Texas Medical Association Resident and Fellow Section saw an opportu- nity to serve a population of patients in need of more specialized care and to ensure the long-term viability of her practice. “There’s a lot of competition to
“Science is exploding. We’re not in a time when general practitioners can do everything.”
have a better job and a better lifestyle and be competitive for good jobs,” Dr. Moussa said. “But money isn’t the only driver. We spend three years on our fellowship. That’s three years of lost income. So you also have to think about whether this is something you can live with as a career and some- thing you love, because it is still very demanding.”
SUBSPECIALTIES GROW Dr. Moussa is among many physicians who go on to hone a subspecialty through fellowship training. In 2015, a record-setting year for fellowship appointments followed what was the largest Main Residency Match to date, according to the National Resident Matching Program (NRMP). (See “The Age of Subspecialization,” page 42.)
As with residency, educators em-
phasize that wher- ever fellows train they tend to prac- tice, making reten- tion critical to an adequate physician workforce. As sub- specialties grow, however, some ques- tion whether the trend is also narrow- ing access to needed general care, for ex- ample, primary care, general surgery, gen- eral obstetrics, or general psychiatry. The NRMP Specialties Matching
and 80 percent of programs filled all of their positions. Because fellowship matches occur throughout the year, the data are for matches conducted in 2014 and early 2015 for appointments beginning in July. Those numbers reinforce years of
TMA advocacy for investments that ensure a steady physician supply in a state facing shortages across special- ties, says Christian Cable, MD, a mem- ber of the TMA Council on Medical Education and director of the hema- tology-oncology fellowship at Baylor Scott & White Health in Temple. “All postgraduate [medical] education is growing, and has been growing, and what we are seeing now is fellowship catching up with residencies. It’s in our best interest to find room for all of our high-quality graduates or we risk losing them to other states.” While there are a number of rea-
sons residents and established physi- cians go on to pursue fellowships, edu- cators also search for ways to match up subspecialization growth with ac- cess-to-care needs. With general and primary care in just as high demand,
The total number of specialties and subspecialties certified by the American Board of Medical Special-
“it’s a question that deserves serious conversation,” Dr. Cable said. The 2015 legisla-
ties grew from 113 in 2003 to 161 in
2015, according to TMA research.
ture added $53 mil- lion to the state’s graduate medical education (GME) budget, but none of the money would go to fellowships. Most of it would expand or fund existing, unfilled entry-level residency slots in primary care and
Service, the nation’s largest fellow- ship match process, encompassed more than 3,600 programs across 56 specialties — with more than a dozen new specialties joining in the last few years. Programs filled nearly 90 per- cent of the 8,500 positions available,
40 TEXAS MEDICINE July 2015
specialties, with the possibility of add- ing an estimated 200 new positions. According to NRMP, more than
9,500 applicants participated in the fellowship match for a total of 8,500 positions, with 78 percent obtaining an advanced training slot. Fellowship positions have been on an upward trajectory since 2000, out-
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