programs with more inpt vs outpt? what do you think?

[scm]

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hey, as everyone is evaluating their list and so on, wanted some feedback on what people thought about this..

clearly neuro used to be much more of an inpt specialty, before HMOs you could admit someone to adjust their Parkinson's meds(and usually did), whereas now much of neuro and seeing such patients is outpatient..

accordingly, many programs have presented heavy inpatient emphasis, especially as pgy2, as the "old" model, and a stronger emphasis on subspecialty oupt clinic as vital to see a diverse neuro pt population and exposure to subspecialists in this field...

however, for instance the Chair at UW(where there is 10 months inpt pgy2), thought the differences in curriculum for inpt/outpt actually reflected volume. i.e. UMich wasnt able to maintain as much of an inpt service/didnt have the volume and diversity of cases vs UW so shifted to more outpatient. im not sure i bought this. anyone? what are the "top 5 " programs I didnt apply to and/or didnt get interviews at doing?

what do you guys think? any opinions regarding learning in an outpatient vs inpatient experience? clearly inpatient can be excellent, and clearly sometimes you can be primarily doing medical management or just tons of stroke...


would appreciate opinions
take care
scm

 

[neurologist]

hey, as everyone is evaluating their list and so on, wanted some feedback on what people thought about this..

clearly neuro used to be much more of an inpt specialty, before HMOs you could admit someone to adjust their Parkinson's meds(and usually did), whereas now much of neuro and seeing such patients is outpatient..

accordingly, many programs have presented heavy inpatient emphasis, especially as pgy2, as the "old" model, and a stronger emphasis on subspecialty oupt clinic as vital to see a diverse neuro pt population and exposure to subspecialists in this field...

however, for instance the Chair at UW(where there is 10 months inpt pgy2), thought the differences in curriculum for inpt/outpt actually reflected volume. i.e. UMich wasnt able to maintain as much of an inpt service/didnt have the volume and diversity of cases vs UW so shifted to more outpatient. im not sure i bought this. anyone? what are the "top 5 " programs I didnt apply to and/or didnt get interviews at doing?

what do you guys think? any opinions regarding learning in an outpatient vs inpatient experience? clearly inpatient can be excellent, and clearly sometimes you can be primarily doing medical management or just tons of stroke...


would appreciate opinions
take care
scm

This is a very good question. I found your examples to be particularly interesting, since I have some familiarity with UW (although I didn't train there myself). UW's residency is pretty much 3 years of ward scut. You will get really good at treating intracranial bleeds, alcohol withdrawal, and drug overdoses. You are basically being trained (fairly well, mind you) in emergency and critical care neurology. You do about 1/2 day a week of clinic and very little of it is bread and butter neurology.

Contrast that to what most neurologists do in real life, almost entirely in the outpatient setting: headache, back pain, management of chronic disease such as MS and Parkinsons. Are you starting to see my point? I think in general, unless you have a particular interest in critical care neurology, you are better off in a program with a strong outpatient general and subspecialty neurology program than in one that's heavily inpatient weighted.

The problem is that many programs are still heavily weighted to inpatient with maybe only one day a week in outpatient clinic. I've always suspected that this is because many residencies cover multiple hospitals (i.e., a main teaching hospital, a VA, a community hospital, and maybe a childrens' hospital as well), therefore they need bodies to make all those inpatient services run, so they keep the residents on the inpt services. However, the limited outpatient exposure limits your ability to provide meaningful continuity of care to outpatients, a very important factor in the post-residency practice of medicine, which benefits neither you nor the patient.