MD & DO Anyone worried about their residency program changing?

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Worried what the furloughs mean for those entering residency

 

[Amba]

Academic programs are bettered shielded from these furloughs. They are salaried and don’t have to worry as much about overhead costs.

My home surgical attendings are covering medicine teams, so they are still working and bringing in money. It’s not like a private practice where attendings have huge cuts in volume and still have to pay overhead costs.

I wouldn’t stress yet

Elective procedures bring in the money. General floor medicine, not as much. Plenty of academic centers are already cutting salaries. Doesn't really apply to residents, fortunately.

 

[MerYangBey]

Anyone worried about volumes being low/ not getting the typical clinic/specialty experience. Not sure how things will be in July.

 

[Dr. Death]

Anyone worried about volumes being low/ not getting the typical clinic/specialty experience. Not sure how things will be in July.

No. I have 4 years. I'm sure a couple months of atypical won't significantly hurt my learning

 

[MerYangBey]

No. I have 4 years. I'm sure a couple months of atypical won't significantly hurt my learning

There is no way of knowing its only going to be a couple months. I feel like people will wanna avoid hospitals for a while. And who knows what’s gonna happen next fall.

 

[Modstopizdy]

There is no way of knowing its only going to be a couple months. I feel like people will wanna avoid hospitals for a while. And who knows what’s gonna happen next fall.

Yeah it's kind of hard to imagine a way in which things go "back to normal" anytime soon. Worst case scenario is that Covid infections confer no long term immunity and no vaccination is possible. That would make Covid basically a more lethal version of the common cold, which is also typically caused by the coronavirus family. It's a bit of a terrifying prospect to contemplate and would likely shave a decade off the average life expectancy in developed countries and utterly transform society in a very dark way. Imagine a world with the "common cold" except your odds of dying every time you catch it is between .5-1% and over 5% once you reach advanced age. Basically the end of life as we formerly knew it if this is the case.

 

[MedicineZ0Z]

No. I have 4 years. I'm sure a couple months of atypical won't significantly hurt my learning

You're assuming this won't relapse and come back again? Immunity to this thing doesn't last, if you even get it. No vaccine = it's here to stay. And we won't have a vaccine until 2022 for the masses.

Yeah it's kind of hard to imagine a way in which things go "back to normal" anytime soon. Worst case scenario is that Covid infections confer no long term immunity and no vaccination is possible. That would make Covid basically a more lethal version of the common cold, which is also typically caused by the coronavirus family. It's a bit of a terrifying prospect to contemplate and would likely shave a decade off the average life expectancy in developed countries and utterly transform society in a very dark way. Imagine a world with the "common cold" except your odds of dying every time you catch it is between .5-1% and over 5% once you reach advanced age. Basically the end of life as we formerly knew it if this is the case.

You would see insane infusions of money into a cure/vaccine if that were the case. Or it may just become more benign and peoples' immune systems would get a better handle on it.

 

[Modstopizdy]

You're assuming this won't relapse and come back again? Immunity to this thing doesn't last, if you even get it. No vaccine = it's here to stay. And we won't have a vaccine until 2022 for the masses.



You would see insane infusions of money into a cure/vaccine if that were the case. Or it may just become more benign and peoples' immune systems would get a better handle on it.

If our basic level of technology is not up to the task of developing a vaccine it doesn't matter how much money we throw at it. Look at HIV, it's been decades and a vaccine is nowhere on the horizon despite tens of billions invested. Moreover, past a certain point extra funding does not accelerate the R&D process as the experiments just need time to run and then iterate over and over.

The fact that there has never been a successful vaccine for a coronavirus is not reassuring, nor is the evidence that the majority of those with mild Covid symptoms have very low or undetectable antibody titers. If getting symptomatically sick with live virus does not provide immunity, what chance does a vaccine have?

 

[MedicineZ0Z]

If our basic level of technology is not up to the task of developing a vaccine it doesn't matter how much money we throw at it. Look at HIV, it's been decades and a vaccine is nowhere on the horizon despite tens of billions invested. Moreover, past a certain point extra funding does not accelerate the R&D process as the experiments just need time to run and then iterate over and over.

The fact that there has never been a successful vaccine for a coronavirus is not reassuring, nor is the evidence that the majority of those with mild Covid symptoms have very low or undetectable antibody titers. If getting symptomatically sick with live virus does not provide immunity, what chance does a vaccine have?

I do somewhat agree. But I'd say money can pump out a cure more effectively than anything else. An extreme global urgency with all resources directed at one task can move mountains. We went to the moon during an era where flying was unsafe, keep that in mind too.

 

[Modstopizdy]

I do somewhat agree. But I'd say money can pump out a cure more effectively than anything else. An extreme global urgency with all resources directed at one task can move mountains. We went to the moon during an era where flying was unsafe, keep that in mind too.

I agree that more money is typically better than less money, and I certainly hope they'll give it their best shot at a vaccine regardless of the cost. However, we have to recognize the limits to our technological prowess. The Apollo Program was an impressive feat to be sure, but the engineering complexities involved pale in comparison to those we face in medical research. Aside from some materials science and fluid dynamics it was mostly pitting our engineering skills against well understood Newtonian mechanics that could be calculated and modeled with a high degree of precision. In terms of fighting disease, we are pitting ourselves against phenomena we are hardly beginning to understand and that occur at scales and timeframes we have no hope of directly observing and modeling. Biological systems are absurdly more complex than those we have been able to engineer ourselves and our ability to affect them in desirable ways are correspondingly more limited.

 

[Lawpy]

I agree that more money is typically better than less money, and I certainly hope they'll give it their best shot at a vaccine regardless of the cost. However, we have to recognize the limits to our technological prowess. The Apollo Program was an impressive feat to be sure, but the engineering complexities involved pale in comparison to those we face in medical research. Aside from some materials science and fluid dynamics it was mostly pitting our engineering skills against well understood Newtonian mechanics that could be calculated and modeled with a high degree of precision. In terms of fighting disease, we are pitting ourselves against phenomena we are hardly beginning to understand and that occur at scales and timeframes we have no hope of directly observing and modeling. Biological systems are absurdly more complex than those we have been able to engineer ourselves and our ability to affect them in desirable ways are correspondingly more limited.

The best measure is to conduct rapid clinical trials and push for existing and other new drugs that work ASAP. It's completely impractical to wait for any vaccine but having some treatments can significantly control and weaken the disease and allow things to return mostly to normal soon

Luckily there are several in the works and i'm betting on them far more than placing any hopes or interests in a vaccine.

 

[IntheClouds4ever]

Yeah it's kind of hard to imagine a way in which things go "back to normal" anytime soon. Worst case scenario is that Covid infections confer no long term immunity and no vaccination is possible. That would make Covid basically a more lethal version of the common cold, which is also typically caused by the coronavirus family. It's a bit of a terrifying prospect to contemplate and would likely shave a decade off the average life expectancy in developed countries and utterly transform society in a very dark way. Imagine a world with the "common cold" except your odds of dying every time you catch it is between .5-1% and over 5% once you reach advanced age. Basically the end of life as we formerly knew it if this is the case.

Odds, death rates, and even infection rates at this time are unknown.. our total testing is abysmal and even the testing that is available was rushed through and isn’t as reliable (large number of false negatives) as we are typically used to. Don’t fall for the doom and gloom. The virus is something we should be aware of but we should also realize how crappy our data is currently so we don’t know the true extent of anything at this point.

 

[MedicineZ0Z]

Odds, death rates, and even infection rates at this time are unknown.. our total testing is abysmal and even the testing that is available was rushed through and isn’t as reliable (large number of false negatives) as we are typically used to. Don’t fall for the doom and gloom. The virus is something we should be aware of but we should also realize how crappy our data is currently so we don’t know the true extent of anything at this point.

I think this whole "asymptomatic carrier" or "how we're all positive" is utter nonsense.
This disease WILL make almost everyone who gets it sick. And the asymptomatic carrier thing is very likely just the incubation period. And what's even more silly is suggesting that this has been around since the Fall (like chris Cuomo tried to suggested last night).

 

[hallowmann]

Anyone worried about volumes being low/ not getting the typical clinic/specialty experience. Not sure how things will be in July.

Its going to be heavily dependent on the program. We're getting busier already as patients and schedulers are getting better at the telemed visits. I have seen only a slight reduction in my number of clinic visits (the lows lasted 1-2 wks and then rebounded to something like 70-80% what we usually see). I don't know about other services, but there's plenty still to do, we're just doing it over video or over the phone.

There is no way of knowing its only going to be a couple months. I feel like people will wanna avoid hospitals for a while. And who knows what’s gonna happen next fall.

Things are not "returning back to normal" after this. SARS made a pretty lasting impact on China, and I imagine SARS-CoV2 will be similar, but globally. That said, medicine will adapt and we'll still be working.

Imagine a world with the "common cold" except your odds of dying every time you catch it is between .5-1% and over 5% once you reach advanced age. Basically the end of life as we formerly knew it if this is the case.

Illness tend towards less lethality over time. Even if this does turn into an annual thing, it'll probably settle at around the same level of influenza, so we'll just have 2. You know, until the next global pandemic. That might take years though.

I think this whole "asymptomatic carrier" or "how we're all positive" is utter nonsense.
This disease WILL make almost everyone who gets it sick. And the asymptomatic carrier thing is very likely just the incubation period...

Too early to tell. I suspect there are "asymptomatic" cases, but whether they are truly asymptomatic is probably up for question. There's a lot of people that don't necessarily spike a fever, that have a chronic cough or have myalgias and attribute it to something else. I think its obvious some people's disease course is very different than others. For some reason it takes weeks for some to clear the fever even if they are young and healthy, and for others it takes days.

More data will come over time, but I'm honestly getting tired of the drawing immense conclusions over all this preliminary stuff. Did you see that CNN news article about Santa Clara county? Its all ridiculously interpreted. The study they reference tries to extrapolate percentage of infected in the county based on a convenient sample where a poorly tested antibody test with at best a specificity of 99% came up positive for ~1.5% of the sample, i.e. 2/3 of those could be false positives, let alone that the subjects were not a random sample. My guess is someone wants CA to open up sooner and will use this to argue fatality rate is only as high as the flu.

 

[Wordead]

I think this whole "asymptomatic carrier" or "how we're all positive" is utter nonsense.
This disease WILL make almost everyone who gets it sick. And the asymptomatic carrier thing is very likely just the incubation period. And what's even more silly is suggesting that this has been around since the Fall (like chris Cuomo tried to suggested last night).

I aM aN eXPeRt oN nOVel cORonaViRus

 

[sunshinefl]

Things are not "returning back to normal" after this. SARS made a pretty lasting impact on China, and I imagine SARS-CoV2 will be similar, but globally. That said, medicine will adapt and we'll still be working.

Well, that’s depressing. Crushing the last hope I had left.

 

[hallowmann]

Well, that’s depressing. Crushing the last hope I had left.

Things like this happen. Things didn't return back to normal after 9/11. Major events cause lasting impacts on how we live our lives. Nothing to get depressed about. We will eventually gather in groups again, I just think there will be a lot of aspects of our lives that will change. That's OK, change is a part of life, mourn little bits, but embrace the change and the fact that you are living through something that will change how people live for some time.

 

[DoctwoB]

The best measure is to conduct rapid clinical trials and push for existing and other new drugs that work ASAP. It's completely impractical to wait for any vaccine but having some treatments can significantly control and weaken the disease and allow things to return mostly to normal soon

Luckily there are several in the works and i'm betting on them far more than placing any hopes or interests in a vaccine.

There are reasons we don’t have vaccines for other coronaviruses and it’s not because making one is too hard or impossible. It’s because any individual type of Coronavirus is responsible for a minuscule percentage of common colds. Offering a patient a vaccine that may require periodic boosters in order to reduce their incidence of common cold by 5% isn’t going to sell, and that’s whyno one has ever thrown much money at it. Look at how there are multiple vaccine targets identified and trials beginning within a few months of virus identification. Any individual one may not work but I’d put my money on at least one of them working out.

A universal common cold vaccine would sell, but that would require being effective against multiple different strains of Coronavirus, rhino viruses, parainfluenza, rsv, etc and that is beyond our current ability.