Excessive Fellowships?

[Miami_med]

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I was wondering what the general mindset is on the fellowship issue here?

I've noticed that we have new felloships popping up for Hospitalist work and urgent care. The more I think about it, I realize that the ridiculous fellowship system that we are creating will stifle any career flexibility in the future. People are going farther into their working lives with minimal income and reduced career options because of this system. Why does medicine have to work this way?

Who really needs an extra fellowship to do urgent care? Many people who work in these places aren't even board certified in anything. Who needs an extra hospitalist fellowship? Shouldn't anyone with decent IM training be able to handle this?

Just looking for opinions.

Thanks

 

[TIVA]

I think there a couple of things that are driving this trend to greater fellowships:

1. Hospitals and departments are looking for cheap labor and if they can get it in the form of a fellow, why not? After all, they only have to pay the fellow $50 grand whereas they'd have to pay an attending well over $100 grand.

2. Residents themselves don't feel prepared to face the outside world upon completing their residency. Thus, they feel doing a year or two of fellowship will improve their clinical acumen and give them more confidence to practice in the real world. Plus, it'll be another feather in their cap if they can say they've done a fellowship.

Personally, I'd say a hospitalist fellowship along with the urgent care fellowship is complete and utter garbage. I've seen senior residents moonlight in both of those fields. Thus, a fellow-trained attending in either of those two fields is overkill. However, there are other fields where further subspecialty training necessary (i.e. cardiology, GI, critical care, etc ... ).

 

[Miami_med]

I think there a couple of things that are driving this trend to greater fellowships:

1. Hospitals and departments are looking for cheap labor and if they can get it in the form of a fellow, why not? After all, they only have to pay the fellow $50 grand whereas they'd have to pay an attending well over $100 grand.

2. Residents themselves don't feel prepared to face the outside world upon completing their residency. Thus, they feel doing a year or two of fellowship will improve their clinical acumen and give them more confidence to practice in the real world. Plus, it'll be another feather in their cap if they can say they've done a fellowship.

Personally, I'd say a hospitalist fellowship along with the urgent care fellowship is complete and utter garbage. I've seen senior residents moonlight in both of those fields. Thus, a fellow-trained attending in either of those two fields is overkill. However, there are other fields where further subspecialty training necessary (i.e. cardiology, GI, critical care, etc ... ).

Yes. I'm not talking about the traditional medical subspecialties. It is the specialities like "hospitalist" and "urgent care" that I am referring to. Obviously most internists aren't prepared to do Invasive Cardiology, but I would say that anyone who has reasonable internal medicine training should be able to do these things.

What worries me is the legal issues. Soon, everything done in the hospitalist role will be criticized if it is not done by a fellowship trained hospitalist. In communities with these fellowships, the internests that often take these jobs will be seen as being "below the standard of care" by the legal system.

 

[Faebinder]

What worries me is the legal issues. Soon, everything done in the hospitalist role will be criticized if it is not done by a fellowship trained hospitalist. In communities with these fellowships, the internests that often take these jobs will be seen as being "below the standard of care" by the legal system.

Yes agreed there 100%.... the bar keeps going up.

 

[3dtp]

I think there a couple of things that are driving this trend to greater fellowships:

1. Hospitals and departments are looking for cheap labor and if they can get it in the form of a fellow, why not? After all, they only have to pay the fellow $50 grand whereas they'd have to pay an attending well over $100 grand.

2. Residents themselves don't feel prepared to face the outside world upon completing their residency. Thus, they feel doing a year or two of fellowship will improve their clinical acumen and give them more confidence to practice in the real world. Plus, it'll be another feather in their cap if they can say they've done a fellowship.

Personally, I'd say a hospitalist fellowship along with the urgent care fellowship is complete and utter garbage. I've seen senior residents moonlight in both of those fields. Thus, a fellow-trained attending in either of those two fields is overkill. However, there are other fields where further subspecialty training necessary (i.e. cardiology, GI, critical care, etc ... ).

Bullseye! This is a hospital scam to compensate for the 80-88 hour work week. Gotta make up that extra 30-30 hours / resident somehow.

Duke came up with the Brilliant idea that they should start a "residency" for PA's. I hope they're not biting. The scheme was blatently justified by saying they could get PAs for $30k/year for a two year "residency" and they weren't hamstrung by the then new 80 hour work week.

Concerning raising the bar: Show me the evidence! This is supposed to be evidenced based medicine: Show me the randomized controlled prospective studies that demonstrate we have a problem, other than the hospitals wanting to make more money. Years ago, a year of internship and you went to work. Then it was do a residency and become a specialist, now residency is mandatory and GPs are gone. Since everyone is a specialist, the PAs and NPs are lobbying to replace them. Are we really going in the right direction or are we catering to the greed of those who own training programs?

 

[Faebinder]

Bullseye! This is a hospital scam to compensate for the 80-88 hour work week. Gotta make up that extra 30-30 hours / resident somehow.

Duke came up with the Brilliant idea that they should start a "residency" for PA's. I hope they're not biting. The scheme was blatently justified by saying they could get PAs for $30k/year for a two year "residency" and they weren't hamstrung by the then new 80 hour work week.

Concerning raising the bar: Show me the evidence! This is supposed to be evidenced based medicine: Show me the randomized controlled prospective studies that demonstrate we have a problem, other than the hospitals wanting to make more money. Years ago, a year of internship and you went to work. Then it was do a residency and become a specialist, now residency is mandatory and GPs are gone. Since everyone is a specialist, the PAs and NPs are lobbying to replace them. Are we really going in the right direction or are we catering to the greed of those who own training programs?

You know I didnt mean it that way... the bar is beign raised regarding who can do what but the question is exactly as you stated... is there a difference between an internal medicine attending who just finished residency and 1 year of post residency experience vs an internal medicine attending who finished residency and a year fellowship as a hospitalist? I suspect the answer is no.

Hospitals aren't the only ones fueling this... Turf wars are doing it as well.