Already a specialist, still a trainee: recognizing dual professional identity in subspecialty fellowship

Dear Editor, Simpson and colleagues argue that praise for trainees’ resilience can draw attention away from the structural conditions that make such resilience necessary [1]. Their analysis points to a related difficulty: training structures may allow trainee status in a new subspecialty to obscure expertise that a physician has already earned in a core discipline. Where subspecialty fellowship follows training that permits autonomous practice in a core specialty, physicians enter a new field as learners but remain qualified specialists [2]. This creates a dual professional position: specialist in one domain, trainee in another. Fellowship should therefore recalibrate autonomy to context whilst preserving recognition of prior expertise. Two qualitative studies illustrate this tension. Chiel and colleagues described new fellows as “novice experts”: unfamiliar systems, knowledge, roles and responsibilities made them feel inexperienced even as others expected expertise [3]. Chan and colleagues similarly found that setting, language, responsibilities, and privileges shaped the identities of qualified specialists in further training; participants described dissonance when they delivered consultant-level care whilst still labelled trainees [4]. These accounts point to a possible mismatch between a physician’s credentialled competence and the identity recognized by the institution. This mismatch can be framed as a “recognition gap.” Direct evidence remains sparse, so this should be treated as a working concept to be tested, not an established outcome.