Wednesday, May 2, 2012

The Fellowship Match: Geriatrics Is In, Palliative Care is Still Out


140:365 – Left Out


The biggest announcement so far at the American Geriatrics Society Annual Meeting is that Geriatrics will be entering into the fellowship match for the 2014 academic year! This is huge news for geriatrics and should serve as a push for Hospice and Palliative Medicine to get out of the position of being the last fellowship program outside of the match.

Why is this important news? Both geriatrics and palliative care have been stuck with a dysfunctional matchless system. We have written on the chaos of not being in the match previously on GeriPal, heard what being 'matchless' means to applicants via a Pallimed post by Brian McMichael , and have had important foundations encourage us to join (see this Hartford Health AGEnda post).

With Geriatrics now agreeing to join the match, there is really one holdout among all other subspecialties that have agreed that residents deserve the opportunity to have more time to decide on a fellowship path (match lists are now due 5 months into the last year of residency), more opportunity to see other programs besides their home program, and more clarity on the timelines on when programs will take applications, interview, and make offers. The last remaining subspecialty is Hospice and Palliative Medicine.

If you are still on the fence, I again encourage you to read Brian McMichael’s post on what it is like to be an applicant in the current system:
“My [application] process was cut short by a spoils-to-the-swift ethic. Because of the asynchronous timelines, I had to decline interview offers from programs I was very interested in. Given the inherent power disparity in the roles and the dynamics involved, I did not believe I had the latitude to walk away from offers from great programs in order to "explore my options" further. Perhaps my issue, but I doubt mine alone."  
It is just sad that this is the first impression that we give to applicants coming into our field.  We can and we must do better.

by: Eric Widera (@ewidera)

10 comments:

Steve Smith, AAHPM CEO said...

Hospice and Palliative Medicine is heading in the same direction. AAHPM will be facilitating a webinar and discussions with Fellowship Training Programs again in June and throughout the summer. More information to come.

Physicians Costa Rica said...

Interesting article. thanks so much.

Stacie Levine said...

Kudos to AGS - this was a long time coming.

But wait....Hospice and Palliative Medicine IS working on the match! We have an NRMP webinar coming up in June with subsequent discussions to move forward. Stay tuned...

Gavin W. Hougham, PhD, Univ Chicago said...

Hi Eric,

Thanks for your passionate writing about this topic, and thanks to AGS, ADGAP, and many others for helping move this to a very good place.

When I first posted that Hartford Health AGEenda piece back in 2009, a lot of folks wrote to me offline hoping that JAHF would keep pushing on this issue. But, at the end of the day, this was something that only the profession itself could change. So, I am very happy to see this happen and can't wait to see the positive impact this will have!

Jeanette Ross MD said...

Great post Eric.
My sense is that palliative medicine will soon be in the match. During the fellowship summit and the AAHPM fellowship director SIG meeting the majority of the HPM fellowship directors manifested an interest in the NRMP match. AAHPM has a webinar planned for June 2012. It is a matter of getting 75% of the HPM fellowship programs to participate. I'm optimistic this will be son. HPM has only been a ABMS specialty since 2008, HPM fellowships are moving in the right direction.

Brian McMichael, M.D. said...

Thank you Eric for this post. I am gratified to hear of the deep consideration and gathering momentum toward NRMP participation.

HPM is an amazing field. I think because of its newness it is characterized by widely-embedded, rapidly-responsive, broad and sophisticated connectivity and communication via web-based tools and social media. This forward-leaning stance perhaps engenders a certain impatience towards processes that are not Web-2.0 phenomena.

So, thanks to all for the hard work in real-time under real-world constraints amid a sea of demands, concerns and priorities. I believe the rewards moving forward will be manifold for learner/applicants, programs and the field.

Brian McMichael, M.D. said...
This comment has been removed by the author.
Christian Sinclair said...

I think this is an important issue, but I disagree with the tone of the post. Too much to comment on here, so I took some artistic license and reimagined your post over on Pallimed Eric.

Eric Widera said...

I am very happy to see the optimism that others in the field have for a Hospice and Palliative Care match and the level of disagreement with my post (which I find very reassuring). My main hope is that the leaders of this movement discuss with those who performed a Herculean task of getting geriatrics into the match, as the match has been an ongoing discussion at a national fellowship level for many many years.

Eric Widera said...

I am very happy to see the optimism that others in the field have for a Hospice and Palliative Care match and the level of disagreement with my post (which I find very reassuring). My main hope is that the leaders of this movement discuss with those who performed a Herculean task of getting geriatrics into the match, as the match has been an ongoing discussion at a national fellowship level for many many years.