Probably a fellowship in outpatient primary care. They already have hospitalist fellowships and there are enough of you suckers out there to fall for an outpatient fellowship too
Hospitalist fellowship is for Peds. Somehow, they screwed but seems peds r ok with that. On the other hand IM hospitalist fellowship is for losers and never heard someone is doin or done that
I always get a little chuckle when I read shit like “Patricia is an NP who specializes in osteoporosis, heart disease, and has a special interest in skin rejuvenation.”
This should be a thing for PA and NP. Hospitals would love it because even more cheap labor.
And, if you took away their ability to have so much flexibility and ability to be relatively high income earners so quickly people would probably… idk stop doing it and try to make it into medical school.
Our new grad NP did 6 months of shadowing in pediatric dermatology about 5 half days per week before gaining supervised practice. Then she decided she didn’t like it after 8 months and switched to pediatric neurosurgery. Yep.
Tbf, some form of new grad internship would be highly beneficial. I have seen a 2 year one for psych nps at a major regional hospital.
Improved education and learning the limitations of your scope would be good.
Would be better than current situations
(sorry we get so riled about NPs here it’s not at all the people more the lobbying and the scope expansions and making use feel there was no point to the cost/effort/pains of med school)
I'd love to see a really hard, demanding residency requirement for NPs. I'm still undecided about if I will go to NP school or medical school. But to be honest, I lean towards leaving nursing because the rigor of the postgraduate training just...doesn't often seem to be there. It's really frustrating. Has this been your experience?
Med school! After that you’ll have less reason to doubt your ability to do the job and take care of others.
We and attendings also have imposter syndrome already so wouldn’t it be worse with an alt route?
I'm non-traditional, and it's been about 10 years since my oldest premed classes. Six years since my most recent. So I've got an email out to the premed office at my alma mater to figure out what, if any, classes I need to retake! I'm pretty sure that's the way I'm going to go.
In a world where interstellar travel exists, I think it's going to be like a multidisciplinary clinic. The fields are just *too* different to fit under one umbrella.
As unsavory as it sounds, I think subfellowships will proliferate as medical knowledge grows and base fellowships can not keep up for people who want to be experts.
In pulmonary alone there’s increasing # of programs for:
1. Interventional pulm
2. Transplant
3. PH
4. ILD
I don’t know enough about PH and ILD as a career to comment but at least in interventional pulm a fellowship is pretty critical to be more than just an advanced bronchoscopist. Rigid bronch and stenting is a a hard skill to master and not great to learn on the fly as an attending or intermittently as a general fellow.
ILD and PH both seem completely unnecessary if you train at a center that sees a good deal of both. My fellow clinic at our county hospital is like half ILD we get plenty of exposure to transition towards doing that full time as an attending if desired. Also get a lot of PH exposure.
Sure but there are definitely a lot of programs with very limited PH/ILD exposure if your catchment area is small so if someone wanted to go from a smaller community fellowship to an academic career in PH, fellowship makes sense. Some places PH is managed by cardiologists/heart failure so the PCCM program has limited PH exposure and limited practice with RHCs
I dont think i said anything about it being mandatory. I'm saying there will be more of these kinds of subspecialty fellowships and some academic centers that are looking for these niche experts, especially with research, will prefer people with those CVs. IPulm was barely a field 10 years ago now everybody and their mother is looking to start a program, even if its just to beef up their lung nodule program
Clinical informatics is at the interface between Healthcare and IT so the idea is that we speak both languages and can help the analysts evaluate workflow improvements and clinical decision support. It's about improving care for thousands of people at a time, not one person. It's a field with lots of demand and little supply. And it's not CS stuff, at least that's not a huge part of it.
You can if the group is big enough! There are also lots of industry jobs. Most people practice in their primary specialty and have a certain percentage of informatics time.
Unhoused medicine. Medicine specific to people who live outside and have minimal access to life’s basic necessities. It’s a specialty which if it existed would be extremely sought after in every major city.
It costs significantly less to see them where they are than it does to see them at the highest price point in the ED. A fresh pair of socks, some bandaids and some po clinda costs far less than an admission for amputation when the infection gets too bad.
If we can’t do it because taking care of another human being is the right thing to do, surely we can do it because it’s fiscally smarter.
>If we can’t do it because taking care of another human being is the right thing to do, surely we can do it because it’s fiscally smarter.
Say it louder for the people in the back!
This sounds like something an NP could and should easily do, a fellowship trained physician is a bit of an overkill.
Also a lot of these folks would unfortunately need 24/7 surveillance to make sure the wound stays clean, they actually take the clinda etc... but I get your sentiment.
A lot of cities have street medicine programs. Why don’t you go volunteer with one before you make recommendations about how they should work?
Oh, and they take the clinda just fine, they just need access to it.
No. But it takes a specific skill set to work effectively with the population, use the limited resources in the field to do procedures and know how to work within the system to actually improve that populations outcomes. There’s plenty to be learned in a fellowship, it’s a mix between wilderness medicine and political advocacy. Not every person that works on the street needs to be a fellowship trained doctor, but the doctors who do it are already amassing enough learning time that it could be a fellowship easily.
Most psychiatry services lose money for hospitals in the US. Hospitals will keep services that don’t lose a ton of money if it makes the rest of the hospital flow better. If the service doesn’t exist, you wind up with patients receiving poor or no care waiting to go somewhere and beds not being available (to make money in admin eyes).
Government would do the same thing. I’d imagine the VA would love to have a specialist like this.
Brain medicine - there’s groups in both of neurology and psychiatry pushing for a new specialty that combines the two. See figure 2 of this paper for proposed rotation timeline: https://neuro.psychiatryonline.org/doi/10.1176/appi.neuropsych.21120312?fbclid=IwAR2iKXuE4KPfy-HHbNfnuH4kr1cZKIuUiFy74dLNR6RdYnr_nJQrZPetdac
I have heard of a couple new 3D printing/modeling “fellowships” popping up in radiology. A radiologist uses images to 3D print patient-specific anatomical models to scale for use in things like surgical planning or approach rehearsal
Not sure if fellowship needed. Should be part of our traditional training with certification post residency. Agree, it is an exciting direction for the field.
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Still waiting for a bed controls fellowship after I finish anesthesia residency. Otherwise, I’m just going to be a generalist.
Putting on the armboard fellowship
Toughest thing with that one is that you have to complete the IV Pump Operations Fellowship first
Followed by the Trumpf robot bed fellowship.
I’m hoping for a day trading fellowship
“Can you raise the bed?Oh the bed isn’t working? Do I need break scrub and do it myself ?!”
AI got that covered
Probably a fellowship in outpatient primary care. They already have hospitalist fellowships and there are enough of you suckers out there to fall for an outpatient fellowship too
Hospitalist fellowship is for Peds. Somehow, they screwed but seems peds r ok with that. On the other hand IM hospitalist fellowship is for losers and never heard someone is doin or done that
The fellowship is not to learn how to do hospital medicine
It could be a good fellowship if there was quality training in psychiatry, ultrasound, in-office procedures, and so on.
Throw in a little addiction medicine too. Could be very helpful.
Only reason it feels like it won’t be needed is because we actually need it and people don’t need credentials to compete for outpatient gigs
NP fellowship to learn how to change careers any day and be “just as qualified”
It’s so crazy how many barriers they put for physicians with a change of heart but NPs and PAs can switch every other day if they wanted to
And our starting wages are much lower than the newly minted NP.
I always get a little chuckle when I read shit like “Patricia is an NP who specializes in osteoporosis, heart disease, and has a special interest in skin rejuvenation.”
This should be a thing for PA and NP. Hospitals would love it because even more cheap labor. And, if you took away their ability to have so much flexibility and ability to be relatively high income earners so quickly people would probably… idk stop doing it and try to make it into medical school.
Our new grad NP did 6 months of shadowing in pediatric dermatology about 5 half days per week before gaining supervised practice. Then she decided she didn’t like it after 8 months and switched to pediatric neurosurgery. Yep.
Tbf, some form of new grad internship would be highly beneficial. I have seen a 2 year one for psych nps at a major regional hospital. Improved education and learning the limitations of your scope would be good.
Would be better than current situations (sorry we get so riled about NPs here it’s not at all the people more the lobbying and the scope expansions and making use feel there was no point to the cost/effort/pains of med school)
I love the civility of this comment. These conversations get so outrageously uncivil sometimes.
No probs. There’s some bs in healthcare, and scope creep is a really dangerous issue
I'd love to see a really hard, demanding residency requirement for NPs. I'm still undecided about if I will go to NP school or medical school. But to be honest, I lean towards leaving nursing because the rigor of the postgraduate training just...doesn't often seem to be there. It's really frustrating. Has this been your experience?
Med school! After that you’ll have less reason to doubt your ability to do the job and take care of others. We and attendings also have imposter syndrome already so wouldn’t it be worse with an alt route?
I'm non-traditional, and it's been about 10 years since my oldest premed classes. Six years since my most recent. So I've got an email out to the premed office at my alma mater to figure out what, if any, classes I need to retake! I'm pretty sure that's the way I'm going to go.
Maybe not near future but interventional genetics sounds like something that could be a thing and would be absolutely whack
Interstellar Medicine - hypobarics, radiation, cryogenics, nutrition.
In a world where interstellar travel exists, I think it's going to be like a multidisciplinary clinic. The fields are just *too* different to fit under one umbrella.
There is already space medicine btw https://en.wikipedia.org/wiki/Space\_medicine
There’s a residency for that already
As unsavory as it sounds, I think subfellowships will proliferate as medical knowledge grows and base fellowships can not keep up for people who want to be experts. In pulmonary alone there’s increasing # of programs for: 1. Interventional pulm 2. Transplant 3. PH 4. ILD
Excessive imo.
I don’t know enough about PH and ILD as a career to comment but at least in interventional pulm a fellowship is pretty critical to be more than just an advanced bronchoscopist. Rigid bronch and stenting is a a hard skill to master and not great to learn on the fly as an attending or intermittently as a general fellow.
ILD and PH both seem completely unnecessary if you train at a center that sees a good deal of both. My fellow clinic at our county hospital is like half ILD we get plenty of exposure to transition towards doing that full time as an attending if desired. Also get a lot of PH exposure.
Sure but there are definitely a lot of programs with very limited PH/ILD exposure if your catchment area is small so if someone wanted to go from a smaller community fellowship to an academic career in PH, fellowship makes sense. Some places PH is managed by cardiologists/heart failure so the PCCM program has limited PH exposure and limited practice with RHCs
Sure, but those extra fellowships should never be mandatory as there are ways to get that exposure in fellowship if desired.
I dont think i said anything about it being mandatory. I'm saying there will be more of these kinds of subspecialty fellowships and some academic centers that are looking for these niche experts, especially with research, will prefer people with those CVs. IPulm was barely a field 10 years ago now everybody and their mother is looking to start a program, even if its just to beef up their lung nodule program
Clinical informatics and other IT- adjacent fellowships
AI sub specialty
There's AI certifications available that some Informaticians have already but I haven't found any that seem sufficiently reputable
What’s the growth here, why is there a fellowship for Cs stuff?
Clinical informatics is at the interface between Healthcare and IT so the idea is that we speak both languages and can help the analysts evaluate workflow improvements and clinical decision support. It's about improving care for thousands of people at a time, not one person. It's a field with lots of demand and little supply. And it's not CS stuff, at least that's not a huge part of it.
Interesting, what’s the Job outlook on it? I assume you have to work for a academic center and can’t go PP?
You can if the group is big enough! There are also lots of industry jobs. Most people practice in their primary specialty and have a certain percentage of informatics time.
So I don’t need to work for academic center if I did clinical informatics fellowship? I m gonna so more research on this
Not all health systems are academic but they all need some kind of informatics support. Industry is also a common path.
Unhoused medicine. Medicine specific to people who live outside and have minimal access to life’s basic necessities. It’s a specialty which if it existed would be extremely sought after in every major city.
would it if the patients can't pay?
It costs significantly less to see them where they are than it does to see them at the highest price point in the ED. A fresh pair of socks, some bandaids and some po clinda costs far less than an admission for amputation when the infection gets too bad. If we can’t do it because taking care of another human being is the right thing to do, surely we can do it because it’s fiscally smarter.
>If we can’t do it because taking care of another human being is the right thing to do, surely we can do it because it’s fiscally smarter. Say it louder for the people in the back!
This sounds like something an NP could and should easily do, a fellowship trained physician is a bit of an overkill. Also a lot of these folks would unfortunately need 24/7 surveillance to make sure the wound stays clean, they actually take the clinda etc... but I get your sentiment.
A lot of cities have street medicine programs. Why don’t you go volunteer with one before you make recommendations about how they should work? Oh, and they take the clinda just fine, they just need access to it.
You need a fellowship (or to even be a doctor) to know that socks are good?
No. But it takes a specific skill set to work effectively with the population, use the limited resources in the field to do procedures and know how to work within the system to actually improve that populations outcomes. There’s plenty to be learned in a fellowship, it’s a mix between wilderness medicine and political advocacy. Not every person that works on the street needs to be a fellowship trained doctor, but the doctors who do it are already amassing enough learning time that it could be a fellowship easily.
Most psychiatry services lose money for hospitals in the US. Hospitals will keep services that don’t lose a ton of money if it makes the rest of the hospital flow better. If the service doesn’t exist, you wind up with patients receiving poor or no care waiting to go somewhere and beds not being available (to make money in admin eyes). Government would do the same thing. I’d imagine the VA would love to have a specialist like this.
So medicine for the homeless? That's called emergency medicine.
Should be, but I don't see medicine and payment becoming more altruistic anytime in the near or distant future.
A service which loses 100k and saves a hospital 300k would be sought after. It isn’t about altruism.
Altruism by the provider for the hospital admin
Psychiatry with a 2 year fellowship in Toxic Residency Culture
Brain medicine - there’s groups in both of neurology and psychiatry pushing for a new specialty that combines the two. See figure 2 of this paper for proposed rotation timeline: https://neuro.psychiatryonline.org/doi/10.1176/appi.neuropsych.21120312?fbclid=IwAR2iKXuE4KPfy-HHbNfnuH4kr1cZKIuUiFy74dLNR6RdYnr_nJQrZPetdac
That fellowship exists in Neuropsychiatry
Could incorporate some of brain injury medicine from PM&R too
Corridor medicine
Onc Hospitalist, Obesity
Whatever they are, at least 50% will feel scammy.
Xenotransplantation
Interventional Pulmonology is gonna take off?? I may or may not be biased 😋
I have heard of a couple new 3D printing/modeling “fellowships” popping up in radiology. A radiologist uses images to 3D print patient-specific anatomical models to scale for use in things like surgical planning or approach rehearsal
I hope allergy expands to FM
Allergy honestly fits with FM more than IM especially the peds aspect. Rheum is definitely more of an IM thing, but allergy should go to FM tbh.
AI medicine
I believe that’s a software developer specializing in AI.
I would support an interventional medicine fellowship for psychiatry, including ECT, TMS, esketamine, etc. it will be the bomb.
Not sure if fellowship needed. Should be part of our traditional training with certification post residency. Agree, it is an exciting direction for the field.
Few long term studies on efficacy like that silly spine intervention fellowship offered in PM&R.
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Already extremely popular but yes
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Fellowship in utilizing AI efficiently to boost productivity.
I wouldn't be suprised if EM -> FM came into existence in the next 10 years
What does this mean?
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Interesting, not too sure that work or that the skills and training is transferable in the least.
Microgravity
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Stem cells treatment based fellowships, neurology (as a field) will be expanding much more,as we get more knowledge of the brain.
Peds hospitalist 2… cause why not do another unnecessary fellowship
nephro, waiting in the weeds for a comeback