Making the Perfect Match

PEM fellowship rank lists are due in the next few weeks. Here is select data from the 2105 NRMP Match, with a few comparison specialties for reference. Check out the full dataset if you’re really obsessed.

# US apps # total apps # positions # programs # matches % filled
PEM 126 201 162 73 159 98.1%
Peds Cards 112 181 141 57 137 97.2%
Peds Crit Care 136 206 168 62 160 95.2%
Peds ID 21 34 66 51 30 45.5%
Pedi Surg 70 83 48 47 48 100%

This data tells us a few things. First, you don’t have to go into fellowship after residency. Thousands of residents graduate each year and not all of them do further subspecialty training. Second, if you’re going into PEM, it’s competitive since only a small number of programs don’t fill (three in 2015, to be exact). Third, if you’re a pediatric surgery fellowship applicant, yikes! 48 spots for 83 applicants! We reached out to our PEMNetwork faculty from around the country to get their advice on how to find the Perfect Match.

The places are all starting to blend together. How do I get more information now that my interview day is over?


David Kessler

David Kessler, Columbia University: Find residents, fellows, etc. There’s probably someone you know in every program. Give them a call and ask them questions. But remember: Don’t say anything you wouldn’t want to say to the program director themselves. It’s all an interview!

A PEM Program Director (who is speaking on the condition of anonymity): Call! Program coordinators and fellows are always eager to share. Program directors may not respond to a “thank you email” but should respond if you have a specific queries! Second visits are also a great way to see what really happens beyond “the interview day”.

Maneesha Agarwal, Emory University: Don’t burn bridges. Interviews are an awesome way to connect in PEM. You may want an attending job and find that interviewer is now the division chief!

Marc Auerbach, Yale University: Don’t forget to ask mentors and friends.

Anonymous PD

Anonymous PD

Anonymous PD: Websites for fellowships are still in evolution and program leadership doesn’t always have a say in what goes on them. If there isn’t much of a web footprint please don’t judge. Reaching out to program leadership ahead of time is a good way to find resources.

Okay, now how do I decide what’s best (for me)?

Maneesha: You will find a number of fellowships that will be great fits for education and training. A big part will be what you make of it.

Marc: Consider the number of clinical hours. In addition, the number of staff per hour (nursing and MD) really impacts your life. Try finding out what workflow is like during a “normal” shift and a month’s worth of shifts.

Remember the “Life” part of Work-Life Balance


Maneesha Agarwal

Maneesha: Before I became a mother, I did not think at all about support for family. However, I became a mom at the end of fellowship and my little one had significant health issues. I am incredibly fortunate to be at a place where I have a large and supportive division. It’s something I did not consider but really lucked out with.

David: Don’t underestimate being near family and friends. Geography and lifestyle should probably trump everything else. Can’t learn if you aren’t happy.

How do I let programs know that I am really interested?

Maneesha: Once you have an idea about your favorite programs, let the program directors and your local advocate for PEM fellowship know. This can sometimes help your position on the rank list.

Anonymous PD: If you really like a program, a message to the program director would indicate that you are serious about the program. Don’t expect a response though, as some program directors do not want to be misleading with well-meaning replies.

David: Second visits are not required (don’t stress) but they demonstrate interests. Can’t visit? How about a phone call with a faculty member you didn’t get to meet and have a specific question for?

Anonymous PD: Thank you letters, if copied and pasted to everyone you met, can seem insincere. Reach out to faculty with similar interests. Think beyond what the program can offer you and to what you can offer to the community.

What if I don’t match?

Maneesha: Not matching does not mean you are a bad applicant. If you don’t match, you have a few options.

  • Consider scrambling. Most years there are handful of unfilled positions. If you are open to that location, reach out to those programs ASAP.
  • Keep working and reapply. You don’t need a PEM fellowship to work in an emergency department taking care of children. Consider an urgent care position where you can hone your clinical skills and efficiency. If you find an urgent care position associated with a PEM fellowship you can access important learning and research opportunities. Many fellowship programs have accepted fellows from their own urgent care division or successfully advocated for their urgent care doctor on subsequent reapplications.
Brad Sobo

Brad Sobolewski

Brad Sobolewski, Cincinnati Children’s: Maneesha, your #2 at the end is great. We’ve had several fellows who worked as ED staff physicians in the past for family reasons or otherwise and the experience is always great. Makes them more ready for fellowship IMHO.

David: Most cases of matching are not about merit. It’s about your rank list being too limited. I was always taught to have 10 places on the list and you will match.

Anonymous PD: If you don’t match, it’s not the end of the world. Don’t take it personally. Remember for one spot, sometimes program directors get over 50 applications. The applicant pool can include some pretty impressive resumes, but merit badges also aren’t everything. Maybe you don’t interview well. If you haven’t been prepared for an interview, make sure to ask for help from your program director. To do well on an interview, you need practice. Not that it should ever seem rehearsed but interviews are designed to get into depth. Mock interviews are important. Keep an open mind, learn from the experience, and use time before you reapply to self-reflect and ask for specific feedback from trusted friends or mentors.

Good luck with making your choices!

Let us know how it goes and welcome to the PEM community. For readers who are interested in how The Match works, Match Day is a book that is part investigative reporting and part personal journey of a several people going through the residency match process. A good read that is healthier and more hygienic than nervously biting your nails.

Sonny Tat

Sonny Tat

Assistant Clinical Professor at University of California at San Francisco
Sonny's academic interests are in team performance in resuscitation, developing learning platforms for medical education, and transitioning academics to the digital age. Sonny created PEMAcademy, a collaborative regional blog for PEM education and is the Editor-In-Chief of the PEMNetwork Blog. His hobbies include photography and cooking.
Sonny Tat
Sonny Tat

Sonny Tat

Sonny's academic interests are in team performance in resuscitation, developing learning platforms for medical education, and transitioning academics to the digital age. Sonny created PEMAcademy, a collaborative regional blog for PEM education and is the Editor-In-Chief of the PEMNetwork Blog. His hobbies include photography and cooking.