how arduous are Mil residencies vis-a-vis civilian ones?

[l4t3bl00m3r]

Dear All,
How arduous are Military (esp. Army) residencies as compared to civilian ones? Are the 30 hour shifts and the like as prevalent in the world of military medicine as they are in civilian life?
One one hand, it seems plausible. The Army has a very Charlie Mike attitude, but on the other a resident in the military is an officer, not a "under-thing" as in civvie hospital culture.
Bonus points for anyone who's been in a Family Medicine role in a military residency.

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[psychbender]

Residency is residency. Yes, you will work long hours in milmed, like your civilian counterparts. Patients at teaching hospitals still come at all hours of the day and night, need evaluation, admission, surgery, resuscitation, etc. Also, as a military resident, you are an officer, but you are also an "under-thing," as you put it.

 

[colbgw02]

Military residencies are ACGME accredited and are subject to all of the relevant regulations and restrictions. And there is still very much a hierarchy.

 

[HomeSkool]

Keep in mind that your rank is pretty irrelevant as a resident. You may be the same rank as a junior attending, but you'll be in for a world of hurt if you think that puts you on equal ground.

 

[HighPriest]

I didn't even have to do a residency. Somebody just said "Welcome to the Army, you're a surgeon now. If anybody asks, you tell 'em you did a residency." Then they handed me a certificate. When I asked why, they said "You're an officer, that's why. Now scram."

 

[bobbyseal]

In my opinion, I think they are less grueling than civilian residencies. Tricare for life tends to push patients out into community PCPs once they hit 65. Therefore, it seems that fewer elderly patients are being seen in military hospitals. Also, the volume at military hospitals tends to be slower. Fewer patients on a service. I've found it somewhat alarming when residents would tell me that their outside rotations in the local private civilian hospitals are more rigorous than the main MTF. I trained on the civilian side and I always welcomed the rotations in the local private hospitals compared to the university service. It was train wreck after train wreck at the university.

However, that's not to say the attendings at milmed hospitals are not as good. It's just that the volume doesn't seem to be as high.

 

[HighPriest]

I can only speak for my own training. We had far fewer inpatient admissions. We had far busier clinics. We were probably slightly skewed towards a younger crowd, but honestly not by much. Our outside rotations were usually busier, but they were a part of our residency, so to separate them is not to really consider our residency, but rather the portion spent at the Army hospital.
I don't feel that we saw less in terms of variety, but probably less in terms of routine admissions. Again, I'm speaking solely to how busy we were (frequency of call, working hours).

 

[Homunculus]

I didn't even have to do a residency. Somebody just said "Welcome to the Army, you're a surgeon now. If anybody asks, you tell 'em you did a residency." Then they handed me a certificate. When I asked why, they said "You're an officer, that's why. Now scram."

really? me, too! just not the surgeon part.

In my opinion, I think they are less grueling than civilian residencies. Tricare for life tends to push patients out into community PCPs once they hit 65. Therefore, it seems that fewer elderly patients are being seen in military hospitals. Also, the volume at military hospitals tends to be slower. Fewer patients on a service. I've found it somewhat alarming when residents would tell me that their outside rotations in the local private civilian hospitals are more rigorous than the main MTF. I trained on the civilian side and I always welcomed the rotations in the local private hospitals compared to the university service. It was train wreck after train wreck at the university.

However, that's not to say the attendings at milmed hospitals are not as good. It's just that the volume doesn't seem to be as high.

i agree. we rotated at civilian centers as residents, and as a fellow as well. i think there does come a point where you are so busy you stop learning, at which point volume is pointless and you are just trying to survive. rarely are the residents here at that point-- which you can argue is a good thing, and i think is more good than bad as long as they have a steady flow of patients that are good learning cases or bread/butter cases. from an hours standpoint though, it's identical. ACGME has forced everyone into night float like systems, and the "back when i was a resident" urges are sometimes hard to fight off. interns are overly protected now at the expense of the 2nd and 3rd years, but the work is still the same-- it's just divided differently. and there is a hand-off/signout basically occurring constantly. it's all about the signout sheets now.

anyway, at the risk of derailing the thread-- for all intents and purposes, the "work" will be about the same. don't come into the military expecting to be treated any differently than any other intern. oh, and you have to take PT tests and stuff as well.

--your friendly neighborhood uphill both ways in the snow walking barefoot on the tops of barbwire fences caveman

 

[backrow]

I didn't even have to do a residency. Somebody just said "Welcome to the Army, you're a surgeon now.

Well that did work for one very senior person in the Army

 

[psychbender]

Well, quality is a different question, and has been discussed on this board repeatedly. The OP seemed to be asking primarily about hours and how residents were treated, which I would have to say is pretty similar to the outside world. You are correct, though, in that inpatient acuity and census is typically lower for military versus civilian teaching hospitals (in some settings), which can affect how those 30 hours are spent. I am not familiar with the IM programs either at my old program, or where I am now, but I sincerely hope that their residents spend a few months in a civilian ICU, because what they do now is ridiculous. I remember as a resident (just me) having 20+ patients in my small SICU, while the IM team (intern plus resident, sometimes plus med student) upstairs had three or four. Here, the combined unit is even smaller, is only occasionally filled, and they feel overwhelmed when they have a post-op heart there, so the surgery residents spend more time rotating on the ICU service. They still get pimped a lot, but I would hope that, since they only have a little over a half-dozen patients at most, that they know absolutely everything about their patients and their disease processes.

 

[Homunculus]

Well, quality is a different question, and has been discussed on this board repeatedly. The OP seemed to be asking primarily about hours and how residents were treated, which I would have to say is pretty similar to the outside world. You are correct, though, in that inpatient acuity and census is typically lower for military versus civilian teaching hospitals (in some settings), which can affect how those 30 hours are spent. I am not familiar with the IM programs either at my old program, or where I am now, but I sincerely hope that their residents spend a few months in a civilian ICU, because what they do now is ridiculous. I remember as a resident (just me) having 20+ patients in my small SICU, while the IM team (intern plus resident, sometimes plus med student) upstairs had three or four. Here, the combined unit is even smaller, is only occasionally filled, and they feel overwhelmed when they have a post-op heart there, so the surgery residents spend more time rotating on the ICU service. They still get pimped a lot, but I would hope that, since they only have a little over a half-dozen patients at most, that they know absolutely everything about their patients and their disease processes.

this. +1

--your friendly neighborhood back when men were men caveman

 

[Perrotfish]

Nvm