Do you need to do an unopposed program to practice/be capable in rural?

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Would opposed programs give you adequate training?

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It would really depend on the job that you are taking. Some rural locations are simply looking for someone to cover a single role (outpatient only, nursing home only, hospital or ER coverage only). For most locations, if you are committed to working in the community over time, then with other healthcare providers and administrators, you figure out ways to cover for services that you are not comfortable with. That being said, the transition from residency to rural practice will be much smoother if you train at a program that provides adequate exposure to broad spectrum care. I wouldn't look solely at opposed or unopposed as there are horrible and great programs that fall under each category. I recommend looking for programs that have built in training exposure to decent volume inpatient, OB and office based procedures. If a program attempts to recruit claiming that they can make something happen to suit your needs, odds are it wont happen.
 
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It would really depend on the job that you are taking. Some rural locations are simply looking for someone to cover a single role (outpatient only, nursing home only, hospital or ER coverage only). For most locations, if you are committed to working in the community over time, then with other healthcare providers and administrators, you figure out ways to cover for services that you are not comfortable with. That being said, the transition from residency to rural practice will be much smoother if you train at a program that provides adequate exposure to broad spectrum care. I wouldn't look solely at opposed or unopposed as there are horrible and great programs that fall under each category. I recommend looking for programs that have built in training exposure to decent volume inpatient, OB and office based procedures. If a program attempts to recruit claiming that they can make something happen to suit your needs, odds are it wont happen.

This statement is the best piece of input you could ever receive regarding residency selection. Now, having said that -- no, you don't need to go to an unopposed program to do well in rural medicine but you need to be sure that you will have the opportunity to learn the skillsets you'll need for your future practice. For example -- it's one thing to have an OB/Gyn rotation where you get your 10+30 -- it's another thing for those 30 to come from the non-complex cases that the Ob/Gyns let the midwives/med students/EMT students handle. You need the other critical/complex cases because when you're out there on your own, guess what, Sportsfans -- ain't no help coming. The day I interviewed for my first job, we had a general surgeon covering the ER and a patient with no prenatal care came in crowning -- he didn't know what to do so he called his PA who had at least done a few vaginal deliveries. I asked the CEO if he wanted to grant me emergency privileges and malpractice coverage so I could go deliver and ride the ambulance to the next town over since we had no Ob/Gyns on staff. Situations like that are what you need to play to and organize your residency to teach you how to handle.

F
 
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The words "opposed and unopposed" definitely get thrown around a lot and TBH I haven't thought about it once since I've been in residency. True, going to a malignant program would affect you, I've found that as much as I want to do in my university based residency, the other services let me do. Get assigned super complicated OB? Check. Put in central lines while in the ICU? Ok. Do as many procedures as possible in the ED? Just tell me what you want and you can do it. Limiting yourself to an unopposed program is silly. One of the very good benefits to being at a teaching hospital with other residency programs is that those attendings from others services WANT to teach. Rotating with Surgery or ID is awesome. Treated just like the others and given the same opportunities if you ask for them. You control your destiny no matter where you go. I'm confident I'll be able to practice how I want wherever I want after being here. I love that.

tl;dr don't worry about opposed or unopposed. It really doesn't matter.
 
It all comes down to the rotations you choose in residency and how aggressive you are in learning procedures. I knew I wanted to do rural medicine so I made sure I knew what was urgent, emergent. What ortho could wait. What type of cases would I need to medevac? I did a good radiology rotation since I knew I wouldn't always have say day reads. I did a good ortho rotation and learned what I could reduce and splint in the office. OR does not help me in the rural setting - where I work those doen't exist. I did a good podiatry rotation.

If you really want super good/cool rural training, do the FP residency in Anchorage, Alaska. You will get all the rural/frontier you will ever wish for.
 
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The words "opposed and unopposed" definitely get thrown around a lot and TBH I haven't thought about it once since I've been in residency. True, going to a malignant program would affect you, I've found that as much as I want to do in my university based residency, the other services let me do. Get assigned super complicated OB? Check. Put in central lines while in the ICU? Ok. Do as many procedures as possible in the ED? Just tell me what you want and you can do it. Limiting yourself to an unopposed program is silly. One of the very good benefits to being at a teaching hospital with other residency programs is that those attendings from others services WANT to teach. Rotating with Surgery or ID is awesome. Treated just like the others and given the same opportunities if you ask for them. You control your destiny no matter where you go. I'm confident I'll be able to practice how I want wherever I want after being here. I love that.

tl;dr don't worry about opposed or unopposed. It really doesn't matter.

Agree yet disagree somewhat --- In one sense, you are responsible for your training and no one else. Get what you need before you graduate. In another sense, sometimes, your learning can be blocked. For me -- I showed up on my Ob/Gyn rotation at a county hospital in the Southwest (hint,hint). We rotated with the Ob/Gyn residents -- I introduced myself to the attending who was running the culpo clinic and was flat out told that I would not be learning culpos as they had too many residents to train. Fine -- it was the start of the year, I get it -- so I offered to take an elective to learn the procedures in Ob/Gyn -- I was told in no uncertain terms that because I was family medicine, I would not be taught culpos or Ob/Gyn procedures, period, no matter when in the year I rotated through.

I'm not interested in Ob so it's no great loss but my training was certainly limited beyond my control. Heck, that Ob department used FM residents as gofers and let the MS3/MS4 deliver, see patients in the Ob urgent care center, etc.
 
Agree yet disagree somewhat --- In one sense, you are responsible for your training and no one else. Get what you need before you graduate. In another sense, sometimes, your learning can be blocked. For me -- I showed up on my Ob/Gyn rotation at a county hospital in the Southwest (hint,hint). We rotated with the Ob/Gyn residents -- I introduced myself to the attending who was running the culpo clinic and was flat out told that I would not be learning culpos as they had too many residents to train. Fine -- it was the start of the year, I get it -- so I offered to take an elective to learn the procedures in Ob/Gyn -- I was told in no uncertain terms that because I was family medicine, I would not be taught culpos or Ob/Gyn procedures, period, no matter when in the year I rotated through.

I'm not interested in Ob so it's no great loss but my training was certainly limited beyond my control. Heck, that Ob department used FM residents as gofers and let the MS3/MS4 deliver, see patients in the Ob urgent care center, etc.

Dude your program sounds like ass, have you told us which one it is so we can avoid it?
 
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Dude your program sounds like ass, have you told us which one it is so we can avoid it?
Well --- county hospital in the Southwest was one hint --- UTSouthwestern is another. There's evidently a "current resident" who will periodically come into the threads and say that my information is "years old" and/or "second hand" -- yeah, try again, Sparky -- I lived that hell from around 2010 to 2013 -- For me, I wouldn't recommend that program to anyone. The phrase I commonly use is,"They couldn't teach a bunch of BoyScouts what to do inside a Vegas cathouse". I will not get into the litany of offenses but let's just say that I have it on good authority that the program is the one that has the most lawsuits against it of all the programs at UTSW. I am seriously resisting getting into the idiocy of it all right now.....if you must know the gory details, PM me and I'll chat with you.
 
Well --- county hospital in the Southwest was one hint --- UTSouthwestern is another. There's evidently a "current resident" who will periodically come into the threads and say that my information is "years old" and/or "second hand" -- yeah, try again, Sparky -- I lived that hell from around 2010 to 2013 -- For me, I wouldn't recommend that program to anyone. The phrase I commonly use is,"They couldn't teach a bunch of BoyScouts what to do inside a Vegas cathouse". I will not get into the litany of offenses but let's just say that I have it on good authority that the program is the one that has the most lawsuits against it of all the programs at UTSW. I am seriously resisting getting into the idiocy of it all right now.....if you must know the gory details, PM me and I'll chat with you.

Parkland......
 
I went to an unopposed program and the big deficiency I had was a lack of office procedures, because in my residency the staff made a huge deal if you tried to do certain procedures outside of set procedure clinic hours. However this was also largely my fault, because it wasn't until halfway through my second year that I realized I needed more procedures and started to make them happen myself. I had to do a little bit of sweet talking to get them set up but it was entirely in my control.

I also think I lucked out in that this hospital attracted a lot of specialists who actually like teaching. Not all unopposed/ rural programs have that.
 
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