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This fellowship guide is updated quarterly with information obtained from fellowship programs, residents, and other interested parties. If you wish to be added to this guide, please e-mail webmaster@medpeds.org with any additions, corrections, or further information that you feel would be helpful.


Table of Contents
Introduction
Timeline

Why Do a Combined Fellowship?
Subspecializing in Either Medicine or Pediatrics but Doing Both as a Career
Advantages of Combined Fellowships
Disadvantages of Combined Fellowships

The Nuts and Bolts of Fellowship Applications
The Boards
Job Market
Fellowship Salary
Finding Institutions to Sponsor Combined Fellowships
American Board of Pediatrics (ABP) and American Board of Internal Medicine (ABIM)

Descriptions of Fellowships Open to Med-Peds Residents

Appendix A – Partial List of Subspecialty Organizations
Appendix B – Additional Information about Fellowship Program Participating in the Electronic Residency Application Service (ERAS) and the National Resident Matching Program (NRMP)
Appendix C – Comments from Med-Peds People in Academic Careers Regarding Combined Fellowships


Introduction

A

Med-Peds Fellowship Guide has been a perennial item of discussion in the Med-Peds community.  As Med-Peds has grown, so have the number of Med-Peds people wanting to pursue fellowship training in a wide variety of areas, from traditional combined fellowships (e.g. pediatric and adult cardiology) to medical informatics, to Robert Wood Johnson Clinical Scholars.  As of 2002, 15-17% of the estimated 3546 Med-Peds graduates have pursued some form of formal post-residency training.  From the annual survey of graduating Med-Peds residents coordinated through the American Academy of Pediatrics, we know that currently about 25% of graduating Med-Peds residents anticipate some kind of fellowship training.  Despite the growing numbers, no centralized source for information regarding Med-Peds post-residency training exists.

With this background, this Med-Peds Fellowship Guide is an attempt to collate information about Med-Peds Fellowships in one place. This Guide contains:

  1. General information about Med-Peds Fellowships.
  2. A list and description of Med-Peds Fellowship options.
  3. A list (incomplete) of institutions known to support combined fellowships.
  4. A list of people who have completed, or are completing, combined fellowships and who have agreed to be contacted by others with questions about their particular post-residency training path.

We hope this Guide will be helpful to many Med-Peds residents as they consider fellowship training. We hope the Guide will expand as more information about combined Med-Peds Fellowships becomes available. If you have comments or questions about this Guide, or additional information to add to this Guide, please send an email to fellowships@medpeds.org.

This Guide does not contain information about subspecialty training that is not interdisciplinary, such as adult cardiology fellowship information.  This Guide is also not meant to be 100% exhaustive.  The information in it was combined by surveying people within the Med-Peds community, including Med-Peds Program Directors, American Academy of Pediatrics Med-Peds Section members, National Med-Peds Residents’ Association (NMPRA) members, and people subscribed to various Med-Peds list servers.  We included all information provided from these sources, however, we recognize that programs and contacts exist that are not included in this Guide.  Finally, this Guide should not be seen as a position statement from any Med-Peds organization, but an information source for Med-Peds residents considering fellowships.

This Guide, would not have been possible without the help and support of dozens of people within the Med-Peds community. Special thanks go to Tommy Cross, MD, MPH, Allen Friedland, MD, Richard Lavi, MD, Daniel Reirden, MD, and David Kaelber, MD, PhD.

—Ashley Blake, MD
National Med-Peds Resident Association (NMPRA) Director of Professional Advancement, 2015-2016


Timeline

T

This is a general timeline to use when considering combined Med-Peds Fellowships. The decision to pursue subspecialty training may be present from the initiation of residency or evolve within an individual as they gain experience and exposure to diverse career paths. Over the past several years, there has been a trend to try to move the fellowship application deadlines closer to the completion of residency training. Internal medicine fellowships have moved quicker than pediatrics fellowships, which adds to the complexity of pursuing combined fellowship training. If one hopes to start fellowship right after residency, it is generally best to be ready to apply for fellowships by the middle of the PGY3 year. Many pediatric fellowships start the fellowship application process the December (~18 months) before the following July fellowship training start date. Many internal medicine fellowships start the fellowship application process the July (~12 months) before the July fellowship training start date. (see Appendix B for details)

Overall, the path to post-residency training can vary greatly. Included below are some things to consider in a timeline format broken down by PGY year. This timeline is geared to Med-Peds residents who hope to pursue formal post-residency training right after completing their Med-Peds residency.


    • Focus on your internship.
    • Begin to think about what area(s) of post-residency training might interest you.
    • If you have an elective, use it to explore an area of post-residency training you may be interested in. Show interest and do well in these rotations.
    • If possible, select a career adviser in your area of fellowship interest.

    • Use electives to explore areas of possible post-residency training.
    • Begin to narrow down on what area of post-residency training interests you the most.
    • Consider trying to become involved in a research project in an area of postresidency training that you are interested in (this could also fulfill your Med-Peds residency scholarly activity requirement).
    • Consider attending a general (e.g. Pediatric Academic Societies meeting ) or specialty (e.g. American College of Cardiology meeting society medical conference.

    • Use electives to explore areas of possible post-residency training.
    • Decide upon what post-residency training you will pursue.
    • Talk with people that you know have completed post-residency training in the area that you want to pursue (even if they did not complete a Med-Peds residency; for instance talk with Pediatric and Adult Endocrinologists if you are looking to pursue a combined Endocrinology Fellowship).
    • Make a list of programs where you think you could pursue the training you desire.
    • Contact the Program Directors/programs where you would like to train to see if they are open to accepting Med-Peds residents and what their application involves.
    • Apply to a few Fellowship programs in December (see Appendix B for fellowship list)
    • Interview at perspective programs.
    • Decide which program offers the best training for your needs.
    • Consider (if not already doing) working on a research project in the area of postresidency training that you are interested in (this should also fulfill your Med-Peds residency scholarly activity requirement).
    • Consider attending a conference related to the Fellowship training you are interested in.

    • Apply to most Fellowship programs in July (see Appendix B for fellowship list)
    • Interview at perspective programs.
    • Decide which program offers the best training for your needs.
    • Consider (if not already doing) research in the Fellowship area you will be going into.
    • Consider attending a conference related to the Fellowship area you will be going into.
    • Submit a proposal for the combined fellowship you pursue to both the ABP and the ABIM (This is only required if you are pursuing a fellowship unique to Med-Peds


Why Do a Combined Fellowship

Once you have made the decision to choose a subspecialty career, the question now comes up — should I do a combined fellowship or pursue categorical subspecialty training? This Guide will help you think through this decision and decide if a combined fellowship is something you should pursue. This is often a difficult and personal decision. This Guide will answer some of your questions, but also may inspire you to come up with other questions that do not have “correct” answers.

If you ask physicians who have completed combined fellowships why they chose this route, you will receive a multitude of answers. For some it was simple -”because it was there.” But for others it was because they wanted to continue their combined training and rather than narrow their focus to a single age range. Some saw it as a great way to move up the academic ladder very quickly — a quadruple-boarded physician has great marketability! Others did it for the challenge. Others state it is a unique opportunity to provide continuity of care or conduct research on a population of patients with chronic diseases from infancy to adulthood.

However, it must be noted that the majority of Med-Peds residents choose either a categorical internal medicine or pediatrics fellowship and forgo the combined fellowship route. This guide will delve into the “whys” of this decision later.



Subspecializing in Either Medicine or Pediatrics but Doing Both as a Career

This has become a path for some Med-Peds specialists. For most of the non-procedural fields, you can do an adult or pediatric fellowship and consider spending elective time (which may be up to a year) in the comparable pediatric or adult subspecialty (assuming the institution/near-by institution has both the relevant adult and pediatric specialists). In doing this, you would not qualify for both subspecialty certifying exams, but you could still be triple boarded as a board certified internist, pediatrician, and an adult or pediatric specialist. There are varying degrees of overlap between the two subspecialties across all fields. This route decreases overall training time and reduces some of the costs associated with certifying and recertifying.

Some Med-Peds trained physicians take this route with regard to taking care of certain populations. For example, a double boarded Med-Peds physician completing a pediatric pulmonary fellowship (becoming triple boarded,) but then taking care of cystic fibrosis (CF) patients, including adult CF patients (without performing invasive procedures on the adult patients), as a board eligible/board certified internist, pediatrician, and pediatric pulmonologist. Similarly, a double boarded Med-Peds physician completing an adult rheumatology fellowship but still helping to provide rheumatologic care for children in shortage areas of pediatric rheumatologists. For the procedural oriented subspecialties this is more difficult to do, mainly due to difficulties obtaining credentialing in hospitals for privileges like pediatric cardiac catheterizations or chemotherapy in children, etc. Also, in the future, some third party payers may only reimburse for sub-specialty care provided by a board certified specialist in that field (i.e. might not reimburse for care provided to an adult CF patient by a board certified pediatric pulmonologist and general internist). Despite these challenges, some view this route as an alternative in the era of prolonged training times for combined fellowships. If you choose this path, some of the steps suggested in the subsequent sections of this guide will not apply.



Advantages of Combined Fellowships

To begin, a caveat: the following is based on opinion only, not evidence-based data. However, both the pediatric and internal medicine boards strongly encourage subspecialists in both fields to be on par with categorical sub-specialists if you plan on providing care in both age groups.

We will talk about academic careers first. Some who take this route feel like it helped push their careers in academia along a little faster and gave them certain advantages. Most people who do combined fellowships and enter into academic careers proceed directly into the Assistant Professor level and bypass “Instructor” status. This has some disadvantages, though: it puts the clock in motion for you to advance to Associate Professor with tenure almost immediately. With the “Instructor” label you have some time to get research, clinical practice, or teaching established before you have to get into the grind of “producing” towards your next promotion (usually 5-7 years out). Also doing a combined fellowship allows you to have credentials in both departments, which can be helpful to you in that it provides a wider base for funding for your career as well as providing access to the other department’s strengths.

Doing a combined fellowship continues what you have already done during residency training (practicing as an internist and a pediatrician in two departments). This dual appointment provides you with an array of teaching and research opportunities, as well as clinical avenues, to pursue. Usually you will have to pick and choose what areas you want to focus on — the choices will be staggering, but allow you to be diverse as well as do things that you really want to do. Doing a combined fellowship allows you to participate in multiple national organizations, again providing opportunity for you to advance your career. Frequently, national organizations are looking for someone who can fill a special niche, and a person who is board certified in three or four areas frequently can provide needed diversity to a committee or group.

For those interested in private practice, a combined fellowship provides the tools to expertly practice both disciplines with confidence. Combined specialists have gone to large metropolitan areas and easily put out their shingle as a dual certified subspecialist. Hospital credentialing and insurance credentialing are much easier with the “board certified” behind your name. For example, it is more difficult to get privileges to see pediatric pulmonary patients if you are only board certified in adult pulmonary medicine, especially in a larger metropolitan area. For smaller communities, combined fellowship may not provide as large an advantage. Also, being quadruple boarded may increase your standing in the medical community and may allow increased number of referrals (especially initially on arrival to a community) if you are viewed as an expert in both adult and pediatric diseases. Over time, this probably becomes less important and success depends more on how well you provide service for your colleagues.



Disadvantages of Combined Fellowships

Time and money. The more time you spend in fellowship training, the less money you are making in “the real world”. It is doubtful that a combined specialist will make more money than a categorical specialist. In general, an adult specialist will make more money than a pediatric specialist. No data exists on how much a combined specialist makes compared to a categorical specialist, but you can infer that they generally do not make more than a categorical adult specialist. This can vary, though, as some combined specialists have worked out agreements to supplement their incomes by providing a service that otherwise would not be available to a hospital or community. For example, it may be worthwhile for a hospital or multispecialty group to supplement a combined pulmonologist (who would be the only board certified pediatric pulmonologist in the area) in order to attract pediatric asthma or pediatric complex lung disease patients to that hospital or practice.

During the fellowship years, student loans are still growing and moonlighting becomes a priority supplement income. Also, many fellows are starting or expanding families so income becomes more important. From a monetary viewpoint, it does not make sense to stay in fellowship for 2 or more years longer when essentially you can make the same amount of money if you just complete a categorical fellowship.

Once you become dual subspecialty certified you will have a large amount of dues to pay to all of the professional organizations in which you will want to remain a member. Plus, you may have to pay for multiple subspecialty journals. This brings up the point of staying current in knowledge in all of these areas, which can be very difficult to do. Think about where you are right now, trying to keep up with general internal medicine and general pediatrics. Now, add to that keeping current in two sub-specialties as well.

Finally, for people in academic medicine you have responsibilities in two departments. In a sense you have two full-time jobs with differing demands, priorities, and supervisors. For academic success, you will probably need to align yourself with one primary department (either internal medicine or pediatrics), although you may have responsibilities (clinical, research, teaching, administrative, etc) in both departments.



The Nuts and Bolts of Fellowship Applications

The most important decision is to determine where you want to pursue your fellowship training. Contact the adult and the pediatric fellowship program directors for your programs you are interested in directly and find out if they are interested/can support having a combined fellow. Email is probably the quickest and most convenient way to communicate with program directors. Also, feel free to contact the combined fellows listed at the end of this Guide for their recommendations. Many programs are willing to pursue combined fellow applicants to match a high quality applicant. If it appears they are not interested or they are putting up a lot of roadblocks, move on. You do not want to waste time and energy on a program that is going to be difficult to work with, especially since there are numerous programs willing to help you succeed. Remember, if the programs are making it difficult at the onset, imagine what it will be like when they have to work around combined schedules. It may be helpful to look at programs that have an affiliation with a combined Med-Peds residency program, as they are frequently aware of the interest in combined fellowship training. If you are lucky, one of the subspecialty program directors may be a member of the internal medicine or pediatric residency program advisory group and be familiar with Med-Peds. Though helpful, this is not crucial, as many combined fellows have done fellowships at programs with no Med-Peds residency program.

After you have found which programs to apply to, you need to find out if they require you to go through the Electronic Residency Application Service (ERAS) and National Residency Matching Program (NRMP) Fellowship Match. As of 2016, most programs are requiring use of NRMP and ERAS. Appendix B at the end of this Guide has some additional information about fellowships that participate in ERAS and the NRMP. If programs have a several strong applicants who are ready to commit to their program, they may completely drop out of the match for that year. You will have to work around these issues when you apply. Generally, the programs will be pretty accommodating and will hopefully view you as a special case —and should be able to pull a spot out of the match for you— if you reach an agreement before Match day.

Most people start applying in the early Fall of their third year of residency. It is helpful though to start contacting programs late in your second year or mid-July in the third year to see what special requirements they have and if they are willing to look into a combined fellowship. You will need several letters of recommendations from both pediatric and internal medicine faculty, as well as your program director. These letters should come from people you have worked closely with, and should also include a subspecialist from the area in which you are interested. It can be helpful if your subspecialist trained at the program you are interested in or if they are well known in their particular subspecialty. However, if you do not have any of these advantages, do not worry — a good interview can compensate for any lack of personal connections.



The Boards

Once you have found at least one program that you think might be willing to work with you, you need to contact the American Board of Internal Medicine and the American Board of Pediatrics and let them know you are interested in pursuing a combined fellowship in specialty X. Generally, they will let you know of the specific requirements they have. The key is to get, IN WRITING, how many years they want you complete to qualify for combined fellowships. Typically, the rule has been the following: Categorical Internal Medicine fellowship years + Categorical Pediatrics fellowship years – 1 = the number of years to do a combined fellowship. For example, in infectious diseases the equation is [2 (minimum for internal medicine) + 3 (minimum for pediatrics) – 1 = 4 years to do a combined infectious disease fellowship]. Occasionally the boards are more flexible for applicants who have already published, have a Ph.D. or something else in your CV to set you apart. It is worth a try to see if they will reduce the training time.

The other issue is cost. First time takers of the general internal medicine boards currently pay >$1300. General pediatrics boards currently cost >$2200. Board fees for first time takers in a subspecialty of internal medicine range from $2200-$2900 and for a subspecialty in pediatrics >$2900. There are also fees associated with ongoing maintenance of certification cycles that are 10 year cycles (both for general maintenance of certification, as well as subspecialty certification). Many physicians in academics and private practice have the cost of these exams written into their employment contracts.



Job Market

Subspecialists are needed in most areas of the United States. There are geographic areas of oversupply for a few adult and pediatric (e.g. Pediatric Infectious Disease) subspecialists, but for most pediatric subspecialists and many adult subspecialists there are areas of need. A combined trained subspecialist should have little difficulty in finding multiple job opportunities.



Fellowship Salary

Med-Peds residents entering fellowship, based on their 4 years of Med-Peds training, should be eligible for pay at the PGY-5 level during their first year of fellowship. Recognize, however, that most other residents starting fellowship will only be eligible for pay at the PGY-4 level. Your fellowship may only be willing to pay you at the PGY-4 level during your first year of fellowship because this is the salary for other fellows who only completed a categorical program in the first year of their fellowship. You may want to inquire during your interview process what PGY level you would be paid during your first year of fellowship.



Finding Institutions to Sponsor Combined Fellowships

Unlike combined Med-Peds residency programs which are Accreditation Council for Graduate Medical Education (ACGME) certified, no combined fellowships are ACGME certified. This means some additional up front logistic work for the applicant to a combined fellowship. It can seem quite daunting, but is made easier by following 3 steps:

  1. Find an institution that offers both the adult and pediatric version of the fellowship you desire. A combined fellowship can be done at two separate institutions, but will be more difficult to manage.
  2. Discuss the possibility of doing a combined fellowship with both the adult and pediatric fellowship directors. If they do not advertise an already existing combined curriculum, they may be amenable to the idea if approached.
  3. Petition the American Board of Internal Medicine (ABIM), and the American Board of Pediatrics (ABP) to ensure board eligibility in both the adult and pediatric specialties.The ABIM and ABP will only accept such petitions from applicants who have already been accepted by an adult and pediatric fellowship program. This last point can be tricky as it means up front discussions with both fellowship directors about the applicant’s plans, and acquiring their verbal (if not written) support for combined training before applying and ranking through ERAS.

The programs listed in the Combined Fellowship section of this Guide have generally successfully supported and been granted petitions from the ABP and ABIM for combined fellows. However, even at these institutions any new fellows would need to submit their own petition to the ABP and ABIM. Again, institutions may be amenable to support combined training if approached individually, even if they do not appear in this guide.



American Board of Pediatrics (ABP) and American Board of Internal Medicine (ABIM)

Ultimately, to become quadruple board certified, both ABP and ABIM need to agree that your combined fellowship meets their criteria for board eligibility. Again, this should be done PRIOR to starting your fellowship. Additional information can be found in subsection of the ABP and ABIM websites.



Descriptions of Fellowships Open to Med-Peds Residents

T

his section contains a list, broken into 3 categories of fellowships open to Med-Peds residents. The first group (unique fellowships) includes fellowships which are only open to Med-Peds residents. The only type of fellowship currently in this group is the MedPeds Generalist Fellowships. The second group (combined fellowships) contains fellowships that can be done as a combined or single discipline fellowship, such as combined adult and pediatric cardiology. The third group (special fellowships) contains fellowships that are not unique to Med-Peds, such as adolescent medicine or sports medicine.

Within each group, the fellowships are in alphabetical order by fellowship name. Fellowships are listed and then a more thorough section for each fellowship occurs. Along with a brief description of each fellowship, we include a list of specific programs where individuals have completed combined fellowships in the past or are currently doing combined fellowships or have expressed interest in having combined fellowships. In addition, we include specific email contacts of people who are in or have completed that fellowship or have special knowledge of this area, and have agreed to be contacted if people have additional questions.

Within the combined fellowships category, we have included only those programs known to us that offer or have accommodated a combined subspecialty pursuit. Those individuals listed as contacts are people who have pursued a combined course of training. Many people who have done combined fellowships did so at programs not listed in this guide. For many people it was set up specifically for them and was not perceived as an ongoing program—and as such is not listed here. Feel free to contact programs you are interested in and see if they might be interested in doing a combined program. They may already have or might be very willing to do so. It usually just takes someone to express an interest to get the ball rolling!

Within the special fellowships category, we have listed only those programs that have been known to accept Med-Peds graduates in the past.

If you are looking to try to find a contact at a program listed under a particular fellowship, you can generally start with the Med-Peds Program Director at that institution. Contact information for most Med-Peds Program Directors can be found on the National Med-Peds Residents’ Association (NMPRA) website. A second approach is to contact the categorical subspecialty Fellowship Directors, which can generally be found through the Fellowship and Residency Electronic Interactive Database (FREIDA).

Please click the links in the table below to visit separate pages for each clinical specialty.

Unique Fellowships Combined Fellowships Special Fellowships
Med-Peds Generalist Cardiology Adolescent Medicine
Endocrinology Allergy and Immunology
Gastroenterology Clinical Informatics
Hematology and Oncology Community Medicine
Infectious Disease Epidemic Intelligence Service (EIS)
Nephrology Global Health
Pulmonary/Critical Care Health Services Research
Rheumatology HIV Medicine
Medical Genetics
Medical Toxicology
Quality Improvement
Palliative Care
Robert Wood Johnson Clinical Scholars Program
Sports Medicine
Transition Medicine

NMRPA is always looking to add more programs and contacts to the following descriptions and that this information included here is not exhaustive. If you know of programs and/or contacts that can be added, please email the information to fellowships@medpeds.org.

For some listed fellowship, one contact has an * next to their name. This designates that they had the lead role in preparing the fellowship description, programs, and additional contacts information.



Appendix A – Partial List of Subspecialty Organizations

Depending on the post-residency training path you are planning to pursue, you may benefit from reviewing web sites of subspecialty organizations. Many of these websites contain information about post-residency training related to their subspecialty.

A partial list of subspecialty organizations is a follows:
American Academy of Allergy, Asthma, and Immunology
American Academy of HIV Medicine
American College of Cardiology
American College of Chest Physicians
American College of Rheumatology
American Gastroenterological Association
American Geriatrics Society
American Medical Informatics Association
American Medical Society for Sports Medicine
American Society of Clinical Oncology
American Society of Hematology
American Society of Nephrology
American Thoracic Society
Infectious Diseases Society of America
Society of Critical Care Medicine
Society of General Internal Medicine
Society of Hospital Medicine
The Endocrine Society



Appendix B – Additional Information about Fellowship

Program Participating in the Electronic Residency Application Service (ERAS) and the National Resident Matching Program (NRMP)

(information for this Appendix was adapted from information provided by Charles P. Clayton former with the Alliance for Academic Internal Medicine)

The Electronic Residency Application Service (ERAS) provides a uniform service for medical students to transmit applications to residencies and for residencies to manage applications. In 2003, the Association of American Medical Colleges, which manages ERAS, debuted ERAS Fellowships to assist residents and fellowship programs with the application process for subspecialty training. ERAS Fellowships builds on the decade of success with ERAS, and its applicant interface will be very familiar to those who used it to apply to residencies. More information on ERAS Fellowships is available on the ERAS website.

Similarly, the Specialty Matching Service of the National Resident Matching Program (NRMP) extends the match process to a growing number of internal medicine and pediatric subspecialties. The subspecialty matches take place throughout the academic year, sometimes for positions beginning as early as the next July (for example, pediatric critical care medicine matches in December for positions beginning in July) and sometimes (as is the case with all internal medicine subspecialty matches) for positions beginning roughly 13 months after the match (for example, internal medicine infectious diseases programs match in July for positions beginning July of the following year).
Visit the NRMP website for more details.

Nearly all internal medicine and pediatrics subspecialty programs have joined ERAS Fellowship and NRMP match processes. Despite this growth, applicants should check with individual programs to see if they participate in ERAS Fellowships and the NRMP. The chart below provides information on this rollout as of April 2016 based on the information found at AAMC website.

2016-2017 Applications (for positions beginning July 2017) 
Allergy and Immunology (J)

Internal Medicine Cardiology (J)
Internal Medicine Critical Care Medicine (J)
Internal Medicine Endocrinology (J)
Internal Medicine Gastroenterology (J)
Internal Medicine Geriatrics (J)
Internal Medicine Hematology (J)
Internal Medicine Hematology/Oncology (J)
Internal Medicine Infectious Diseases (J)
Internal Medicine Nephrology (J)
Internal Medicine Oncology (J)
Internal Medicine Pulmonary Medicine (J)
Internal Medicine Pulmonary and Critical Care Medicine (J)
Internal Medicine Rheumatology (J)

Hospice and Palliative Medicine (J)
Medical Genetics (J)
Sleep Medicine (J)
Sports Medicine (J)

Pediatric Adolescent Medicine (J)
Pediatric Cardiology (D)
Pediatric Child Abuse (J)
Pediatric Critical Care Medicine (J)
Pediatric Developmental and Behavioral Medicine (J)
Pediatric Emergency Medicine (J)
Pediatric Endocrinology (J)
Pediatric Gastroenterology (J)
Pediatric Hematology/Oncology (D)
Pediatric Infectious Diseases (J)
Pediatric Neonatal-Perinatal (J)
Pediatric Nephrology (J)
Pediatric Pulmonology (J)
Pediatric Rheumatology (J)

For Fellowships participating in ERAS, D designates that the application process generally starts in the December ~18 months before the fellowship would start and J designates that the application process generally starts in the July ~12 months before the fellowships would start.



Appendix C – Comments from Med-Peds People in Academic

Careers Regarding Combined Fellowships

I. Things you wish you had known:

  • How you advance academically. The fact that you are smart, nice, teach a lot, take good care of patients (all the things you have been rewarded for up until now) are not the criteria for advancement. It is mainly about number and quality of publications and further about grant money that you can attract to the institution. Some institutions have created clinician/educator advancement tracks, but at many of those sites, you are still required to have written dissemination of your work and a profile on the regional/national level to advance.
  • Do the basics – research, publish, and get your name known as an expert in some area.
  • There is a danger in becoming a leader nationally in a tiny Med-Peds niche too early. That leadership role occupies a lot of your time and then you are not producing your own first author research.
  • Find an area of “medicine” that you are passionate about and become an expert in that area, know the literature cold.
  • Going into fellowship can satisfy a need to feel expert in a field rather than feeling like you need to know all of general medicine and pediatrics. Make sure you really love the subject matter and that you can deal with the bread and butter cases of that field (in addition to the smaller area of interest that you may have).
  • Figure out your story for the interviews and stick to it. You must have a vision of how you see your career unfolding and your possible area of research interest. You can totally change your mind once you are in. But, for interviews, pick that story and stick to it. Be convincing. Know your stuff. Read the key articles related to that area. Research the attending physician at the institutions that you are interviewing at and if someone is doing research in that field, read their work. Have a niche that you can fill. Be a solution for them for some problem that they want to solve or work on. If you have done any work, know your research cold.
  • You may well only have an academic appointment in one institution/department even if you are dually board certified and practicing in both. There are advantages and disadvantages to this. Be very aware of the danger of having two departments think you belong to them and having your total expected commitments add up to more than 100% as a result. Get good with breaking everything down to numbers and addition/subtraction/division to show what you should be doing, but do not be surprised if they work the numbers differently and give you more responsibilities.
  • It can be very helpful to go where someone has already tread this path before and worked out some of the kinks and shown the division chiefs and department chairs why the “extra hassle” for a Med-Peds person is worth it in the end.
  • You have to be accepted into both fellowships first and then you can submit your request for that particular dual fellowship to be approved to ABP and ABIM. So, the fellowships have to give you an acceptance and only after that can you officially get permission for the fellowship from the boards. Places that have not had a dually trained fellow before may find this unnerving.
  • Think carefully about what you say yes to. People will offer you projects, leadership roles, etc. You will be flattered/excited/feel pressured to say yes. Learn to say no at times. Pick your projects carefully. Think about those that excite you, fill a great need for the department, lead to academic product–balance that against your time, ability to do something well, quality of life, protected research time, etc. Opportunities will come your way again. You do not have to say yes to everything early on.

II. Should you have done research as a resident by the time you are applying to your fellowship?

  • At some places this is important to be competitive. Some programs are just so competitive to get into, that they can set this bar as a way to weed out applicants.
  • At most places they recognize you do not have time to do this as a resident (especially Med-Peds), but they want some evidence that you have “scientific potential”. For example, can you think about a problem and come up with a question to investigate that is reasonable? Do you have some understanding of what research really entails? Can you write, meet deadlines? Even for clinical research, know what you need to be successful. Discuss your plan for getting adequate training in stats, research design, do you need an MPH, etc. Have ideas that you want to explore.

III. Is dual fellowship training and/or dual being quadruple board-certified really helpful?

  • Dual fellowship training is and people do not regret it (similar to the perspective of doing dual residency training). It allows you to really straddle two institutions and have validity in each. You can bring authority to the discussions on one side about transition issues, etc. if you have had formal training in the other side. It allows you to go into great depth of training in less time. Makes a natural branch to transition care.
  • Maintaining quadruple board certification is likely not a high priority for anyone except the Med-Peds physician who is quadruple boarded.

IV. If you plan to pursue research, what is a good timeline?

  • Meet a mentor in your PGY2 year.
  • Have an idea for a project by the end of your PGY2 year.
  • Try to do some work developing your idea, setting up your project early in your PGY3 year.
  • Ask for research elective time in a way that matches up with the needs of your mentor which could be in your PGY3 or PGY4 year.
  • Try to go to a national meeting in your area of academic pursuit.

Adapted from commentary compiled by Colleen Monaghan, MD.