I had an exam and interview a few days ago for a position in (yet another) fellowship training program. When I was way younger, I used to look with awe at those people who took training a few extra steps further. I mean, medicine by itself is already challenging, and residency is definitely not for the weak of heart. Sub-specialty training in is often a must among Internal Medicine residency grads who intend to practice in urban centers, and is no walk in the park either.
After I was done with fellowship training several years ago, the concept of going for further "sub-subspecialty" training seemed like such an abstract idea for me. Maybe its because I felt that I didn't have what it takes? Or perhaps after having been in training so long, I wanted to do things on my own terms? Or maybe because I was just tired of going through the entire process?
To give you an overview of the life of a person in medical training, here is a breakdown of the average years spent in education of someone who would eventually be a sub-specialist:
College degree - 3-5 years*
Medical School - 4 years
Postgraduate internship - 1 year
Residency (Specialty) Training - 3-5 years**
Fellowship (Subspecialty) Training - 2-3 years***
For the sake of simplicity, I chose not to include the INTARMED program popularized by UP Manila.
* College courses in the Philippines are 3 to 5 years in length depending on the university of enrollment and the coursework involved.
** Residency training ranges from 3 years for Internal Medicine and Pediatrics, to 5 years for General Surgery. Not included among these are the so-called "Straight programs" offered by some institutions wherein trainees have a lengthened residency period but are already qualified to take the sub-specialty examinations upon completion (common among the surgical sub-specs like Neurosurgery and Orthopedics).
*** Fellowship training for most sub-specialties like Pulmonology and Gastroenterology last around 2 years. Cardiology and Oncology fellowships are usually longer by a year. I have little idea about the subspecialities for other feilds, but I know Thoracic Surgeons have to take an extra 3 years after their General Surgery residency.
People may opt to take things one step further and pursue either a new sub-specialty (like one of my bosses who is BOTH a Pulmonologist and Oncologist), or delve further into the specialty by choosing a focused area of study to concentrate on (e.g. Interventional Cardiology, Hepatology (Gastroenterology), Sleep Medicine (Pulmonology). The length of this further training is variable, depending on the extent of training required.
From what I have seen, specialization can range from all-out fellowship programs lasting a year or two, to short trainings abroad (2 weeks to 6 months) for the emerging and newly-established fields of study.
Medical practice has been continuously evolving by leaps and bounds the past few decades, and the growth of specialization was inevitable, since it is necessary to keep up with the tremendous amount of new research and advanced techniques.
Having said all that, I made the decision to go and try for further training. Since my practice is in the highly competitive environment of the metropolis, its easy to get lost in the background noise and be considered irrelevant unless you have something that can help you stand out. ;)
I just hope everything eventually works out in the end.. :)
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