So I went to what I’d call a “semi-opposed” program, that became an “opposed” program. Though I think that term has obvious negative connotations that don’t automatically apply to residency programs that aren’t “unopposed”.
Where I went, we had a hospital where we were the main residents. There was an FMG IM shop there, they were solid residents, but we ran the hospital. We had our own services, there were 4 total medicine teams, 2 FM and 2 IM. The FM teams were different in that one team was attended by an FM attending from our continuity clinic; while the other team had hospitalist attendings. Those hospitalist attendings also attended the IM team’s, but not at the same time they attended the FM team.
There were some Podiatry residents as well, but they were useless and never actually around. They may have covered other hospitals too. That was it for residents.
But we rotated off site for Peds and we’re embedded with the pediatric interns at the children’s hospital. We also rotated with them for NICU. Other than that, we were a stand-alone program. The training was solid, we learned well.
then our hospital went belly-up and the program had to scatter us across multiple facilities to get everything done. Our new spot for hospital medicine was actually a stronger hospital. It was a satellite location for the main IM program (the one filled with US grads from high ranking schools). They had like 20 residents per class, and 8 at a time were at this hospital. They also did the ICU at this place, as did we.
But we (FM) had such great experience from the other place that we sorta took over that hospital too. Before long FM was its own teaching service, and they’d give us the same acuity they were giving the IM residents. We weren’t just folded into the IM teams, we were our own entity. By this point I was in my second year, and when I was on at night it would be me and an Intern and that’s it.
Pretty soon at this hospital, we became the defacto GYN consult service, we rotated in surgery (with the surgery residents). We got good training and saw more pathology because this new hospital was better equipped to care for sicker people. It was also larger.
we moved our OB service to the women’s hospital, which was owned by our original hospital’s parent company. That was an unmitigated disaster. The hospital was a joke, the OB residents were evil, the OB faculty was as well. They were being bossed around by CNM’s and those CNM’s didn’t like that we had actual medical knowledge when sick expectant mothers ended up in OB triage. But before long, we just carved out our own little niche and left the OB’s to destroy themselves with toxicity. I started moonlighting as a medicine consultant there, and I’d like to think it helped the OB residents realize that we were more utilitarian than they were. We could manage the obstetrics just as well (if not better) than they could. They certainly had surgical skills we didn’t, none of us were doing hyster’s or Gyn-Onc surgeries for example. But we (myself and the few other FM guys that eventually started moonlighting with me) bailed them out right and left when they had complicated medical patients because they didn’t know anything about managing illness that didn’t involve the Female Repro system. Even a few cases that did, they needed a bail-out. I remember advising them to image a woman who they thought had a bartholin cyst; but I could smell the necrosis from the doorway, and she was a poorly controlled diabetic. It was totally necrotizing fasciitis, and the woman nearly died. She’d been admitted the night before, placed on oral bactrim, and had an OR booked for a cyst drainage and marsupialization. They actually consulted me for pre-op clearance.
Anyway, I experienced both models; and I can confidently say that if you end up in a strong program, you end up in a strong program. I’ve seen people from “unopposed” places who are downright terrible, and the “unopposed” mantra is a dangerous think to rely 100% on. It doesn’t absolutely mean “quality training”.
