Part Time Residency

[SeekerOfTheTree]

Just curious why this isn't more of a thing. I'm already a physician and have bene practicing. I want to change gears because I am honestly bored with what I see. I don't want to give up making money completely. In regular life you could work and pursue other vocations part-time. Why isn't part-time residency more of a thing. We've already proved we are physicians. The argument of being a physician is much harder and you can't do it part-time I don't buy. Residency has more fillers than Michael Bay's movies and alot of time is wasted not learning. Has anyone seen this model before of part-time residency?

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[DrMetal]

Just curious why this isn't more of a thing. I'm already a physician and have bene practicing. I want to change gears because I am honestly bored with what I see. I don't want to give up making money completely. In regular life you could work and pursue other vocations part-time. Why isn't part-time residency more of a thing. We've already proved we are physicians. The argument of being a physician is much harder and you can't do it part-time I don't buy. Residency has more fillers than Michael Bay's movies and alot of time is wasted not learning. Has anyone seen this model before of part-time residency?

It should be.

There's no reason why someone has to give up their paycheck if they want to learn new skill (ultrasound, hell even critical care).

But we're too stupid and almighty in medicine to realize this. We insist on making a residency or fellowship out of everything (during which you get paid a nominal salary), and then comes the 'board certification'. Are you board certified in obesity, in addiction medicine?!?

Every other profession, but medicine, has legitimate pathways for on-the-job-training for certain skills.

 

[Franzd'Epinay]

Just curious why this isn't more of a thing. I'm already a physician and have bene practicing. I want to change gears because I am honestly bored with what I see. I don't want to give up making money completely. In regular life you could work and pursue other vocations part-time. Why isn't part-time residency more of a thing. We've already proved we are physicians. The argument of being a physician is much harder and you can't do it part-time I don't buy. Residency has more fillers than Michael Bay's movies and alot of time is wasted not learning. Has anyone seen this model before of part-time residency?

It should be.

There's no reason why someone has to give up their paycheck if they want to learn new skill (ultrasound, hell even critical care).

But we're too stupid and almighty in medicine to realize this. We insist on making a residency or fellowship out of everything (during which you get paid a nominal salary), and then comes the 'board certification'. Are you board certified in obesity, in addiction medicine?!?

Every other profession, but medicine, has legitimate pathways for on-the-job-training for certain skills.

Would either of you still want to do residency part time if residency paid better (for example, $150k or higher)?

 

[VA Hopeful Dr]

Just curious why this isn't more of a thing. I'm already a physician and have bene practicing. I want to change gears because I am honestly bored with what I see. I don't want to give up making money completely. In regular life you could work and pursue other vocations part-time. Why isn't part-time residency more of a thing. We've already proved we are physicians. The argument of being a physician is much harder and you can't do it part-time I don't buy. Residency has more fillers than Michael Bay's movies and alot of time is wasted not learning. Has anyone seen this model before of part-time residency?

Maybe I just went to a world class FM residency but I don't recall a bunch of wasted filler time.

That aside, other countries have easier (time wise) residencies than we do. They aren't usually part time but are more like regular full-time jobs as opposed to the longer hours we work. Their residencies are also longer than ours are, but that's definitely an option that could be considered.

 

[SeekerOfTheTree]

Would either of you still want to do residency part time if residency paid better (for example, $150k or higher)?

I definitely would be happy to do it at that salary. Atleast I would feel I am paid the same as the NP at my place. Yes the NP at my place makes 150k.

 

[SeekerOfTheTree]

Maybe I just went to a world class FM residency but I don't recall a bunch of wasted filler time.

That aside, other countries have easier (time wise) residencies than we do. They aren't usually part time but are more like regular full-time jobs as opposed to the longer hours we work. Their residencies are also longer than ours are, but that's definitely an option that could be considered.

I went to a very good residency but I don't think for people that learn at the speed that we do sitting through the same lecture that interns are sitting through that you sat through as an intern, then second year, then third year is a good use of your time just to name one example.

Another example is watching NPs sign-out at SICU rounds because they have to go home on time while your time can be wasted.

Another example would be getting pimped on a research article that the senior resident read and wanted to feel smart just today on.

Another example would be staffing with the attending today who wants to rip into you about ordering enough due to med-mal while you got another attending that is a minimalist and thinks you waste resources.

These are just little examples. Last year of residency at most institutions should show you what a waste of time it is. For most specialties it's elective time/research time. It's like 4th year of medical school. You pay 50k to go get recommendation letters and interview.

Residency is 50% wasted time and that is by my conservative estimate.

 

[VA Hopeful Dr]

I went to a very good residency but I don't think for people that learn at the speed that we do sitting through the same lecture that interns are sitting through that you sat through as an intern, then second year, then third year is a good use of your time just to name one example.

Another example is watching NPs sign-out at SICU rounds because they have to go home on time while your time can be wasted.

Another example would be getting pimped on a research article that the senior resident read and wanted to feel smart just today on.

Another example would be staffing with the attending today who wants to rip into you about ordering enough due to med-mal while you got another attending that is a minimalist and thinks you waste resources.

These are just little examples. Last year of residency at most institutions should show you what a waste of time it is. For most specialties it's elective time/research time. It's like 4th year of medical school. You pay 50k to go get recommendation letters and interview.

Residency is 50% wasted time and that is by my conservative estimate.

Huh, maybe my residence really was great.

Our lecture series ran on a 3 year cycle so you weren't supposed to have the same lecture twice during your time in residency. It wasn't perfect but the repeats were pretty rare.

We had 1 NP who saw patients in clinic. She was not part of our education (except that she would often come up to 3rd year residents with questions). No NPs on service with us for any rotations.

When I was a 3rd year, I would give the interns on service with me articles and then we'd discuss them the next day. But I could see how just asking questions with no heads up is a different thing and I can't say I like that.

I think different attending styles is actually very valuable. Its a great way to learn that there isn't one right way to practice, and it can help you decide how you want to practice. Now this is contingent on the attendings not being jerks about it, which can be a big problem.

If you honestly believe 50% of your residency was a waste of time then I can only say that your program must have been pretty terrible and I can understand your frustration about training.

 

[hallowmann]

Many fellowships can actually coordinate to run half-time split between two fellows where they work their day job half the time and the fellowship the other half. I know our Addiction fellowship was coordinating that for 2 prospective fellows.

I have never really seen this happen for residency, but I've heard that a special situation involving a couple splitting IM residency due to the family situation has happened. The logistics of that seems quite complicated though, and I can't imagine it's common.

We had 1 NP who saw patients in clinic. She was not part of our education (except that she would often come up to 3rd year residents with questions). No NPs on service with us for any rotations.

To be honest, you graduated long enough ago, that this in particular is just not the case anymore. It's funny talking to attendings that were residents when I was an intern that are surprised by this, but the presence of NPs/PAs on services and throughout the residency education system has significantly increased over just the last 3-4 yrs. Half the time you're consulting an NP or PA here. This has happened in other academic institutions as I've heard as well. It's partly why when the FM RRC recommended changes to allow non-physicians as core faculty and supervisors, it really wasn't a surprise.

As an example of how this ends up directly damaging our training, they've expanded our PA "residency", and these PAs weren't even in PA school before we became residents. They sometimes take priority on procedures, despite them having better hours, better retirement benefits, and better pay than us, and we're told, they "only have a year" to learn this stuff or "have to go home by 5" as justification. We brought this up recently with literally the APD and they were shocked, despite them graduating barely 6 yrs ago.

Everyone who is wondering why current residents and med students are so bitter at all the NPs and PAs, it's because we've watched our academic centers favor them over us or our education. We've watched some of our attendings constantly give them a greater benefit of the doubt than us. All at the same time having to deal with the fallout of their treatment decisions. And this is coming from someone who actually believes they can be valuable, but not as independent medical practitioners.

 

[anonperson]

I went to a very good residency but I don't think for people that learn at the speed that we do sitting through the same lecture that interns are sitting through that you sat through as an intern, then second year, then third year is a good use of your time just to name one example.

Another example is watching NPs sign-out at SICU rounds because they have to go home on time while your time can be wasted.

Another example would be getting pimped on a research article that the senior resident read and wanted to feel smart just today on.

Another example would be staffing with the attending today who wants to rip into you about ordering enough due to med-mal while you got another attending that is a minimalist and thinks you waste resources.

These are just little examples. Last year of residency at most institutions should show you what a waste of time it is. For most specialties it's elective time/research time. It's like 4th year of medical school. You pay 50k to go get recommendation letters and interview.

Residency is 50% wasted time and that is by my conservative estimate.

For procedural specialties the last year is pretty critical to learn to be more independent in the OR etc and manage cases from start to finish while still having an experienced attending available.

Staffing with different attendings can be a pain but you need that variety so you can determine how you want to practice. If you are only exposed to very few attendings you will practice one specific way.

 

[VA Hopeful Dr]

Many fellowships can actually coordinate to run half-time split between two fellows where they work their day job half the time and the fellowship the other half. I know our Addiction fellowship was coordinating that for 2 prospective fellows.

I have never really seen this happen for residency, but I've heard that a special situation involving a couple splitting IM residency due to the family situation has happened. The logistics of that seems quite complicated though, and I can't imagine it's common.


To be honest, you graduated long enough ago, that this in particular is just not the case anymore. It's funny talking to attendings that were residents when I was an intern that are surprised by this, but the presence of NPs/PAs on services and throughout the residency education system has significantly increased over just the last 3-4 yrs. Half the time you're consulting an NP or PA here. This has happened in other academic institutions as I've heard as well. It's partly why when the FM RRC recommended changes to allow non-physicians as core faculty and supervisors, it really wasn't a surprise.

As an example of how this ends up directly damaging our training, they've expanded our PA "residency", and these PAs weren't even in PA school before we became residents. They sometimes take priority on procedures, despite them having better hours, better retirement benefits, and better pay than us, and we're told, they "only have a year" to learn this stuff or "have to go home by 5" as justification. We brought this up recently with literally the APD and they were shocked, despite them graduating barely 6 yrs ago.

Everyone who is wondering why current residents and med students are so bitter at all the NPs and PAs, it's because we've watched our academic centers favor them over us or our education. We've watched some of our attendings constantly give them a greater benefit of the doubt than us. All at the same time having to deal with the fallout of their treatment decisions. And this is coming from someone who actually believes they can be valuable, but not as independent medical practitioners.

My residency program still has just the 1 NP who is clinic only.

 

[hallowmann]

My residency program still has just the 1 NP who is clinic only.

In the department perhaps, but what about all the specialty services the residents rotate through? I'm sure their role in resident education is greater than it was when you were there.

 

[VA Hopeful Dr]

In the department perhaps, but what about all the specialty services the residents rotate through? I'm sure their role in resident education is greater than it was when you were there.

So I checked. ENT has no midlevels. Ortho doesn't either. Cardiology does but the same number they had 10 years ago. Peds has none, OB has none. Pulm has 2 which are new since I left.

So mid-level involvement might be more than when I was there but most services aren't any different than they were.

 

[wholeheartedly]

So I checked. ENT has no midlevels. Ortho doesn't either. Cardiology does but the same number they had 10 years ago. Peds has none, OB has none. Pulm has 2 which are new since I left.

So mid-level involvement might be more than when I was there but most services aren't any different than they were.

That’s lucky. One of our nursing home residents got sent to the main big hospital in our region and was being managed by 5 different specialty services and only saw one specialist doc her entire week + long stay, rest were NPs. unfortunately that wasn’t rare.

 

[VA Hopeful Dr]

That’s lucky. One of our nursing home residents got sent to the main big hospital in our region and was being managed by 5 different specialty services and only saw one specialist doc her entire week + long stay, rest were NPs. unfortunately that wasn’t rare.

Oh yeah it's definitely a problem. Absolutely no argument there.