Jack of all trades, master of none: Why do a fellowship?

The Financial Value of Fellowship Training in Otolaryngology

Objective

To evaluate the financial impact of pursuing a fellowship in otolaryngology.

Study Design

Retrospective financial analysis using American Academy of Otolaryngology—Head and Neck Surgery survey data.

Subjects and Methods

The American Academy of Otolaryngology—Head and Neck Surgery report, entitled Socioeconomic Study among Members April 2011, gives a financial profile of respondents who reported their primary area of specialization as either general otolaryngology or a specific area of subspecialization. Weighted averages were calculated from the reported data. The weighted averages were used to calculate a net present value (NPV) over a 30-year contiguous career.

Results

The NPV for general otolaryngology was $4.73 million. The NPV for the following subspecialties in relation to general otolaryngology were (in hundred thousands) as follows: otolaryngologic allergy (−$1153), sleep medicine (−$677), otology/neurotology (−$339), laryngology (−$288), head and neck (−$191), pediatric otolaryngology (−$176), facial plastic surgery (−$139), skull base surgery ($122), rhinology ($285), and allergy and immunology ($350). Ninety-four percent of general otolaryngology respondents were in private practice. Most subspecialists worked in an academic setting.

Conclusion

Fellowship training in otolaryngology will affect career earnings of prospective fellows. The overall financial impact of fellowship training, calculating in the delay in receiving a full clinical salary, should be factored into the decision to pursue fellowship training.

MRI interpretation proficiency of musculoskeletal fellows in training

RATIONALE AND OBJECTIVES

The aim of this study was to evaluate the magnetic resonance imaging (MRI) interpretation proficiency of musculoskeletal fellows in training.

MATERIALS AND METHODS

Between July 2003 and June 2007, 14 musculoskeletal fellows were independently tested with 20 MRI studies of the knee and shoulder at four separate time points during their fellowship years. Trends in true-positive and false-positive interpretation results were evaluated. Fellows who completed their residencies at the fellowship institution (internal fellows) were compared with those from other residencies (external fellows).

RESULTS

There was a significant improvement in proficiency between the initial and final (9-month) evaluations (P < .0001). At the initial evaluation, there was a mean of 52.8% (41.7 of 79) true-positive results (range, 32-51); at 9 months, there was a mean of 71.0% (56.1 of 79; range, 40-72). The number of false-positive results also declined during this time period from a mean of 8.1 (range, 2-13) at initial evaluation to 4.7 (range, 2-8) at 9 months (P < .001). External fellows had more incorrect diagnoses initially but showed greater improvement than internal fellows at 9 months.

CONCLUSION

Fellows continued to improve their MRI interpretation skills throughout the first 9 months of their fellowships. External fellows were slightly less proficient at the start of their fellowships but slightly more proficient at 9 months compared to internal fellows.

Neuroradiology fellowship match: year 4 applicants' perceptions

BACKGROUND AND PURPOSE

The selection of neuroradiology fellows who will start on July 1, 2005, marked the fourth year in which program directors in neuroradiology used the National Resident Matching Program (NRMP) as the selection modality. The aim of this study was to investigate fellowship candidates' views regarding the match process.

METHODS

A Web survey was distributed electronically to all candidates applying for neuroradiology fellowship positions offered for the July 1, 2005, start date, with questions about the match. One hundred thirteen neuroradiology fellowship candidates responded to the survey, representing 73.9% of the surveyed fellowship pool. Candidates were also allowed to enter their comments regarding the match process via the Web survey.

RESULTS

Of the 113 neuroradiology fellowship candidates responding, 75.7% felt that the NRMP system was fair, 86.0% were satisfied with the outcome, 88.8% had matched with one of their top three choices, 54.5% recommended continuing the neuroradiology fellowship match, and 15.5% stated that they experienced violations of the match rules. The main perceived advantages of the match from the candidates' perspectives were the ability to see many programs and explore multiple options, the perception of fairness, and the efficiency of using the match program. The main disadvantages were the cost of applications and traveling, the number of days required to interview, and the perception that the match program favors internal candidates.

CONCLUSION

The majority of fellowship candidates felt that the match system for selection is a fair process and were satisfied with the outcome. However, the perceived disadvantages produced tepid (54.5%) support for the continuation of the match. Program directors in neuroradiology and other radiologic subspecialties should consider the data provided in this article in deciding the future selection process.