Tips and Strategies for Matching Into an REI Fellowship - Geography

Drs. Victoria Jiang, MD and Zachary Walker, MD share tips and strategies on securing a match keeping in mind the geography of the location.

Hello, trustee REI applicants and company. My name is Dr. Victoria Zhang and I'm your SREI associate member co-chair. And I'm Dr. Zach Walker.

I'm a member of the ASRM Education Committee. And today we're gonna give you another hashtag med talk about matching into fellowship. Today's focus is about geography and how that curtails into future career and ranking.

Some of you are on the long haul of medical training. I remember thinking four years of college, four years of medical school, four years of residency, and then I signed up for three more years of fellowship match. All while in that time period, some people have found furry companions.

Some people have found, sought, married, or parted with partners. They have found changes in their family dynamic. Maybe they've even thought about where they wanna practice in the future.

Maybe they've made large career shifts. And how does that all play into fellowship? I remember thinking, when is my life gonna start? Well, Dr. Zhang, I hate to break it to you, but life comes at you fast and you have to be ready. Okay, I wasn't prepared for this sage philosophical advice from you.

But I do think that considering geography and considering where you wanna match for fellowship is gonna be really important, especially when it comes to practice type, when it comes to where you're practicing, where you wanna practice. Is there a mandated coverage or non-mandated coverage? So what kind of key things do you think we should consider when we're applying for fellowship? So I like to parse it down into three big questions. One is, what kind of practice do you want to see yourself in in the future? Two, are you practicing in a mandated state versus a non-mandated state? And how does that curtail into your counseling style or where you see yourself? And then third is, how big of a factor is surgery into my future career? I absolutely love when present me gets to think about future me.

So let's jump right in. The first thing I always wanna think about is what kind of practice do you see yourself practicing in the future? Do you wanna go into private practice? Are you looking for a private-emics or hybrid model? Are you looking to practice at a big academic institution? What kind of practice do you think that that's gonna be when you are able to practice on your own in the attending? And how does that fit the geography of where your personal needs may be? And I think that thinking about that as you're applying into it will allow you to be able to look for fellowships that may align with the type of structure that you're looking for. When I was applying, I don't know if you had the same experience, but I was shocked at how different some of these fellowship programs can be structured.

Sometimes it's a private practice partnering with an academic institution. Sometimes it's just a pure academic, like we're serving the needs of the medical community in that area. Sometimes it's just completely private practice and they are running it from the ground up and looking at it from a completely different business model.

And so considering what kind of practice you want to look for in the future is gonna be really important. There's one caveat to that. If you're interested in working in academic medicine, it's always really important to consider bigger academic programs because a lot of the times they can network with you.

They can help you develop relationships with committees, get you involved in things that are gonna really help propel your research interests and your ability to be able to find academic jobs kind of either in that region or nationally because they are few and far between sometimes. Yeah, I totally agree. I think the type of job you see yourself in can definitely reflect like your fellowship training or how you trained as an RAI physician, what you are interested in or what you feel comfortable with doing even after graduating fellowship.

So that goes into our next thing about practicing in a mandated state versus a non-mandated state. So we both practice in a mandated state during fellowship and we both have moved to non-mandated states. So it's very interesting seeing the contrast from how we were trained as far as protocols and mindset and counseling.

But definitely there are benefits to both models of fellowships. So if you practice in a mandated state, you can potentially see a lot of different protocols being used or different kind of thoughts about how to do the same thing. Because finance is not always the primary concern because there's usually coverage for a majority of the IVF treatments versus in a non-mandated state, the finance kind of conversation is a big key and may influence how well or what protocols you use for that patient.

So it has been very interesting practicing now in a non-mandated state and what I may not use as often or may do something differently now. Yeah, maybe we're gluttons for punishment for looking for different types of programs than what we necessarily were able to practice now. I do think that having that financial burden lifted from our patients allows you to pursue that second or that third cycle that a lot of the times can't be accessible for a lot of the patients who are paying out of pocket in non-mandated states.

And so you get to see the variation of protocols, how the patients react, counseling them on their second, third or fourth cycle that maybe just the first or second didn't go as you expected. That being said, I always have a really hard time talking about finance with the patients, having a conversation about the costs of medication, the costs of the cycle and just even access to care is a huge interest of ASRM. But it's something that I think anybody as a resident or as a fellow should be interested in kind of pursuing because starting those conversations early, being thoughtful about the cost of a cycle and what that may cost from a financial burden for the patient is only gonna be more helpful for you as you move forward in your career.

Totally agree. That kind of goes into our next topic about talking about surgery and how does that go into your future career? So I think surgery experience is so important to consider when you're thinking about how you're gonna structure your future career but also the fellowship you may pursue. We as REIs used to be the minimally invasive gurus.

We used to do all of the reproductive surgery. We would always make sure that we were caring for our fertility patients from beginning to end. And that model has shifted a little bit over the course of the last 10 or so years but there's a huge resurgence in interest in making sure that our next series of graduating REI fellows has that experience of surgical training.

So that's laparoscopy, that's myomectomies, that's stage four endo, like you're in the knit and grit of that minimally invasive surgery that is gonna be focused on. Are there any programs that you know of that would be really important for these people to consider? Yeah, there are actually several. So I'm a recent graduate of the Surgical Scholars Track that is through the SREI SRS program within ASRM and there are about 10 institutions that have already enrolled or are currently having fellows complete the Surgical Scholars Track.

Brigham and Women's was one, Mass General Hospital was another one. So it definitely did help me understand a little bit more about how to integrate surgery into my future practice and also how to negotiate or think about things from a surgical perspective for patients that I'm treating and whether or not I would do surgery first or do IVF first and then also counseling patients about the most up-to-date evidence about surgical treatment for infertility patients. So it can be very useful if you're thinking about doing surgery in your future career and having that as a part of your practice.