May, 2017

Jolly Good

By Michael J. Katin, MD

Recognition of one's accomplishments provokes favorable emotions in all but the most self-sufficient of persons. Throughout the educational process, grade advancements and, then, diplomas, indicate to the world that a person has mastered a certain collection of skills. In the medical profession, post-graduate programs designate that levels of achievement have been reached as one goes through PG-numbered years and then completion of specialty programs and, it is hoped, board certification. Other professions have their own levels of stratification and certification. Outside of the educational realm, other activities, such as kendo or Shriners, have their own ways of recognition. In the military, where an error in advancing an underqualified person to a rank may result in severe consequences, promotions are best given out as a tribute to advanced ability.

For years, persons in the United Kingdom with significant contributions were recognized by being given aristocratic titles (duke, earl, etc.) , often accompanied by castles and sometimes land that could be handed down to their progeny. In this era of redistribution this would not be considered appropriate, and titles have tended to have fallen onto hard times, but at least knighthoods and lesser honors can still be granted.

In academia, physicians may seek gratification by rising professorial status, possibly culminating in being named to an endowed chair. In real-world practice, there are no stratified ways to recognize accomplishment. A popular internet column of the 1990's suggested one method, but, unfortunately, this was not adopted. At least it is still possible to be recognized as a "Top Doctor" by one's regional magazine or even by an in-flight magazine (the same ones that have three or four different listings for the "Best Steak Houses in America") or other national organizations. Those who make the list have the opportunity to pay for plaques and other paraphernalia to document this status, and those who don't make the list are just jealous and need to try harder, or else should just go ahead and find other ways to satiate their egos.

There is one more mechanism to recognize achievement in the medical profession. In April, The American Brachytherapy Society announced, at its 2017 Annual Meeting, the first-ever awarding of Fellowship status to 13 prominent persons (to reflect the 13 original colonies/states, since the meeting was in Boston?). These persons will now be able to display the initials "FABS " after their names. Among these 13 are six FACRs, two FACROs, one FASTRO, and one FRCPC. This then provoked interest in the evolution of the fellowship designation and what the future may hold.

It should be noted that the term, "Fellow," may not truly be sexist (considering the original Old Norse felag, meaning "partnership," or, more specifically, "a laying down of property") but certainly sounds as if it is and should have been replaced long ago by a term such as "Person Sharing a Similar Interest " or a non-Norse term such as "Comrade." Be that as it may, naming of Fellows has been part of participation in medical specialty colleges such as the American College of Radiology (FACR), American College of Surgeons (FACS), American College of Physicians (FACP)l, and the American College of Radiation Oncology (FACRO). The American College of Radiology expresses that only 10% of the membership will achieve the Fellowship level based on their accomplishments (253 were inducted in 2017) but, interestingly, it appears all members of the American College of Surgeons are Fellows (as always, surgeons have always figured this out way ahead of everyone else, including the $200 application fee and $400 initiate fee for Fellowship). The American College of Physicians will be adding 253 new Fellows this year, with a $150 Fellowship Initiation Fee. The American Academy of Family Physicians, sort of like a College, awards Fellowship to distinguished members, who can become FAAFPs after fulfilling the requirements and paying a $210 application fee. In 2006, ASTRO, not a College, started awarding Fellowships, with a policy of not accepting more than five per cent of the active membership per year. Only 269 members have made it to FASTRO status so far, with only ten d inducted in 2017. The American Association of Physicists in Medicine and the American Association of Medical Dosimetrists generate Fellows (FAAPMs, FAAMDs ). It's no surprise that the American Brachytherapy Society did not want to be left out in being able to award recognition. Now that F-words are being flung around in increasing numbers, it would be a matter of time before Fellowships are offered by the American Registry of Radiologic Technologists (FARRTs---both junior and senior levels for young FARRTs and old FARRTS) and by the Association of Freestanding Radiation Oncology Centers (FAFROCs ).

Who knows what's to fellow...er, follow? As for me, I'm holding out to be a Sagamore of the Wabash.

(Thanks to Mark L. Sobczak, MD, FAFROC, for creative and intellectual input)

Emanuel Countdown: Dr. Ezekiel Emanuel's biographies list his birth year as 1957 but, interestingly, do not list a birth date. He has expressed that he does not wish to live past his 75th birthday. Giving him every benefit of the doubt, he will have his 75th birthday no later than December 31, 2032. Including May 1, 2017, this leaves 5,724 days to his goal.