Fellowship E&M (Evaluation and Management) for Aspiring Retina Fellows

By James G. Howard, MD

Vitreoretinal Fellow, University of Iowa

So it sounds like you are interested in becoming a retina fellow. I think this is an outstanding choice for several reasons. First, it is probably the most rapidly advancing and evolving subspecialty in ophthalmology. The only other one that even comes close is refractive surgery. Second, what we do as vitreoretinal specialists is unbelievably cool – we take eyes that are destined for a date with the ocular pathologist and often are able to restore some measure of useful vision. Third, the surgery is hands down the most sophisticated and challenging in ophthalmology. Fourth, retina is a very treatment oriented field. Consequently you will spend more time treating pathology than wading through diagnostic dilemmas.

Once you have decided on retina as your occupation of choice, how do you select which program would be best for you? In this regard I think that retina fellowships are like ice cream – they come in a variety of flavors and textures, but most are satisfying and give you what you need. However, in this process of selecting a program I think you have to be brutally honest with yourself and what you are all about. Interestingly, many of the factors that will affect how you may feel about your fellowship will probably have little to do with your actual job of learning to evaluate and manage retinal pathology, but will be more influenced by who you work with, your call schedule, where you live and your social support structure. Therefore, in addition to that little spreadsheet that all of you inevitably will make, you need to develop an adequate gestalt of where, how much, and with whom you will work.

And lastly, how do you survive once you are a fellow? Here are two thoughts that may be helpful. First, the fellowship is a little bit like a marriage relationship. Before the marriage (or match), you should keep your eyes wide open, trying to be cognizant of all the things that might get under your skin if you were tied to a program. Then after marriage (or match), you should keep your eyes half shut – in other words try not to get caught up in the little petty things that might drag you into misery. In the end, your approach to fellowship may be aided by keeping Andre Agassi's famous line in mind, "Attitude is everything." As you well know at this point in your career, most of what you get out of an educational experience has far more to do with what you put into it than any other factor.

So jump in with both feet, work hard, shun pettiness, keep a positive attitude welded to your frontal lobes, and within a short time you will be well on your way to a career in one of the greatest subspecialties in medicine.