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How confident is a 1st or 2nd year resident?

Discussion in 'Clinical Rotations' started by gablet, Dec 17, 2005.

  1. gablet

    gablet Senior Member
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    I signed up for a doctor through my insurance that, as it turns out, does not actually see patients on a regular basis. He is actually a director (of 5) of a practice consisting of 1-3 year residents.

    I will have to get at least one mole removed (as suggested by my OBGYN) and I am concerned that they might not have enough practice at doing procedures. Am I over-reacting? Is this something that you learn in school well and is really an easy procedure?

    How confident are you when you get out of med school?
     
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  3. (nicedream)

    (nicedream) Fitter Happier
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    That's really odd. Residents aren't even board-certified, and usually insurance companies won't pay for services from non-board-certified physicians. Are you sure about this?
     
  4. Yeah.... in resident clinics all care is supervised by an attending. The degree of oversight depends on the resident, the attending, and the dynamic betwen the two. I'd guess that for the mole removal the attending will likely be present, especially if the resident is less experienced, but perhaps not if they are very experienced. Either way I should think that you would get normal quality care.
     
  5. Smurfette

    Smurfette Antagonized by Azrael
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    I think your question is how COMPETENT are you when you graduate, not how confident are you...

    I removed moles as a med student. It's a simple procedure assuming it is a pretty benign looking mole and isn't too big. And if the resident hasn't done many, the attending would supervise. As far as insurance is concerned, the insurance will cover it if the resident was the primary care-giver. The attending just signs off on the billing/coding sheets (this is routine; I as a resident will fill and sign coding sheets in clinic but my attending also signs it).
     
  6. toofache32

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    Not necessarily. I cut off facial goobers every week in clinic and I've never had an attending even in the building. But it's generally a simple procedure assuming it's actually a mole.
     
  7. gablet

    gablet Senior Member
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    Thanks for your input everyone.

    I do have one question, though. I thought that after you graduate from med school you have to take your boards and then take more tests after your residencies.
     
  8. toofache32

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    "Med school" is just one step along the way and only makes you "competent" in doing physical exams and chasing down xrays. Then you do a "residency" in your chosen specialty. If you choose to be "board-certified" in your specialty (not required), you can take the board exam when you're done with residency.
     
  9. Smurfette

    Smurfette Antagonized by Azrael
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    There are 3 parts to the generic medical boards (USMLE). Two are taken prior to beginning residency and the third is taken after at least one year of residency. All docs must pass this for a permanent license to practice medicine. (after graduating medical school, you get a temporary or training license to practice medicine pending passage of the third part of the boards). Specialty boards are taken after finishing residency and allow you to call yourself "board-certified" in a given specialty, and need to be retaken every so many years to maintain this "board certification". As the above poster states, you can practice a specialty without being board certified. Some practices require their physicians to be board certified, but most (varies by specialty though) just require you to be "board eligible". The nuances of what board certification gets you as compared to just being board eligible is something that is still a mystery to me...
     
  10. gablet

    gablet Senior Member
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    Thanks again!
     
  11. AJM

    AJM SDN Moderator
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    Board eligible means that you've completed a full residency in a certain specialty, but have not yet taken that specialty's board exam. For most specialties, there's a large gap of time between the completion of residency and taking the boards. For example, in Internal Medicine, residents finish their training at the end of June, but don't take the IM boards until the end of September, and then don't find out the results on whether they passed until November. Instead of having to be unemployed for 6 months while waiting for their board results to come back, practices will hire them as board-eligible physicians with the caveat that they are expected to take and pass their boards in a certain amount of time.

    So the reason practice groups will hire board eligible physicians is so that they can hire new residency/fellowship graduates without waiting for them to take their board exams. Every specialty has their own rules as to how long you can be board eligible for, but if you decide you're never going to take the board exam, you will not remain board eligible forever. Usually there's a time limit on this -- for example after 5 years of completing your residency without passing the board exam, you will no longer be board eligible, or if you've failed your boards 3 times you will not be allowed to take them again. (I'm just making these numbers up -- every specialty has it's own rules).

    Most practices that hire board eligible physicians include in their contract the requirement that they pass their boards within a certain amount of time -- if they don't, then they lose their spot in the practice.
     
  12. AJM

    AJM SDN Moderator
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    The question is, are you actually billing for the mole removals that are done when the attending is out of the building? If so, that's considered insurance fraud, and your clinic may get in big trouble if it gets audited. It's okay to do minor procedures with no attending supervision - heck, they're done all the time - but if a procedure is done with no attending immediately available, then you can't bill for the procedure, and the hospital/clinic/attending loses that potential extra income.
     
  13. Adcadet

    Adcadet Long way from Gate 27
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    I switched insurances last year and was looking for a internal medicine doc and clinic. I was just fine being seen by residents (and even liked the idea of contributing to education and getting looked over by a resident and attending) but eventually decided to avoid teaching clinics because I am likely to be applying to internal medicine residencies down the line. I could have gone to a family medicine teaching clinic, but I prefer internists and my new clinic is a whole two blocks from my house.
     
  14. YouDontKnowJack

    YouDontKnowJack I no something you don't
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    i got some moles on my skin that grew out this past year.

    are they really easy to remove? I was thinking I'd have to use a laser. :)
     
  15. toofache32

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    Why laser?
     
  16. njbmd

    njbmd Guest
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    Hi there,

    Even more important than the level of confidence of the residents is the location and characteristics of your moles. While considered minor surgical procedures, mole removal can be loaded with complications especially when the person removing the mole does not recognize the potential for harm.

    Some moles in locatations like upper chest and face (especially around eyes) can leave a hypertrophic scar or compromise the function of they eyelid if removed incorrectly. Make sure your attending physician supervises the person doing the removing if you lesion is in a location that might compromise function.

    If your "mole" turns out to be a melanoma, incorrect removal can lead to your death. For example: Little "freckle/mole" on the bottom of a foot. Patient goes to internist who does a "scrape biopsy". Two weeks later, groin swells to size of baseball. Internist did not examine groin lymph nodes. Patient diagnosed with Stage IV melanoma. Six months later, patient is dead.

    Skin ditzels can be very simple little office procedures or they can be something more dangerous like Merkel cell carcinoma or melanoma. Be sure to ask about the pathology report after your lesion is removed. Sometimes these things are not just little "chip shots".

    njbmd :)
     

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