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What specialties are Team oriented and what ones are less so?

Discussion in 'Allopathic' started by copacetic, May 25, 2009.

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  1. copacetic

    copacetic Copacetic Was Here!

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    just a quick question, what specialties tend to revolve around team oriented care (e.g. with midlevels, other physicians, surgeries etc), and which ones facilitate more solo work (e.g. you make diagnoses and carry out treatments on your own)?
  2. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    All specialties require some amount of interaction with other physicians/techs/etc.

    Most team oriented - Surgery (and its subspecialties), OB/gyn.

    Least team oriented - Pathology, Radiology, EM.

    IM can be somewhere in the middle, depending on the subspecialty and which setting.
  3. bydotte

    bydotte

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    I would say EM belongs on the most team oriented list.
  4. copacetic

    copacetic Copacetic Was Here!

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    i agree about surgery and its subspecialties, OB, gyn, and the others, though i would concur with bydotte about EM being pretty team oriented...at least for trauma
  5. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    I think that's a common fallacy that most people have.

    When I did my EM rotation, I had no idea what was happening on the other side of the ED, nor did I really care. It had no bearing on the patients that I was following. Compare that to the surgery rotations, where everyone knows what's going on with everyone's patients. For me, there's no comparison in how team oriented EM was vs. surgery.

    Even running a trauma is less team oriented than you might think. It's just an algorithm that people follow - it doesn't require THAT much teamwork. Everyone sort of does their own little thing, but your cog in the wheel isn't necessarily all that drastically affected by the other cogs in the wheel. (Besides, trauma in many places does not make up the majority of the work that the EM guys do.)
  6. Indryd

    Indryd

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    In child psych you spend all day sitting and discussing kids with nurses, social workers, other doctors, parents, etc. Extremely team-oriented.
  7. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    Nah, I actually would have put these both ahead of many other fields as being team specialties. First, IR is equivalent to a surgical field, so those radiologists fit into your "most" category. And secong in these diagnostic fields you are always calling over colleagues to "take a look at X", or "what do you think of Y?". These fields are group sports, at least at the academic centers. You are actually off doing your own thing more in fields like IM. Not to mention that in these consultant roles, you are always meeting with the folks who ordered the test, talking them through the results, going to tumor boards, etc.
  8. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    Well, as I pointed out earlier, ALL specialties require some degree of team work.

    The question that the OP is asking is not "What are team-oriented specialties, and what specialties have you working in COMPLETE, TOTAL, ISOLATION where you will NEVER speak to another human being for at least eight hours?" The question is just "What are team-oriented specialties and what are less-team oriented specialties?"

    All doctors should expect to work with other physicians, nurses, and techs. No physician works in solitary confinement, or anything like that.

    But a radiology and pathology service are not run with residents working together to help run the service - each is given their work and, for the most part, that work is done by yourself. In radiology and pathology, particularly, there is no "central list" in which the team gets together to review twice a day - so I don't think there is anyway you can consider these to be "team oriented" specialties. I never "ran the list" when I did my path rotation, and I can't think of a pathology department that would.

    And IR is not equivalent to a surgical field. I'm not sure where this assertion is coming from.
  9. DeeJay2728

    DeeJay2728

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    Really??? Did you run the codes all by yourself???
  10. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    :rolleyes:

    In 14 shifts in the ED, I saw 2 traumas. No codes. In all my other shifts, I was too busy seeing the much larger number of people with chest pain, back pain, abdominal pain, and r/o pregnancy.

    Trauma is NOT the only (or even the main) thing that the EM guys do all day.

    And if a trauma does come into the ED, it's not like 4 residents rush to the trauma bay. Unless it's a major trauma, there's usually one or two residents assigned to the trauma bay. The rest are taking care of whatever patients are otherwise coming through the door.

    I don't know why there's such a rush to defend EM. "It is SO a team-oriented specialty!" It's a good field; just not as team-oriented as surgery or OB. It's not a big deal.
  11. DeeJay2728

    DeeJay2728

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    Don't get me wrong, I know the ED isn't always action packed. But I'm a NYC Paramedic and I've been in many emergency rooms and most of the time there were "teams" waiting for us when we got there. Not just for gun shot wounds, MVA's, or any other instances when resident a might be excited to "get a tube". I'm also referring to medical emergencies, adult and peds. Cardiac/Resp arrest, COPD/CHF exacerbation, asthma... things like that. These are the things that might not be as exciting as the 3 car roll over on 95, but these too, require a team. By the time the pt gets to a floor, most of the time you already know what's wrong with them. In the ED, you need all types of consults from neurology to surgery, from cardiology to dermatology, from vascular to radiology. You need many different departments to rule out this and that. It actually requires teams from all parts of the hospital to come together to make a decision. Maybe I'm just bias to EM...
  12. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    Um yes....I think, yes, you're biased towards EM. :oops:

    As a paramedic, you're seeing just ONE aspect of the ED - which is usually the more "exciting part" that yes, often requires the use of "teams."

    But what you're not realizing yet is that that type of sporadic, occasional teamwork that you're referring to down in the ED is no different from the occasional, sporadic teamwork that is often seen on the inpatient medicine/pediatrics/surgery floors. It's no different from the sporadic teamwork that is often seen in the ICU. And it's not even any different from the sporadic teamwork that is seen in the in-patient psych units at times.

    Occasionally resorting to a team-based approach to treat an urgent patient, though, does NOT make it a "team-oriented" specialty. Most of the time, in the ED, you pick up a patient's chart and go see them. Just you, as the attending/resident. Not a team of people - and certainly not a team of people who will continue to care for that patient as long as that patient remains in the ED. This is very different from the way surgery, and certain IM, services are run.

    On a surgery service, you work with the same people for a long stretch of time. The team members do not change. They work with each other all day, take care of the same patients together, and round together. As a paramedic, each time you bring an urgent patient to the ED, are you greeted by the EXACT SAME people each time? Most likely not.

    And the need to call in consults also does not make it a "team-oriented" specialty. Radiologists and pathologists return consult calls all day. These, however, are definitely not team-oriented specialties. In any case, ALL fields call in consults or return consults - does this mean that all fields are team oriented? Definitely not.

    I am in NO WAY saying that people in a "non-team oriented" specialty will never interact with another living human being all day long. All physicians need to know how to work with people in other fields. But some are more team-oriented than others. EM is not a particularly team-oriented specialty.
  13. DeeJay2728

    DeeJay2728

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    Fair enough. I can't argue this point... as I have never been on a surgical rotation. The only time I've spent in the OR was shoving tubes down pts who were just knocked out by the anesthesiologist. And you're right, my view is definitely one sided. I can see your point... my regards.
  14. howelljolly

    howelljolly

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    Yeah, Im a NYC Paramedic also. EM is NOT a team sport. Each EM doc does their own thing in parallel. They take a chart from the rack see the patient, write orders, and follow them. Lather, rinse repeat. Ina trauma, everyone has their own little piece of the action. Its algorithmic, everyone does their choreographed job on autopilot. Much the same with ACLS. Nobody really works "with" each other.

    I think we all have different definitions of what "team oriented" means.

    With my definition...
    On one end of the continuum, theres inpatient psychiatry (MDs have to collaborate with PsyDs for therapy and (sadly) diagnosis... LCSWs for placement and F/U... OT/PT....nursing). Theres Oncology (surgery, rad-onc, for treatment, Pulm, Psych, Pain, and hospice for paliation, medicine for F/U....)

    On the other end of the continuum... Radiologists and Pathologists can sit in their rooms and do their own thing. They can call a colleague for advice if they want. But mostly, they have a stack of studies to interpret... and they submit their reports. They dont need other services or even other people to get their job done.

    However, I'd argue that just a bit more midline from the Rads/Path side of things is OB/Gyn and Urology. These fields really are on a bit of an island. They rarely need to consult surgery - they can go to the OR on their own. They rarely need to consult Medicine. OB/Gyn has their own guidelines for the management of DM and HTN. OB/Gyn has their own urology specialists, and their own oncologists. The garden variety urologst or OB/gyn handles the total diagnosis and total treatment of everything in their organ system.

    Thats my 2 euros.
  15. copacetic

    copacetic Copacetic Was Here!

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    you've pretty much got the same definition that i had in mind. where do you think IM or cardiology would fit?
  16. DeeJay2728

    DeeJay2728

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    Really... Where'd you work out of???
  17. howelljolly

    howelljolly

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    Depends on how you set up your practice.

    You can do IM and do strictly outpatient work, and never see another doctor again. Or you can be a teaching attending and work with a team all day and night.

    As a cardiologist you can set up a practice so that you spend half of your day in the dark reading echos and nuclear studies, and the other half of the day doing official reads on EKGs and interpreting stress tests. Or you can be a cardiologist on a transplant team. Ive got a feeling though, that unless you are fellowship trained in nuclear cardiology where you're more valuable in a dark room by yourself, that you might make less money if you try to set up a solo practice.
  18. howelljolly

    howelljolly

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    21

    but Im not working right now.
  19. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    Actually at academic centers they have teaching rounds in both these fields where attendings sit down with the residents several times per day and go through the list of cases. I actually saw residents with more "alone time" work in IM than either of these fields.
  20. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    Going over a list of cases is not the same as having a group that is all in charge of taking care of a certain set of patients. I used the example of running the list as one aspect of team-oriented care - but are there more than one resident assigned to a patient? Do they run all decisions by the group?
  21. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    No and yes to the above, respectively. One person goes through his own set of cases, but then they are gone through again as a team, with discussion and teaching. IM residents don't run all decisions by the group much differently. I'm sure this is different at different places, but at least at the academic centers I'm most familiar with, pathologists and radiologists sitting by themselves over a microscope/film, with no team interaction, are a thing of the past.
  22. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    :confused:

    Weird. That has definitely not been my experience on any of my rads rotations OR my path rotations.
  23. AmoryBlaine

    AmoryBlaine the last tycoon

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    Who cares? This is no kind of measure to use when deciding on your specialty.

    The "team" in EM really consists of the doctor and those to whom the doctor is issuing orders. Sure there are some awesome nurses who can help steer you in the right direction and occasionally save your ass but mostly you are making the decisions and telling other people what to do. It's not like there is a pow-wow where you discuss patient care a la a tumor board in Oncology.
  24. BigRedBeta

    BigRedBeta Why am I in a handbasket?

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    I think you need a more consistent definition of teamwork. Working with midlevels or nurses in the OR is very different than working with pharmacists, respiratory therapists, nutritionists/dieticians, speech path, and intensive care nurses in ICU/PICU/NICU settings. The teamwork in those settings is much more one of equal input than in the OR. HOwever there's even a gradient of teamwork with other physicians in those ICU settings. Adult ICU's typically make greater use of consults than PICU, while NICU is often very limited in the number of consults they request.
  25. SoCuteMD

    SoCuteMD

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    FWIW, I would definitely not place EM in the "least team-oriented" category. The other specialties in that category are very much "loner" pursuits. EM is team-oriented, but the team has different players. At some EM programs, one resident works with the same nurse and tech for every single patient they see for that shift. Which nurse/tech you are paired with has a HUGE impact on your day. You may be in a "pod" with one other resident and may coordinate your day with them - stuff like, "I'll grab the next patient, you go eat, and then hopefully I'll grab a bite when you take the patient after" but you know little about their patients or their shift.

    I've also found far more camraderie amongst EM residents than amongst those in other specialties. Rarely was my surgery chief hustling people out of sign-out post-call, while the EM seniors or oncoming residents would pay close attention to who was supposed to be gone already. You'll rarely find anyone else grabbing a beer post-call, but EM residents do occasionally or even often grab breakfast and a nightcap.
  26. G-Man82

    G-Man82

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    Did anyone mention Anesthesiology? There's tons of independence in that specialty, unless you count the surgeon on the other side of the drapes and the OR nurses as part of your team. It's subspecialties though can be more team-oriented, e.g CCM and Pain Management.
  27. Rendar5

    Rendar5

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    yeah everything really depends on your definition of "team-oriented" for me EM is very team-oriented (in academic settings), but that's not talking about doctor-doctor teaming. I t also really really dependson teh structure of the ED. Some I saw very compact units of attending + resident/PA + 2 nurses whose shifts were completely alligned give or take an hour. Other places There'd be two very independent areas, different shift alignments, 4 nurses and 4 doctors and nurses weren't linked with specific doctors.
  28. BrickHouseMD

    BrickHouseMD

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    How about PM&R (especially SCI or TBI). You lead the team of OTs, PTs, PAs, RTs etc and work in conjunction with basically every subspecialty of IM. They even have weekly 'team meetings' and go over the management plan of every patient on the service.
  29. MrBurns10

    MrBurns10 Excellent, Smithers Moderator Emeritus

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    I'm with smq...on the radiology rotations I've been on, it's been: resident reads --> attending goes over reads with resident. No group work other than the occasional interesting case (and obviously teaching conferences).

    I think it's important to remember that 80% of us will not be going into academics. Private practice radiology is one of the most independent fields I can think of.
  30. JHopRevisit

    JHopRevisit

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    Jesus, they've gotten to all of you guys.

    Next you'll be asking which specialties provide the most opportunity for Problem Based Learning.

    Whatever happened to the good'ol days of picking specialties based on reimbursement and pressure from your physician parents. *sigh*
  31. MossPoh

    MossPoh Textures intrigue me

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    So.....Just scanning through this, it appears we all have different definitions of what "team oriented" means. Not only that, but it appears that only a select few have multiple experiences within multiple fields to help determine whether that is characteristic of a particular specialty or just that particular system. My perception of radiology is very different than the one where it sounds like people get their work and do their own thing. I've observed lots of interaction and discussion about things within a radiology group as well as other specialties. Not to mention the fact that someone has to be on the other end of that report, maybe several people. I've been part of international teams that relied on each other for nearly everything without even seeing the other person's face....until a teleconference a few months later that is.

    This just seems far too subjective too me. I admittedly have a looser definition of what a team is than many people though.
  32. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    Agreed. Everyone is right/wrong on this thread, because everyone is working from a different definition, and everyone has seen teamwork or not at their own institution in various departments, which may be as different as night and day at other programs. So the short answer is probably that, depending on what you consider teamwork, there will be a ton of teamwork in ANY specialty, but not at every program. So if you are a team player there is probably a role for you in any specialty, but you have to pick the right program.
  33. howelljolly

    howelljolly

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    Well said... I think thats the take-home point.

    And, I'd suspect that this goes for whatever practice you decide to join when you're an attending.

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