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Importance of Residency for Fellowship/Academia
Hi, I'm a noob so I'll be asking some noob questions:

1. How important is the residency program you match at for matching into fellowship, and then how important is the fellowship program you match at for your future career in academia (appointments at a good hospital/university, not private practice)? Obviously it's a very significant part of your application, but exactly how significant? What other factors are there, besides the obvious interview/research? 

For example, while the undergrad you go to is a factor in medical school admissions, anyone from a low tier college can still get into a top tier medical school with an outstanding MCAT score, GPA, LORs, research, ECs, interview, etc. By the same token, anyone from a low tier medical school can get into a top ranked residency program with outstanding USMLE scores, grades, LORs, AOA, sub-Is, research, interview, etc. 

But what exactly can someone from a low tier residency do to match into a good fellowship program, since there isn't really a standardised NSG exam during residency (boards are pass/fail?). At this point, is it all about who you know, personal connections, interview, etc. rather than how good of a neurosurgeon you are?

Similarly, for university/hospital appointments in academia after fellowship (or residency), how significant of a factor is your fellowship? Residency? Where does this fit in the traditional tenure track of assistant professor → associate professor → full professor → chairman/chief of department?

2. It seems like a lot of neurosurgeons land an academic position at their home residency program right after residency, instead of going somewhere else for a fellowship, and move up the rungs of the ladder until they become full professor, then most likely move somewhere else to become chairman/chief of department? Is doing fellowship really that skippable then?

3. I always thought that medical school was a lot more high stakes than residency (despite residency being harder work), since in medical school you are competing with the other students to get into a better residency, while in residency you aren't really competing with the other residents to get a better fellowship/job? In medical school, you are trying to outperform your peers to match into the best possible residency program for the next 7 years of your life (and is a major factor for the rest of your career), but during residency you can't really do make yourself more competitive (besides doing research), and someone who has matched at Barrow is infinitely times more at an advantage than someone who matched at a low tier program, no matter how hard they work? Or does this only really apply for your first job? Would this be correct then, that medical school is more high stakes?

4. Also, what is the competitiveness of different subspecialty fellowships (neuro-oncology, spine, functional, endovascular, cerebrovascular, pediatric, epilepsy, skull base, etc.) from least to most competitive?

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