Program Red Flags

[TypeADoctor]

As the interview season approaches does anyone have any advice or can enlighten me as to what red flags to look out for that are not so obvious as some (such as all the residents seem fatigued/unhappy)?

---

Members don't see this ad.

 

[lowbudget]

Tired and grumpy residents isn't really a red flag. Too many false positives, given the prevalence... "Don't come here" or "I would rather die", however, is a red flag.

 

[MJB]

As the interview season approaches does anyone have any advice or can enlighten me as to what red flags to look out for that are not so obvious as some (such as all the residents seem fatigued/unhappy)?

Personally, I'd be a little leary of any program that is eager to pre-match a lot of people.

Ask about off service rotations if you're not going unopposed.

 

[TypeADoctor]

I eventually want to practice full spectrum FM in a more rural area. When I ask a resident about how many vaginal deliveries and c-sections they do, what kind of numbers should I be looking for towards that end. I would also like a wide variety of procedural skills under my belt when I finish residency. Some places even offer EGD/colonoscope. Are these procedures worth learning and getting certified in/carrying the malpractice for said procedures, or is it not a big deal at all if a program doesn't offer training in these?

 

[rachmoninov3]

The usual number of deliveries I heard last year was around 120/3 years. I'm at a "cowboy" program that says they do full scope FM and you can have surgical OB previledges but it's not that common. Whether or not my program is truly rural focused, I honestly can't tell you b/c I'm too busy learning how to be an intern.
The best program I interviewed at last year for full scope was Spokane/colville in NE Washington, I would def. check them out. If OB is really your thing make sure you train at a place with only one hospital so you'll get great numbers. Also helps to know the scope of practice of Family Medicine in each state. Some states don't allow FM docs to have surgical priviledges at all, some require a MFM fellowship for surgical OB, etc.

I think the best way to gage a program is see if you can talk to the 3rd years and ask what type of offers they are getting and what they are planning on doing.

Good luck with interviews this year!

 

[sia_simba]

Why would you need an MFM fellowship to do cesarean? Matter of fact, majority of MFM don't do any surgeries at all. To obtain an MFM fellowship you would need 4 years of ob/gyn residency. Not sure how FM residency is going to get that.

If you have FM/OB fellowship, you can do deliveries and cesarean GRANTED that you pay the OB portion of the malpractice premiums.

In NYS, for a family practice malpractice coverage, its about $45,000 which includes office and non-complicated OB with No surgery. To have full OB coverage, its $165,000. Gyn coverage is about $90,000.

Just based on those numbers alone, OB is what Increases the malpractice.

Therefore, no issue doing Obstetrics, but you just have to pay the premium.

 

[lowbudget]

Adult inpatient medicine with code procedures (ACLS, tube, central lines), pediatric inpatient (LP), newborn nursery, outpatient (stress EKG, fracture management, injections, gyn procedures), sideline sports medicine, low risk prenatal care (no deliveries).

My malpractice is $8,000 per year, claims made.

 

[EdibleEgg]

1) find out what recent grads are doing
2) ask the residents about numbers, not what they think they will do, but how many times they have actually performed procedure x
3) do FM attendings actually perform whatever procedure you are interested in vs someone else will teach you x (it's better if FM's teach, it's great to learn from others, but it shouldn't be the only outlet)

I'm not positive... but I've practiced in several states and there was not a difference in scope of practice from state to state. There is a difference from area to area. In general, there is no such thing as "certification". You basically need to convince a credentialing committee at a hospital that you are competent to perform what ever it is you want to do. That may be by board certification, numbers of procedures completed, or recommendations from attendings.

I think she meant OB fellowship.

My malpractice is about 12,000, but I am an endoscopist and I work in the ED part time. OB is difficult, but you work a lot and don't make much money. It has to be a passion.

 

[sia_simba]

Yeah... claims made is cheaper... but depends on where you go, you might have a huge tail coverage. One attending in NYC has a tail coverage of $350,000.

Of course we can't use NYS as an example because its malpractice is just off the roof. I am pretty sure other states are a lot better.

But to the Poster from before, if you want to do OB, just need OB coverage and credential from the hospital. In the smaller places, it should NOT matter much. In larger cities, might be more difficult.