An examination of professional and ethical issues in the fellowship application process in pathology

Approximately 34 medical specialty and subspecialty fellowship programs in the United States have formalized the application process through the National Resident Matching Program. This approach sets standards for the application process, offers a formalized match similar to that for residency programs, functions within a specific timeline, and establishes binding rules of behavior for both applicants and programs. For fellowship programs that operate outside the National Resident Matching Program, such as those in pathology, no published guidelines exist to help programs and applicants address the many questions and problems that can arise. As a result, programs are free to set their own timelines for interviews, application requirements, contract negotiations and finalizations, and other details. Consequently, applicants often feel pressured to apply earlier and earlier in their residency for competitive fellowship programs, are often required to fill out multiple unique applications, may feel no "loyalty" toward honoring an acceptance without a contract, and often feel disenfranchised by the whole process. This article addresses professional and ethical aspects of the current application process and offers possible solutions for improving it.