Can I moonlight in a specialty not related to my residency field as a PGY2?

[medschoolappl]

My advanced program allows me to moonlight. I am in a fairly relaxed residency (mostly 830-5 M-F. Home call, 1 call on average per week based on what current residents tell me). I will have an unrestricted Maryland licence. Can I moonlight in an emergency room, as a covering night float IM doc, urgent care? I had really strong medical school training and am at a very high volume, high acuity residency program with a lot of intern autonomy. All this assumes I feel competent to practice independently at the end of my intern year. Anybody know of any opportunities for moonlighting in the Baltimore-DC metro area? Thanks for the recs.

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[Raryn]

My advanced program allows me to moonlight. I am in a fairly relaxed residency (mostly 830-5 M-F. Home call, 1 call on average per week based on what current residents tell me). I will have an unrestricted Maryland licence. Can I moonlight in an emergency room, as a covering night float IM doc, urgent care? I had really strong medical school training and am at a very high volume, high acuity residency program with a lot of intern autonomy. All this assumes I feel competent to practice independently at the end of my intern year. Anybody know of any opportunities for moonlighting in the Baltimore-DC metro area? Thanks for the recs.

If your program allows you to moonlight externally and you can get a clinic or hospital to credential you, sure. Just make sure your malpractice is covered by your employer.

Best you'll probably get is an urgent care or a rural ER (no clue how far you'd have to go out of Baltimore, not that many rural areas around there).

Good luck.

 

[AdmiralChz]

Raryn had some great advice above. I'd add that your residency contract will spell out exactly what rules are for external moonlighting (many programs prohibit it, but many also offer ample internal moonlighting). I did some internal moonlighting in our ED after intern year and occasionally moonlight on the weekends at a rural ED now during fellowship - they require completion of a residency, though. At my residency several of us in different specialties did moonlighting - Anesthesiology, IM, surgery (including subs), and FM off the top of my head.

Can I moonlight ... as a covering night float IM doc

The hospitals I know that offer this require it to be done by internists only, mostly done by fellows in IM-based specialties to my knowledge.

Another point - beware of "under the radar" moonlighting if you are prohibited in your contract. It was prohibited at my residency institution and I know of 2 residents who were terminated when they were found to be in violation of this rule. I am sure many on this forum have done it in the past or know people do it (as do I), but carefully weigh the risk vs benefits of doing so.

 

[BoardingDoc]

I am in a fairly relaxed residency (mostly 830-5 M-F. Home call, 1 call on average per week based on what current residents tell me).

Jesus, that's a residency? That's less hours as a resident than many/most attendings work in other fields.

Can I moonlight in an emergency room, as a covering night float IM doc, urgent care? All this assumes I feel competent to practice independently at the end of my intern year.

Just to reiterate what Raryn said, make sure your malpractice covers you. Maybe you're going to be great! Who knows. All I can say is that as an EM intern, I definitely hit the same point that I think you're on right now on the Dunning Kruger curve (left and high) before I started realizing I would certainly have killed some people / missed serious **** due to lack of experience at that stage.

You do you, just remember that you don't know what you don't know.

 

[Psai]

Jesus, that's a residency? That's less hours as a resident than many/most attendings work in other fields.



Just to reiterate what Raryn said, make sure your malpractice covers you. Maybe you're going to be great! Who knows. All I can say is that as an EM intern, I definitely hit the same point that I think you're on right now on the Dunning Kruger curve (left and high) before I started realizing I would certainly have killed some people / missed serious **** due to lack of experience at that stage.

You do you, just remember that you don't know what you don't know.

We have nurses calling their 1 week orientation a residency.

 

[flightnurse2MD]

We have nurses calling their 1 week orientation a residency.

And I remember my first beer too....

 

[medschoolappl]

Jesus, that's a residency? That's less hours as a resident than many/most attendings work in other fields.



Just to reiterate what Raryn said, make sure your malpractice covers you. Maybe you're going to be great! Who knows. All I can say is that as an EM intern, I definitely hit the same point that I think you're on right now on the Dunning Kruger curve (left and high) before I started realizing I would certainly have killed some people / missed serious **** due to lack of experience at that stage.

You do you, just remember that you don't know what you don't know.

That’s a really good point. I am about 3 months into intern year where I feel confident managing under supervision most bread and butter but I agree I don’t have the experience to deal with unusual presentations and haven’t developed the intuition for what could go wrong and how to anticipate it. Thanks for the input

 

[rokshana]

That’s a really good point. I am about 3 months into intern year where I feel confident managing under supervision most bread and butter but I agree I don’t have the experience to deal with unusual presentations and haven’t developed the intuition for what could go wrong and how to anticipate it. Thanks for the input

3 months in and you think you are confident that you can manage most bread and butter...maybe you should see how much your seniors are acting as a safety net for you...please refer to the Dunning- Kruger Effect chart...you are to the far left...while your learning curve has been steep, no 3 month old intern should be confident that they can manage even bread and butter...

revisit this thread and your post this time next year...

 

[gutonc]

That’s a really good point. I am about 3 months into intern year where I feel confident managing under supervision most bread and butter but I agree I don’t have the experience to deal with unusual presentations and haven’t developed the intuition for what could go wrong and how to anticipate it. Thanks for the input

I'm 6 years out of fellowship and largely feel confident managing most bread/butter cases (and the bulk of the complicated stuff) in my sub-specialty. Bring me something complicated in cards or renal though and I'm totally going to s*** the bed.

Can I keep these folks alive overnight while moonlighting and then dump them on someone else in the morning? Absolutely.

Should I feel competent enough to do so? Absolutely not.

But you know man...you do you.

 

[AdmiralChz]

That’s a really good point. I am about 3 months into intern year where I feel confident managing under supervision most bread and butter but I agree I don’t have the experience to deal with unusual presentations and haven’t developed the intuition for what could go wrong and how to anticipate it. Thanks for the input

Not to derail too much, but this is exactly the mindset of new nurse practitioner graduates itching for independent practice and more autonomy with a sliver of the same training. It’s a little scary.

But we see it all the time in residency, try to stay humble and keep reading/learning.

 

[Perrotfish]

My advanced program allows me to moonlight. I am in a fairly relaxed residency (mostly 830-5 M-F. Home call, 1 call on average per week based on what current residents tell me). I will have an unrestricted Maryland licence. Can I moonlight in an emergency room, as a covering night float IM doc, urgent care? I had really strong medical school training and am at a very high volume, high acuity residency program with a lot of intern autonomy. All this assumes I feel competent to practice independently at the end of my intern year. Anybody know of any opportunities for moonlighting in the Baltimore-DC metro area? Thanks for the recs.

1) What kind of Intern year are you in,
2) How many hours per week do you work during your Intern year?
3) What kind of advanced year?

 

[medschoolappl]

What kind of I term year are you in, and how many hours do you work during your Intern year?

I am doing preliminary medicine at a large urban hospital. I average 65-70 hours per week on my inpatient rotations which constitute about 80% of the year.

Dermatology for my advanced training.

 

[gutonc]

I am doing preliminary medicine at a large urban hospital. I average 65-70 hours per week on my inpatient rotations which constitute about 80% of the year.

Dermatology for my advanced training.

Just go do a Botox course and open an aesthetic medicine clinic on the weekends then.

 

[NotAProgDirector]

Anyone else notice that the D-K graph above has a grammatical error on it? Somewhat ironic that you "No Nothing".

 

[Apollyon]

Anyone else notice that the D-K graph above has a grammatical error on it? Somewhat ironic that you "No Nothing".

Then again, it also mentions a non-existent Nobel in psychology.

Alternately, it could mean "no nothing at all", which is proximate to a double negative, or it could be exclamatory.

 

[KnuxNole]

Jesus, that's a residency? That's less hours as a resident than many/most attendings work in other fields.

That's how year 2 and 3 of my residency was like. M-F from 8/9-5 on most outpatient rotations. Of course some were more demanding but there were months that were lighter hour wise.

 

[NotAProgDirector]

Then again, it also mentions a non-existent Nobel in psychology.

Brilliant! Missed that.

 

[HLxDrummer]

If your program lets you and the hospital hires you, then yes. Like others said, I would be very cautious, however. For example working in an ED: do you feel comfortable delivering a baby (then resuscitating it and mother)? Needle cric on a toddler? Not missing a Wellen's in a stack of EKGs? Not missing the posterior stroke in a patient that comes in for "feels sick"?

 

[Rendar5]

If your program lets you and the hospital hires you, then yes. Like others said, I would be very cautious, however. For example working in an ED: do you feel comfortable delivering a baby (then resuscitating it and mother)? Needle cric on a toddler? Not missing a Wellen's in a stack of EKGs? Not missing the posterior stroke in a patient that comes in for "feels sick"?

You don’t even have to get into the esoteric stuff.
Can you do basic ED cases without supervision? Choose a correct splint and place it, deliver a baby, intubate someone with a low pulse ox without killing them, Perform procedural sedation, insert a chest tube, insert a central line, correctly tpa a borderline stroke, lumbar puncture, reduce a dislocated shoulder and hip.


I doubt a Derm intern can do all those comfortably but you never know. Most sure but all? Would have to be a helluva place to do internship at. Basic medical cases I’m not as worried about. And basic wound care a Dern intern might even be good at.

So urgent care may be a great place to moonlight but not an ED because it’s too unpredictable. At my low acuity low volumefreestanding ED that I sometime do overtime shifts at still has something complicated or emergent every 2 or 3 shifts.

 

[Triple Cheeseburger]

At anesthesiology interviews, I asked about moonlighting. No programs I have been at so far allow external moonlighting or doing it outside of anesthesia. The opportunities have seemed rather limited Seems ridiculous to me we can't do urgent care or the general floor or emergency room. I'm baffled since NPs are allowed to work in these areas, seems like a double standard. Anyone else finding similar moonlighting opportunities as they interview?

 

[AdmiralChz]

At anesthesiology interviews, I asked about moonlighting. No programs I have been at so far allow external moonlighting or doing it outside of anesthesia. The opportunities have seemed rather limited Seems ridiculous to me we can't do urgent care or the general floor or emergency room. I'm baffled since NPs are allowed to work in these areas, seems like a double standard. Anyone else finding similar moonlighting opportunities as they interview?

Seek out programs with more internal moonlighting - we had a ton and it paid pretty well.

 

[Rendar5]

At anesthesiology interviews, I asked about moonlighting. No programs I have been at so far allow external moonlighting or doing it outside of anesthesia. The opportunities have seemed rather limited Seems ridiculous to me we can't do urgent care or the general floor or emergency room. I'm baffled since NPs are allowed to work in these areas, seems like a double standard. Anyone else finding similar moonlighting opportunities as they interview?

It’s not really a double standard. If you moonlight you’re not operating under physician guidance or supervision. An NP typically is.

 

[link2swim06]

At anesthesiology interviews, I asked about moonlighting. No programs I have been at so far allow external moonlighting or doing it outside of anesthesia. The opportunities have seemed rather limited Seems ridiculous to me we can't do urgent care or the general floor or emergency room. I'm baffled since NPs are allowed to work in these areas, seems like a double standard. Anyone else finding similar moonlighting opportunities as they interview?

Have you done residency in those fields? There is a reason there is an entire residency for every specialty.

It would be as plausible as me moonlighting as an anesthesiologist when I was in EM residency because nurse anesthetists do it. I could intubate and run drips...not much harder than that, right? (/obvious sarcasm).

 

[Triple Cheeseburger]

Have you done residency in those fields? There is a reason there is an entire residency for every specialty.

It would be as plausible as me moonlighting as an anesthesiologist when I was in EM residency because nurse anesthetists do it. I could intubate and run drips...not much harder than that, right? (/obvious sarcasm).

No, I'm applying to anesthesia right now.

As a PGY-2, are you suggesting one would be less qualified than a NP/PA at an urgent care? I know there is an entire residency for each specialty, but after four years of medical school and PGY1 I should be way more qualified for these opportunities than an NP. That is the double standard I'm referring too. 90% or more of ED visits are things that should be addressed in an outpatient clinic, things a PGY2 in any specialty should be able to handle.

 

[Triple Cheeseburger]

It’s not really a double standard. If you moonlight you’re not operating under physician guidance or supervision. An NP typically is.

Many states allow NPs to practice without physician supervision. In the states that require supervision, the NPs often rarely (if ever) actually consult with their supervising physician. It is just a way for the supervising physician to make more cash. I'm not taking a position on if this is right or wrong, just sayin'.

 

[rokshana]

Many states allow NPs to practice without physician supervision. In the states that require supervision, the NPs often rarely (if ever) actually consult with their supervising physician. It is just a way for the supervising physician to make more cash. I'm not taking a position on if this is right or wrong, just sayin'.

your license, dude...and if you think that after having 1 year of anesthesia that you would be capable of medicine (whether EM or IM) AND you can actually find a hospital that will credential you (and take on the liability you would be), more power to you...though you better have really really good malpractice insurance.

 

[BoardingDoc]

90% or more of ED visits are things that should be addressed in an outpatient clinic, things a PGY2 in any specialty should be able to handle.

I truly love the confidence about the percentage of BS that an ED sees and the capabilities of a 2nd year resident from someone who has not yet graduated from medical school.

Many states allow NPs to practice without physician supervision. In the states that require supervision, the NPs often rarely (if ever) actually consult with their supervising physician.

I work in a state where NPs do not work independently in the ED. Your comment that they rarely if ever consult with me is utterly false. NPs and PAs are treated much like residents. They see patients on their own, but I am aware of the history and plan of 100% of the patients that they see while working with me.

Your call, but I'd do a serious reevaluation of your level of expertise before you keep walking confidently in the wrong direction.

 

[Rendar5]

90% or more of ED visits are things that should be addressed in an outpatient clinic, things a PGY2 in any specialty should be able to handle.

You do realize that you still have to see 100% of ED patients, not 90%. I would trust a PGY-3 EM resident to moonlight in a low acuity ED, but not an average EM PGY-2 let alone a PGY-2 of any other field. Urgent care for a pgy-2 sure considering that I routinely get referrals from UC’s from appropriate abdominal pain and chest pain work ups to unnecessary head CT requests or minor EKG abnormalities (meaning whether they’re making a clinical mistake or have someone beyond their scope of practice they have someone to pass the ball to)

 

[Perrotfish]

Many states allow NPs to practice without physician supervision. In the states that require supervision, the NPs often rarely (if ever) actually consult with their supervising physician. It is just a way for the supervising physician to make more cash. I'm not taking a position on if this is right or wrong, just sayin'.

So I'll take a position: that's wrong. Its wrong for them, but its even more wrong for a physician who should know better.

I think the point for @medschoolappl is that, if he's going to moonlight with just an intern year he should:
1) work in an environment with either limited acuity (urgent care) or in an NPs role (under the supervision of an attending who is physically present). If OP is alone, and the response to a code is anything other than 'call 911 and start BLS', then its the wrong job. No hospitalist work unless there is someone board certified in house.
2) work exclusively with the patient population that you see in an IM prelim year. No kids. No gyn. No ED
3) work only with access to adequate references. If they don't provide an uptodate subscription then buy one.
4) study for his job in addition to his residency. Urgent care RAP is a good place example

Not saying OP should moonlight at all, but I will say OP definitely shouldn't moonlight as the attending in a rural ED. That is a recipe for disaster.

 

[Pes anserine]

My advanced program allows me to moonlight. I am in a fairly relaxed residency (mostly 830-5 M-F. Home call, 1 call on average per week based on what current residents tell me). I will have an unrestricted Maryland licence. Can I moonlight in an emergency room, as a covering night float IM doc, urgent care? I had really strong medical school training and am at a very high volume, high acuity residency program with a lot of intern autonomy. All this assumes I feel competent to practice independently at the end of my intern year. Anybody know of any opportunities for moonlighting in the Baltimore-DC metro area? Thanks for the recs.

In a rural ED, probably. Not your average ED. Plenty of ED/family trained docs to fill those positions. And I think anyone who has not formally trained in ED/FP/IM would be crazy to moonlight for a few bucks in a rural ED. ANYTHING can come through the door, and you'd have to be ready to deal with it. If you are the only provider there you can find yourself in heaps of trouble. Is the $1k you are going to make worth a potential lawsuit? At my program, the fellows/chiefs sometimes did nightfloat IM, but otherwise interns were not allowed to moonlight at all, and rarely PGY-2s but not commonly. If you are going to moonlight makes more sense to do so in a more protected environment - maybe do things like H/Ps, disability evals, evals for weight loss, etc. Low risk, decent pay.

 

[link2swim06]

No, I'm applying to anesthesia right now.

As a PGY-2, are you suggesting one would be less qualified than a NP/PA at an urgent care? I know there is an entire residency for each specialty, but after four years of medical school and PGY1 I should be way more qualified for these opportunities than an NP. That is the double standard I'm referring too. 90% or more of ED visits are things that should be addressed in an outpatient clinic, things a PGY2 in any specialty should be able to handle.

Ok that's unlikely true, given that more than 10% of patients are admitted in many (most?) EDs.

Also remember in most ER the NP/PA is out front handling the fast track stuff. Probably still stuff you have done a lot of (or any of). How many nails have you trepinated? Digit blocks, fingers you reduced, nursemaids reduced, etc.

But most of the stuff I see as an ED physician in the back is all ESI 1, 2, or 3. I wouldn't have been comfortable cardioverting, chest tubes, ems medication direction (pronouncing over the radio), etc. as an intern.

And our fast track PAs who have been doing it for 5, 10, 15 years have way more experience with the fast track stuff than you would. The new PAs/NPs end up basically running most all cases by either a senior PA or myself (the attending) and essentially function as an intern.

Are there unsupervised NP who just graduated? Sure, but they are dangerous. Not sure why you would want to put yourself in the same position.

 

[DocVapor]

No, I'm applying to anesthesia right now.

As a PGY-2, are you suggesting one would be less qualified than a NP/PA at an urgent care? I know there is an entire residency for each specialty, but after four years of medical school and PGY1 I should be way more qualified for these opportunities than an NP. That is the double standard I'm referring too. 90% or more of ED visits are things that should be addressed in an outpatient clinic, things a PGY2 in any specialty should be able to handle.

I am a PGY-2 in Anesthesia with prior EMS experience, and the thought of moonlighting in even an urgent care scares me, and the thought of moonlighting in any ED without the safety net of an attending terrifies me. We aren't trained for that, even after an intern year. You have to remember that you're subconsciously going to know you're going into Anesthesiology, so how well are you REALLY going to remember all your bugs and drugs (unless you're just going to drop a z-pack on everyone?) How comfortable are you going to be suturing up some kid's periorbital lac because you can't find an Optho to come do it? When you moonlight Saturday, but work all day Sunday in the OR, how are you planning on following up on any labs and making changes to treatments or making referrals in a timely manner? Sure you could drop tubes like a champ, but how about emergent b/l chest tubes and femoral central lines in the random trauma that comes through your door instead of the more appropriate hospital 30 minutes away?

Could you potentially make it through a shift without seeing that? Definitely. A month? Maybe. A year? Doubtful. You better be prepared to handle that - which means studying it all at the same time you're actually trying to learn your own primary career.

 

[Psai]

No, I'm applying to anesthesia right now.

As a PGY-2, are you suggesting one would be less qualified than a NP/PA at an urgent care? I know there is an entire residency for each specialty, but after four years of medical school and PGY1 I should be way more qualified for these opportunities than an NP. That is the double standard I'm referring too. 90% or more of ED visits are things that should be addressed in an outpatient clinic, things a PGY2 in any specialty should be able to handle.

🙁 I wish we had more cool people joining our specialty.

 

[AMEHigh]

No, I'm applying to anesthesia right now.

As a PGY-2, are you suggesting one would be less qualified than a NP/PA at an urgent care? I know there is an entire residency for each specialty, but after four years of medical school and PGY1 I should be way more qualified for these opportunities than an NP. That is the double standard I'm referring too. 90% or more of ED visits are things that should be addressed in an outpatient clinic, things a PGY2 in any specialty should be able to handle.

Sure. A PA/NP that's been working in urgent care for 10 years might be better qualified than me as a 2nd year resident who has never set foot in an urgent care.

Where are you getting your 90% statistic from?

Lastly, I know everyone likes to hate on family practice/outpatient medicine, but we see plenty of things that not any speciality would be able to handle. It's not like we just see the sniffles all day long.

I hope you have your over confidence in check during you're residency interviews because it's not a good look.

 

[mvenus929]

90% or more of ED visits are things that should be addressed in an outpatient clinic, things a PGY2 in any specialty should be able to handle.

So, I graduated from residency (pediatrics) back in June, and now work in the fast track of our pediatric emergency room (among other places, but that's most pertinent to what you're asking about). Things that I easily picked up and managed as a resident now terrify me (especially abdominal pain in a teenager). There is an entirely different mentality when you don't have an attending behind you anymore watching you for mistakes, and most residents don't actually understand that feeling until they are on their own. I have two of my classmates who are working in (a pediatric) urgent care now, and they see a ton of things that we didn't see during residency--because they went to the urgent care or fast track rather than the main ED or our clinic. I have a classmate who is now a PCP, and she comes to us every week with patients she saw in clinic and things that she feels like she missed.

So, yes, as a resident, I could handle a lot of things that came into the ER. But having the ability to run my plan by an attending, or ask questions when I had no idea what was going on was invaluable.

 

[cbrons]

What about urgent care or addiction medicine clinic moonlighting? The latter is actually quite limited scope of practice.

 

[Triple Cheeseburger]

Sure. A PA/NP that's been working in urgent care for 10 years might be better qualified than me as a 2nd year resident who has never set foot in an urgent care.

Where are you getting your 90% statistic from?

Lastly, I know everyone likes to hate on family practice/outpatient medicine, but we see plenty of things that not any speciality would be able to handle. It's not like we just see the sniffles all day long.

I hope you have your over confidence in check during you're residency interviews because it's not a good look.

I have spent several months in the ED, mostly in a rural setting. True emergencies are greatly out numbered by non-emergency stuff. By non-emergency I mean things that can wait until a PCP addresses them the next day. I'm not over confident, but I have seen plenty of NP/PAs in the ED, some fresh out of school working in the ED. If they can do it, we should be able to as well.

 

[Triple Cheeseburger]

Ok that's unlikely true, given that more than 10% of patients are admitted in many (most?) EDs.

Also remember in most ER the NP/PA is out front handling the fast track stuff. Probably still stuff you have done a lot of (or any of). How many nails have you trepinated? Digit blocks, fingers you reduced, nursemaids reduced, etc.

But most of the stuff I see as an ED physician in the back is all ESI 1, 2, or 3. I wouldn't have been comfortable cardioverting, chest tubes, ems medication direction (pronouncing over the radio), etc. as an intern.

And our fast track PAs who have been doing it for 5, 10, 15 years have way more experience with the fast track stuff than you would. The new PAs/NPs end up basically running most all cases by either a senior PA or myself (the attending) and essentially function as an intern.

Are there unsupervised NP who just graduated? Sure, but they are dangerous. Not sure why you would want to put yourself in the same position.

The bold is what I'm referring too. I was never intending to imply that a PGY-2 could handle everything that comes through the ED, but they could work in the same capacity as an NP/PA (attending supervision).

 

[rokshana]

The bold is what I'm referring too. I was never intending to imply that a PGY-2 could handle everything that comes through the ED, but they could work in the same capacity as an NP/PA (attending supervision).

point being is that no one here is saying that a PGY-2 can't work in an ED as.. well as a resident...the OP thinks that after one year on internship (and not as an EM intern) he can handle moonlighting (i.e. as an attending) in the ED...that is just fraught with all sorts of danger.

 

[Triple Cheeseburger]

point being is that no one here is saying that a PGY-2 can't work in an ED as.. well as a resident...the OP thinks that after one year on internship (and not as an EM intern) he can handle moonlighting (i.e. as an attending) in the ED...that is just fraught with all sorts of danger.

Yea, i agree entirely with what you stated. No way should any PGY-2 work as an attending, especially in the ED.

 

[mvenus929]

Yea, i agree entirely with what you stated. No way should any PGY-2 work as an attending, especially in the ED.

But unless you do internal moonlighting shifts, that's what moonlighting is--working as an attending. Our NPs are not directly supervised like a resident is--they function independently and have chart reviews done each month on a sampling of the patients they saw.

 

[Brahnold Bloodaxe]

But unless you do internal moonlighting shifts, that's what moonlighting is--working as an attending. Our NPs are not directly supervised like a resident is--they function independently and have chart reviews done each month on a sampling of the patients they saw.

That's so effing depressing. In effect, you are saying that 4 years of medical school +1 year of residency makes you less proficient at the actual clinical practice of medicine than some glorified nurse who took a couple online courses and has a few years experience of real world monkey-see monkey-do. What a scam medical education is.

 

[rokshana]

That's so effing depressing. In effect, you are saying that 4 years of medical school +1 year of residency makes you less proficient at the actual clinical practice of medicine than some glorified nurse who took a couple online courses and has a few years experience of real world monkey-see monkey-do. What a scam medical education is.

you must be a med student if you think the 4 years in medical school gives you any proficiency in clinical practice...

 

[Brahnold Bloodaxe]

you must be a med student if you think the 4 years in medical school gives you any proficiency in clinical practice...

What...huh? You quoted my post, in which I clearly and unambiguously state that medical school is utterly worthless for the practice of medicine. Yet your takeway from reading a post in which I say medical school is useless is that I think medical school is useful? Uh, no.

I think I used plain English and said medical education is a scam. Just learn the bare basics like nurses do and jump straight to residency after a year of classroom, since apparently a few years out in the real world on top of a nurse's level of medical knowledge is much more valuable than endless rote memorization of medical school minutiae that is remembered only for a few days before a block exam and a few weeks before Step 1 and then forgotten.

 

[mvenus929]

That's so effing depressing. In effect, you are saying that 4 years of medical school +1 year of residency makes you less proficient at the actual clinical practice of medicine than some glorified nurse who took a couple online courses and has a few years experience of real world monkey-see monkey-do. What a scam medical education is.

Our medical students have so many limitations put on what they can do... they can write notes, but the notes can't be used by residents or attendings for billing purposes, so in effect, their notes get overlooked. They can't write orders, they are discouraged from speaking with families alone for fear that they will say something wrong... They are glorified shadowers, and it's a shame.

Of course, by and large, I think NPs have too much freedom in their practice for similar reasons.

 

[mimelim]

That's so effing depressing. In effect, you are saying that 4 years of medical school +1 year of residency makes you less proficient at the actual clinical practice of medicine than some glorified nurse who took a couple online courses and has a few years experience of real world monkey-see monkey-do. What a scam medical education is.

Just out of curiosity, how many NPs and PAs have you worked with? Despite the constant sky is falling posts on SDN, midlevel encroachment is primarily a pre-med/medical student issue.

 

[Perrotfish]

Just out of curiosity, how many NPs and PAs have you worked with? Despite the constant sky is falling posts on SDN, midlevel encroachment is primarily a pre-med/medical student issue.

No, its not. It hasn't fully hit surgery yet, but there are midlevels practicing with either actual or practical independence in every field of internal medicine and pediatrics.

I can't even get a consult anymore. If I send kids to derm they see the derm NP. If I send kids to Psych they see a Psych NP. If I sent them to neurosurgery they see the neurosurgery NP. Apparently board certification now just exists so that old doctors can leach off of NPs. I am back to being a small town 1950s provider, doing every subspecialty myself because subs effectively don't exist anymore.

 

[mimelim]

No, its not. It hasn't fully hit surgery yet, but there are midlevels practicing with either actual or practical independence in every field of internal medicine and pediatrics.

I can't even get a consult anymore. If I send kids to derm they see the derm NP. If I send kids to Psych they see a Psych NP. If I sent them to neurosurgery they see the neurosurgery NP. Apparently board certification now just exists so that old doctors can leach off of NPs. I am back to being a small town 1950s provider, doing every subspecialty myself because subs effectively don't exist anymore.

I'm in no way saying that they aren't more prevalent than they used to be. They most certainly are. But, I certainly don't see an issue with an NP being the first point of contact for many consult services. If anything, the way you put it, it seems like the NP/PA proliferation is better for a good many doctors.

 

[Perrotfish]

I'm in no way saying that they aren't more prevalent than they used to be. They most certainly are. But, I certainly don't see an issue with an NP being the first point of contact for many consult services. If anything, the way you put it, it seems like the NP/PA proliferation is better for a good many doctors.

They're not the first point of contact, they're the subspecialty appointment. I guess you can argue that the neurosurgery PA fills a diagnostic role to free the neurosurgeon to be in the OR (though I still don' t need the PA's help for diagnosis) but for Derm, Psych, Endo, or whatever else they just manage the patients. I have no idea how sick you need to be to merit seeing an actual physician, but apparently none of my patients have ever been sick enough.

 

[Raryn]

They're not the first point of contact, they're the subspecialty appointment. I guess you can argue that the neurosurgery PA fills a diagnostic role to free the neurosurgeon to be in the OR (though I still don' t need the PA's help for diagnosis) but for Derm, Psych, Endo, or whatever else they just manage the patients. I have no idea how sick you need to be to merit seeing an actual physician, but apparently none of my patients have ever been sick enough.

IMO, thats inappropriate behavior on your consultants sake. I wouldn't want an NP seeing initial outpatient consults, just helping with follow-ups. Maybe that's just me though.