Fellowship

There are a wide variety of fellowship training options available to emergency medicine (EM) residency graduates. These include critical care, advanced emergency ultrasound, toxicology, research, administration, medical education, and simulation, to name a few. These fellowships vary in duration, requirements, and availability in different regions of the country. While plentiful, the sheer variety of fellowships in EM can make the fellowship application process challenging to navigate. That's where the Society for Academic Emergency Medicine's (SAEM) Residents and Medical Students (RAMS) group can help.

This section serves as a basic introduction to EM fellowships. We will discuss requirements and timelines in general terms that are applicable to any fellowship training program. For information about specific fellowships and academic tracks, check out the SAEM RAMS Roadmaps homepage and select a specialty track.

Why Should I Pursue Fellowship Training?

• To obtain specialized knowledge in a focused area of EM to facilitate clinical practice, scholarship, and education.
• To strengthen your resume for the EM job market.
• To obtain an additional degree or certification sponsored by a fellowship program.
• To acquire additional skills for scholarship such as grant writing or study design.
• To advance individual career goals that align with a fellowship curriculum (e.g. obtaining NIH funding through an EM Research fellowship).

In general, completing a fellowship will give you a competitive edge, particularly if you're pursuing an academic career in EM. However, this benefit must be balanced against potential opportunity costs - such as sacrificing some independence and the hands-on experience you would gain as an attending physician - along with earning a lower salary (often coparable to a PGY-5 to PGY-7 pay scale, depending on the fellowship).

ACGME vs Non-ACGME Accredited Fellowship Programs

The Accreditation Council for Graduate Medical Education (ACGME) is an independent body that defines the standards and requirements for various aspects of medical education, including a number of EM fellowships. Fellowship programs can seek ACGME accreditation if they meet certain standards. To maintain accreditation, fellowship programs undergo regular evaluation through milestones, trainee feedback, and activity logs. The primary benefit of training in an ACGME-accredited fellowship is a standardized curriculum paired with ongoing program reviews to ensure consistent training quality. For more details on accreditation, visit the ACGME website.

Several EM fellowships, including those Toxicology and Critical Care, are ACGME-accredited, while many EM fellowships are not accredited. Not being ACGME-accredited means that the fellowship program is overseen by a governing body other than the ACGME. Some may be overseen by the state's medical board, SAEM, or the institution itself. Evaluation processes and curriculum requirements therefore vary significantly. The advantage is that you have a greater chance of finding a program that can cater specifically to your needs, since programs have the freedom to design individualized curriculums and get creative in their educational offerings. The disadvantage is that the degree of standardization or independent oversight will vary by program/governing body. There is a risk that the fellowship program might not be held accountable for failing to meet your educational needs. If you decide to pursue a non-ACGME accredited fellowship, research your options carefully. The advice or experiences of recent graduates will be particularly helpful. Take care to review the program's website and contact the individual program with specific questions.

Fellowships with Advanced Degrees

Some fellowship programs include an advanced degree or certification that can either be required or optional for graduation. Common examples include medical education fellowships that offer a Masters of Education degree, administration fellowships that offer a Masters of Business Administration (MBA) degree, or health policy fellowships that offer a Masters of Public Health (MPH) degree. One of the most common certifications is the Focused Practice Designation (FPD) through the American Board of Emergency Medicine (ABEM) associated with advanced emergency ultrasound fellowships.

Fellowships and Academic Careers

For a comprehensive database of all available EM fellowships, please visit the SAEM Fellowship Directory. You will be able to search for fellowships by specialty, region, and institution. Here is a sampling of some of the fellowship options available to EM physicians:

For more information on different academic career pathways in EM, please visit our SAEM RAMS Roadmaps. These guides provide fellowship overviews, job interview timelines and tips, and other career advice for several common academic tracks in EM.

Key Fellowship Questions

Finding the right fellowship program is similar to finding the right residency program. It is important to identify programs with mentors that can support your education and help you obtain your ideal job after graduation.

Do I Need to Pursue Fellowship to Have a Career in Academic EM?

Absolutely not. There are many highly successful EM physicians at academic institutions who never received fellowship training, instead relying on job experience, higher education (such as an advanced degree), scholarship, and/or teaching. In fact, depending on your particular situation and background, it may be more advantageous for you to pursue on-the-job experience or an advanced degree immediately after residency. That being said, fellowship training is viewed more and more favorably by academic institutions, especially as job candidates become increasingly competitive. Fellowship training provides for a niche in EM that often helps to diversify a department in their various academic pursuits. Here are some questions you can ask yourself to help determine if fellowship will help you achieve your career goals:

• Will the fellowship provide concrete opportunities for education and career advancement, including a structured curriculum and readily accessible faculty mentors?
• Does your ideal job or academic niche require fellowship training? Would you be less competitive or unqualified without it?
• What is the opportunity cost of pursuing fellowship? Is there a readily available position in your area of interest, or at your institution of interest?
• Are you comfortable with the compensation in fellowship, compared to the higher compensation you would receive as a full-time EM attending physician?

What is the Application Process and Timeline for Fellowship in EM?

In general, EM residents make the decision to pursue fellowship in the spring before their last year of residency. The application process varies widely depending on the type of fellowship, ranging from a structured match program to a simple interview and handshake with the Fellowship Director and Department Chair. Most ACGME-accredited EM fellowships along with ultrasound participate in a national fellowship match process, while most non-ACGME-accredited fellowships each have their own institutional application process. Fellowships that include an advanced degree or certification will additionally require an application to a graduate school. You should always reach out to individual fellowship programs to obtain information regarding their unique application process and requirements.

What are the Roles and Expectations for a Fellow?

The role of the fellow will vary depending on the type of fellowship and institution, but there are some universal requirements. These include resident and/or medical student teaching responsibilities, research and/or quality improvement project requirements, and a minimum clinical requirement. Additionally, you will also have a faculty mentor or supervisor. You should reach out to individual fellowship programs to clarify the specific roles and expectations. Some important questions to ask include:

• In an ACGME-accredited fellowship: how much faculty oversight will there be for clinical shifts?
• In a non-ACGME-accredited fellowship: what kind of support will I be able to access as a new attending on clinical shifts?
• How much faculty mentorship will I receive for research and projects?
• What are my teaching responsibilities for residents and students?
• Will I be directly supervising residents, students, or PAs?
• What facilities will I work at?
• Will I be able to moonlight?
• What are the expected roles of a fellow in your program?