What is a medical fellowship?

As you progress through your medical career, you will be given a choice to become one of two types of doctor: a general physician or a specialist. Patients who have complicated or specific conditions will seek the help of a specialist who has years of training and education on that aspect of medicine — their specialty. Becoming a specialist is a greatly sought-after route in medicine. Many medical students want to become specialists, but not all candidates get to be fellowship trained. Fellowship training is a vital part of the process of becoming a specialist doctor.

Understanding the process of becoming fellowship-trained is important if it’s a path that interests you. There are lots of aspects to consider, including the position requirements and the expected salary.

What is a medical fellowship?

A medical fellowship is the training a doctor embarks upon to become a specialist in their chosen field. During training, the learning physician — also known as a fellow — works closely with a specialist to deepen their knowledge and experience of the subspeciality they’re interested in. The specialist will be an expert and leader in their field.

Fellowships are designed to provide significant work experience, and fellows are usually given a lot of responsibility very quickly. It depends on the fellowship program, but fellowship training is usually experiential, hands-on, and full of practical experience.

The American Medical Association (AMA) has reported 5,110 specialty programs with 68 specialties and 11,767 fellowship positions for 2020-2021.

What are the requirements for a medical fellowship?

Medical fellowships are extremely coveted. With limited places available, it is usually the best and brightest candidates that are chosen. Specific requirements vary per fellowship, but successful candidates should be able to demonstrate:

Motivation, self-direction, and personal integrity
Highly developed interpersonal and writing skills
Leadership and potential for continued leadership

Candidates should prepare themselves for extensive applications which can include a resume, transcript, letters of recommendation, and sample writing. Some fellowships may also request additional supporting materials. Alongside your application, the majority of programs will include at least one interview — this could be an individual interview, an interview with a panel, or a group interview where candidates work as a team to answer a question or solve a problem.

The majority of fellowship applications are submitted through the Electronic Residency Application Service (ERAS). According to ERAS, the average applicant spends roughly $691 on applying to their chosen programs. As is the case with the application process, the costs associated with the fellowship interview process vary based on volume. The majority of fellowship applicants (62 percent) spend more than $4,000 on interviews.

How long is a medical fellowship?

The length of a medical fellowship depends on the chosen specialty. The Washington University School of Medicine reports the following:

Specialty	Length of Training*
Anesthesiology	3 years plus PGY-1 Transitional/Preliminary
Dermatology	3 years plus PGY-1 Transitional/Preliminary
Emergency Medicine	3-4 years
Family Practice	3 years
General Surgery	5 years
Internal Medicine	3 years
Neurology	3 years plus PGY-1 Transitional/Preliminary
Neurosurgery	7 years
Obstetrics/Gynecology	4 years
Ophthalmology	3 years plus PGY-1 Transitional/Preliminary
Orthopedic Surgery	5 years (includes one year of general surgery)
Otolaryngology	5 years
Pathology	4 years
Pediatrics	3 years
Physical Medicine	3-4 years
Plastic Surgery	6 years
Psychiatry	4 years
Radiation Oncology	4 years plus PGY-1 Transitional/Preliminary
Radiology, Diagnostic	4 years plus PGY-1 Transitional/Preliminary
Transitional/Preliminary	1 year
Urology	5 years (includes one year of general surgery)

What is the average medical fellowship salary?

Medical fellowship salaries can vary between cities and countries. On average, physicians working in residency and fellowship programs earn between $51,000 to $66,000 per year for the 3 to 8 years they spend in the program. As time progresses, with more learnings and experiences taking place, fellowship-trained doctors can earn very impressive salaries. Not many doctors make it to become experts and leaders in their specialties, and those that do are highly sought after and respected in their fields. With this in mind, the below table shows the average fellowship-trained physician’s salary per specialty:

Average US Physician Salaries by Specialty

Allergy and Immunology	$296,705
Anesthesiology	$357,116
Cardiology	$436,849
Colon and Rectal Surgery	$343,277
Dermatology	$400,898
Emergency Medicine	$320,419
Endocrinology	$217,610
Family Medicine	$227,541
Gastroenterology	$379,460
General Surgery	$360,933
Hematology	$376,660
Infectious Disease	$205,570
Internal Medicine	$223,175
Medical Genetics	$158,597
Medicine/Pediatrics	$205,610
Neonatology/Perinatology	$290,853
Nephrology	$306,302
Neurology	$243,105
Neurosurgery	$609,639
Nuclear Medicine	$290,639
Obstetrics & Gynecology	$315,295
Occupational Medicine	$229,450
Oncology	$341,701
Ophthalmology	$343,144
Orthopedic Surgery	$535,668
Otolaryngology (ENT)	$369,790
Pathology	$302,610
Pediatric Cardiology	$303,917
Pediatric Emergency Medicine	$273,683
Pediatric Endocrinology	$157,394
Pediatric Gastroenterology	$196,708
Pediatric Hematology & Oncology	$192,855
Pediatric Infectious Disease	$163,658
Pediatric Nephrology	$183,730
Pediatric Pulmonology	$218,106
Pediatric Rheumatology	$200,027
Pediatrics	$206,961
Physical Medicine/Rehab	$278,283
Plastic Surgery	$407,709
Preventive Medicine	$270,888
Psychiatry	$227,478
Pulmonology	$317,323
Radiation Oncology	$418,228
Radiology	$404,302
Rheumatology	$244,765
Thoracic Surgery	$471,137
Urology	$381,029
Vascular Surgery	$428,944

It’s not just a fantastic salary that fellowship-trained physicians can enjoy. Other benefits include:

License reimbursement
Health insurance
Tuition reimbursement
Commuter assistance
Paid time off

There is a pay disparity between specialist salaries in the US and Canada — especially in surgical specialties. An orthopedic surgeon working in the US earning upwards of $400,000 would earn just over half of that in Canada. The more specialized your practice is, the more you stand to gain from practicing in the US.

Should you consider a medical fellowship?

Fellowship training is a huge commitment. The competition from other candidates is significant, so you should be confident in your ability to stand out from your peers in terms of skills, experience, and talent. The financial burden of applying to various programs and then funding the subsequent interviews is high, and the time committed to ongoing fellowship training and development is even higher. You must stay dedicated to your specialty and the niche you wish to focus on, as the commitment you make will need to last for many years. Once you end your fellowship and become an attending physician, the pressure to perform and succeed — from yourself and from others — will be immense.

However, in exchange for all of these commitments, you will receive training like no other. You will work closely with experts in their fields — the kind of physicians who shape the face of medicine around the world. You will learn quickly, experience plenty, and have the opportunity to shine in a specialty that you are passionate about. If you chose medicine for the chance to change lives, then becoming a fellowship-trained doctor is a fantastic way to achieve that goal. This is also true for physicians who have had a burning interest in a specific specialty all along. As well as a great salary and well-earned respect from the medical community, you will also get the chance to train new fellows later on down the line, thus helping to shape the future of medicine.