pacing the growth rate of residency positions, according to the Accredi- tation Council for Graduate Medical Education (ACGME) Chief Executive Officer Thomas J. Nasca, MD. While most of the expansion is in
existing specialties such as cardiology and gastroenterology, he says during the past 15 years, a whole new series of subspecialties have cropped up: sleep medicine, hospice and palliative care, and medical informatics, to name a few.
The total number of specialties and subspecialties certified by the Ameri- can Board of Medical Specialties grew from 113 in 2003 to 161 in 2015, ac- cording to TMA research. “By and large, the new subspecial-
ties are the result of scientific advanc- es in particular disciplines and spe- cific patient care needs in the popula- tion,” Dr. Nasca said. Sleep medicine, for example, emerged out of research leading to new techniques that allow physicians to study sleep patterns, its respiratory components, and the cen- tral nervous system, and in turn, make better diagnoses and design better treatments. Hospice and palliative care arose to provide more effective ways to keep terminal patients com- fortable psychologically and physically, beyond just pain relief.
PASSIONATEPURSUIT For the most part, physicians choose a particular area of expertise based on what they are passionate about, and educators generally counsel them in that direction, Dr. Cable says. None- theless, trainees are increasingly cog- nizant of the technical, financial, and lifestyle pressures facing them in to- day’s workforce.
The decision often starts with
graduates choosing a residency pro- gram that also has a fellowship in a subspecialty that has piqued their in- terest. And fellowship program direc- tors tend to be more comfortable with residents from their own residency programs “because you basically have a three-year audition on how they
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July 2015 TEXAS MEDICINE 41
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