<p>In some specialties, fellowship is only required to puruse a sub-specialty. keep in mind that very many will not be willing to give additional several years of practicing medicine for additional years of (basically) residency. Fellows are there with the residents and medical students, they are not running or partiicipating in running of specific office. Some will go for it, many will not. Not sure how it is connected to the amount of research in general. That is going back to the original pointâŠ
What I am saying, as one example, is that if one wants to be a Pediatric Dermatologist or Cosmetic Dermatologist,there are other sub-specialties there, then they have to go thru fellowship program. Otherwise, for a just Dermatologist, there is no need for the fellowship. There are many people in a very high positions (even academically related) who never been in fellowship programs at all.</p>
<p>The many residents to which I refer are those who want to end up practicing in medical groups affiliated with programs similar to where they went to medical school - academic medical centers where they will practice medicine, have residents, and do some research. What I am saying is more medical students will at least think about sub-specializing after residency. There are a limited number of fellowships but what I believe is that an added layer of education is going to be more expected than in the past if you want to work for the âbig boysâ in medicine. JMHO</p>
<p>âŠand I should clarify saying that the need for fellowship may well apply in some areas of medicine more than others.</p>
<p>âWhy we even discuss fellowship here?â</p>
<p>Anything goes here. We will also be discussing super specialties which come after fellowships. Not sure why you think it is what you want to talk about and nothing else?</p>
<p>Interesting article⊠matches perfectly with what my son-in-law has experiencedâŠ</p>
<p>âThe Impossible Workload for Doctors in Trainingâ</p>
<p><a href=âDoing the Math on Resident Work Hours - The New York Timesâ>Doing the Math on Resident Work Hours - The New York Times;
<p>A couple (wife and husband), both in this situation, told DS that she at one time saw her husband only once in a week, while he was sleeping.</p>
<p>Our son-in-law stayed as long as he could in the program where he was (until his new program orientation started. In reality, he could have moved away from there immediately after the Match results came out, and he could have been living all this time with his new wife! Up until the time he left there, he did not even think this past year was going to âcountâ as a completed year of residency. I am glad he did the honorable thing, though, by staying through this year. </p>
<p>All the same, he felt awful because when he actually left the program where he spent his first intern year to move to the new program, the remaining residents were left in a bind. Basically, two people are going to have to cover ALL the night-float duty for a few weeks. This because, in addition to our son-in-law leaving, another guyâs two year old child was just diagnosed with leukemia and will be undergoing chemotherapy, so the guy is taking a few weeks off. Another resident left when her mother became very ill. I cannot even imagine the stressâŠ</p>
<p>churchmusicmom,</p>
<p>Re: âI cannot even imagine the stressâŠâ</p>
<p>Your post reminds me of a conversation with a relatively young (but 35-ish yo?) doctor at a hospital when I was sick last year.</p>
<p>I believe he had completed his residency less than 6-7 years ago. When we talked about the stress that most residents are put under, he actually had a quite negative opinion about how this happens.</p>
<p>He does not buy into the commonly mentioned ânoble goalâ that goes like this: All the new doctors in training need to go through the high stress training system to âtoughen them upâ because they should be good at performing well under a lot of stresses and the hospital should train them like this. He basically points to the âgreedâ factor of this system (he did not say whether it is Medicare/Congress or the hospital or the insurance industry which makes the system like this.) He believes that, in order to maximize the profit, somebody decides to hire as few residents and/or doctors as possible. It is the same greed that is common in other business where the profit is the main concern. The only difference may be that in other corporate America world, when it is understaffed and the project is delayed, the managerâs (and those work under him as well) career may be put into danger, while in the healthcare, the patientâs life may be put into danger as well as the residents/doctors are put under stress. In one year, I heard some patients died in one of UTSWâs teaching hospitals precisely because of the understaff issue at the hospital - to put it bluntly, for this particular case, the society as a whole chose to do this mostly because most patients at that hospital are poor. The well-to-do patients will not go to that hospital.</p>
<p>Another doctor, who is a surgeon, just said that, because he was still young at that time, he could still manage to take it. If he is at his age now (35-40-ish), he will probably have a hard time to take it.</p>
<p>I am not sure whether he has a point.</p>
<p>@mcat2: I had the opportunity to watch the transition from pre-80 hour work rule to post-80 hour work rule. I worked probably 90 - 130 hours per week during my internship. By PGY2, the rules changed and I worked 65 - 90 hours per week. I can definitely attest to the fact that there was a significant change in the experience and knowledge base of the interns and residents at all levels after the rules were implemented. I heard the argument that residents needed to be toughened for the âreal worldâ. I donât agree with that at all. I also didnât agree with the belief that the hours were necessary for learning purposes. Those hours were meant for labor reasons. Nevertheless, the educational opportunities and work ethics suffered after the 80 hour work rule. I wouldnât want to go back to the old days but something needs to be done for the negative aspects of the work restrictions.</p>
<p>Here are the changes I would recommend:</p>
<p>1) No one learns at the same pace and no two programs provide the same opportunities. I would prefer a system where residents complete their training after meeting their minimum amount of procedures, cases, and passing their written board exams. This may mean that a resident may complete a 6 year residency in 4 - 5 years while another may take 7 years. This would change the labor aspects of the residency and tip it back to the educational side.</p>
<p>2) I would get rid of the Match. I know this has already been suggested by some experts. Residency is really an apprenticeship and the match no longer makes sense in our technological world. Programs should be allowed to recruit and students should be allowed the ability to choose a program based on the best fit and not the best chance.</p>
<p>As for staffing: I can get emotional here talking about the evolving world of medicine. Understaffing has become the norm. This transition has been occurring since at least the 1990s and continue to progress. The amount of patients that floor nurses manage now and the surgeries whizzing through the operating rooms are staggering. I remembered a surgery resident rounding on 70 patients in one morning. Now, I know surgeons who see that many in one day in the office and another who has done at least that many surgeries in a week. Patients are also being herded out of the hospitals as soon as possible. The hospital and insurance companies want you in the hospital for as little time as possible.</p>
<p>I would advise todayâs residents to continue to learn the clinical aspects of their specialties, learn to work very quickly and learn how to BILL!! Thatâs the world they will enter and usually they are only prepared for the clinical side. Billing issues are the biggest problem we deal with in the large group that employs me. So few providers understand the details of it.</p>
<p>mcat2,
My D. who is one of the youngest in her class, said exactly the same thing about artificially created emotional non-justified amount of stress, particularly in OR. She rejected the idea of the surgeon way back in HS, she said because she imagine this type of situation and her rotation (somehow misteriously she got H - she believes undeserved) has proven her to be correct. She heard excelty the same, that in order to achieve perfection, you need to be tough and it supposedly spreads to iterractions between the memebers of the team in the OR. She totally completely disagree with this approach and it turned her off. She strongly believes that much more could be achieved if everybody treats others with the utmost respect and behaves proffessionally no matter what. Frankly, I personally shut down if somebody raises voice on me, I just stop understanding what is said and my focus is totally of the fact that person has raised the voice talking to me. I believe that level of distraction might be pretty severe and that would open to more errors not less.
D. was screamed at (not in OR) by the attending. She was very very upset. Doc appologized the next day, apparently he was also thinking about it. All of it was created artificially by unproffessional behavior and required additional attention to get corrected. It would be beneficial to everybody if doc. in this specific situation spent his time thinking about some patientsâs cases than about the fact that he mistreated a medical student. I am very appalled at this, in normal âcorporateâ America, few cases like this would be a subject to personâs dismissal, nobody would deal with this type of person, proffessional behavior is absolute must.
No understaffing or any other condition calls for artificially created additional level of stress. As far as being late in the project in âcorporateâ world, it is not much permissimal either (govenrment is a very different story). People are just required to work sometime twice as much day after day (and WITHOUT pay, slaried employee are not paid overtime) to complete the projects on time. Nobody wants to loose customers, the business will not exist if customers are gone somewhere else. </p>
<p>Thanks for sharing your experience.</p>
<p>Just curious: Is neurology a âlife styleâ specialty (not completely as in most of âR.O.A.Dâ or pathology, but to some degree)?</p>
<p>"My D. who is one of the youngest in her class, said exactly the same thing about artificially created emotional non-justified amount of stress, particularly in OR. She rejected the idea of the surgeon way back in HS, she said because she imagine this type of situation and her rotation (somehow misteriously she got H - she believes undeserved) has proven her to be correct. She heard excelty the same, that in order to achieve perfection, you need to be tough and it supposedly spreads to iterractions between the memebers of the team in the OR. She totally completely disagree with this approach and it turned her off. "</p>
<p>Miami</p>
<p>Unfortunately that is the culture of surgery. When my S was applying for residencies his home program practically begged him to rank them high, they wanted him to stay on an everyone from the dept chair to the Docs who wrote his recs told him so. He wanted no part of staying and ranked them fairly low on his match list.</p>
<p>While out on the interview trail at virtually every stop when other candidates saw where he went to Med school they asked " is it really as malignant as we hear?" which in his own mind helped to justify not wanting to stay there. As parents we asked /stated that in our opinion every program was malignant in some way, it was only the degree of malignancy that varied. </p>
<p>Heâs about to finish year two of a six year surgical residency. I can tell you unequivocally that the stress is not artificially created because in the OR it is often life and death, particularly in trauma surgery or when rotating through the ER. The stress is real, the fatigue is real and as has been said by many here before, the ONLY way one should consider surgery is if they cannot see themselves doing anything else. Itâs the most brutal residency where very few words of encouragement are ever offered and criticism either snarky or condescending is the rule. </p>
<p>Iâm not saying I agree with this but itâs the way it is. </p>
<p>A certain dept chair NEVER says anything positive, literally eviscerates residents in front of their peers on a daily basis and seems to delight in it. My S said that he later learned from the attendings that this doctor only picks on people he likes and if he doesnât like them he fails to even acknowledge that they exist. One had better be very thick skinned to survive in that environment.</p>
<p>He has three more years of residency, at least two of research and two more for a fellowship which is standard course for most every specialized surgeon. One of his three remaining years is actually a stop out year
where he can begin to do required research or even pick up a one year fellowship in a related area like critical care etc.</p>
<p>Surgery is a very ego driven field. " We fix things" is the mantra. You had better be confident or the consequences are dire. Thatâs why itâs not for everyone.</p>
<p>Yes, exactly, âIâm not saying I agree with this but itâs the way it is.â, I agree 100% and my D. somehow knew it all along.<br>
And yes, âThatâs why itâs not for everyoneâ, âOne had better be very thick skinned to survive in that environment.â
I would add that this skin should be removed in connection to the patient and his/her needs, still got to stay very sensitive on all levels, performing surgery, dealing with the person and family members. For some, it will be too much bending of their personalities.<br>
When I was talking about âartificialâ stress, I mentioned âadditional layerâ. It is perfectly understood that saving personâs life is very stressful. However, avoiding distraction, like not needed yelling and putting people down, would result in more efficient environment (just like any working environment outside of medicine does not permit such a behavior, not under extreme stress, of course, nothing could be compared, buzzilions of dollars that are sometime at stake still do not measure up to a single human life, that is perfectly understood.) You really need to worry about beeing efficient under this counting milliseconds situations. So remaining calm and proffessional is even much more important and will sage those crucial milliseconds. This is all I am saying, nothing else. I just wish that doc. who spent his time thinking about correcting the artificially created situation when he mistreated my D., I just wish that he spent this time thinking about patient and not been forced by his own behavior to spend time thinking about apologising to my D (who fuly desrved his apology) </p>
<p>S has finished his intern year which included almost 8 months of 12-15 hour days 6 days or nights per week. As you can imagine he and his fellow interns were beyond ecstatic. Although his schedule was brutal he felt has grown exponentially especially after he just spent some time rounding with the incoming interns who seemed utterly clueless. Attendings and residents assured S that he and his fellow interns were just as clueless last June as were they (attendings and residents) when they started their residencies. In my opinion I think this speaks somewhat to why residency program directors (PDs) care less about the name at the top of your diploma than the fact that one graduates from any US med school. To PDs, all US med schools are roughly the same educationally wise and the ârealâ training doesnât begin until residency.</p>
<p>Second year is apparently only 4-5 months of the above schedule with remaining time 5 days a week 8-5 days. So more chances to have a ânormal life.â Yeah. </p>
<p>^Congrats!
Today is Dâs first day of 4th year. Next week she is going to national conference with her poster presentation. She has never been to such an event, I feel that she is somewhat nervious - a bit out of her character. </p>
<p>There is now a thread on CC about âRecommended loan limitâ.</p>
<p>What is the amount of accumulated student loans (when a student graduates from med school) that you think is not excessive so that you think it can not be paid off in 10 years?</p>
<p>Thanks!</p>
<p>Can be paid off or can be paid of without too much pain? Under $200k seems smart, but I see lots of posters on SDN with $300k, $400k, etc., especially people who have undergrad debt and did DO or Caribbean.</p>
<p>My comment on witnessing the beginning of residency, âtheyâ tell you it will be intense, but no one is quite prepared for how that feels on the first few days, how hungry they get on a busy day, how your body feels after 16 hours, on the 3rd day in a row of that schedule, how weird it is to walk in and be handed files and be totally in charge of half a dozen or more patients. Yes, there is an attending, but the difference between student and intern is vast. Knowing the computer system is less help than one thinks, because as a student those real docs used to go behind and fix anything you messed up, now you both have to realize something needs fixing and figure out how to fix it.</p>
<p>The computer system at my daughterâs hospital is different from where she went to med school so she has that to learn. She doesnât have pre-founds during this first rotation and mentioned that it has made it more civilized than she expected. That being said, she is exhausted, really likes her co-residents and the attendings, lives the furthest of the residents from the hospital (which may not have been her smartest move - though she isnât second guessing her apt. choice at all) and is slowly figuring out the geography of the hospital. On nice days she rides her bike to work. She has developed a liking for Macrobars which are keeping her upright during the work day. </p>
<p>I will have my daughter check into Macrobars. I know this is the residency thread, but I am posting here because no other place to share and vent. My 3rd year med student is into her 2nd week of her surgery rotation, and she says âI hate it that I like it so much.â Yikes, didnât see that one coming.</p>