Congratulations on deciding to pursue a career in vitreoretinal surgery. There has never been a more exciting time to become a vitreoretinal surgeon. The subspecialty of retina has become one of the most exciting within ophthalmology over the last couple of years. Undoubtedly, the field of retina will undergo many more surgical and medical paradigm shifts throughout our career, guided by research and innovation.
Applying for a vitreoretinal fellowship can be a daunting experience. As individuals who just went through the application process, we offer perspectives on how you can obtain the fellowship of your dreams.
BACKGROUND
According to the most recent San Francisco (SF) Match statistics for vitreoretinal surgery, in the past 5 years the number of available positions ranged from 86 to 104. In 2007, 97 positions were available—with 86 positions filled through the match, leaving 11 vacancies to be filled after the actual match. In 2008, the application will take place through the Central Application Service (CAS). This is to the benefit of applicants and will save you from some of the stresses we experienced last year with the application process. All that is required of applicants is to is fill out one universal application form, gather one copy of each of the appropriate documents, and mail the entire package to CAS. They will do the rest.
RESIDENCY PREPARATION: YEARS 1 AND 2
Most of us probably had some idea of what it meant to be a vitreoretinal specialist but did not truly appreciate the field until residency. For those with even the slightest inkling of interest, we encourage you to spend some time—clinically, surgically, and academically—with your favorite retinal specialists early in your residency. Such experiences can help confirm (or change) your career path and also help you to find a mentor. Further, participating in research publications, presenting at meetings, and gathering informed letters of recommendation will help prepare you to be a strong fellowship candidate.
In December of your second year, your seniors will match at vitreoretinal surgery fellowships, and then their sole purpose in life will be to mentor you. Seize the opportunity. Request that your mentor review your curriculum vitae (CV) and offer advice on specific programs. Use their example as motivation to wrap up any outstanding research projects; "submitted" always seems more substantive than "in progress" on a CV.
APPLICATION PROCESS
Prior to June of your second year of residency, we strongly suggest getting several items in order to prepare for the actual application process. Regarding prerequisites, obtain your undergraduate and medical school transcripts, update your CV, and obtain your US Medical Licensing Examination score reports. Applicants will also be required to submit three original letters of reference: one from the chair of your department, and one from a retina faculty member. Some programs may also require letters from other sources. Therefore, set up meetings with your Chair, residency director, and some of the retina faculty for possible letters of reference, as they can be quite busy and it may take several weeks to for them to complete this task. Retina is a small subspecialty, so we believe having another retina faculty submit the third letter of reference on your behalf would be more beneficial than a letter from another subspecialty.
In our opinion, it is better to have an uber-strong letter from a less famous attending who knows you well than a generic letter written by one of the biggest names in retina. The reality is, however, that giants in the field have significant influence, particularly during the deluge of phone calls made after interviews. Hopefully you will have strong support from several retina attendings, fostered during your first 2 years of residency; your third-year mentor can guide you in asking two attendings for letters. Ask early, even as early as May, to ensure you meet the deadlines.
APPLICATION: JUNE/JULY
The next step is to register with the SF Matching Program at www.sfmatch.org in June. It is to your advantage to register as early as possible so you have access to the match materials. After paying the registration fee of $250, you will have access to all the basic information for programs participating in the match program.
Before selecting to which programs you want to apply, you must first decide which characteristics of the fellowship are most important for you. Things to consider include :
- program reputation,
- geographic location,
- surgical/clinical volume,
- didactics,
- call schedules,
- number of faculty,
- exposure to ophthalmology residents,
- supervision or lack thereof,
- opportunities for clinical/basic science research,
- training in ocular oncology/pediatric retinal surgery,
- spouse considerations, and
- number of fellows.
You should also think about what goals you have after fellowship, as job options may be influenced by your fellowship training. Do you desire a position in full-time academics or private practice? Do you want to do research or just have clinical responsibilities? Where do you want to end up geographically? Vitreoretinal fellowship programs may range from being very strong in academics/research and weaker in clinical/surgical training to the opposite. The ideal program should have a good balance of academics and clinical/surgical training. Another resource for information about programs to which you can turn are third-year residents who have recently matched into a retina fellowships. Other resources include retina fellows, retina faculty (both full-time and community), and your Chair.
CHOOSING A PROGRAM
The most significant distinction is between academic and private practice programs, though most programs will fall somewhere along the spectrum between the two extremes. On one end of the spectrum is an academically driven university-based retina practice that expects its fellows to produce substantive translational research during a 2-year stint. The program carves out dedicated research time, sometimes prioritizing publications over clinical and surgical experience (eg, 100 surgical cases). Graduates will likely become academic faculty members and continue a productive career rich in research. However, they may not feel as prepared surgically as graduates from other programs.
On the other end of the spectrum lies the private practice fellowship in which the fellow is inundated with medical and surgical retina (eg, 1,000 surgical cases). There is little to no emphasis on research or other academic endeavors. Such graduates will be comfortable in the operating room and office and, although they will likely join a high-volume private practice, they will not participate in significant research.
Fortunately, most programs contain elements of both scenarios to various degrees. There are a handful of programs that appropriately balance the rigor of an academic environment with the surgical training typical of a high-volume practice. These programs are highly attractive and, therefore, competitive. The key is to know who you are and what you want; it is called a "match" for a reason.
Most applicants apply to between 10 and 50 programs. How you decide on the number of programs is based partially on cost and time constraints, but also on whether you have the "I want to only match at certain programs or not match at all" philosophy vs the "I just want to match somewhere" philosophy. Just keep in mind that the first eight programs are free and any program applied to beyond this number is an additional $35. Once you have decided to which programs you want to apply, visit each program's Web site to look for any additional program-specific application requirements (Ophthalmology Knowledge Assessment Profile score reports, medical school dean letters, photocopies of internship certificate, MD degree and/or college degrees, photos in various sizes or digital formats, letter from program director). You should also be starting on your personal statement at this time.
You have written several personal statements since high school and have learned to be interesting, concise, and grammatically correct. Think about why you are applying for a vitreoretinal fellowship and how you envision your career a decade from now. Also, you can use this opportunity to explain any aberrations in your application. Remember, personal statements rarely help your application, but an offensive comment or dangling infinitive can be destructive.
In July, you should be busy completing the six-page CAS application and gathering reference letters, and any supplemental program specific application requirements. July 23, 2008, for example, was the target date this year to have your application submitted for central distribution. This is not a deadline but it takes about 3 weeks for the materials to be distributed to the respective programs. Remember, some programs accept applications at any time while others have specific deadline dates and supplemental application requirements. Make sure your centralized application is submitted at least 3 weeks before those dates as it may take this long for the application to be distributed once it is received by CAS.
AUGUST/SEPTEMBER
During these 2 months, you should try to complete any research projects or publications that were listed on your CV as "in progress" or "in submission." This will help you on the actual interview day and give you something to talk about. You will also begin hearing back from various programs regarding interview dates and should begin planning for travel accommodations as soon as possible. The key here is to be organized. Try to arrange for interviews that are geographically close to one another around the same time in order to minimize time and expenses. Most important, respond to the programs as soon as possible to ensure you get the date you want. Also, try to be prompt when declining an interview, in order for the program to offer an interview to another prospective candidate. Begin to refamiliarize yourself with the programs and faculty at the places, where you received interviews so you can be prepared for your interview day.
INTERVIEWS: OCTOBER/NOVEMBER
Interviews begin in early October and end in late November. Most of the interviews we attended were rather relaxed. You should remember that on paper you already made the cut and this interview is a chance for you to see if the program is a good fit for you and for the program to see if you are a good fit for it. Personnel have invested their time and energy in giving you an interview so they are already interested in you. Attend any preinterview event or stay for a postinterview event because the more face time you receive the more you distinguish yourself from everyone else. Staying with friends (especially if they happen to be residents or fellows at your prospective institution) can save you a lot of money and give you the inside scoop on a program and city.
On the day of the interview, plan to arrive early in case of traffic or becoming lost. Interviews range from one-on-one to panel interviews with up to eight interviewers. Topics for questions will include items on your CV, your goals in life, hobbies, ethical scenarios, clinical management of patients, philosophic questions, and so forth. The most important thing is to let your personality shine.
Perhaps the best use of your time is to speak to the current retina fellows and see if they are happy there. After the interviews you should consider sending a thank-you letter or e-mail unless otherwise instructed. Once you have interviewed at each program, begin formulating a tentative rank list.
RANK LIST
For this match cycle, all rank lists must arrive in the SF Match office by 12:00 pm (PST) on January 8, 2009. You may call the SF Match 24 hours after the arrival of your rank list to get a telephone confirmation. Our advice is to submit the rank list as soon as you are done interviewing and have the list in before this day. That way, you have time to receive confirmation before it is too late to do anything about it. Be sure you call the SF Match 24 hours later to get confirmation of your rank order; we have heard of horror stories where lists are inaccurate.
December 11, 2008. Programs are e-mailed match results on this day, and you will be contacted either today or the next day by the fellowship program congratulating you on the match.
December 12, 2008. If you have not heard about the match results, you should call the SF Match office to receive it directly. Dial +1 415 447 0350 and press '0' at the opening menu to speak with a Match representative (between 8 am and 4 pm PST). Results are also mailed to applicants and programs on this day.
December 15, 2008. Any postmatch vacancies that remain will be announced on the SF Match site. Applicants who did not match may begin scrambling into these positions by negotiating directly with the programs and providing any documentation that they require.
CONCLUSION
Our final advice is to have fun and relax. Interviewing for fellowship is a once-in-a-lifetime experience. It is exciting to meet the giants in our field as well as your future colleagues in the process. Some of those you meet will remain friends for life, so take a deep breath and enjoy the ride.
Lawrence Y. Ho, MD, is a first-year vitreoretinal surgery fellow at Associated Retinal Consultants/William Beaumont Hospital in Royal Oak, MI. He may be reached at ho.lawrence@gmail.com; Chirag P. Shah, MD, MPH, is is a first-year vitreoretinal surgery fellow at Wills Eye Institute in Philadelphia. Dr. Shah may be reached at cshah99@gmail.com.
Omesh P. Gupta, MD, MBA, and Anita G. Prasad, MD, are first-year fellows at Wills Eye Institute. They are both members of the Retina Today Editorial Board. Dr. Gupta can be reached at ogupta@hotmail.com; Dr. Prasad may be reached at anita.g.prasad@hotmail.com.
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