Characteristics and Success of Internal Medicine Applicants to Subspecialty Fellowships

The fellowship application process represents a critical step in the pathway to a subspecialty career for internal medicine residents. Understanding applicant factors associated with successful entry into fellowship can inform application strategies and fellowship selection processes.

To investigate internal medicine resident applicant factors associated with successful entry into fellowship.

Repeated cross-sectional study of all single-time applicants to the eight largest internal medicine subspecialties from 2008 to 2020 utilizing nationwide data.

Applicants to cardiovascular disease, endocrinology, gastroenterology, hematology/oncology, infectious disease, pulmonary/critical care medicine (PCCM), nephrology, and rheumatology. Applicant characteristics included demographics (age, sex, and underrepresented in medicine [URiM] status), publication count, chief resident status, graduate degree, medical school setting (Doctor of Medicine, Doctor of Osteopathy [DO], and International Medical Graduate [IMG]), and residency program setting/size.

Applicants were defined as successful if they applied to fellowship and were subsequently documented as fellows in that subspecialty the next year.

Out of 38,179 applicants, 32,091 (84.1%) were successful. In multivariable analysis, the highest publication count (≥ 11) compared to the lowest count (0) was associated with higher likelihood of success (aOR 4.18, 95% CI 3.57-4.90). Groups with lower likelihood of success included older (0.88, 0.88-0.89), female (0.89, 0.83-0.94), URiM (0.84, 0.77-0.93), DO (0.53, 0.47-0.59), and IMG (0.44, 0.41-0.47) applicants, as well as those who attended community-based (0.53, 0.47-0.61) or community-based, university-affiliated residencies (0.65, 0.60-0.71). Female applicants to cardiovascular disease and gastroenterology and URiM applicants to PCCM had lower likelihood of success.

Applicants with higher publication count had a higher likelihood of success, whereas older, female, URiM, DO, and IMG applicants had a lower likelihood. Fellowship programs and their governing bodies should consider the adoption of mission-aligned selection processes to provide more balanced consideration of applicant characteristics.