Fellowship mismatch: Factors to consider when switching specialties

By Kristen Fuller, MD
Published June 23, 2023

Key Takeaways

  • Switching fellowships is a major step that shouldn't be taken lightly—it can be done, but first, be sure you want to switch for the right reasons.   

  • Seek help from colleagues and mentors in making your decision, and once you decide, talk with your program director or coordinator right away. They'll be key players in helping you move on. 

  • Ultimately, when a switch is necessary, your colleagues and mentors will likely be happy to help—happy fellows are easier to work with, and they provide better care.

Fellowship is the start of your journey to becoming a super specialist in your field. But what happens if you start your fellowship and realize you made the wrong decision?

Related: Fork in the road: Should you pursue fellowship or go straight into practice?

Fellowships, in general, are highly competitive, and that sense of competition can make it feel very unsettling and stressful when considering switching programs or fellowship specialties.

When your fellowship feels like a mismatch

There are many reasons for changing fellowship programs. Maybe you don’t mesh well with your program, you’re not happy with the location, you realize you want to change specialties, or you decide to go into private practice or hospital medicine and forgo a fellowship altogether. 

Switching is possible, but it’s important to make sure you are making the right decision and aren't burning any bridges along the way. 

The first step is to set aside some time to do some soul-searching and figure out why you want to switch. The decision is likely to be a stressful one, so make sure you are rested so that you can think clearly.  

Ask yourself: Is there a specific incident or temporary situation that is driving you to contemplate a switch? Are you unhappy with your location, your program, or your specialty altogether? Will switching programs, locations, or specialities make things better for your career? Is burnout playing a factor?

Related: Expert perspective: Maintaining mental health during the rigors of fellowship

"Fellowship is difficult, and although you are finished with residency, burnout is still very real in fellowship."

Kristen Fuller, MD

Talk about it

It’s important to talk it out with others in making your decision. It will be an emotionally and logistically challenging time, and you’ll need people you trust who can help you through the process. 

Before you decide to switch, take the time to talk about it with friends, family members, colleagues, and mentors. They've likely helped you make it this far and can provide some valuable perspective. Be as clear as possible with them about what you’re feeling, and why. 

The scariest part might be telling your program director you want to leave. However, if there is a true mismatch—because of location, specialty, or some other reason—most people will be supportive of your decision. 

In addition to program directors, reach out to other fellows who have first-hand experience with switching, or sympathetic clinicians in the field you’re looking to go into who can give advice or help you network.

It may be that the solution isn’t to leave, but rather to stay put and make some changes. In other cases, a switch may be the best decision. If so, your peers and mentors can be helpful in suggesting options that may better suit you.

Getting started with the process

The switching process will be different from your initial match. You’ll still have the planning, paperwork, travel, and interviews required to secure a new position—but without the framework of the match itself.

It will be on you to reach out to fellowship program directors who may have openings; you will also be in charge of scheduling interviews around your current workload. 

You may need to get coverage from other fellows to go to these interviews—and be ready to repay for that coverage.

Related: Acing the real test: Your interview into fellowship

Each person will have their own unique process, depending on the timing and the specialties you’re switching to and from. However, there are some general resources available to help you start the process:

  • FREIDA, the AMA Residency and Fellowship Database, lists open postings.

  • The Match is the ultimate guide to the fellowship matching process. 

  • FindAResident is a search tool to help you locate open fellowship positions.

Consider reaching out directly to program directors or coordinators, as not all available positions are posted on these websites. Brief emails directly stating who you are and why you’re reaching out are best; it’s usually advisable to attach your current CV, but no other supplemental material. If you don’t hear back within a few weeks, you may want to call the program.

Secure a letter of recommendation

A relevant letter of recommendation (LOR) for your desired speciality is important, but this can often be hard to obtain. For example, if you want to switch from a hematology-oncology fellowship into a gastroenterology fellowship, you need to think about obtaining a LOR for a gastroenterology fellowship. This may take some time and effort.

Did you do a residency rotation specific to the speciality you want to switch into? If so, can you obtain an LOR from that attending?

It is also important to obtain a solid LOR from your current program director, and this may mean finishing out your first year of fellowship to stay on good terms.

Switching fellowship specialties can also mean you take a year or two working as a hospitalist in a teaching hospital with your desired fellowship speciality, so you can get to know the program.

Keep in mind that your new fellowship program will also want to know your experience in this desired specialty and the reason you are switching from one specialty to another. 

"Leaving a program is not necessarily a red flag when applying or switching to other fellowships. "

Kristen Fuller, MD

This is especially true if you have clear reasons behind your switch and have made the time and effort to seek out a new program or specialty that truly matches your needs and desires. 

The next steps will be interviewing for a new spot. This will likely be similar to your initial fellowship interview, but with added questions and concerns about why you’re transferring, as well as filling out paperwork to make the transfer. 

A worthwhile pursuit

At the end of the day, programs want happy fellows. This benefits the medical team and patients.

Switching fellowships may seem overwhelming at times. But if you’re making the switch for the right reasons, it should all be worth it in the end. 

You will be in a program where you are happier for personal or professional reasons (or both). And the happier you are, the better care you can provide to patients.

What this means for you

Switching fellowships is a major step that should be taken with the utmost care and consideration. Seek help from colleagues and mentors in making your decision, and find the right candidates to provide you with a letter of recommendation. Make every attempt to avoid burning bridges. Finally, if moving on is the right choice, pick your next fellowship carefully. Hopefully it will all be worth it in the end—after all, happy fellows make better doctors.

Read Next: Doctor's perspective: Juggling parenthood and fellowship

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