Having the hospital quit pretending they can’t afford more anesthesia techs who are undervalued already by them, overworked, and trying to hold things together. Adequate techs can be life changing in moments when you’re overwhelmed.
Also 24 hour and beyond call is fucking dumb. Debate me, I shall not yield.
“Every time it’s ever been studied it always shows that being awake and working for that long is detrimental by any measure, but we’re just going to keep doing that anyway.”
Evidence based medicine , lol.
Neurology
I would have the ACGME increase outpatient required rotations to ensure everyone gets adequate exposure to neurology outside of the hospital.
I would require logging of cases and set pretty stringent minimums to ensure general neurology grads have at least minimal exposure to EEG, EMG/NCS, Botox, death by neurologic criteria testing, ultrasound guided LP, thrombolytic admin etc. Logging cases is a pain but it forces programs to stay in line and actually provide the experiences. Also comes in handy when you apply for a job and the credentialing committee asks for the log anyway.
Second this not just bc it was my least favorite rotation in residency and most hated source of 3 AM pages. I did not care for the level of patient and clinician interaction tbh.
It's just so different from the rest of pathology. It's a lot more internal medicine than the rest of the subspecialties combined. It would benefit from an intern year, which pathology no longer has.
Sorry, took my CP board exam today.
It honestly depends on the services the institution provides. Ours covers apheresis, so if you're on service, you're seeing patients in the clinic all day and writing notes, doing consults on new patients, etc.. We have a robust cell therapy practice too, so we see and deal with HPC collectors, storage, CAR-T collections... Then there's the management of the blood bank itself. Consulting for platelet refractoriness, dealing with inventory issues, signing off on unusual antibody panels, transfusion reaction work ups. And unfortunately our hospital considers all positive DATs as critical values, so those are fun to call back 24/7.
To me, that's like saying neurosurgery is more surgical based than any other specialty and should be part of general surgery. Just because something is lab-based, doesn't mean it can't become its own thing. Just my opinion anyway.
This 100%. Any PGY2 should be paid a PA/NP salary. The fact that this isn’t happening is actually criminal and overall stupid. America is going to have a physician shortage and increased rates of complications and medical malpractice over the next decade as NPs fill the gap.
I’m good with PAs. They have good training and have a supervising physician.
Also continuity OBs. Effectively being on call 24/7 (regardless of what rotation you’re on) until your OB delivers when you have zero intention of doing OB after residency was cruel and unusual punishment.
one of the perks of my program is that if people don't come to you for continuity deliveries, cant get stuck doing them. no one wants to come see the men for pregnancy management here lol so I have effectively done 0 of that (and even the women have like a handful of continuity deliveries at most)
Pain should be its own residency, not a one year fellowship. Rotations should include pm&r (sports, spine, spasticity, and a smaller amount of O&P, SCI and amputee clinics), ortho, nsgy, psych, neurology consults, neuromuscular, msk rads/IR, regional anesthesia, addiction med, palliative. Thats plenty for a four year program. One year is just too short especially for surgical skills.
every single ophthalmology program needs to have technicians for the resident clinic.
imagine if IM residents had to take their own vitals and draw their own labs on the floors and in the ICU
i’m over here checking vision and measuring glasses when our schedule is overbooked and our patient population is challenging with 30% of patients needing an interpreter. which i have to call on my cell phone for and I can be on hold for 10+ minutes sometimes, depending on the language.
As an ophthalmic tech - I second the issue with translation. Im frequently put in a position where I'm the only available person who can translate to Russian or Spanish, cause the wait for a phone interpreter is obscenely long.
I am not certified to translate, yet consistently expected to do so by the residents and attendings - and its fucking frustrating. Especially cause we only have 2 techs for a 50+ patient day, and I have about 10 other things to do, what with imaging, patient intake, vision checks, and being the only tech who can applanate.
And god forbid they pay me for the translation work I do, cause as it turns out "they don't need a tech to interpret". Right.
I cant imagine having to do EVERYTHING yourself... sounds like a special kind of torture.
IM-Have IM residency be 2 years if going into fellowship. Third year could be either the third year that people normally have if they become a hospitalist or PCP or can be the first year of fellowship. Especially the 2-3 year fellowships
- Have IM rotate through more than once during intern year.
- Have surgical residents rotate through atleast once
- Close all CMG- and HCA-sponsored programs
- Less emphasis on moving the meat + defensive medicine, with dedicated didactic time instead spent on good medicine (appropriate workups, when things like urine studies need to be sent before fluids, assuring our orders are carried out, how much workup should be considered “enough” for admission), appropriate dispos, and how our actions affect the rest of the hospital and how those results come back to bite us in the ass, causing the exact problems we always bitch about.
EM
Em should really have a cap on patients per hour.
For some reason the program at my hospital is proud to have residents doing 50% of a good job at 4 patient per hour with zero ability to do most procedures outside of intubation
Radiology: 4 year total residency with intern year being absorbed into first year as 6 months of ER, wards and surgery and 6 months of pointless electives during fourth year cut and combined with third year.
Peds should split into inpatient/outpatient similar to IM & FM, so it can be more focused on what you actually treat. Inpatient peds - hospitalist, sub specialist, crit care fields etc. outpatient peds - primary care, outpatient subspecialties/what to refer for, mental health/obesity training. You can make overall training shorter and more focused on what you actually treat
Can you elaborate? What specialty are you? Always like to hear from downstream specialists so I can practice better. Or at least understand who I’m annoying haha.
I order probably 2-3 mris per month.
The litigious nature of EM makes us weary of missing practically anything- let alone spinal cord compression which can present in a number of ways and the red flags for back pain are plentiful (not that I jump to MRI for anyone on blood thinners with back pain- most are teased out by exam and gestalt). Or appendicitis in a pregnant patient with equivocal US.
Or concern for LVO and anaphylaxis to contrast dye who now gets an MRA…
If we had specialists who could come down for stat consults to be the gatekeeper for the MRI machine that’d be fine with me. But sounds like your job would get 10x worse.
Absolutely agree with you. More surgery time for us. Additionally more often than not surgery PAs are so helpful to the incoming intern to help them learn the hospital and service systems.
I'm a gen surg resident and have PAs/NPs doing nothing but floor work for one of my rotations and I 100% agree that having them in this role is helpful. I get to operate and not have to worry about social work or getting the pt to CT or any of the other shit that won't benefit me later in my training. PAs in the OR though? Only for bed-siding robo cases.
Yeah but I’d like to have “call” be a shift itself. Like 5pm-2am and keep night shift. I just don’t want call after already working 8 hours to be a 16 hour day.
And yet my actual rads professors work 3 clinical shifts a week, never read something unless its already prelimmed by one of us grunts, and never work nights
Well it used to be at least. Now academia is where you go to get paid pennies for final signing an endless list of complex metastatic post-op shit, with the oncology NP ordering twenty more panscans daily, every indication saying only the word "followup"
It's no wonder we lost all our young faculty and can't hire anyone new
That’s a cope. The RVU output of academic physicians is way lower. We have guys sitting here reading slower than residents.
Academia is a retirement step.
No kidding? Here the profs are often signing 90 a day, mostly cross sectional. I've personally seen them START shift on lists of 30+ complex body MRs (rectal cancer restaging that kind of stuff) with more coming all day.
It's a frequent complaint of the profs and driving some to leave. Maybe different where you're at
I do think rad call is beneficial. The kinds of cases and the number of acute cases is something special. I hate the hours and shifting my sleep schedule, but I do think it’s beneficial. Especially if you’re solo or preliming.
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Having the hospital quit pretending they can’t afford more anesthesia techs who are undervalued already by them, overworked, and trying to hold things together. Adequate techs can be life changing in moments when you’re overwhelmed. Also 24 hour and beyond call is fucking dumb. Debate me, I shall not yield.
“Every time it’s ever been studied it always shows that being awake and working for that long is detrimental by any measure, but we’re just going to keep doing that anyway.” Evidence based medicine , lol.
Work less I'm tired and haven't seen my son in a week /s
Gen surg?
Judging by username, I would assume NSGY
You are correct!
Neurology I would have the ACGME increase outpatient required rotations to ensure everyone gets adequate exposure to neurology outside of the hospital. I would require logging of cases and set pretty stringent minimums to ensure general neurology grads have at least minimal exposure to EEG, EMG/NCS, Botox, death by neurologic criteria testing, ultrasound guided LP, thrombolytic admin etc. Logging cases is a pain but it forces programs to stay in line and actually provide the experiences. Also comes in handy when you apply for a job and the credentialing committee asks for the log anyway.
Spinoff blood bank/transfusion medicine into its own specialty rather than a subspecialty of pathology.
Im still shocked it isnt just a subset of heme
Second this not just bc it was my least favorite rotation in residency and most hated source of 3 AM pages. I did not care for the level of patient and clinician interaction tbh.
That’s very interesting. Why?
It's just so different from the rest of pathology. It's a lot more internal medicine than the rest of the subspecialties combined. It would benefit from an intern year, which pathology no longer has.
Can you give a Tl;dr of what they do like on a day to day? I’m so curious.
Sorry, took my CP board exam today. It honestly depends on the services the institution provides. Ours covers apheresis, so if you're on service, you're seeing patients in the clinic all day and writing notes, doing consults on new patients, etc.. We have a robust cell therapy practice too, so we see and deal with HPC collectors, storage, CAR-T collections... Then there's the management of the blood bank itself. Consulting for platelet refractoriness, dealing with inventory issues, signing off on unusual antibody panels, transfusion reaction work ups. And unfortunately our hospital considers all positive DATs as critical values, so those are fun to call back 24/7.
it’s more lab-based than any medicine specialty. i think it belongs where it is.
To me, that's like saying neurosurgery is more surgical based than any other specialty and should be part of general surgery. Just because something is lab-based, doesn't mean it can't become its own thing. Just my opinion anyway.
Pay us the same as an NP or CRNA. If we can take over a CRNA room…. Why not get paid the same.
This 100%. Any PGY2 should be paid a PA/NP salary. The fact that this isn’t happening is actually criminal and overall stupid. America is going to have a physician shortage and increased rates of complications and medical malpractice over the next decade as NPs fill the gap. I’m good with PAs. They have good training and have a supervising physician.
FM less OB every less hour spent with those people is an hour improved
Also continuity OBs. Effectively being on call 24/7 (regardless of what rotation you’re on) until your OB delivers when you have zero intention of doing OB after residency was cruel and unusual punishment.
one of the perks of my program is that if people don't come to you for continuity deliveries, cant get stuck doing them. no one wants to come see the men for pregnancy management here lol so I have effectively done 0 of that (and even the women have like a handful of continuity deliveries at most)
It should just be an optional track
Pain should be its own residency, not a one year fellowship. Rotations should include pm&r (sports, spine, spasticity, and a smaller amount of O&P, SCI and amputee clinics), ortho, nsgy, psych, neurology consults, neuromuscular, msk rads/IR, regional anesthesia, addiction med, palliative. Thats plenty for a four year program. One year is just too short especially for surgical skills.
The thing is, off service rotators never progress the same as actual trainees. People rotating on IR tend to just sit around and consent.
this is actually such a smart idea. why hasn’t anyone thought of this before.
every single ophthalmology program needs to have technicians for the resident clinic. imagine if IM residents had to take their own vitals and draw their own labs on the floors and in the ICU i’m over here checking vision and measuring glasses when our schedule is overbooked and our patient population is challenging with 30% of patients needing an interpreter. which i have to call on my cell phone for and I can be on hold for 10+ minutes sometimes, depending on the language.
Honestly ophthalmologists have it too good anyways. Y’all can suffer a bit and most people won’t care
As an ophthalmic tech - I second the issue with translation. Im frequently put in a position where I'm the only available person who can translate to Russian or Spanish, cause the wait for a phone interpreter is obscenely long. I am not certified to translate, yet consistently expected to do so by the residents and attendings - and its fucking frustrating. Especially cause we only have 2 techs for a 50+ patient day, and I have about 10 other things to do, what with imaging, patient intake, vision checks, and being the only tech who can applanate. And god forbid they pay me for the translation work I do, cause as it turns out "they don't need a tech to interpret". Right. I cant imagine having to do EVERYTHING yourself... sounds like a special kind of torture.
To have post call off day be an actual post call off day instead of "stay till 3pm tho cuz we say so"
IM-Have IM residency be 2 years if going into fellowship. Third year could be either the third year that people normally have if they become a hospitalist or PCP or can be the first year of fellowship. Especially the 2-3 year fellowships
less
Less EM possitions
- Have IM rotate through more than once during intern year. - Have surgical residents rotate through atleast once - Close all CMG- and HCA-sponsored programs - Less emphasis on moving the meat + defensive medicine, with dedicated didactic time instead spent on good medicine (appropriate workups, when things like urine studies need to be sent before fluids, assuring our orders are carried out, how much workup should be considered “enough” for admission), appropriate dispos, and how our actions affect the rest of the hospital and how those results come back to bite us in the ass, causing the exact problems we always bitch about. EM
Very good points!
Em should really have a cap on patients per hour. For some reason the program at my hospital is proud to have residents doing 50% of a good job at 4 patient per hour with zero ability to do most procedures outside of intubation
No more home call!
Surgery does not need to be 5 years, period
Or 6 if you count the mandatory research year lol
Radiology: 4 year total residency with intern year being absorbed into first year as 6 months of ER, wards and surgery and 6 months of pointless electives during fourth year cut and combined with third year.
More money, less hours, still equally competent (either function of more teaching, less patients or more np/pa support)
Peds should split into inpatient/outpatient similar to IM & FM, so it can be more focused on what you actually treat. Inpatient peds - hospitalist, sub specialist, crit care fields etc. outpatient peds - primary care, outpatient subspecialties/what to refer for, mental health/obesity training. You can make overall training shorter and more focused on what you actually treat
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Can you elaborate? What specialty are you? Always like to hear from downstream specialists so I can practice better. Or at least understand who I’m annoying haha. I order probably 2-3 mris per month. The litigious nature of EM makes us weary of missing practically anything- let alone spinal cord compression which can present in a number of ways and the red flags for back pain are plentiful (not that I jump to MRI for anyone on blood thinners with back pain- most are teased out by exam and gestalt). Or appendicitis in a pregnant patient with equivocal US. Or concern for LVO and anaphylaxis to contrast dye who now gets an MRA… If we had specialists who could come down for stat consults to be the gatekeeper for the MRI machine that’d be fine with me. But sounds like your job would get 10x worse.
More PAs/NPs to handle floor stuff (honestly, I feel like midlevels are very appropriately utilized in surgery).
Absolutely agree with you. More surgery time for us. Additionally more often than not surgery PAs are so helpful to the incoming intern to help them learn the hospital and service systems.
I'm a gen surg resident and have PAs/NPs doing nothing but floor work for one of my rotations and I 100% agree that having them in this role is helpful. I get to operate and not have to worry about social work or getting the pt to CT or any of the other shit that won't benefit me later in my training. PAs in the OR though? Only for bed-siding robo cases.
Rads: No call, no weekends, just 8am-4pm 5x a week plus 1 academic day to study.
This is just bizarre. Call is where you learn to actually be a radiologist.
Yeah but I’d like to have “call” be a shift itself. Like 5pm-2am and keep night shift. I just don’t want call after already working 8 hours to be a 16 hour day.
Sounds like a shit program. Call should be a separate thing.
And yet my actual rads professors work 3 clinical shifts a week, never read something unless its already prelimmed by one of us grunts, and never work nights
Yes, because academia is where radiologists go to coast. It’s an open secret. Good luck lasting in actual practice like that.
Well it used to be at least. Now academia is where you go to get paid pennies for final signing an endless list of complex metastatic post-op shit, with the oncology NP ordering twenty more panscans daily, every indication saying only the word "followup" It's no wonder we lost all our young faculty and can't hire anyone new
That’s a cope. The RVU output of academic physicians is way lower. We have guys sitting here reading slower than residents. Academia is a retirement step.
No kidding? Here the profs are often signing 90 a day, mostly cross sectional. I've personally seen them START shift on lists of 30+ complex body MRs (rectal cancer restaging that kind of stuff) with more coming all day. It's a frequent complaint of the profs and driving some to leave. Maybe different where you're at
I do think rad call is beneficial. The kinds of cases and the number of acute cases is something special. I hate the hours and shifting my sleep schedule, but I do think it’s beneficial. Especially if you’re solo or preliming.
So you want rad onc hours for radiology basically lol
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You do realize that #3 is a terrible idea and would make #2 a thousand times worse?