March 31st, 2014
Master of All Trades
Saurav Chatterjee, MD
Several Cardiology fellows who are attending ACC.14 in Washington, D.C. are blogging for CardioExchange. The fellows include Kumar Dharmarajan, Seth Martin, and Saurav Chatterjee. For more of our ACC.14 coverage of late-breaking clinical trials, interviews with the authors of the most important research, and blogs from our fellows on the most interesting presentations at the meeting, check out our ACC.14 Headquarters.
An intriguing and practical discussion with a nearly graduated fellow opened up new avenues for thought. In spite of general feelings on how mentorship may sometimes be lacking – especially in terms of quality – for those in academic cardiology, overall most fellows are fortunate enough to have at least one or more academic mentors who allow them to fine-tune their careers according to sage advice. However, those embarking on careers in private practice appear to have less available and structured guidance.
From my conversation with the aforementioned fellow, it appears as though many practices have now set the bar high in terms of clinical experience – in other words, they want applicants to have COCATS level IIs and IIIs in several (if not all) of the sub-specialties. The logical question, of course, is with other commitments to education and research, how realistic it is to expect one person to become proficient in several of these sub-specialties? In addition, there appears to be several boards for certifications like the “echo boards,” “Nuc boards” and the “Vascular boards.”
Another largely unanticipated issue is the fact that someone planning on taking one or more of these boards may incur significant additional expenses in the final year of fellowship. This may need to be budgeted for ahead of time – especially for those with families and children. In addition, the American Board of Internal Medicine has has implemented a “maintenance of MOC” program for board-certified physicians in various specialties that may potentially add to further expenses. These are surely things to ponder ahead of time.
3 Responses to “Master of All Trades”
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Points well- taken! While it may seem too much and rather expensive to undergo this process, sevral things merit a consideration:1) most fellowships offer level 2 training in major modalities;2) one would really need level 3 only if they are academically bound; 3) some of the boards are not an immediate requirement, and can be staggered to avoid additional expenses. Eventually, I believe we may consolidate the imaging boards into one MULTIMODALITY imaging board. Yet, it is important for the fellows to have passion for the things they do, and pick a modality where they shine while having a good working knowledge of others.
Couldn’t agree more – over the last decade +, certifications and boards have exploded – nuclear, echo, CT angio, vascular, etc. General fellowships would serve there mission well to ensure fellows interested in practicing in the community are qualified and prepared to sit for these boards/ obtain these certifications prior to completion of fellowship. Three years is more than enough time to obtain these skills and fellows interested in community practice should be supported and guided by training programs to personalize their training early on. Increasingly, additional board certifications serve as a competitive edge in a tight job market and program directors should emphasize this point from day one for those pursuing careers in the community.
This issue is very important. Today many physician believe specialization is the best path. I can disagree more. For me a specialist is a physician, but in the path they forgot what is a physician. What is a Physician? A cardiologist, a gastroenterologist? I don’t think so. If you really want to promote, maintain or restore Heath you need to have a complete, a broad picture. I have seen many of us to become extraordinary in a very small area of medicine but after few year they become functional an-alphabets outside their field, they need a team of many specialist to help them with one patient and the results are not very good. The secret is don’t abandon the medicine to become a specialist, continue practicing all medicine and become very good in your speciality but this is very important, learn your limits and ask for help when you need it. When you ask for advice never transfer the responsibility of the well-being of you patient, you stand at his side and learn from your colleagues so the next time you do a better job. Most of the patients don’t need a specialist they just need a good doctor.