Characteristics and Success of Internal Medicine Applicants to Subspecialty Fellowships.

BACKGROUND: The fellowship application process represents a critical step in the pathway to a subspecialty career for internal medicine residents. Understanding applicant factors associated with successful entry into fellowship can inform application strategies and fellowship selection processes. OBJECTIVE: To investigate internal medicine resident applicant factors associated with successful entry into fellowship. DESIGN: Repeated cross-sectional study of all single-time applicants to the eight largest internal medicine subspecialties from 2008 to 2020 utilizing nationwide data. PARTICIPANTS: Applicants to cardiovascular disease, endocrinology, gastroenterology, hematology/oncology, infectious disease, pulmonary/critical care medicine (PCCM), nephrology, and rheumatology. Applicant characteristics included demographics (age, sex, and underrepresented in medicine [URiM] status), publication count, chief resident status, graduate degree, medical school setting (Doctor of Medicine, Doctor of Osteopathy [DO], and International Medical Graduate [IMG]), and residency program setting/size. MAIN MEASURES: Applicants were defined as successful if they applied to fellowship and were subsequently documented as fellows in that subspecialty the next year. KEY RESULTS: Out of 38,179 applicants, 32,091 (84.1%) were successful. In multivariable analysis, the highest publication count (≥ 11) compared to the lowest count (0) was associated with higher likelihood of success (aOR 4.18, 95% CI 3.57-4.90). Groups with lower likelihood of success included older (0.88, 0.88-0.89), female (0.89, 0.83-0.94), URiM (0.84, 0.77-0.93), DO (0.53, 0.47-0.59), and IMG (0.44, 0.41-0.47) applicants, as well as those who attended community-based (0.53, 0.47-0.61) or community-based, university-affiliated residencies (0.65, 0.60-0.71). Female applicants to cardiovascular disease and gastroenterology and URiM applicants to PCCM had lower likelihood of success. CONCLUSIONS: Applicants with higher publication count had a higher likelihood of success, whereas older, female, URiM, DO, and IMG applicants had a lower likelihood. Fellowship programs and their governing bodies should consider the adoption of mission-aligned selection processes to provide more balanced consideration of applicant characteristics.