Ambulance1drybrushWell, it is EMS fellowship interview season again, and every year after the lovely encounter with very well qualified candidates, I am left wondering if they have achieved a good return on their investment of time and money coming to visit us. Did they really get a good idea of the important aspects of our program, or will they just have to make an educated guess about whether they would be happy spending a year or more with us?

In addition to geography, applicants tend to stratify based on preferences such as urban versus rural practice environment, daily traffic and parking issues, and salary/benefits. There are also many personal questions a candidate may wish to ask about a program. Is the Program Director an ogre? How many squash courts are in the student recreation center? Does the hospital cafeteria have veggie food options–certainly an important one for me. There are, however, some important universal questions that everyone should be asking if they want to get the highest value possible in exchange for giving yet another year of their lives to being a student. Here is my suggested top 10 list to ask during your interview:


  1. Is your EMS fellowship program ACGME accredited? This is an important question if you wish to become EMS medicine board certified, and why else would you do an EMS fellowship? In a few short years the non-accredited fellowship pathway will close and many if not most of the best jobs for EMS medicine physicians will require sub-specialty certification. This means passing your EMS medicine board exam, which you will only be able to do by completing an accredited fellowship program.
  2. Are you, or a portion of your EMS fellowship faculty, board certified or board eligible in EMS medicine? In a few years, you should drop the board eligible option part of this question, but right now the exam cycle is only every 2 years, and the sub specialty is so new that many faculty are still in the exam process. Other specialists can be an important part of your learning process, but having teachers who have passed the exam you need to pass and master the spectrum of knowledge you need to master is critically important. The latter should be able to teach you how to do it. If you wanted to practice cardiology, you would want to spend some time learning the practice from cardiologists.
  3. What are your program graduates doing now? If there are a lot of them, ask for a list and contact a few. They should ideally be including EMS medicine as a part of their practice and doing things in their careers that you would like to be doing. If not, ask why. Part of a good program’s responsibility to its graduates is to help them to find jobs in the field. You want one too. Why else would you be going to so much trouble?
  4. Have you had fellows continuously since the start of the program, and have you had fellows in your program who are graduates of your residency? If not, why is that? This is a loaded question for many programs. The house of ACGME requires directors to find stable funding sources outside of the residency support from the Center for Medicare & Medicaid Services (CMS), but does not allow them to bill directly for clinical care provided. So variability of funding sources year to year can be the norm. This wreaks havoc with continuity especially because the application cycle is a full year ahead of the funding cycle (which leads to cataplexy in the hallowed halls of public funder administration). However, fellowship consistency can give you clues to institutional support for the program, residents’ feelings about the fellowship, and program leadership. There could be very good reasons for gaps, but they are a part of the program history you want to know about.
  5. What is your program balance between service and learning? Too much service and you may not be ready for the Boards. Too much academics/learning and you may feel that you are not actually getting to improve anything in your EMS system. A good portion of your time should be spent providing care, teaching, and interacting with EMS providers to improve their practice. And you should have focused time to study that ginormous EMS medicine text. Good thing there is a free online EMS study guide for the 2009 edition (and one in the works for the 2014 edition) to help you on the ALiEM website!
  6. How many faculty participate in the fellowship, and what are their roles? A satisfactory answer to this question is very dependent on the questioner. Some students prefer a more one-on-one mentorship experience with the downside being that no one teacher can be an expert on every aspect of EMS medicine. Others would rather have a large group to draw upon many types of expertise with the downside being that continuity can suffer. At a minimum, the Program Directors should have the support that s/he feels they need to provide a good learning experience.
  7. What is the fellow’s interaction with other learners, especially EM residents and prehospital provider students? To some degree, everyone needs their peeps, and that’s what the EM residents are for you, so you should be interacting with them somewhat regularly. The prehospital students look up to you like a god, which, while ego-gratifying, is not the main reason this is important. We are trying to change the practice of EMS medicine. If from the very start of their careers, our EMS providers are interacting with dedicated, knowledgeable, young emergency physicians supporting their development, they are more likely to regard us as colleagues worth consulting and to provide better care to our prehospital patients.
  8. When I’m off work, how off am I? This may seem like a no-brainer with strict ACGME duty hour rules, but an important aspect of many EMS fellowship programs is providing MD-level support of certain EMS functions, ranging from disaster duties in MCI’s to in-field care at special events. Even if an event is fun, you need a reasonable amount of time to yourself for your own growth and development.
  9. What cool features does your program have? The right answer depends on your own personal interests. Train with the SWAT team? Awesome. Work a week-long disaster simulation with other professional responders and managers? Amazing. Self-dispatch to high level EMS with a well-equipped special response vehicle while wearing a set of Level A personal protective equipment (PPE)? Well, you had me until the Level A part. There should be some “wow” factor for you to enjoy particularly because you are investing up 2/3 of your earning potential as an emergency physician for a year to pursue this fellowship. Another approach is to ask what elements of EMS medicine am I weak in, and does your program address my needs? Your goal should be to be a great practitioner of EMS medicine, and your fellowship needs to help you get there.
  10. Do you have an option for a second year to pursue an advanced degree?Another tough one—remember both the personal and professional costs of a second year of Fellowship. While the ACGME fellowship curriculum is thorough and specifically designed to be completed within one year, it is impossible to obtain subject mastery depth in all areas of EMS medical practice. Do you have an abiding interest in mastering a component of EMS? If research is your thing, look for programs with links to Masters of Clinical Research degrees where you can grow more passionate about confidence intervals. If it’s public health, aim for a program with a Masters of Public Health degree where you can collaborate with Master’s students from other health backgrounds to solve community health inequities. Technologically or systems inclined and wanting to develop the next big thing in mobile integrated health care? A Masters in Business Administration will up your game considerably. And if you envision EMS system direction, think about a Masters in Public Administration. An additional credential is hard to beat when you compete for a great job. If you’re going to get an advanced degree, why not do it in a program that pays for it and is structured to support it? You may change your mind during your first year and not exercise the option, but it’s important to consider it if your interest aligns.

There are probably more questions that I haven’t thought of. If you have been on the interview trail or have done your fair share of interviews, I invite you to chime in with your experiences. Good luck to the upcoming fellowship applicants, and may every happy fellow find a home in a program happy to have them!

John Brown, MD

John Brown, MD

Associate Clinical Professor, UCSF
Medical Director, San Francisco EMS Agency
Medical Officer, DMAT CA-6