DO/MD vs NP/PA in the Family Medicine setting

[Splenda88]

In what world are FM residents off almost every weekend as PGY2? Our cat PGY2 residents work almost as hard as interns in PGY2 and have weekend call on the FM service half the time on outpatient rotations.

Sure PGY3 has plenty of electives/outpatient subspecialty time, but still. FM life is better as an attending, but at least at my hospital, 2nd year is pretty rough.

I talked to 2 FM residents where I am training and they said they will work about 12-14 weekend only during PGY2 academic year... That is being off almost every weekend for me in the IM world. They are allowed to moonlight as PGY2 and we are not

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[hallowmann]

I talked to 2 FM residents where I am training and they said they will work about 12-14 weekend only during PGY2 academic year... That is being off almost every weekend for me in the IM world. They are allowed to moonlight as PGY2 and we are not

Yeah, the ones here are lucky if they get 12-14 off the whole year in 2nd year. The rest are spent on the inpatient service or OB (or surgery, SICU, etc.).

 

[Splenda88]

Yeah, the ones here are lucky if they get 12-14 off the whole year in 2nd year. The rest are spent on the inpatient service or OB (or surgery, SICU, etc.).

Isn't FM PGY2/3 most outpatient and electives almost everywhere?

I look at their curriculum and they have 8 wks FM inpatient, 4 wks ED, and 8 wks electives in PGY2 and the rest are outpatient stuff.

 

[hallowmann]

Isn't FM PGY2/3 most outpatient and electives...

Depends on the residency. The one here is inpatient heavy. Only 3rd year is majority outpatient, the rest are majority inpatient. Even then though, you're still in the call pool for the FM & FM-OB inpatient service when you're on outpatient, which means working at least 1-2 weekends per outpatient block.

 

[Splenda88]

Depends on the residency. The one here is inpatient heavy. Only 3rd year is majority outpatient, the rest are majority inpatient. Even then though, you're still in the call pool for the FM & FM-OB inpatient service when you're on outpatient, which means working at least 1-2 weekends per outpatient block.

Their program is not OBGYN heavy... I guess that why people say in SDN rural FM programs provide better training than big university hospitals.

 

[TheOther]

In what world are FM residents off almost every weekend as PGY2? Our cat PGY2 residents work almost as hard as interns in PGY2 and have weekend call on the FM service half the time on outpatient rotations.

Sure PGY3 has plenty of electives/outpatient subspecialty time, but still. FM life is better as an attending, but at least at my hospital, 2nd year is pretty rough.

Same.

 

[hallowmann]

Their program is not OBGYN heavy... I guess that why people say in SDN rural FM programs provide better training than big university hospitals.

To clarify, I'm at a big university hospital in the midwest, we just happen to have a strong FM program with its own independent inpatient service and OB service that prides itself in being "full scope" and what not. Its purely program dependent, but there are a lot of inpatient heavy FM programs out there. Plenty of the people graduate here doing FM+OB or hospitalist medicine right after graduation.

 

[FrustratedFamDoc]

Their program is not OBGYN heavy... I guess that why people say in SDN rural FM programs provide better training than big university hospitals.

definitely program dependent. Somebody's gotta see the patients and write notes and it ain't faculty attendings. Academic centers with numerous programs are better able to spread the workload vs unopposed hospitals where FM is it. Administrators LOVE pushing more off on the residency because it means less hospitalists they have to hire. A $50,000/yr subsidized resident is much cheaper than a $250,000/yr hospitalist. When a large percentage of your business is 'caid/self pay/indigent, those things really matter.

At my unopposed community program, we front loaded inpatient responsibility. 1st year was pretty brutal. We had 8 residents at our program. Call was 1 first year and 1 second year. It meant covering OB, all peds, our patients (typical census of 40-45 pts), admissions and all codes/rapid responses/death pronouncements. Open ICU so at any time, we typically had a few pretty sick patients. 2nd year was stressful as call and inpt responsibility were only slightly less than 1st year. 3rd year was great. I felt very well prepared after graduation.

 

[VA Hopeful Dr]

Isn't FM PGY2/3 most outpatient and electives almost everywhere?

I look at their curriculum and they have 8 wks FM inpatient, 4 wks ED, and 8 wks electives in PGY2 and the rest are outpatient stuff.

Nope.

My old program currently has 6 months of inpatient PGY-2. 2 of peds, 2 of OB, 4 of medicine.

 

[SLC]

My program (2nd year) had 2 inpatient, 2 ICU, 2 ED (peds and adult), 1NICU, 2 OB. Then you had 1-2 weekends/month of inpatient services coverage while on outpatient rotations. The only way to protect yourself and get a guaranteed month without weekends was to do an away elective and make yourself physically unavailable.

 

[Splenda88]

I guess ACGME rules are not set in stone then...

 

[Splenda88]

My program (2nd year) had 2 inpatient, 2 ICU, 2 ED (peds and adult), 1NICU, 2 OB. Then you had 1-2 weekends/month of inpatient services coverage while on outpatient rotations. The only way to protect yourself and get a guaranteed month without weekends was to do an away elective and make yourself physically unavailable.

That sounds like an IM program sans OBGYN and peds

 

[SLC]

That sounds like an IM program sans OBGYN and peds

IM hospitalist attendings often commented that they preferred working with us to the IM residents. Mainly because we were more comfortable recognizing things that can be effectively managed outpatient. This led to shorter length of stay on average.

Plus, our program was considered highly regarded. The IM program was “so-so”

 

[VA Hopeful Dr]

I guess ACGME rules are not set in stone then...

No, they are:

6M and 750 inpatients, 1 month OR 15 ICU patients, 2M or 250 ED patients, 1M or 150 geriatrics, 2M and 250 inpatient/emergency peds, 2M or 250 outpatient peds, 1650 outpatient FM clinic patient encounters, 2M ortho/sports med, 1M gyn, 2M inpatient OB, and then a bunch of "must have experience in X" like derm, radiology, practice management, and so on.

 

[Splenda88]

No, they are:

6M and 750 inpatients, 1 month OR 15 ICU patients, 2M or 250 ED patients, 1M or 150 geriatrics, 2M and 250 inpatient/emergency peds, 2M or 250 outpatient peds, 1650 outpatient FM clinic patient encounters, 2M ortho/sports med, 1M gyn, 2M inpatient OB, and then a bunch of "must have experience in X" like derm, radiology, practice management, and so on.

And yet outcomes for NP are equal or better with 500-700 hrs

 

[TheOther]

And yet outcomes for NP are equal or better with 500-700 hrs

The f

 

[hallowmann]

My program (2nd year) had 2 inpatient, 2 ICU, 2 ED (peds and adult), 1NICU, 2 OB. Then you had 1-2 weekends/month of inpatient services coverage while on outpatient rotations. The only way to protect yourself and get a guaranteed month without weekends was to do an away elective and make yourself physically unavailable.

This is essentially the same setup here.

That sounds like an IM program sans OBGYN and peds

Not a ton of differences, but I think the IM program has more ICU and instead of OB, does some time on the Med-Psych unit, which is essentially just like being on a regular inpatient rotation with psychiatrically sick patients.