Why do attendings at community hospitals hate med students?

[voxveritatisetlucis]

So we rotate at a community hospital in the city of my med school and it seems like a lot of the attendings are either completely indifferent or downright annoyed about med students being there. Like it is a resident service, so not sure why they are expecting there to be no med students. On all the procedures that they do, they are extremely hesitant to allow med students. Most of the time they won’t even let us see patients and it’s more like shadowing. Like weren’t they in our shoes before? I don’t really understand but it’s annoying to be honest.

I feel like many of these attendings want the benefits of working on a resident service (ie, having most notes prewritten by residents, barely having to see patients for more than 5 min because already checked by resident) but none of the possible drawbacks like teaching med students

I’m guessing this is much different at big teaching hospitals?

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[Dral]

I'd say your assessment could be correct. However, there could be a number of things going on. Let's say there were physicians working at said hospital and then the academic center acquired the hospital. Then one day it was sprung on the physicians that their services would become teaching services (I don't know the timeline here). If someone is in their routine (both life and work), they may not be likely to pick up and leave with the reason "I don't want to work on a teaching service".

Also for better or for worse, community hospitals of course have a different vibe/atmosphere than academic digs. There may be more of a 'customer service' thing and thus attendings don't want students being too involved. Furthermore, even though it is 'academic', patients who go there may be way less likely to be ok with a med student doing anything mainly because they THINK it's a community hospital and thus do not expect to have learners involved. In a perfect world, patients would know this ahead of time, and if they weren't ok with it, they would go somewhere else (if they are able). The attendings may be somewhat in tune to this which is why they may be hesitant to let med students get involved.

In these types of situations (community set ups), I've seen it happen where attendings are asked if they are interested in teaching. If so, they will be on the teaching service. If not, they are left to do their own thing.

 

[nofliesonme]

Gentle medical student....sorry to be the bearer of uncomfortable news, while I am sure you are not annoying and are very helpful, most medical students offer no benefits to the community hospital attending.....your teaching is most likely to come from the person immediately senior to you (intern).....if you are truly of benefit you will learn and be taught ....I wish you well

 

[voxveritatisetlucis]

Gentle medical student....sorry to be the bearer of uncomfortable news, while I am sure you are not annoying and are very helpful, most medical students offer no benefits to the community hospital attending.....your teaching is most likely to come from the person immediately senior to you (intern).....if you are truly of benefit you will learn and be taught ....I wish you well

Of course I know that I don’t add any value as a medical student, but weren’t they in the same position at one point? I would be fine with just observing but oftentimes it feels like our presence actively bothers some of the attendings

I guess that it’s possible that it varies by specialty as well. The internal medicine, FM, peds attendings are very hands on with students

 

[nofliesonme]

Gentle medical student....yes, I was in your shoes many years ago, as a student i received most teaching from the interns and residents on my service....you will get attention from an attending if you establish yourself as a productive member of the team...i'm a surgical sub specialist...many students come to the operating room late, not knowing the diagnosis, indications for surgery, pre-op work up, possible post-op complications, rudimentary anatomy...I'm sure this doesn't apply to you, unfortunately it applies to many of your predecessors and it is so depressing for the attendings to try and teach the unprepared....while the students of today may have more medical info, they seem much less clinically capable and interested.....you are likely to have a good teacher if you are a good student

 

[LucidSplash]

Of course I know that I don’t add any value as a medical student, but weren’t they in the same position at one point? I would be fine with just observing but oftentimes it feels like our presence actively bothers some of the attendings

I guess that it’s possible that it varies by specialty as well. The internal medicine, FM, peds attendings are very hands on with students

While I love having students, not all physicians like to teach or are good teachers. This is like saying “why don’t childless people want children, don’t they remember being a child?”

Also, the metrics required of physicians at community hospitals are often different than those at academic centers. While academics is built for inefficiency at times, because of the needs of trainees, community hospitals operate on metrics that focus more on quality and the bottom line. As reimbursement continues to drop, and hospitals are squeezed more, so are employed and private practice physicians. They are expected to take on more administrative burdens and more clinical work with less support.

Additionally, teaching medical students is a different ballgame than teaching residents. It’s the difference between caring for a toddler and caring for Tween or teen.

“Show me a [medical student] who only triples my work and I will kiss his feet.”
-Samuel Shem, House of God

Ideally only people who want to teach students and residents would be in a position to teach students and residents. But such is not always the case in reality.

 

[When the Moon Forgot]

I run my own practice now, and I love having medical students around. I don't get them often so I really cherish the opportunities to teach when I have them around. Not everyone in community hospitals or private practice loves teaching. I was trained in academic centers, and shockingly, not everyone there loves to teach either.

 

[mrbreakfast]

A little secret from academic medicine - most academic attendings enjoy teaching, and when the service is slow, or even average, I enjoy having med students around to teach. When things are brisk, however, most attendings would prefer med students just watch (and when things are very brisk, I would prefer no interns or juniors either - just me and the senior).

In an ideal world academic physicians would be compensated for teaching medical students (in the sense that we would have lesser workloads to allow time for teaching). Unfortunately this is often not the case, and while I would much prefer to teach for 30 minutes on each case we see, that is simply not happening when we are expected to see 20 cases in a shift.

I feel like many of these attendings want the benefits of working on a resident service (ie, having most notes prewritten by residents, barely having to see patients for more than 5 min because already checked by resident) but none of the possible drawbacks like teaching med students

Keep in mind that, in many specialties, with the exception of senior residents, a resident seeing a patient first does not save an academic attending time, especially on the inpatient side.

 

[ACSurgeon]

Of course I know that I don’t add any value as a medical student, but weren’t they in the same position at one point? I would be fine with just observing but oftentimes it feels like our presence actively bothers some of the attendings

I guess that it’s possible that it varies by specialty as well. The internal medicine, FM, peds attendings are very hands on with students

Older attendings were not in your same shoes.
When they were students they were not entitled. They did not complain. They were not self righteous. I was written up by a student for giving them feedback on their presentation. Apparently they thought I was mean. I’ve never given a student feedback since. The clerkship frequently received complaints of microagressions that students bring up as complaints of things that happened around them, not towards them. They show up for a couple of weeks but think it’s their job to police the workforce.

Also, older academic attendings trained when the academic physician would literally be at home as the senior resident started a surgery. So, the perks of being in academia were more palpable. Today, academic duties are often added on to a full clinical load.

Residents don’t save attendings as much time as a well trained PA would. So, often times no real benefit to the attending in a community hospital. They do it because they like teaching residents or because this was forced on them.

 

[GadRads]

Residents don’t save attendings as much time as a well trained PA would. So, often times no real benefit to the attending in a community hospital. They do it because they like teaching residents or because this was forced on them.

Until the PAs become the "attendings". A senior resident is superior to PA. You were resident at one point. Pay it forward. Save our profession,

 

[Goro]

So we rotate at a community hospital in the city of my med school and it seems like a lot of the attendings are either completely indifferent or downright annoyed about med students being there. Like it is a resident service, so not sure why they are expecting there to be no med students. On all the procedures that they do, they are extremely hesitant to allow med students. Most of the time they won’t even let us see patients and it’s more like shadowing. Like weren’t they in our shoes before? I don’t really understand but it’s annoying to be honest.

I feel like many of these attendings want the benefits of working on a resident service (ie, having most notes prewritten by residents, barely having to see patients for more than 5 min because already checked by resident) but none of the possible drawbacks like teaching med students

I’m guessing this is much different at big teaching hospitals?

I'm trying to say this in the nicest possible way, but it is possible that the attendings at the hospital see students from your school as arrogant entitled students with a poor work ethic.

 

[ACSurgeon]

Until the PAs become the "attendings". A senior resident is superior to PA. You were resident at one point. Pay it forward. Save our profession,

Don’t shoot the messenger. If I was in charge of the world I’d make it different. I’m just explaining the reason community attendings don’t love teaching. The argument about saving time doesn’t hold water, because the current norms don’t pan out.

 

[voxveritatisetlucis]

I'm trying to say this in the nicest possible way, but it is possible that the attendings at the hospital see students from your school as arrogant entitled students with a poor work ethic.

why assume that?

 

[nofliesonme]

why assume that?

Gentle medical student....your response is emblematic of why attendings find medical students annoying....a seasoned, senior educator asks "in the nicest possible way......is it possible?"....instead of reflecting upon the question that he asked.....your response is "why are you assuming that"
No assumption was made, in fact it seems to me that you are making an assumption......your response is one that many attendings would find annoying

 

[VA Hopeful Dr]

Until the PAs become the "attendings". A senior resident is superior to PA. You were resident at one point. Pay it forward. Save our profession,

That's what academic attendings are for as well as community attendings that want to teach.

 

[Tenk]

Really depends on the students for me, their level of engagement and interst. Some students and scribes I’ve kept in contact with for years and have watched them become a doctor themselves. Those students I tried to always teach, let them do procedures and of course buy pizza and watch Starship troopers during a shift because they had never seen it.

Other students I sent home early.

 

[Med Ed]

why assume that?

Years of longitudinal observations?

 

[LucidSplash]

why assume that?

He didn’t assume. He posited a possible explanation.

 

[Goro]

why assume that?

We've had some students like that. They can give a school a bad name

 

[voxveritatisetlucis]

Really depends on the students for me, their level of engagement and interst. Some students and scribes I’ve kept in contact with for years and have watched them become a doctor themselves. Those students I tried to always teach, let them do procedures and of course buy pizza and watch Starship troopers during a shift because they had never seen it.

Other students I sent home early.

Does this mean I’ve been making a bad impression? I’ve been asking to get more involved, stay after getting dismissed etc. but hasn’t seemed to work. Actually they get annoyed if I ask to stay later

 

[Tenk]

Does this mean I’ve been making a bad impression? I’ve been asking to get more involved, stay after getting dismissed etc. but hasn’t seemed to work. Actually they get annoyed if I ask to stay later

Not necessarily no but you do have to read the room. However, staying over in the community is kind of annoying because we attendings just want to leave asap so when a student suggests staying after it’s like whyyyyyyyyyyyyyy????

 

[LucidSplash]

Does this mean I’ve been making a bad impression? I’ve been asking to get more involved, stay after getting dismissed etc. but hasn’t seemed to work. Actually they get annoyed if I ask to stay later

What rotation is this? If community surgery, I gotta say, I tell students and residents that there is an additional rule beyond the oft quoted “eat when you can, sleep with you can, don’t eff with the pancreas” or “never stand when you can sit, never sit when you can lie down.” I tell them the additional rule is “When someone tells you that you can go home, GTFO.”

 

[voxveritatisetlucis]

What rotation is this? If community surgery, I gotta say, I tell students and residents that there is an additional rule beyond the oft quoted “eat when you can, sleep with you can, don’t eff with the pancreas” or “never stand when you can sit, never sit when you can lie down.” I tell them the additional rule is “When someone tells you that you can go home, GTFO.”

It is obgyn

 

[voxveritatisetlucis]

Not necessarily no but you do have to read the room. However, staying over in the community is kind of annoying because we attendings just want to leave asap so when a student suggests staying after it’s like whyyyyyyyyyyyyyy????

Oh okay thank you, I feel like I haven’t been too persistent and have always gone once they say there is nothing else since I can usually read the room

 

[LucidSplash]

It is obgyn

Ahhhhh. Ok guys who wants to tell him?

 

[Hzreio]

Gentle medical student....your response is emblematic of why attendings find medical students annoying....a seasoned, senior educator asks "in the nicest possible way......is it possible?"....instead of reflecting upon the question that he asked.....your response is "why are you assuming that"
No assumption was made, in fact it seems to me that you are making an assumption......your response is one that many attendings would find annoying

dude are you kidding? this is so toxic lmao

 

[xDNA]

My experience has been quite opposite OP. I feel as though my time in the community hospitals have been the best, with the exception of one service during surgery rotation. But any other rotation in the community has been great. really advance progression of chronic disease, I mean like patients straight out of a USMLE prep book. and often times the residents were really cool and gave me what I would deem considerable autonomy especially in the clinics. I was able to do nasolaryngoscopy, paracentesis, and so much more I didnt think they'd really let me do throughout clerkship year.

 

[xDNA]

It is obgyn

OBGYN residents have a stereotype for being not the nicest. It'll get better. I was pretty much ignored in OB clinic, but my time on UroGyn/GynOnc, and L&D were cool

 

[Tenk]

It is obgyn

This is completely normal and expected then.

 

[LucidSplash]

dude are you kidding? this is so toxic lmao

My dearest MS3. You think someone suggesting something as a possibility to consider, a gentle offer of insight, as toxic? Life is going to be hard for you friend if you can’t differentiate when someone is genuinely trying to help you with non-positive feedback vs being toxic.

 

[LucidSplash]

It is obgyn

My community obgyn rotation, at least the 2 weeks I spent in outpatient clinic and the 2 weeks I spent in L&D, were my most miserable periods of training… until my fellowship. The 2 weeks of gyn surg/uro gyn were where I realized I liked surgery.

While not all stereotypes are 100% true, what you have described as your complaint is definitely reflective of my own experience on community obgyn as well as most of the experiences on Obgyn others have shared with me through the years. I don’t entirely understand the reason for it, but many obgyn programs, from attending to resident, seem to have a large portion of unpleasant people, at least as experienced by medical students, mostly those not interested in obgyn.

While I have wonderful friends who are in obgyn and love my own doc, there just seems to be some of the most unpleasant people in medicine in that specialty. Again, not all, but a strangely large portion compared to pretty much any other specialty. And I say that without irony as a vascular surgeon, knowing full well my specialty is not exactly known for sunny personalities.

 

[Hollow Knight]

Honestly man I'd keep in mind that these attendings are probably taking a pay cut to spend time with you.

Medical school so far has been disappointing. Hopefully we'll actually learn to do this job in residency (surely we'll have to learn by then....... right?)

But I think it's less the attendings and more systemic factors (CMS and insurance companies are reimbursing less, patients don't want trainees practicing on them, lawyers having a field day, etc).

It sucks, but I have friends at everywhere from VCOM to hopkins and it seems it's like this everywhere. People just expect interns to show up utterly helpless now on July 1st. It is what it is, just pass your shelves/step 2 so you can get the residency you want. Stop worrying about clinical experience.

 

[LucidSplash]

Honestly man I'd keep in mind that these attendings are probably taking a pay cut to spend time with you.

Medical school so far has been disappointing. Hopefully we'll actually learn to do this job in residency (surely we'll have to learn by then....... right?)

But I think it's less the attendings and more systemic factors (CMS and insurance companies are reimbursing less, patients don't want trainees practicing on them, lawyers having a field day, etc).

It sucks, but I have friends at everywhere from VCOM to hopkins and it seems it's like this everywhere. People just expect interns to show up utterly helpless now on July 1st. It is what it is, just pass your shelves/step 2 so you can get the residency you want. Stop worrying about clinical experience.

I don’t think this is entirely true. I suspect you’ll find your sub-I and 4th year rotations with significantly more bang for your buck, eg once you’ve settled on a specialty. For one you likely don’t appreciate your learning curve in MS3 - my experience is most don’t until they are an M4 and are sheparding the new M3s. The same goes for the learning curve intern year. Sometimes it can feel you are just treading water and not really taking anything in. But boy did I see how much I had grown when I started PGY2 and saw the new interns. And honestly my 1st year in practice was incredibly stressful as I learned to be an attending. By the 2nd year I was much more comfortable in my role and it was easy to reflect on how much I’d grown.

Medical training is a funny thing. The days are long but the years are short. In a few years you’re going to look back and it will seem like time has flown. So much of what we learn feels as though it is almost by osmosis. Pattern recognition happens by seeing the same things over and over. That senior resident or fellow or attending who “just gets a hunch” or feels a patient isnt quite right and then it turns out they were about to crash even though they didn’t seem that sick… what we call intuition is really just your brain operating on a different level beyond the kind of conscious thought and memorization that you initially use in these first years of your training.

I know you don’t really see the forest for the trees yet. But there is a method to this madness, I promise. I’m am about to hit my 5th year out in practice, so while I’m not exactly a fresh grad, I am still close enough to my training years that I feel I am not hopelessly out of date when I make that statement. I still remember how it feels to be the new M3 on the service, what my 4th year rotations were like, the anxieties of intern year etc. Medical training has not radically changed since I have finished it, so I feel safe in saying that for almost everyone, it can be hard to really grasp how you are being shaped to think during these early years, and then how one day it will hit you that things that once seemed difficult have become second nature without you realizing it.

 

[RangerBob]

It is obgyn

Yeah, ob-gyn is generally horrible/malignant rotation at any school.

OB's in general also seem more hesitant to allow trainees to take part in the treatment of their patients-- likely for a number of reasons, but I suspect their ridiculously high liability risk is among one of the reasons.

A lot of community docs don't really like teaching because they're usually not paid for it. Academic attendings are (though we can argue about whether they're paid enough), but community docs are typically expected to see private practice volume and yet find time to teach the students, often just for the "prestige."

 

[voxveritatisetlucis]

Yes this all makes sense but I’m at a loss for who I am going to ask to do my evaluations since most don’t seem to want me to see patients or even come up with mock plans.

I feel like I can definitely honor this shelf but the evals much less so. Why would they give me an honors level eval when most of my interactions with them have just been chit chatting

 

[Med Ed]

I feel like I can definitely honor this shelf but the evals much less so. Why would they give me an honors level eval when most of my interactions with them have just been chit chatting

Have you ever had a conversation with an M4? Because this is all pretty basic stuff.

Sometimes you work your fingers to the bone, learn a ton, and land a P. Sometimes you do very little, or spend an entire get an entire rotation being yelled at, and get an H.

The number one student complaint about M3 years is that grading is overly subjective. Faculty will tell you that 90% of the students are interchangeable in terms of performance. This is why a lot of weight is put on the shelf exam, which is the only objective measure of knowledge. So your job is to make nice with your superiors during the day and then study for the shelf at night.

Also, Step 2 is basically a composite of all the shelf exams, so you're killing two birds with one stone.

Finally, you previously mentioned ob/gyn as a potential specialty of interest, presumably because of the surgical aspect. I hope this rotation has been enlightening.

 

[SurfingDoctor]

I was written up by a student for giving them feedback on their presentation. Apparently they thought I was mean. I’ve never given a student feedback since.

Yeah, if you ever think about giving feedback… don’t.

Just gamma knife that little neuron that gave you such a terrible idea and that way you don’t ever have to worry about it again.

 

[Hzreio]

My dearest MS3. You think someone suggesting something as a possibility to consider, a gentle offer of insight, as toxic? Life is going to be hard for you friend if you can’t differentiate when someone is genuinely trying to help you with non-positive feedback vs being toxic.

Who talks like this like seriously? This is an internet forum chill out lmao

 

[LucidSplash]

Who talks like this like seriously? This is an internet forum chill out lmao

Welcome to SDN. Your first time?

For clarity, the answer is: mature adults.

 

[ChordaEpiphany]

I was written up by a student for giving them feedback on their presentation. Apparently they thought I was mean. I’ve never given a student feedback since.

Wow. One of my favorite things about surgery is that the feedback is immediate and blunt. It's literally how learning happens and why we pay $$$$ and time to train. Feedback is for course correction, and at its core the number of cycles of this feedback-correction is what determines the quantity of training. It's why all of clinical medicine values volume and experience.

Until the PAs become the "attendings". A senior resident is superior to PA. You were resident at one point. Pay it forward. Save our profession,

PAs fill a different role, especially on a surgical service, and are likely more useful to an established attending. A senior resident is training to be an attending. They need to learn to make every tiny decision, from pre-op/post-op management to every single bite taken in the OR. That means the attending has to wait for the resident to make each of these decisions and provide feedback. Also, residents are better clinicians, but have less experience on that service. On my last sub-I my senior was on her 3rd month of that sub-specialty. The PA had been there for years, doing month after month after month on that service. She has incredible institutional knowledge and knows how to push things forward. If I have some undifferentiated surgical problem I know which one of them I want in charge of my care, but an attending doesn't require another highly-trained clinical mind. They require a stable employee who crunches through the day-to-day work without requiring feedback-correction.

That distinction is exactly why PAs don't replace residents and fall behind residents clinically in just a few years. However, they are more useful because they have more institutional knowledge and don't require the burden of teaching or involvement in attending-level decision making.

 

[LucidSplash]

Wow. One of my favorite things about surgery is that the feedback is immediate and blunt. It's literally how learning happens and why we pay $$$$ and time to train. Feedback is for course correction, and at its core the number of cycles of this feedback-correction is what determines the quantity of training. It's why all of clinical medicine values volume and experience.

PAs fill a different role, especially on a surgical service, and are likely more useful to an established attending. A senior resident is training to be an attending. They need to learn to make every tiny decision, from pre-op/post-op management to every single bite taken in the OR. That means the attending has to wait for the resident to make each of these decisions and provide feedback. Also, residents are better clinicians, but have less experience on that service. On my last sub-I my senior was on her 3rd month of that sub-specialty. The PA had been there for years, doing month after month after month on that service. She has incredible institutional knowledge and knows how to push things forward. If I have some undifferentiated surgical problem I know which one of them I want in charge of my care, but an attending doesn't require another highly-trained clinical mind. They require a stable employee who crunches through the day-to-day work without requiring feedback-correction.

That distinction is exactly why PAs don't replace residents and fall behind residents clinically in just a few years. However, they are more useful because they have more institutional knowledge and don't require the burden of teaching or involvement in attending-level decision making.

So… all of this really only applies to places that have trainees. In reality, the vast majority of hospitals do not have trainees or may only have them in a very limited capacity for certain services, usually FM residents. Only 5% of US hospitals are major teaching centers. While tertiary referral centers are a vital part of the system, in reality the majority of medical care and surgery occurs outside of these places.

PAs and NPs fill a vital role in the context of team-based healthcare outside of academia, but yes are being used at times in inappropriate ways IMHO, but much less commonly in surgical specialties.

There are plenty of threads on this subject so we don’t need to devolve this thread as well, but your perspective is limited to your training environment, which is typical for your stage of training. At most hospitals in this country, NP and PA providers don’t replace residents or “become attendings.” There simply are no residents and they do a critical job because it’s pretty tough to answer all the pages and write all the notes and do all the operations simultaneously in community surgery practice.

 

[voxveritatisetlucis]

PAs and NPs fill a vital role in the context of team-based healthcare outside of academia

At least at the hospitals I rotate at, mid levels are expected to see 6 patients per day whereas attendings (non surgical) generally see 20-25. Not sure how triaging 6 patients helps move things along more than a resident who could probably see 15-20

 

[LucidSplash]

At least at the hospitals I rotate at, mid levels are expected to see 6 patients per day whereas attendings (non surgical) generally see 20-25. Not sure how triaging 6 patients helps move things along more than a resident who could probably see 15-20

I will try to clarify because I think you are missing my intended point. I can’t stress enough that you are limited by only experiencing settings where residents exist. It’s normal not to appreciate the scope of healthcare outside academia at your level of training because all you observe, as a trainee, are places with trainees. You don’t appreciate that the majority of the US healthcare system does not have trainee involvement.

Again, there are no residents at most hospitals in the US. Like 95% of hospitals are not teaching institutions. In these settings, residents are not losing out to mid-levels because residents don’t train there. It’s not like there are residents who aren’t being allowed to rotate at certain hospital because of the mid-levels. There are way more hospitals than there are trainees and not all hospitals are meant for trainees.

I can speak best to surgical services as I am a surgeon. Will defer to non-surgeons on the utility of midlevels in their practices. For hospital-based surgical practices without trainees, mid-level support is critical for all the items I mentioned previously. Just because the midlevels you observe are only responsible for 6 patients doesn’t mean that’s how they function everywhere. Indeed, hopefully mid-levels are seeing limited numbers of patients where trainees are also present, as you wouldn’t want to dilute the training experience of the residents. On surgical services where there is no resident or fellow presence, PAs or NPs will first assist in the OR, handle orders, handle discharges, communicate with other specialties for routine issues, handle nursing calls, field initial consults and staff with the surgeon, manage office issues, see routine post ops or yearly surveillance visits, etc. Outside of academia, a midlevel greatly improves the efficiency of a surgeon and quality of life. Basically anything they do, a surgeon would have to do if they weren’t there. Without support, I’d be at the hospital until midnight every night trying to manage all the demands placed on a community surgeon. No thank you.

 

[annoyedpsychiatrist]

Interesting that lately other attendings have reported/written up or w/e as a result of med students. I teach med students and residents, no one has complained about me so far (that i know of, knock on wood). I also try to avoid controversial topics as much as possible and be real with them. Im a pretty brazen guy/super blunt and honest, so im glad that so far i havent had to "tread carefully". Ive had the occasional event where someone may have disagreed with me, but I dont make them feel bad for disagreeing (try not to at least to) I just try to encourage them to see things from another perspective and I attempt to see theirs.

Everyone thinks they have the right answer, and Ill admit that ive been wrong before.

 

[dgdg]

Just learn the best you can, academically and socially.
You'll have similar experiences to come, but don't let that stop your career goals.

 

[Med Ed]

Interesting that lately other attendings have reported/written up or w/e as a result of med students. I teach med students and residents, no one has complained about me so far (that i know of, knock on wood).

Just wait. Medical education has fallen prey to the same death-by-feedback mentality that now plagues everything.

"Tell us how we did with your purchase of dental floss in the self-checkout lane."

I'm not saying we should go back to the good old days when student opinions went either unsolicited or were outright ignored. But the LCME and AAMC have fomented an environment where everyone's feelings are given equal weight in real time. And the effect is arguably somewhat corrosive.

I have also seen faculty fail to address grossly unprofessional behavior out of a sense of disbelief, which is often coupled with a fear that the institution won't back them up if things get contentious.

 

[guytakingboards]

I will try to clarify because I think you are missing my intended point. I can’t stress enough that you are limited by only experiencing settings where residents exist. It’s normal not to appreciate the scope of healthcare outside academia at your level of training because all you observe, as a trainee, are places with trainees. You don’t appreciate that the majority of the US healthcare system does not have trainee involvement.

Again, there are no residents at most hospitals in the US. Like 95% of hospitals are not teaching institutions. In these settings, residents are not losing out to mid-levels because residents don’t train there. It’s not like there are residents who aren’t being allowed to rotate at certain hospital because of the mid-levels. There are way more hospitals than there are trainees and not all hospitals are meant for trainees.

I can speak best to surgical services as I am a surgeon. Will defer to non-surgeons on the utility of midlevels in their practices. For hospital-based surgical practices without trainees, mid-level support is critical for all the items I mentioned previously. Just because the midlevels you observe are only responsible for 6 patients doesn’t mean that’s how they function everywhere. Indeed, hopefully mid-levels are seeing limited numbers of patients where trainees are also present, as you wouldn’t want to dilute the training experience of the residents. On surgical services where there is no resident or fellow presence, PAs or NPs will first assist in the OR, handle orders, handle discharges, communicate with other specialties for routine issues, handle nursing calls, field initial consults and staff with the surgeon, manage office issues, see routine post ops or yearly surveillance visits, etc. Outside of academia, a midlevel greatly improves the efficiency of a surgeon and quality of life. Basically anything they do, a surgeon would have to do if they weren’t there. Without support, I’d be at the hospital until midnight every night trying to manage all the demands placed on a community surgeon. No thank you.

This 100%. The OP is upset community medicine isn't tertiary academic medicine. That's the point in most cases.

 

[SurfingDoctor]

I will try to clarify because I think you are missing my intended point. I can’t stress enough that you are limited by only experiencing settings where residents exist. It’s normal not to appreciate the scope of healthcare outside academia at your level of training because all you observe, as a trainee, are places with trainees. You don’t appreciate that the majority of the US healthcare system does not have trainee involvement.

Again, there are no residents at most hospitals in the US. Like 95% of hospitals are not teaching institutions. In these settings, residents are not losing out to mid-levels because residents don’t train there. It’s not like there are residents who aren’t being allowed to rotate at certain hospital because of the mid-levels. There are way more hospitals than there are trainees and not all hospitals are meant for trainees.

I can speak best to surgical services as I am a surgeon. Will defer to non-surgeons on the utility of midlevels in their practices. For hospital-based surgical practices without trainees, mid-level support is critical for all the items I mentioned previously. Just because the midlevels you observe are only responsible for 6 patients doesn’t mean that’s how they function everywhere. Indeed, hopefully mid-levels are seeing limited numbers of patients where trainees are also present, as you wouldn’t want to dilute the training experience of the residents. On surgical services where there is no resident or fellow presence, PAs or NPs will first assist in the OR, handle orders, handle discharges, communicate with other specialties for routine issues, handle nursing calls, field initial consults and staff with the surgeon, manage office issues, see routine post ops or yearly surveillance visits, etc. Outside of academia, a midlevel greatly improves the efficiency of a surgeon and quality of life. Basically anything they do, a surgeon would have to do if they weren’t there. Without support, I’d be at the hospital until midnight every night trying to manage all the demands placed on a community surgeon. No thank you.

Clearly, you didn’t get the latest newsletter that the PA/NPs are comin’ for yer jerb!

 

[LucidSplash]

Clearly, you didn’t get the latest newsletter that the PA/NPs are comin’ for yer jerb!

Well, I am a dues paying member of PPP and I do think they are being used by corporate medicine and VC inappropriately in huge number of circumstances, mainly motivated by profits.

Which is why I said it the way I did: they have a vital role in the context of team-based healthcare. I don’t agree with independent practice or even remote supervision. The proliferation of online NP programs with 100% acceptance rate and policies that force NP students to find their own preceptors and don’t verify reported clinical hours is a travesty that has severely diluted the NP pool and the state nursing boards have refused to address it.

But I do think in the context of a team lead by physicians, they have the capacity to be great colleagues with much to add.

But I also said there are enough threads on this topic and we don’t need to derail this thread.

 

[annoyedpsychiatrist]

Just wait. Medical education has fallen prey to the same death-by-feedback mentality that now plagues everything.

"Tell us how we did with your purchase of dental floss in the self-checkout lane."

I'm not saying we should go back to the good old days when student opinions went either unsolicited or were outright ignored. But the LCME and AAMC have fomented an environment where everyone's feelings are given equal weight in real time. And the effect is arguably somewhat corrosive.

I have also seen faculty fail to address grossly unprofessional behavior out of a sense of disbelief, which is often coupled with a fear that the institution won't back them up if things get contentious.

one perk is there really isnt alternative sites for psych here for the students i take, so if the school ever did something to make me upset, then they would only be hurting themselves if they lost the rotation.