Fellowship training in medical toxicology: Characteristics, perceptions, and career impact

Study Objective: To determine the number of physicians who have received fellowship training in medical toxicology and to describe fellowship-trained medical toxicologists' perceptions of fellowship training and its career impact. Methods: All current medical toxicology fellowship directors were contacted by mail for information on who had trained at their program. Subsequently, a written survey was mailed to all current American College of Medical Toxicology members regarding work force and educational issues pertaining to medical toxicology. Fellowship-trained toxicologists were asked about their clinical and research experiences during fellowship, and career impact of toxicology fellowship training. Results: Fellowship directors from 21 programs reported that 147 physicians had completed a toxicology fellowship since 1970. Of the 236 current American College of Medical Toxicology members surveyed, 160 (68%) responded. Ninety-four of the 160 (59%) are fellowship trained. Sixty-four of the 94 (68%) fellowship-trained toxicologists are emergency medicine board certified. About half the respondents believed they did not have enough inpatient and outpatient experiences during fellowship, but poison center time was more than adequate. After fellowship, 91% remain in medical toxicology although 78% spend less than 3/4 time in toxicology-related activities. More than 50% of respondents believed that fellowship training impacted their career by choosing an academic career, developing a toxicology clinical program, and altering clinical responsibilities. Conclusions: Most fellowship-trained toxicologists only work part-time in medical toxicology, but fellowship training has significant impact on choice of academic career and altering clinical responsibilities. Training concerns include limited bedside experiences, particularly outpatient, and uncertain job prospects.