Hi everyone – recently matched resident here. I thought I'd give my thoughts on the process and the programs in the hopes of helping current and future applicants. Best of luck to everyone applying!
General stuff: It's competitive. Like, really competitive. I don't think the numbers do it justice, but over the past few years the match rate has been about 85-100 applicants - and by applicants meaning people who actually got interviews and submitted rank lists - for ~55 slots. You realize on the interview trail that you're with a bunch of superstars. After one interview, I got the weekly JAMA email with online first articles...realized was just at the interview with the first author of one of those papers. At the Boston interview, one of the guys was staying around after to give a lecture at MIT. Yikes...can't make this stuff up. I don't say this to scare people away, just for the junior residents out there - start getting your application beefed up as much as you can!!
Advice for matching: I think the two biggest things are research and who you know. There were a number of applicants from schools that you might not necessarily think of as top programs, but then you remember that last year's SSO president is their chairman, or the former head of MDA, etc. But the flip side of this is pretty much everyone out there has bigwigs vouching for them.
-No one ever asked me about my ABSITES. I do know one guy had bad scores and it got brought up a couple places
-It does seem like residency program prestige matters, especially at the big places. Lot of folks from the Penns and Michigans, etc of the world.
-I think the interview matters a ton at MSK and MDA. Hard to tell at other places as it seemed less emphasized or you met fewer faculty
-MSK had a very strong NE/NY bias in terms of their interviewees (probably 1/4 of their interviewees were from the NY area programs), and a lot of people had either done rotations or research there. As I said above- connections matter a lot.
-How many interviews? I saw a big range, from 4-5 (many times these were people coming from a place with a home program like Hopkins) to 14-15. I went kind of in the middle of that. About mid-way through the trail I was worried I hadn't gone on enough, but looking back I think that was a good number.
The Interviews: For the most part these were very collegial. MSK has the most intense interview day with a series of themed rooms.
-Be prepared to talk about any aspect of your research/CV. Should be obvious by now but bears repeating. I'd find someone asking me about a review article I wrote five years ago.
-Have a stock answer to "why surg onc?" and "why fellowship at all, why not just go get a job?"
-Have an interesting case or two to discuss, including the important take home of "what did you learn from it?"
-Have a 5-10 year plan. Not like a "I will apply for my K award by 2019" kind of plan, but a plan for what you want to do clinically and what your future research interests are in. It's okay if this doesn't 100% align with what you did research on in residency!!!
-Have something interesting outside of work to talk about. Everyone is going to ask you the "what do you do for fun?" question
-Other common questions were - biggest challenge in residency? Biggest strengths/weaknesses? How do you think you work as a team leader? How do you interact with juniors/medical students/nurses?
Picking a program/ranking:
-I think the first branch point in the decision tree is standalone cancer center such as MSK or academic medical center such as Pittsburgh. Advantage for standalone centers is that you have no residents to compete with, the programs are very much focused on training fellows, and there is usually no ED/less emergent stuff. Disadvantage is less support from residents - no one to write notes for you, see consults, etc. At U Chicago the fellows take NO CALL because the residency has an in house night float.
-Next branch point is based on areas of clinical interest. Some programs are stronger in areas than others. I think for MSK and MDA you'll be pretty much set for anything (although they each have their own strengths), not sure I can say that about everywhere else.
-Next branch point comes down to fit and where you want to live. I think this was a very important one for me. The good part about there being such a small number of programs is that the bar is high for all the programs and you're going to come out of it with solid training and board certification.
Program Specifics:
-Everyone wants to know about rankings and tiers. Well there aren't really any, at least not formally. MDA and MSK are clearly the top programs. After that who knows. Even among the top two, it felt like MSK really felt like they needed to assert their superiority. Maybe they deserve it, they did invent the fellowship after all.
-I'm not gonna tell you where I matched because even though this is anonymous it's a really small field and because it doesn't really matter. The order I'm listing here is not my actual rank order (Or is it?)...I'm just trying to pass along the info I picked up this year.
-MSK (7 fellows per year, normally interview 24 people, interviewed 30 last year due to strength of applicant pool per their program director): Really outstanding program. Very very strong in HPB (and by this I mean H, P, and B, not just P which you will see at a lot of places), coming on strong in robotics. Probably the best gastric experience in the country with Vivian Strong, but a little unclear how much you are doing vs watching in those cases. They have a ton of robots - 13 I think they said - mostly the new Xi and they have teaching consoles and bedside PAs. Fellows also raved about their robotic colorectal experience. Very educationally focused - their teaching conferences are intense but by far the best on the interview trail. Nice facilities including a brand new outpatient surgery center. Living in NY seems like a ton of fun but does require sacrifice. They take you to 3 of the subsidized housing options. Two were great and one looked like dingy grad student housing. Really liked the faculty including the PD. Interview day is intense as well - each room has a theme such as leadership or technology in surgery. Big plus of the program is a mentoring model rather than service model - you're paired with an attending for a month at a time. If they are in clinic, you go to clinic. If they have an OR day, you have an OR day. If they have an academic day, you have an academic day (*allegedly. Sounds like you get pulled to cover cases sometimes on those days). Their OR days are long - elective cases booked until 9pm or so - and they have a 6 day workweek meaning elective cases on Saturdays. Second year have the flexibility to customize your schedule a lot based on your interests. Call - you take home call for your patients pretty much full time and one person is on call at night for new surgical consults. I hadn't really thought about this before the interview trail but at these stand alone cancer centers you're it as far as a general surgeon, so you get calls on all the patients on the BMT service with neutropenic fevers and butt abscesses or typhlitis. Bummer.
-MDA (7 fellows per year; have a 2 yr track and a 3 yr research track, interview 24 people): Also outstanding. Different feel than MSK. Really strong for sarcoma, GI. Better exposure to HIPEC - about 100 HIPEC cases per year. Their program director is younger, an endocrine surgeon, really liked her and she seems super invested in the fellowship. They talked about how they've used the CGSO certification process to change some parts of the fellowship for the better - they didn't really say it openly but I think this was a veiled response to the rumors that the fellowship used to be almost too busy. System is set up in more of a traditional service model than the mentoring model at MSK. Rotations are flexible in second year to allow people to track based on interests. Three year option with T32 funding for the extra year - have to formally rank this separately through the NRMP. If you think you might be interested in this tell them up front on the interview day as they definitely want to find people with strong research interests for it. This may sound dumb but I really appreciated how much information they gave us at MDA. Most places you got a powerpoint with some vague numbers and maybe they flash up the fellows case logs for minute. MDA put together a really nice bound packet with all the specifics including two years of fellows case logs, prior fellows job placements, details about the call schedule and rotation structure, etc. Having all that information in a format where I could actually look back at it helped a lot because after a bunch of interviews it all starts blurring together. Call schedule is pretty awesome…because you get paid to take in house call (150 per hour). Fellows sign out their patients to the on call person so when you go home you go home. Since it is paid you basically can take as much or as little call as you want since there will usually be someone itching for the extra shifts. You also get paid a significant stipend to be the staff for their line/port clinic - it's PA run and you are the supervision. Fellows usually end up having to put in less than a dozen lines themselves as the PAs are very good. For those struggling to decide between MDA and MSK, all I can say is go on the interviews and try to get a feel for the two programs as it really did feel like they have different "personalities". But I really struggled deciding for a long time as I loved both.
-Pitt (5 fellows per year, interviewed 33 people): Loved Pitt. Huge hospital system with a ton of clinical volume. Their fellows definitely graduate with the most cases. Very heavy in HPB and HIPEC. The rotation with Dr. Bartlett sounds amazing - you operate with him for two straight months and get a lot of autonomy. If you're certain you want to do HPB I think you really should consider strongly ranking this place #1. They are way ahead of the curve on robotics/MIS whipples, but still have good open volume too (doing >50% of their whipples robotically now, but still do 75ish open whipples per yr according to their faculty). Dr Zeh was the man, probably one of the favorite people I met on the trail. They have a very robust robotics curriculum that all the fellows have to complete before they get to do significant console time. I appreciated how thought out this was as opposed to other programs where you kind of appear to just get thrown into the pool. Fellows also praised the colorectal experience. Probably not as robust a sarcoma experience, definitely lighter on melanoma and breast although I'm sure most would not complain about that. Of the university hospitals, they probably have achieved the best balance of incorporating residents without sacrificing the fellows training. Posters here in the past have talked about them having a lot of different tracks - they've actually it sounds like largely done away with that in favor of a more structured/consistent curriculum, but there are some elective options. Still have a separate HPB fellowship that is not CGSO-certification eligible.
-Hopkins (2 fellows per year, 1 HPB track 1 research track, interviewed approx 35 people): This is probably where I'm going to most significantly disagree with the prior opinions. I think Hopkins has really worked hard to make this an outstanding fellowship. There were a lot of questions about Hopkins on the interview trail as Tim Pawlik is leaving for the OSU chair job, but I loved their new PD Weiss. He is a clinical workhouse and when you rotate on his service it's just you and him cranking through cases. Very good for HPB. I will say I was not very interested in the research track - it's 14 months clinical, 10 months research. I'm going to fellowship to get more clinical training in oncology so it just wasn't for me. In terms of service structure, it sounds like you run the service with a junior resident or two, very similar to chief year. You do one rotation at a community hospital outside Baltimore with a breast surgeon that the fellows were very positive about (rare to hear people raving about breast). They are working to try and revamp/improve their teaching conferences which was probably one of the weak points. Probably the most pleasantly surprised by this program of any on the interview trail.
-Chicago (1 fellow per year, interviewed a lot of people, maybe 35-40): Liked it a lot. Biggest change since the prior reviews I've read here is that they've acquired/developed a partnership with the Northshore hospitals. This has given them a lot more volume for the fellows. The current fellows really raved about this rotation. Only downside is getting to/from the north side of chicago in traffic (hour plus commute home depending on time of day!!!). Posner seems great but I have heard rumors he may not be there much longer. Generally very strong, good HPB. Seemed to integrate well with the residents, likely in part since there is only one fellow and they traditionally send a lot of people into surg onc. No call!! Night float covers everything. Brand new hospital which was beautiful. Converting the old hospital into a dedicated cancer hospital over the next few years which should be awesome. Another big change since this thread was last updated is that they have dropped the formal third year requirement - it is still an option if interested but it is a 2 yr program now.
-Moffitt (4 fellows per year, interviewed approx 25-30): Very strong for melanoma/sarcoma/breast. GI is solid but it's only 2-3 faculty doing it so while you get good numbers, not quite as much breadth of experience in terms of who you work with. Liver they just recruited new faculty but this was an admitted area of weakness prior to that. They do a lot of esophageal on the surg onc side which was not my cup of tea but if you're interested in having that in your practice this was probably one of the few with adequate experience. Liked their current fellows a lot. Kind of an interesting experience on the interview day as several of the fellows more or less said this was not their top choice but they have been very very happy with their training. I actually wish more places the fellows were that honest with us. Tampa seems like a very easy place to live. The hospital felt a little small and dated compared to some of the others (abt 200 beds if I recall), but they are starting a major renovation/expansion project over the next few years. Also had more of a mentoring model for their rotations which I liked a lot. They did a great teaching conference (review for orals) however it was with all of us applicants there so may have been more for show than their normal conference.
-Dana Farber/Partners (1 fellow per year, interviewed approx 25): Despite what I'd heard, I went. It's Harvard, who can say no? I will say they are certainly up front about the elephant in the room (the elephant being the MGH/Brigham chiefs), they talked about how they know this is people's main concern and tried to reassure us. I'm still not sold. At MGH you rotate on a separate service and it sounds like you get treated basically as a chief but with less leeway since they don't know you. You don't get to rotate with Lillemoe or Fernandez as that's the chief's service. You do get a good experience with sarcoma (the PD - Raut), you get some time with Tanabe (who I really, really liked on my interview). Lot of breast and melanoma. They showed their case volumes for past fellows and they were alarmingly low - like low enough to potentially be in trouble with the new ACGME case minimums. Second year has a lot more unstructured/research time. The research opportunities are as you would expect amazing given the Harvard resources.
-Ohio State (3 fellows per year, interviewed approx 30): Probably the biggest up-and-comer on the circuit. Really good training. Just built a beautiful new cancer center. Hired Pollock as head of surg onc a couple of years ago, then hired Pawlik as department chair. Expecting this program to keep getting better. In terms of HPB, their PD seemed great - liver surgeon Schmidt. They are reloading a bit right now I think on the pancreas side. Very good endocrine experience (associate PD - Shirley). Pollock is obviously a huge name in sarcoma. Not as much colorectal exposure. Have also transitioned to a mentoring model pairing with 1-2 attendings at a time. In terms of interactions with the residents...the fellows were nice about it but more or less said they take what they want and the residents get the rest. Call setup is kind of strange as the first year fellows take all the call and the second year fellows none of it. Support from residents at night but I didn't really get a good sense of how much exactly. I liked this program a LOT.