Friday, May 4, 2012

Fellowship Match: Geriatrics in, Palliative Medicine up Next?

[Ed. note: This post is a reimagining of a post at Geripal. Same facts - some simliar sentences - wholly different approach.]

This week the American Geriatric Society is holding their annual meeting and they announced they will now do a fellowship match starting with the 2014 academic year. This is huge news for geriatrics since they have been without a match since they were first officially recognized by the ACGME in 1988. It also serves as an important benchmark for palliative medicine fellowships.

Why is this important news? Both fellowships have a lot in common and hopefully directors at geriatrics programs can work with their HPM colleagues to accelerate working through the complexities of getting a HPM match. We have seen posts on GeriPal and Pallimed about the frustrations caused by not having a match.

With Geriatrics now having a match, hopefully our field will be inspired to do the same in a rapid manner. This should be easier because we have gotten past the toddler years as a subspecialty. Can you believe it was only 6 short years since ACGME officially recognized HPM? We now have over 70 HPM fellowships and a few score that have been existence under voluntary guidelines for more than a decade.

The match offers many benefits to future fellows: 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. With all these benefits it is surprising to me that out of nearly 150 recognized specialties only 50 or so participate in a match.  Thankfully our field is marching towards a match, but it is not as easy as one might think. 

I have been in discussions at meetings with over 40 fellowship directors in the room who are all desiring great candidates in a fairly small pool.  When the match comes up, the tension in the room can rival a challenging family meeting when you start talking about what dates work, and how soon to implement a program.  One thing nearly everyone agreed on is the importance of a match for fairness to programs and applicants.  The challenge is more in taking a good idea and making it reality.
If you may not understand why this is important, 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 sad that this is the first impression that we give applicants coming to the field. I am happy that Geriatrics has accomplished this and that we now realize we do not have to wait 24 years for palliative medicine to do the same.  We will do better.

[Ed. note:  I appreciate what GeriPal and Eric Widera have accomplished and their ongoing contributions to the field.  I enjoy working with him and the writers at Geripal.  These words represent no one but myself.  This is not a war between us, so please  don't make it out as such.  This is more of a creative writing exercise because after reading his post I felt insulted.  Not as a board member, or as a blogger, but as a member of this field.  We have studious people accomplishing great things in palliative medicine and hospice organizations.  We are not perfect and it is good to encourage us to do better, but language matters.  Our work makes this clear. - Christian Sinclair]

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