CHAPTER 4
THE IMPORTANCE OF A FELLOWSHIP: JUMP START YOUR ACADEMIC CAREER By David S. Howes MD, Professor and Residency Program Director, Section of Emergency Medicine, University of Chicago, Chicago, IL, and William Northington MD, Emergency Medical Services Fellow, University of Pittsburgh, Pittsburgh, PA Fellowship training may necessitate a delay in earning a large salary and it may be difficult for a senior resident to turn away from clinical practice with fewer work hours and a larger salary. Compensation packages may vary greatly, particularly when the fellowship is not an ACGME accredited fellowship. Once free of the traditional housestaff pay scale, non-accredited fellowships may offer higher salaries. It is important to appreciate that fellowship training in Emergency Medicine does not often lead to the substantial salary increases that accompany subspecialty certification in other primary care specialties. The majority of fellowship-trained Emergency Physicians will continue to work clinical hours in the Emergency Department in addition to practicing in their specialty area in order to sustain a viable income.
The number and variety of fellowships in Emergency Medicine has grown substantially over the last two decades in response to broader areas of interest. Witness the popularity of International Emergency Medicine in the last five years and more importantly, the recognition by graduating residents that the skill set of a successful academic physician may not completely be provided by an Emergency Medicine residency training program. It may also be a response to the marketplace: graduates of fellowships have more to offer than graduates straight out of training and are able to obtain an academic faculty position because of this. After all, the fellowship training period offers an emergency physician dedicated time to further develop one’s skills in an area of interest, gain training in the medical, educational and scholarly aspects of that interest, and allows one to establish an area of expertise within the broader field of Emergency Medicine. For a good overview of whether a fellowship is right for you, review the Fellowship section of the new SAEM website at www.saem.org.
Further analysis might suggest that fellowship training may qualify the graduating fellow for an academic position in which the work hours, though often longer than in the private sector, are a balance of clinical hours spent working with residents and medical students, and time spent pursuing academic interest. Though there are no long term studies assessing the career satisfaction of fellowship trained Emergency Physicians; it is likely that the payoff in fellowship training includes the perception that there is longevity in an academic environment and the prestige associated with training medical students and resident physicians. Contributing to the body of knowledge in Emergency Medicine through research also contributes to career satisfaction.
The two most important elements that a fellowship provides is the time to pursue an area of interest and a relationship with a more senior faculty member(s) in order to effectively pursue an educational goal. A fellowship also allows an emergency physician to identify and develop a niche. A fellowship program allows young physicians to pursue specific interests and acquire a specific skill set during protected time with a reduced number of clinical shifts. These programs also provide an established mentor who will help guide and shape the fellow into a developing academician. Desirable fellowship programs may allow the pursuit of a post-baccalaureate degree to complement the additional training. Depending on the area of interest and the institution, the degree earned is typically at the Master’s level in an area that complements the Emergency Medicine area of interest, e.g. pursuing an MBA is a sound strategy for the physician who is completing an Administrative Fellowship, a Master in Health Professions Education is perfect for the person seeking expertise in medical education, an MPH or MS for Research, etc.
Types of Fellowships Five fellowships are approved by the ACGME and recognized by the American Board of Medical Specialties (ABMS). Completing these fellowships allows access to the ABMS board certification pathway in Hyperbaric and Undersea Medicine, Hospice and Palliative Care, Pediatric Emergency Medicine, Sports Medicine, and Toxicology. Since many other fellowships do not lead to ACGME accreditation, what is the benefit of undertaking one of these programs? Fellowship training may not be a prerequisite to holding a job in one of these specific fields (e.g. many EMS medical directors have not completed an EMS fellowship), but the fellowship offers specialized training that will provide relevant experience in the field and better prepare the fellow for a job in that field. Most fellowships last one to two years. Pediatric Emergency Medicine is a minimum of two years and is often three years in length. The Pediatric Emergency Medicine Fellow often has the opportunity to pursue an advanced degree in an associated graduate school. For an extensive listing of fellowships offered, please visit the Fellowship Catalog on the SAEM website.
Fellowships in Emergency Medicine vary a great deal from site to site and there are no standardized curricula for most fellowship experiences except those accredited by the Accreditation Council for Graduate Medical Education (ACGME). Completing an ACGME accredited fellowship allows a candidate to seek board certification in that specialty. The Society for Academic Emergency Medicine has published guidelines for Emergency Medical Services and Research Fellowships but there is no requirement that programs follow these formats. 10