Honestly, does residency even matter?

[relapse]

>>If you know you're going to enter private practice after residency, does it honestly matter what school you go to?

Too many times I see people worked up about which top tier residency they die to get into knowing they'll end up in private practice in the near future.

Overrated.

---

Members don't see this ad.

 

[MrBurns10]

It depends. Are you trying to practice in Shelby, North Carolina? If so, you're right, it probably doesn't matter one bit. Are you hoping to do something competitive (ophtho, rads, etc) in San Francisco? Then residency/fellowship prestige matter more.

 

[Winged Scapula]

Don't be misled into thinking that those in the community aren't swayed by such things either.

You get an automatic prestige (deserved or not) by going to a Top Tier residency/fellowship. If you suck, patients can't get in to see you or referring physicians can't reach you, then your residency's rep isn't going to go far, but it will initially get you some attention. If you live up to the rep, it will attract referrals and patients.

Is it as important as in academics? Probably not and probably not in fields where referrals aren't utilized.

 

[relapse]

I can understand that if your going to go into academia, then school of choice matters to get into a good fellowship program and maybe PH.d if your really motivated.

But for the most part, I don't hear much regarding where a private practitioner did his residency no matter where he works. From the little knowledge I know about it, it doesn't really matter whether you do your residency at shelby, NC, the Bronx, or a ****ty community hospital.

 

[BabyPsychDoc]

I can understand that if your going to go into academia, then school of choice matters to get into a good fellowship program and maybe PH.d if your really motivated.

But for the most part, I don't hear much regarding where a private practitioner did his residency no matter where he works. From the little knowledge I know about it, it doesn't really matter whether you do your residency at shelby, NC, the Bronx, or a ****ty community hospital.

little boy whistling in the dark.

 

[relapse]

one man with one eye will always be king in the city of blinds

 

[Winged Scapula]

I can understand that if your going to go into academia, then school of choice matters to get into a good fellowship program and maybe PH.d if your really motivated.

But for the most part, I don't hear much regarding where a private practitioner did his residency no matter where he works. From the little knowledge I know about it, it doesn't really matter whether you do your residency at shelby, NC, the Bronx, or a ****ty community hospital.

As I noted above, I beg to differ. Given that I am in private practice and I hear people talk about other physicians and where they trained, I know people pay attention to it, at least in my field. Perhaps just surgeons, Rad Onc and Med Oncs care about it.

Patients come in all the time with my CV printed out and despite having 2 DO schools in town and my partner being a DO, I'll be told they picked me because of my training over hers. So bias does exist, even in private practice, even amongst patients, despite the conventional wisdom that it doesn't matter in PP.

You have admitted you have little knowledge about it, so I'm not sure why you are challenging me on this topic.

 

[tripleJ]

As I noted above, I beg to differ. Given that I am in private practice and I hear people talk about other physicians and where they trained, I know people pay attention to it, at least in my field. Perhaps just surgeons, Rad Onc and Med Oncs care about it.

Patients come in all the time with my CV printed out and despite having 2 DO schools in town and my partner being a DO, I'll be told they picked me because of my training over hers. So bias does exist, even in private practice, even amongst patients, despite the conventional wisdom that it doesn't matter in PP.

You have admitted you have little knowledge about it, so I'm not sure why you are challenging me on this topic.

I would say, however, that that is exactly the patient YOU would not want

 

[Winged Scapula]

I would say, however, that that is exactly the patient YOU would not want

Why? It's a perfect opportunity to educate them about the lack of difference between DO and MD as I tell them they have to be comfortable with her as we cover for each other.

 

[Winged Scapula]

And whether we like it or not patients pick physicians for all sorts of reasons. Some will prefer the older guy, some want the younger one, some want fellowship trained and it's no mystery to me why most of the Indian pts see my partner.

Our field attracts high maintenance patients and if I turned away every patient who did research and decided they preferred me for X reason, I'd have a slow day.

 

[tripleJ]

I am in a high maintenance field too, but we discharge patients all the time. A patient who is inquiring about your education, etc. is a definite red flag to me. I'll gladly pass on that patient all day long. My other observation is the more you help a certain patient (give them a break on charges or copay, etc.) the more likely it is they will be a hassle.

 

[Winged Scapula]

I am in a high maintenance field too, but we discharge patients all the time. A patient who is inquiring about your education, etc. is a definite red flag to me. I'll gladly pass on that patient all day long. My other observation is the more you help a certain patient (give them a break on charges or copay, etc.) the more likely it is they will be a hassle.

You are absolutely right, especially with your last sentence. The more you bend over backwards to help a patient, the more they complain.

And I've terminated (discharged) patients before as well: the one who objected to seeing my partner because of her race, the one who made sexually suggestive comments to me and my staff, the one who physically touched me inappropriately, the one who would argue with her mother during the office visits and whose mother would pretend to be her and call for information, several who would not follow medical advice...etc. Patients don't have to inquire about my education, its on our website and easily available on-line from the state medical board.

The point I was making above was to relapse who said that education didn't matter in private practice. I'd counter that its almost more important because IMHO private practice patients tend to look that stuff up just as often, if not more AND referral patterns can be based on it.

But I see your point - the patient that makes a big deal about where you went to medical school or residency, whether you're a DO/MD or the color of your skin is broadcasting that they are high maintenance and probably more trouble than its worth. Now I feel more comfortable terminating patients but when starting in practice, its hard to turn away paying customers until you learn the pain isn't worth the measly reimbursement.

BTW, I was under the impression that you cannot give patients a break on their co-pay or any other charges if you accept Medicare (which you may not in your practice). I've been told that I have to charge everyone the same, even friends, no waiving co-pays or charging less than what they are supposed to pay. Is this not true?

 

[tripleJ]

You are correct. I'm referring to a patient in the office for suture removal, etc. saying "oh, can the doctor just look at this other spot" or "I was just here last week and I forgot to ask about this, why do i need to pay a copay" or "I was here for symptom X two weeks ago and I'm here for follow up, why do I have to pay for an office visit if I'm still having symptom X".
The more breaks you give these patients, they are the very ones to complain to staff/ state board/ etc. when they eventually do not get exactly what they want (which is of course inevitable).

 

[Moonglow]

Tis' true, one doesn't need to have done a residency on the Hopkins Osler Medical Service to open a clinic in the North Carolina Mountains - but, you never know, you might have competition from a doc from Duke in the next town.

 

[relapse]

Do medicare patients and other patients for that matter actually have the ability to look up the credentials of a doctor?

I thought it was some mandatory fee of like $25 to look up that information and even paying that sometimes led you to just their home address and telephone number.

 

[gutonc]

Do medicare patients and other patients for that matter actually have the ability to look up the credentials of a doctor?

I thought it was some mandatory fee of like $25 to look up that information and even paying that sometimes led you to just their home address and telephone number.

Are you kidding? You may or may not have heard about this thing called Google. To the best of my knowledge, every state medical board has a website that allows you to look up any licensee and this generally includes info on where they went to med school as well as residency and fellowship. If you want it printed out and mailed, there's generally a fee but to look it up on line is free.

Also, pretty much every academic or private clinic/hospital, even a lot of solo practices, have websites that include that same information somewhere.

I have seen patients come to clinic with a printed copy of the CV of attendings before.

 

[michaelrack]

If you plan on staying in 1 smaller state for the rest of your life, it's fine to do a residency/fellowship at one of the state's main medical centers, even if it is not known outside the state. For example, if a doc plans on staying in MS, it's perfectly fine to do a residency at the university of Mississippi medical center.

 

[Winged Scapula]

Are you kidding? You may or may not have heard about this thing called Google. To the best of my knowledge, every state medical board has a website that allows you to look up any licensee and this generally includes info on where they went to med school as well as residency and fellowship. If you want it printed out and mailed, there's generally a fee but to look it up on line is free.

Also, pretty much every academic or private clinic/hospital, even a lot of solo practices, have websites that include that same information somewhere.

I have seen patients come to clinic with a printed copy of the CV of attendings before.

Ditto.

I'll have patients comment that my hair is longer or that I look different because they've printed out info from our website. Others will comment that they looked me up on the Medical Board. Still others can find it on various hospital websites.

That info is WIDELY available.

You (not YOU gutonc, but relapse) should be aware of what's publically available. On our medical board site, you can see actions against physicians, including DETAILS. I actually know more about some local physicians than I want to.

 

[Miami_med]

You are absolutely right, especially with your last sentence. The more you bend over backwards to help a patient, the more they complain.

And I've terminated (discharged) patients before as well: the one who objected to seeing my partner because of her race, the one who made sexually suggestive comments to me and my staff, the one who physically touched me inappropriately, the one who would argue with her mother during the office visits and whose mother would pretend to be her and call for information, several who would not follow medical advice...etc. Patients don't have to inquire about my education, its on our website and easily available on-line from the state medical board.

The point I was making above was to relapse who said that education didn't matter in private practice. I'd counter that its almost more important because IMHO private practice patients tend to look that stuff up just as often, if not more AND referral patterns can be based on it.

But I see your point - the patient that makes a big deal about where you went to medical school or residency, whether you're a DO/MD or the color of your skin is broadcasting that they are high maintenance and probably more trouble than its worth. Now I feel more comfortable terminating patients but when starting in practice, its hard to turn away paying customers until you learn the pain isn't worth the measly reimbursement.

BTW, I was under the impression that you cannot give patients a break on their co-pay or any other charges if you accept Medicare (which you may not in your practice). I've been told that I have to charge everyone the same, even friends, no waiving co-pays or charging less than what they are supposed to pay. Is this not true?

You do have to charge everyone the same. Whether you actively attempt to collect or send someone to collections is up to you. Furthermore, you can work pro-bono. What you are not allowed to do is wave the co-pays and still bill the insurance/government for the service. It is perfectly legal to not bill anyone. You just can't selectively waive the patient's bill and still charge everyone else.

 

[thedrjojo]

What do you guys think about the residency vs fellowship level though? My current situation has me heavily looking at my home program for residency, which while a very good training program which has produced some very nice fellowships in the past few years (Vascular surgery at Wash U, CT at MGH and UCLA, Transplant at Columbia, Surg Onc at Roswell Park, Trauma at UNC) it does not have the prestigue factor by name. Will people be more likely to just look at the name of the fellowship you had or will the residency actually be something they still look at?

 

[McGillGrad]

You have to remember that the OP is fresh out of high school. He has a different view on life.

 

[tkim]

one man with one eye will always be king in the city of blinds

You are quoting the great philosopher Levolor, maybe?

In caecus terrae, luscus rex est.

 

[relapse]

If your going to go into academia, or do superspecialize, choice of residency program matters immensely, but if you have some type of connection to a family and can take over their practice avoiding massive overhead, I really don't think It should mean much.

 

[McGillGrad]

If your going to go into academia, or do superspecialize, choice of residency program matters immensely, but if you have some type of connection to a family and can take over their practice avoiding massive overhead, I really don't think It should mean much.

Who are you trying to convince...us or yourself? How would a recent high school graduate know this anyway?

 

[JackADeli]

...If you know you're going to enter private practice after residency, does it honestly matter what school you go to?

Too many times I see people worked up about which top tier residency they die to get into knowing they'll end up in private practice in the near future...

I will first rephrase your question....

Q: If you are going into private practice and really not concerned with post-graduation job options/opportunities, does it matter if you go to a lower tier residency?
A: NO; you can get a job.

Q: Does a high end "pedigree" help, if you plan on private practice/non-academic career?
A: Yes. When job openings come up in highly desired areas the numerous other folks graduating the same time as you in addition to those folks with a few years experience and already board certified will be competing for the position. Your potential partners/employers want a good surgeon. Getting a good surgeon with a good pedigree is even better. There is marketing and there is patient/public perception. It's true in all professions.

So, yes, you can get a job. But, I always encourage everyone to shoot for training that is more likely to open doors and keep other possibilities open then to choose an easy road that may limit your options down the road....

 

[deleted87716]

You are quoting the great philosopher Levolor, maybe?

 

[babel]

Who are you trying to convince...us or yourself? How would a recent high school graduate know this anyway?

I could be wrong, but based on some of the OP's other posts in the Psych forum, I thought that he/she is an American attending a foreign med school, not a recent high school grad.......

 

[Winged Scapula]

I could be wrong, but based on some of the OP's other posts in the Psych forum, I thought that he/she is an American attending a foreign med school, not a recent high school grad.......

McGill Grad is still right, AFAIK.

The OP went straight to India for medical school rather than do undergraduate college here in the US.

 

[Buzz Me]

Yeah, IIRC, most (if not all) MBBS programs in India are 5 1/2 years long, done right after high school.