The issue of gender equity in academic medicine has been explored consistently over the past few years. We know that half of accepted and matriculating medical students are female, but the numbers plummet as physicians become more senior. Data from 2008 shows that although 48% of student entering school are female, less than 15% of medical schools deans or department chairs are women[1]. There are obviously many reasons for this discrepancy, but studies have shown that physicians (especially women) who complete post graduate fellowship training are more likely to stay in academic medicine.[2] [3] [4]

That data might seem intuitive in fields like surgery or medicine. The sub specialization of fellowship training may require you to be in proximity of a tertiary care center (usually academic) or augment your desire to do NIH-funded research, but is the same true for emergency medicine? A 1999 survey of EM program directors showed that although one-third of upcoming graduates planned on pursuing a career in academic medicine, less than 6% were going to take the fellowship route there.[5]   In another survey study of EM residents only half of the residents interested in an academic medicine thought fellowship training was important for successful an academic EM career.[6] So maybe EM doctors who want to be academic don’t need the push of fellowship, right?

The problem with this data is that although fellowship training may not have been necessary or even preferred 15 years ago, in the quickly evolving landscape of academic emergency medicine that may not be true anymore. The SAEM website currently lists 28 different post graduate training program in EM.  Fellowships in administration, simulation and ultrasound are relatively young and not ACGME accredited but provide specific skills to the trainee.  With the ever increasing number of EM- trained graduates,[7] setting yourself apart from the pack could be helpful in the community and academic EM job search.

Still, some senior residents may feel they have “enough” training in specialty areas by graduation and would rather just “get to work.”    Additionally, the Career Planning Guide provided to EM residents by EMRA suggests that fellowship training may “pigeon-hole” postgraduate residents into one particular area and that the “knowledge and skills gained during fellowship training can be obtained as an attending physician[8]. However, unfortunately, many junior attendings find they have less free time on their hands than they had expected.  

To many who have pursued fellowship training, the additional post graduate training time allows for a strong academic foundation in an area of interest. Developing that “niche” allows leverage when pursuing a career in academic medicine.  Women who embark on academic medicine careers, often make that decision during their fellowship year(2).  According to this study, postgraduate training allowed them time and opportunity to seek out female mentorship(9).  Other articles have highlighted the personal career satisfaction, success as an academic ED faculty member, and increased time available to pursue advanced degrees as specific advantage noted by fellowship trained female physicians.

Ultimately, the decision of whether or not to pursue postgraduate fellowship in emergency medicine is an individualized one. For women in particular, studies have shown that postgraduate training and pursuing a career in academic medicine allows for greater career satisfaction. For myself, I can say that the additional training and relationships I established during my fellowship have changed the course of my career.

References:

  1. Leadley J. Women in US Academic Medicine: Statistics and Benchmarking Report 2008-2009. https://www.aamc.org/download/53502/data/
  2. Retrieved on 10 July 2013
  3. Borges NJ, Navarro AM. Women Physicians: Choosing a Career in Academic Medicine. Acad Med 2012; 87: 105-114.
  4. Borges NJ, Navarro AM. How, When, and Why Do Physicians Choose Careers in Academic Medicine? A Literature Review. Acad Med 2010; 85(4): 680-686.
  5. Straus SE, Straus C. Career Choice in Academic Medicine: Systematic Review. J Gen Intern Med. 200; 21(12): 1222-1229.
  6.  Stern S, Kim HM. The Impact of Environmental Factors on Emergency Medicine Resident Career Choice. Acad Emerg Med 1999; 6: 262-270.
  7. Neacy K, Stern S. Resident Perception of Academic Skills Training and Impact on Academic Career Choice. Acad Emerg Med 2000; 7: 1408-1415.
  8. News Release: Highest Match Rate for US Medical School Seniors in 30 Years. AAMC. 16 March 2012.
  9. [8] Garmel, GM. Career Planning Guide For Emergency Medicine. Irving: EMRA, 2007. Print.
  10. [9] Stern S. Fellowship Training: A necessity in today’s academic world. http://www.saem.org/newsltr/2001/july-august/stern.html. Retrieved on 10 July 2013.

 

SAEM GME Committee.