Coronavirus: Residents being told to work in DIFFERENT specialty

[calvinhobbes]

Just got word that residents at my institution (a large academic medical center in NY) across *all* specialties (OB, Peds, Psych, etc.) will be required to staff and work adult medicine floors as expected adult admissions, including to the ICU, increase as more test positive and need hospitalization. Some floors such as Psych may close for the time being as well if needed and instead open admits to adults with the virus.

Anyone else hear about this? Is ACGME okay with this?

Also saw this today: “Mark Jarrett, chief quality officer for Northwell Health, which runs 23 hospitals, including Lenox Hill on the Upper East Side, said there was a scramble to find available hospital wings and smaller units. He said he planned to put some coronavirus patients in a wing that had been closed at Glen Cove Hospital on Long Island.”

Coronavirus in N.Y.: Will a Surge in Patients Overwhelm Hospitals? (Published 2020)

“We are not prepared,” one doctor said. New York City’s hospitals may be moving too slowly as the outbreak spreads, experts say.

www.nytimes.com

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[NVO]

imagine path residents working the floors

 

[DocVapor]

Depends. Staffing as essentially a newish intern again? Seems like that shouldn't be too difficult for most. Staffing as a moonlighting hospitalist? Could be trouble.

 

[GoSpursGo]

There’s nothing fair about this pandemic. Undoubtedly we’re heading for some exceptional measures.

 

[Mass Effect]

This is what happened in Italy. The pathologists were doing medicine admits. That's what happens in a national medical emergency.

I'm a psych attending and our hospital has made it clear we should stand by as we may be called to hit the medicine floors.

 

[Slatches]

imagine path residents working the floors

And if a path resident can’t handle a week on the floor with a patient having respiratory ( hopefully stable ) issues then our medical training has failed us. I could bring a grad from Africa and he will deal with it. When I see statements like this, it shows why midlevels are pushing for autonomy. If you are a resident of any specialty and you can’t handle this crisis, it’s a big shame. You are not a doctor.

 

[cbrons]

There will be supervision (hopefully) from senior medicine residents and hospitalists, and hopefully this will only be necessary if the **** is really majorly hitting the fan.

 

[Piebaldi]

imagine path residents working the floors

I find it particularly ironic that the poster "DrDeath" liked this post. But yep I don't see how it's ok for this to happen. Why not have the janitors work the floors too?
I received a note from one of our hospitals that med student rotations are being cancelled for the month. Not sure how that works - do these students get 2 weeks off?
It's way way overboard what's happening.

 

[GoSpursGo]

I find it particularly ironic that the poster "DrDeath" liked this post. But yep I don't see how it's ok for this to happen. Why not have the janitors work the floors too?
I received a note from one of our hospitals that med student rotations are being cancelled for the month. Not sure how that works - do these students get 2 weeks off?
It's way way overboard what's happening.

Because janitors don’t have a medical degree?

It’s not happening today. As pointed out above it’ll happen if/when this escalates. Unfortunately given what we’re seeing in Italy that’s not unrealistic.

 

[rokshana]

I find it particularly ironic that the poster "DrDeath" liked this post. But yep I don't see how it's ok for this to happen. Why not have the janitors work the floors too?
I received a note from one of our hospitals that med student rotations are being cancelled for the month. Not sure how that works - do these students get 2 weeks off?
It's way way overboard what's happening.

Medical students are not essential and frankly probably hamper the ability to take care of people if and when the admissions are high.
I don’t think they are going to have path or radiology residents intubate patients or frankly even work in the icu... but come on, surely they are capable and adaptable enough to do an H&P, PE and write orders( heck most emrs have orders sets that makes this even easier)... if they are not capable, then they are a waste of a Doctor. Better the residents/fellows that can be helpful in the icu are utilized there instead of Having to do non covid admissions of floor pts.
Many residents have had at least an intern year with a few months in the ED or IM...it should come back to them.

Though there are institutions that are having residents not see covid pts or potential covid pts.

 

[AMEHigh]

It’s good that places have a plan in place, why are people getting mad about? Maybe it won’t be needed, but maybe it will. Common sense dictates that in an emergency it’s better to have a plan than not.

 

[Mass Effect]

I find it particularly ironic that the poster "DrDeath" liked this post. But yep I don't see how it's ok for this to happen. Why not have the janitors work the floors too?
I received a note from one of our hospitals that med student rotations are being cancelled for the month. Not sure how that works - do these students get 2 weeks off?
It's way way overboard what's happening.

What's overboard about it? There are entire threads dedicated to canceled rotations. It's happening all over the country for good reason.

 

[Dro133]

Medical students are not essential and frankly probably hamper the ability to take care of people if and when the admissions are high.
I don’t think they are going to have path or radiology residents intubate patients or frankly even work in the icu... but come on, surely they are capable and adaptable enough to do an H&P, PE and write orders( heck most emrs have orders sets that makes this even easier)... if they are not capable, then they are a waste of a Doctor. Better the residents/fellows that can be helpful in the icu are utilized there instead of Having to do non covid admissions of floor pts.
Many residents have had at least an intern year with a few months in the ED or IM...it should come back to them.

Though there are institutions that are having residents not see covid pts or potential covid pts.

Waste of a doctor? Seems a little harsh. And path residents don't do a medicine intern year.

 

[Matthew9Thirtyfive]

Waste of a doctor? Seems a little harsh. And path residents don't do a medicine intern year.

They do in the Navy. This might be one of the few times I’d be glad for that.

 

[rokshana]

Waste of a doctor? Seems a little harsh. And path residents don't do a medicine intern year.

Path residents are not stupid people and went through medical school...while maybe a few years ago,they have done H&Ps as med students...should not be hard for them to remember how to do them...they do occasionally see patients...I believe they see them when they do transfusion medicine rotation.
So, yes, if somehow you have forgotten or feel that seeing an actual patient is beyond your abilities, then waste of a medical school education.

 

[DeucesHigh3]

I'm a rads PGY5 and haven't seen a patient outside of IR or mammo in 4 years. I don't relish it, but I'm fully expecting to be on the front line within one week.

 

[Mass Effect]

And path residents don't do a medicine intern year.

Seriously? Wow.

 

[rokshana]

I'm a rads PGY5 and haven't seen a patient outside of IR or mammo in 4 years. I don't relish it, but I'm fully expecting to be on the front line within one week.

But if given a script or check list and an order set, you could admit or follow a floor pt,right?

 

[Giovanotto]

Path residents are not stupid people and went through medical school...while maybe a few years ago,they have done H&Ps as med students...should not be hard for them to remember how to do them...they do occasionally see patients...I believe they see them when they do transfusion medicine rotation.
So, yes, if somehow you have forgotten or feel that seeing an actual patient is beyond your abilities, then waste of a medical school education.

You know who else went through medical school? 4th year medical students.

 

[rokshana]

You know who else went through medical school? 4th year medical students.

But not even a little bit of residency...there is a difference.

Come back at the end of July...then you will know.

 

[DeucesHigh3]

But if given a script or check list and an order set, you could admit or follow a floor pt,right?

Of course. Our IR service admits patients, so we're all familiar enough with the epic ordersets and flowsheets, and I think intern-year reflexes will come back quickly enough.

 

[lal4life]

I was curious about this as well as I’m approaching the end of my training and trying to do less work, hoping that certain specialties or clinics may be considered non-essential. So I checked out the ACGME website to see what they had to say.

“Over the next several months there may be significant pressures on the health care system. The ACGME recognizes that patients must be cared for and that exigent circumstances may require residents/fellows to be redeployed to meet the needs of patients. Significant changes in resident/fellow education of more than four weeks in duration should be reported to the Executive Director of the applicable Review Committee.”

Depending on your hospital system, redeployment to a different specialty is appropriate, per the ACGME. Duty hours are expected to be the met.

 

[Roxas]

You know who else went through medical school? 4th year medical students.

With no medical license and inability to put in orders

 

[Mass Effect]

You know who else went through medical school? 4th year medical students.

You know who doesn't have a license to practice medicine nor the experience of intern year medicine? 4th year medical students.

 

[Mass Effect]

I was curious about this as well as I’m approaching the end of my training and trying to do less work, hoping that certain specialties or clinics may be considered non-essential. So I checked out the ACGME website to see what they had to say.

“Over the next several months there may be significant pressures on the health care system. The ACGME recognizes that patients must be cared for and that exigent circumstances may require residents/fellows to be redeployed to meet the needs of patients. Significant changes in resident/fellow education of more than four weeks in duration should be reported to the Executive Director of the applicable Review Committee.”

Depending on your hospital system, redeployment to a different specialty is appropriate, per the ACGME. Duty hours are expected to be the met.

This is the same for attendings too. These are crazy times.

 

[Giovanotto]

You know who doesn't have a license to practice medicine nor the experience of intern year medicine? 4th year medical students.

You out of all people should know that not every specialty has an intern year of medicine.

 

[Giovanotto]

With no medical license and inability to put in orders

PGY1s don't get a medical license till pretty late in their year, if not PGY2, no?

 

[Mass Effect]

You out of all people should know that not every specialty has an intern year of medicine.

Uh, why me of all people? What other specialties don't have medicine during intern year?

 

[Mass Effect]

PGY1s don't get a medical license till pretty late in their year, if not PGY2, no?

No PGY 1 walks onto the floors without a medical license. None. They all have a resident license on July 1st if not earlier.

 

[Giovanotto]

No PGY 1 walks onto the floors without a medical license. None. They all have a resident license on July 1st if not earlier.

Am I confusing it with NPI numbers and the ability to prescribe? Don't you need Step 3 boards first?
What's the difference between medical and resident license?

 

[Giovanotto]

Uh, why me of all people? What other specialties don't have medicine during intern year?

Lots of them? Psych, gen surg and ob/gyn for example don't have medicine prelim years. They do some inpatient medicine, but I say "some" because apparently it varies from program to program.

 

[Mass Effect]

Am I confusing it with NPI numbers and the ability to prescribe? Don't you need Step 3 boards first?

PGY 1s all have NPI numbers, resident licenses, and ability to prescribe on day one. No, you don't need Step 3 as long as you're a resident.

 

[Giovanotto]

PGY 1s all have NPI numbers, resident licenses, and ability to prescribe on day one. No, you don't need Step 3 as long as you're a resident.

Oh. I guess it's only IMGs that this is untrue for, correct?

 

[Roxas]

Am I confusing it with NPI numbers and the ability to prescribe? Don't you need Step 3 boards first?
What's the difference between medical and resident license?

That's for a permanent license. Residents operate under a temp license until then.

 

[Mass Effect]

Lots of them? Psych, gen surg and ob/gyn for example don't have medicine prelim years. They do some inpatient medicine, but I say "some" because apparently it varies from program to program.

No one was talking about a full prelim year. Pathology residents don't do internal medicine and/or surgery during intern year and as far as I know, they're the only specialty to not.

 

[Mass Effect]

Oh. I guess it's only IMGs that this is untrue for, correct?

IMGs have an NPI number, resident license, and prescribing ability day one as long as they're a resident.

 

[AMEHigh]

Am I confusing it with NPI numbers and the ability to prescribe? Don't you need Step 3 boards first?
What's the difference between medical and resident license?

When you get an unrestricted license varies by state.
A resident license or some places known as a training license is not a full license. You are not able to practice on your own.
An NPI number is not a medical license. It's a unique number given out by cms.

 

[Crayola227]

There is plenty that some medical students or graduates can do in a hospital setting to help with this pandemic. No shortage of work, even scut.

And yes, there is still an advantage of having a medical student do some types of scut over just a person off the street or the janitor.

They can do reasonable vitals checks and pulmonary exams just for one, and pend orders going by a checklist which can save time. They understand most medical jargon which also has a value. The list goes on.

This is arguably valuable educational experience for another thing.

Also, don't know about you guys, but I took the Oath of Geneva at my matriculation, and student doctor was a fair title after.

We tell students to begin conducting themselves as a professional (the concept goes beyond an occupation or money) and fulfilling ethical duties of benevolence and being a fiduciary (which means putting the interests of those you're treating above your own even when they conflict).

We tell students to do all they can to emulate the example of exemplary physicians. They are to start acting as a physician on day 1.

Well, being a doctor isn't just about being a pathologist or [insert specialty]. If you don't agree then you weren't paying attention when you took an oath or when you were trained.

If you can wash your hands and take orders (med students are selected for this quality) then you can be part of this fight in some way.

I'll change bed pans and sponge bathe the sick if it comes down to it.

None of these duties end just because you didn't do an intern year or you specialized. Some of us will be more or less useful or able to do some things.

 

[Mad Jack]

And if a path resident can’t handle a week on the floor with a patient having respiratory ( hopefully stable ) issues then our medical training has failed us. I could bring a grad from Africa and he will deal with it. When I see statements like this, it shows why midlevels are pushing for autonomy. If you are a resident of any specialty and you can’t handle this crisis, it’s a big shame. You are not a doctor.

You realize pathologists don't even do a traditional intern year right? They just do path for four years?

 

[Crayola227]

Residents will be impacted by this, along with probably every other person on the planet.

They may have their training extended as just one consequence, I don't know. But if so welcome to the ranks of suck the whole world is part of right now. Many of us are having life plans disrupted on ways that are going to ripple forward even years right now.

 

[siliso]

You graduated medical school and your senior resident or attending will get you up to speed, we do it routinely every year. Let’s roll.

 

[Mad Jack]

I saw a lot of people die in my prior career. Honestly it really messed me up for a while, and may have been a reason why I went toward specialties in which I didn't have to deal with the dead or dying on a day-to-day basis. I'm going to do what I have to do, but I don't look forward to more of the dead keeping me awake at night. Anyone who thinks this is going to be anything but a nightmare has another thing coming.

You'll be asked to do things you never wanted to do. That's part of signing up to be a doctor, it comes with rights and responsibilities. No amount of signing up for this can prepare you for what you are in for, however. I wish you all, and your families, the best in these troubled times. May you all survive and thrive in the months and years to come, and may all of my greatest fears not come to pass.

 

[Slatches]

You realize pathologists don't even do a traditional intern year right? They just do path for four years?

And?
You education has failed you then. You are doctor aren’t ya? I guess not. If you can’t handle the basics, then I really don’t know what to say and I don’t want to say anything beyond this point. Smh.

 

[rokshana]

You out of all people should know that not every specialty has an intern year of medicine.

Why? Psych interns usually spend 2-3 months doing Inpt IM.

 

[rokshana]

Oh. I guess it's only IMGs that this is untrue for, correct?

Nope ..F/IMGs get assigned and npi number and have training licenses in the states that require training licenses...they are however restricted licenses that require supervision of a physician that has an unrestricted license.
Interns and residents write scripts under an institutional DEA but have a unique number to tag into the back of the institutional DEA...see this is a sample of the difference in knowledge between an almost finished Med student and an intern...never mind actual clinical knowledge.

 

[Mass Effect]

We tell students to begin conducting themselves as a professional (the concept goes beyond an occupation or money) and fulfilling ethical duties of benevolence and being a fiduciary (which means putting the interests of those you're treating above your own even when they conflict).

Prescisely why they shouldn't be on rotations right now.

 

[Mass Effect]

Why? Psych interns usually spend 2-3 months doing Inpt IM.

And 2 more months doing IM elective/subspecialty and another 2 months doing inpatient neuro and another month in the ED. In some programs an ICU month as well. In other programs, another month of neuro (sometimes outpatient).

 

[Giovanotto]

And 2 more months doing IM elective/subspecialty and another 2 months doing inpatient neuro and another month in the ED. In some programs an ICU month as well. In other programs, another month of neuro (sometimes outpatient).

I believe you're a real doctor, don't worry.

 

[Mass Effect]

I believe you're a real doctor, don't worry.

Trust me when I say I was never worried about what you think. I just think that gaps in knowledge about the most basic things should be corrected.

 

[Giovanotto]

Trust me when I say I was never worried about what you think. I just think that gaps in knowledge about the most basic things should be corrected.

What gaps? The amount of inpatient medicine a pgy1 psych resident receives is not the same from one hospital to another. Until psych decides to introduce a prelim/medicine year, it would be difficult to assume the strength of a pgy1 psych resident in medicine. At least medical students receive standardized training. See? We can both play this game.