Why do attendings at community hospitals hate med students?

[NITRAS]

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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.

Things of changed in medical education.

“If the school ever did something to make me upset. . . ”

 

[Hollow Knight]

There seems to be a disconnect going on in med ed right now- obviously, we all get to sleep more than you older docs did (thank God). I think this is a good thing. Some residencies are still wild though; the general surgery residents I was with last rotation worked 36 hour shifts 2 or 3 times a week. Ironically, they all seemed happy and told me they were in a supportive environment.

I personally would complain of 36+ hour shifts, attendings threatening my career or sexually assaulting me, etc. I'm fine working 80 hours a week as a resident or med student though, that's what I signed up for.

However- I have noticed among SOME in my generation of students a certain amount of, well, lack of professionalism? One of my classmates "filed a complaint" because the attending told him (politely, I was there) to show up to work on time....... etc. Pimping is abuse, etc. I imagine these are where the weird reports on attendings come from. Then those attendings meet people like me who want to be coached/challenged, and I'm disappointed with my learning experience......

I recently started IM. The service uses our notes, and we can do everything but put in orders. It's gonna be awesome. So it seems like I just had a bad rotation and @LucidSplash was right to tell me to chill.

 

[Angus Avagadro]

Lpts of good comments above. What has been mentioned earlier but not emphasized is that 3rd yr med students can be little help to a service or attending they are rotating with. It is very frustrating for both student and teacher. After 4 yrs of college, and possibly an advanced degree, 2 yrs of rigorous pre clinical, they find themselves low on the totem pole and not very useful, through no fault of their own, except lacking experience. 3rd yrs require time to learn basics, history, exam, emr, differential, etc.. Attending are burdened with productivity requirements and documentation. A busy radiologist might have little spare time to spend with a 3rd year. Make the most of every learning experience, even if it is notnthebgreatest environment. Medicine is hard, and some people don't do ...hard.. Keep your head down and remember every encounter provides something to learn

 

[scootad.]

Med students are over-achievers generally speaking. As stated by Angus, 3rd year is unlike any experience they've had before and many people have trouble reacting to being the least useful, least experienced person on the team who is often in the way. It takes some humility to be able to play second fiddle for a hot minute and *get out of the way* when necessary. And yes, it's okay and sometimes necessary to shadow someone more experienced. And to have the ability to read the room, let other more knowledgeable people talk, etc. Many med students have problems with this and it shows. Just know that in time (either later in the rotation or later in the year) you will have the opportunity to be more useful. Need to have some patience.

 

[SurfingDoctor]

It's almost as if a lot of the things you are "educated" on in medical school have little practical relevance to the actual "business" of medicine.

That's the disconnect.

 

[voxveritatisetlucis]

The most frustrating part is how the clinical “grades” are going to be determined. Since we’re basically just shadowing and not rounding or presenting patients, then the assessment basically just becomes a popularity contest and you can’t honor the rotation without honoring the assessment

 

[RangerBob]

The most frustrating part is how the clinical “grades” are going to be determined. Since we’re basically just shadowing and not rounding or presenting patients, then the assessment basically just becomes a popularity contest and you can’t honor the rotation without honoring the assessment

Welcome to M3!

The whole year can be rather arbitrary, and it's best to just accept that's how it will be.

It gets much better. You have to start somewhere low on the totem pole. The first step in an apprenticeship is usually observation. We did that a bit as pre-meds, but without much of a foundation/knowledge background. Now you have the basic medical education to get something out of observing an experienced physician. Ideally they give you some slack on the leash and let you interview patients on your own/present/etc, but unfortunately this varies wildly from school to school and even rotation to rotation. I worked with some students on my away rotations who essentially spent all of their M3 shadowing (more common with DO students who rotated through only community hospitals).

M3 is a long year of complaining about the arbitrariness of grading, of how people get assigned to rotations, about how unimportant we appear to be as medical students, how miserable hours are/how little control you have over them (and your life in general).

M3 gets a lot better when you accept that there are some things you can't change about it. Take it a day at a time and go with the flow. Work within the system you have, because frankly you won't change it in time to benefit you (but do give feedback to help future students).

If your attendings aren't teaching you much, then learn even more on your own.

It will get better.

 

[voxveritatisetlucis]

Welcome to M3!

The whole year can be rather arbitrary, and it's best to just accept that's how it will be.

It gets much better. You have to start somewhere low on the totem pole. The first step in an apprenticeship is usually observation. We did that a bit as pre-meds, but without much of a foundation/knowledge background. Now you have the basic medical education to get something out of observing an experienced physician. Ideally they give you some slack on the leash and let you interview patients on your own/present/etc, but unfortunately this varies wildly from school to school and even rotation to rotation. I worked with some students on my away rotations who essentially spent all of their M3 shadowing (more common with DO students who rotated through only community hospitals).

M3 is a long year of complaining about the arbitrariness of grading, of how people get assigned to rotations, about how unimportant we appear to be as medical students, how miserable hours are/how little control you have over them (and your life in general).

M3 gets a lot better when you accept that there are some things you can't change about it. Take it a day at a time and go with the flow. Work within the system you have, because frankly you won't change it in time to benefit you (but do give feedback to help future students).

If your attendings aren't teaching you much, then learn even more on your own.

It will get better.

Thank you, I’ll try to just accept it but let’s say I get back to back passes, is general surgery basically out of the question

 

[LucidSplash]

Thank you, I’ll try to just accept it but let’s say I get back to back passes, is general surgery basically out of the question

Your grade on your OB rotation will not determine the answer to this question. Now, your surgery rotation grade, that’s another thing entirely.

 

[LunaOri]

People expect OBs to be nice people because pregnancy is often a happy event and patients rarely die. For some reason, though, academic OB attracts some malignant attendings, who torture the residents, who take their frustrations out on the medical students. One attending actually struck me in the OR for moving my hand too close to the field. Ouch! Just get through the rotation and move on.

 

[voxveritatisetlucis]

Your grade on your OB rotation will not determine the answer to this question. Now, your surgery rotation grade, that’s another thing entirely.

So if I got a P in FM, P in OBGYN, if I honor surgery and then get HP on the rest (of course I’ll try for H), would I have a chance assuming decent step 2? What if I got HP on surgery as well?

 

[LucidSplash]

So if I got a P in FM, P in OBGYN, if I honor surgery and then get HP on the rest (of course I’ll try for H), would I have a chance assuming decent step 2? What if I got HP on surgery as well?

It’s been awhile since I matched. I think GS is slightly more competitive than it was 15 years ago, it was middling competitive then, but I still think this is likely reasonable.

 

[voxveritatisetlucis]

It’s been awhile since I matched. I think GS is slightly more competitive than it was 15 years ago, it was middling competitive then, but I still think this is likely reasonable.

Which of the following do you think is the best backup? I like inpatient environments and don’t like monotony. Thank you

Prelim surgery (likely a dead end but would give me another chance, though I don’t know how many people prelims actually get categorical spots)

Neurology (neurohospitalist)

EM (terrible job market)

IM —-> GI/Cards (unlikely since if I can’t match community general surgery then I would have a tough time matching academic IM that is required for these sub specialties. I would hate being a PCP or hospitalist I think)

Anesthesia (unlikely as I don’t have a home program and it’s even harder to match than GS these days)

 

[Med Ed]

It’s been awhile since I matched. I think GS is slightly more competitive than it was 15 years ago, it was middling competitive then, but I still think this is likely reasonable.

This past match there were 237 more GS positions than US MD applicants.

There were over 6,000 more categorical IM positions than US MD applicants.

 

[voxveritatisetlucis]

This past match there were 237 more GS positions than US MD applicants.

There were over 6,000 more categorical IM positions than US MD applicants.

True but most of those 6000 extra slots are community IM programs that basically only lead to being a PCP or hospitalist so basically family med. If you want to match at a program that gives you a fighting shot for cardiology, GI, hemeonc, PCCM then it’s probably somewhat similar to the GS match rate. For example, my school’s IM program has literally never matched a single person to GI and most go on to do primary care or hospitalist

 

[LucidSplash]

This past match there were 237 more GS positions than US MD applicants.

There were over 6,000 more categorical IM positions than US MD applicants.

Yes. I just looked up the charting outcomes data for 2024. There were 237 more GS categorical positions than US MD SENIORS (not accounting for other USMD applicants, which is in a separate table) There were 1,480 US MD seniors. But only 1,070 of 1,480 US MD senior applicants to GS matched to GS. Some of those were likely double applying and using surgery as a backup but not all (and there’s no way from the released data to know). There were 5 total unfilled GS spots (99.7% fill rate) and I guarantee those 5 spots all went quickly in the SOAP. Plus they’ve added 181 categorical positions overall since 2020 but the fill rate hasn’t really changed. 2 programs were on probation but no idea if they filled or not, I did not find the list of unfilled programs with a minimum effort Google.

Pretty competitive IMHO. Unsure how it would directly compare to IM or why that was even brought up. Different applicant pools.

 

[Med Ed]

True but most of those 6000 extra slots are community IM programs that basically only lead to being a PCP or hospitalist so basically family med. If you want to match at a program that gives you a fighting shot for cardiology, GI, hemeonc, PCCM then it’s probably somewhat similar to the GS match rate. For example, my school’s IM program has literally never matched a single person to GI and most go on to do primary care or hospitalist

Then quit.

 

[Med Ed]

Pretty competitive IMHO. Unsure how it would directly compare to IM or why that was even brought up. Different applicant pools.

OP brought up IM. Agree that they are very different pools, so there is almost no utility in gaming out one vs. the other before completing either clerkship.

The ratio of positions to US seniors is just a rough guide to relative competitiveness of specialties. GS is close to parity. For FM it's about 3 to 1, IM it's 2.5 to one, peds about 2 to 1.

For ortho, IR, integrated plastics, etc. the ratio is less than 1.

 

[HuskyMD Emeritus]

1. The community hospital attendings I know, including me, like to teach. Often, we are unable to because we're not given time to teach unless we're on a dedicated teaching service. We often have overbooked patients in clinic waiting for us while we're rounding in the hospital, meetings to go to, too many patients on the service, procedures to perform, unending calls from nurses, unending requests for consults .... and the list goes on.
2. I have colleagues who went to community IM programs who are now subspecialitst in cardiology, PCCM, etc. Just do well in residency, get good LORs. Research and connections can't hurt.

 

[LucidSplash]

Which of the following do you think is the best backup? I like inpatient environments and don’t like monotony. Thank you

Prelim surgery (likely a dead end but would give me another chance, though I don’t know how many people prelims actually get categorical spots)

Neurology (neurohospitalist)

EM (terrible job market)

IM —-> GI/Cards (unlikely since if I can’t match community general surgery then I would have a tough time matching academic IM that is required for these sub specialties. I would hate being a PCP or hospitalist I think)

Anesthesia (unlikely as I don’t have a home program and it’s even harder to match than GS these days)

Honestly, I don’t think these are appropriate questions for a forum with a bunch of people who don’t know you. I don’t think we can give good advice on what else you might enjoy or flourish in because we don’t know enough about you or your personality. I would seek advice from mentors and friends.

 

[Nontrad_FL_LGBT]

True but most of those 6000 extra slots are community IM programs that basically only lead to being a PCP or hospitalist so basically family med. If you want to match at a program that gives you a fighting shot for cardiology, GI, hemeonc, PCCM then it’s probably somewhat similar to the GS match rate. For example, my school’s IM program has literally never matched a single person to GI and most go on to do primary care or hospitalist

You know there are community cards and GI programs, right? You don't have to go to Harvard to scope people.

Have you considered that most people going to your lower ranked school probably don't have both the scores and the interest in sub specializing and are happy to be PCPs or hospitalists? Like attracts like, you're the odd one out in this situation. DOs get into Ortho and Neurosurgery these days, your future is in your hands. You have got to figure out how to stop spiraling over nothing, my guy.