Issue: January 2018
January 01, 2018
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Should the 3-year residency requirement be shortened to address the endocrinologist shortage?

Issue: January 2018
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Click here to read the Cover Story, "Diabetes epidemic spurs renewed focus, creative solutions for US endocrinologist shortage."

POINTCOUNTER

POINT

A 3-year residency requirement is one factor that is limiting entry into endocrinology as a specialty.

There was a time in the late 1960s and early 1970s when you needed only 2 years of internal medicine residency training to become board certified in internal medicine. The American Board of Internal Medicine recognized the first year of specialty training as the third year of internal medicine residency. Of course, this only applied if you were going on to a medical subspecialty.

Robert A. Vigersky

I benefited from that approach. As far as I can tell, that was a successful approach, in general. It was particularly attractive in my case because I did a 3-year fellowship at NIH. Thus, I finished all my postgraduate training in 5 years rather than 6.

Shortening the residency requirement now would accomplish two things. First, it would encourage residents to concentrate on a research career by not penalizing them for taking an additional year of fellowship. Second, it would encourage more medical students to apply for MD/PhD programs for similar reasons. In both cases, it would increase the pool of endocrine researchers with a clinical background — a highly desirable and needed cohort.

In many teaching hospitals, endocrinologists also must act as an attending physician on the internal medicine service. Since medicine has become so complex, some might argue that you need an attending physician who has had a full-fledged, 3-year internal medicine education to perform that function competently. However, I believe that the pass rate on the internal medicine boards was no different for those who took it after 2 years vs. 3 years of internal medicine training. Personally, I was well-prepared to fulfill the role of an attending physician on the medical wards, despite its complexity. After all, the complexity of endocrinology trains us well to take on those challenges.

There are, of course, other factors affecting the endocrinologist shortage. Limited salary expectations compared with other specialties is probably the biggest limitation at this point, given the large amount of debt that physicians have as they enter postgraduate training. Shortening residency requirements certainly would help because it would mean 1 year less of training before endocrinologists start earning a living and begin to pay back that debt.

Robert A. Vigersky, MD, is senior medical director for Medtronic Diabetes, professor of medicine at Uniformed Services University of the Health Sciences in Bethesda, Maryland, and past president of the Endocrine Society. Disclosure: Vigersky reports he is medical director for Medtronic Diabetes.

COUNTER

Losing a year of residency would mean losing valuable experience and vital exposure to the endocrinology specialty.

I have worked with many medical students, residents and fellows over the years. For quite a few years now, we have been trying to provide a more focused medical education in a time frame that fits the needs of our current health care system. It can be difficult for residents to find that focus while still gaining valuable experience.

If residency were to be shortened, some physicians would go into any fellowship, including endocrinology, wonderfully after 2 years. For others, losing that third year could reveal surprising weaknesses. Even someone who may seem to be a strong candidate from a strong program may struggle in endocrinology because the specialty really focuses on the whole body, whether it’s diabetes, Cushing’s disease or thyroid. In losing that third year, residents lose a chance to mature, no matter how good they were during their second year.

Debra L. Simmons

When starting off in medical school and residency, students must make many important decisions. The third year of residency offers an opportunity to rotate through the many different types of experiences that help a resident decide on a specialty. We in endocrinology already believe that many medical students and internal medicine residents do not get enough exposure to us. By changing the residency requirement to 2 years, I would worry that we would lose people with that shortened time frame. We need more, not fewer opportunities to get people excited about endocrine.

If you can’t think as a reasonably good general internist, you’re not going to be a good endocrinologist. Almost everyone in endocrinology who I have really respected can always do a lot with general internal medicine. Additionally, the hospital setting that residents are typically exposed to today can offer a limited view of what happens in medicine. It depends on the residency, but from a maturity standpoint, a resident is always going to miss out by not having that vital third year.

Debra L. Simmons, MD, MS, FACE, FACP, is professor of medicine at the University of Utah and director of clinical affairs at Utah Diabetes and Endocrinology Center in Salt Lake City. Disclosure: Simmons reports no relevant financial disclosures.