San Francisco Match Dual Fellowship Out-Of-Match Process And Tips

Similar to the Electronic Residency Application Service (ERAS) match process for residency, the San Francisco Match Program (SF Match) also has a match system for fellowships. Residents rank fellowship programs they interviewed at, and fellowship programs rank all the candidates they chose to interview. Once these lists are submitted by both the applicant and each institution, an algorithm “matches” the resident to a fellowship program.

Going into my fellowship interview trail, I knew I wanted to train at the same institution for both critical care and cardiothoracic anesthesiology. Since I officially chose to start with critical care, I was subject to the rules outlined by the Society of Critical Care Anesthesiologists (SOCCA), which offers six instances where candidates can be offered a place outside of the traditional San Francisco Match.

  1. Active military service at the time of application
  2. Commitment to come to the institution of the critical care fellowship for more than one year
  3. Enrolled in an anesthesiology residency outside of the USA
  4. Reside outside the USA who are not eligible for ABA certification due to non-US training
  5. Spouse/partner is applying for a GME-approved post-graduate training program in a medical specialty in the same region as the critical care fellowship
  6. Internal candidates

The reason I received an offer outside of the match was instance #2 – I’ll be spending two years at the same program. 🙂 The program will rank me to match (meaning that if they have 10 fellowship positions, I will be ranked no lower than #10). On my end, I not only rank this program as #1 but rank NO other programs. After completing the agreement, I received the following email:

This is to confirm that both of you have entered into an agreement whereby Dr. (Program) will ensure your acceptance into the ACCM fellowship program (through the SF match) and Dr. (Applicant) will only be ranking (Program) in the SF Match.  If your understanding is different from this, please contact me at once.  Thank you and congratulations.

So this May, I’ll be matched to the only program I ranked for critical care. Next year, I’ll also enter the match for cardiothoracic anesthesiology and, again, only rank this program.

Regarding tips for people considering dual training in both fellowships, here are some tips and things to consider during the application and interview season.

  1. Consider doing both fellowships at the same institution. Besides the out-of-match exemption process, I think there are benefits to working with colleagues over the course of two years. It’s easier to get to know the city, program, and people over that time rather than worrying about moving to another program after only one year.
  2. Have everything prepared ahead of time and submit the application materials as early as possible.
  3. Stay organized! I had a spreadsheet with columns like program name, program directors for both fellowships, secretary contact information, important dates (submitted application, secondaries, interview, etc), and notes where I would leave my thoughts after an interview.
  4. Your personal statement should reflect your interests in both fields and how you want them to tie together to achieve your career goals. 🙂
  5. Inquire about the formal didactic curriculum. Is this time protected? Do you receive formal training in echocardiography, advanced airway techniques, bedside procedures (thoracentesis, paracentesis, lumbar punctures), etc?
  6. What are the types of attendings you’ll be working with? Do they come from diverse backgrounds (e.g. anesthesiology, emergency medicine, surgery, internal medicine)?
  7. During the ICU fellowship – what’s the team structure like? Do you lead rounds? What disciplines are involved with rounds (physicians, nurses, dietitians, pharmacists, etc.)
  8. During the CT anesthesia fellowship – what’s the balance between doing cases solo versus supervising residents? It’s important to have this balance… especially if you end up doing academics.
  9. What’s the educational allowance? Those exams and membership expenses add up quickly. 😞
  10. What’s the alumni network like? Where did recent graduates end up?
  11. What kinds of electives can you pursue in both fellowships?
  12. Are there opportunities to moonlight? I know as an ICU fellow (especially before oral boards), I wanted some OR shifts to brush off the rust. 😂

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  1. Thanks for the information this is really helpful. I am trying to apply to both OB and cardiac (I know it’s weird, don’t ask) and I was planning on doing cardiac first then doing OB, and i’m trying to get the SF match exception as well. However, my partner is in peds and she is applying for fellowship and her match is later than mine, so I want to make sure she is able to get a fellowship at the same institution, which makes the dual fellowship thing for me helpful (because I get to stay with her 2 years) but also risky (because I can’t guarantee she’ll come to the same place). My questions for you:
    – Some programs are asking me to apply to both matches this year, to see if they would take me into OB first before Cardiac, which I am fine with. But if I do that, how does that work in terms of the SF match? Because if I apply to both matches won’t I be applying to the same year? I don’t want to get into match breaches and all that.
    – Other programs are asking me to apply to cardiac and then will discuss with both PDs if they want to take me for OB the year after. If that is the case, do I just apply to cardiac this year?


    • Hi there! It’s actually not that weird! One of our current chief residents is staying here to do both OB and cardiac! 🙂 I think it’s a great combination especially given the increasing number of parturients with cardiac comorbidities.

      Your second bullet point is what my experience was. Because of limited “days off” as a CA-2 (vacation, post-call/pre-call, etc.), I only applied to programs that would interview me for both CV and ICU during the same interview day. I applied through SFMatch for ICU (there’s a place in the application to indicate that one is also interested in CV). Some had secondaries and other things they needed me to fill out. My interview days were roughly 8-10 interviews with faculty from both divisions. They each had to rank me to match before offering me a spot outside of the SFMatch.

      For the programs you’re referring to with your first bullet point, I think that’s a great question for the SFMatch because you’ll be applying to two fellowships simultaneously for the same start date. Give them a call for clarity.

      If there’s one thing I learned in this process, it’s the importance of communication and following up. This is your career – you want to make sure everyone is on the same page and you’re not assuming anything. Keep at it, and let me know what you learn! 🙂

  2. What if you matched into a fellowship through the dual process but do mot wish to pursue the second fellowship because of personal reasons. What will such a wothdrwala mean. I havent signed the contract of the second fellowship yet.

    • That’s something to discuss with the program in question and the SFMatch. They’ll likely recommend a traditional route (apply and match to one… then apply and match to the second) especially if you anticipate something down-the-road that might prevent you from doing the second fellowship.

      Programs invest in dual-trained applicants by carving out positions in both fellowships; however, it’s no secret that some applicants (not saying you) apply the dual route and use the less competitive fellowship (e.g., critical care) to get a spot into the more competitive fellowship (e.g., adult cardiothoracic anesthesiology)… only to withdraw from the ICU fellowship. Not sure what the ramifications for this are (breach of a match contract, etc.) Programs counter this by usually having the applicant complete the ICU fellowship first.


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