Early exposure in medical school, residency encourages careers in allergy, immunology
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Key takeaways:
- The need for allergists and immunologists is growing as the number of fellowship applications is falling.
- 59% of respondents participated in allergy/immunology rotations during residency.
Allergists and immunologists often decide to enter the specialty during their residency, primarily because of the work-life balance it offers, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.
The clinical aspects of the field and clinician mentorships also drove these decisions, Kasey Lanier, MD, allergist and immunologist, division of allergy and immunology, Nationwide Children’s Hospital, and colleagues wrote.
As allergic and immunologic diseases continue to grow in prevalence, the researchers wrote, the need for new specialists grows as well. Yet the researchers also noted that there has been a trend in fewer applicants for allergy and immunology fellowships.
Survey population
To improve recruitment, the researchers worked with the American Academy of Allergy, Asthma & Immunology Program Directors Assembly Committee to survey first-year trainees in allergy and immunology who began fellowships between 2017 and 2021.
The researchers collected 321 responses (67% women; 70% aged 30 to 35 years) to their 20-question survey, with 76% of respondents graduating from a medical school in the United States. Primary residencies included internal medicine (47%), pediatrics (45%) or both (8%).
Also, 17% identified as a member of a racial or ethnic group that has been historically underrepresented in medicine (URiM), including African American/Black, Hispanic/Latino, American Indian/Native and Native Hawaiian/Pacific Islander.
The researchers noted that this percentage was higher than the 10.2% of allergy and immunology fellows who identified as URiM in 2021 and 2022 data from the Association of American Medical Colleges.
The respondents also reported participating in allergy and immunology rotations in residency (59%), in both medical school and residency (35%) and in medical school alone (< 1%), with 3% not participating in an allergy and immunology rotation before fellowship.
Additionally, 37% said that their medical school and residency institutions had an allergy and immunology division, as well as an allergy and immunology fellowship program where they completed their residency.
Most respondents (76%) also said the institution where they completed their residency had an allergy and immunology division, but 15% did not have an allergy and immunology division affiliated with their medical school, nor did they have one affiliated with their residency.
Among respondents who identified as URiM, 67% had an allergy and immunology division where they completed their residency, but 13% did not have any institutional allergy and immunology presence.
The survey also found that approximately 20% of respondents had participated in the AAAAI’s Chrysalis Project, which helps medical students and residents attend the group’s annual meeting as part of their career exploration.
Similarly, 53% had attended an AAAAI meeting or an American College of Allergy, Asthma & Immunology meeting before their fellowship.
Forty percent of respondents first were exposed to allergy and immunology during medical school, 32% were first exposed during residency and 17% were exposed before they started college.
Nearly three-quarters (73%) decided to pursue allergy and immunology during their residency, with 55% of them making that decision during year 2.
The most common influences on the decision to pursue allergy and immunology were work-life balance (79%), the field’s clinical aspects (75%), mentorship (29%), research opportunities (25%) and income potential (24%).
Specifically, the researchers said, 76% said they had a mentor in allergy and immunology before their fellowship, with 67% of these mentors in academics and 15% in private practice.
Although rheumatology and hematology/oncology were the most common alternatives, the researchers added, most of the respondents did not consider any other fields besides allergy and immunology for their fellowships.
Next steps
Considering the growing need for allergy and immunology specialists, the researchers said these findings on how and why physicians and training enter the specialty may inform strategies for engaging with medical students and residents in recruitment.
Increasing resident and medical student exposure to allergy and immunology in clinical and non-clinical settings probably will increase interest in the field, the researchers said, especially since many of these students currently lack this early exposure.
The researchers also suggested that efforts designed to increase interest in the specialty need to be more creative and intentional, particularly in programs and medical schools that do not offer allergy and immunology services.
Further, the researchers encouraged allergists and immunologists to proactively introduce the medical students and residents that they encounter to the specialty.
The researchers additionally cited the need to promote the inclusion, recruitment and retention of URiM trainees and faculty, considering disparities in allergy and immunology in these communities and how these physicians are more likely to practice in underserved areas that would benefit from their care.
While studies investigating perceptions and misperceptions related to allergy and immunology would help as well, the researchers continued, they emphasized that increased visibility in medical school and residency settings along with mentorship would have the most impact in promoting the specialty as a career.
Perspective
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Mahboobeh Mahdavinia, MD, PhD, FAAAAI
These results are not surprising. They also are informative for the future of the specialty.
My experience was very similar to these results. My own interest in this field was shaped during residency and cultivated by my mentors. As faculty, I have mentored more than 20 residents or medical students who have chosen this field and are now our colleagues.
To encourage more students to pursue allergy and immunology as a specialty, physicians can present at residency, medical school speaking events, grand rounds and case discussions. They also can be role models and demonstrate the specialty’s real work/life balance.
Perspective
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Priya J. Bansal, MD, FAAAAI, FACAAI
The findings of work-life balance being desired are not surprising, as medicine has evolved through the years. For physician wellness, work-life balance has become increasingly valuable. What is surprising is the continued lack of exposure and accessibility to mentorship for medical students and residents.
Allergists and immunologists are an integral part of the care team for the patient and provide value in preventative health. Early exposure to allergy and immunology will help our specialty to grow and give those outside of our specialty a unique perspective of what we do regularly to reduce risk and treat disease.
As a private practice physician who works regularly with students and residents, I have found that the students who rotate have a genuine appreciation for the work we do in allergy and immunology and use it in the fields they go into. Or they decide to pursue allergy and immunology themselves.
Simultaneously, through the AAAAI, I have worked with the Regional Outreach on A/I for Residents (ROAR) program to expose residents to the specialty. In addition to these programs, mentorship is sustained in the AAAAI through the Leadership Institute for Graduating Allergy and Immunology physicians. The mentorship component is vital to advancing students’ passions and interests.
To encourage more students to pursue allergy and immunology as a specialty, physicians can participate as volunteer faculty to help mentor students and residents. Advocating with local specialty societies using the AAAAI ROAR program as a model, allergists and immunologists can host a program for residents to introduce them to a career in the field. Academic centers also can partner with private practice physicians to support rotations at their clinics. Academic institutions can try to bring allergists and immunologists in to present key topics to students and residents as well.
Additionally, organizations can continue to expand mentorship opportunities. They can create a database to connect students and residents with local mentors who are interested in helping. They can provide mentorship training for these opportunities as well. They can also continue to expand efforts to create programming for exposure to students and residents, making sure to highlight the work-life balance and fascinating aspects of our field.
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