Is the Current Hand Fellowship Interview Process Broken?

Fellowship training in hand surgery has become increasingly popular, resulting in a significant number of applicants failing to obtain a fellowship position.  From 2012-2014, 25% of applicants did not match.  In 2016, there were 199 applicants for only 166 positions; this left 17% of applicants unmatched.¹  This competitive environment has led to applicants applying to an increasingly larger number of programs (sometimes 40-50), theoretically to improve the chances of matching.  In addition, an applicant may interview at 15-20 programs, if the applicant is “lucky enough” to have been invited to that many interviews.  This process places a financial burden on applicants and also takes the applicant away from his/her residency programs, potentially missing surgical cases and learning opportunities.  I think we all know fellows who have spent nearly $10,000 on the interview trail between hotels, rental cars, and flights.

The fellowship programs are also affected by the large number of applicants.  While having a large pool of talented and interested applicants is great from the standpoint of matching qualified and interested surgeons, there is also a burden on the program to sort through a hundred applications for a limited number of positions.  Faculty need to take time away from clinical activities to interview prospective candidates, usually over several days.  In addition, the sheer number of applicants results in less time spent with each one during the interview process.  I feel bad for an applicant that, having traveled several thousand miles to interview at my program, gets to talk to me for ten minutes before being whisked to the next room to interview with another faculty member.

Although no system is perfect, the biggest problem with the current one is the number of programs to which applicants apply.  It is hard to blame an applicant for applying to as many programs as possible.  Many applicants would be willing to match at any hand fellowship program than none at all.  That is a tribute to our field.  However, it would be much better for everyone (applicants and programs) if applicants were only able to apply to 10 programs.  There would need to be some soul searching and sound advice from mentors about where an applicant would fit and to which “type” of program an applicant should apply.  For example, an applicant that has absolutely no interest in shoulder surgery should not even apply to a program that is “shoulder heavy.”  That may seem obvious, but hand fellowships are so competitive that most applicants would rather match in a program that does surgery in which they are not interested than fail to match.  An applicant that is committed to enter private practice after fellowship and has no interest in research should probably not apply to a fellowship program that highly values fellow research.  There would be an increased burden on programs to have up-to-date and accurate information available for applicants to review prior to making a decision.  My current fellow class has noted that program websites are notoriously outdated and often inaccurate.

By limiting the number of programs to which applicants may apply, this would allow programs to decrease the number of applicants interviewed by pre-selecting those that are “truly interested” as opposed to those that are “casting a wide net.”  In addition, applicants would attend fewer interviews overall, with decreased costs and decreased time away from their respective programs.  One potential problem with this strategy is the possibility that applicants may apply to 10 programs and not be invited for any interviews or only 1 interview.  Some applicants are not great on paper but are a joy to interview and to train.  This could limit opportunities for these applicants.

As I mentioned, no interview process will be perfect, and limiting the number of programs that each applicant may apply to is just one potential solution.  A central interview date at the hand society meeting, similar to what the Orthopaedic Trauma Association uses, could decrease travel costs and improve efficiency.  More efficient use of modern technology with respect to electronic applications, transcripts, and other “paper forms” could significantly cut down on the “busy work” currently required of applicants and program staff.

Change is always resisted but is often necessary to keep advancing our field.

1. http://www.nrmp.org/wp-content/uploads/2016/03/Results-and-Data-SMS-2016_Final.pdf. Page 40. Accessed October 22, 2016.