Demographics and characteristics of leadership at allergy and immunology fellowships in the U.S. as of 2022
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Background: The subspecialty of allergy and immunology (AI) has grown tremendously since the first fellowship programs were developed nearly 80 years ago; however, there is little information with regard to the demographic characteristics and trends in training of fellowship directors (FDs). Objective: Our goal was to analyze the demographic characteristics and pathways in training that have led FDs to advance in the field and train the next generation of allergists and immunologists. Methods: We created a list of all current AI fellowship programs and FDs within the United States. Specific biographical, training, and research information was collected via an Internet search and questionnaire responses. The data were recorded and analyzed in a spreadsheet and unpaired t-tests were performed between male versus female groups for H - index comparison to establish if there was a statistically significant difference. Results: There were 84 total AI fellowship programs with 84 FDs. Forty-one FDs (48.8%) were men and 43 FDs (51.2%) were women; mean age was 51.1 years; and the average age at appointment for men was 45.7 years and for women was 41.4 years, with a statistically significant difference (p = 0.02). Self-reported race and ethnicity (77.4% response rate [n = 65]) were as follows: 55.4% white (n = 36), 23.1% Asian (n = 15), 6.2% biracial (n = 4), 7.7% Middle Eastern (n = 5), 4.6% Hispanic (n = 3), and 3.1% Black (n = 2). The average Hirsch-index (h-index) for FDs was 14.2, with an average of 42.1 publications and 1532.2 citations. The difference between the h-index for the men and for the women was statistically significant, being 17.8 and 11.2 respectively, with p = 0.0143. Conclusion: In AI FDs, women were adequately represented, and men and women were hired at similar ages. There was a statistically significant difference in research output (estimated by the h-index) between men and women. This suggests that research output did not limit women in being appointed as FDs.Keywords:
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Objective: To determine the number and distribution of internists in subspecialty training and compare with data collected since 1976; to determine the distribution of activity of subspecialty fellows; and to focus on hematology and oncology. Design: Repeated mail survey with telephone follow-up. Participants: All directors of subspecialty training programs in internal medicine in the United States. Results: The 1988-1989 census identified 7530 fellows in training, 55 more than in 1987-1988. There are 24 more first-year fellows. Reports on the activities of subspecialty fellows show that, overall, 53% of fellows' time is spent in direct patient care, 20% on basic research, 15% on patient-related research, and 12% in teaching. Conclusions: The number of internists entering subspecialty training has risen at a considerably slower rate in the last 5 years compared with the 5 years before that. The length of subspecialty training has increased significantly since 1976. There has been a shift in subspecialty choice from hematology to oncology and toward joint programs offering both subspecialties.
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Over the past 20 years, hospitalists have emerged as a distinct group of pediatric practitioners. In August of 2014, the American Board of Pediatrics (ABP) received a petition to consider recommending that pediatric hospital medicine (PHM) be recognized as a distinct new subspecialty. PHM as a formal subspecialty raises important considerations related to: (1) quality, cost, and access to pediatric health care; (2) current pediatric residency training; (3) the evolving body of knowledge in pediatrics; and (4) the impact on both primary care generalists and existing subspecialists. After a comprehensive and iterative review process, the ABP recommended that the American Board of Medical Specialties approve PHM as a new subspecialty. This article describes the broad array of challenges and certain unique opportunities that were considered by the ABP in supporting PHM as a new pediatric subspecialty.
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To determine whether Medicaid patients have ready access to subspecialty care.A survey was administered to training program directors and federal clinic chiefs to ascertain, for each medical and surgical subspecialty, whether their patients had access to care "never, rarely, sometimes, usually, or always."Seventeen respondents indicated that, on average, subspecialty care in Connecticut was available "never, rarely or sometimes," 36% of the time. Results of a smaller national sample, mirrored Connecticut responses.Despite government mandates, Medicaid patients have insufficient access to subspecialty care.
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In Brief In this study, we sought to determine the long-term effect of the additional year of anesthesia residency (postgraduate year [PGY]-4) instituted in 1989 by the American Board of Anesthesiology on the number of individuals who pursued 12-mo subspecialty anesthesia training. We tested the hypothesis that extending education by a year would decrease the number of anesthesia subspecialty trainees. Surveys were collected from approved anesthesia residency training programs in the United States from 1989 to 2001. The questionnaires determined the number of individuals pursuing subspecialty training during PGY-4 and PGY-5. The subspecialties included cardiac anesthesia, pediatric anesthesia, pain management, obstetrical anesthesia, neuroanesthesia, outpatient anesthesia, intensive care medicine, and research. The number of anesthesiology residents (PGY-5) pursuing 12-mo subspecialty training increased over this period. The specific subspecialty distribution of fellows changed, with the largest increase in number and percentage occurring in pain management. The largest declines occurred in critical care medicine and research. Our data do not indicate a decrease in the number of anesthesiology subspecialists. Factors other than the duration of training appear responsible for the selection of subspecialty education. IMPLICATIONS: The purpose of this study was to determine the long-term effect of the additional year of anesthesia training instituted in 1989 by the American Board of Anesthesiology on the number of individuals enrolled in subspecialty training. Our data indicate that the number of fellows increased over 10 yr. We conclude that factors other than the duration of training influence the selection of subspecialty education.
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Reorganization of outpatient services at Western Psychiatric Institute and Clinic identified a small percentage of patients who did not fit into the subspecialty framework. This necessitated the reestablishment of a General Psychiatry Clinic. A review of 100 patients in the Clinic revealed that they represented the most difficult diagnostic and management problems in the system. General Psychiatry in this subspecialty setting has practically become a subspecialty in its own right, rather than fulfilling a more traditional role of providing general care to the least complicated patients.
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