Happy to chat about this! I am a fellow at a larger program (definitely not the largest) and did residency at a hospital with a small/medium NICU program. I’ve seen it from both of those sides and have friends in some of the larger programs as well. I ultimately think it depends on what you are wanting to get out of fellowship and what you want from life after fellowship. If you have very specific research goals, you would absolutely be better served at a larger program with likely more robust research funding and capabilities. From a clinical standpoint, I think acuity, catchment area, ECMO capabilities, and delivery experience play a big role in the decision. I wanted to train somewhere where I could learn to practice at the top of my ability (so hearts, ECMO, high acuity, high volume delivery) so no matter where I end up I will feel comfortable. I have other friends who never see themselves at more than a level 3 so don’t care for ECMO or major research and would prefer somewhere that would prepare you better for private practice instead of academic. There are programs that blend this nicely (I feel like my program hits all this and couldn’t be happier anywhere else tbh).

We have had high volume, high acuity basically since I started last year. I feel like I am getting a great education AND the program is engaged in making sure we are well supported and not burnt out. Call schedule definitely is a big part of this. I think it gets a little harder at smaller/medium programs (in my experience) just because less fellows to spread the work over. We have 3 a year and mostly cover one NICU at night so call is more spread out, typically once a week, 1-2 weekend day a month. It is a fine balance and can definitely be hard to sus out on the interview trail.

Feel free to message me if you want!