Thursday, July 16, 2015

Physicians Choosing Fellowship as Medicine Becomes More Specialized, Competitive

More physicians are turning to fellowships — additional, specialized training after they become doctors — to serve patients in need of more specialized care, reports Texas Medicine, the Texas Medical Association’s (TMA’s) monthly physician publication. Doctors also find doing so can ensure the long-term viability of their practice.

After medical school, graduates continue their training in a medical specialty, such as internal medicine or emergency medicine, known as residency. A fellowship is additional training post-residency in a medical subspecialty, such as cardiology or hospice and palliative medicine.

2015 was a record year for fellowship appointments, according to the National Resident Matching Program. Fellowship programs filled nearly 90 percent of the 8,500 positions available, and 80 percent of programs filled all of their positions.

Fellowship positions have been on an upward trajectory since 2000, outpacing the growth rate of residency positions, according to the Accreditation Council for Graduate Medical Education. Most of the training is in more traditional specialties such as cardiology and gastroenterology, but in the past 15 years, new subspecialties have cropped up such as sleep medicine, and hospice and palliative care.

For the most part, physicians choose a particular area of expertise based on what they are passionate about. But now physician trainees are increasingly aware of the technical, financial, and lifestyle pressures facing them in today’s workforce, and say fellowships can help them fill a specific need and give their practice an edge.

“We have to be competitive. We have to provide good quality care. And everyone — Medicare, Medicaid — is looking at your performance,” said Hind N. Moussa, MD, a Houston obstetrician-gynecologist (OB-Gyn) and fellow in maternal-fetal medicine at The University of Texas Medical School at Houston. “With all of these changes, it makes sense to subspecialize to meet all of these new requirements to prove you are providing the best quality care.”

Before deciding to pursue her fellowship, Dr. Moussa worked five years as a general OB-Gyn, often referring many of her patients hours away for subspecialty care or filling in gaps when she could by providing some tests they needed immediately. She knew there was a nationwide shortage of maternal-fetal medicine specialists. “I had a great job,” she said. “My practice grew. But I really wanted to go back [into training] and felt like I could do more for high-risk patients.”

Angela Siler Fisher, MD, an emergency physician and director of the emergency medicine administration fellowship at Baylor College of Medicine, uses fellowships to arm physicians-in-training with leadership skills to cope with practice pressures. She says fellowships help create physician leaders and increase quality of care.

“Specialization is a good thing because you want experts taking care of you,” Dr. Fisher said. “We’re going to continue to see increases in fellowship and, as a result, stronger physician leaders in a position to advocate for their patients in a more meaningful way.”

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