Questions & Considerations 

This is a very important question to ask that will give you insight into what kind of projects you will likely be involved in, ranging from “bread and butter” EHR implementation to billing and compliance to ambient AI dictation technology. An ideal fellowship should at least in part have shared alignment with your personal interests.

Some programs will pay you on a PGY-scale, while others may pay for some (or all) of your clinical time on an attending scale. While it may feel “impolite” to ask about this during interviews, this is an important question given significant variability between programs (sometimes even within the same program), and programs will not be taken aback if you ask about this.

Most programs maintain a 20% clinical, 80% informatics split. If there is a higher clinical requirement, investigate the reason why, and find out how these “extra” shifts beyond 20% are paid (if at all). While additional clinical time so soon after residency graduation is not necessarily a bad thing, choosing a program that allows you to do this as additional moonlighting will give you more flexibility (often with higher attending-scale pay).

Some larger programs will manage and design their own didactic curriculum based on ACGME guidelines. Some smaller programs may not have the resources to support this, and many programs as a result use a standardized online curriculum (e.g. OHSU graduate certificate/masters program) which can also be highly effective.

An older program has a larger existing network, which is important for getting job offers. A newer program may experience growing pains, but potentially can allow for more freedom in “choosing your own experience”.

In addition to different total slots per year, some programs may have fluctuating support every year. Many programs can only support fellows from certain specialties, and some programs even have rotating specialty slots (e.g. taking surgery trainees on odd years, EM trainees on even years).

CI is unique in that the fellowship training program can be housed in a variety of different specialty departments, ranging from pediatrics to pathology. While where fellowship is housed will certainly influence your experience, many of the best programs may be housed in a department outside of our clinical background, and this is perfectly fine. Your fellowship will work with you to ensure that you are practicing clinically in your clinical “home”, if this is not the same as the fellowship department.

Programs vary widely in the non-clinical expectations of a fellow, especially when it comes to project management and research. One of the best ways to get an unbiased look at the program is to ask a current fellow about what a typical day might look like for them.

Opportunities for moonlighting are highly desirable, as this will not only significantly increase your income during fellowship but also help upkeep the critical clinical skills you need to maintain as a brand-new attending. Opportunities will vary by program. Generally moonlighting will be in your primary clinical specialty.

Some programs require (or give the option) of a concomitant masters, often in biomedical informatics. While having more structured coursework can be helpful, others have felt that a masters degree takes time away from other opportunities such as informatics project work or clinical moonlighting. A master’s degree can, but doesn’t necessarily increase your competitiveness in the job market.

Having core informatics faculty from a variety of clinical specialties (not just in EM) opens up more opportunities for projects and cross-collaboration. Having faculty across the seniority spectrum allows for a more relevant mentorship experience while preserving access to executive sponsorship when needed.

Beyond choosing where you want to live for the next 2 years, the biggest factor influencing job offers after fellowship graduation is through your network and the kind of jobs available in your geographic area. A program in a larger metropolitan area tends to give you more flexibility and variety in job offers, but may also face a more saturated market

Not all programs have the same expectations or resources for academic research. There are many great programs that are not heavily focused on academic output, operational-first programs will have plenty of hands-on project experience as well as business, project management, and financial exposure, and may set you up well for a CMIO role. Note that if you want a job in academic medicine after fellowship graduation, having research experience will be important.