FELLOWSHIP TRAINING
After completing four years of medical school
and several years of residency, many
physicians consider seeking a fellowship for
training in a subspecialty. While still in med-
ical school, additional training beyond the
residency is considered remote but this attitude
is reversed in the course of time. By gaining an
awareness of the advantages of subspe-
cialization, trends in various medical
disciplines, and the challenge involved in securing a
suitable fellowship, one can more easily decide
if this is an appropriate course to follow.
Motivating factors influencing residents to
pursue fellowship training vary. For
some, the issue is to enhance the marketability
of their own specialty. Others are con-
cerned with the issue of variety of work
experience, while some seek the special chal-
lenge that certain subspecialties present, such
as critical care, neonatology, etc.
Financial remuneration is also significant when
considering subspecialization.
While primary care physicians are now in
increasing demand, specialty practices are
financially more rewarding, as specialists
perform more billable procedures. In addition,
their patients are more likely to have medical
insurance.
Subspecialization is also attractive to some
because of its implied higher status
within the medical community. Being interested
in a limited area makes it easier to keep
abreast of new information and technological
advances in a particular field. A subspe-
cialist also usually has a more routine work
schedule. Thus, all the aforementioned fea-
tures have resulted in the increased
attractiveness of subspecialization in recent years.
While the number of medical school graduates
choosing an internal medicine residency
has declined somewhat, the number of those
electing to subspecialize in this field has
remained high. Some subspecialties are
attracting more candidates than others. There
has been some decline in interest in
hematology, rheumatology, endocrinology, geri-
atrics, and infectious diseases. On the other
hand, the fastest growing subspecialty
within internal medicine is critical care, due
to the fact that it is an action-oriented area.
The demand for this type of subspecialty will
continue to grow as more hospitals offer
high tech procedures such as open heart surgery
and organ transplants.
Another very popular field is pediatric
emergency medicine, with a substantial
increase in the number of fellowships
available. Orthopedic surgery is still another area
where subspecialization is very common. Areas
of special interest include orthopedic
oncology, knee reconstruction, and hand and
spine surgery. Subspecialization is also
increasingly common among radiology
residents.
During medical school and residency, the
individual has to focus on the clinical side
of medicine. After the residency, research
becomes important. This includes developing
a suitable project, collecting data, and
analyzing and reporting the results. Potential fel-
lows should determine in advance where research
funding will come from or if they
must secure it on their own. Candidates should
determine the extent of interest of the
fellowship program in generating publications,
especially if the program is academically
oriented. This can be ascertained by inquiring
about the program's publication record
and if it supports fellows in presenting
abstracts of their research at academic meetings.
Fellowship candidates should try to determine
the strength of the director's commitment
to the program, so as to judge the extent of
support they can anticipate.
It is useful to determine in advance the role
of the fellow in the program to find out
if the staff position, while an important one,
does not place an excessive burden on the
individual. Knowing the number of attendings
and residents available to assist can help
determine if the fellowship will merely serve
to fill a resident gap, or if it will be a gen-
uine advanced training position. Obtaining a
current copy of the conference and call
schedule can provide a good insight into the
nature of the position. The number of fel-
lows in a program is also important, because
the environment is more stimulating when
a group that is on a similar educational level
is working together.
Accreditation of fellowship programs varies. It
usually takes place after being estab-
lished at a large hospital that has an adequate
number of fellowships. When a program is
not accredited, it is important that the
program director have a strong enough reputation
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