Addressing the Negative Financial Impact of Fellowship to Increase the Workforce

In this issue of Pediatrics , Catenaccio et al1 examined the impact of completing a pediatric fellowship on lifetime financial returns (expressed as net present value) compared to pursuing a general pediatrics private practice and the effect of eliminating medical school debt, shortening fellowship, and loan repayment on the return. The authors also compared these results to a similar study they conducted 10 years ago.2 The main finding is that for all but 3 subspecialties (cardiology, critical care, and neonatology), the net present value is lower for trainees that pursue a fellowship compared with those who enter private practice general pediatrics. The authors also found that the difference between the highest and lowest paying subspecialties has widened over time, as has the gap between most subspecialties with general pediatrics. To calculate net present value, the authors use 3 well-recognized databases and assume that all subspecialists are practicing in an academic medical center, whereas general pediatricians are in a private practice. However, these assumptions are not entirely accurate. Freed et al3 reported that, although the majority of recent fellowship graduates are initially employed by universities or … Address correspondence to Richard B. Mink, MD, MACM, Harbor–University of California, Los Angeles Medical Center, 1000 W Carson St, Box 491, Torrance, CA 90502. E-mail: rmink{at}ucla.edu