Frustrating thing general surgery applicants should look into with programs

[GenSurg2019]

Something all general surgery applicants should look at when applying to residency programs is the role of mid level providers. I am a surgery resident (at an established university program) and I have been annoyed that my program allows residents to regularly get bumped from cases so that mid level providers can scrub in and learn to first assist. We have the junior residents (PGY1 and 2) running clinic and managing the floor while the mid level providers are scrubbed into cases. Honestly I am not sure if this something new but I have noticed increasingly that PAs/NPs are demanding to scrub into cases. It is quite frustrating as a resident since my primary objective is to learn surgery and not get paid less then minimum wage to run the service (perhaps I would think differently if I could paid like the PAs/NPs). On top of that in our program the mid levels are designated as "faculty" so they get evaluate the residents (not sure if other programs are like this) so it makes for a weird dynamic--also not sure how it makes sense to have MDs be evaluated by people who never went through residency.

Just remember the soul sucking experience that is surgery residency is so that some A-hole will teach you a bit of surgery, so try looking for programs where the A-holes at least has some backbones.

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[Giovanotto]

Something all general surgery applicants should look at when applying to residency programs is the role of mid level providers. I am a surgery resident (at an established university program) and I have been annoyed that my program allows residents to regularly get bumped from cases so that mid level providers can scrub in and learn to first assist. We have the junior residents (PGY1 and 2) running clinic and managing the floor while the mid level providers are scrubbed into cases. Honestly I am not sure if this something new but I have noticed increasingly that PAs/NPs are demanding to scrub into cases. It is quite frustrating as a resident since my primary objective is to learn surgery and not get paid less then minimum wage to run the service (perhaps I would think differently if I could paid like the PAs/NPs). On top of that in our program the mid levels are designated as "faculty" so they get evaluate the residents (not sure if other programs are like this) so it makes for a weird dynamic--also not sure how it makes sense to have MDs be evaluated by people who never went through residency.

Just remember the soul sucking experience that is surgery residency is so that some A-hole will teach you a bit of surgery, so try looking for programs where the A-holes at least has some backbones.

hoooooooly sh**t.

 

[RNthenDoc]

Why would an academic faculty need a mid level to first assist? Why would that be helpful at all?

 

[0ncogene]

Wow that sucks. I am in ortho and work with NPs/PAs. Residents get first pick on what cases they want to do over NPs/PAs 100% of the time. At our program, NPs/PAs do not evaluate us formally, and it does not make sense for them to do so. However, there are hospital evaluations available for anyone to evaluate anyone, but these are not mandatory and are not part of our formal evaluation process.

 

[libertyyne]

Name and shame this program. Report it to the acgme during those surverys.

 

[DoctwoB]

Something all general surgery applicants should look at when applying to residency programs is the role of mid level providers. I am a surgery resident (at an established university program) and I have been annoyed that my program allows residents to regularly get bumped from cases so that mid level providers can scrub in and learn to first assist. We have the junior residents (PGY1 and 2) running clinic and managing the floor while the mid level providers are scrubbed into cases. Honestly I am not sure if this something new but I have noticed increasingly that PAs/NPs are demanding to scrub into cases. It is quite frustrating as a resident since my primary objective is to learn surgery and not get paid less then minimum wage to run the service (perhaps I would think differently if I could paid like the PAs/NPs). On top of that in our program the mid levels are designated as "faculty" so they get evaluate the residents (not sure if other programs are like this) so it makes for a weird dynamic--also not sure how it makes sense to have MDs be evaluated by people who never went through residency.

Just remember the soul sucking experience that is surgery residency is so that some A-hole will teach you a bit of surgery, so try looking for programs where the A-holes at least has some backbones.

That is awful. First off who assigns cases? At most places it will be the Chief, who should be prioritizing you over NPs/PAs. If not Is your PD aware of this? If not I would have a sit down with him to discuss it. If he endorses it well you might be SOL.

 

[watermelon master]

Something all general surgery applicants should look at when applying to residency programs is the role of mid level providers. I am a surgery resident (at an established university program) and I have been annoyed that my program allows residents to regularly get bumped from cases so that mid level providers can scrub in and learn to first assist. We have the junior residents (PGY1 and 2) running clinic and managing the floor while the mid level providers are scrubbed into cases. Honestly I am not sure if this something new but I have noticed increasingly that PAs/NPs are demanding to scrub into cases. It is quite frustrating as a resident since my primary objective is to learn surgery and not get paid less then minimum wage to run the service (perhaps I would think differently if I could paid like the PAs/NPs). On top of that in our program the mid levels are designated as "faculty" so they get evaluate the residents (not sure if other programs are like this) so it makes for a weird dynamic--also not sure how it makes sense to have MDs be evaluated by people who never went through residency.

Just remember the soul sucking experience that is surgery residency is so that some A-hole will teach you a bit of surgery, so try looking for programs where the A-holes at least has some backbones.

You're doing a disservice to the community by not naming and shaming.

 

[Instatewaiter]

Before you name and shame, bring up your concerns with your program administration. They may not even realize this is a problem. Shaming and naming will not only hurt your program but will hurt you by extension.


Do this by first sending an email asking to meet about program concerns, list them succinctly. The email is key bc it creates a paper trail and protects you in part, much more than asking in person would.

This is only a good idea if you are in good standing. Even if you are, print off all evaluations at the time of the email in case they are punative when you bring up your concerns

 

[AnatomyGrey12]

I really wish there was a way for applicants to learn these kinds of things before applying.

 

[Giovanotto]

I really wish there was a way for applicants to learn these kinds of things before applying.

Auditions help, but isn't a realistic solution if you're applying to 40+ programs. I've already rotated at programs where in speaking with the residents they had some concerns over the NPs/PAs (and rightfully so).

 

[GenSurg2019]

I dont think naming the program is the way to go. Despite my frustrations, I am actually happy to be here. I think overall my program is great and we place people into good fellowships. Our chief graduate with a good number of cases and are very proficient. My main reason for bringing this up is because i wanted to make applicants aware about this. I am not sure if the situation will worsen overtime as most of these demands are made by the younger midlevel providers who are a few years out of school and are wanting to expand their skill sets.

This is something that has been discussed with the program leadership quite a bit. Although the leadership is not happy about it they really dont put up as much of a fight with the individual divisions (at the end of thr day program directory have power over residents but its much harder to control the different divisions under surgery). For the divisions perspective the residents rotate in and out every month and may not came back for another rotation for couple years, so its nicer to teach the midlevels that are constants instead of teaching resident. For example I was going to walk my med stud through a bed side procedure but the faculty wanted me to instead teach it to the midlevel. In my mind I was thinking that I'm not paid to spend the extra time to teach their midlevels, I am however responsible for my med study education. Unfortunately for the sake of professionalism I complied (sorry med stud).

For the people that are applying ask the current residents and PD exactly how you will be evaluated and by who. Its important to know what exactly is used to determine promotion the the next pgy year. Also ask about work flow during the day and try to get a good detailed picture of their week. After being on the other side of the interview dinners I can say (I made the same mistakes) that instead of asking questions have a conversation with the residents instead of asking question after questions. Usually with direct questions I think most of us try to be balanced but during Frank conversation we are more likely to give a better picture.

 

[GenSurg2019]

That is awful. First off who assigns cases? At most places it will be the Chief, who should be prioritizing you over NPs/PAs. If not Is your PD aware of this? If not I would have a sit down with him to discuss it. If he endorses it well you might be SOL.

Cases are divided by chiefs but lol chiefs are powerless in the grand scheme of things. PA goes and brings up a stink that they want OR time for months. Faculty find the easiest way to remove this annoyance is by telling chief to evenly split cases--> chief complies. And as bonus they get to avoid having an malignant midlevel provider.

 

[GenSurg2019]

Wow that sucks. I am in ortho and work with NPs/PAs. Residents get first pick on what cases they want to do over NPs/PAs 100% of the time. At our program, NPs/PAs do not evaluate us formally, and it does not make sense for them to do so. However, there are hospital evaluations available for anyone to evaluate anyone, but these are not mandatory and are not part of our formal evaluation process.

Nope they get full input into your evaluation.

 

[Señor S]

I dont think naming the program is the way to go. Despite my frustrations, I am actually happy to be here. I think overall my program is great and we place people into good fellowships. Our chief graduate with a good number of cases and are very proficient. My main reason for bringing this up is because i wanted to make applicants aware about this. I am not sure if the situation will worsen overtime as most of these demands are made by the younger midlevel providers who are a few years out of school and are wanting to expand their skill sets.

No offense but I think you are developing a bit of Stockholm Syndrome here. Maybe your program is "great" in the sense that it does well in the academic-research circlejerk that is the fellowship match, but how can a program designed to train surgeons to operate independently be "great" if trainee surgeons are getting "bumped" from cases so a PA can do them?

A training program should always prioritize the learning of trainees; for one thing they are subsidized by the government to do exactly that, but for another thing these trainees have a finite time to learn to do these things before they have to do them on their own. If attendings would rather be the "cool" doctor and curry favor and play grabass with a bunch of 24 year old PAs named Abby and Rachel, well, there are plenty of community hospitals where they can do exactly that and structure their practices so they are never so much as in the same room as a resident. The only time a trainee should be "bumped" from anything is to make room for a more senior trainee, or if they're unprepared or otherwise incompetent to do it.

With all that said, I wouldn't be voicing these concerns directly to the PD. If things are this way it's not by accident and you as a resident have next to no leverage in this regard, and you said they already know and aren't doing anything about it. I would voice these concerns in anonymous surveys (especially to the ACGME or wherever) and then, when you get a little bit of distance, name the program on SDN and elsewhere. Stuff like this will never change until trainees stop carrying water for their programs. You are not your program and your reputation is not your program's reputation; never forget that.

 

[Splenda88]

I really wish there was a way for applicants to learn these kinds of things before applying.

Unfortunately, there isn't... The big place (Emory, Vandy, U of Miami, etc...) increasingly rely on midlevel for a lot of things. People think that midlevel will never be granted the privilege to do "minor" surgeries, but after spending time in these big academic centers, I don't think it will take 10 yrs for ANA to start pushing for that. These places are opening residency for mid-levels in everything you can think of.

 

[Lawpy]

I really wish there was a way for applicants to learn these kinds of things before applying.

Unfortunately, there isn't... The big place (Emory, Vandy, U of Miami, etc...) increasingly rely on midlevel for a lot of things. People think that midlevel will never be granted the privilege to do "minor" surgeries, but after spending time in these big academic centers, I don't think it will take 10 yrs for ANA to start pushing for that. These places are opening residency for mid-levels in everything you can think of.

Geez, the absurdity of physicians throwing trainees and colleagues under the bus in favor of training their cheap midlevel replacements continues. shame that the nonsense happens in academic centers

 

[nimbus]

I would add that as a surgical trainee, you need both operative experience and experience running a clinic and an inpatient service. As an attending, you will be expected to do both. Also some tasks such as vein harvesting for CABG are probably better left to mid levels. I don’t know any surgeon who wants to do that for a living.