Transition to Fellowship
Our Goal: Fellowship Ready on Day 1
The Council on Resident Education in Obstetrics and Gynecology (CREOG) is concerned about the difficulty residents face in transitioning from residency to fellowship and other post-residency training programs. With roughly 35% of ob-gyn residents pursuing additional training after graduation, the tight turnaround from the end of residency (June 30) and the proximity of the American Board of Obstetrics and Gynecology (ABOG) Qualifying Board Exam (last Monday in June) to the start of fellowship July 1 has potential for a negative impact on resident well-being, as well as on fellowship education and patient care.
CREOG has engaged the resident and fellowship communities regarding this issue, and recommends delaying the start of fellowship programs and staggering fellowship interviews.
Easing the Transition: Our Recommendations
1. Delay Fellowship Start Dates
Fellowship programs to start no earlier than August 1.
- Move is consistent with other specialties to address wellness and readiness (surgery and orthopedics fellowships currently start August 1 and pediatrics start July 7 or after)
2. Stagger Interviewing
Recommended Subspecialty Interview Schedule
| Interview Dates | Subspecialty |
|---|---|
|
June 3–12 |
GYN ONC |
|
June 17–26 |
REI |
|
June 24–July 3 |
MIGS |
|
July 1–10 |
GYN ONC |
|
July 5–August 21 |
MFM |
|
July 15–24 |
REI |
|
July 22–31 |
MIGS |
|
July 29–August 7 |
GYN ONC |
|
August 5–14 |
CFP |
|
August 12–21 |
REI |
|
August 15–28 |
MIGS |
| August 19–28 |
CFP |
|
September 2–12 |
CFP |
Ob-Gyn Fellowship Start Date Frequently Asked Questions
Delaying the start of fellowship programs to no earlier than August 1 would facilitate the following:
- Allow residents to fully complete their final year of residency training without having to manipulate schedules or use vacation or paid leave to personally manage the transition
- Provide residents with time to relocate and accommodate new institution/fellowship orientation
- Avoid overlap of the 4th of July holiday
- Afford residents time to prepare for the ABOG Qualifying Board Examination without pressure of immediately starting fellowship training
- Separate the start dates of new residents and new fellows providing a more stable clinical learning environment for all learners and for patients
- Allow incoming fellows time to rest and reflect on both their residency and their next stage of training prior to fully engaging in their new role
- Lessen the impact of a stressful move and transition for families of residents
Feedback from residents and fellows regarding this change has been overwhelmingly positive. Concerns regarding the loss of salary, visa limitations, and health insurance coverage have been raised. These frequently asked questions address those concerns and others to assist programs and fellows with the recommendation of a delayed fellowship start date.
Read the frequently asked questions below, or download as a PDF.
Questions
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No, ACGME accreditation is based on compliance with ACGME requirements. ACGME mandates a set length of training, but not a particular start date.
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Many programs have made accommodations to allow senior residents to use the last week/s of their training to do board prep, and for relocation purposes. However, this is not a universal policy and often mandates residents use their own personal time off or unpaid leave time to accommodate. It also diminishes the residency experience. This change will allow graduating residents to focus on reviewing for the qualifying exam and the end of their residency program and decreases resident concerns about relocation prior to starting their fellowship.
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Perhaps, but only for the 1st year. After that, the graduating fellows will be on a new cycle that will provide similar attendance as before. For example, a fellow who started on August 1 would graduate on July 30 upon completion of their fellowship. As any gap in coverage will be known in advance, programs will be able to plan for the transition.
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Perhaps. This gap may be up to 6 weeks depending on the particular pay period cycles of their residency and fellowship sponsoring institutions. However, many residents will receive a final paycheck 2-4 weeks after their last day of employment according to their resident employment contract. Regardless, trainees would be able to plan far in advance. In surveys, residents overwhelmingly prefer a brief gap in pay and insurance to the gain in time to prepare for fellowship. In fact, most residents entering employment choose to take off more time than this between residency and the start of their new job resulting in a similar or longer pay.
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There are options for residents to maintain or obtain health insurance in the gap between their graduation from residency and start of fellowship.
- Typically, health insurance lasts through the final pay period. If their pay from residency extends past their end date (such as if their final paycheck is a week or two after their last day of work, then their health insurance should continue through that last pay period).
- Residents also have the option to obtain their own insurance through the Consolidated Omnibus Budget Reconciliation Act (COBRA). Coverage with COBRA can be obtained retroactively so the costs would only be incurred if needed during the short time period between residency and fellowship.
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Sponsoring institutions have their own approach to orientation and "boot camps." If fellowships within a single institution have different start dates this may impact the ability to provide a collective simultaneous orientation. However, the onboarding process is becoming more fluid and many institutions are utilizing virtual or remote orientation. With a larger proportion of our senior residents graduating off cycle, there are typically multiple orientation cycles occurring in the same institution to accommodate later-starting fellowships. There are other fellowships (surgical and pediatrics) with similar delayed start dates, and institutions and DIOs have adjusted to that.
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Each year, many international graduates enter GME programs in the United States. This begins an endeavor to secure and/or maintain an appropriate visa status that will allow for clinical U.S. training. The visa application process may be complex, and it is important to know regulations, requirements, and timelines. Common issues that foreign national physicians may encounter during the visa application process and general solutions are listed on the ECFMG website.
Since U.S. surgical fellowship programs begin on August 1, there is an approximately 30-day gap between the completion of a residency and entry into fellowship training. This has an impact on ECFMG-sponsored surgical trainees as J-1 regulations require full-time participation in a program of graduate medical education (GME). To address this issue, the U.S. Department of State (DoS) has instructed ECFMG that J-1 surgical trainees can formally seek to maintain J-1 status during the gap between training programs through submission of a formal “sponsorship authorization (SA)” request.
Each sponsoring institution may have their own approach to visa situations and incoming fellows with visa concerns should proactively reach out to their fellowship programs to learn what they need to do for that sponsoring institution. Some sponsoring institutions have access to immigration lawyers to help incoming fellows if this is needed.
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CREOG recognizes that there may be other concerns that have not been addressed or fully vetted. In an effort to promote a universal approach please raise concerns with CREOG leadership through correspondence addressed to [email protected] at CREOG/ACOG. During the COVID-19 pandemic, many fellowships adjusted to virtual orientations, the delayed qualifying exam, and a later start, and found it to be more feasible than expected.