MD M4 going to a community program where residents said “Residents don’t run the hospital, you’re here to learn.” This makes me worried. Should I be?

[Latteandaprayer]

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I matched at a community hospital when I was hoping for academic. I want to make the best of it. Senior residents said that residents are here to learn, not run the hospital. (during a post-match zoom). Basically it sounds like NPs and PAs do a lot of the nitty gritty work and so do attendings (since it’s community and the bottom line is volume). I’m worried my training will suffer. I didn’t ask them to really clarify because I was so upset about matching there that I was just kinda numbly sitting through the zoom but now I’ve had time to process.

How do I become the best physician (neurologist) despite this? Is it bad form to bring up this concern to my PD on day 1? Is it bad if I tell my attendings on service that I want to “run the show” for my patients? I don’t want to be an oppositional force to the culture, but I also want the experience of doing everything I can from A to Z for each patient even if it’s inefficient or I make dumb mistakes. Maybe it sounds silly and overly ambitious, but I don’t want this community program to define me. I want to excel and match into an excellent fellowship. Importantly, I want to be fully competent and not just there to write a note or step back to let the midlevel do everything and come out a helpless doc.

 

[operaman]

You’re going to be just fine. Just sit back and learn and read and work hard. If you have half a brain, you’ll buzz past the midlevels in terms of knowledge and decision making within a year or two.

A lot of medicine is algorithmic and easy to- that’s the part they do and you’ll learn that easily. You’re there to learn the hard part, learn to think and make tough decisions.

When I was a m4 I used to think resident autonomy was a big deal. By the time I was a chief, I didn’t want to be alone in the OR, I wanted to be with my favorite attendings watching them do really tough cases. I knew how to operate, had the basic skills, but wanted to see rare things done well.

You will have 20-40 years of absolutely autonomy where the only meaningful feedback you get is patient outcomes. Savor these years where you get taught and get real feedback. When you graduate, be sure to join a practice where you have some senior partners to bounce tough things off of - I’m almost 4 years out of fellowship and I do this all the time. Nothing in training will ever make you good enough that you don’t need to ask for help.

 

[LunaOri]

Community docs don't want you to "make dumb mistakes" on their patients. Come in expecting to learn, get to know your attendings and the rest of their team, and don't be in too much of a hurry. A year from now, when they know they can trust you, your attendings will likely let you have much more autonomy.

 

[Dral]

I obviously wasn't on the meeting, but that might be a GOOD thing. To me it sounds as if they could be telling you "You won't have to deal with all the social placement stuff, prior authorizations, and other scut work. You will just be here to learn".

Half of what I did on the floors as an intern seemed like it was placement, insurance, and social stuff. I didn't have a bad year, but it would have been better if I didn't have to deal with all of that extra stuff and could have just learned/treated patients.

I understand your concerns that it might just end up being a 'shadowing' type experience, but I doubt that will really be the case.

 

[slowthai]

This is exactly what you want, an attending-run program. You get to focus on doing what you're actually there to do: learn, not be a workhorse.

My program is mostly attending-run (outside of call of course), so if you're gone (or sick, or whatever), no one will have to be pulled off electives to cover for you. It's fantastic.

 

[Latteandaprayer]

This is exactly what you want, an attending-run program. You get to focus on doing what you're actually there to do: learn, not be a workhorse.

My program is mostly attending-run (outside of call of course), so if you're gone (or sick, or whatever), no one will have to be pulled off electives to cover for you. It's fantastic.

Thanks! It’s good to hear from someone who had a good experience with it. Obviously my disappointment with where I matched has colored everything and hence I’m trying to see another angle.

 

[Dantes]

Agree with what's been said. My program (also neurology) relies far too much on residents, and I find the day-to-day teaching and feedback inadequate. If you have super low volume it could be a problem, but as long as you're getting enough reps and seeing enough cases, it should be fine.

 

[Lost in Translation]

I wish I trained at a hospital/program where there were appropriate staff to do non-patient facing tasks. Instead, residents did almost everything from scheduling clinic visits to arranging outpatient referrals (beyond just placing an order in the chart). Real valuable learning experience.

 

[slowthai]

I wish I trained at a hospital/program where there were appropriate staff to do non-patient facing tasks. Instead, residents did almost everything from scheduling clinic visits to arranging outpatient referrals (beyond just placing an order in the chart). Real valuable learning experience.

That’s just the absolute worst. Psych always gets a bad rap for being social work heavy, but we literally do zero social work at my program.

 

[Saddleshoes]

Maybe it sounds silly and overly ambitious, but I don’t want this community program to define me. I want to excel and match into an excellent fellowship. Importantly, I want to be fully competent and not just there to write a note or step back to let the midlevel do everything and come out a helpless doc.

It doesn't matter where you match!
You are going to grow and learn no mater where you go.
Guess What!?!?! --- YOU are the one in charge of how you grow and learn not the program.
So go there with a plan and give it your best shot!

 

[operaman]

Will add one more thing -

My program went through a small transition during my training where we started adding midlevels to our inpatient services, and we were one of the last as many others already had very strong midlevel cohorts.

Having been on both sides of it, I vastly preferred the midlevels on service and I think it gave me a much better education. A few reasons:

1) they handle all the bs social dispo stuff. You do need to learn and understand this, but the basics you can probably master in a couple of weeks and after that it’s just a time suck.

2) they get good at procedures but have zero desire to take them from you if you want them. Had plenty of midlevels help me through my first central lines and art lines as an intern. Once you’re more senior and little bedside procedures more of a chore, they can bang it out while you go to the OR and do something more interesting (or they can take the new intern through it for you).

3) they are immune from the cyclical ignorance of trainees and they develop incredible institutional knowledge. Trainees come and go on a service and they become vital members of the team, but then they rotate off and you get a new batch. Having a permanent resident of sorts means there’s always someone who knows all the people who can get things done. So while the new intern is still looking up the pager number for the case manager, the NP has already texted them directly or caught them in the hallway and moved things along.

4) they can become great sources of information. To this day, much of my knowledge of complex Peds airway prostheses came from our NP who had been caring for these kids for years. That info never got formally taught that I can recall, but I learned it by hanging out with her and asking lots of questions because at first I didn’t understand all the subtle variations in devices, or how you would plan and order a custom one. I’ve actually used that knowledge for some of my current adult patients.

 

[mistafab]

There are pros and cons to an attending- vs resident-run service for residency.

Doesn't matter to you. You'll go to your program.

Main thing is make it clear to people you want to learn and you care about the practice. Residents who actually want to learn are not as common as you'd think. Come in with that attitude and the people who like to teach will teach you. Trust the process. You'll be trained well anywhere with an attitude like that.