious implication that you better hurry lest you be left with a less than desirable fellowship for your goals. If you can manage to get interviews at places you think are high on your list early, then definitely do so. The whole process will go so fast it will make your head spin. When my third interview place called me the first week of september to tell me they were sorry but they filled their spots, I took one of the offers I had on the table.

I plan to do community based spine so my main area of interest will be adult degenerative. We get tons of spine trauma in my residency (SLU), so I don't feel like I need a trauma oriented fellowship to take care of the trauma I will see (almost none). This definitely made my application process easier. If you want to go to a big academic spine center, then it seems that connections matter, phone calls from your attendings help, and being proactive about getting your stuff in as early as possible helps. Have your application and letters sitting in their mailbox the day they begin accepting applications. Start early on your rec letters, busy attendings sometimes will let your request sit on their desk for weeks before they get around to dictating your letter.

As an aside comment, in my opinion the new fellowship at SLU where I'm a resident should be a very good one. We currently have two excellent adult attendings with very different approaches and interests. Dr. Place does mostly deformity and trauma, is one of the nicest people you will ever meet in your life, and simply loves to teach young physicians. Dr. Alander does more degenerative work focusing on minimally invasive techniques and disk arthroplasty whenever we can get insurance to actually pay for it. He is also a great guy who is easy to work with and gives plenty of autonomy to us residents once we prove ourselves capable. We get a lot of spine trauma at the hospital which can be busy as hell, but you get great exposure to a variety of traumatic spine. There are two residents on the spine service to help share the call and rounding etc. There is also a busy pediatric spine practice here, with most of it being done by Dr. Place and one of our pediatric attendings Dr. Puryear. Puryear is a young guy who is a favorite among the residents consistently. He does a ton of neuromuscular, idiopathic, and congenital scoliosis. In the summer it's 2-3 a week consistently.
The program is definitely a DePuy spine place, but you will see some products from other companies as well.
Call is all ortho (neuro spine has left the building), from home. We have a PACS system accessible from home, which made a huge difference in how often you have to come in and help a junior read films. In my eight months of spine call I probably came in about one in every eight to ten nights on call. St. Louis is a great town, I've loved living here (came from Dallas). Not sure how much they are paying the fellow.
Facilities are fair to good. Nursing is in general very good at both hospitals.

Sorry for the ramble. I hope it doesn't come off as touting my own fellowship (I'm not staying for fellowship). Just trying to help out since when I was applying it was damn near impossible to find any first hand info on any programs out there.