Fellowship Programs

Abstract

Strong passions are aroused within our specialty when the issue of subcertification is raised. "Fragmentation," "second-class citizen," and "varied scales of reimbursement" are but a few of the phrases often repeated by those who fear further subspecialization.In reality, subcertification is more accurately viewed as a recognition of those individuals who by virtue of added interest, training, skills, talent, and experience have equipped themselves to be possessed of "special qualification"-perhaps a better and safer term than "special competence. " Few would argue that specially qualified individuals exist in several subspecialties within otolaryngology; subcertification simply recognizes these acknowledged special qualifications in those individuals who already possess them. "Fragmentation" therefore is already a moot term. I prefer to look upon this phenomenon as specialty "diversification," which will inexorably continue to occur as long as new knowledge and technology develop in medicine. It is now rather clear that should the 23 member Boards of the American Boards of Medical Specialties (ABMS) fail to provide pathways or mechanisms for the recognition of skills in subspecialty areas, the mechanism is facilitated for provision by those groups outside ABMS of so-called certification with lesser standards.To intelligently study the effect of granting subspecialty certificates to existing fellowship programs, one must study and assess the fellowships that currently exist. Since fellowships (and preceptors) wax and wane, the precise number offered and occupied is difficult to identify, but in general they exist in these approximate numbers: Plastic and reconstructive, 19; head and neck surgery, 26; otology and neuro-otology, II; allergy, I; and other, 9.Fellowships tend to emerge and develop for a variety of reasons-some laudable, some less so. A recog-

The Pursuit of Otolaryngology Subspecialty Fellowships

“…Over the past several decades, multiple opinion and editorial publications have attempted to explain why otolaryngology residents choose subspecialty training or not. 1,4,5,7-10 Few data-driven studies have sought to determine these reasons for choosing a specific path. Goulb et al, 11 in 2010, surveyed all otolaryngology residents and also noted that interest in fellowship training decreased from 62% in PGY-2 residents to 58% in PGY-5 residents.…”

“…Over the past several decades, multiple opinion and editorial publications have attempted to explain why otolaryngology residents choose subspecialty training or not 1,4,5,7‐10 . Few data‐driven studies have sought to determine these reasons for choosing a specific path.…”