Why only 3 year fellowships

[Perrotfish]

Discussion topic: why does Pediatrics only have 3 year fellowships? I get a few of them: NICU, Cards, and PICU fellowships all seem to make sense as 3 year training programs, but why everything else? Why do fellowships like Adolecent or Peds EM, jobs still primarily performed by pediatricians without fellowship, take 3 years to train in? Why do fellowships like Nephrology, ID, Pulm and Gastro, which are almost half research and which don't significntly increase your after fellowhship pay, 3 years long? Why don't we follow the family practice model and have six month or one year fellowship for General pediatricians who want to stay outpatient but focus on a particular subset of their outpatient medicine, like sports medicine, ER, and adolescent? Why don't we have shorter, 1 or 2 year fellowships in the subspecialties for people who are willing to sacrifice some research time to practice sooner?

I would like to know if there are any opinions on why we stick with such a time intensive model of training. Also, does anyone know if there is anyone out there working to evaluate and possibly change how we train?

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[RySerr21]

allergy/immunology is 2 years, i think thats the only one that isnt three... i am hearing more and more people talk about in the future there being tracks for people who don't want to do intensive research (which to my understanding is why they are all 3 years) than can get out in 2 years or so. i dunno how far away we are from this happening but sounds like a lot of people have the same opinion as you do

 

[oldbearprofessor]

Allergy/immunology fellowships are not organized or sponsored by the AAP or any of its subgroups. Please see http://www.nrmp.org/fellow/match_name/allergy/about.html for more details. They can be two or three years and include some time training in adult medicine related to these fields even for those whose residency was in pediatrics.

All of the subspecialties currently organized by the AAP are three years to the best of my knowledge. I'm not sure about the upcoming plans for pediatric hospitalist medicine. Does anyone here know?

Now then, lets go back and explore the history and current situation related to the original question. I've been around long enough to watch these transitions. 😱

When I was in training, fellowships were only 2 years. Beginning in the late 1980's (specifically for fellows entering training in 1987 or 1988) the governing boards changed all of the pedi specialties to 3 years. This was not done by the comparable governing boards in internal medicine. The rationale, and I believe the ONLY real rationale at the time was the belief that pediatric specialty training should be designed to produce physician-scientists and that 12 months clinical and 12 months research was not enough to complete a serious research study as a fellow.

This rationale may not really be as relevant today. First, we have a serious shortage of subspecialists in the "lower paying" fields such as pedi rheum, endo, etc. The financial and personal toll of doing three extra years is considerable and keeps many away. Whether going to two years (less isn't going to happen) would improve that is unknown. Second, the debt load and changes in academics lead many doing fellowships to not do much or any research and having a fellowship of 3 years with 50-60% of time as research may not be a good trade off of time and money.

Yet, there is relatively little impetus to the best of my knowledge for a change to occur. Don't shoot me, I'm just the message deliverer, I have no role in this issue at all. One thing that may limit enthusiasm for a change are the work hour rules that affect both residents and fellows. Some may feel that new fellows enter with less knowledge and experience than in the past and that fellows are working fewer hours with less training opportunities. I'm open to seeing actual data about these issues, not just guesses and have no strong opinion about it without any real data.

Regardless, although advocacy through the AAP and resident groups is always a good idea, I'm not expecting much change in the 3 year rule in the near future if ever.

 

[mdphd2b]

Allergy & Immunology are 2yr.
Sports Medicine and Sleep Medicine are 1yr.
Peds grads can also apply to Toxicology, which I think is 1 yr.

I think as OBP suggests, if you apply for these fellowships, you are competing with IM applicants too.

I'm in Pedi GI fellowship now, but the research years are ideal for me because that's what I wanna do.