Addiction Medicine Training Fellowships in North America: A Recent Assessment of Progress and Needs

Abstract

Objectives: Although unhealthy substance use and addiction contribute to 1 in 4 deaths and are estimated to cost the US more than $740 billion annually, fewer than 12 hours of physician education over the 7 years of medical school and primary residency training specifically address alcohol and other drug-related issues. Addiction Medicine was formally recognized as a medical subspecialty in 2016 to address the need for physicians trained in prevention, treatment, and management of substance use. This study examines the characteristics of the Addiction Medicine fellowships in operation during this critical period in the subspecialty's development to identify needs and potential. Methods: This study is a cross-sectional survey of Addiction Medicine Fellowship Directors from 46 fellowships accredited as of 2017 (43 in the United States and 3 in Canada). The response rate was 100%. Results: Directors estimated significant growth in available fellowship slots between 2016 to 2017 and 2017 to 2018 (F = 49.584, P < .001). The majority of Directors reported that demand for their graduates was high (79.5%). Fellow training in screening, brief intervention, and referral to treatment spanned many substances and age groups, although fewer programs focused on nicotine and on adolescent populations. Notably, most directors reported that graduates completed waiver training to prescribe buprenorphine-naloxone (77.5%) and gained clinical experience in an opioid treatment setting (89.1%). Funding was the #1 need among 56.8% of Directors. Conclusions: Despite significant growth in Addiction Medicine fellowships over the past 6 years, meeting future workforce demands for Addiction Medicine specialists depends on access to funding to support fellowships.

Hospitalist perspectives on buprenorphine treatment for inpatients with opioid use disorder

“…Since addiction medicine was formally recognized in 2016 as a medical subspecialty, there has been an increase in the number of fellowship training programs. Notwithstanding, there remains a significant addiction medicine workforce shortage and a dearth in fellowship funding ( Derefinko et al., 2020 ). Until this deficit in medical education is addressed, the onus to provide evidence-based addiction care will fall onto the hospitalists’ shoulders.…”

“…asserted that basic addiction care should be a core competency for all hospitalists and that hospital-initiated addiction treatment should be hospitalist-led without over-reliance on specialists. This initiative could include the development of more robust guidelines or order sets for inpatients with OUD, coordination with community OUD treatment facilities to ensure timely and efficient linkage, and training of students, residents, and other staff in basic addiction management ( Derefinko et al., 2020 ; Englander et al., 2020 ).…”

Preparing for the Future of Medical Education: A Case Series of Traditional and Virtual Clinical Rotations in Addiction Medicine Spanning the COVID Pandemic

“…The field of addiction medicine was developed to enhance the science and quality of care provided to people with substance use disorders and achieved recognition as a subspeciality of preventive medicine by the American Board of Medical Specialties in 2015 5 . Still, the number of addiction medicine specialists in the country do not approach the magnitude of patient need and medications for opioid use disorder remain underutilized 6 , 7 , 8 . Research suggests this is in part due to provider attitudes toward individuals who have substance use disorders and may also be associated with lack of provider confidence in their ability to offer adequate care 9 .…”

“…5 Still, the number of addiction medicine specialists in the country do not approach the magnitude of patient need and medications for opioid use disorder remain underutilized. 6,7,8 Research suggests this is in part due to provider attitudes toward individuals who have substance use disorders and may also be associated with lack of provider confidence in their ability to offer adequate care. 9 As such, there is a national call to enhance addiction medicine training in undergraduate medical education.…”