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Wednesday Jun 03, 2015

Fellowships Aim to Enhance FPs' Training, Not Limit Our Scope

In just a few short weeks, I will reach the end of my residency, a milestone seven years in the making. Around the country, thousands of newly minted family doctors will be entering the workforce. I, however, will not be one of them. Instead, I plan to further my training with a fellowship in obstetrics. And I am not alone. Each year, roughly 15 percent of graduating family medicine residents enter a fellowship.

Most family medicine residencies offer well-balanced training that will allow graduates to deliver comprehensive care. But some individuals, like me, want to build on that training based on our individual passions. Others may seek to fill perceived gaps in their training. Of course, fellowships are just one avenue to expand our training. Others include focused use of elective time and, in some cases, developing formal areas of concentration(www.stfm.org).

In recent years, however, I have heard some physicians raise concerns about the growing number of fellowships -- in behavioral health, geriatrics, obstetrics, rural medicine, sports medicine and more -- and the growing number of residents applying for those positions. Specifically, some wonder whether these fellowships pose a threat to the generalist aspect that makes family medicine the vital specialty that it is.

In fact, a recent study(annfammed.org) in the Annals of Family Medicine found that increasing a family physician's comprehensiveness of care was associated with decreased costs and fewer hospitalizations.

It's true that for specialties such as internal medicine and pediatrics, a fellowship in cardiology or endocrinology will narrow a physician's scope of practice to the specialty that physician chooses. It's also true that a decreasing number of family physicians are providing maternity care and caring for patients in hospitals.

We're told as medical students that family medicine will allow us to care for the whole individual, at every age, and for entire families from cradle to grave. That's my calling. I plan to practice full-scope family medicine and teach after fellowship.

In this way, family medicine fellowships are designed to enhance our training and broaden our scope, rather than limit it. Increased fellowship opportunities give graduating residents the extra training to feel comfortable practicing in the hospital or providing maternity care (as well as satisfying requirements of hospital credentialing committees). And although there are opportunities out there for family physicians who want to focus solely on sports medicine or geriatrics, the vast majority of those completing fellowships will continue to practice broad-scope family medicine. My practice won't be focused on maternity care, but I'll have a deeper knowledge and stronger skillset regarding that subject.

Fellowships themselves aren't the issue. It's how we use that education. Fellowships offer family medicine graduates the flexibility to further our education, augment training in areas of interest and shape our future practices. So although a significant number of family medicine graduates plan to pursue advanced education, most of us will continue to practice general family medicine, albeit with some degree of focus. And learning more can only be a good thing for our patients and our practices.

Andrew Lutzkanin, M.D., is the resident member of the AAFP Board of Directors.

Posted at 10:12AM Jun 03, 2015 by Andrew Lutzkanin, M.D.

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