Sample Timelines

Fellowship Pathway Timeline

During PGY2/3 Year

• August: Start actively exploring fellowship options.
• October or May: Attend a fellowship fair. The two biggest are the Resident and Fellowship Fair at the SAEM Annual Meeting in May and the Emergency Medicine Residents' Association (EMRA) Job and Fellowship Fair at the American College of Emergency Physicians (ACEP) Scientific Assembly in October. If there's a particular fellowship that you like, email the director in advance to ask questions and set a time to meet at their booth or virtually if available.

During PGY3/4 Year

• May-June: Create a list of fellowships that you're interested in and reach out to the directors (or designated recruiters/coordinators). It is okay to email them out of the blue. There is no portal or common electronic application for emergency department (ED) administration fellowships, so you need to reach out to each program individually. Doing this prior to the start of your last year is increasingly important.
• July: Begin filling out your fellowship applications. Requirements for applications vary widely, but typically include an updated CV, letter of interest/intent or essay questions, letter(s) of recommendation, and a graduate school application for fellowships with degree programs.
• August-December: There is a trend toward earlier interviews over the past few years, with some programs starting during the summer months. So don't wait - reach out and inquire about their application timeline. Some general tips:
  • When scheduling your interviews, try to cluster them over a two-month period at most. You want fellowship offers to come at approximately the same time to avoid a situation where you are forced to respond to an offer before you hear back from other programs.
  • Be prepared for long interview days as the fellowship interview process is similar to residency interviews. Expect back-to-back interviews, lunches with applicants, and ED or site tours.
  • Be prepared to speak with non-physician interviewers. Remember that ED administration involves nursing and hospital leadership, as well as administrative leaders from outside the ED. Don't be surprised to have an interview with the Director of Nursing, for instance, who asks you about your experience working with nursing on projects.
  • Look up the organizational structure of the institution/organization before you interview. You should know the people in key positions such as department chair, CMO, or President, and the major hospital sites or offices.
  • Learn about the department/institution. Showing awareness of current projects, recent publications, or challenges demonstrates interest and quality due diligence.
  • Be prepared to talk about both your clinical and administrative experiences in a meaningful way. Come up with an arsenal of different projects or cases throughout your medical training where you had meaningful involvement, and be able to succinctly describe the nature of your impact or the lessons learned.
  • Demonstrate curiosity about the institution's or organization's administrative challenges or projects. Inquire about key initiatives, why they were chosen, who is involved, selected goals, and early outcomes. If possible, find a project that both you and the institution are interested in and start talking about how you might get involved.
• September-April: Fellowship offers arrive! Recognize there is nuance in how to manage this process, especially if you are awaiting several potential offers, as fellowships operate on different timelines. It is not uncommon to receive an offer with a decision deadline - accept it if it is your program of choice, and do not miss your deadline if you are waiting for additional offers. If a response time is not provided, thank them for the offer and graciously inquire about a specific response date.
  • When you accept an offer it is reasonable to ask for written confirmation. This doesn't need to be a formal contract; a simple email from the Fellowship Director is sufficient.
  • Once the offer is accepted, notify other programs of your decision so they can move to other candidates.
• Acceptance-June: Begin your credentialing process early. Reach out to the Fellowship Director regarding the point person for credentialing and inquire about any specific training requirements that may differ (i.e. most recent ATLS, PALS, etc.). Most fellowships have a July start date, and credentialing can take anywhere from two-six months depending on the state, so don't fall behind on the paperwork!

Degree Pathway Timeline

In general, we recommend this pathway once you have concluded residency and have some emergency medicine (EM) attending experience as this allows you to have a better understanding of which professional degree would fit your interests and provides a greater degree of specificity regarding programmatic content. In addition, this allows for your focus to be on completing your boards during year one and gaining additional clinical insight and administrative exposure. If you desire to start your advanced degree concurrent with residency completion, the same content applies except that you will want to see if you can negotiate assistance with your academic expenses and/or clinical workload.

Year Prior to Starting Your Degree

• Identify potential degree offerings of interest.
• Inquire about GRE or GMAT requirements for an MD or DO candidate.
• Discuss sponsorship with your current department or organization as early as possible (and likely before you accepted the initial contract). Will there be financial assistance covering the cost of the degree? Will there be a commensurate clinical reduction? Is there a contractual agreement for effort after the completion of the degree?
• Identify the application timelines and complete appropriately.
• Once accepted into the program, obtain (in writing) the agreement of support and stipulations as discussed above prior to enrollment.

During the Degree Process

• Align degree-based projects with current or needed initiatives in your department or medical center when possible.
• Share learned content within your administrative team.
• Create a network within your degree cohort that may provide value in future discussions or projects.
• Remain dedicated to the educational process and its application to your department.

Job Experience Pathway Timeline

Here are some more specific tips about how to find a first-year attending job that can launch a career in ED administration.

• Make certain to keep clinical medicine at the heart of what you do. Clinical excellence is the baseline expectation for all leaders in the department, so take care to select an institution that will allow you to deliver high-level patient care and hone your skills as a new clinician.
• When looking for future positions, inquire about opportunities to lead administrative projects or initiatives early on in your career. The more experience you gain during residency, the greater value proposition you bring. If you participated or led one or more significant quality improvement (QI)/quality assurance (QA) projects, held one or more leadership positions, been involved in committee or interest group work at both the institutional and national levels, and published some of your work/findings as abstracts, posters, or papers, articulate that in your interviews. If you have a particular area of interest or experience, such as QI, patient safety, or risk management, delineate it. With this level of experience, you should be well prepared to participate in hospital or departmental administrative projects without difficulty as junior faculty, and the hiring institution will likely recognize this and assign you responsibilities accordingly.
• Look for institutions or organizations with well-defined ED administration promotion tracks. You want a job where administrative work by ED physicians is valued by the Department Chair or leadership. Talk to ED administrative leaders within the institution and get a sense of their career path. Were they promoted from within or brought in from outside? How many years did it take? What are their obligations to administrative work vs. clinical shifts vs. research and education, and how much did each one contribute to their promotion? All this will give you a sense of how much they value ED administrative work and the potential for upward mobility.

Frequently Asked Questions

• Do I need to do an away rotation or administration elective during residency? Unlike the EM-critical care or ultrasound pathways, an away rotation or elective is not necessary for ED administration, regardless of whether you're pursuing a fellowship or job. If you are set on one particular institution or organization, you may find it rewarding and beneficial to visit there and gain exposure. However, it's certainly not mandatory.
• Is there a fellowship portal for ED administration fellowships? Not currently. Remember that all ED administration fellowships are non-ACGME accredited, although there is a higher standard for many that have sought SAEM approval. You will need to look up or contact each institution individually to obtain their updated application requirements. We highly recommend attending the ACEP and SAEM job and fellowship fairs. Remember that new ED administration fellowships are being created annually, so this is the best way to get the lay of the land.
• Which fellowships or degrees require the GRE/GMAT? This varies tremendously, so the best thing to do is research the fellowship or degree program thoroughly before deciding to take the test. ED administration fellowships will only require the GRE/GMAT if their degree offering requires it.