Opposed FM program

Discussion in 'Family Medicine' started by undereducated, Jun 21, 2008.

  1. undereducated

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    Hi, I am starting in an opposed FM program and I was wondering if anyone here is already in an opposed program. I feel like, when I interviewed with opposed programs, they try to sell their program saying that there's no worry as far as getting all the experience a Family resident should get. But now that I'm really headed into one, I'm just getting a bit nervous about if anyone CHOSE an opposed program over an unopposed program, and if so, why?

    This opposed program that I matched into was actually my number one choice. For me, I felt like whether I went into opposed or unopposed, I would basically get a Family doc training. and I figured whatever I missed out in my program, I can always acquire those skills later on in conferences. Am I thinking correctly? Is it possible? For example, I know that in my program, I will not be taught to do any colonoscopy. I don't think even anoscopy will be taught. I was also told that C-sections will be given to the OB/Gyn. So, I know I'll come out of this residency with a lack in these skills, but I was thinking, if for some reason in the future, that I do want to acquire these skills, would I be able to???

    And please also answer if u are someone who chose an opposed program over an unopposed program and share your reason why. Thanks.
     
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  3. Ypo.

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    I didn't think most FPs did colonoscopy (i know sigmoidoscopy they can commonly do). As far as anoscopy, is it really that hard?

    I think both have their perks and downsides. And it depends on what you what to do in your practice and where you want to go. Ie-if you are going to be in a place where you are on your own, you may want to get comfortable doing a wider spectrum of procedures. On the other hand, if you want to have a more narrowed focus and feel comfortable referring a lot, training in an opposed program is just fine. I know some FPs who weren't at all interested in doing deliveries or c-sections, or who only wanted to deliver for a few years.
     
  4. Leukocyte

    Leukocyte Senior Member

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    I am in an Unopposed program that is university affiliated. Our main clinical site is at a 450 bed community hospital. However, because we are affiliated with the medical school next door from us, we are REQUIRED to do some of our rotations at the medical school's University Hospital.

    When doing rotations at our main clinical site (the community hospital), I feel like I do and learn more. The FP residents are the ONLY residents in the entire hospital. In OB, I am the OB resident (not FM resident). In medicine, I am the medicine resident. In surgery, I am the surgical resident....and so on. We get involved in every aspect of the service we are in. When in OB, the OB/GYN attendings will raise hell if we are not present in the delivery room/CS. Same with surgery, medicine, and peds. Basicly we run the service we are rotating in. We are held accountable, and given lots of responsibilites. No competition with Internal Medicine over complicated cases and the ICU. We do it all. It can be VERY rough at times.

    When doing rotations at the University Hospital, I feel like a medical student again. I had limited responsibilities, and we have to call the attending or senior resident for everything. When I am on call, I cannot do anything unless I notify the attending (even for something stupid like giving tylanol for pain). Also, admissions are done by the original residents, we only watch them, again like medical students. If there are procedures, the original residents get notified first, and they get to do the procedure, while I sit down and watch.

    I do not know, but things could be different at opposed programs.
     
  5. AwesomO

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    Just to contrast this with an opposed program here is how we operate.

    We are located at a 700+ bed community hospital that is affiliated with the medical school. We have several other residency programs in our hospital IM, Peds, Surgery, Rads, Ortho, and OB.

    We have our own Medicine and OB services. On Medicine we run it on our own. We take admissions for a good chunk of the community physicians and when an unassigned patient comes in they are alternated between IM and FM services. We have open SICU, ICU, CCU, PICUs that we admit and manage our patients in. For OB we share the floor with OB residents but have our own board that we manage indepently. They can't come in and steal our cases or poach a procedure as we are completely independt of them. We our also the only residents the community physicians use in the seperate birthing center. We have two months of ICU work and we are the only residents on the service. We have weekly scope clinic where the surgery attendings do scopes on our clinic patients exclusively so we our the only residents in the procedure room.

    We do peds floor on the peds servce as interns and because the peds program is relatively small we basically function as peds interns for them when we are on. The floor would have hard time being run if they couldn't use our residents every month.

    We never have to go to a University Hospital. And are never regulated to the role of a medical student (unless we are on rads where I've heard many a resident has rekindled the greatness of 4th year by leaving at noon:D)

    To the OP:
    I chose my program because it fit with what I wanted to do as an attending and the one I felt most comfortable in.
    In particular I thought the following things shined
    1) Strong clinic training: I want to do mostly clinic when I am an attending so this made sense.
    2) Flexibility: Good number of elective months and I could decide if I wanted to do OB past the required 2 months in intern year. Where as some programs made the residents do 2 months every year.
    3) Procedures: We do a good number of procedures due to our good relationship with surgery attendings and the hospitalist service that is staffed with a good number of our graduates. At the same time however you don't have to do the procedures. Going to work in Urgent care? Well then no one is going to force you to do that central line at 4 AM.
    4) Atmosphere: I think as a whole we are a pretty laid back residency. And this is more of a personal preference but I've always viewed medicine as a job. At a lot of unopposed programs they see medicine as a higher calling and treat it as such. And thats fine to but you don't want to be the resident who just views it as a job at a residency full of people who think it's a higher calling and vice versa.
     
  6. sophiejane

    sophiejane Exhausted
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    While it's true that most don't, certainly some do, and if you want that training, you better get it in residency, because some hospitals are starting to require upwards of 150-200 scopes to get privileges.

    I am up to 100 after year one, so it shouldn't be a problem for me, but I think it would be really hard to get that many in while in practice, you'd essentially have to precept with someone, someone who doesn't care if you slow them down (would be hard to find a colorectal surgeon or GI who would take you under their wing).

    Same goes for C Sections. I can't imagine how you could learn that after residency without doing a fellowship.
     
  7. undereducated

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    Hi,

    Sorry for responding back so late. I've been super busy getting my BLS, ACLS and PALS out of the way before my residency started. And I can't believe it's already started (sort of.) Well, I say sort of because we have two weeks of orientation.

    Btw, how many weeks do you guys get for orientation? (just curious.)

    I almost forgot that I posted this thread until I was reminded of my doubts about my opposed program again today.

    While being introduced to our program, we were basically warned that during our surgical rotation, it may be more preferable to do floor work rather than scrub into an OR because if we were to scrub in, we would probably only be 2nd assists. I couldn't help feel like I would be missing out on learning true surgical procedures if I were to do a whole month of surgery just doing floor work.

    Which brings me to wonder, for those of you in unopposed FM, when you do surgeries in the OR, I assume you assist in all kinds of procedures from trauma to lap chole's and lap appy's, will you then be qualified to do these surgeries on your own AFTER RESIDENCY? For instance, if you were to take a position in a rural area where you are the only doctor, would you be allowed to do these major surgeries on your own????

    I just want to get a feel for how much I should know to train myself. Even though I've selected an opposed program, I was under the impression that my basic experience would be not too different from a FM resident coming out from an unopposed program.

    Recap: Please answer my questions:

    1)How many weeks of orientation do you guys get?

    2)Can an FM surgical experience allow an FM doc to do major surgeries?
    (Which brings me to wonder, if you do any trauma surgeries, are there FM programs out there that also require you to take ATLS?)
     
  8. tcpro

    tcpro Junior Member

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    Graduated this year from an unopposed program. NO 1st assisting surgeons in no means makes you qualified to do any surgeries on your own when you graduate. plus, hospitals won't grant you OR privledges as an FP. Unless you acutally had some real surgical training and certification, I dont' think this is realistic.

    Our residents get 2-3 weeks of orientation.
     
  9. Dr McSteamy

    Dr McSteamy sh*tting in your backyard

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    having heard all this, i dont mind the idea of an opposed program.

    i just want to get the clinic bread and butter crap down, and so several months of electives in things I'd probably include in my practice.

    I can't care less about C-sections and the whopping malpractice insurance that goes with it, esp since I plan to practice in nevada.
     

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