"Meet the Expert": A conversation with Dr. Danielle Brandman
On Sunday November 13th, LFN hosted it’s third “Meet the Expert” session. These sessions are facilitated through our Workroom platform. In this session, Dr. Danielle Brandman from Weill Cornell Medicine shared advice into changing landscape of transplant hepatology fellowship applications.
Below is a summary of the conversation:
Mian: Can you share your medical training journey with us and your recent move?
Dr. Brandman: I am originally from New Jersey and attended undergrad at Boston University. After not getting into med school on my first shot, I got in on the 2nd try and attended UMDNJ in Newark (now known as Rutgers). There, I first encountered liver disease and was impressed with how smart the hepatologists were and aspired to be like them in the future. I then went on to UCSF for internal medicine residency, and my love of the liver was cemented on my liver transplant rotation and research mentored by Dr. Norah Terrault. I stayed at UCSF for my GI fellowship; I was on a T32 track and thought I was headed to a research career, so also completed a masters during that time. I opted against a primarily research career and completed my hepatology fellowship also at UCSF.
I joined the faculty at UCSF and stayed there for an additional 10 years--->17 years at UCSF!!! I was recently recruited to become the medical director of liver transplant at Cornell in NYC. It was difficult to leave UCSF (the institution, the people, and the city), but ultimately a really important career move for me, as well as the chance to be back on the east coast closer to my family and my husband's family.
My career thus far has been a mix of clinical work, administrative and educational leadership, and some research.
Mian: I didn't know that! Dr. Terrault is a very engaging speaker. I think I can safely say all of us have benefited from her research at one point or another. So glad the move went well for you as difficult as it was!
Dr. Brandman: She served an integral role in my career development, and I will forever be grateful for her mentorship.
Mian: Sounds like she was both a mentor and sponsor (a distinction I learned at Dr. Arpan Patel's talk at the liver meeting just this past week!).
Dr. Brandman: Absolutely, great point! and I definitely felt like I learned a lot from Dr. Patel's and Dr. Nephew's talks at the AASLD career development session.
Mian: One of the main reasons we requested you to be our expert for this session was the transplant hepatology application process. What are the reasons you had led the charge for revamping the prior transplant hepatology application process? Was this work supported by one of the AASLD members committees?
Dr. Brandman: The application process for hepatology fellowship had become incredibly chaotic. We were excited that more and more people seemed to be interested in hepatology as a career and saw increasing numbers of applicants. However, because the fellowship had been so competitive from the programs' perspectives (more spots available than applicants applying), programs were understandably aggressive in their attempts at trying to recruit fellows. What happened over the past several years made us concerned that the application process was not serving the applicants, the programs, or the field of hepatology well.
The specific issues we saw were:
1) The timeline for applications was moving earlier and earlier. This made us worried that we would miss out on fellows who may gain interest in hepatology later in fellowship, particularly for those who may not have had significant hepatology exposure during residency. If they didn't have pre-formed connections/relationships, this could limit entry into our field.
2) Applicants were not able to complete interviews at programs in which they were interested because they were getting offers so early, and given sometimes only 2 days to respond to the offer. Understandably, fellows did not want to give up an offer since there was no guarantee their other programs would extend offers. We faced this problem as programs, as our potential applicant pool sometimes dwindled as other programs who interviewed earlier snatched up candidates.
3) Due to these issues, I worried that the process was not fair nor equitable for applicants and programs alike and it needed to change.
I connected with Dr. Janice Jou, the chair of the AASLD Training and Workforce committee on this issue. She and I were on the same page, and her support and work were integral to moving change forward. Together, we put together proposals to change the process. She presented this to AASLD, and they supported the development of the standardized application process.
Mian: As a program director, what were your experiences and impressions with the AASLDApp.org transplant hepatology fellowship process just this past year?
Dr. Brandman: The AASLDapp.org site was incredibly easy to use from a program perspective. My program coordinator was able to enter our information into the centralized system. We received applications for our open slots through this portal. It was well-designed, as we did not experience any technical glitches.
The most challenging part was the uncertainty of whether the system would work out. There were no formal regulations that prevented programs that had enrolled in the system from acting outside of the system. However, it seemed like the participating programs all abided by the "gentlepersons'" agreement to play by the rules.
The offer process was still chaotic. While we had issued guidance about offering positions, it was clear that the lack of a match made the offer process clunky. Each program sent out offers for their open slots. Candidates were given up to 5 days to respond to that first offer. Subsequent offers made beyond that first offer/first window could be given as little as 48 hours to respond.
The great news for applicants in the system is that they all got hepatology fellowship positions!
Mian: While I was not part of the process this past year, I remember being grateful for the tiered application fee structure, which was more affordable than the NRMP Match when we all applied to GI or IM.
Dr. Brandman: That was an important component of this---we did not want to burden applicants with this. Programs did pay a fee to be listed on the portal, and it was a reasonable amount (and I expect supported by the institutions).
Mian: I attended the Career Development Workshop at The Liver Meeting and for those of us who don't know yet, transplant hepatology process is a Match now! I know you have discussed some of this already, but what do you foresee are the positives and negatives of this new approach?
Dr. Brandman: Yes! So excited that the match is a reality for hepatology. FYI the new timeline for AY24-25 is available for your review at AASLDApp.org.
The positives are that applicants and programs will be able to do the interviews they want without the worry of offers being made prior to their completion. We will also continue to be able to acquire data about how many people are applying for hepatology fellowship and ultimately entering into programs. The offer process will now be seamless, just like all other matches.
I personally do not see any downside to the match. It's definitely a win for the applicants, since all matches are in favor of the applicants. I would imagine programs may feel like they have less absolute control over who ends up as their fellows, but I have to say that the old process and its chaos were not great. I know some have been concerned that our field is too small for a match, but the success of the match in peds hepatology should refute this belief.
Finally, smaller programs may be disadvantaged since they may have fewer applicants, but I don't think this will be a match-specific phenomenon. I would think that the current system would give them more visibility since their information will be available in a centralized location.
Mian: Is there a concern that not all transplant hepatology programs are part of the Match? Do we foresee this as affecting applicants who may still have to navigate applying to a select few programs not part of the match for geography/family reasons but still sign up to access the Match?
Dr. Brandman: Almost all of the programs are expected to participate. 41 of the 56 open programs participated in the system last year. 9 of the 15 programs who didn't participate last year indicated they were likely to participate this year.
This is similar to what happens with the ASGE/advanced endoscopy Match, though it seems like participation in the AASLD Match may be better than for ASGE. We also know that there are many programs that tend to keep their own fellows for at least one of their slots and this may impact their likelihood of offering spots through the Match.
I think that the system is still in favor of the applicants, as there are almost always going to be more slots available than applicants applying, though I do hope this trend flips over time!
Session attendee: I completely agree that the current matching process is way better than before. I only had a chance to interview with three programs and had to accept the offer early. I believe this matching system makes the application process better. Once applicants accepted the offer, do we have rule or policy to say that they can’t change their decision?
Dr. Brandman: Great question. I would expect the match to be binding, as other matches have been. I have not seen the language included in the current system. We should be having a town hall for program directors in the near future, and I will make sure this question is addressed. Will also discuss with Dr. Janice Jou about having the rules and regulations listed on the AASLDApp.org website.
Session attendee: How much research or publications do you need to apply for transplant hepatology fellowship? Do you need to have hepatology research/publication to be considered for competitive fellowship programs?
Dr. Brandman: That is going to vary from program to program. As you know, the hepatology fellowship has a predominantly clinical focus. The ACGME mandates that no more than 20% of a fellow's time is dedicated to scholarly activities. Each program may have different goals for who their fellows will be. Even in large programs, the expectation may not be for all fellows to have a research focus. That being said, publications or other work will never hurt an applicant. At UCSF, there was definitely a broad range of how research-focused former fellows had been.
Mian: This might be “out there,” but I was very curious on your thoughts on the job prospects for transplant hepatologists in academia, especially considering we start searching for jobs early on in hepatology fellowship. Do you have any advice or thoughts based on recent trends?
Dr. Brandman: Happy to answer this. Please know that the job landscape is constantly changing at specific centers, but that there are lots of jobs available now. Because of the huge public health program liver disease is, there is a growing need for more and more hepatology providers.
Geographics definitely play a big role. If you are tied to a particular city (or even state), this can make finding your dream job more challenging. Keep in mind that it is very common for people to not stay in their first job out of fellowship, so don't look at your first job as your last job.
I recommend starting your job search process early in your hepatology year. The first quarter of fellowship carries challenges---you're learning new material (and sometimes in a new system or city), you're studying for GI boards, and you may be applying for grants). Despite this, you must start planning for your job search. I recommend at least putting together your potential list of programs in the first 2 months of fellowship, and arranging for calls/meetings to happen in October/November (though earlier is fine also). You should meet with your program director to help compile your list of programs and to help with introductions.
Mian: Thanks so much, Dr. Brandman! We really appreciate you taking time to share your advice with us (especially after such a big move!). This is very informative and relevant for all of us.
Dr. Brandman: Thanks for having me! Anyone on this channel should feel free to email me with any questions you may have. Best of luck to everyone in your training pursuits and future careers!