Finding Your Niche in the World
There are over 30 International Emergency Medicine (IEM) fellowship programs, with more being added every year. Fellowship tracks are as varied as the programs that offer them. IEM is young enough that it is not yet a board-certified fellowship, so there is no set-in-stone curriculum that governs all programs. For instance, many fellowships center on advanced degrees like a Masters in Public Health (MPH); others incorporate training in tropical medicine and infectious disease. Programs offer a variable amount of time and funding for fieldwork outside of the country; most require fellows to work part-time as clinical faculty at their teaching hospital or affiliated facilities. There are also independent private fellowships that allow the advantage of a private attending salary, supplemented with a mentorship in international health. IEM fellowships are as diverse as the fellows they train.
Your list of top potential fellowship programs should be narrowed down by the summer before your graduation year.
Step 1. The first step is to determine if the fellowship route is right for you.
Clarify your career goals. If you are interested in academic medicine, a fellowship at an academic center will let you get involved in resident education and develop your niche. If your interest is research, a fellowship provides opportunities through collaboration with ongoing projects in your chosen program. Fellowships are an opportunity for networking, mentorship, and a firsthand expert education, which is priceless. IEM is still a small community where major players know one another. Personal relationships and connections you make during training will be a valuable resource for the rest of your career.
During fellowship you are expected to focus on developing international skills; this usually translates into schedule flexibility with a reduced shift load to accommodate travel and advanced degree work. Many, but not all, programs subsidize an advanced degree program and travel expenses, but this rarely offsets lost potential gains you would see in private practice. The fellowship track is not a decision to be taken lightly.
There are other options besides the fellowship path. Many physicians must balance family and other commitments with a desire to pursue research in global health. An alternative option to fellowship is to work clinically and use spare time to undertake short-term international projects. While difficult, advanced degrees can be pursued while working full time. In addition, it is possible to opt out of U.S.-based clinical medicine altogether, and engage with non-governmental organizations (NGOs) like Médecins Sans Frontières. While good alternative options, these tracks lack the formalized mentorship that fellowship training offers.
Step 2. If you decide you want to do a fellowship, start looking for the right program.
Begin the process of researching fellowships at least 18 months before graduation. Currently, the application process for applying for an IEM fellowship is more like applying for a job than for a residency position. However, with the advent of the International Emergency Medicine IEM Fellowship Consortium website (www.iemfellowships.com), the application process is becoming more standardized each year. The 2014 application season will be the second year applicants apply using a common online application with universal deadlines. The website also provides an overview of most fellowship programs, along with directors' contact details.
When looking at a program, there are several things to keep in mind. Its length, the clinical requirements, MPH funding, locations of current projects, and travel funding are all important to consider. These variables should also be taken into account when you are comparing salaries. If you have a geographic region of interest, look for programs that currently work in that part of the world. Most field time is spent working on projects that are already established, as opposed to creating a new program, which takes more time than is usually allotted in a fellowship. Once you make contact with a program, you may get a chance for a “test drive” as a resident by collaborating on a current project.
Step 3. Create a robust application and prepare for your interviews.
Don't feel like you need to have done medical work over half of the globe to be considered. It will help if you have invested time during residency in research or international and public health. The key is getting started early to build your résumé.
Your list of top potential fellowship programs should be narrowed down by the summer before your graduation year. Interview season starts in September and typically extends through the fall. Each fellowship is unique, and a successful experience hinges heavily on your compatibility with the fellowship director. Therefore, it is important to represent yourself and your goals truthfully in your personal statement and during your interview day. It is also necessary to have insight into the fields within global health that interest you. Be sure to contact current and past fellows, as they usually have a different perspective than program directors. Just like residency program directors, fellowship directors are trying to sell their program to a limited pool of applicants.
How can I be a competitive applicant? Experience is a must. With medical school and residency restrictions, your international experience may not be extensive, but you need enough on your CV to demonstrate that you know what to expect. It will help if you have done research, or used residency electives for international or public health. Remember, program directors are not looking for medical tourists, but for doctors who will commit to a sustainable project.
Get to know the players. IEM is a well-networked group. You can meet many program directors if you attend the IFEM, ACEP, or SAEM conferences, or other international symposiums. It is often hard to get a feel for the competitiveness of IEM fellowships. While more established programs are very competitive, if you are committed to doing an IEM fellowship, you shouldn't have a problem getting a position. Most importantly, you need to know what you want out of your time, then seek out the best match for you.
Should I pursue a master's? Many IEM Fellowship programs are focused on obtaining an MPH. Some believe that since IEM is not a board-certified fellowship, it is wise to have a degree to take away from your time in training. Not all programs provide an MPH, but most allow you to develop an understanding of the larger issues in public health that are critical to international work. Some offer a Master of Health Science (MHS) if you are pursuing a research-focused career.
How important is training in infectious and tropical diseases? Tropical and infectious diseases, along with hygiene, are some of the predominant areas of morbidity and mortality in the developing world. Understanding local health ecology is essential to providing adequate care in international settings and is valuable in providing a context for policy development.
What about research? Realistically, it would be very difficult to develop and complete your own independent large-scale research project over a one- to two-year residency, especially if IRB approval or grant funding is required. Most often you will assist in faculty projects while developing your own research and grant-writing skills.
Clinical practice, or health system development? Most fellowships are geared toward infrastructure development, research, and developing international leaders and policy makers. If your interest lies primarily in clinical or mission work, you can subsidize your training while in private practice or work with independent agents. Instead of committing to a fellowship, you may want to pursue work with an NGO.
What special interest opportunities are available? There are lots of subspecialties within IEM, including EMS development, disaster relief, and displaced populations; each program has its own flavor. Make sure to ask program directors about your special interests and whether they are capable of facilitating opportunities in these areas.
What kind of salary will I need? Salaries vary and will always be less than what you earn in private practice. Make sure to take into account fringe benefits and program stipends. Completing a master's is costly, so programs that include an MPH may offer a lower salary but be of more value. Some programs will pay more but expect you to fund your own international travel. Don't be afraid to ask about moonlighting opportunities. An IEM fellowship can be an expensive investment ”“ travel, conferences, and classes add up quickly. If you have outstanding school loans and/or mortgages to pay on top of living expenses, your budget may be stretched.
Is a structured curriculum better than developing my own path? Some programs are very structured in their educational curriculum and have years of experience with successful fellows. There are also programs that offer fellows a chance to formulate their own plan. Opportunities exist to help develop newer programs and blaze the trail for future fellows to follow.