hierarchy

[vyc]

there was a thread recently in which some of you kindly went through the whole medical hierarchy.
like what PGY stood for, where residents were on the chain, etc.

i did a search for it and can't find it anymore...
can anyone repeat it for me?
(i'm a little slow on the uptake!!)

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[Whisker Barrel Cortex]

Here is the hierarchy of medicine:

Attending Physician: Out of residency (and felloship if applicable), has the final say and responsibility for patient care. Teaches everyone below him/her. Earns a good salary.

Fellow: Has graduated from residency and is pursuing subspecialty training (e.g. cardiology, GI, cardiothoracic surgery, neuroradiology, etc.) Depending on the service, may teach a lot and lead a team in the absence of the attending.

Resident (Post graduate year-2 (PGY-2) through residency graduation). Usually runs day to day operation of the team and directs interns (PGY-1), senior, and junior medical students.

Intern (PGY-1): Does much of the floor work on the team. Answering pages about patients problems. Depending on the specialty and service, the intern may have primary teaching responsibility for third year medical students.
Answers to the resident and attending.

Senior medical student (MS-IV): On some rotations such as sub-internships, they have a lot of responsibility and are similar to interns except cannot right orders without a cosignature. On other rotations, they are considered similar to third year students and have little responsibility. Can teach MS-IIIs if they want.
May answer directly to residents instead of interns.

Junior medical student (MS-III): Lowest rung on the ladder. Basically clueless for the first few months. May do a lot of "scut" like getting radiology films, gathering labs. As the year goes on, usually get more responibility. They work with interns frequently, and residents and attending occasionally.

 

[vyc]

does everyone do a year of being an intern before becoming a resident?
i'm confused...

 

[neutropeniaboy]

•••quote:•••Originally posted by vyc:
•does everyone do a year of being an intern before becoming a resident?
i'm confused...•••••"Residency" refers to the whole post-graduate education (i.e., what comes between medical school and a real job/fellowship). Traditionally, the first year of residency is known as the "internship" year.

 

[vyc]

what about pay for residents?
is it generally around $25K for the whole duration?

 

[med student]

pay starts in the low 30's and goes up slightly after each year so you can end up making 40k if you are a 5th year surgery resident. It also depends on the on the program you are going into.

 

[vyc]

thanks everyone for answering all my questions!

a couple more:
what is the difference between internal medicine and family practice?

and what is the difference between preliminary internal medicine and categorial internal med?

 

[AJM]

There is a thread on the differences between family practice and IM in the Rotations and Residencies forum -- it's titled FP vs. IM.

Categorical Internal Medicine is the full three-year internal medicine residency program so you can be licensed in IM and subspecialize in an IM field after that. The Prelim IM program is a one-year internship in internal medicine mostly for people who are going into other residencies that require an initial internship year (prelim or transitional) before starting their residency program (ex: anesthesia, radiology, derm...).

 

[vyc]

okay so wait... i still haven't grasped this whole concept. i'm young, you'll have to forgive my ignorance!

can't someone go through categorical IM and then specialize in something like radiology, etc?

what falls under a subspecialty of IM?

•••quote:•••Originally posted by AJM:
•Categorical Internal Medicine is the full three-year internal medicine residency program so you can be licensed in IM and subspecialize in an IM field after that. The Prelim IM program is a one-year internship in internal medicine mostly for people who are going into other residencies that require an initial internship year (prelim or transitional) before starting their residency program (ex: anesthesia, radiology, derm...).•••••

 

[ducam]

what do fellows make? like 60,000+

 

[AJM]

•••quote:•••Originally posted by vyc:
•okay so wait... i still haven't grasped this whole concept. i'm young, you'll have to forgive my ignorance!

can't someone go through categorical IM and then specialize in something like radiology, etc?

what falls under a subspecialty of IM?
•••••Well, technically you could specialize in Radiology after you finish a categorical IM residency, but only if you do a full residency in Radiology (so you end up wasting a couple of years in the categorical track). Rads only requires one year of post-graduate training before their residency, so most people only do that one year.

There are lots of subspecialties that are in the IM subspecialty arena. To do them, you basically have to do the full 3-year IM residency. Examples of the many IM subspecialties are: cardiology, gastroenterology, pulmonary, hematology/oncology, rheumatology, endocrine, allergy & immunology, renal, geriatrics.

Hope that helps!

 

[Whisker Barrel Cortex]

Categorical: will recieve three years of training in internal medicine and be eligible to take internal med boards. May apply to the subspecialties mentioned in AJMs post above for fellowship training.

Preliminary: Radiology, anesthesia, some neurology, some derm, some ER, some optho, and a couple of other specialties need preliminary (mostly medicine subspecialties and general medicine) or transitional (slightly more diverse year) year before they can start training in their specialty.

The above explanations are for prelim medicine. There is also prelim surgery, which is similar, but with all surgery subspecialty rotations. People who want to do most of the surgical subspecialties (urology, ENT, some ophto, etc.) must do this year.

Fellows generally make a little more than residents. Depending on location, this can range from 40K-60K. Many fellows have fewer hours than residents and can do some moonlighting to make extra money (work in ERs, urgent care, etc.)