Fellowships in Family Medicine

Fellowships are six months to two years of additional training after the three years of a family practice residency. A listing of fellowships in Family Medicine is located at http://www.aafp.org/fellowships/

Geriatrics For those interested in Board Certification in Geriatrics. This is a two year fellowship. Many geriatricians will work in academic programs. One of the few with certification. Most fellowships do not have accreditation or any type of "degree". this will be the only route to Board Certification in Geriatrics.

Sports Med For those who would like to work with athletes involving the prevention or treatment of injuries and the preparation for maximal effort. Sports medicine is less a surgical approach than orthopedics.

Obstetrics One of the most popular fellowships, lasting 6 to 12 months. OB fellowships are for those who would like to do operative obstetrics, ob ultrasound, tubals, amniocentesis, etc. There will never be enough obstetricians to deliver all the nation's babies. Some rural and procedural fellowships include 4 to 6 months of ob.   http://www.aafp.org/fellowships/obstet.html

Procedural There are only a handful now. The curriculum is procedures - colposcopy, endoscopy, ultrasound, obstetrics, treadmills, orthopedics, etc. The training is guided by the fellow and the resources of the program.

Emergency Some of these are in the developing stage. Again there are again not enough ER docs to do ER. Many FP residents choose ER. Many ERs actually prefer FPs because ER involves primary care so much. Another advantage is the ability to do family medicine after you get tired of ERs, not an uncommon situation. The military also uses FPs to do front line triage, etc.

Faculty Development  Family practice is still a relatively new specialty. Residency training does not prepare residents for faculty positions. Faculty development programs last from 3 months to 2 years. They concentrate on skills in teaching, research, leadership, management, and the doctor-patient relationship areas. Some include a masters in public health. Many train faculty to continue on in the parent program. Fellowship trained faculty are much in demand for clinician-researchers and other positions. If you really want to teach or do research, this is for you. There is even a special faculty development program for program directors, given by AAFP.

Why do a fellowship?

Desire for increased range of services to patients - Three years of any residency is a short time to prepare. This is certainly true of the procedural specialties (five years for surgery, ortho, ob). Some 30 % of senior FP residents would like a fourth year of training. Family practice fellows continue to be real doctors, focusing on patients, but also keeping surgical skills a part of their practice. Many people expect physicians to "do it all". Many students and residents would like to be like GPs of the past who "did it all". With all the developing areas of medicine this may not be possible for some residents without adding extra months or years.

Desire to develop special area of competence - Medical education has a way of making students and residents feel inadequate. A fellowship allows one to develop such an area. Almost certainly at some point in your life, you will wish from some time to do some intensive training in one or more areas for better care, job security, a new job, or other reasons. Remember that medical education never ends. If you think medical school or residency is an end point, retire now!!! Continuing education is essential. Each year there are more opportunities for hands-on procedural training after graduation. Obstetrics, colposcopy, endoscopy, and treadmills are just a few of the courses offered. It is often easier to train an extra six months or year (and be paid as a fellow) rather than lose weeks or months of income after you have started a practice.

Increased income potential - Fellows who obtain extra procedural training can increase their income.

Desire for increased contact with like-minded colleagues in academic circles.

Looking for a job or looking to get job security for present job

A Reminder - To obtain privileges you need:

1. Evidence of adequate training during residency, fellowship, or course(s) as documented by standards of training, the program director, or faculty who trained you and are approved in the area themselves.

2. Evidence of enough numbers to document competence in the procedure (50 to 100 are numbers that continue to come up). Numbers are not the only answer as surgical technical skill may overlap into other areas. For example someone who has done only 20 – 30 C-sections but having 30-40 hysterectomies or similar procedures may also qualify for privileges. Privileges granted often vary by the size of the medical staff and the availability of subspecialists.

3. Evidence of enough numbers to continue to do the procedure. You must be able to afford the equipment and staff to do procedures. You must also do enough to keep up your skills. Again doing related procedures may keep up your volume enough.

For further information contact Robert C. Bowman, M.D., [email protected]