jimmyd1

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This is more of a question for residents. But do you find there to be a fair amount of resentment or tension between residents between different specialties because of certain residencies being more competitive than others? Maybe certain residents were limited in where and what they could apply to and they compare themselves to you and think I'm just as smart as this guy why couldn't I have matched into that field?
 

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This is more of a question for residents. But do you find there to be a fair amount of resentment or tension between residents between different specialties because of certain residencies being more competitive than others? Maybe certain residents were limited in where and what they could apply to and they compare themselves to you and think I'm just as smart as this guy why couldn't I have matched into that field?

No
 
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xffan624

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This is more of a question for residents. But do you find there to be a fair amount of resentment or tension between residents between different specialties because of certain residencies being more competitive than others? Maybe certain residents were limited in where and what they could apply to and they compare themselves to you and think I'm just as smart as this guy why couldn't I have matched into that field?

Most residents choose a specialty they're happy with. I've worked with the Ortho residents several times in the ER as a peds resident and my only thought after watching a reduction is "Thank god someone wants to do this, 'cause no way in hell I would want to." As soon as you stop being obsessed with the relative competitiveness of residencies vs. what residency would actually fit you and your personality you will be a happier and more content person.
 
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Dermpire

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This is more of a question for residents. But do you find there to be a fair amount of resentment or tension between residents between different specialties because of certain residencies being more competitive than others? Maybe certain residents were limited in where and what they could apply to and they compare themselves to you and think I'm just as smart as this guy why couldn't I have matched into that field?

Generally speaking no. In residency most people have respect for their fellow MDs, and in actual practice everyone loves FM doctors (who are super well respected) and tries to get referrals from them.

That being said, I have seen a couple of derm residents been spoken down to by faculty/residents from other fields who made snarky lifestyle remarks to their face during consults or meetings. I've also heard rude comments about derm from residents in other fields who were convinced that dermatologists aren't real doctors. I would say 95% of the time this isn't the case, but there are always a couple people who won't let go of the med student mentality. In private practice no one gives a **** about other specialties, they're too busy doing their job to care what anyone else is doing.
 
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Donald Juan

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I don't think there is resentment related to competitiveness. People do bitch about other specialties for various reasons, but I don't think it's related to someone else having a high board score.
 
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I don't think there is resentment related to competitiveness. People do bitch about other specialties for various reasons, but I don't think it's related to someone else having a high board score.

What if you're the smartest person in your class and you want to do FM? It happens, you can't assume everyone in FM is there because their board scores dictates it.
 
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Stagg737

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I've seen more resentment by chief residents/final year residents towards their attendings than between residents. Typically because the resident makes a fraction of the salary while doing the same amount of work or something like that.
 
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I've seen more resentment by chief residents/final year residents towards their attendings than between residents. Typically because the resident makes a fraction of the salary while doing the same amount of work or something like that.

I too have observed some passive aggressive behavior between residents and attendings.
 

flightnurse2MD

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I love it when they talk to me and look down to see my school ID badge...
 
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I too have observed some passive aggressive behavior between residents and attendings.
Agree with Panther 100%. Residency is a "game". How to navigate the political landmines. Wish I knew how about how not to be labeled a problem resident before I got in trouble with my attending.
 
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Atom612

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Dumping ground specialties (internal medicine, general surgery) tend to develop resentment toward the dumpers (ED, surgical subs)

Yeah I was going to ask about IM and GS especially, I've heard other specialties are always trying to turf their patients onto their services and don't seem to respect them as much as other specialties. Is this accurate, or are IM and GS residents so overworked they think everyone's out to get them?
 

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Yeah I was going to ask about IM and GS especially, I've heard other specialties are always trying to turf their patients onto their services and don't seem to respect them as much as other specialties. Is this accurate, or are IM and GS residents so overworked they think everyone's out to get them?

both
 
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HooliganSnail

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Dumping ground specialties (internal medicine, general surgery) tend to develop resentment toward the dumpers (ED, surgical subs)


Those are NOT "dumping ground" specialties. Those are the teams that can ADMIT a patient.

It is rare that a specialty service will admit a patient on their own.

I am not dumping on you, I am admitting a patient. GET. OVER. IT.
 

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I've got a quick question about resentment in the hospital. I'm finishing up one of my first rotations as an MS3, and while I had some amazing fellow students on my team, I also had some downright hostile and apathetic fellow students. They're not even "gunners" but they can be really hostile (like downright aggressive) and difficult to interact with. I am not sure how to deal or approach them... and it's also very uncomfortable to be around them. Any tips?
 

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What? That's the literal definition of a dumping ground.

Specialty services won't admit THEIR OWN PATIENTS OR PATIENTS WITH DISEASE PROCESSES SPECIFIC TO THEIR SPECIALTY, so we get stuck with them.


It is not a "dumping ground". It's just the smartest, safest, most efficient way to get patients what they need.

Admit a patient to either an internal medicine doctor for a primarily medical problem, or a general surgeon for a surgical problem. In my experience, gen surgery will only admit something themselves if they know the patient needs surgery. Almost everything else goes to medicine.

Specialists are terrible at coordinating care. They are terrible at seeing a big picture. They are uncomfortable with any issue outside of the scope of their own specialty. I have had young healthy patients with no medical problems with a single problem (ankle fracture, nosebleed), that a specialist will admit to themselves, but truly that situation is rare.

If it was your mother......you know you would want them admitted to IM!!!
 
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This isn't a conversation about what services patients are best suited on.

It's about what breeds resentment in the hospital.

When ortho refuses to admit a 50 yo NIDDM with a broken leg because of "'medical issues" - it breeds resentment.

When neurosurg leaves a non-op subdural with no other issues on the trauma floor - it breeds resentment.

I agree that the ortho one is BS, but I don't understand why a non-op brain bleed would be on a NSGY service?
 

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I agree that the ortho one is BS, but I don't understand why a non-op brain bleed would be on a NSGY service?

Can't speak for him but a lot of the time nsgy accepts the patient to evaluate and more often than not, they say there's nothing for them to do so admit to medicine or gen surg. It is frustrating to deal with a palliative care situation with a family who is resistant to anything but a full court press when you didn't even accept the patient. It takes away time from patients you can actually help.

Then comes the eventual trach, peg, send to some facility where they will take months to die except they were basically already dead when they got here.
 
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Wordead

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Can't speak for him but a lot of the time nsgy accepts the patient to evaluate and more often than not, they say there's nothing for them to do so admit to medicine or gen surg. It is frustrating to deal with a palliative care situation with a family who is resistant to anything but a full court press when you didn't even accept the patient. It takes away time from patients you can actually help.

Then comes the eventual trach, peg, send to some facility where they will take months to die except they were basically already dead when they got here.

Sure but let's be real that's medicine's wheelhouse; they often get transfers for the patient to basically die because the outside hospital is too chicken**** to have a real pall care talk. Why would it be better for NSGY to have those discussions and arrange for dispo to a LTAC? To me, medicine or trauma is the better place for them rather than NSGY where you have 1 or 2 people on the floor who are also trying to operate at the same time. Medicine and trauma have much bigger teams and can more readily take care of those patients.
 
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PrettyLadyDoc24

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This is more of a question for residents. But do you find there to be a fair amount of resentment or tension between residents between different specialties because of certain residencies being more competitive than others? Maybe certain residents were limited in where and what they could apply to and they compare themselves to you and think I'm just as smart as this guy why couldn't I have matched into that field?

In my field (Pathology) we have very little contact with other specialties, and when we do it's often because a preliminary diagnosis is needed and there is a serious diatribe that needs to take place. I would agree with the tone of the forum that the tension is going to be the strongest between attendings and possibly between ourselves. There's not a lot of extra time to dwell on residents in other specialties and what might have been. Every branch of medicine has its own set of hardships and we all know and respect that.
 
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wegh

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I think it's more based on being stressed or frustrated and displacing that on others. It also depends on the hospital. At our hospital general surgery runs the trauma in the EC, so they think they are 10x better than the EC residents. There are plenty of bright people with high scores on both sides of the fence. I have also heard internal medicine doctors say surgery is for the "non-thinkers". Honestly I hate when anyone says stupid crap like that. You are all doctors, you are all bright. Stop trying to feed your ego
 

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Because managing head bleeds is hardly my area of specialty or interest?

Why not just stick a nonop diverticulitis on NSGY by that logic?

Do you think a neurosurgery resident can do a proper tertiary survey? Or maybe nothing is ever missed on initial exam at your institution, I don't know.

And to say that managing head bleeds is not a part of trauma is pretty weak man.
 

Wordead

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We do tertiaries ourselves on every trauma patient, regardless of what service they are admitted to.

Here's my management of a head bleed: start Keppra, call neurosurg. Any change in neuro status? Call neurosurg. Family has questions? Call neurosurg. Can I send patient home/to LTAC? Call neurosurg.

All of that would be more effectively managed on a neuro surg service.

I don't like neuro trauma. It doesn't interest me. It's not the purview of any general surgeon outside of a trauma/CC.

Calling us "weak" for not wanting to take other specialties leftovers is a nice diverting tactic.

Man I wish my specialty just got to label the boring stuff as "nonop" and turf it to others.

Well okay if you guys are doing tertiaries on off service patients it'd make some sense. I've just been on enough NSGY services that I think having them be in charge of patients who are still somewhat undifferentiated is a very bad idea. There simply aren't enough residents (or know-how for that matter) to properly take care of patients.

And yes I agree it's not the purview of gen surg outside of crit care/trauma, but those are services gen surg commonly runs. In the end I understand why it's annoying especially as a resident, but I think having the trauma service being the one admitting these patients is much safer. I don't have a dog in the fight being ENT so I don't really care one way or another but from a patient care perspective it's pretty obvious to me what the answer is.
 
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Neopolymath

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Man I wish my specialty just got to label the boring stuff as "nonop" and turf it to others.

This is the biggest reason that I am not totally sold on pursuing general surgery. I don't need the other extreme of this situation, but I do feel like I would be really affected by constantly feeling dumped on with no end in sight. In my job prior to school, I was in a similar situation and it affected my mood/attitude after years of it. I also saw what surgical specialties "owned" their patients more than others for years before school. As an attending at a larger community hospital, how can one minimize this feeling or situation? What practice styles or fellowships help with this? It seemed like the PP MIS guys at my hospital didn't really deal with this.
 

omn

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This is the biggest reason that I am not totally sold on pursuing general surgery. I don't need the other extreme of this situation, but I do feel like I would be really affected by constantly feeling dumped on with no end in sight. In my job prior to school, I was in a similar situation and it affected my mood/attitude after years of it. I also saw what surgical specialties "owned" their patients more than others for years before school. As an attending at a larger community hospital, how can one minimize this feeling or situation? What practice styles or fellowships help with this? It seemed like the PP MIS guys at my hospital didn't really deal with this.

I read all these... and hopefully it's just a coincidence that the topic stalls when someone speaks in complete sentences varying their sentence structure and syntax.

It's too easy to see anti-intellectualism as the reason why a group of people might look down on a person who varies their sentence structure. Indeed, that attitude is not much different from the anti-intellectualism of not being willing to clarify one's boundaries of responsibility in a workplace. ((about why I'm in medicine now)) In general, anti-intellectualism in medicine -- while not nearly comparable to other fields, like business -- sucks and is surprising. And unfortunately, we are living in a time and governed by MANY hidden norms and personas that ARE anti-intellectual... (( r sort of like the 80's )) GOD BLESS AMERICA

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Person Who Grew Up With Duffle Bags
 
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omn

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... and just FYI, for hundreds if not thousands of years (.. i.e., this is not about how we understand the continuity of ancient Greek and Roman thought to the modern day (go figure) ) there have been long, complex writings discussing how the "interests" of "groups" are often at odds with one another, and how "groups" sometimes termed "collectives", understand "competition" between those "interests" and their "resolutions"... the subject is normally termed "political theory" and is something like the orphaned son of philosophy that is normally only taught in university political science departments by people who might not be very good at philosophy (but should be)
...
It is normally seen as an "interesting" area of study.

I believe the "applied discipline" of this field is something we have have called "law", and the study of this subject more specifically within "law", occurs in a field we call "jurisprudence" (which is no longer a required course in "law" "school" anymore).
 

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I read all these... and hopefully it's just a coincidence that the topic stalls when someone speaks in complete sentences varying their sentence structure and syntax.

It's too easy to see anti-intellectualism as the reason why a group of people might look down on a person who varies their sentence structure. Indeed, that attitude is not much different from the anti-intellectualism of not being willing to clarify one's boundaries of responsibility in a workplace. ((about why I'm in medicine now)) In general, anti-intellectualism in medicine -- while not nearly comparable to other fields, like business -- sucks and is surprising. And unfortunately, we are living in a time and governed by MANY hidden norms and personas that ARE anti-intellectual... (( r sort of like the 80's )) GOD BLESS AMERICA

signed,
Person Who Grew Up With Duffle Bags

... and just FYI, for hundreds if not thousands of years (.. i.e., this is not about how we understand the continuity of ancient Greek and Roman thought to the modern day (go figure) ) there have been long, complex writings discussing how the "interests" of "groups" are often at odds with one another, and how "groups" sometimes termed "collectives", understand "competition" between those "interests" and their "resolutions"... the subject is normally termed "political theory" and is something like the orphaned son of philosophy that is normally only taught in university political science departments by people who might not be very good at philosophy (but should be)
...
It is normally seen as an "interesting" area of study.

I believe the "applied discipline" of this field is something we have have called "law", and the study of this subject more specifically within "law", occurs in a field we call "jurisprudence" (which is no longer a required course in "law" "school" anymore).


Wut.


It seems the meds have stopped working.



[Waiting to be inexplicably called an anti-intellectuallist].
 
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Psai

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Sure but let's be real that's medicine's wheelhouse; they often get transfers for the patient to basically die because the outside hospital is too chicken**** to have a real pall care talk. Why would it be better for NSGY to have those discussions and arrange for dispo to a LTAC? To me, medicine or trauma is the better place for them rather than NSGY where you have 1 or 2 people on the floor who are also trying to operate at the same time. Medicine and trauma have much bigger teams and can more readily take care of those patients.

Because that's like me accepting a patient with ludwigs angina and admitting them to ent
Why should anyone have to clean up someone else's mess?
 
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Meh. I've spent more time on trauma than nearly any other poster on this site. Outside of some pretty isolated situations, you'll have a hard time convincing me that isolated organ system traumas are ever better served being on general surgery than on the relevant subspecialty.


And I've said this before - the argument that "there aren't enough residents" or "you guys have bigger teams" falls absolutely flat with me. We are all working hard. Trying to argue that I should take your dumps because you think I'm less busy than you, or that my learning is less important, is a nonstarter


It is obvious that you are a resident, because you're thinking about patients like a resident does

I am sorry you hate your job.....but trauma, and all that comes with it, is your job.
 
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Because that's like me accepting a patient with ludwigs angina and admitting them to ent
Why should anyone have to clean up someone else's mess?

That seems perfectly reasonable to me depending on the circumstances. If I had even minimal airway concerns Id take him on the ENT service or the ICU. If there are no medical issues or airway issues it should go to OMFS if its odontogenic. If there are a ton of medical issues underlying it then medicine. But if a patient is accepted for eval and ENT is where theyre best served then thats where it should go.
 

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Meh. I've spent more time on trauma than nearly any other poster on this site. Outside of some pretty isolated situations, you'll have a hard time convincing me that isolated organ system traumas are ever better served being on general surgery than on the relevant subspecialty.


And I've said this before - the argument that "there aren't enough residents" or "you guys have bigger teams" falls absolutely flat with me. We are all working hard. Trying to argue that I should take your dumps because you think I'm less busy than you, or that my learning is less important, is a nonstarter

I'm ENT our traumas are rarely ever something that requires admission in and of themselves.

You're thinking about it in terms of gen surg's workload; I'm thinking about it in terms of what is safest. You guys do a lot more ICU and general head to toe patient care than us or NSGY. I think you guys would be a lot more likely to catch new findings after a trauma. It's that simple. We don't even rotate on trauma anymore during residency.
 

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This is the biggest reason that I am not totally sold on pursuing general surgery. I don't need the other extreme of this situation, but I do feel like I would be really affected by constantly feeling dumped on with no end in sight. In my job prior to school, I was in a similar situation and it affected my mood/attitude after years of it. I also saw what surgical specialties "owned" their patients more than others for years before school. As an attending at a larger community hospital, how can one minimize this feeling or situation? What practice styles or fellowships help with this? It seemed like the PP MIS guys at my hospital didn't really deal with this.

It seems most surgeons outside of teaching hospitals don't really deal with this, or at least not nearly as much. I'm rotating at a smaller community hospital right now, and the surgeons here admit almost every patient through a hospitalist and function as a consultant. Pretty stark contrast to how things run at my main teaching hospital.
 

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It is obvious that you are a resident, because you're thinking about patients like a resident does

I am sorry you hate your job.....but trauma, and all that comes with it, is your job.
This seemed unnecessary and rude.
 
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This seemed unnecessary and rude.

How is this being rude, it's so clearly true.

If someone is complaining about getting more patients, and "this isn't my job", and whining about being "dumped on", they are a resident. Take it to the bank.

Attending physicians just don't talk like that, and if they do, they change their tone real quick, because they know that patients = revenue.
 
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I haven't had any trouble with other residents for the most part - the primary exception being a couple of general surgery residents, and they apparently have a reputation of being... unpleasant.

It's typically the attendings from other services that I have more trouble with.
 
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dr zaius

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In training there is resentment all around. Sub specialty residents become resentful because they're carrying the inpatient load, handling calls from home for every attending's patients, and in the OR/clinic all day. Then you get inundated with inpatient consults for outpatient problems (ie recurrent UTIs, BPH, whatever the equivalent is for ENT, etc) and the inpatient team demands that you see the patient. You then add a couple of hours to your day just so you can see a patient and write a note that says there's nothing we can do in this inpatient situation because the work up is contraindicated at this time given the current clinical status. Patient can follow up on X date at Y time. As I said on the phone.

We haven't bought into the "patients are best managed on IM" thing yet so we still admit all of our own patients unless they are super medically complex.

As an attending that gets reimbursed for those calls it's great. For us it's of little learning value and just means more time at the hospital.
 
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xffan624

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In training there is resentment all around. Sub specialty residents become resentful because they're carrying the inpatient load, handling calls from home for every attending's patients, and in the OR/clinic all day. Then you get inundated with inpatient consults for outpatient problems (ie recurrent UTIs, BPH, whatever the equivalent is for ENT, etc) and the inpatient team demands that you see the patient. You then add a couple of hours to your day just so you can see a patient and write a note that says there's nothing we can do in this inpatient situation because the work up is contraindicated at this time given the current clinical status. Patient can follow up on X date at Y time. As I said on the phone.

We haven't bought into the "patients are best managed on IM" thing yet so we still admit all of our own patients unless they are super medically complex.

As an attending that gets reimbursed for those calls it's great. For us it's of little learning value and just means more time at the hospital.

I think there's naturally going to be resentment based on intrahospital relations which patient belongs on which service and each service's responsibilities, but OP's question was in relation to "certain residencies being more competitive than others." None of the conflicts that have been mentioned in this thread seem to be related to that. They're due to how services interact and how patients/duties/work is managed/split in the hospital.
 

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Dude, it's a thread about things that breed resentment in the hospital. These are things that breed resentment among fields like gen surg and gen med. I'm not sure why you feel the need to get up on your soapbox in here.

Not sure. The OP specifically addressed residents, so it makes sense that residents would discuss what breeds resentment during residency.
 
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dr zaius

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I think there's naturally going to be resentment based on intrahospital relations which patient belongs on which service and each service's responsibilities, but OP's question was in relation to "certain residencies being more competitive than others." None of the conflicts that have been mentioned in this thread seem to be related to that. They're due to how services interact and how patients/duties/work is managed/split in the hospital.

You're right. It was derailed.

No one has outward resentment based on specialty competitiveness in my experience. Maybe deep down someone who matched IM or gen surg as back up to ortho or something has resentment, but I haven't found it to be a factor/obvious to me.
 

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I think there's naturally going to be resentment based on intrahospital relations which patient belongs on which service and each service's responsibilities, but OP's question was in relation to "certain residencies being more competitive than others." None of the conflicts that have been mentioned in this thread seem to be related to that. They're due to how services interact and how patients/duties/work is managed/split in the hospital.

That's because no one cares how competitive each residency is. At my hospital, every field is competitive and we're all special snowflakes with 240 step 1 scores
 
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Dumping ground specialties (internal medicine, general surgery) tend to develop resentment toward the dumpers (ED, surgical subs)

On a similar note, the psych ward is not a boarding service for your unplaceable patients, even if they do happen to have mental illnesses.

Looking your way, Internal Med...
 
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On a similar note, the psych ward is not a boarding service for your unplaceable patients, even if they do happen to have mental illnesses.

Looking your way, Internal Med...

If you are consulting psychiatry, please note:

1) If your patient is intubated, in the ICU, and nonverbal, I do not have a magic incantation for making them not be agitated. I will see them every day because our policies require us to, but getting snarky with me because I have not been able to identify which of their 15 medical problems is causing them to be a little worked up gets us nowhere. My impression is that neurology, who you also consulted about this, is also not super appreciative of the attitude.

2) You can have it one of two ways: either you can ask us to do your capacity evaluation for you when a patient makes a decision you don't like, or you can do it yourself. When you ask me to do it and then want to call me up to argue about it when you don't like the results, you are really not improving anyone's lives.
 
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omn

7+ Year Member
Nov 24, 2009
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Wut.


It seems the meds have stopped working.



[Waiting to be inexplicably called an anti-intellectuallist].


No, no... I can appreciate that social and political analysis take a long time .. and that the definition of "Amateur" goes far beyond "not getting paid for it"

That's an interesting line you push.. Where misguided commentary becomes outright fraud ... you apparently are a "master" at it...

And you DO KNOW it's quite insulting to be talked down to by a mildly intelligent person who has no idea what they are talking about...

But here's another good one, possibly from one of your "Colleagues"...

It's your next question.....
---> What subcategory would you put this in...?


upload_2017-9-6_17-13-8.png
 
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jw3600

7+ Year Member
Jan 7, 2013
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No, no... I can appreciate that social and political analysis take a long time .. and that the definition of "Amateur" goes far beyond "not getting paid for it"

That's an interesting line you push.. Where misguided commentary becomes outright fraud ... you apparently are a "master" at it...

And you DO KNOW it's quite insulting to be talked down to by a mildly intelligent person who has no idea what they are talking about...

But here's another good one, possibly from one of your "Colleagues"...

It's your next question.....
---> What subcategory would you put this in...?


View attachment 223323
What is wrong with you.
 
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