Residency vs. Fellowship

[deuce924]

I have been to the ACGME website but really haven't gotten a good answer on this topic. Who decides whether a specialty requires a residency or a fellowship post an IM Residency? For example, why is Neurology a residency while Cardiology or Pulmonology a Post-IM Fellowship? It seems strange that some require a residency and some don't. I am interested in Cards but am hesitant of risking not matching once I am in the IM Residency. Thanks for the help.

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[Winged Scapula]

I have been to the ACGME website but really haven't gotten a good answer on this topic. Who decides whether a specialty requires a residency or a fellowship post an IM Residency? For example, why is Neurology a residency while Cardiology or Pulmonology a Post-IM Fellowship? It seems strange that some require a residency and some don't. I am interested in Cards but am hesitant of risking not matching once I am in the IM Residency. Thanks for the help.

Huh? Everything requires a residency.

Neurology is a residency requiring a Prelim Year in IM; some programs are 4 years in length and include the intern year in IM.

Cards is a fellowship, or subspecialty of internal medicine and requires completing an IM residency.

If you are interested in Cardiology, the only way to become one (currently) is to complete an IM residency and Cards fellowship. There are no guarantees.

Is it the Prelim IM year in Neurology that is confusing you?

 

[Renova]

I think the OP is asking why a specialty like neuro has its own dedicated residency programs whereas cards/pulm are fellowships after IM. He/she is interested in cards, but is afraid of not matching into the fellowship after an IM residency.

 

[mercaptovizadeh]

I think neuro is likely a separate residency for historic reasons (i.e. the links with psychiatry). That and obviously they don't think you need the same extent of integrated internal medicine knowledge you need for cardiology (just 1 yr. vs. 3). If you look at the bios of many neuros at academic centers, it seems that many did do neurology after a complete IM residency.

OP: cardio, pulm, GI, renal, endo, etc. need to do an IM or peds residency first because they need to understand how these systems interrelate and just basic medical knowledge. You could never do a 3 year cardio residency out of med school - if you dropped IM as a prerequisite, the cardio "residency" would probably have to be 5 years and incorporate all the most pertinent aspects of IM to prepare you for the "real" cardio years.

 

[deuce924]

I apologize for the confusion. I think I over-simplified my question. I understand all specialties require at least a residency. I also understand that if Cards was a residency it would be longer than the 3 year fellowship. My question is who decides whether a specialty requires a fellowship or a residency? For example why make GI, Endo, Renal, and Cards (to name a few) fellowships post IM and not just stand alone residencies that would last 5 years? Thanks for help.

I have talked to ENTs who trained a while back and said that their ENT training was a fellowship of general surgery residency. Now I know it has it's own residency programs just like Neuro Surg, Ortho Surg, and Plastics. Who makes these decisions to create the programs? Thanks again for the help and sorry to bother all you guys.

 

[Dimoak]

I have talked to ENTs who trained a while back and said that their ENT training was a fellowship of general surgery residency. Now I know it has it's own residency programs just like Neuro Surg, Ortho Surg, and Plastics. Who makes these decisions to create the programs? Thanks again for the help and sorry to bother all you guys.

I could be completely wrong (not an expert), but I'm not sure if matching into Plastics is similar to how one would match into NSurgery or Orthopædics. Plastics is generally a post GSurgery fellowship, but you can also match into an integrated program where you're essentially accepted into a Plastics track that would begin after completing a certain amount of GSurgery years, where the resident would function essentially as a GSurgery housestaff. This is sorta different from NSurgery and Orthopædics, where the resident would be a housestaff in the respective specialty they matched into right off the bat (even though they may be working on other services at various points). You have the option of doing a Plastics fellowship after a GSurgery residency, but you cannot gain Neurosurgery or Orthopædics board eligibility by just doing a post GSurgery fellowship. In terms of deciding what kind of training (and how long) would be necessary to gain Board Eligibility in a field, I believe this is determined by the actual specialty board in conjunction with the ACGME and programs offering the training. If these bodies believe that the modern training program for a certain field or specialty should be altered in order to improve the quality of education and competence of graduates it provides, they will toggle it appropriately. Recent examples would include the integrated Vascular surgery track and the removal of the GSurgery year from NSurgery residency. Hope that helped somewhat.

 

[deuce924]

Thanks for the help. I think I get it now. Just confused on who actually made these decisions. Thanks again.

 

[Trifling Jester]

I think neuro is likely a separate residency for historic reasons (i.e. the links with psychiatry). That and obviously they don't think you need the same extent of integrated internal medicine knowledge you need for cardiology (just 1 yr. vs. 3). If you look at the bios of many neuros at academic centers, it seems that many did do neurology after a complete IM residency.

It is my understanding that neurology used to be a fellowship after a complete internal medicine residency, like cards GI etc.

-The Trifling Jester

 

[mercaptovizadeh]

It is my understanding that neurology used to be a fellowship after a complete internal medicine residency, like cards GI etc.

-The Trifling Jester

I was thinking of that, because of so many old neuro resumes reading with 3 years IM and then 3 years neuro. Just wasn't sure because at least in Europe it used to be neuropsychiatry (at least my grandmother was), so I thought it was the same in the states.

Don't understand why they changed it, one would think broader training in IM would make you a better neurologist.

 

[Vader]

These decisions are made by the accrediting bodies/agencies. In order to be board certified in a specialty, you need to fulfill the requirements for that specialty. The accrediting boards change their requirements from time-to-time when they feel it is in the interest of their specialty to modify training requirements.

Neurologists do benefit by the prelim medicine year, but I doubt that an additional 2 years of IM residency would make a significant difference in the ability of most neurologists to manage the major clinical problems they focus on in the specialty. I think the additional experience would benefit neuro-hospitalists the most since they are more often dealing with the patient's non-neurological medical problems.

 

[DrJosephKim]

Every specialty organization has a professional medical board that provides certification (board certification). They operate independently and I'd have to guess that it's a matter of internal politics when it comes to these types of issues.

 

[oldbearprofessor]

I apologize for the confusion. I think I over-simplified my question. I understand all specialties require at least a residency. I also understand that if Cards was a residency it would be longer than the 3 year fellowship. My question is who decides whether a specialty requires a fellowship or a residency? For example why make GI, Endo, Renal, and Cards (to name a few) fellowships post IM and not just stand alone residencies that would last 5 years? Thanks for help.

I know you asked about IM and got the answer, but I wanted to make a few comments about the pedi side of this same question. It is the opinion of the program directors (of which I am not one...) that pediatric specialists should be fully trained as pediatricians before beginning their specialty. There are some shortened ways to do this (fast track) in special circumstances, but most do a full 3 years residency and then 3 years fellowship.

A benefit to this is that a lot of folks change their mind about whether to do a fellowship and which one to do while residents. It is easier to switch when not doing coordinated programs.

A disadvantage, that you pointed out, is that if you go into the field ONLY interested in one subspecialty, you might not get it or might not get it where you want to go for the training. This isn't a big problem in general for pedi (with the possible exception of pedi EM and pedi cards), but is a reminder that one goes into pedi (and presumably IM) recognizing that one may not get the exact fellowship of choice.