The American Board of Medical Specialties formally recognized Medical Toxicology as a specialty in 1993. Seven years later, Medical Toxicology fellowships received approval in the USA by the Accreditation Council for Graduate Medical Education (ACGME). Less than 3 decades as a formal specialty, the 2023 NRMP (National Residency Matching Program) Match results confirm demand for this relatively young specialty has increased significantly in the last few years and is now at an all-time high.
A medical toxicologist specializes in the prevention, evaluation, and treatment of illness from exposure to drugs, chemicals, and radiological and biological agents. The specialty also focuses on the diagnosis and management of addiction, which includes the treatment and prevention of withdrawal conditions. Some key attributes of medical toxicologists are their intimate knowledge of pharmaceuticals, chemicals, and venoms and how to treat patients with such exposures. This unique knowledge positions the medical toxicologist as skilled clinician, educator, researcher, and administrator. This scope of opportunity has made Medical Toxicology an intriguing specialty for many residents looking for a career with advanced expertise and high job satisfaction [1, 2].
Due to the breadth and depth of knowledge required for this specialty, the expertise of Medical Toxicology spans many disciplines in medicine. These include, but are not limited to, emergency medicine, pediatrics, occupational medicine, critical care, internal medicine, psychiatry, nephrology, clinical pharmacology, and others. Medical Toxicology is truly a multidisciplinary specialty. Though most residents enter the specialty through emergency medicine, applicants from all specialties are invited to apply [3]. The diversity of expertise is needed and welcomed in Medical Toxicology. We still have much work to do to encourage applicants from other specialties [4].
As interest in the specialty has grown, the American College of Medical Toxicology (ACMT) Fellowship Directors Committee has made several strategic moves to ease the application process. In 2013, for the 2014 appointment year, Medical Toxicology fellowships joined the NRMP. This allowed programs to coordinate the application cycle while applicants complete all desired interviews before entertaining offers. In 2022, Medical Toxicology fellowships implemented ERAS (Electronic Residency Application System). Not only does ERAS professionalize the application process, but applicants can also more simply submit the numerous required documents to programs across the country. These two steps improved the efficiency of the busy recruitment season for both fellowship directors and applicants.
Since implementation of the NRMP, Medical Toxicology fellowships have seen a slow, albeit steady rise in applicants (see Table 1) [5, 6]. November 16, 2022, signified the most current Match Day for Medical Toxicology fellowships. This was a momentous day for both fellowships and applicants as it signified the culmination of a hectic recruitment season. More importantly, this Match Day was particularly historic as the busiest in Medical Toxicology history. For the first time since joining the NRMP, all Medical Toxicology fellowships filled, and a record number of applicants vied for one of 49 available fellowship positions across the country.
Table 1.
| Matriculation year | Programs | % programs filled | Positions | % positions filled | Applicants | # applicants per position | % matched | % unmatched |
|---|---|---|---|---|---|---|---|---|
| 2014 | 25 | 48.0% | 37 | 54.1% | 24 | 0.6 | 83.3% | 16.7% |
| 2015 | 25 | 60.0% | 40 | 70.0% | 35 | 0.9 | 80.0% | 20.0% |
| 2016 | 26 | 34.6% | 41 | 46.3% | 21 | 0.5 | 90.0% | 10.0% |
| 2017 | 26 | 65.4% | 47 | 74.5% | 42 | 0.9 | 83.3% | 16.7% |
| 2018 | 27 | 66.7% | 47 | 74.5% | 40 | 0.9 | 87.5% | 12.5% |
| 2019 | 28 | 50.0% | 54 | 66.7% | 41 | 0.8 | 87.8% | 12.2% |
| 2020 | 26 | 61.5% | 51 | 76.5% | 46 | 0.9 | 84.8% | 15.2% |
| 2021 | 28 | 60.7% | 50 | 68.0% | 36 | 0.7 | 94.4% | 5.6% |
| 2022 | 28 | 85.7% | 54 | 92.6% | 58 | 1.1 | 86.2% | 13.8% |
| 2023 | 28 | 100.0% | 49 | 100.0% | 70 | 1.4 | 71.4% | 28.6% |
The fellowship directors also adapt well. In particular, the COVID-19 pandemic has greatly impacted post-graduate recruitment. Program directors quickly moved to virtual interviews when needed and have currently migrated to a hybrid approach. The ability to perform interviews in this fashion has empowered applicants to explore more programs while allowing individual fellowships to meet a deeper and broader pool of talented applicants. This strategy also strives to right-size an important equity issue. Virtual and hybrid options afford trainees with limited resources and time the opportunity to interview with programs beyond their means. This is critically important as we seek to increase diversity within our programs. This flexibility among fellowship directors, and therefore our programs, should be viewed as a strength. In part, our ability to recruit strong and diverse applicants can be attributed to the flexible nature of the interviewing process.
Likewise, the future of the Medical Toxicology specialty is healthy. As fellowships succeed, the specialty will continue advancing. There is a well-defined need for medical toxicologists to thrive in value-driven health care. We clearly provide better health, better care, and lower costs [7, 8]. Notably, we have most recently demonstrated our positive impact with patients suffering from substance use disorder [9]. Our growth allows opportunities to have even greater impact in areas such as the prevention of adverse drug events and pharmaceutical stewardship [10]. There is great demand for our expertise, and both applicant and medicine-at-large recognize the demand.
ACMT will continue to work diligently to advance our specialty as a valued and recognized contributor to improved health care within the country and across the globe. Rather than becoming complacent, we will continue our unwavering commitment for steady growth and positive impact to patient care. Medical Toxicology is committed to diversity and equity, and our healthy Match and current trajectory will allow us to reflect on these important priorities as we continue to expand our reach, elevate our standards, and continue to welcome interested applicants who will meaningfully contribute to our developing specialty.
Sources of Funding
None.
Declarations
Conflicts of Interest
The authors (AP, LK, MM, PW) are currently members of the ACMT Board of Directors, and two authors (AP, LK) currently serve as program director of a fellowship training program.
Footnotes
Publisher's Note
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References
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