|Volume 21, Number 2||Fall, 1994|
Goals of Residencies Versus Graduate Programs
- The clinical residency is designed to train a competent clinical specialist, who can be certified as such by passing a specialty board examination. The specific goals for each specialty college vary, but typically include developing residency programs, serving as a certifying agency to qualify members as specialists, and encouraging members to pursue original investigations and to contribute to the literature.
- MS, PhD, and postdoctoral programs are designed to train researchers.
- Parallel residency and graduate training is intended to train a competitive academic clinician who can do research. When goals of residency and graduate training coexist, especially in a parallel fashion, these programs can be both complementary and competitive.
History of Residency Programs
Most specialty residency programs started at universities' teaching hospitals were combined with MS degree programs. This probably reflected the transition of training for future academic clinicians going from strictly graduate degree programs to preparation for the new specialty boards, which developed in the 1960s and 1970s.
Since there were frequently academic positions for residents completing their training, the MS and PhD degrees were considered important credentials for faculty. At Georgia, the Department of Small Animal Medicine strongly supported the parallel residency/graduate program from the early 1970s to the late 1980s. Most of these residents entered academia and progressed well through the academic ranks. Although goals of resident and graduate programs frequently conflicted, most residents were able to simultaneously complete their residency programs with the MS in 3 years or the PhD in less than 5 years. However, academic positions became sparse in the mid-1980s and most residents currently enter private specialty practice.
The number of clinical specialists is rapidly increasing. The number of new Diplomates certified by the American College of Veterinary Surgeons demonstrates this trend in specialty training (Table 1). The annual number of new Diplomates slowly increased until 1986, when it nearly doubled. Since then the number has remained high and fairly stable. In 1994, the number increased again, probably as a reflection of a change in the publication requirement.
Job opportunities for clinical specialists
The following 2 tables demonstrate job trends and the current opportunities for jobs for residents that have just completed their training programs. Since 1986, residents finishing small animal residencies at the University of Georgia have entered private practice at a rate comparable to academia (Table 2). However, fewer residents are finding employment as tenure track faculty with an increasing trend toward temporary academic positions and additional training programs. The data in Table 3 are from a survey of perceptions of Department Heads and Hospital Directors from 16 training programs. They felt that only ophthalmology had a strong demand in academia and the opportunities in private practice are best in ophthalmology, surgery, and dermatology. Residents completing several specialty programs are apparently having difficulty finding employment even in private practice. It is important that the number and type of training programs should have a relationship to job opportunities.
Table 1. American College of Veterinary Surgeons: Diplomates by year of completion of credentials.1965: 16 1975: 18 1985: 19 1966: 5 1976: 12 1986: 36 1967: 1 1977: 15 1987: 28 1968: 12 1978: 14 1988: 31 1969: 4 1979: 8 1990: 27 1970: 5 1980: 17 1991: 39 1971: 9 1981: 17 1992: 40 1972: 13 1982: 23 1993: 34 1973: 10 1983: 19 1994: 63 1974: 9 1984: 11
Table 2. Job trends in Georgia residents over time.Academic Academic/ Practice Practice 75-80 7 2 4 81-85 9 2 1 86-90 6 4 7 91-93 6* 1 4 Total 28 9 17 *1 took a job as temporary instructor, 2 entered other training programs, and 1 serves in the military.
Redirection of Residency
In 1990, small animal residencies at the University of Georgia were converted from being a mandatory parallel graduate training (MS/PhD) program to an elective option. This departmental decision was based on the job opportunities, student debt of residents, and the increasing complexity of case management, diagnosis, and treatment. This complexity intensifies clinical specialty training and produces greater conflicts with graduate training. The combination of residency training, graduate courses with rigid schedules, and research had resulted in many residents failing to complete the MS degree by the end of the 3-year residency. Another concern was whether the graduate training involved in an MS program truly prepared a clinical resident for the competitive environment at many institutions. Focused research training was felt to be a critical background if junior faculty are to be competitive for research funding and promotion. Although some research training continues to be an integral component of a clinical residency, the need to train competent specialists with additional marketable skills for private practice has increased. Most residents elect not to pursue a degree, but all are required to complete at least one original research project and to publish. Others have not only done the graduate degree training, but also completed the PhD after the residency. Deletion of the graduate courses has increased the need for some didactic training during the residency and permitted addition of subspecialty training. These additional training areas can include ultrasonagraphy, cytology, endoscopy, oncology, cardiology, and practice management.
Programs should be modified following reassessment and the intense competition in many academic positions frequently means that greater research training (PhD or postdoctoral research fellowship) of at least two years is needed. This could result in two types of faculty, teaching clinicians vs. research faculty.
Table 3. Small animal residency positions and opportunities: Perceptions of department heads and hospital directors.(1)Residency Program No. (2) Academic Practice Opportunities (3) Opportunities Medicine 3.3 1.8 2.5 Surgery 3.5 2.1 3.2 Anesthesia 2.0 2.6 1.1 Ophthalmology 1.7 4.0 4.0 Neurology 1.0 3.2 2.4 Dermatology 1.0 2.8 3.1 Nutrition 2.0 1.6 1.0 Oncology 2.5 2.1 1.8 Cardiology 1.2 2.6 2.0 Critical Care 2.0 2.1 1.9 Exotic Medicine 1.8 1.8 1.5 (1) Means of responses from a survey in 1994 for the American Association of Veterinary Clinicians taken by Dr. Roger Fingland and including data from 14 veterinary colleges, Angell Memorial, and the Animal Medical Center.
(2) Mean number of residents in each program.
(3) Opportunity scores are based on a scale with 1 (few jobs available now and residents had a problem finding jobs) to 4 (many unfilled positions, residents always able to find jobs).
Future of Residency and Graduate Training Positions in Veterinary Medicine
The number of positions and type of training in both clinical and basic sciences should reflect job opportunities and requirements. There have been few academic faculty positions due to lack of new schools and the restricted budgets during the early 1990s. Some positions should occur, as faculty that were hired in the 1960s and 1970s retire, and if new positions are needed to teach students electing focus areas. Despite these potentials for additional faculty positions, there continues to be a trend to produce more clinical specialists. The opportunities for clinical specialists in private practice opportunities are poorly defined. Training positions at some institutions may decrease if they can be converted to temporary and junior tenure track faculty positions.
Suggested Questions to be Answered in Planning Residency Programs
- Why do faculty desire to have residents in their programs?
- Should residencies be structured to assist the resident in completing credential requirements for their respective specialty board?
- What do faculty want residents to become after training? (Typical answers: academia, medical school, biotechnology, industry, basic science, practice)
- What do residents want to do after training? (Typical answers: practice, academia, other, don't know)
- How should outcome assessment data be collected for residency programs?
- Should outcome assessment be used to modify residency programs?
- How many specialists can practice in the private arena?
- What are the problems if more residents are trained than there are opportunities, especially for those desiring private practice?
- Should core and elective veterinary education (DVM) and continuing education programs be modified in consideration that more specialists are available for referral by private practitioners?