A medical fellowship is the next stage of training for medical school graduates who have already completed a residency and have chosen to specialize in a specialty or sub-specialty of medicine that requires additional post-graduate instruction beyond a residency. Requirements for licensure to practice medicine vary from country to country and within countries from state to state or province to province. The requirements also vary based on the specific medical specialty or sub-specialty upon which the applicant seeks to focus his/her practice. Depending on the jurisdiction and area of specialization, an additional two to four years of training after completing a residency may be required. This additional training following completion of a residency is known as a fellowship. Upon completion of their training, physicians are qualified to become “board certified” in their chosen specialty or sub-specialty. Board certification is an option, not a requirement, but it does enhance a physician’s qualifications and presumably their skills thereby increasing their appeal to certain prospective patients. Requirements for board certification also vary depending on the specialty and jurisdiction. In the U.S., for example, there are 24 specialty boards that establish the criteria candidates must meet to be board certified in their specialty. All certification boards require documentation that the candidate has completed the required training and passed a written examination administered by the board. Some boards also require an oral examination. Physicians who successfully complete all the requirements for board certification are referred to as diplomats. Obtaining a medical license to practice medicine in a specific state is a separate process governed by medical licensing boards established by each state or province. Predictably, the application procedures vary from one jurisdiction to another. Regardless of whether a physician chooses to become board certified, upon completion of his/her training he/she must apply for and receive a permanent license to practice medicine in the state or province desired. As was the case for securing a residency, the process of securing a fellowship can be challenging given the number of potential choices for both the applicants and the programs. To address that complexity, the same type of ranking system used to match the preferences of medical school graduates with the preferences of residency programs to optimize the assignment of medical residencies, is used to optimize the assignment of medical fellowships. Both programs are administered by the National Resident Matching Program (NRMP), www.nrmp.org a private, not-for-profit corporation. NRMP’s Specialties Matching Service (SMS) matches the applicant’s highest preference for a fellowship program with the fellowship program’s highest preference for applicants. The SMS does an exceptional job of addressing and simplifying a complex process to serve the needs of both applicants and program administrators as optimally as possible. For the 2012 Appointment Year, for example, approximately 8,000 applicants competed for approximately 7,000 fellowship positions, in approximately 3,000 programs within 44 specialties. Of the 7,000 fellowship positions offered, approximately 6,000 were filled, resulting in a match for approximately 75% of the applicants. Unlike residency matches, fellowship matches occur throughout the year with different specialties maintaining different application periods and different match days – the dates when the pairings are released/announced. Each specialty match requires a separate registration with the NRMP. Although the application periods and announcement dates vary by specialty, most fellowship positions begin in July. The registration fee for applicants of $50.00 must be paid at the time of registration. Couples applying in the same SMS Match seeking compatible programs that will meet their needs as a couple have the option of notifying the NRMP of their interest in participating as a couple and paying an additional $15 per partner. There are other sources that can be used to identify fellowships, such as the websites of individual programs and the American Medical Association (AMA). However, the most comprehensive listing of fellowships and the unique ranking system for matching applicants with programs makes NRMP’s SMS, the primary vehicle for obtaining fellowships.