Why do you have to do 3 years of IM before you can even subspecialize?

[ProfMD]

---

Members do not see this ad.

Do not be fooled to think hospital administrators lose money on residents. They save money indirectly because they dont have to hire staff at full salaries. You really think they would be increasing residency spots if they were losing money? You are only looking at direct costs but residents/fellows do most of the work to keep a hospital running 24/7/365. IM residents run the hospital in a teaching institution. Imagine having mulitple attendings covering those hours instead of residents on a subsidized $50K a year salary.

Except that attendings bill and residents don't.

 

[W19]

Are the 4-year trained EM docs better than the 3-year ones?

 

[oncology2020]

Except that attendings bill and residents don't.

Still allows for admissions in the evening and overnight by a trainee which can be staffed by attending next morning.

 

[NotAProgDirector]

My proposed medical education model:
--2 years of premed for those that know they want to do med school (allow for 4 years for those that are unsure but absolutely no need to make students take on additional debt and waste time)
---3 years of med school (make basic sciences 1-1.5 yrs..and 4th year can be condensed, besides being a nice break, it is a complete waste of time for the most part)
---2 years of IM residency for those that want to practice primary care independently (no need to force 9 months of elective time for these people) or 1 year of IM + specialty training

Saves several years and lowers debt and allows people to start making a decent salary at a normal age. We already have the most rigorous licensing and board exams in the world--we are constantly tested at a high level at every step from the MCAT to the 4 USMLEs to board exams and recertification exams. If all those exams are doing their job then that should ensure quality of doctors produced isn't negatively affected.

I'm a bit late to the discussion. I agree that the current model is overkill. I'd favor 2 years of core IM training + specialty / 1 year Hospitalist / 1 year primary care. I disagree that the "electives" aren't helpful for PC -- I think it's critical that PC docs learn from specialists so that they can manage some things on their own, rather than just referring everything. But it's this way because "that's the way it is", and I don't see any easy way to change it.

 

[Neopolymath]

Do not be fooled to think hospital administrators lose money on residents. They save money indirectly because they dont have to hire staff at full salaries. You really think they would be increasing residency spots if they were losing money? You are only looking at direct costs but residents/fellows do most of the work to keep a hospital running 24/7/365. IM residents run the hospital in a teaching institution. Imagine having mulitple attendings covering those hours instead of residents on a subsidized $50K a year salary.

As someone very close to the people directly responsible for starting a handful of residency programs at my large local hospital, I agree. They tell me they are doing it for several reasons, but the main one is financial. An intern works for 50k and huge hours. An NP or PA (in most specialties) works far less than a resident/intern does for at least double the money if not more. This doesn't mention the intangible aspects of becoming an academic hospital system.

I'm sure it's more nuanced than my summary, but it seems like a no-brainer based on how my contact explained it as someone actually at the head of the table at the hospital.

 

[ProfMD]

Still allows for admissions in the evening and overnight by a trainee which can be staffed by attending next morning.

I think you are overestimating the value in that.

 

[Wordead]

I think you are overestimating the value in that.

I dont know the true answer to the question of whether residents are a financial windfall vs a cost, but we (ENT) usually take an attending by to staff 5-15 consults per day that they can bill for (often with a scope exam, which is some $300-400 itself). Takes an attending less than an hour to bill for 10 consults and sign the notes. I can't imagine that not being a significant amount of money compared to time required to see all those consults.

 

[ProfMD]

I dont know the true answer to the question of whether residents are a financial windfall vs a cost, but we (ENT) usually take an attending by to staff 5-15 consults per day that they can bill for (often with a scope exam, which is some $300-400 itself). Takes an attending less than an hour to bill for 10 consults and sign the notes. I can't imagine that not being a significant amount of money compared to time required to see all those consults.

I hear what you are saying.

My only point is that residency programs are not a "financial windfall" for hospitals. They may break even, but hospitals are not staying afloat on the backs of residents.

 

[alpinism]

Are the 4-year trained EM docs better than the 3-year ones?

Fun fact of the day: the first EM residencies back in the 1970s were only 2 years (technically 3 years total residency training if you count the preliminary year beforehand).

The 4 year programs in existence today are for all intensive purposes 1+3 programs that incorporate a preliminary year into 3 years of EM residency training. Like most things in life there are exceptions however nearly all 4 year programs make you spend your first year doing mostly non EM rotations outside the department while seeing mostly low acuity urgent care type patients while inside the department. As a result you don't start seeing real emergency patients till your 2nd year of residency. Based on the above it should come as no surprise then that nearly all "4 year programs" and "3 year programs" have identical board pass rates and produce equivalent emergency physicians.

 

[eteshoe]

Ok thanks for the summary! Helps clarify a lot. My only concern with the current system is it makes IM a necessary 3-year extension of medical school involving general medical training and principles before specializing.

If an MS1 decided to pursue medical oncology no matter what (say because of personal tragedy), they would need to endure 7 years of necessary general education and training before they could even train as an oncologist. Seems rather unusually long, although assuming said MS1 does cancer research throughout medical school and residency, that's 7 years worth of solid productive research.

Imagine being an MD/PhD lol. But it's how the game goes.

 

[Cyberdyne 101]

Fun fact of the day: the first EM residencies back in the 1970s were only 2 years (technically 3 years total residency training if you count the preliminary year beforehand).

The 4 year programs in existence today are for all intensive purposes 1+3 programs that incorporate a preliminary year into 3 years of EM residency training. Like most things in life there are exceptions however nearly all 4 year programs make you spend your first year doing mostly non EM rotations outside the department while seeing mostly low acuity urgent care type patients while inside the department. As a result you don't start seeing real emergency patients till your 2nd year of residency. Based on the above it should come as no surprise then that nearly all "4 year programs" and "3 year programs" have identical board pass rates and produce equivalent emergency physicians.

Is there a difference in competitiveness between the 3 and 4 year programs?

 

[Perrotfish]

I think you are overestimating the value in that.

I am 100% sure what the value of that is, because I have seen multiple programs that lost residents and had to hire PAs or NPs to replace them when the residents could no longer staff the wards. The hospital went from a 70K windfall (the 'tuition' Medicare/Medicaid pays for the resident) to a 120K cost (a midlevel's salary) for the exact same work.

Residents are worth a fortune to the hospital.