It’s also a matter of quality. Insurers will insist on quality care, and quality care needs to be available in all regions, not just those served by tertiary centers such as MD Anderson.
Explore This IssueMay 2013
Proposed Model of Training
Dr. Weber proposed a modular system with a nine-month basic surgery period with training in neurosurgery, intensive care, general surgery and plastic surgery. That could be followed by an otolaryngology module of 36 months, with a broad educational experience in all of the otolaryngological subspecialties.
Then, those who wanted early specialization could move on to 18 months of a head and neck specialty module with a defined scope of knowledge, goals and objectives. The specialized areas could include radiology, pathology, speech and swallowing, advanced head and neck surgical techniques or other areas, Dr. Weber said.
Trainees would file a formal application and selection process. Dr. Weber said there would need to be an approval process for the early specialization modules from the Accreditation Council for Graduate Medical Education. The head and neck surgery subspecialty module would be a program recognized by the ABOto, those in the program would take a special exam and certification would be tied to their training, Dr. Weber proposed.
He said data would need to be collected to determine whether such a training option is really wanted, and suggested focus groups with trainees seeking fellowship training and surveys of current residents.
He acknowledged some potential downsides, saying it could lead to a fragmentation of the specialty, might prompt a desire for a certificate of added qualifications or board certification in head and neck surgery and might limit the scope of practice of a primary certificate holder.
He pointed to a precedent for early specialization in general surgery, in which the first four years of general surgery could be followed by subspecialty training, every year of which counts as credit toward general surgery training.
It’s a concept at least worth exploring further, he said. “I think the overarching rationale for this, at least from my perspective as a cancer specialist,” he said, “is to really improve the quality of head and neck cancer care. That’s the main rationale.”