Couple of questions about residencies...

[Mastashake]

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I know I shouldn't worry about this stuff right now, and I'm not really worrying. But I do find it motivational to ask questions about residency, even now.

My first question is this: Is it possible to do residencies in a non-hospital setting? Most every residency I hear of is in a hospital. Do people do them in doctor's offices or urgent care clinics as opposed to a hospital?

Second: How much of a person's residency is done in the ER? I know this is very determinant on what specialty you pick, but for a general example, lets say IM and also Rad.

Third: Is it possible to get residencies in places that aren't county hospitals? I'm pretty sure it is, but are these non-county residencies harder to get?

Finally: Is it possible to find small-town residencies? Or are most all residencies in metro areas?

I know I have a lot of questions, but if someone is bored and doesn't mind answering, I'd appreciate it. 🙂

 

[Winged Scapula]

My first question is this: Is it possible to do residencies in a non-hospital setting? Most every residency I hear of is in a hospital. Do people do them in doctor's offices or urgent care clinics as opposed to a hospital?

If your residency is in a hospital based specialty (ie, ER, Surgery, etc.) you will do your residency in a hospital.

Outpatient based residencies (ie, Family Medicine, Dermatology) spend much more time out of the hospital, but generally still have hospital based rotations they must do.

Thus, you may spend time with a preceptor in his/her office outside of the hospital or in an Urgent Care clinic, but most residencies are strictly controlled with regard to what is approved by the RRC and program and typically it would involve a fair bit of hospital time, at least during the early years.

Second: How much of a person's residency is done in the ER? I know this is very determinant on what specialty you pick, but for a general example, lets say IM and also Rad.

Well, someone has to read the radiology studies the ED orders, so even if you did your residency in a hospital without trauma or a busy ED, you can expect to spend some time there. As for IM...well, let's just say that those guys are in the ED a LOT. How do you think patients with medical problems in the ED that need a specialist consultation or admission get seen?

There are very few specialties in which you wouldn't spend some time in the ED. There are few emergencies in Derm, Rad Onc, PM&R, Pathology (maybe that would be the best one to keep you out of the ED, although you'd have to be in a hospital), Medical Genetics, etc. Even Derm has to do some Medicine rotations, as do many other specialties, so again, avoiding the ER is hard to do.

Third: Is it possible to get residencies in places that aren't county hospitals?

Of course. There are lots of places without county hospital experience. I was just talking to a friend today about her experience at Charity in NO; let's just say that she saw a *lot* of things, eye opening things, that I never came close to seeing during my residency. I haven't stepped foot in a county hospital since I was a pre-med.

I'm pretty sure it is, but are these non-county residencies harder to get?

Depends. Some might be, some might not be. You can get some pretty terrific training at places with county hospitals and there are people who want that training. Thus, I can think of a lot of places much uglier, dirtier and smellier than where I trained and despite that, they were much more competitive programs.

Finally: Is it possible to find small-town residencies? Or are most all residencies in metro areas?

I know I have a lot of questions, but if someone is bored and doesn't mind answering, I'd appreciate it. 🙂

There are plenty of small town residencies. You have to bear in mind that the more specialized your field the more you need a patient population base to support it...thus, while it would be possible to do a FM or EM residency in a smaller community, you probably couldn't do Rad Onc, Peds Heme Onc fellowship or Medical Genetics.

You seem scared or uncomfortable with the idea of hospitals, ER and especially county hospitals. Any particular reason?

 

[Mastashake]

First off, wow. That was a great post, Mr. Scapula.

Second, I don't know if scared is the right word. But I am definitely intimidated. It seems like all of my experiences with an Emergency room have'n been positive, like multi-hour waits, and very sketchy characters in the waiting room. I'm sure its different from place to place, but I get the overwhelming feeling that this area of the hospital, moreso than others is very...frantic. Whenever I've had to go there, I always feel very uncomfortable.

Strangely enough, the rest of the hospital seems very calm and organized in comparison. Even in ICU, it seems there is a lot more order to the system, which pleases me. I really have no problem working in a hospital setting, but as I said, the ER intimidates me (as a pre-med with no experience), and I've heard county hospitals are notorious for overcrowded ERs and rowdy patients, both of which at this point freak me out. 🙂

Anyway, I know this isn't a deal breaker for me. I have NO problem whatsoever being in that environment if it helps me achieve my ultimate goal. But I wanted to know if a specialty like IM is going to have me spending my whole three years in a place that isn't my favorite...

 

[Mastashake]

Well, someone has to read the radiology studies the ED orders, so even if you did your residency in a hospital without trauma or a busy ED, you can expect to spend some time there. As for IM...well, let's just say that those guys are in the ED a LOT. How do you think patients with medical problems in the ED that need a specialist consultation or admission get seen?

Not that I'm too concerned about this aspect, but I was under the impression with most everything being digitally imaged, most rad studies are electronically transferred to the rad department... But I could be totally off base here.

 

[RTrain]

First off, wow. That was a great post, Mr. Scapula.

Second, I don't know if scared is the right word. But I am definitely intimidated. It seems like all of my experiences with an Emergency room have'n been positive, like multi-hour waits, and very sketchy characters in the waiting room. I'm sure its different from place to place, but I get the overwhelming feeling that this area of the hospital, moreso than others is very...frantic. Whenever I've had to go there, I always feel very uncomfortable.

Strangely enough, the rest of the hospital seems very calm and organized in comparison. Even in ICU, it seems there is a lot more order to the system, which pleases me. I really have no problem working in a hospital setting, but as I said, the ER intimidates me (as a pre-med with no experience), and I've heard county hospitals are notorious for overcrowded ERs and rowdy patients, both of which at this point freak me out. 🙂

Anyway, I know this isn't a deal breaker for me. I have NO problem whatsoever being in that environment if it helps me achieve my ultimate goal. But I wanted to know if a specialty like IM is going to have me spending my whole three years in a place that isn't my favorite...

"Mr. Scapula" gave me a chuckle. For one thing, WS is "Dr.," but we're all on a first name basis here. For another, if she weren't a doctor, she'd be pretty hard to mistake for a Mister.

But to address your negative experiences in the ER, you will find that on the other side of the curtain, it's quite a different experience. Yes, the ED patients are anxious, upset, impatient, and in generally poor spirits. This is not the case for the doctors, however. We're just working. The actual work in the ED is sometimes hectic and exciting, but generally organized and efficient. Being a resident in the ED is pretty much nothing like being a patient there, never fear.

 

[Winged Scapula]

Not that I'm too concerned about this aspect, but I was under the impression with most everything being digitally imaged, most rad studies are electronically transferred to the rad department... But I could be totally off base here.

It certainly is true that many hospitals widely utilize teleradiology. However, most trauma centers and busy EDs do not. For example, a busy trauma center generally needs the radiologist or rads resident there during the traumas, doing the stat exams and wet reads. There were times when the Rads residents and I were not sure about a finding and called up the attending at home to look at the exam with us, but in most academic medical centers you will have in house radiology 24/7.

In addition to the trauma, there will be exams and or procedures that need to be performed and require the presence of at least a radiology resident, if not an attending; these cannot be done "digitally" nor can they be done by a tech (ie, drain placement, needle guided biopsy).

I used to moonlight at a small community hospital without after-hours radiology. The EM guys and I got pretty good at looking at the studies ourselves but at times we did have to call the nighthawk guy up wherever he/she was and ask for some assistance.

So I think your interpretation of the widespread use of digital imaging is correct but without knowledge of the systems and requirements of the hospital, you wouldn't be expected to know that, for example, a Level 1 Trauma Center HAS to have a radiology resident, at least, in house at all times (as well as many other specialties); we cannot rely on teleradiology in those situations.

I agree that the ED is a very hectic place and I share your sentiments about it. But keep a few things in mind:

- all EDs are not created alike; yes, some are dirty, smelly and filled with "characters" who'd just soon as shoot you as ask you for directions and wait times are long (the reasons for this are myriad...people using the ED for non-emergent things like dandruff [true story] is one of the reasons)

- many hospitals with active Level 1 Trauma centers are not these "county" type of places; however, trauma does tend to draw some interesting characters so you can't totally escape them, even in Santa Barbara or New Haven

- as you progress in your medical career, the strange EM will either cease to be scary or will fascinate you. I cannot understand the people who love EM but there are others who feel the same about my field. As things become more familiar, they become less intimidating to us. I find it interesting that you do not find the same in the ICU; if anything, most people are scared of the ICU and less so of the ED. But I guess "characters" are less intimidating biting on some white plastic rather than roaming around your ED screaming obscenities

- finally, yes, I am female and while you do not have to call me Doctor, I would prefer not to be called Mr. It still fascinates me, the assumptions people make.

 

[elwademd]

also, if/when you get to medical school, keep an open mind. i know that county hospitals get a bad rap, but just because people say it so doesn't make it so.

personally, i went to emory. grady hospital is the county hospital it serves in atlanta, and it gets a lot of bad press (much of it deserved unfortunately). however, the only place i ever saw a patient with a gun was in the er... at emory university hospital. yep, the nice one. the patient just so happened to tell me about a fight he was in (in which he sustained an abdominal injury), and said he had something in his pants pocket for that guy. the pants were over on the counter, and that something was a loaded 9mm! i quickly went to the lead ed doc (who i knew previously from volunteer work as a 1st and 2nd year med student), and let him know, and we went and got security. no bad outcomes. but according to those in the know, that was supposed to happen at grady, not at emory university hospital.

as far as finding the er hectic, most people do. but once you know what you're doing, it can slow down a bit. a lot of medicine seems scary, but hopefully you find your groove in a particular field and you're comfortable.

 

[Mastashake]

Thanks for all the great information.

And I feel really bad about the faux-pas Dr. Scapula. 🙂 I thought I saw a former post of yours that helped me think you're a man, but obviously I was wrong.

Perhaps I should immerse myself in this strange world of Emergency Medicine in order to find out what its about. Perhaps my uneducated negative opinion is worse than any sort of educated one.

Thanks to everyone who posted!!!

 

[Blade28]

And I feel really bad about the faux-pas Dr. Scapula. 🙂 I thought I saw a former post of yours that helped me think you're a man, but obviously I was wrong.

FYI, a quick look at her signature line would reveal that she's a female. 🙂

 

[OldPsychDoc]

FYI, a quick look at her signature line would reveal that she's a female. 🙂

Actually, that sig line mentions nothing that would indicate any useful identifying information to a new SDN user regarding Winged Scapula's identity, as it only refers to local legend regarding the late Dr. Kimberli Cox, who has since moved on to better things... 😉

 

[Winged Scapula]

Actually, that sig line mentions nothing that would indicate any useful identifying information to a new SDN user regarding Winged Scapula's identity, as it only refers to local legend regarding the late Dr. Kimberli Cox, who has since moved on to better things... 😉

I hear they burned her in effigy back in Pennsylvania one night after she refused to indulge in a dinner of scrapple, shoo-fly pie and Rolling Rock. 😀

BTW, mastashake, here is a tip:

-click on a user's name and you will get a drop-down menu
-click on user profile and you will find a wealth (or not) of information the user has chosen to provide.

For many of us, our gender is included and indeed, sometimes even a picture.

 

[OldPsychDoc]

I hear they burned her in effigy back in Pennsylvania one night after she refused to indulge in a dinner of scrapple, shoo-fly pie and Rolling Rock. 😀

BTW, mastashake, here is a tip:

-click on a user's name and you will get a drop-down menu
-click on user profile and you will find a wealth (or not) of information the user has chosen to provide.

For many of us, our gender is included and indeed, sometimes even a picture.

Hey no fair putting a picture of Princess Di on your profile! 😍

 

[RTrain]

Hey no fair putting a picture of Princess Di on your profile! 😍

But with better hair! 😉

 

[Winged Scapula]

Hey no fair putting a picture of Princess Di on your profile! 😍

But with better hair! 😉

Ha ha....you guys are funny. I wish I looked like her.😀