The Meaning of Medical Specialty Society Fellowship is Being Degraded
Fellowship in a medical specialty society has traditionally been a distinction bestowed upon physicians who have reached a certain level of height within their chosen specialty. While the details of how to become a fellow are specific to a given medical specialty society, the general requirements are service to the society and reaching the highest levels of professionalism and scholarship. For example, the American College of Physicians, the largest medical specialty organization in the United States, requires physicians to have membership for several years, board certification in the specialty, continuing scholarly activities (such as research, publications and continuing medical education), and teaching. Leadership positions within the society or in the community are considered pivotal. To become a Master in the College, the requirements are even more stringent and physicians must be “highly accomplished” and demonstrate significant impact in the field of internal medicine or neurology.
Unfortunately, at least three medical specialty societies, the Society for Hospital Medicine (SHM), the Academic College of Critical Care Medicine (ACCM), and the American College of Cardiology (ACC), have opened up the Fellowship designation to non-physicians including nurse practitioners, physician assistants, and even hospital administrators.
The SHM states that fellows may include “physicians, practice administrators, physician assistants and pharmacists.” The requirements for this are more about overall commitment to hospital medicine rather than to expertise, and include time practicing hospital medicine as well as attending annual conferences. Likewise, the ACCM has included “practitioners, researchers, administrators, and educators” for eligibility for Fellowship and Mastership. Masters designation is specifically to identify those who have achieved “national and international professional prominence.”
On the other hand, while the ACC states that they consider fellows to be recognized as the “very top” of the field, they recently opened fellowship to “clinicians, researchers, scientists, cardiovascular team members and cardiovascular administrators.” While other members of the healthcare team may be dedicated to a specific field, they cannot, by definition, be at the “top” or “experts” when compared to physicians.
Physicians dedicate significantly more time and practice to their specialties when compared to other members of the team.
Beyond the actual time spent in training, the most important aspect of this time is in the “how” that time is spent.
While the 10,000 hour “expert rule” has been codified to include hours, effort and talent, deliberate practice has been shown to lead to expertise and physician training lends itself to exactly this. Nonphysicians, on the other hand, spend far shorter time on their education and, upon initial certification, do not undergo the same rigorous continuous evaluation over years of residency and subsequent fellowship. This difference persists even in board re-certification and continuing medical education requirements for maintenance of state licensure. A good review of nurse practitioner education can be found in another blog post.
When non-physicians are permitted to apply for and obtain fellowship within a medical specialty society, it degrades the meaning of achieving the highest level within the given specialty.
While nurse practitioners, physician assistants and administrators are members of the healthcare team, they are ultimately not the experts within a given specialty. Further, non-physicians have other opportunities for specific recognition in their fields which allow them to be differentiated amongst their colleagues. Lastly, allowing the additional blurring of the line between physicians and nonphysicians only serves to further confuse patients about the role of each individual on the team.