med-surg residencies

[schiznits]

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Does such a thing exist?

Hi,
I am a medical student in the midst of applying to surgery programs, and as I was thinking about it, I've always thought about how much I respect well rounded surgeons. Some have named them surgeons who think like internists or simply great surgeons.
Here in the US, there is no house officer or GP year during which all residents rotate through both surgery and medicine. This is a pity because I think surgeons learn a lot from medicine.
Are there any medicine-surgery residencies? It seems that such a program would have many eager candidates. I have searched without success. Anyone know of such a residency?

 

[zinjanthropus]

Does such a thing exist?

Hi,
I am a medical student in the midst of applying to surgery programs, and as I was thinking about it, I've always thought about how much I respect well rounded surgeons. Some have named them surgeons who think like internists or simply great surgeons.
Here in the US, there is no house officer or GP year during which all residents rotate through both surgery and medicine. This is a pity because I think surgeons learn a lot from medicine.
Are there any medicine-surgery residencies? It seems that such a program would have many eager candidates. I have searched without success. Anyone know of such a residency?

of course not
surgeons get plenty of medicine during their surgery residency

 

[cchoukal]

It's true that some of the surgical specialties end up learning some medicine along the way, but certainly not in the depth/breadth offered by a medicine residency. The is a great variability among the specialties in the degree to which that knowledge is gained and required. In my opinion as an anesthesiology resident who works with a variety of surgeons, I'd say the folks in general surgery, urology, and, sorry, OB/GYN tend to know the most medicine and the folks in ophtho, ENT, and ortho know the least. So, if you're truly interested in both, you can certainly opt for a surgical specialty that requires a lot of medical managment.

 

[Blade28]

A transitional year will provide exposure to both medicine and surgery.

 

[lowbudget]

No way. There's too much to know and see in medicine, and too many cases to do in surgery to do to be good in either. Even within medicine and surgery there're so many divisions. Pick one and run with it and be appreciative what your colleagues do. I mean, seriously. As G Surg, do you really care about high TIBC, low ferritin in microcytic anemia? As OB/GYN, do you really care about BNP 700, EF 10%, Cr 3.5?

Besides, in most surgical programs, you spend the first 1-2 years outside the OR anyways. Use that time to learn your medicine, your diagnostic skills. You'll pick it up as you go along anyways. And if you don't, who cares, it's not your field. After your first 2 years, you need to focus on getting the highest volume of surgical cases you can get in on and getting the most exposure to managing complications that you caused and how to manage the most complicated patients we send you.

Let us worry about the anti-Jo antibody or whether or not he needs to be on combination ACEI and ARB in lieu of his potassium. I'll let you worry about how to bypass his coronaries or just how you're going to get that bullet out of his head.

 

[GuP]

It's true that some of the surgical specialties end up learning some medicine along the way, but certainly not in the depth/breadth offered by a medicine residency. The is a great variability among the specialties in the degree to which that knowledge is gained and required. In my opinion as an anesthesiology resident who works with a variety of surgeons, I'd say the folks in general surgery, urology, and, sorry, OB/GYN tend to know the most medicine and the folks in ophtho, ENT, and ortho know the least. So, if you're truly interested in both, you can certainly opt for a surgical specialty that requires a lot of medical managment.

That's a mighty generalized statement! How can you judge entire fields based on your limited experience with a few doctors? That's like saying all black men can jump...

 

[Ceez]

That's a mighty generalized statement! How can you judge entire fields based on your limited experience with a few doctors? That's like saying all black men can jump...

but they can. maybe you should pick a better analogy

 

[deleted109597]

As G Surg, do you really care about high TIBC, low ferritin in microcytic anemia? As OB/GYN, do you really care about BNP 700, EF 10%, Cr 3.5?

Answer to number one, yes, because that means they might have colon cancer, which is operable. Answer to number two, hell yes, because it means they are going to die soon. Cardiomyopathy of pregnancy much?

 

[GuP]

but they can. maybe you should pick a better analogy

I guess the only black people you know are the ones you see on TV.

 

[cchoukal]

That's a mighty generalized statement! How can you judge entire fields based on your limited experience with a few doctors? That's like saying all black men can jump...

That's why I said things like "in my opinion," and "tend to." These are obviously sweeping generalizations which, at their core, in my opinion, have a kernel of truth.

 

[lowbudget]

Answer to number one, yes, because that means they might have colon cancer, which is operable. Answer to number two, hell yes, because it means they are going to die soon. Cardiomyopathy of pregnancy much?

Um... yea. And they're the first ones in line to consult that crap out. Or at least they should. When I checked out an HIV pregnant patient from L&D Triage, my OB attending told me to d/c her with mono AZT. Well, turns out, from my FP attending, that that's not standard of care anymore. I ended up doing more harm than good.

 

[LanceArmstrong]

Um... yea. And they're the first ones in line to consult that crap out. Or at least they should. When I checked out an HIV pregnant patient from L&D Triage, my OB attending told me to d/c her with mono AZT. Well, turns out, from my FP attending, that that's not standard of care anymore. I ended up doing more harm than good.

You gotta admit tho... that was pretty slick the way IbnSina flipped that tho...😉

👍

 

[lowbudget]

You gotta admit tho... that was pretty slick the way IbnSina flipped that tho...😉

👍

TOTALLY! Good job

 

[sacrament]

Cardiomyopathy of pregnancy much?

And with this, the inexplicable lingo-fad of putting the word "much" after a phrase has totally and completely jumped the shark.

 

[toxic-megacolon]

If you really wanted to you could do a medicine residency after your gen surg residency. For someone boarded in Gen Surg, you can do IM in only 2 years, skipping intern year. I guess that would be 5+2, which would be shorter than many gen surg sub specialties.

Why you'd want to do this is beyond me though. General surgeons (unlike many surgical subspecialists) are well trained in inpatient internal medicine. Better off doing a one year critical care fellowship if you really want to be "the internist who operates."

 

[Mman]

The general surgery residents I've seen make it their goal to discharge every single surgical patient on the exact same medication regimen they were taking at home before their surgery.

Blood sugar been running in the high 200s for the last week in the hospital requiring all kinds of sliding scale insulin? Just send 'em home on that metformin 500 bid they were on 6 weeks ago at home and perhaps have them get an appointment with their pcp in a week or two.

 

[Methyldopa]

The general surgery residents I've seen make it their goal to discharge every single surgical patient on the exact same medication regimen they were taking at home before their surgery.

Blood sugar been running in the high 200s for the last week in the hospital requiring all kinds of sliding scale insulin? Just send 'em home on that metformin 500 bid they were on 6 weeks ago at home and perhaps have them get an appointment with their pcp in a week or two.

Indeed that's why in the future you'll see more and more internist start being primary even on post op pts, while surgeons will be consults.

 

[deleted109597]

And with this, the inexplicable lingo-fad of putting the word "much" after a phrase has totally and completely jumped the shark.

Ouch. I could say "groovy" or "rad" or something. Guess I fail.

Oh well. O'Doyle RULES.

 

[Mman]

Indeed that's why in the future you'll see more and more internist start being primary even on post op pts, while surgeons will be consults.

I have been told that in many hospitals, pediatric surgical patients are on a primary peds service and the surgeons just consult. I'm sure the surgeons love it as well 🙂

It should be noted that I'm an anesthesia res myself so I get to interact with the surgeons plenty. They are all too happy to have someone else manage medical problems.

 

[toxic-megacolon]

What?!? I went into surgery to manage someone's HgbA1C and mildly elevated blood pressure!

But seriuosly, the whole reason they follow up with their PMD postop is to let thier body recover from the surgery to some sort of baseline. A blood pressure of 160/100 on post op day 2 doesn't mean crap, and their BP meds should not be tinkered with at that time by ANYONE. Same could be said of a blood sugar of 180.

 

[gutonc]

Our VA hospital has instituted a peri-op medicine program run by a couple of hospitalists. The sole purpose is the medical management of pre- and post-op patients. This allows the surgeons to do what they do best (cutting, suturing) and the IM docs to do what they do best (the stuff you can't fix by cutting and suturing).

It also allows for a slightly less flawed transition between services such as for very complicated medical patients post-op. They usually get a few days of coverage by the per-op medicine people who then present them to the medicine team taking over their care. This is better for everyone than the usual situation where a poor GS intern who's cross-covering 82 patients has to transfer a trauma patient who is 7 days post-op and hasn't had a surgical issue since POD #2 but has uncontrolled HTN and DM, new onset a fib and horrible COPD, never mind his metastatic prostate Ca that was only dx'd while he was getting pan-scanned in the ED after his MVA.

I've actually thought it might be "fun" or at least interesting to be a medicine resident rotating on a surgery service for the purpose of helping to manage medical issues. This way everybody gets to do what they're good at and the patients get the benefit.

 

[deleted87716]

What?!? I went into surgery to manage someone's HgbA1C and mildly elevated blood pressure!

But seriuosly, the whole reason they follow up with their PMD postop is to let thier body recover from the surgery to some sort of baseline. A blood pressure of 160/100 on post op day 2 doesn't mean crap, and their BP meds should not be tinkered with at that time by ANYONE. Same could be said of a blood sugar of 180.

I've gotta agree with you, there. I've lost count of the number of patients I've seen for hospital follow-up who were hypotensive from all their new BP meds, and hypoglycemic from their new insulin regimen. Never mind the fact that they were normotensive and had a HbA1c of less than 6.5 on oral agents prior to hospitalization... 🙄

Some days, I actually find myself wishing I still did inpatient medicine. But only for a second, then I come to my senses. 😉

 

[deleted87716]

I've actually thought it might be "fun" or at least interesting to be a medicine resident rotating on a surgery service for the purpose of helping to manage medical issues.

That sounds like almost as much fun being the only medical student on a surgical service who's professed to be interesed in family medicine...you wind up getting asked to manage all the medical stuff, whether you want to or not. On the bright side, it gets you out of holding retractors on yet another marathon esophagectomy and gastric pull-up (which you've seen five times already), and the other residents love you because you're doing the stuff that they loathe, so they can spend more time in the OR. 😉

 

[Ceez]

I guess the only black people you know are the ones you see on TV.

and the one i see in the mirror

 

[hokte]

If you really wanted to you could do a medicine residency after your gen surg residency. For someone boarded in Gen Surg, you can do IM in only 2 years, skipping intern year. I guess that would be 5+2, which would be shorter than many gen surg sub specialties.

Why you'd want to do this is beyond me though. General surgeons (unlike many surgical subspecialists) are well trained in inpatient internal medicine. Better off doing a one year critical care fellowship if you really want to be "the internist who operates."

If a person is boarded in Internal medicine, are they allowed to skip an intern year for Surgery? Just wondering if it worked both ways. Lately, I've run into quite a few people with more than one residency under their belts......

 

[Winged Scapula]

What?!? I went into surgery to manage someone's HgbA1C and mildly elevated blood pressure!

But seriuosly, the whole reason they follow up with their PMD postop is to let thier body recover from the surgery to some sort of baseline. A blood pressure of 160/100 on post op day 2 doesn't mean crap, and their BP meds should not be tinkered with at that time by ANYONE. Same could be said of a blood sugar of 180.

Excellent point (and one I meant to make yesterday but got busy).

Despite the comment above about surgeons discharging patients with Blood Sugars running in the 200s back to the PCP, I agree with you...post-op changes in metabolism/homeostasis are well-known and it would be a huge mistake to assume that the patient needs an adjustment in his usual meds in the post-operative period (provided you haven't operated on the pancreas or some other organ which would be expected to result in long-term changes in medical management).

 

[Winged Scapula]

If a person is boarded in Internal medicine, are they allowed to skip an intern year for Surgery? Just wondering if it worked both ways. Lately, I've run into quite a few people with more than one residency under their belts......

Generally no. You are required to have so many months of SURGERY to meet the requirements of ACS for Board Eligibility. Since most IM internships include NO surgery, you would be required to spend anothe year past PGY5 to complete the requirements of the ACS. Most internal medicine internships would not qualify - with the exception of perhaps an ICU rotation which you might get credit for.

 

[Winged Scapula]

Indeed that's why in the future you'll see more and more internist start being primary even on post op pts, while surgeons will be consults.

Really? Where did you hear that? I cannot find a single internist who would want a post-op surgical patient on their service (except perhaps a cadiologist in the case of a post-op MI, and even that is pretty unusual).

 

[toxic-megacolon]

If a person is boarded in Internal medicine, are they allowed to skip an intern year for Surgery? Just wondering if it worked both ways. Lately, I've run into quite a few people with more than one residency under their belts......

Like Kimberli said above, it only goes one way.

Its some provision made by the internal medicine board itself that allows this.

 

[Mman]

Excellent point (and one I meant to make yesterday but got busy).

Despite the comment above about surgeons discharging patients with Blood Sugars running in the 200s back to the PCP, I agree with you...post-op changes in metabolism/homeostasis are well-known and it would be a huge mistake to assume that the patient needs an adjustment in his usual meds in the post-operative period (provided you haven't operated on the pancreas or some other organ which would be expected to result in long-term changes in medical management).

I agree that for the most part you shouldn't mess with long term meds. When a patient is just finishing up a 14 day hospital course, however, it is reasonable to assume they might need some tweeking of meds instead of just copying the discharge meds off the H/P.

I also always wondered why our gastric bypass patients got discharged home on roughly 1/4 of the BP meds they came in. We'd have 400-500 lb patients on all kinds of meds (for example: toprol xl 100, lisinopril 20, hctz 25, hydralazine, etc) and we would send them home on POD #3 with Toprol 25 and Lisinopril 5 and nothing else and make them a f/u appointment. Did something in their 500 lb cardiovascular physiology change that much in three days? I asked a couple of the attendings and fellows, but never got a great answer other than that they just don't need as much and we'll have them follow up with PCP (as if their cardiologist isn't going to keel over when they see the change in meds).

I'm not trying to knock surgeons. Personally I think they are better at critical care than medicine folks, but when it comes to the standard hum-drum of stuff like diabetes and hypertension and copd I think the medicine folks do better. Just my 2 cents in a big name academic hospital with powerhouse programs in medicine and surgery.

 

[Winged Scapula]

I'm not trying to knock surgeons. Personally I think they are better at critical care than medicine folks, but when it comes to the standard hum-drum of stuff like diabetes and hypertension and copd I think the medicine folks do better.

I don't disagree. Medicine types are better at the run of the mill diagnoses you give and some of the zebras (I happen to think that nephrologists are amongst the most intelligent people in the hospital), but some of their critical care stuff boggles my mind.

At any rate, my comment earlier was based on some of the posts that seemed to believe that surgeons shouldn't be doing any medical management, which I think denies the extensive med-surg training we get.

 

[NotAProgDirector]

Excellent point (and one I meant to make yesterday but got busy).

Despite the comment above about surgeons discharging patients with Blood Sugars running in the 200s back to the PCP, I agree with you...post-op changes in metabolism/homeostasis are well-known and it would be a huge mistake to assume that the patient needs an adjustment in his usual meds in the post-operative period (provided you haven't operated on the pancreas or some other organ which would be expected to result in long-term changes in medical management).

I can't help but put my "I'm at morning report and I have to make a comment" hat on. The controversy over glucose control in the post op period is very complex. There is good evidence that post op patients sent to the ICU have improved outcomes with aggressive glucose control. Quoting from Up To Date:

"In a trial of surgical ICU patients, more than 1500 mechanically ventilated patients were randomly assigned to receive intensive insulin therapy (target blood glucose 80 to 110 mg/dL [4.4 to 6.1 mmol/L]) or standard care (target blood glucose 180 to 200 mg/dL [10 to 11.1 mmol/L]) [73]. Intensive insulin therapy decreased hospital mortality (7 versus 11 percent) and decreased ICU mortality (five versus eight percent) (show figure 1). The greatest reduction of ICU mortality was noted among patients admitted longer than five days (11 versus 20 percent). Hypoglycemia (glucose <40 mg/dL [2.2 mmol/L]) was more common in the intensive insulin therapy group (five versus 0.7 percent), although there were no episodes of hemodynamic instability or seizure. A subsequent study by the same investigators demonstrated that the benefits of intensive insulin therapy were more closely associated with blood glucose control than cumulative insulin dose."

The same has been found for medical ICU patients, and also for post cardiac surgery patients (I believe, although I am not sure of the reference for that).

Elevated glucose (over 200) perioperatively has been shown to be associated with an increased risk of CVA, MI, and death in patients undergoing CEA (ref: http://www.ncbi.nlm.nih.gov/entrez/..._uids=16723885&query_hl=4&itool=pubmed_docsum )

There is also evidence that elevated glucose in the post op period increases more minor risks, esp wound infection.

There has not been a good RCT looking at this issue in diabetic patients undergoing low risk procedures, and we would expect that since the incidence of adverse outcomes would be much lower in that population, then the benefit for tight glucose control might be very small, perhaps non-existant if the risk was low enough.

Given this imperfect evidence, it appears that tight glucose control in the immediate post op period is likely of benefit and simply riding out the elevation in blood sugar seen in the post op period is potentially harmful to patients.

OK, morning report hat off, back to work! 😳

 

[Faebinder]

I can't help but put my "I'm at morning report and I have to make a comment" hat on. The controversy over glucose control in the post op period is very complex. There is good evidence that post op patients sent to the ICU have improved outcomes with aggressive glucose control. Quoting from Up To Date:

"In a trial of surgical ICU patients, more than 1500 mechanically ventilated patients were randomly assigned to receive intensive insulin therapy (target blood glucose 80 to 110 mg/dL [4.4 to 6.1 mmol/L]) or standard care (target blood glucose 180 to 200 mg/dL [10 to 11.1 mmol/L]) [73]. Intensive insulin therapy decreased hospital mortality (7 versus 11 percent) and decreased ICU mortality (five versus eight percent) (show figure 1). The greatest reduction of ICU mortality was noted among patients admitted longer than five days (11 versus 20 percent). Hypoglycemia (glucose <40 mg/dL [2.2 mmol/L]) was more common in the intensive insulin therapy group (five versus 0.7 percent), although there were no episodes of hemodynamic instability or seizure. A subsequent study by the same investigators demonstrated that the benefits of intensive insulin therapy were more closely associated with blood glucose control than cumulative insulin dose."

The same has been found for medical ICU patients, and also for post cardiac surgery patients (I believe, although I am not sure of the reference for that).

Elevated glucose (over 200) perioperatively has been shown to be associated with an increased risk of CVA, MI, and death in patients undergoing CEA (ref: http://www.ncbi.nlm.nih.gov/entrez/..._uids=16723885&query_hl=4&itool=pubmed_docsum )

There is also evidence that elevated glucose in the post op period increases more minor risks, esp wound infection.

There has not been a good RCT looking at this issue in diabetic patients undergoing low risk procedures, and we would expect that since the incidence of adverse outcomes would be much lower in that population, then the benefit for tight glucose control might be very small, perhaps non-existant if the risk was low enough.

Given this imperfect evidence, it appears that tight glucose control in the immediate post op period is likely of benefit and simply riding out the elevation in blood sugar seen in the post op period is potentially harmful to patients.

OK, morning report hat off, back to work! 😳

Yup, this has been known for a while... still not every ICU is gun hoe about using insulin for control of glucose. It's hard to teach surgeons managing the SICUs that a sugar level of 200 is not a good thing. *starts running before the surgeons attack him*

 

[Winged Scapula]

I can't help but put my "I'm at morning report and I have to make a comment" hat on. The controversy over glucose control in the post op period is very complex. There is good evidence that post op patients sent to the ICU have improved outcomes with aggressive glucose control. Quoting from Up To Date:

"In a trial of surgical ICU patients, more than 1500 mechanically ventilated patients were randomly assigned to receive intensive insulin therapy (target blood glucose 80 to 110 mg/dL [4.4 to 6.1 mmol/L]) or standard care (target blood glucose 180 to 200 mg/dL [10 to 11.1 mmol/L]) [73]. Intensive insulin therapy decreased hospital mortality (7 versus 11 percent) and decreased ICU mortality (five versus eight percent) (show figure 1). The greatest reduction of ICU mortality was noted among patients admitted longer than five days (11 versus 20 percent). Hypoglycemia (glucose <40 mg/dL [2.2 mmol/L]) was more common in the intensive insulin therapy group (five versus 0.7 percent), although there were no episodes of hemodynamic instability or seizure. A subsequent study by the same investigators demonstrated that the benefits of intensive insulin therapy were more closely associated with blood glucose control than cumulative insulin dose."

The same has been found for medical ICU patients, and also for post cardiac surgery patients (I believe, although I am not sure of the reference for that).

Elevated glucose (over 200) perioperatively has been shown to be associated with an increased risk of CVA, MI, and death in patients undergoing CEA (ref: http://www.ncbi.nlm.nih.gov/entrez/..._uids=16723885&query_hl=4&itool=pubmed_docsum )

There is also evidence that elevated glucose in the post op period increases more minor risks, esp wound infection.

There has not been a good RCT looking at this issue in diabetic patients undergoing low risk procedures, and we would expect that since the incidence of adverse outcomes would be much lower in that population, then the benefit for tight glucose control might be very small, perhaps non-existant if the risk was low enough.

Given this imperfect evidence, it appears that tight glucose control in the immediate post op period is likely of benefit and simply riding out the elevation in blood sugar seen in the post op period is potentially harmful to patients.

OK, morning report hat off, back to work! 😳

Your point is well taken, and I've read the ICU literature on glucose control in the critically-ill extensively, so no need to preach to the choir here.

What we were discussing is not in-hospital glucose control but rather control of patient's baseline medications after discharge. The OP was complaining that surgeons don't change long term home medications when an in-hosptial patient has elevations in glucose and requires SSI.

There is no reason to assume that post-op increases in glucose are due to a chronic problem which needs a change in a patient's long-term medications. The observation that the stress of surgery changes one's metabolism - in the short term - is well noted.

I entirely agree that patient's, especially the critically ill, need tight glucose control, but I don't not agree with the earlier statement that surgeons are making a mistake by not changing a patient's long term home medications just because of a random and likely short-lived elevation in glucose.

 

[Winged Scapula]

It's hard to teach surgeons managing the SICUs that a sugar level of 200 is not a good thing. *starts running before the surgeons attack him*

You must be at a place with some behind the times surgeons. I cannot tell you how many conferences, seminars, journal clubs, etc. I attended as a surgical resident where the topic was tight glucose control in the critically ill. If our patients routinely ran over 115 or so, we (the residents) were criticized for it and if we couldn't get it under control with a drip or otherwise, and other reasons for the elevation were ruled out (ie, sepsis) an endocrine consult was called.

Tell your surgeons to get with the times (and start reading some of the SICU literature)!

 

[deleted87716]

still not every ICU is gun hoe about using insulin for control of glucose.

You're obviously not a former marine. The phrase is "gung ho." 😉

Just trying to help prevent future humiliation.

 

[toxic-megacolon]

Yup, this has been known for a while... still not every ICU is gun hoe about using insulin for control of glucose. It's hard to teach surgeons managing the SICUs that a sugar level of 200 is not a good thing. *starts running before the surgeons attack him*

You realize that the studies everyone points to for tight glucose in critically ill patients comes from the SURGICAL literature?

 

[toxic-megacolon]

I also always wondered why our gastric bypass patients got discharged home on roughly 1/4 of the BP meds they came in. We'd have 400-500 lb patients on all kinds of meds (for example: toprol xl 100, lisinopril 20, hctz 25, hydralazine, etc) and we would send them home on POD #3 with Toprol 25 and Lisinopril 5 and nothing else and make them a f/u appointment. Did something in their 500 lb cardiovascular physiology change that much in three days?

You sound like a medicine person so I'm sure you realize that being hypertensive for a few days/weeks is HARMLESS.
Being hypotensive/orthostatic and falling or infarcting even once over a few days/weeks can be DIASTEROUS.
I think you are missing the point.

 

[Winged Scapula]

You realize that the studies everyone points to for tight glucose in critically ill patients comes from the SURGICAL literature?

Thanks...I thought I was the only one who was confused by this. Surgeons, if anyone, should be familiar with this literature!

 

[Winged Scapula]

You sound like a medicine person so I'm sure you realize that being hypertensive for a few days/weeks is HARMLESS.
Being hypotensive/orthostatic and falling or infarcting even once over a few days/weeks can be DIASTEROUS.
I think you are missing the point.

Exactly. It is much better to send a s/p GBP patient home hypertensive or even hyperglycemic to try and abate the common events of post-op n/v, dehydration, orthostatis, etc. that happen frequently in this population.

 

[Faebinder]

You're obviously not a former marine. The phrase is "gung ho." 😉

Just trying to help prevent future humiliation.

Thank you Kent, I stand corrected *they can't pay me enough to go to the marines* 😉

 

[deleted87716]

Thank you Kent, I stand corrected *they can't pay me enough to go to the marines* 😉

Well, I'm not a marine, either...but I'd hate for Panda Bear to have seen that. 😉

 

[Faebinder]

Well, I'm not a marine, either...but I'd hate for Panda Bear to have seen that. 😉

I graduated already. I am no longer affected by ER docs, Radiologists and other evil bad words....

 

[deleted87716]

I graduated already. I am no longer affected by ER docs, Radiologists and other evil bad words....

Congrats! You need to change your profile, though...it still says "resident."

Where are you practicing that you don't have ER docs waking you up at 2AM to ensure follow-up (as if you could make someone an appointment from your bedroom, or you'd actually refuse to schedule an appointment if the patient called the office in the AM?) 😉

 

[Faebinder]

Congrats! You need to change your profile, though...it still says "resident."

Where are you practicing that you don't have ER docs waking you up at 2AM to ensure follow-up (as if you could make someone an appointment from your bedroom, or you'd actually refuse to schedule an appointment if the patient called the office in the AM?) 😉

I ment graduated from med school heh... doing a research year now... come on Kent, you saw my interview threads... This is where you are supposed to support me by saying... yes Radiologists, Pandas and ER Docs are evil and we should not tolerate their abuse.

Boy has this thread gone off track or what...

 

[deleted87716]

Boy has this thread gone off track or what...

Ah, what the heck. 😉

^ Cool...tiny type. Never did that before.