The Physician Fellowship Track: Is It for You?
October 2002
By Bonnie Darves
Editor’s Note: “A fellowship can broaden and deepen a physician’s knowledge, clinical skill, and acumen. It can also facilitate the transition to a well-rounded professional life by enabling physicians to engage in networking, organized medicine, and administrative and research activities. Most important, a fellowship can reaffirm your dedication to medicine and enhance your fulfillment as a physician.”
— John A. Fromson, M.D., Chairman of the Department of Psychiatry at MetroWest Medical Center
Assess your personal and professional goals, and if you elect the fellowship route, research your options carefully.
Physicians who plan to work and teach in an academic environment almost always pursue a fellowship because most teaching institutions require it. But for those who aren’t sure exactly how or where they want to practice, making the fellowship decision can be less clear-cut. After all, fellowships — whether one or several years in duration — delay the transition from training to active practice, often at a considerable economic cost. Yet while fellows typically remain at low earning levels until they complete the program, the investment can pay off in many ways later in their careers.
Recent consumer demand for access to specialists and the rising rate of chronic conditions among aging baby boomers mean that recruiters are targeting fellows in specialties or subspecialties. This helps explain why a growing number of physicians are pursuing postresidency training. According to data gathered by the American Medical Association’s Division of Undergraduate and Graduate Medical Education Policy and Standards, an estimated 25 percent of medical residents pursue fellowships or additional training after residency.
“Fellowships really appeal to physicians who want to focus on a subspecialty area,” says Deborah Danoff, M.D., vice president in the Division of Medical Education at the Association of American Medical Colleges. For example, an internal medicine physician who pursues a cardiology fellowship might obtain the credentials to later become head of cardiology at a community hospital — a post that a generalist might not be equipped for. In addition, Dr. Danoff says extra training, especially in procedure- or technology-intensive areas, can increase a physician’s long-term marketability. The financial bottom line: Physicians who complete fellowships generally have higher lifetime earning potential than do generalists.
The decision to subspecialize through a fellowship may also yield substantial nonfinancial benefits, says Michael Gropper, M.D., Ph.D., director of critical care medicine at the University of California-San Francisco (UCSF). “Fellowships and specialized training allow you to have a bit more control over the types of patients you see and the time you spend with them,” says Dr. Gropper, who works with fellows in UCSF’s 10-physician critical-care fellowship program.
For Love, Not Money
Economic and lifestyle benefits notwithstanding, the decision to pursue a fellowship should be based, ideally, on personal interest and career satisfaction, says Marvin Dunn, M.D., director of residency review activities for the Accreditation Council for Graduate Medical Education (ACGME) and a former medical school dean. “I give residents the same advice I gave to medical students — carefully select the field or area you think you will enjoy working in most, and you will be rewarded, regardless of the reimbursement,” Dr. Dunn says.
Michael Suk, M.D., J.D., M.P.H., past chair of the American Medical Association’s Residents and Fellows Section, chose the fellowship program he is in now — at the Hospital for Special Surgery in Manhattan — to obtain additional expertise in highly specialized orthopedic trauma and fracture work. Dr. Suk’s fellowship decision-making process was simplified somewhat by the fact that few institutions offer programs focused on such complex orthopedic cases. “Already, it’s enabled me to become more of a thinking surgeon than a technician, and it’s very fulfilling to see how surgeons can achieve the same outcomes by doing things in very different ways,” Dr. Suk says.
Like many physician-fellows, Dr. Suk chose his program for experiences that were different from the ones he’d had during residency. And when advising residents, he suggests they do the same. “I encourage residents to go into a program that will offer a perspective different than what they’ve been used to,” he says.
Checklist for Choosing a Fellowship
Look beyond basic program descriptions and statistics before applying to or making a final decision about a fellowship. The following tips will help you avoid potential pitfalls:
Talk to current and past fellows. Most fellowship programs will arrange for prospective fellows to meet with current fellows (without faculty present) during a visit to the institution, and this meeting can provide valuable insight into the pluses — and drawbacks — of the program. Ask specific questions about the scope of responsibility, work hours, and case or procedure volume. Find out whether fellows have clearly delineated responsibilities and whether teaching requirements, if applicable, are clear. In addition, talk to fellows who are two or three years out of a program to find out how the fellowship affected their professional life.
Assess the program’s stability and viability. Identifying the top fellowship programs is mostly accomplished by word-of-mouth, but you should consider factors other than the program’s reputation. For example, determine whether the program’s slots are consistently filled year after year and whether there has been frequent turnover in the directorship. A low fill rate or frequent changing of the guard may portend problems. Also, research the hosting institution to determine whether it’s experiencing — or might soon encounter — financial difficulties that could affect the fellowship.
Accreditation isn’t a make-or-break consideration, but it counts. ACGME’s accreditation system assures that programs meet standards of teaching quality, fellow oversight, and working environment, among others. Still, not all specialties require accreditation of programs, and an unaccredited fellowship may be very high quality. Some programs remain unaccredited because doing so permits them to bill Medicare for direct care of patients. Still, there are no benchmarks without accreditation, and the main objective of some unaccredited programs is to obtain relatively low-cost labor or to offload less-than-desirable procedures onto fellows.
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Resources
Accreditation Council for Graduate Medical Education, Chicago, Ill. www.acgme.org
This organization accredits fellowship programs, and its highly informative website includes a comprehensive listing and description of fellowship programs.
American Medical Association, Chicago, Ill. www.ama-assn.org/go/FREIDA
The AMA’s Fellowship and Residency Electronic Interactive Database (FREIDA) enables users to obtain information on 7,800 graduate medical education (GME) programs and 200 combined specialty programs.
Association of American Medical Colleges, Washington, D.C. www.aamc.org
AAMC’s website contains sections devoted to GME and a listing of clinical research training programs.
Council on Graduate Medical Education, Rockville, Md. www.cogme.gov
COGME focuses on physician workforce trends and training, as well as GME financing issues.
National Consortium of Residents. www.residents.org
Developed by residents for residents, this website serves as an information clearinghouse on issues affecting residents and fellows — from work hours and public policy to young physician leadership. It also facilitates an online forum (www.residentweb.com) for discussing issues and problems.
National Library of Medicine, Bethesda, Md. www.nlm.nih.gov
This website provides information on residency and fellowship programs, plus a handy listing of links to other relevant sites.
NOTE: The author, Bonnie Darves, is an independent health care writer based in Lake Oswego, Oregon.
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