I have been an attending for 9 months. I am enjoying my 3 day weekend, reflecting on the journey. Every day since freshman year was looking to the future. "I only need 3 more years of college, 4 years of medical school, 3 years of residency, and then I've made it". Well, it's finally here. Residency was tough but rewarding. Being an attending is incredibly difficult and I am learning more and more every day... Looking back, I would do it again. I had more fun in medical school than I did in undergrad, and my undergrad was fun. I made more close friends in medical school than I did in undergrad. My residency? the most supportive, chill IM residency in the country! I made even MORE friends AND I met my wife. It wasn't even my #1 rank. So when you're sitting there slogging through mandatory bull**** lectures, or freaking out about your stupid OMT bull****, just remember that it is worth it.
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It's all worth it
Started by Dr. Puffs
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Mandatory lectures? That's so 20th Century!
Consider OMT (and COMLEX) a tax on screwing up either MCAT and or undergraduate GPA.
At least it helps you get used to touching other people, which patients really like, and learning your surface anatomy.
Otherwise, close your eyes and think of England.
in DO school, can you choose to not participate in OMT stuff?
Also, as a DO physician do you still use OMT on patients?
I wonder as an ER DO doc would you do OMT in an acute care setting? - would be interesting to see
You might not have to disrobe for certain religious reasons. But still have to do it. It’s on your board exams.
Most of the OMT that’s actually real hasn’t proven to be more efficacious than standard medical therapy and is likely inferior to PT. When you consider OMT requires special equipment and is time consuming and the standard options are a click in the EMR, there’s little utility in the real world. I’ve done for patients in renal failure and in a few pregnant patients. They can’t take NSAIDs so OMT+ Tylenol is probably better than Tylenol alone.
You should be very cautious doing OMT in the acute setting. In our litigious environment, claims could be made that you worsened a patients pain. Very few select reasons I would consider.
Furthermore, you have to keep up with OMT to be safe doing it. But there’s so little real world utility most won’t use it in the rare instances it would be useful.
did OMT with an FM resident who was a DO and felt like a freaking masseuse, not a physician.
But I agree patients appreciate palpation and there are times when I feel in conjunction with stretching, it would help them more than taking NSAIDs/OTC medications.
There is seldom ever time in the ER to do OMT, maybe its helpful for knwoing the anatomy but unless you do FM or PMR, using OMT as an attending is unheard of.
I don’t know about y'all but I in include checking Chapman’s points as a part of my primary survey on all traumas. Airway, breathing, Chapman’s points. The trauma ABC’s
How do assess for ocular trauma without palpating the humerus?
Exactly. Ophtho loves it when I consult them right away when I feel bogginess at the numeral head
wait no way thats a thing
Yes. Chapman’s points and cranial OMT are the bane of every DO students existence. These “techniques” are literally rote memorization high yield easy points on boards. Chapman’s points is memorized with a YouTube video.
The OMT that actually exists has some real world variability and can be difficult to write questions for when different people like to do different things.
Ironically, the ridiculous stuff we’re describing came out in like the 70s. AT Still’s stuff from the 1800’s was pretty solid for MSK complaints. It just doesn’t have the broad scope beyond that he thought it did.
I’ve had a large number of incredibly bad “physical exams” for eye stuff over the years, but by the deity of your choice, if someone called a consult because of a shoulder rub during my residency, I might still be in jail for the repercussions.
And Anatomy faculty as well!
It’s really not. It’s definitely not real. I complained a lot in med school about it. But even your board exams in residency under the “MD Boards” has a lot of “Well we know that this info isn’t real and no one’s done this procedure since the 80s. But we don’t want to write new questions and I had to learn it so…”
i went down the rabbit hole and TIL the IT band maps to the colon.
i would love to see a gen surg attending getting paged at 2AM bc a pt’s leg is “boggy”
i would love to see a gen surg attending getting paged at 2AM bc a pt’s leg is “boggy”
I don't know if that's the case, people thought my MCAT and grades were "too good" for DO. Despite that I didn't have other options, maybe Caspr counts for more than I thought? At least for me I see it as a privilege to get into a med school in the first place
Even supposed high scores apparently can't carry an application much, at least for me they didn't
Yup, looking to the future definitely helps get me through the powerpoint slog.
You forgot to say that you make a ton of $$$ on top of it.
Not to be a “well this one time”
But in all seriousness, my wife went to the ER for chest pain one day (sent by PCP). Once labs and ekg were clear, the ER doc (obviously a DO) cracked her neck and back and she felt 10x better..
I finished residency in 2017. The world keeps changing, but my paychecks remain as regular as ever. It's not Downton Abbey but it's a stable and high quality life.
I've been an attending for 2 years now.
It honestly all feels like a fever dream looking back. Almost a little hazy and unreal lol.
But honestly it's a good job, stable, and the quality of life is rather good. But medicine is changing for the worse. A lot more midlevels. A lot more insane things like insurance companies downgrading your coding. A lot of significantly unwell people who are stressed, working too much, and bringing their struggles to your office and looking for the speed that they need to keep them productive so they can keep the roaring 20s going.
It honestly all feels like a fever dream looking back. Almost a little hazy and unreal lol.
But honestly it's a good job, stable, and the quality of life is rather good. But medicine is changing for the worse. A lot more midlevels. A lot more insane things like insurance companies downgrading your coding. A lot of significantly unwell people who are stressed, working too much, and bringing their struggles to your office and looking for the speed that they need to keep them productive so they can keep the roaring 20s going.
Yup. That’s why all attendings, especially the younger ones, gotta get while the getting is good. Work hard, invest aggressively, and have a good emergency fund.
Things are ok so far, but will change for the worst in 5-10 yrs. Midlevel will definitely take over as health systems will try to control cost. If you are working now, save/invest your money. Don't buy into the consumerism they are selling on TV and social media every second.
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I think saving up is probably smart in general over the next 3-5 years irrespective of occupation.
I've been hearing that midlevels are going to 'take over' for the past 15 years. I am sure it has been said long before then, too. I will agree with you that they will occupy a chunk of space and patients that had been previously been seeing physicians, but its far from taking over. The vast majority of midlevels don't want the responsibility we have and are given. Some do, I get that, but most that I have spoken to and work with don't. As a physician, I am not worried about my job, my ability to make money, or my career in regards to midlevel providers. We need more docs/PAs/NPs, especially in primary care. Have you tried to set up an appointment with a new provider lately? 3-4 month minimum around us, and its been like that in multiple areas of the country that I have worked in. I work in EM and have never had difficulty finding a job.
I just finished paying school loans off last month. I'm 10 years into practice and I had refinanced twice with private companies. Keep saving, be smart, don't go by a new Range Rover or Tesla Plaid the second you get out, and you'll be fine. As physicians we will forever be HENRYs (high earner, not rich yet), but you will be able to live a really good life. 👍
Imagine that there were no midlevels, administration would kiss our behind and we would likely make more $$$.
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Maybe. Just because they exist and are making money doesn't mean they're taking over though. I wish we had more control into the education, especially the online NP/DNP mills, but such is life. At least try to train them as you can to make your life easier since they arent going away.
