How big must a hospital be to have adequate pathology for residency training? Can one get good residency training in a 100 bed hospital? 200? 300? 500? etc.
Size of hospital for residency
- Thread starter JT19
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Makes sense. So what's a good ratio of residents to bed?
That's not an easy question.
How many teams? How are those teams set up? How many hospitals does the IM residency cover (for example, a lot of residencies will also cover the local VA)?
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I agree and think your best bet is to look at the residents' schedules, typical admission numbers/ census/ call, and the types of rotations they are doing. Do they have subspecialty services, transplant cases, stuff that you will see because it is a referral center.
And then not be afraid to work hard. Even for bread and butter cases, volume is key to learning and feeling comfortable with management.
If there is a lot of pathology/beds, the hospital to some degree will be incentivized to have residents cover these patients because mid levels and hospitalists are a more expensive way to handle it, and the interesting patients probably belong on a teaching service.
You could also ask about non-teaching services to get an idea.
EDIT to make this more useful to OP who specifically asked about what size hospital.
"According to Truven, major teaching hospitals are those with at least 400 beds in service and a high intern- and resident-per-bed ratio, while teaching hospitals have 200 or more beds and a less-intense training component. Large community hospitals are those with 250 or more acute-care beds; medium-sized community hospitals have 100 to 249 beds; and small community hospitals have 25 to 99 beds."
http://www.modernhealthcare.com/article/20130608/SUPPLEMENT/306089949
So my initial post is more relevant for a major teaching hospital, but I don't think you are exclusively looking at those programs if you are asking about a 100 - 200 bed hospital.
I think if you train at a small/medium community hospital, you will probably feel comfortable with bread and butter but likely out of your league with complicated and rare cases. There is nothing wrong with that as long as you are clear about your career goals, and also read enough to know when you are going to need to refer to a tertiary center. You don't want to miss a diagnosis and refer too late or otherwise mismanage a complicated case.
I would still ask about the intensity of training because there is really not a whole lot of substitution for volume.
Also, consider that major teaching hospitals actually have more residents per bed- that is likely because there are many specialties with residents. Really complicated cases often have multiple residents because of multiple consultants involved. I think you have to look at each program's training/ rotations individually.
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a good amount of patients to have imo is around 10 per intern with fast turn over and a nonteaching service to dump rocks to. win win for everyone. my Bias is that even your highest estimate of 500 beds is a very small hospital.
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Interesting replies so far. So smaller community hospitals don't necessarily offer sub-standard training?
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How is 500 beds a small hospital?? I would venture to say that the majority of most university teaching hospitals range in the 500-700 bed capacity
It's a balancing act. In some ways a small unopposed program offers better training because you aren't handing patients/procedures off to a different team. On the other hand, you're much less likely to be receiving referrals from outside facilities, which means your chance of catching a patient with a rare condition is much less. Of course if you have a 1 in 32 chance of actually taking care of that patient (say, 8 residents a year), then there's still a chance that you won't get the interesting patient.
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Overall agree- you can see one definition of a small hospital above.
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I've never worked in a small community hospital but my most comparable experience would be the VA associated with my training program.
In the end, I think your competence coming out of medical school/residency will be related to:
1) case mix/ clinical volume - you just won't feel comfortable managing something unless you've seen and done it lots of times. One advantage of the VA is that you do get the bread and butter cases, and generally more autonomy.
2) quality of your teachers - even though VA was a smaller place, faculty there were still quality (clinical skills, teaching). I'm sure you can find good teachers at smaller hospitals.
3) motivation to read and seek out experience to deal with deficiencies in 1 and 2. Clearly there will always be something rare enough you just haven't seen it, and attendings don't know everything.
Also, I don't know how true this is, but I just don't see getting much exposure to certain areas of medicine in a small community hospital (thinking of transplant medicine, advanced procedures of all sorts - whatever sorts of things that these hospitals ship to referral centers). Also, you dont have many of the worlds's expert physicians practicing in small community hospitals. But I'm sure coming out of such a program you will be more than qualified to treat the bread and butter. That's probably why it's harder to get a fellowship/ academic job. Nothing wrong with being a community doc - just be a damn good one. Keep learning after training and know when you are over your head.
Edit: by my putting the VA comments in the middle of points 1 and 2, I did not mean to imply that the experience is the same as at a tertiary/ quarternary care center. You are just being taught different things. At least in my training program, it was a good place to experience increased autonomy in a setting that is acute, but less acute than U Hospital.
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I feel they do.
I came from a DO school where the IM program covered very small (99-175) bed hospitals. The residents, in retrospect, really had no idea what to do with more complex patients. The patients that they referred to as being 'so complex' were in fact less complex than the average patient we manage at our hospitals.
Big hospital, high volume, and broad exposure is the only way to go IMHO if you want to know what you're doing.
Also, our VA is nothing like a community hospital as it tends to have the absolute sickest and most complex patients we see (and we cover a big community hospital, county hospital and university hospital as well).
There is only so much you can learn by reading, and you need to see and do everything you possibly can in residency. Judging from the type of mismanaged cases that regularly get transferred into our hospitals, i think the community needs smart and broadly competent generalists at least as much as academia does.
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Your experience may allow a more accurate comparison between small community, large community, VA, and teaching hospital.
I have worked in large teaching and VA only.
Our VA patients may have been sicker than the average community hospital. Typical patient was older male, smoker/ sometimes drinker with comorbidties that go along with that.
But we still sent patients away for certain things that were not done at the VA, hence my impression of higher acuity at U Hospital.
To answer your suggestion that community docs should be trained in a large academic hospital- while I don't disagree you will get a better education at said academic center, I don't think it will be possible for all community docs to get that kind of training. There aren't enough spots and many folks are just not competitive for those residencies.
So if an "average joe" type of internal medicine resident ends up at a community hospital program, my advice is to get really good at bread and butter and know when to ship out.
Clearly if you want to be an IM doc and have the choice between a community program and an academic center, take the academic center position unless you are just lazy.
But somehow I don't think that this is actually a choice that people are actually struggling with. I'd be curious what types of programs OP was actually referring to.
I have worked in large teaching and VA only.
Our VA patients may have been sicker than the average community hospital. Typical patient was older male, smoker/ sometimes drinker with comorbidties that go along with that.
But we still sent patients away for certain things that were not done at the VA, hence my impression of higher acuity at U Hospital.
To answer your suggestion that community docs should be trained in a large academic hospital- while I don't disagree you will get a better education at said academic center, I don't think it will be possible for all community docs to get that kind of training. There aren't enough spots and many folks are just not competitive for those residencies.
So if an "average joe" type of internal medicine resident ends up at a community hospital program, my advice is to get really good at bread and butter and know when to ship out.
Clearly if you want to be an IM doc and have the choice between a community program and an academic center, take the academic center position unless you are just lazy.
But somehow I don't think that this is actually a choice that people are actually struggling with. I'd be curious what types of programs OP was actually referring to.
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Yeah I'm a DO student interested in becoming a community hospitalist, but I don't want to get substandard training. Of course I will try to get a spot at an academic hospital, but if that doesn't happen I want to go somewhere where I can still get great training and be a great hospitalist. It's just difficult to figure out which programs fall in that category.
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Well, clearly hospital size is one thing to look at. But it's not the only thing. Ask your faculty.
Also, I think resident:bed number as a strict ratio is not useful.
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your right. My hospital has about 600 beds. thought it was 900.
