Hello,
Thoughtful questions!
On the spectrum of fellowship competitiveness, I would say HPM falls on the low-moderate side of the curve.
Using 2018 data, US MD had about an 85% match rate, US DO about 80%, IMG closer to 70's. The data does not delineate between applicant specialty, so it is hard to say how many applicants which didn't match come from IM vs FM vs EM vs Radiology etc... There are 10 primary specialties eligible to apply to the fellowship.
IM and FM make up the great majority of applicants and currently practicing palliative docs. However, as noted above folks from other fields maintain a presence too. I am trained in EM for example.
One last comment on competitiveness, if your goal is to simply match anywhere, there I would say it is more on the low side; however if you are hellbent on matching in CA (insert specific geographic region) or at certain institutions (Harvard, Mayo, Stanford, Hopkins, etc) then it is obviously quite competitive since you are now shooting for a very limited number of spots.
Research is not necessary to match; however, it is a nice boost for your application -- bonus points if it is HPMcentric research. Many match without any significant research however. Likewise, you do not need to do away rotations or multiple HPM rotations. What you need to be competitive to just match somewhere is the following: graduate from an eligible primary specialty, have not failed Step 1/2/3, composed a strong personal statement which answers "why HPM", and have a good interview. The more picky you get with where you want to be, the more these facets need to ramp up.
Working a few years would not significantly hinder your application. At worst it will just be neutral, at best it will actually help out quite a lot. There are many mid-career applicants every year that apply and succeed.
In regard to schedule and jobs [borrowed from another one of my posts]:
As a fellow, my schedule depends on the service. I'm scheduled for clinic one day per week. We have a cap of 4 patients with the option to add-on 1 if we wish. I typically choose to have the add-on when someone needs close monitoring -- say H&N cancer doing a course of radiation. If the options are to be seen by me as an add-on, or not be seen and to suffer until my next regular slot opens up, I'm going to put them as an add-on and stay later so be it.
I have 2 types of appointment windows -- 90 minute intakes and 45 minute follow-ups (so, yes, plenty of time for patients/families). Clinic goes from 8-5p. One hour lunch. If your schedule ends at 4 and you're done with your tasks at 4 -- go home at 4.
When I'm on the consult service, I typically carry about 6 patients per day. Days start at 8a and end at 4-5pm. One hour lunch. When I'm on the inpatient palliative unit, you are in charge of the census -- it is a budding program in its infancy -- so that is usually 3-6 patients. One hour lunch.
GIP hospice typically 2-7 patients on census. One hour lunch.
Onward to the job market:
It is good... at baseline.
There is currently a bit of a shortage compared to regular years due to many large hospitals being on hiring freezes 2/2 COVID.
Often you can work in multiple settings pending your employer contract stipulations. Otherwise, many large robust practices actually have inpatient, hospice, and community presence -- so it is not rare to find positions that have split responsibilities across practice settings while still staying under the umbrella of the same institution.
There is a wide range in total comp between 160k-300k in being seen (to use MGMA's approach). Average is around 225k."
What about job satisfaction?
Longitudinal surveying show 98-99% satisfaction among grads in choosing the field and would recommend it to others.
Here is about 6 years worth of data on palliative fellowship graduate satisfaction. The percentages speak for themselves and to my knowledge unmatched in healthcare.
2014
View attachment 296618
2016
View attachment 296619
2018
View attachment 296620