Increases in Residency Length Begin

[inspirationmd]

Well people it is starting. The ACGME and AAFP are rolling out a pilot to increase Family Medicine residency length to 4 years! People have been suggesting for years that with the duty hour restrictions this is the only alternative left. This is exactly why I think that the duty hours in their current form go to far. I am far more tired from the 16 hours 6 days a week than the 28 hour call I used to do when I was a medical student. Of course, I know that my residents did more work than I did as a 3rd and 4th year but I had a similar schedule to them so based on my experiences I think it was a better system.

Thoughts? Anyone willing to keep things the way they are? For the people who like the new duty hours what if the tradeoff is a 4 year FM/IM residency, 5 years Anesthesia, 7 years Surgery, or increased length of [insert residency of choice]? How much extra debt will that be for people with $250K in loans.

http://www.aafp.org/online/en/home/...fessional-development/20120427acgmepilot.html

"Some people see a four-year program as a logical innovation "given the increasing complexity of medical care, decreased clinical experience (due in part to reduced residency work hours) and responsibility in medical school, the reduction in available education hours, and now the addition of new skills needed to practice in medical homes," said the ACGME."

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[dragonfly99]

I don't think it is unreasonable to increase residency length, from a "learning" point of view. In my opinion interns seem to know less (about how to apply things clinically, in any case) at a given point in the year than they did a few years ago. I do think some of it is because of the reduced work hours. On the other hand, I do see people being less tired and overall happier, and that is also important. There were honestly times when I was an intern or med student and I really wanted to drop in my tracks after a 30+ hour call, with not enough time to eat, drink or urinate, much less get any sleep at all. It was brutal. They did have "work hours" limits starting when I was an intern, but they weren't necessarily stringently applied. When I was a med student there were none, and if they wanted us to work 100 or 120 hrs/week, or 35 hrs in a row, we did. It wasn't pretty...
I have the same concerns as the OP regarding student debt. I think tuition needs to be flat/static or reduced if we are really going to have longer residencies. Also, I think fp docs have to know a hell of a lot, but I can't help but think that if they increase residency length to 4 years they will get even fewer applicants for fp spots, especially if peds and IM remain at 4 years.

 

[dragonfly99]

Sorry...I meant if peds and IM stay at 3 years, not 4...

 

[DrBowtie]

And FP will continue to decline in popularity.

 

[peppy]

If FM becomes a 4 year program, I can't see why anyone who is interested in primary care would go to med school. It would make a lot more sense for anyone who likes primary care to just become an NP or PA. Basically this is penalizing people who are interested in primary care for becoming a doctor instead of a mid-level provider.

Yes, medicine is becoming more complex, but I don't think it's realistic to expect people to endure increasingly lengthy residencies to try to make sure they do/see everything that they might encounter in their careers before they leave residency. Maybe the better way to address that is to assess how good residents are at recognizing when they're in over their head and if they can appropriately find the answers or seek expert help when they do encounter a situation they haven't dealt with before.

 

[Buzz Me]

Do you think that one extra year will make all the difference? It's just one year! Doesn't seem like enough to deter people who have a passion for whatever field they're going into.

 

[DrBowtie]

Do you think that one extra year will make all the difference? It's just one year! Doesn't seem like enough to deter people who have a passion for whatever field they're going into.

Its all relative. If IM, Peds, EM stay 3 years, then yes the 1 year difference makes a huge deal. I think many people would sacrifice the Peds/OB training in FM and go for IM if they wanted to do primary care outpatient (since the vast majority of the patients would be non pregnant adults).

 

[Law2Doc]

Its all relative. If IM, Peds, EM stay 3 years, then yes the 1 year difference makes a huge deal. I think many people would sacrifice the Peds/OB training in FM and go for IM if they wanted to do primary care outpatient (since the vast majority of the patients would be non pregnant adults).

There are already a handful of 4 year EM programs, and a number of proponents for that model, so I have to wonder whether that field will hold strong at 3 years.

If FM can brand itself to the public as a better trained specialty, they may capitalize on the change at the expense of fields like IM and peds. It's all in the packaging. Part of the reason "advanced" residencies get away with billing what they do is the higher level of training, so FM could remake themselves as the intelligencia of primary care if they did it right.

 

[45408]

Do you think that one extra year will make all the difference? It's just one year! Doesn't seem like enough to deter people who have a passion for whatever field they're going into.

I think it would push more people into med-peds. Three years to learn peds/IM/OB is a pretty short stint.

 

[Socrates25]

If FM can brand itself to the public as a better trained specialty, they may capitalize on the change at the expense of fields like IM and peds. It's all in the packaging. Part of the reason "advanced" residencies get away with billing what they do is the higher level of training, so FM could remake themselves as the intelligencia of primary care if they did it right.

I dont know about IM, but there's no way in hell FP programs are going to be seen as surpassing the competency/training of peds, even with an extra year. You could certainly argue that they will be seen as superior to peds for "treating the whole family", but thats true now without adding a stupid extra 4th year.

 

[Socrates25]

If you read the press release closely, you'll see that the ACGME is pushing this not to enhance clinical training but to enhance BS feelgood causes such as "systems management", "team leadership", "population health" etc.

This is the kind of crap that PhD "health management experts" come up with. People who have zero clinical training and have no clue how the profession of medicine is practiced.

An extra 4th year for all of that crap? 🙄

 

[NotAProgDirector]

There are already a handful of 4 year EM programs, and a number of proponents for that model, so I have to wonder whether that field will hold strong at 3 years.

If FM can brand itself to the public as a better trained specialty, they may capitalize on the change at the expense of fields like IM and peds. It's all in the packaging. Part of the reason "advanced" residencies get away with billing what they do is the higher level of training, so FM could remake themselves as the intelligencia of primary care if they did it right.

EM actually went the other way I believe. It started as a 4 year program, and then institutions shortened it to 3 years. The 4 year programs have been dying out.

Changing residency to a 4 year program is a terrible idea. There is plenty of time in 3 years to what you need to know for IM. FP is theoretically a broader field (encompassing some OB and peds also), but still I expect that most FP's felt that they were trained well.

 

[Dirt]

What they should do is find some way to utilize the final 9 or so months of med school in some sort of abbreviated internship.

I cannot think of a much bigger waste of time and money than the end of 4th year.

 

[Law2Doc]

...

Changing residency to a 4 year program is a terrible idea. There is plenty of time in 3 years to what you need to know for IM. FP is theoretically a broader field (encompassing some OB and peds also), but still I expect that most FP's felt that they were trained well.

well there's still some buzz of actually continuing to lower duty hours beyond the current 80 hour threshold, and if you want to continue this course I don't see many options besides adding years. A lot of programs had to nix some of the didactics, rounds and conferences just to stay within the new intern hour structures, and that has resulted in lesser training at some places. And FP has always had a bad reputation amongst the other specialties it interacts with of trying to know too little about too much, so it's not a bad move for them -- a large pool of fourth year residents will go a long way to balancing out how little their juniors know. Just my two cents.

 

[Law2Doc]

EM actually went the other way I believe. It started as a 4 year program, and then institutions shortened it to 3 years. The 4 year programs have been dying out...

I don't disagree with your history, but theres been a bit of a whip saw effect going on out there, and certain academic center pundits have been suggesting that a mere three years, combined with the move to lower hour shift work, is creating a significantly less well trained EM physician these days. (hard to argue with that when even popular magazines are running stories about how EM orders too many imaging studies compared to just a few years ago, etc). It remains to be seen whose view will carry the day, but certainly the perceived shorter hours and short residency is currently popular with med students, so they may stay the course if only to match a more prestigious grouping for a while.

 

[NotAProgDirector]

I believe EM has been working with a self imposed 60 hour week from the start. Whether the ED orders too many tests is a matter of debate (althogh I personally agree that they probably do) -- less tests will result in more missed diagnoses.

 

[Dwindlin]

I believe EM has been working with a self imposed 60 hour week from the start.

This. They have been doing 60 hour weeks on ED months for quite some time, well before the hour limitations.

 

[gutonc]

I believe EM has been working with a self imposed 60 hour week from the start. Whether the ED orders too many tests is a matter of debate (althogh I personally agree that they probably do) -- less tests will result in more missed diagnoses.

I also think saying that the ED orders too many years because they're not well trained is profoundly naive and intentionally misleading.

 

[Roguelyn]

If FM was 4 years, I'd have gone into IM or EM. I'm sure I'm not alone.

 

[SouthernSurgeon]

I believe EM has been working with a self imposed 60 hour week from the start.

Yes. Which leads to some interesting reactions when their interns rotate on our surgery services and we make them work 80...

 

[45408]

Yes. Which leads to some interesting reactions when their interns rotate on our surgery services and we make them work 80...

This sounds like story time....go on...

 

[filter07]

What is the average hours per week on FM residency? Could the longer training be blamed on the work hour restrictions? Maybe if Neurosurgery or General Surgery was increasing training years it would be more obviously related.

 

[Buzz Me]

I believe EM has been working with a self imposed 60 hour week from the start.

Their RRC restricts them to working 60 hours a week max? 😕

 

[Buzz Me]

Its all relative. If IM, Peds, EM stay 3 years, then yes the 1 year difference makes a huge deal.

I meant if all these 3-year residencies expand to 4 years. It would shock me if someone deadset on Peds, for example, changes career path because of one lousy year.

Then again, I voluntarily delayed finishing residency by 2 years, and have 3 more years of fellowship to go, so maybe I'm not the best person to talk about wanting to finish training quickly.

 

[ztaw15]

I feel the opposite way actually. I would be a lot less hesitant on FM if it were four years; provided the extra time was clinical training and not this systems/community/public health stuff.

As for fourth year being "wasted time", I hear people complain about this, but then most places have very few requirements in fourth year. Just make good use of your time, take a lot of Junior internships/sub-I's or whatever instead of vacation. I guess a lot of people don't want to do this, but seeing a fourth year come on as a surgical intern after basically four-five months off and struggle hard core because of it for a while made a big impression on me.

 

[gutonc]

Their RRC restricts them to working 60 hours a week max? 😕

While in the ED. When they are off service, they are subject to whatever that service's rules (or lack thereof) are.

But I did have one EM intern tell our ICU attending he couldn't work more than 60h in a week. He was very quickly disabused of that notion courtesy of a page from his own PD.

 

[gutonc]

I feel the opposite way actually. I would be a lot less hesitant on FM if it were four years; provided the extra time was clinical training and not this systems/community/public health stuff.

I've actually thought that FM should be 4y (or more) for awhile now. As it stands, the training is basically at the level of an intern in 3 different specialties without the time or training to go any deeper. There's just way too much stuff to try and learn in that short of a period of time.

 

[Chakrabs]

I'm doing neurosurgery, and the thought of doing an even longer residency is absolutely nauseating. Especially because there is absolutely no data that supports fewer hours leading to better outcomes, and some studies reporting POORER outcomes due to additional handoffs. I know neurosurgery as a field is pretty upset with the duty hours and there has been talk of neurosurgery programs uncoupling themselves from the ACGME if the duty restrictions become even more draconian. Working 6 days a week on the neurosurgery service is absolutely brutal. I'd take a 28-hr call and a post-call day anytime.

 

[Doctor Bagel]

I've actually thought that FM should be 4y (or more) for awhile now. As it stands, the training is basically at the level of an intern in 3 different specialties without the time or training to go any deeper. There's just way too much stuff to try and learn in that short of a period of time.

I've always thought this, too, even though I know there are really well trained FM folks. I think the extension has more to do with concerns like this than duty hours.

 

[group_theory]

I get the feeling that those in the ivory towers (eg AAFP) don't really see the reality and don't know what medical students are going through.

Facing assaults on primary care by midlevels and express clinics in Walmart/CVS/Walgreens, frozen or decreasing reimbursement, and students finishing undergrad with sizable loans (and finishing medical school with larger loans) with loss of subsidized loans, fixed rate of 6.8% (above current market value), and increasing annual tuition

Their solution is to increase residency length? So that residents can be better "team managers" and understand "population health"?

At some point, those in the ivory towers have to realize that people have families and lives ... and putting it on hold for another year (and NOT make attending salary for another year, forebearing loans for another year, etc) will place a large burden on the resident and his/her family too.

Good luck to whichever FM program sign up for this pilot study. I can see their recruitment - "come to our program, it's 4 years compare to everyone else who is 3 years. You get paid as a resident for all 4 years, but don't worry, you will be an excellent team leader and will understand population health by the time you are done ... well worth the extra year in training while your colleagues will be making 3-4 times your salary but they won't be as good a team leader as you


The leaderships is acting like Colonel Cathcart (from Catch-22 by Joseph Heller) - increasing the number of missions, except it is not him that suffers the consequences of his decision but his airmen who have to fly more (and risk their lives)

*there was a similar article a few years back (and posted on SDN) where there was talk of increasing family medicine to 4 years, and the picture on the article is of residents jumping for joy!!

 

[Groove]

EM actually went the other way I believe. It started as a 4 year program, and then institutions shortened it to 3 years. The 4 year programs have been dying out.

Changing residency to a 4 year program is a terrible idea. There is plenty of time in 3 years to what you need to know for IM. FP is theoretically a broader field (encompassing some OB and peds also), but still I expect that most FP's felt that they were trained well.

EM started as a 2 year residency, after a rotating internship. It evolved primarily into a 3 year residency with the internship year combined. There have been 4 year residencies for awhile, but always a minority. The 4 year residencies aren't dying out, the PGY 2,3,4 residencies are dying out and they are transitioning to a full 4 which includes the internship which has always been structured like a transitional rotating internship with a few modifications making it more suited for EM. I think one of the primary reasons you saw so many PGY2-4 programs is inability to get funding for the first year. Our program got around it by creating a transitional internship tailored for EM that was technically under the anesthesiology department. It has since been formalized into a 1-4 EM residency but I'm actually not sure how the funding issue was worked out. Traditionally, Medicare GME funding would only provide 3 years of funding for EM training. They may have changed now, I'm not sure. It doesn't change the fact that the vast majority of EM residencies are 3 year programs though.

To, the OP.. I just posted something about this in another thread... It's all the result of these work hour restrictions and nobody is going to fight to shorten residency programs. I mean, think about it... Who cares? Predominately the resident, and the resident alone. He/She is the one with 200+K of med school debt accruing interest at insane rates. The hospital doesn't care, it's more free labor. The residency program doesn't really care, it's less turnover and better/faster work from better trained residents, or they might even be ambivalent about the matter. Ultimately, you are free labor and the higher powers will always find ways to lengthen residency training, lengthen fellowship training, anything possible to squeeze more work out of you on the penny. Add up your hours and salary, do a few calculations and see how far above minimum wage you really are. It's depressing.

The age old argument of more training = better physician is plain warped logic in my opinion. Are you better trained after 4 years compared to 3? Sure. Are you better trained/more experienced after 6 years versus 4? Yes. What about 10 years into your clinical practice and say compare that clinician with the one you were 6 years prior... Better? Absolutely. That's the insanity of this whole mentality of lengthening residencies in my opinion. What ever happened to evaluating the level of training based on ITE's and the like, what do we even have those for? I was scoring high enough to pass the EM boards when I took it my 2nd year of residency and the scores were even higher this year and likely even higher next, so that means regardless of clinical experience, I could have probably walked into the written boards for EM and passed as a 2nd year resident. I would bet the same would go for FM.

4 years is going to suck for FM, especially at a time when we are having a drought in primary care providers and a vast need that NP's are being quick to fill in the gap due to poor medical student interest in FM. Who can blame them? They've got 2-300K in loans to pay off, a 3 and now maybe 4 year residency only to come out making half of what most of their colleagues are making that finished residency a year early or at the same time.

I just don't get it.

I had a friend rads resident and another of his faculty attending tell me there were talks to lengthen it by an extra year also.

Trauma surgeon buddy of mine a year out was on a 6 or 7 year track. One of those years was mandatory research year. They did OR time but had a bunch of research requirements. That's a year longer than most surgery residencies. What does he have to show for that extra year of research? He's not here to answer and might even think it was a valuable year, but to me it seems awfully like a quasi wasted year that could have been incorporated with the typical 5 years of surgery. Hey, they got an extra year of cheap labor from him though.

 

[DrBowtie]

I feel the opposite way actually. I would be a lot less hesitant on FM if it were four years; provided the extra time was clinical training and not this systems/community/public health stuff.

As for fourth year being "wasted time", I hear people complain about this, but then most places have very few requirements in fourth year. Just make good use of your time, take a lot of Junior internships/sub-I's or whatever instead of vacation. I guess a lot of people don't want to do this, but seeing a fourth year come on as a surgical intern after basically four-five months off and struggle hard core because of it for a while made a big impression on me.

The problem is that there is a lot of variability on what sub I's are at various institutions.
Even the most hardcore sub I doesn't substitute for actually being an intern.

 

[Law2Doc]

...

I had a friend rads resident and another of his faculty attending tell me there were talks to lengthen it by an extra year also....

hard to imagine. Rads is already 5 years and pretty much everyone in that field does a year of fellowship after. And that's not a field that was particularly impacted by the recent duty hour changes anyhow. They could cut duty hours down to 65 hours a week and most rads programs wouldn't have to change anything.


But as to your initial point, I happen to believe that the more you do of something, the closer to n expert you become. So yes, if you do 50 of procedure X a year, or read 50 more images Y, or see another 50 cases of Z a year, getting another year to do another 50 procedures, etc makes you that much closer to an expert. It does result in you being better trained, as much as you want to spin it that some percent is scut or what have you, or that at some point you are "ready enough". Sure there's always a cutoff point where you have to take those training wheels off, but thanks to duty hour changes, where interns can't work as much solo as before, the second year residents are much more green than in years past, at least at the start of their second year, and so on. So I think it's probably justified to say that 3 years is now too little.

 

[inspirationmd]

EM started as a 2 year residency, after a rotating internship. It evolved primarily into a 3 year residency with the internship year combined. There have been 4 year residencies for awhile, but always a minority. The 4 year residencies aren't dying out, the PGY 2,3,4 residencies are dying out and they are transitioning to a full 4 which includes the internship which has always been structured like a transitional rotating internship with a few modifications making it more suited for EM. I think one of the primary reasons you saw so many PGY2-4 programs is inability to get funding for the first year. Our program got around it by creating a transitional internship tailored for EM that was technically under the anesthesiology department. It has since been formalized into a 1-4 EM residency but I'm actually not sure how the funding issue was worked out. Traditionally, Medicare GME funding would only provide 3 years of funding for EM training. They may have changed now, I'm not sure. It doesn't change the fact that the vast majority of EM residencies are 3 year programs though.

To, the OP.. I just posted something about this in another thread... It's all the result of these work hour restrictions and nobody is going to fight to shorten residency programs. I mean, think about it... Who cares? Predominately the resident, and the resident alone. He/She is the one with 200+K of med school debt accruing interest at insane rates. The hospital doesn't care, it's more free labor. The residency program doesn't really care, it's less turnover and better/faster work from better trained residents, or they might even be ambivalent about the matter. Ultimately, you are free labor and the higher powers will always find ways to lengthen residency training, lengthen fellowship training, anything possible to squeeze more work out of you on the penny. Add up your hours and salary, do a few calculations and see how far above minimum wage you really are. It's depressing.

The age old argument of more training = better physician is plain warped logic in my opinion. Are you better trained after 4 years compared to 3? Sure. Are you better trained/more experienced after 6 years versus 4? Yes. What about 10 years into your clinical practice and say compare that clinician with the one you were 6 years prior... Better? Absolutely. That's the insanity of this whole mentality of lengthening residencies in my opinion. What ever happened to evaluating the level of training based on ITE's and the like, what do we even have those for? I was scoring high enough to pass the EM boards when I took it my 2nd year of residency and the scores were even higher this year and likely even higher next, so that means regardless of clinical experience, I could have probably walked into the written boards for EM and passed as a 2nd year resident. I would bet the same would go for FM.

4 years is going to suck for FM, especially at a time when we are having a drought in primary care providers and a vast need that NP's are being quick to fill in the gap due to poor medical student interest in FM. Who can blame them? They've got 2-300K in loans to pay off, a 3 and now maybe 4 year residency only to come out making half of what most of their colleagues are making that finished residency a year early or at the same time.

I just don't get it.

I had a friend rads resident and another of his faculty attending tell me there were talks to lengthen it by an extra year also.

Trauma surgeon buddy of mine a year out was on a 6 or 7 year track. One of those years was mandatory research year. They did OR time but had a bunch of research requirements. That's a year longer than most surgery residencies. What does he have to show for that extra year of research? He's not here to answer and might even think it was a valuable year, but to me it seems awfully like a quasi wasted year that could have been incorporated with the typical 5 years of surgery. Hey, they got an extra year of cheap labor from him though.

This is just depressing and shows how powerless residents really are. I have definitely done the numbers and it is certainly not a happy moment when I look at them. Thankfully my program allows moonlighting which I will be doing ASAP to offset the financial blow. I am choosing to hope that PDs are aware that this not a good idea and will push back a little though this may be a naive hope. There is no concrete data that patient care has been improved overall with these changes. Residents may look happier and better rested but at the same time our education is being compromised with less experience and progression of our lives is at least partially stunted with the developing solution to extend residency training.

I believe Medicine is still a great field but at this rate the writing is on the wall for the pipeline to get even longer from M1 to Attending. At some point Medicine is going to be frankly an unwise investment unless you want to be paying loans into your 50s from schooling in your 20s, you earn a full/substantial tuition scholarship or you are born into money. It will be even more questionable for older students who may have less working years ahead of them. Then you read the Pre-Allopathic section where naive idiots are saying that they would borrow $500K to become a MD/DO without any concept of how much interest accrues while you are in training all while criticizing residents/attendings that try to warn them. Meanwhile physician salaries are declining across all specialties while loan debt peaks. It both depresses and pisses me off.

I think that if many FM programs pursue the extension of the 4th year to their curriculum there will be a significant drop in their recent rise in popularity that they love to tout as people with options flock to Med-Peds or categorical IM or Peds to pursue primary care. This will occur until those residencies decide to extend their training if the rumored 60 hour work week ever comes to fruition. Electives are not even true electives anymore at my home IM program, med school IM program, and some other places I interviewed as seniors are having to be pulled for coverage on other services on weekends that would have previously been mainly off. The rumored Radiology extension is unsettling though frankly Radiology, Anesthesia and Pathology grads are having to do fellowships to get the most job opportunities now anyway. Then the MIS fellowships for Surgery grads where they get increased operating experience that they could not get as residents because of having to get out of the hospital.

At a certain point Medicine needs to grow some teeth and tell the ACGME to calm down. Fear of possible regulation by a Congress that can't even get its s*** together long enough to pass a budget can not be the reason to over police ourselves. Its been almost 20 years since the Libby Zion case and while I think some initial changes were warranted (120 hrs a week was a bit much) I think we are going a bit too far.

I like sleep and free time as much as the next guy but residency is supposed to be hard so that at 3AM as an attending when all hell is breaking loose you know what to do. I believe wholeheartedly that I need to learn this but I do not want to spend an extra 2-3 years to do this. If PDs do not step up and push back then I hate to see where residency training will be when I am finished.

If Neurosurgery programs pull out then maybe that will be the jolt to calm ACGME down as they realize that programs may start leaving the organization. Who knows? In any event it should be interesting to watch...

 

[lizzy596]

Good lord

Reimbursement cuts, loan increases, now residency length increases

squeezed from both sides of the tunnel

It's taken me three years to get into med school....I start in less than 2 months...and I'm already wondering if I'm about to make the biggest mistake of my life.

 

[Substance]

Family medicine is the most ridiculous field.

Up here in Canada back before the early nineties med grads did one year of general internship - a hard year with zero hour restrictions - and could thereafter go and be a general practitioner, or "family doc" as they tend to call themselves today. One year and you're out making a good living practicing medicine. Patients got excellent care, there wasn't much of a shortage of primary care docs, and things were good. If anyone wanted, they could reapply whenever they felt like it for that plastics or radiology spot later on.

Then the match was started and "family medicine" became a residency. Smartly, most students become specialists and enjoy the higher income and greater prestige.

If anything, your system should adopt a one-year-to-general-practice model and do away with family medicine residencies. If people are truly worried about medical knowledge deficits, just make medschool hard again like it was in the 80s. None of this pass/fail bull****.

If they instead decide to make family medicine an even longer residency, its like charging Maserati prices for a Kia car. It is just a terrible value.

 

[Winged Scapula]

Trauma surgeon buddy of mine a year out was on a 6 or 7 year track. One of those years was mandatory research year. They did OR time but had a bunch of research requirements. That's a year longer than most surgery residencies. What does he have to show for that extra year of research? He's not here to answer and might even think it was a valuable year, but to me it seems awfully like a quasi wasted year that could have been incorporated with the typical 5 years of surgery. Hey, they got an extra year of cheap labor from him though.

Can't speak for your buddy obviously but I would suspect that he is like most other surgery residents. That is, the required research/lab time is designed to allow for learning how to run a lab, write research grants, and most importantly, to get published and is often enjoyed. One could question the wisdom of that for someone going into trauma (i.e., not a difficult fellowship to obtain, doesn't require research and except in academic programs, most trauma surgeons aren't heavily into research) but since it was mandatory, he likely didn't have a choice.

Most surgery residents actually enjoy their lab time, or at least we did back in the day. It was a time of going home before dark, having dinner with friends and family, being able to work out...essentially have a life. The hours were much much better than in residency. And if your friend also got to operate (most didn't except to cover call) he was better off than most. You could call it a wasted year of cheap labor, but that may not be the way your friend views it (and of course, is totally irrelevant to the OP's concern ).

 

[Substance]

There are already a handful of 4 year EM programs, and a number of proponents for that model, so I have to wonder whether that field will hold strong at 3 years.

If FM can brand itself to the public as a better trained specialty, they may capitalize on the change at the expense of fields like IM and peds. It's all in the packaging. Part of the reason "advanced" residencies get away with billing what they do is the higher level of training, so FM could remake themselves as the intelligencia of primary care if they did it right.

A lot of it has to do with how rare your skills are.

FM is too common. Lengthening the residency will just scare away the average AMGs, leaving the bad ones and the desperate IMGFMGs - and these programs will need warm bodies for the scut.

If FM wanted to scuttle 80% of their residency positions, then that would be a step in the right direction (that is if the NPs and PAs don't step in and fill the need)

Overall I'm bearish on family medicine. The skillset is not unique, and the clout is poor. Plus, "family medicine" is a lame name for a specialty. Where's "bachelor medicine"?

A one-year internship should be the norm, but the entire system would need to be overhauled.

FM sux.

 

[lizzy596]

A lot of it has to do with how rare your skills are.

Plus, "family medicine" is a lame name for a specialty. Where's "bachelor medicine"?

A one-year internship should be the norm, but the entire system would need to be overhauled.

FM sux.

LOL

Very True

'Family Medicine' needs an overall PR makeover

And an extra year will do nothing to help its cause

 

[SeekerOfTheTree]

If the hospital can have a resident for another year that is almost at the competency level of an attending work for the prices we get paid plus subsidized from Medicare, it makes for a very profitable situation. Its a good way to recoup initial investment. Please don't forget the business of medicine. I have been at for profit residency models during my third year. When they don't make enough they fire PDs. I hope some of you do realize that when they say we are doing this for your own good, there are other motivations and powers that are at work. Residency programs care for pass rates, fellowship matches, and research results. They don't care about how many patients Dr. Bob killed 10 yrs down the line because he only trained for 80 hrs a week in residency.

 

[Obnoxious Dad]

According to ACGME 3,318 physicians entered family practice residencies in the U.S. and Puerto Rico. At $150,000 per resident per year the additional cost of an extra year for each residency class would be $497,000,000.

There have been recurring threats to cut residency funding as a cost saving measure. Who's going to come up with an extra half billion per year to fund an extension of the family practice residency?

 

[iliketv01]

What they should do is find some way to utilize the final 9 or so months of med school in some sort of abbreviated internship.

I cannot think of a much bigger waste of time and money than the end of 4th year.

A thousand times this

 

[cowme]

I can. Extending it an extra 12 months into a traditional year

 

[Leukocyte]

I do not know about other specialties, but as far as Family Medicine goes, I personally agree that 4 years (instead of 3) will be helpful. Do FM residencies need to be 4 years? No, but it will be helpful.

BUT, that 4th year will only be helpful if that 4th year resident is treated like a full Attending. That means, full attending patient case load and full attending responsibility and legal malpractice liability. Only then, it will be helpful. Basically, that 4th year should be a "fine-tuning" year, and should be "real-time" practice and pressure. In FM, this means, a full year of full-time clinic time....and non of the non-sence "shadowing" that goes on in off-service rotations (Ortho, Optho, Derm, ......) that gives the FM resident a false sence of what the real pressure of FM is like in real-life.

 

[Groove]

Can't speak for your buddy obviously but I would suspect that he is like most other surgery residents. That is, the required research/lab time is designed to allow for learning how to run a lab, write research grants, and most importantly, to get published and is often enjoyed. One could question the wisdom of that for someone going into trauma (i.e., not a difficult fellowship to obtain, doesn't require research and except in academic programs, most trauma surgeons aren't heavily into research) but since it was mandatory, he likely didn't have a choice.

Most surgery residents actually enjoy their lab time, or at least we did back in the day. It was a time of going home before dark, having dinner with friends and family, being able to work out...essentially have a life. The hours were much much better than in residency. And if your friend also got to operate (most didn't except to cover call) he was better off than most. You could call it a wasted year of cheap labor, but that may not be the way your friend views it (and of course, is totally irrelevant to the OP's concern ).

I'll ask him next time we talk. I really don't know any of the details about that required research year but they were definitely required to do it at his gen surg residency program but he's making close to $5-600K now. I can't imagine that any extra year, no matter how "cush", would be worth $500K.... but that's me!

 

[Winged Scapula]

I'll ask him next time we talk. I really don't know any of the details about that required research year but they were definitely required to do it at his gen surg residency program but he's making close to $5-600K now. I can't imagine that any extra year, no matter how "cush", would be worth $500K.... but that's me!

I'd venture most would agree with you.

Yes, if you are looking at the research year/years as a loss of income, then it does appear to be a waste. But if you look at them as something that needs to be done to further ones's career (i.e., to match into certain fellowships - Trauma is almost never one of those that requires research, or to publish), then its worth it.

 

[Arcan57]

I do not know about other specialties, but as far as Family Medicine goes, I personally agree that 4 years (instead of 3) will be helpful. Do FM residencies need to be 4 years? No, but it will be helpful.

BUT, that 4th year will only be helpful if that 4th year resident is treated like a full Attending. That means, full attending patient case load and full attending responsibility and legal malpractice liability. Only then, it will be helpful. Basically, that 4th year should be a "fine-tuning" year, and should be "real-time" practice and pressure. In FM, this means, a full year of full-time clinic time....and non of the non-sence "shadowing" that goes on in off-service rotations (Ortho, Optho, Derm, ......) that gives the FM resident a false sence of what the real pressure of FM is like in real-life.

Just to play devil's advocate, what's the advantage to a 4th yr vs. being an actual attending for that year? Coming from the other residency that has different CLINICAL training lengths (I did a 4yr program FWIW), 3yr grads are clinically competent and the decision to do a longer program is generally to further specialize in an aspect of EM. For a specialty that is based on generalization, it would seem like that wouldn't be a compelling reason.

If the argument is: new grads are not competent to perform all the aspects of medicine that fall under their specialty. Then either the training methods need to be changed (I don't believe anyone learns how to practice medicine by shadowing if that is a common practice) or the scope of practice needs to be narrowed.