ASCP Resident Council Chair Message by Anna M. Moran, MD

The application process for pathology fellowships is convoluted, requiring applicants to deal with varying application forms, deadlines and interview schedules. In addition, no written procedures are available to guide residents and programs if changes occur after an offer is accepted. It can be a difficult and frustrating process. Many professional pathology groups, including the ASCP Resident Council, the College of American Pathologists Resident Forum, and the Association of Pathology Chairs (APC), along with PRODS, the organization of pathology residency program directors, believe that it needs reform. The key, most believe, is standardization of the fellowship application process.

One advantage of the current system is that fellowship directors can set their own timelines for making decisions about what fellowships to offer. Also, directors can offer a position to an “ideal” candidate on-the-spot without waiting for a long application process to wind down. Likewise, residents can apply and accept early offers, thereby securing fellowships two or more years in advance. Accepting an early offer, however, closes off a candidate’s other options. That can be problematic if his or her needs later change. In addition, a fellowship program may be forced to advertise and fill an unexpected opening. A standardized fellowship application process with a uniform and more realistic timeline would help avoid these kinds of situations.

It’s all About the Applicants

I believe the disadvantages of the present model outweigh the advantages, particularly for applicants. The decision to compress the five-year residency into four has increased the size of each graduating class by 25 percent, so residents face more competition for existing fellowships and, thus, more pressure to quickly nail down an offer. In the 2007 ASCP Job Market and Fellowship Survey of residents, 83.9 percent of the 174 respondents indicated that they had applied for fellowships. Seven percent intended to do so.

Another factor fueling competition is that many residents feel fellowships have taken the place of the fifth year of residency and, consequently, are necessary for securing the best jobs. With no uniform timeline, residents may accept the first offer they receive and never even interview for jobs or fellowships that better meet their needs. Out of 158 respondents to this question on the survey, 99 (62.66 percent) felt that all pathology fellowships should use a uniform sign-up day, while 59 (37.3 percent) did not.

Reform Roadblocks

Certain stumbling blocks may hamper reform efforts. First, no one organization or group has jurisdiction over fellowships. Thus, no centralized database or clearinghouse lists all available positions. Establishing and maintaining such a database would require a major effort. Second, if reforms are voluntary, complying programs may be at a disadvantage compared to those refusing to participate, particularly because the elite programs may be among the latter.

Despite these problems, fellowship reform is now coming off the back burner and will be addressed in earnest. To summarize, residents’ primary concerns are the lack of a uniform timeline and premature start of the application process, which many feel begins too early in the course of training. Moreover, no regulations define changes that could occur following an offer of acceptance. In addition, a standardized application form would eliminate the need to complete a different form for each fellowship.

APC to Take the Lead

To facilitate further discussion, the Association of Pathology Chairs (APC), and James Crawford, MD, immediate past president of APC, agreed to take the lead on fellowship reform. At its March meeting, the APC formed a task group charged with drafting a “Fellowship Reform” document to be distributed to the APC membership for comment in May.

All residents within the United States had an opportunity to express their views on fellowship reform in the recent ASCP Job Market and Fellowship Survey, which was administered via the ASCP 2008 Resident In-Service Examination (RISE) in April. A summary of the survey findings is being prepared for distribution and will be available for discussion at the APC business meeting in July. The goal is to declare recommendations for the Pathology Subspecialty Fellowship Application Process for academic year 2008-2009. Please feel free to express your own views on this topic by contacting me directly at ResidentChair@ascp.org.