opposed vs. unopposed ??

Discussion in 'Family Medicine' started by fsurix, Nov 18, 2003.

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  1. fsurix

    fsurix Junior Member

    Sep 9, 2003
    West Palm Beach, FL
    cany anyone entertain or comment on whether an opposed or unopposed fp program is better? im just thinking an fp resident at a hospital where there are no other residents or atleast IM residents would seem like you would get to do more and have more one on one with the attendings. on the other hand ..training at a place where there are other residencies may be more of a teaching like atmosphere. ???

    your help is greatly appreciated!
    best wishes to all.......
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  3. Darth Vader

    Darth Vader Banned Banned

    I would reccomend going to a place where only fp residents train. When you go to any other institution, there are bound to be others who take the more complex cases that are rich with learning experiences.
  4. larryj

    larryj Member 10+ Year Member

    Oct 10, 1999
    agree with Darth.
    Unopposed is preferred if you want any chance of doing central lines, chest tubes, deliveries, 1st assist on surgeries, or primary management of anything complex.
    there may be some exceptions, but they would be few and far between.
    University setting may be better if you want research? Maybe if you are really interested in teaching in that setting?
  5. ckent

    ckent Banned Banned

    Jul 31, 2000
    yup, i agree with the previous posts. the only reason that an fp should want to train in a major university setting is if you are going into academics or want to do some type of research (often epidemiological/MPH type stuff with FP). Otherwise, stick with the known, reputable community programs that give you a good amount of autonomy with few specialist stealing your patients and procedures. I know that at my med school (where we have both IM and FP in patient services), the emergency room will only admit a patient to the FP service if they are 1. already an FP clinic patient or 2. a fairly simple/straight forward case (I think that they get a lot of cellulits, 1 day IV abx cases). I can't imagine that it's good for their training if they miss the complicated cases that we see in IM sometimes. You should want to see the most complicated, sick patients who have multiple comorbid conditions as a resident, and you can look for the simple admit cases as an attending.
  6. kcrd

    kcrd Playing doctor 10+ Year Member

    Feb 18, 2003
    Could someone give me the definitions of opposed and unopposed? I can kind of figure it out from context here, but just want to be certain.
  7. seattledoc

    seattledoc Senior Member 10+ Year Member

    Aug 11, 2003
    Unopposed means that you're the only residencts in the hospital. Opposed means that there are other residents, presumably competing for patients. I'd go unopposed all the way.
  8. BellKicker

    BellKicker Twisted Miler 7+ Year Member

    Jan 23, 2002
    Up North
    This raises two questions for me.

    Is there no such thing as a super-prestigeous FP program?

    Where are the chances of a sports med fellowship better? In a university program, which are rarely unopposed (which is what I would instinctively believe) or in a community-based program (which in many cases are unopposed?).
  9. emedpa

    emedpa GlobalDoc 10+ Year Member

    Aug 25, 2001
    Taking an Away team....
    bell kicker- check out the fp residency at ventura county in southern california. it is most likely the best overall unopposed residency program in the country in terms of procedures done and atypical experiences. they do it all; trauma, c-sections, appyS, ICU , etc
  10. dj_smooth

    dj_smooth Member 7+ Year Member

    Apr 7, 2003
    no fmgs apparently though :(
  11. emedpa

    emedpa GlobalDoc 10+ Year Member

    Aug 25, 2001
    Taking an Away team....
    ...but a few d.o.'s.....
    also check out the programs at natividad/monterey county and contra costa county in california. they have similar programs. don't know about fmg's there.....
  12. Pepe

    Pepe Senior Member 10+ Year Member

    Oct 17, 1999
    San Antonio, Tx. USA
    If you are lookin for a really strong procedure based residency I would add Via Cristi in Kansas City, and John Peter Smith in Ft. Worth. I usually hear about these three programs in the same context.
  13. binswanger

    binswanger Member 7+ Year Member

    Jul 16, 2002
    Via Christi is not in Kansas City but in Wichita, KS. Affiliated with KU I believe but I do hear good things about them........
  14. RuralMedicine

    RuralMedicine Senior Member Moderator Emeritus 10+ Year Member

    Jan 11, 2003
    I considered FP initially but after further research felt that it wasn't the training that would best serve me for rural practice. That said, I did a fair amount of looking at FP programs in my first and second year and came to the conclusion that for someone interested in rural practice an unopposed program would really be the best option. I suppose that someone interested in purely outpatient in a suburb might be successful after training in an opposed program although I didn't give this path much thought as it wasn't one I wanted to pursue.

    Now I'm a Med-Peds resident at a University program with strong Med-Peds, EM, Medicine and Pediatrics programs. We also have residencies in Surgery, Psychiatry, and OB and a very opposed FP residency. I realize that the FP residents at our institution are probably not representative of FP residents across the country and that this program is probably not a top choice for FP but I'm seriously scared that our FP residents are allowed to admit patients to the hospital. (They only have admitting privileges at one hospital in our system--perhaps understandable since FPs rarely have admitting privileges at stand alone children's hospitals or at VA facilities. Initially I thought it was perhaps wrong of the system to not allow them to admit at our county hospital (a level one trauma center, and tertiary referral center for critical care and burns) or our University Medical Center but now I wonder if this is perhaps for the best.)

    Again I don't mean to knock FP, one of my good friends and medical mentors is a program director and I'm sure his residents would never run away from the bedside of their patient who was coding (and nearly trample the responding medicine code team on their way out the door). I've been in multiple situations where I've needed to put in lines or intubate the FP service's patients because their residents were either unable to try or had tried and failed (in my opinion rural providers need to be comfortable with airway management and be able to establish access at the bare minimum). At this point the patients are usually transferred to a closed ICU where the FP team continues to follow but since their staff resents the closing of the ICU (this happened about 4 years ago and before I started residency but considering this is the same staff that have been mad at the ICU team because they did not continue the outpatient lasix dose of one of their patients with severe sepsis on a norepinephrine drip) the FP residents do not have an opportunity to learn from the ICU team (although in the above example I did try to explain the benefits of aggressive volume resuscitation and ionotropic support in sepsis to the FP intern). Perhaps this FP program is an outlier however I heard similar stories from colleagues at other university programs (in various specialties) with opposed FP programs. I just really don't see how FP residents at opposed programs learn how to take care of sick adults (and please don't even start on children--the disparity seems to be even greater there). I realize that some FP grads have no desire to take care of sick patients (and I'm all for preventive medicine so I applaud their efforts ) these grads may do well in opposed programs but FP grads who intend to work in rural areas really need to train in unopposed programs.

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