Are fellowships the new normal?

[bokelley]

We met with some friends from the hospital.

Different specialities and it looks like fellowships are the new normal. For radiology, it is almost a must to land a job and some do double fellowships. Surgery seems to be heaving into fellowships.

I guess for most people in medical school or even pre/med. can assume they will have intern year, residency and possible fellowship. It make the whole journey seem that much longer.

Any thoughts on this, also are we creating doctors who are too specialized?

[MrsK]

Specialists make money. General practitioners do not. Logically, fellowships would become more popular in that climate. Sort of how MBA's became standard and college degrees were not sufficient.

[medpedspouse]

Some subspecialists make money. DH's subspecialty does not have any procedures. No procedures = no big reimbursement. But they do save the hospital money.

[TulipsAndSunscreen]

A lot of Uro job openings say "fellowship trained" but I know that they will take applications for non fellowship trained docs. They prefer it because frankly it's just another credential that people want. Also, with the limitations now in duty hours, there is some sentiment in the surgical community that you need fellowship to have the same training volume you used to get in residency. I have no idea if that's true but people think that....

[Auspicious]

I don't have the link handy, but last I saw, in pathology 90-something percent do a fellowship and I think 30-something percent do a second fellowship on top of that.

You're not really going to get "too specialized" in private practice pathology, because most places hire people to do their share of the general pathology plus the tough/questionable cases in their subspecialty. So my if my husband gets a derm case that's clear-cut, he just signs it out. If it's questionable, he sends it over to the practice's fellowship-trained dermatopathologist. And she's sending her tough heme cases to him. So you can see how two fellowships becomes much more attractive to a practice than none.

Each subspecialty becomes more and more complex as the field advances. Within living memory we've gone from only diagnosing hodgkins vs. non-hodgkins lymphoma to dozens of subtypes. So I don't see how we could go backward from the high number of fellowships we have now.

[JDAZ11]

My DH had to do a fellowship to do what he wanted. Although, lots of people do infolded fellowships, and then don't waste the extra two years. BUT mine also wanted a very academic job, so he wanted to do two years of research during residency.

For both of us, fellowship was like an amazing vacation. Looking back, even knowing now what we were giving up financially, I'm not sure either of us would vote for him to skip it.

[PrincessFiona]

I think mid-level providers will be taking over primary care, so there will be fewer jobs for docs. In the state of mn almost no male residents stopped after residency this year. Most went on to fellowship. More females stayed with primary care which might make it easier to go part-time.

[SuzySunshine]

In neurosurgery it's definitely practice dependent, to do what DH does you have to be fellowship trained to be spine you have to fellowship trained and to do deep brain stimulation you have to be fellowship trained. He has three guys in his group they're not fellowship trained one of them though has about 12 years experience and does a lot of vascular and tumors the other two are fresh out of training with no fellowship and they basically get the leftovers. For one of the guys that's not an issue he likes to do a little bit of everything, for the other guy it is an issue he has tried to do things that he's not fellowship trained in and a few people have stopped referring stuff to him because of it.

[GrayMatterWife]

In neurosurgery it's definitely practice dependent, to do what DH does you have to be fellowship trained to be spine you have to fellowship trained and to do deep brain stimulation you have to be fellowship trained. He has three guys in his group they're not fellowship trained one of them though has about 12 years experience and does a lot of vascular and tumors the other two are fresh out of training with no fellowship and they basically get the leftovers. For one of the guys that's not an issue he likes to do a little bit of everything, for the other guy it is an issue he has tried to do things that he's not fellowship trained in and a few people have stopped referring stuff to him because of it.

As far as I know, you have to be fellowship-trained if you want to go anywhere in academics. Heck, nowadays, even in academic NSG, an MD-PhD is not considered "overtrained"--it is often highly desirable.

SuzySunshine nailed in for NSG. My hubbie does a lot of DBS and you must be fellowship-trained. Also, while you CAN practice pediatric NSG without a fellowship, you would never get hired in academics. It is an prerequisite for pediatric NSG.