The Neurology Fellowship Application Conundrum

Abstract

For many neurologic subspecialties, the fellowship application process begins early in the first half of the second year of neurology-specific training (PGY3 for adult neurology residents and PGY4 for child neurology residents). In 2019, the American Academy of Neurology (AAN) published a position statement recommending communication between fellowship candidates and training programs begin no sooner than March 1 of the penultimate year of training and that programs offer fellowship positions no sooner than August 1 of the final year of training. A few pilot subspecialties adopted this timeline for 2021 recruitment for positions beginning in 2022. All US-based AAN affiliated neurology and child neurology residents who recently completed the fellowship application process received a survey about their fellowship application experience. Of the 291 residents who responded to the survey, 96% agree that applications should not be submitted before March 1 of the penultimate year of training and 72% feel that August 1 of the final year is a reasonable time to begin offering positions. Nearly half (49%) of residents feel that there is too little time for subspecialty/clinical exposure prior to applying for fellowship and 88% feel the current process and timeline are stressful. Residents who applied to programs in pilot subspecialties report more time to choose, less stress, and a lower number of time-pressured offers. A vast majority of residents (89%) prefer to submit a single application through a centralized system. The survey results suggest that residents who just completed the fellowship application process agree with the AAN recommended timeline for all subspecialties, and that all neurology subspecialties should consider adopting a fellowship match. Programs can help facilitate a better fellowship application experience by providing earlier exposure to a broad range of neurologic subspecialties and ensure that residents are given opportunities to attend national meetings and participate in appropriately scoped scholarly endeavors.

Headache fellowship match shareholder insights

“…Neurology program directors broadly support the later timeline for fellowship as recommended by the AAN and adopted by AHS, as well as a formal match, where recruitment occurs in a universal, standard, and equitable way later in the penultimate year of neurology residency training. Such a fellowship timeline and match has been successful in internal medicine and brings familiarity given the similar process for residency recruitment.” 1 …”

Modern Neurology Training Is Failing Outpatients

“…We should start by acknowledging that general neurology is a valuable specialty; general neurologists need to be promoted and compensated accordingly. The AAN should continue to advocate for later deadlines for fellowship applications so that residents do not feel premature pressure to specialize. The neurology residency review committee of the ACGME should require an increase in the minimum requirements for outpatient training.…”

Finding Fellowship in Neurology Fellowship Recruitment

“…In 2021, fellowship programs in headache medicine, movement disorders, and neuromuscular medicine participated in such a pilot program, although neuromuscular medicine limited the end date of fellowship recruitment to June 1. 5 In this issue of Neurology ® , London et al 6 quantitatively surveyed and qualitatively explored perceptions of all neurology residents who applied for a fellowship position in 2021, including those who applied in the specialties adopting the pilot program. Of the 291 residents who responded, 96% believed that applications should not be reviewed prior to March 1, 89% desired a centralized application process, and 88% believed that the process was stressful, with less stress perceived by applicants to the pilot program specialties.…”