Advice regarding plan B for Thoracic Surgery Fellowship

[TE Fistula]

Dear All,

I failed to match this year into thoracic surgery fellowship as a general surgery applicant. Briefly, I am a US IMG and I have done a substantial amount of Oncology research (Endocrine, Liver, Pancreas) before and during residency and have a good number of presentations/publications. I eventually decided that I would be more content being a thoracic surgeon than a surgical oncologist. I come from a mid-large sized community program and I am interested mainly in general thoracic although definitely keeping an open mind. I had very good support my thoracic surgeons at my program but almost minimal exposure to the cardiac side.

I am looking for advice on how to improve my CV for next cycle and what to do for my gap year. Regarding to the gap year, I am looking at unaccredited thoracic fellowship positions, unaccredited cardiac fellowship/Mechanical circ support/aortic or even applying to lung transplant or foregut fellowships. I am open to suggestions to which of those would look better on my CV when re-applying next year as a PGY5 and what can be done in the interim. I have the ability to do an elective as a PGY5 in my program.

Looking forward to your advice.

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[ThoracicGuy]

You might look into a critical care fellowship. I don't think transplant fellowships would be worthwhile for you. Unaccredited programs may or may not help, depending on who and where you are training. Keep watching for open spots as well, because there may be some that come open.

Did you apply to all the programs and how many interviews did you get overall?

Watch this page for openings:

Open Thoracic Surgery Residency and Fellowship Positions | TSDA

 

[TE Fistula]

You might look into a critical care fellowship. I don't think transplant fellowships would be worthwhile for you. Unaccredited programs may or may not help, depending on who and where you are training. Keep watching for open spots as well, because there may be some that come open.

Did you apply to all the programs and how many interviews did you get overall?

Watch this page for openings:

Open Thoracic Surgery Residency and Fellowship Positions | TSDA

Thank you for your response. Regarding unaccredited positions, they serve to fill the gap year but I won't be working with them until after my 5th year, at which point, I should have re-applied and hopefully matched next cycle. Just something on the CV to discuss during IVs. I am definitely keeping an eye out for any openings, but with this year's match rate, there are plenty others doing the same.
I applied to about 35 programs and received 8 IVs.

 

[ThoracicGuy]

Thank you for your response. Regarding unaccredited positions, they serve to fill the gap year but I won't be working with them until after my 5th year, at which point, I should have re-applied and hopefully matched next cycle. Just something on the CV to discuss during IVs. I am definitely keeping an eye out for any openings, but with this year's match rate, there are plenty others doing the same.
I applied to about 35 programs and received 8 IVs.

You might try to go to at least one of the annual meetings this year as well. STS is usually in January and AATS is usually in April or May. They often have some resident/fellow sessions that could be decent for networking.

 

[SociableJimmy]

Hey there. I was in a similar position to you last year, didn’t match first time around coming from a community program as a US MD. I matched into a top ranked critical care program for next year and fortunately got a CT spot to start in ‘24. I think that for the cardiac-minded applicant (which I am) it’s a great option and easy to spin as relevant experience to your future career. Still applicable for thoracic, but less so in my opinion since the specialty is much lighter on critical care for the most part (unless you plan to be heavily involved in lung tx or ECMO).

If general thoracic is really what you went then I wouldn’t discount the unaccredited 1-year programs. The Brigham, Pitt, and Fox Chase all come to mind, and I’m sure there are more. The current junior fellow where I matched did a year at Pitt and I believe the applicant that matched thoracic track at Baylor/Texas Heart this year is coming from the Brigham’s program. So clearly it works.

I hope I don’t sound too harsh, but you’re doing yourself a disservice if you don’t apply to every single program next time around. You’re already starting with a disadvantage by being an IMG and a reapplicant. The match is too competitive right now for someone in your position to be selective with where you apply. You need to give yourself every advantage possible, especially when you look at the list of matched applicants this year and see most of them came from major academic programs with dedicated research time and great connections. Just think, your 8 interviews this year could have been ~15 if you applied to all 65 programs that participated this year.

When next year’s application season starts, you need to milk absolutely every faculty connection possible to the fullest extent. Have them all reach out to every single person they know and put in a good word for you. Try and get to know your cardiac surgeons too and see if they can do the same. These connections matter enormously.

Just my 2 cents. I’ve been there, and I know it sucks a lot. You’re going to have to work your ass off this year to make yourself a better applicant, but it is totally possible with the right mindset and plan. Best of luck.

 

[TE Fistula]

Hey there. I was in a similar position to you last year, didn’t match first time around coming from a community program as a US MD. I matched into a top ranked critical care program for next year and fortunately got a CT spot to start in ‘24. I think that for the cardiac-minded applicant (which I am) it’s a great option and easy to spin as relevant experience to your future career. Still applicable for thoracic, but less so in my opinion since the specialty is much lighter on critical care for the most part (unless you plan to be heavily involved in lung tx or ECMO).

If general thoracic is really what you went then I wouldn’t discount the unaccredited 1-year programs. The Brigham, Pitt, and Fox Chase all come to mind, and I’m sure there are more. The current junior fellow where I matched did a year at Pitt and I believe the applicant that matched thoracic track at Baylor/Texas Heart this year is coming from the Brigham’s program. So clearly it works.

I hope I don’t sound too harsh, but you’re doing yourself a disservice if you don’t apply to every single program next time around. You’re already starting with a disadvantage by being an IMG and a reapplicant. The match is too competitive right now for someone in your position to be selective with where you apply. You need to give yourself every advantage possible, especially when you look at the list of matched applicants this year and see most of them came from major academic programs with dedicated research time and great connections. Just think, your 8 interviews this year could have been ~15 if you applied to all 65 programs that participated this year.

When next year’s application season starts, you need to milk absolutely every faculty connection possible to the fullest extent. Have them all reach out to every single person they know and put in a good word for you. Try and get to know your cardiac surgeons too and see if they can do the same. These connections matter enormously.

Just my 2 cents. I’ve been there, and I know it sucks a lot. You’re going to have to work your ass off this year to make yourself a better applicant, but it is totally possible with the right mindset and plan. Best of luck.

Appreciate the detailed response. I definitely thought about a lot of what you mentioned. One of the things I am interested in learning about from your experience is why you went for ICU fellowship instead of ECMO/unaccredited cardiac fellowship? and did you go through the ICU fellowship match or go for open positions outside? Finally, how do you think that impacted your application this year? You were probably asked about what you are going to do during that gap year and how that would make you a better applicant when you have not went through the ICU fellowship yet. Interested in learning about how you navigated that

Thanks

 

[SociableJimmy]

Appreciate the detailed response. I definitely thought about a lot of what you mentioned. One of the things I am interested in learning about from your experience is why you went for ICU fellowship instead of ECMO/unaccredited cardiac fellowship? and did you go through the ICU fellowship match or go for open positions outside? Finally, how do you think that impacted your application this year? You were probably asked about what you are going to do during that gap year and how that would make you a better applicant when you have not went through the ICU fellowship yet. Interested in learning about how you navigated that

Thanks

I considered ECMO briefly, but given the high chance of not matching again in today’s environment I went with critical care because it gave me some additional board eligibility that would be useful if I did happen to match and would help with alternative career options if I didn’t. If I did ECMO/unaccredited cardiac and didn’t match that extra year wouldn’t really offer anything as far as career options and I’d be stuck doing general surgery. Feedback during interviews was generally good. My critical care program fortunately offers lots of CTICU, ECMO, and occasionally operative cardiac experience if you work to arrange it, so it was pretty easy to spin it in my favor.