About Critical Values

Pathology residents now have a more structured path to securing fellowships. For fellowships beginning in the July 2026 appointment cycle, three pathology subspecialties have joined Forensic Pathology in a multi-specialty Pathology Fellowship Match through the National Resident Matching Program (NRMP). The three new specialties are Molecular Genetic Pathology, Bone and Soft Tissue Pathology, and Hematopathology. Together, they encompass approximately 123 programs and 202 positions. 

Although pathology has had fellowships for decades, this change marks a huge step in visibility and standardization for the specialty. Participating in NRMP will help streamline the pathology matching process and give residents more time to assess their interests without feeling rushed. 

Why pathology fellowships needed the NRMP match

Pathology fellowships used to operate outside the NRMP. But over time, this created burdensome problems for both applicants and program leaders. 

“In 2021, I sent a survey to the Hematopathology fellowship directors,” says Alexa Siddon, MD, Professor, Department of Laboratory Medicine & Pathology, Hematopathology Fellowship Director, Yale University School of Medicine. “We were all starting to get applications towards the end of the second residency year, when they wouldn’t be starting with us until year five. People were applying earlier and earlier because they thought fellowship spots would be taken. They felt like they had to make a commitment while spots were available, when they hadn’t even rotated that much on our different services.” 

This created a self-perpetuating cycle, with both residents and directors feeling compelled to push the application cycle earlier and earlier.

“The directors felt the need to continue to do this earlier than they would like,” Dr. Siddon says. “We were all a little bit frustrated with the system because there was no routine timeline for when our potential fellows could apply. We decided that we would like a better strategy.” 

NRMP sent a representative to meet with the program directors to share the pros and cons of joining their match system. The majority of directors felt like this would help the programs and fellows alike. And they learned that forensics pathology had already made the jump a year earlier.

“Now that we’re part of NRMP, residents can interview at however many places they want and make an informed decision,” Dr. Siddon says. “The Match happens towards the end of their third year, much further into their training, so they have the opportunity make sure it’s the subspecialty they want.” 

And because the Match is done by an algorithm, residents no longer have to worry about choosing from multiple offers.

“The applicant will no longer be faced with multiple fellowship offers or be pressured into accepting a fellowship offer before having time to fully explore other options,” says Elizabeth Courville, MD, Associate Professor, Department of Pathology, University of Virginia. “Similar to when medical students apply to residency programs, pathology residents will rank pathology fellowships within the NRMP, participating pathology fellowship programs will rank applicants, and the NRMP computer algorithm will do the rest.”

Potential fellows using the NRMP can even delay the application/acceptance timeline by up to nine months, depending on the subspecialty.

“This allows residents more time to fully explore their fellowship options and solidify career goals,” Dr. Courville says.  

How residents begin the application process 

Residents interested in a pathology fellowship should contact the specific programs they’re interested in to confirm application requirements, Dr. Courville says. Not all subspecialties or programs participate in the match, and even those that do may have different requirements. 

Residents can make themselves stand out in the process by knowing their subspecialty inside and out. 

“Residents should be able to discuss the reasons that particular program is of specific interest to them,” Dr. Siddon says. “Showing a bit of personalized knowledge really will go a long way.” 

If a resident is having trouble narrowing down which program they’re most interested in, a mentor can help. 

“A mentor can help the resident identify a good-fit subspecialty, help them gain additional experience in that area, and provide advice on fellowship programs to investigate and possibly apply to,” Dr. Courville says. “A good mentorship relationship is helpful when it comes time to find individuals to write letters of reference as well.”

“We have lots of subspecialties in pathology,” Dr. Siddon says. “It would be nice for the applicants if everybody joined the match so trainees could have more of a structured process for continuing their education.” 

Interested in the fellowship match process? Join the ASCP Pathologists in Training Community and watch the webinar on Pathology Fellowship Match Process to learn more.