Endocrine

[sophiejane]

Is endo a fairly competitive fellowship to get? I'd like to stay in the midwest, and don't need to get into a "top" program, but I'd like to know what I should be doing now (MS1.5) to get into a decent endocrine fellowship. Any thoughts on good programs in the midwest?

Thanks.

 

[lurkerboy]

aren't you a bit ahead of yourself?

endocrine is not especially competitive. there are two sorts of fellowships, ones that are mostly clinical, and others that are research oriented. MGH for example has a 3yr fellowship with 1 yr being clinical the rest being research. I think the research fellowships are the more competitive ones.

 

[asm3]

Don't worry about it at this point - however, particularly in the midwest, endocrine is perhaps the easiest fellowship to get of the IM subspecialties. The best thing you can do for yourself is to focus on the boards...

 

[ys]

Endocrine is amongst the least competitive IM fellowships.

 

[Da Vinci2]

Endocrine is easy. My program has 2 slots and they get 3-4 applicants a year and take mostly in-house candidates. If you go to a residency that has endocrine fellowship, you are pretty much set.

 

[sophiejane]

Thanks so much.

Yes, I'm ahead of myself. Guess it's better than being behind. But thinking about the future shouldn't take so much time that I can't study for the boards...

Thanks again.

 

[Linie]

I concur, having recently been through the fellowship interview process for Endocrine (to start july 2004): It's not competitive. Maybe because it's not a sexy, high octane specialty like Cardiology or Critical Care? I decided to do it bc (1) I want to subspecialize but still be able to practice general medicine, (2) I like diseases that affect the whole body, and (3) it seems endocrinopathies are often the answer to the really interesting cases with mysterious presentations (perhaps second only to Rheum). (4) I also wanted to have regular hours to facilitate having a family.

I considered Rheum, and was quite devoted to it for a while, until I realized (a) I hate fibromyalgia, and (b) Rheum diseases are so vague! With endocrine you have symptoms, you have a series of tests to rule diseases in or out, and then you have treatments that are straightforward, and you have numbers that you can watch to monitor response. What could be more satisfying? Contrast that with Rheum where the disease is some nebulous overlap of two oddball diseases, the treatment is toxic, and the monitoring consists of tracking symptoms that are often so vague.

 

[lurkerboy]

I think there is also something intriguing about a field where levels and dosages are very precise to the point where you can tweak dosages in the micrograms.

Generally patients in endocrine are super-complient, too. I think Type II DM is the only frustrating type of patient you would see.

 

[diesel]

To be honest, I don't see the point in doing a fellowship in endo., because an internist refers out to specialists when he needs a procedure done like cards, pulm, gastro. Otherwise, a general IM is trained in all aspects of endocrinology.

 

[ckent]

Originally posted by diesel
To be honest, I don't see the point in doing a fellowship in endo., because an internist refers out to specialists when he needs a procedure done like cards, pulm, gastro. Otherwise, a general IM is trained in all aspects of endocrinology.

I don't agree with this statement. Internists can regularly manage bread and butter cases of type II diabetes and hypothyroidism, but out in practice, I have noticed that most tend to refer to endocrinologists anyways simply because they don't want to deal with it (can take longer then a 5 minute office visit, and they have to stay up to date on current management guidelines). Also, endocrinologists typically have resources like dieticians and can do more patient education for things like type II diabetes. For type I diabetes, those are almost universally referred to endocrinologist for management since there are so many forms of insulin one can be taking. For every other endocrinologic disorder, I think that internists will generally refer to an endocrinologist. I've never heard of an internist doing a dexamethasone suppression test in his or her office, and many of the other types of endocrinological disorders require decisions to be made about whether or not surgery is indicated or whether or not medical management can be continued. These questions are sometimes better left to the expert. These days, medicine is becoming more and more subspecialized and many internist and FP's simply don't want to deal with any disease, they call the subspecialist early and often. An ID doctor was telling me how in private practice, internists will even routinely call ID specialists to manage things like cellulitis or regular pneumonia in the in-patient setting. They literally just follow specialty reccomendations, I guess it saves them time so that they can see more patients and just let the specialists worry about gathering the history and coming up with appropriate treatment plan.

 

[lurkerboy]

I agree with ckent but would add that while some of the bread and butten endocrine issues can be managed by an internist, there can be very complicated endocrine issues that are best left to the specialist. Even in endocrine there are sub-sub-specialties in neuroendocrine, thyroid, diabetes, etc... so obviously there is some need.

 

[Linie]

Otherwise, a general IM is trained in all aspects of endocrinology.

In an ideal world generalists would only need specialists for procedures, but that just isn't the case in real life these days. I agree with ckent and lurkerboy: any generalist should be comfortable with Type II DM and hypothyroidism, but even those patients get referred to specialists sometimes! I refer my diabetic clinic patients to diabetes clinic when they're hard to manage or I think they could benefit from some quality time with a diabetes educator or nutritionist. Kudos to the generalists comfortable managing panhypopituitarism, acromegaly, pheo, thyroid CA and other less common endocrine diseases. For the rest of the generalists, I'll be here, psyched to see the patient.

 

[diesel]

This is really interesting, you guys are pretty much saying an IM can only do the same as an FP. I dont see the big deal about ordering a dexamethasone suppression test, as I see PA's ordering them. I also see PA's managing Type I, II DM for that matter.

 

[lurkerboy]

You are just flamebaiting, dude. No one is saying that...its just that there is a role for endocrine sub-specialists for the more complicated cases. Clearly, if internists didn't feel comfortable with vanilla DM or thyroiditis, endocrine would be a larger specialty.

 

[sophiejane]

Linie, I PMed you.

sj

 

[Linie]

sophiejane- it didn't work! try again.