A
A. Melanoleuca
Hi.
I am a primary care Resident at a large academic teaching hospital on the East Coast which, to avoid getting too specific, we will call "Earl."
I am pretty sorry I matched into this program. How sorry am I? Let me count the ways.
First of all I have landed in a specialty which is slowly being taken over, body-snatcher like, by PAs and NPs. This is no cut at PAs and NPs who are very intelligent, highly motivated people. Unfortunately, because we pretty much punt everything remotely complicated to one specialist or another the job-description is more "routing clerk" than physician. Why shouldn't it be performed by a motivated, well-trained PA? Certainly a medical degree doesn't seem to be an absolute requirement.
In fact, other than the name-tags, many of our patients don't even know they are seeing a PA or an MD. It's all the same. What they do want is to see a "real doctor" in some other clinic and many resent mightily the non-elimination of the middle-man.
It's not that we don't get medical training. We do. It's just that a lot of it is never going to be used in the real world. We do a lot of labor and delivery, for example, but we are not OB-Gyns and I understand that our specialty, for liability reasons, is abandoning this part of practice. We do some MICU but nobody is ever going to hire us to work in an MICU and this skill, too, will atrophy.
In short, we're receiving good training for a specialty which is vanishing out from under us. Salaries are going down, fewer and fewer people are choosing to go into the field, and even this program at a prestigious university has to fill their shrinking complement of residents through the scramble.
The new paradigm, or philosophy, or gestalt, or whatever you want to call it of our specialty is also not to my liking. It is something called "community medicine" and basically amounts to expecting physicians to be social workers. The time we waste on "fuzzy," happy-happy, non-medical training aimed at preparing us to distribute condoms at high schools and haunt the local churches nagging the fat poor people to lose weight would astound you. We even are scheduled to make home visits where, in the company of a real social worker, we will perform low-skill medicine on people who really would be better served by a community health nurse or a "barefoot doctor" a la Communist China.
Say what you want. Big fan of the welfare state or not. love the poor or don't. I didn't enlist to be a social worker and I am carrying too much medical school debt to even think about wasting my hopefully valuable time on perhaps the most inefficient use of a physican's time that I can possibly think of.
Of course the program is hopelessly liberal. The poor are all saints who's are only medically non-compliant (excuse me: "pre-compliant") because of their insurmountable "barriers to care." To train here is to believe it is somehow society's fault that a patient with no job, drawing disability for a more-or-less bogus condition, and with a functioning phone and an automobile can't keep an appointment and won't take free medications as directed.
We have to sit around in pointless group sessions inventing solutions like "better education," "more public programs," and "more of the same paternalism" when what some patients need is a kick in the ass.
(To be continued.)
I am a primary care Resident at a large academic teaching hospital on the East Coast which, to avoid getting too specific, we will call "Earl."
I am pretty sorry I matched into this program. How sorry am I? Let me count the ways.
First of all I have landed in a specialty which is slowly being taken over, body-snatcher like, by PAs and NPs. This is no cut at PAs and NPs who are very intelligent, highly motivated people. Unfortunately, because we pretty much punt everything remotely complicated to one specialist or another the job-description is more "routing clerk" than physician. Why shouldn't it be performed by a motivated, well-trained PA? Certainly a medical degree doesn't seem to be an absolute requirement.
In fact, other than the name-tags, many of our patients don't even know they are seeing a PA or an MD. It's all the same. What they do want is to see a "real doctor" in some other clinic and many resent mightily the non-elimination of the middle-man.
It's not that we don't get medical training. We do. It's just that a lot of it is never going to be used in the real world. We do a lot of labor and delivery, for example, but we are not OB-Gyns and I understand that our specialty, for liability reasons, is abandoning this part of practice. We do some MICU but nobody is ever going to hire us to work in an MICU and this skill, too, will atrophy.
In short, we're receiving good training for a specialty which is vanishing out from under us. Salaries are going down, fewer and fewer people are choosing to go into the field, and even this program at a prestigious university has to fill their shrinking complement of residents through the scramble.
The new paradigm, or philosophy, or gestalt, or whatever you want to call it of our specialty is also not to my liking. It is something called "community medicine" and basically amounts to expecting physicians to be social workers. The time we waste on "fuzzy," happy-happy, non-medical training aimed at preparing us to distribute condoms at high schools and haunt the local churches nagging the fat poor people to lose weight would astound you. We even are scheduled to make home visits where, in the company of a real social worker, we will perform low-skill medicine on people who really would be better served by a community health nurse or a "barefoot doctor" a la Communist China.
Say what you want. Big fan of the welfare state or not. love the poor or don't. I didn't enlist to be a social worker and I am carrying too much medical school debt to even think about wasting my hopefully valuable time on perhaps the most inefficient use of a physican's time that I can possibly think of.
Of course the program is hopelessly liberal. The poor are all saints who's are only medically non-compliant (excuse me: "pre-compliant") because of their insurmountable "barriers to care." To train here is to believe it is somehow society's fault that a patient with no job, drawing disability for a more-or-less bogus condition, and with a functioning phone and an automobile can't keep an appointment and won't take free medications as directed.
We have to sit around in pointless group sessions inventing solutions like "better education," "more public programs," and "more of the same paternalism" when what some patients need is a kick in the ass.
(To be continued.)
