As someone who will be starting IM residency in a couple months, hopefully I can tackle your question.Ok so I've read all the old threads on this, and I've asked about 10 current med school students, but I always get wishy-washy answers (which is fine, that may just be how this is).
What is a *good* residency? (Not residency field, I'm talking about matching in hospital A vs hospital B. Lets talk only internal medicine as a hypothetical, to keep it simple).
Now, I usually get an answer like "Its the feeling you get when you walk in there, do you see yourself there for four years? Can you work with those people? You'll just get a good feeling."
Secondly, one could go simply by NIH funding numbers. That's a pretty big generalization (obviously, I'm sure nobody's arguing that its not). That list that comes up in google shows about 50 internal medicine residencies - pretty sure there's a lot more also, so not much help...
Obviously, a good residency is located where you want to be located. So lets take location out of the picture. What's left? Is it just prestige and your "gut feeling"?
I'm interested in this too.How much time will you actually spend with patients, versus time spent filling out paperwork or chasing after tests?
Was everyone in your class pleased with their match results? I never hear bitter stories, but I'm not sure if they just don't get focus. Along that vein, how many of your peers are satisfied with their current careers/prospects? (Maybe too rough and subjective to answer)
COOL!!! I never knew how people were able to do this!FYI, there's a quote and multi-quote function.
Narcan administration. That stuff works quick!What's the coolest thing you've seen since intern year started?
Probably at some point. Even if I don't do a "real" subspecialty (Cards, GI, Renal, etc, none of which sound super appealing) I might do a Gen Med fellowship in order to focus on medical education or something, but I'm nerdy like that.future IM hopeful here...
do you plan to specialize?
I was always thinking about it because I like the variety, but I definitively decided after my IM clerkship 3rd year.When did you decide on IM?
Also, would you say there is a mix of people from different med schools at the hospital you work at, or are most of them from the same general area?
I'll take a stab at a couple of his unanswered questions.Has it been difficult for you to maintain social/romantic relationship(s) so far during your internship? How about in med school?
Comes with the territory. As an intern you are everybody's bitch. The attendings, the senior residents. The nurses will try to browbeat you into writing orders for things they think are right because they think you don't know what you are doing yet (which is sometimes true, but still fees wrong). And the patients often don't treat you great either when they aren't trying to die on you.I would like to add that it's nice to see you so calm and helpful. Most of the time I see residents posting they are very moody and grouchy.
I'll let the other guy answer this, but in general there will be folks who spend more time studying for the in-service tests than others based on goals. I wouldn't call it "gunning" per se because unlike med school where you are graded against your classmates, the real competition is going to be external to your program.If you're interested in a particular IM subspecialty, do people end up gunning for it from the start of residency, or even earlier, or do most of you just sort that out during residency?
When you work with folks for 80 hours per week, you end up being at least somewhat friendly with most of them, and you all need each other from time to time to help you with things, cover for you, etc. You can't be a total loner. However, if you have a spouse, family, SO, etc, you probably will want to spend the limited time you have outside the hospital with them rather than your co-interns. That's just normal. So the single interns tend to hit the happy hours when they are off and the rest see the folks they have been neglecting while doing crazy hours. That's true most places. I don't think it's so much a function of friendly vs nonfriendly as it is a function of single vs non-single folks.Are you really close with your fellow interns? I ask this because I hope I end up at a program where colleagues go out together on the weekend or go to each other's bday parties and stuff. I don't think all programs are conducive to friendships.
You won't have much time to think of things or follow politics as a resident, and are too far down the rabbit hole to turn around now regardless of what they decide to do.What is your opinion and the opinion of the other residents and doctors you work with on health care reform and the future of medicine? I am applying next year, but don't want to take on the journey of becoming a doctor if I will be hundreds of thousands in debt when I finish and make as much as a McDonald's worker. I am not very knowledgeable about the bill, and I feel it is too early to predict what the outcome of the medical field will be in the next 5-10 years, however I am curious as to what are your thoughts. Thanks!
Most programs are making an earnest effort to give you a schedule that theoretically keeps you within the 80 hour work week (averaged over 4 weeks) rule. Things happen, you can't always leave to sign out in the middle of that Code Blue, etc and inevitably there will be times that the envelope gets pushed farther than it should under the rules. I'd say a lot of residents find they are working in the ballpark of 70-75 hours/week most weeks, with a few weeks here and there breaking the 80 hour mark and a few "easy" electives where your hours dip into the 60s. Do all programs strictly stay within this duty hour limit? No. Do they all now have schedules that suggest you theoretically should be within the limit? Yes. Do they want your time cards to reflect that you are staying within that limit?...Does your program actually follow the 80hr/week rule for residents? How many actually do?
Hobbies? Dude, you are going to be working 80 hours/week and then coming home and spending whatever time you have with friends/family before you go to sleep at some ridiculously early time each night. But sure, if you collect stamps, baseball cards, I'm sure these things will appreciate during residency. You have 3 weeks of vacation each year. Most people travel, spend them on a beach someplace and the like. But if you want to spend them doing a hobby, you can.In case he ever comes back:
Are you able to make time for hobbies? Do you have hobbies?! How do you maintain your sanity?
How else are you going to get (largely) public hospitals to train individuals? The money you make from the work residents do during their crazy hours is nice, but doesn't really cover the expenses of insurance, training, benefits and salary of these individuals. Paying each hospital $100k per resident sweetens the pot enough to ensure that all of the 20,000 residents each year get the training they need.Also why does medicare/medicaid, indirectly, pay residents, what's the rationale behind this?
You will have down-time on some shifts at every program. Patients stable, nothing to do until the day team shows up. You probably are sitting in a call room unable to sleep but waiting for that next page. You can't go home until the shift ends. Most call rooms have a computer but not always a TV.1 question: what program are you at that gives you so much free time?
I'm not currently a resident but this strikes me wrong.How else are you going to get (largely) public hospitals to train individuals? The money you make from the work residents do during their crazy hours is nice, but doesn't really cover the expenses of insurance, training, benefits and salary of these individuals. Paying each hospital $100k per resident sweetens the pot enough to ensure that all of the 20,000 residents each year get the training they need.
Getting $100k plus the work generated is profitable for hospitals. The work itself minus the training, insurance, salary and costs is not. The reason I know? There are quite a few unfunded spots that are eternally unfilled, but funded spots are more or less all filled each year. The reason, that $100k makes it profitable. Without it, the outlay of costs, the risk of liability, and training effort make it not worth it. Believe me, if it were worth it to hospitals to sign on the cheap labor these unfunded spots would be internally funded. But they aren't and that should tell you they, without the funding, are unprofitable. You have to realize that the costs per resident are not trivial. You have to pay around $45k in salary to start with, then on top of that you have medmal insurance (which for someone new and unlicensed is not a small figure), health & disability insurance and benefits, you have to give book funds, and supply white coats, and maintain call rooms, and give meal tickets. Plus attendings have to take time out of their day to actually train people. All totalled, the costs are going to far exceed the $75k figure you floated, I suspect it's more like twice that. While residents do generate value from their work, a LOT of what residents do is not significantly billable. They may spend hours rounding and writing notes, all of which gets swept into a daily amount for having seen the patient each day. Most of the things they do with an attending or senior present get billed to the patient as a single procedure done by the more senior person. You don't get to bill patients for dictations, dictation summaries, transfer notes, sign-outs/hand-offs and the like, all of which are important for the functioning of the hospital and a big part of your day, but none of which are "value added" activities. So the real contribution of residents, billings-wise, is to allow attendings to manage a greater number of patients. And maybe order more tests than a more senior person might. This is beneficial to the hospital, but hard to quantify in terms of a "should we fund an additional residency slot out of our own pocket" kind of analysis. For the most part, to entice these hospitals to hire residents they need the $100k medicare kicker to seal the deal.I'm not currently a resident but this strikes me wrong.
I'd bet overall that having residents is a very profitable activity for a hospital. Otherwise, why would they do it?
I'd estimate it costs around $75K in total (all benefits and costs covered) to have a resident, and that would be covered with something like $300/day in collected fees. It must surely average much more than that over the course of a residency, with great variability depending on the specialty? Tell me if I'm wrong on this, maybe so, But if not, with the $100K support in addition, having residents then adds up to a much more profitable "business" for hospitals than many other things they do.