The specialty of pathology and laboratory medicine has entered a phase in which the 4-year sequence of residency training is almost universally followed by 1 or more years of subspecialty fellowship training. Such training may occur in an American Board of Pathology-recognized subspecialty or any number of "subspecialty fellowships" that do not lead to subspecialty board certification. Unlike the application process for first-year pathology residency, which is run through the National Resident Matching Program, applications for subspecialty pathology fellowships have no consistent coordination. Responding to widespread dissatisfaction voiced in 2007 by national pathology resident organizations, the Association of Pathology Chairs began evaluation and potential intervention in the fellowship application process. After 3 years of effort, the Council of the Association of Pathology Chairs has recommended implementation of a pathology subspecialty fellowship matching program starting in the 2011-2012 recruiting year for applicants matriculating in fellowship programs in July 2013. We report on the data that informed this decision and discuss the pros and cons that are so keenly felt by the stakeholders in this as-yet-incomplete reform process.