a recent editorial in one of the major medical journals discussed the implications of additional post-residency fellowship training. fellowships are the medical profession’s “finishing schools. ” typically they go for one or two years after completion of a standard residency which itself can be up to seven years after medical school. therefore it is a significant investment by a young physician who already has spent much of his or her youth in training and education. fellowships are very important because as the world of medical practice — in all specialties — becomes more and more complex particularly because of new technology and science it is impossible to master all areas of the core specialty. that important editorial was written by a prominent educator in the specialty of head and neck surgery my core specialty. he noted that of the 265 trainees finishing residencies in head and neck surgery in approved american residencies 39 percent were pursuing additional fellowship training. that is an impressive percentage. the doctor felt that there were several reasons for that quest for more knowledge and experience. first and most laudable the desire for excellence. next the reality that many young doctors are now reluctant to go into private practice because of the expense the hassles of eternally battling insurance companies and more unproductive government regulation and meddling. tied to that they are going to be drawn to working at universities and other mega-sized multi-specialty medical centers. particularly with those seeking an academic affiliation a fellowship represents a great entry onto one’s resume. however the most important thing is whether or not fellowship training for some percentage of surgeons is good for patients. my stance is that it is very important. the best surgeons within narrow niches of given specialties have generally had fellowship training. here is an example from another specialty. orthopedic surgery has so many divisions that it has long operated fellowship programs. after all there are orthopedic surgeons who sub-specialize in spine surgery hand surgery pediatric orthopedics and sports medicine. now there are orthopedic surgeons who do only joint replacements. a subset of that group are the superspecialists in artificial hip placement or artificial knee replacement. this is good for patients because it brings to them the most narrowly focused finely tuned specialty talent. whether you are considering having shoulder replacement or a hernia repair or cosmetic nasal plastic surgery you are generally in the best hands when those hands have been trained by a fellowship.
how much specialty training should physicians have?