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The evolving landscape for pathology subspecialty fellowship applications.

Each year, approximately 16,000 seniors in US allopathic medical schools and 15,000 graduates of osteopathic and Canadian or other national medical schools compete for approximately 24,000 residency training positions through the National Residency Matching Program (NRMP).1 In addition to the Main Residency Match for first- and second-year residency positions, the NRMP Subspecialties Matching Service conducts matches for fellowship subspecialty positions. As of February 2012, 44 subspecialty fellowships participate in an NRMP subspecialty match. This is out of a total of 103 Accreditation Council for Graduate Medical Education (ACGME)-accredited subspecialty fellowship categories.2 None of the subspecialty fellowship categories in “pathology, anatomical and clinical” participate in this rigorously structured process. Instead, the 11 ACGME-accredited subspecialties in pathology, including selective pathology, dermatopathology, and molecular genetic pathology,3 have an autonomous process for sorting out which fellowship candidates will be accepted into what subspecialty fellowship programs. The Council of the Association of Pathology Chairs (APC) examined this autonomous process in detail in the 2007–2010 time frame and, after attempting to implement a uniform time line without a match, ultimately recommended moving toward phased-in enrollment of all pathology subspecialty fellowships in an NRMP-administered matching program. The evaluation process and standing recommendations were summarized in a 2011 report, one aim of which was to document all information available to date on the pros and cons of a subspecialty fellowship matching system.4 

A key driver of the APC recommendations for pathology subspecialty fellowship application reform was the dissatisfaction of fellowship applicants with the autonomous application process. However, in the midst of the APC’s 4-year evaluation process (2007–2010), a funny thing happened. All of the pathology residency trainees who had helped initiate this review process completed their training and graduated, most proceeding on to the self-same subspecialty fellowships, if not 2 or 3 successive fellowships. …