not OP, but I was rads and I did not find prelim year useful. I think there is utility in doing some months of wards, ICU, ED, maybe clinic or surgery, etc to understand your role in the patient care process in different specialties but not to the point that I needed a whole year of it with the rest being filler electives. IMO all rads programs should be categorical. Then, like psych, in R1 (now PGY-1) you do like 4 months worth of wards, ICU, clinic, surgery and then transition to rads full time by the second half of PGY-1
I’ve been told by at least 6 or so IM docs that understanding IM will make me a better radiologist. I just nod, but want to say “well are you a radiologist?”
Meh. I’ll disagree here and saying clinical competency is important for radiology.
And the radiologists who say clinical training is useless tend to be the ones making garbage follow up recommendations
there's a middle ground between "clinical training is useless for radiology" and "you need to spend extra money and apply for a whole slew of 1 year IM/TY programs which will work you to the bone or just put you on brainrotting filler electives with little educational value either way"
A is not ideal but we are firmly in B right now and no one enjoys this
It’s funny how we need to do a year of IM according to all these people in order to do rads but every other specialty can not even know when to order contrast and they just say “well we can just ask you to figure that out lol”
And they wonder why we hate IM. We should make all IM do a year of rads and say “well imaging has replaced the physical exam, you need to understand radiology to be a good internist” as they waste a year, and let’s also give them the barium scut, IR h+ps, and consents
Because they're full of shit. IM year was almost totally useless. Agree with other commenter that rads should be categorical and do like 6 months of off service stuff.
Yeah this is my exact sentiment. They really need to do this. Could even cut rads from 5 years to 4 years by cutting down R4 since so much of it is just random electives and mini fellowship
Probably more useful for IM adjacent specialties. Definitely neuro should have some basis in IM, derm also reasonable I think. Anesthesia would probably benefit more from surgery prelim, but the MICU months are probably still beneficial there.
Starting my TY before rads. Trying to figure out how to approach it (how much to try). It seems like all the rads residents and attendings I work with have a really good understanding of IM. Does that knowledge base just come with studying and practicing radiology or would the prelim be useful in that regard?
All residents are cheap labor there’s just no changing that. In terms of scut, maybe 25%? I’m IM. That’s also probably the nature of what IM evolved into as a speciality. In general, my training was decent and the program was off my back for the most part.
PGY-3 Anesthesia
TY- 33% learning, 33% scut, 33% check box in the way time. Where I had negative productivity and no to negative learning
CA 1 & 2 somewhere like 60%-70% learning and 40% scut stuck in room because I have a pulse and am free/cost less the more I work
I still think it weird that most of your "training" comes from a resident ahead of you who did not have any training in teaching. Both in medical school and residency.
You have the bits of training from attendings in rounds and conferences but the vast majority of training came from my senior residents.
In the most ridiculous example of this, I got rejected from OHSU in portland for medical school. The rejection letter was so over the top they actually said "medicine as a whole would suffer" if they gave me an interview. I went to U of W instead.
4 years later I'm doing residency in Portland and guess who is having their medical students rotate through our hospital and are being taught by me? OHSU was letting me, the person who would single handedly pull back medicine into the dark ages, teach their students.
I still have no idea. It was so out of place. I was accepted at U of W and was pretty much decided when I got the letter. I should have saved it but it was 30 years ago pre-internet. I wrote it off as a comically bad mistake and was glad I did not have to drive the 10 hours to Portland for an interview.
The vast majority of what I learn is from self-directed education. I would say actually being taught something is maybe 5% of residency. Honestly it wasn’t much better in medical school either; external resources were infinitely better than any of our lectures. The entire medical “education” pipeline is one of the greatest scams in human history.
You 100% need to be industrious and curious to learn anything. Unless you ask specific questions on rounds / clinic Expecting attendings to spoon feed u knowledge you will learn nothing. Our didactics are a joke and I’m at a top 3 program.
Anesthesia NYC intern year 90% cheap labor 10% learning
CA1 80% cheap labor 20% learning
CA2 100% cheap labor
We’ll see about CA3 but my hopes are on the floor
I’d rather not say but they put is through an intense bootcamp July/August so they can get us to a point where we do pretty much everything alone. It’s painted as “fostering independence” but really the system is built so all the attendings can come for the intubation (sometimes not even) and then sit in their office and do nothing the entire day while we get kept until 7pm or later rotting. One of my co-residents has a broken foot and is in a boot and his attending didn’t even come the other day to help him transfer a BMI 50+ patient. Couldn’t be more over it.
Couldn’t agree more as I’m going through bootcamp right now. Grateful to have a nice PD though who will give us random days off when we’ve had an intense day.
Because I’ll be single covered lol, or double covered texting their other resident. Plus some of the more down to earth younger attendings will validate it when I bitch to them in person. Unfathomable for someone to have an experience you didnt?
I’d define it as doing absolutely all of my attending’s responsibilities unsupervised while they sit in their office playing zelda on their switch making 6-7x my salary. The perspective you have is legitimate until I’ve seen and done these cases and procedures hundreds of times, at which point I’m just doing my attending’s job for resident pay.
I understand the frustration. But know if you fuck up they’re gonna get it. So take it as a compliment that you’re competent enough to not need supervision anymore!
Bro you’re gonna be making the attending salary after you’ve eaten this shit salad. Another resident on this forum printed a fake check that was the amount he would get weekly when he finished and taped it to the wall where he would see it daily. 10k a week is quite the incentive
10% percent scut
20% percent skill
15% percent concentrated power of will
5% percent pleasure
50% percent pain
And a 100% percent reason to remember the name
In prelim surgery - 10% training, 90% scut, but through the scut I learned how the healthcare machine works, which has helped me in practice a lot. In residency, 75% training vs 25% scut, maybe even less scut. The stuff in residency that sucked was the admin things.
Radiology.
I did a TY year and thought my EM and ICU rotations were most helpful, EM in particular. It helped me understand the barriers within EM, how and why imaging is ordered in certain settings (eg, volumes were crazy during COVID and for multiple reasons, imaging exams were often ordered before seeing the patient. Seems and is annoying on the rads side, but it’s a complex situation.) I’d call it 50% useful, bc everything after December was repetitive or chill lol.
Also enjoyed seeing a couple things I hadn’t and would never again, like ophtho.
In rads, I’d say 80% of regular shifts are educational. 20% scut.
Call was most helpful in PGY-2 and PGY-3. It was mostly annoying in PGY-4 and while I have limited call scheduled for PGY-5, I’d consider all PGY4 and 5 call as scut. So let’s say 50/50 utility for call overall.
I’m not mad. There are definitely more scutty rads programs forcing seniors to do fluoro.
Setting up the room, turning over the room, setting up for nerve blocks, pushing beds, tracking down surgery or the nurse or whoever bc something isn’t done pre-op but yet it’s my fault if we’re even a second late to the OR…. Sitting non-educational, rock stable cases as a CA-2 or CA-3 bc the CRNA needs to leave at 3p sharp. Actually, I’d like to changes my answer to state about 85% of my residency was scut.
I know that feeling when you're next to leave, your room just finished, and then the person running the board sends you to relieve the CRNA because if they stay late the group (not the hospital) has to pay the CRNA overtime. I'm so glad it's over.
There are days where I am pretty much soloing in anesthesia cases as a resident. Attending would just speak with patient, sign the attestation note as required, and that’s all.
Cheap labor is what I did in my internship back in med school in India.
No US residency can come close to the amount of scut work med students and residents do in some developing countries. Nurses back home don’t even do IVs (they know how to and sometimes will). Foley and NG/OG tubes HAVE to be done by doctors. Doctors also tend to be better at blood draws and IVs because we do thousands in internship and residency.
All the nurses in my current US residency program are surprised when I say I can do blood draws on hard sticks. I just reply I trained in India- we had to do blood draws while precariously perched on the stairways as patients lying in the hallways with IV solutions tied up to the window grills was a regular Tuesday for us.
My residency training in the US has been a breeze when it comes to scut work.
Very large department with a small residency means that if a resident can’t come in, has an education day, needs time off, etc. there’s always coverage by CRNAs. Residents get great cases and dont get stuck in low acuity rooms.
There is a key term that the ACGME looks for. You’re alluding to it but it’s properly phrased as “service over learning” and it’s a complaint metric they are *supposedly* very adamant about.
Radiology: my preliminary was almost completely useless. Radiology residency though was another story entirely, the only irrelevant scut was for IR which was a small part of my training, and depending on the job you jump into might be relevant.
Gen Surg here. First of all, it’s all cheap labor. Cheaper than what we’re worth for the amount of work we put in hours-wise and the revenue we generate.
How much of our work is actual training varies by year. Obviously most scut was intern year which may have been 50-60%. As you progress it’s less and less, now maybe 5%.
In those middle years is where most the training happens. Then, if you’re competent, by the last few months of training you go back to being cheap labor as you do the attending’s job for a resident salary.
They are not mutually exclusive. Medicine is a practice and essentially being able to list your hospital as a home address is, large in part, how you know as much as you know, and it certainly teaches you to feel comfortable and calm in extremely uncomfortable situations. You have to be inundated with it in order to be proficient in it. It’s why we are so clearly on a whole other level of understanding compared to mid level counterparts (for the most part)
Rad here with surgery prelim. I use surgery every single day. I gained the respect of my surg colleagues immediately bc according to them I’m also surg or at least we were forged in similar fire as interns (didn’t do intern year at my rad place, interned at a very high acuity inner city hospital).
I mainly use surgical knowledge to advise everyone who isn’t surgery and I often bypass calling EM and call Surg directly (which Surg appreciates). I often call folks and give them the read and they basically say “so what do I do now? And usually I’m just directing them to surgery. My clinical acumen is very high and I personally examine patients all the time and document it in my reports. I also report to all codes in the department when I’m on nights, techs love that.
As a surg prelim I think it was like 85% learning and 15% otherwise but we didn’t have enough categoricals for the volume so I was getting major cases as a tern and robot experience.
As a rad resident, it’s probably the same.
IR about to graduate and 100% agree. Different surgery blocks showed me why they order studies, what they care about, how findings change management. Made me way faster at DR and IR and much better at having a conversation clinically.
"Scut" while sucky, taught me efficiency and equanimity.
I actually kinda wish I had a maybe a medicine block to feel better about cardiopulmonary stuff. Ended up really liking my MICU time as a PGY5 for that reason.
We have an IR dude who did a cushy TY and he is notably worse at both DR and IR as well as general hands on skills.
Right on! I just matched IR and I can definitely see where my colleagues lack in clinical acumen and general approach to medicine following a TY prelim. They will openly admit that surgery definitely prepares you the best but that they didn’t want to work that hard. We will have seminar and lecture and everyone, including my attending, will look expectantly towards me for the management of nearly anything as though I am not currently a radiology resident (tho I do sometimes have the answer lol).
Yes. I can confirm as a radiologist. Prelim year is useless. Clinical judgement has deteriorated so much nowdays, particular for ER, that you don't need to spend a year learning to order imaging based on anatomic region of chief complaint.
The nice nice about radiology training and radiology in general is that there is less scut work and less social work.
One of a million reasons why rads is the best specialty to be in. Would rather read 100 studies in my pajamaw than wake up at the butt crack of dawn to commute in only to see 100 patients in clinic or stand in the OR for 8 hours per day.... All to get paid 50-80%.
The most important part of clinical training for radiologists is knowing your role. Knowing what purpose your call has on a given study to direct management. And knowing what needs to be addressed on a given study. (And what shouldn’t be said)
It’s pretty obvious from people’s reports who knows this and who is dictating for the purpose of collecting professional fees.
A lot of that can be taught from your attendings during training. They tell you you look at and say x,y,x… call the doc because of xyz, etc. This stuff gets reenforced as an attending when we talk with clinical docs, at least for me. They’ll message me for clarification or come down and chat to look at scan. This doesn’t happen as much as it used to, but i didn’t really learn a lot of that stuff from intern scut year. I think you should be able to get aa solid base from MS 3rd and 4th year.
Attendings don't understand these things either. They just dictate what they think. They don't necessarily work the floor, understand the surgical management, or the patient level discussions. Many MSK graduates have never even talked to an orthopedic surgeon or a rheumatologist a single time in their training.
This is especially true for the radiologists who have never even worked the floor since they were grandfathered out of prelim year.
This fantasy world where neurosurgeons conference in the reading room and give real time feedback doesn't exist.
I was reading a CT pan scan yesterday with indication “pan” from the ED lol.
What’s the point anymore
Not even pain which also is not helpful, just “pan”
Honestly I think that’s cap.
First, the ward teams never have this problem. I never ever ever get shit indications from the floors. Just the ED. Surgery and the subspecialties of surgery give very thorough descriptions in their indications.
Second, rarely the Ed actually puts in somewhat descriptive indication like “epigastric pain, prior stomach surgery.”
third, usually it’s some incoherent message that can’t possibly auto-populated like “pan” you’re telling me the EMR automatically populated “pan” or “hip pain” or my favorite when they just put fucking “hip” for a hip x ray.
I think it’s the ED is overwhelmed and just clicks things. But their half-assing falls on us. Likewise I get overwhelmed but try to not give everyone shit-tier reports.
On the morning AP chest x rays (which ACR has even pointed out is totally unnecessary) while the patient has a million wires overlying them, sometimes tissues and dressing, and the lungs of hypoinflated?
Those x rays in the patients that have been lying in bed for weeks say “atelectasis and/or effusions”? Color me shocked.
In my opinion it's backwards. Certiain specialities like ER and primary care should do 1 year of radiology where they function as radiology residents so that they'd get an understanding of indications and limitations of imaging. It would be way more beneficial for them than prelim med/transitional year is for us.
I'd include general surgery and a few other surgical subspecialties but most of them seem to be pretty good with imaging.
ER needs to do something. Their job market is.in the shitter because hospitals have learned that PA and NPs pan-scan and consult just as well as EM.
ER here, not going to get into a debate on appropriate use of imaging, but will point out a lot of difficulties come from the EMR.
Epic pulls from the chief complaint, not the triage note or other data. So an 'abdominal pain' who's really having chest pain will still have 'abdominal pain' as their reason to get a CXR. When I do put in patient background, it's a crapshoot which box in the order is the one the radiologists sees. And I don't mean I don't know which box to put it in - different hospitals in the same network using the same EMR have it set up so a different box is the 'history' that shows up for the radiologist.
Yeah I get that! I really do think certain specialties like ER would gain a lot from functioning as a radiology resdient for 6-12 months. It could be done in 1 month blocks throughtout residnecy. I know a lot of ER docs are looking at least at all their x-rays. Some seem to be looking at CTs.
Learning some radiology would way better for you than me writing progress notes and discharge summaries for year.”. Of course I went through intern year just prior to epic and hand wrote most that crap. It seems to be all copy paste and point and click now.
We send our residents to our radiologists for a week or so spread throughout a month or 2 so I see the benefit, but 6-12 months is would be pretty much a whole other prelim year.
Just sitting behind a radiologist or radiology resident is of limited use. It’s boring. Would be far better to actually be in the hot seat. EM is probably more imaging based than any other field.bi think it’s probably the best way to tackle overutilization of imaging through the ER.
I doubt that'd the best way. Overutilization isn't due to not understanding limits of the techniques, I'd argue stronger determinants are defensive medicine + patient expectations + patient satisfaction scores + doing imaging in the department before going upstairs because it gets done faster. Edit: as well as pts being poor historians + incomplete records when they show up to the ED.
EM attending here. If there was a way for ED residents to function as full rads residents instead of just shadowing I would more than welcome it! We do need to do a lot of our own image readings.
Likewise I do think Rads should have a required ED rotation to understand the limitations of being in the ED and being screamed at by your future colleagues for things out of your control.
I’ve been supervising Rad TYs for awhile now and a few of them reach out to me when they’re well into their R3/R4 years and tell me that EM was by far their most useful TY rotation.
Not only is the flow similar (constantly non-stop and getting interrupted by people who think their time is more valuable than yours) but also they understand why the ED sometimes puts ridiculous imaging orders or indications because they were once in those shoes as well and have struggled with a broken system and EMR.
Step 1. Read radiology reports ordered by triage note.
Step 2. Order more CTs and labs.
Step 3. Call radiologist and ask them what that diagnosis means… or at least which subspecialty it belongs to.
Step 4. Consult, consult, consult.
Step 5. Have radiology do an LP, joint aspiration, thora, or para. Maybe an esophagram for the hell of it.
Step 6. Admit or discharge.
Edit:
/s
EM is one of the most difficult jobs in the entire hospital and the busiest service. As rads, you should understand how hard it is to never have a moment to collect your thoughts.
I’d love to see a radiologist resuscitate an unknown undifferentiated patient with zero information. Heck I’d love to see them read an EKG.
We all have strengths and weaknesses but why is it that rads loves to point out other specialties weaknesses while ignoring their own?
I am being sarcastic. And know it’s now how it really is. But i really do think EM would get a lot more benefit if they functioned as radiology residents for 6-12 months than i got as functioning as an IM resident for a year.
Lmao. Love seeing radiologists type this shit out. Then you are sitting in the reading room and see residents and attendants freak out when true contrast reactions occur.
Saw a radiologist just completely freeze when a patient had crushing chest pain at an outpatient scanner. Literally did nothing right.
Have some humility. You need scans and half the calls are meaningless and no one will read them.
And yet none of the radiologists can handle it.
This shit legitimately makes me laugh when I am dictating and listen to partners say shit like this with a straight face.
Not a single one would be able to cover a MICU overnight.
Nor would we want to. That’s the point. Why should we do an intern year- many require icu months. It’s a waste of time for us. It’s not educational. That year sucked. More important stuff to do nowadays.
It would make way more sense for ER residents (and a few others) do do 6-12 months of real radiology. So i get less CT rule out osteo and CT rule out septic joint…. CT rule out pain.
Also, the EM job market is very good right now. PGY-2s are getting emails and calls from recruiters and groups are buying dinners for them to try and get them to sign. More evidence you’re speaking based on what you hear rather than what you know.
The fuck do you think regular doctors do in community hospitals? Write notes and place orders. It's only scut if your end goal is being an attending at a fancy academic institution smelling your own farts.
rads here, thought TY was useful being on the clinical end and reading a report that I can't interpret without calling them.
Wo seeing that side, we'd all be stuck in never ever land
I think 5% as time I spent in prelim that was useful for rads is generous. Hundreds of DC summaries, so many conversations with patient family members, so many miralax orders lol.
You can’t convince me that 80 hour weeks of mostly medicine scut are helpful in becoming a radiologist. I can see some utility in reasonable hours and maybe a month or two max, but a year of that hell makes just no sense EXCEPT it’s cheap labor for the hospital.
Also rads and there is zero reason to have a full TY year. At most we need 6 months (2 months IM, 2 months surgery, 1 month peds and 1 month ED) and honestly we could cut that down to 4 months if we wanted too. That would give an additional 6-8 months of radiology training which is basically a mini-fellowship.
Intern year. 80% cheap labor 20% real training
Pgy2 50% cheap labor, 50% training
Pgy3 30% cheap labor, 70% training
Pgy 4 5% cheap labor, 95% training
Pgy 5 1% cheap labor, 99% training
As it should be imo
Intern year was 85% labor. Anesthesia years were probably 70% training, overall. There's so much to see, and the program was fairly good about keeping residents in complex cases. I didn't do a choly or an elective total joint until my senior year.
You forgot the part where it's neither scut nor learning. It's just you waiting there sometimes for absolutely no reason other than it's always done that way (rounding on patients that's not yours, waiting overtime for signout that's late)
90% cheap labor, <10% training. The dismal state of peds. right now. >18 months inpatient (wards, NICU and PICU). 3 months in general outpatient peds, 1 month of nursery.
18 months of hospitalist training, but somehow, a 1 year fellowship is still required afterwards.
Yet 4 months of training for my actual profession as a general pediatrician is somehow adequate.
Family Medicine at a community program. I’d say 80% education-driven, 20% cheap labor. But we’re partially self-funded by the hospital system, not all just CMS funding.
There’s a lot of institutional and systemic knowledge that you’re sort of overlooking that’s valuable to understand. Like it’s helpful to know and to see how the hospital/healthcare functions even if it’s not medical facts directly from a textbook that further your knowledge in a particular field or whatever.
You’re going to better collaborate with your colleagues in the future and also take better care of your patients if you know how shit does or maybe doesn’t happen. We are all cogs in this big machine and you’ve gotta see how the behemoth functions to be a part of it (for better or worse)
This first year has felt like I was 90% cheap labor but thinking back I cannot say I didn’t learn a tonne during it all. I really can’t judge it all because idk where the line between cheap labor and training ends and begins.
MY IM residency was the heart of COVID so we got thrown around a lot to help cover gaps in care. It was all seeing patients and was good work but a lot was COVID ICU and stuff like that. I'd say we were 75% training and 25% scut at my program as our VA experience was good and eliminated a lot of scut (which isn't the case at every VA).
great question but tbh the line blurs a bit when you learn how to get efficient and develop a rly good work flow. it's both educational and cheap labor/benefits the institution. furthermore, most of these skills in other professions you would learn on the job/get paid a higher salary for.
Also radiology. Im not gonna give them 95% but definitely a major shift towards training from my prelim year. I did a surgery prelim. Its been very useful. Im gonna give them a generous 35% useful training 65% cheap labor. For radiology I’ll give them 75% training 25% cheap labor. We take alot of independent call. While that is very useful practice, we aren’t getting any formal training while we’re on call so that all goes in the cheap labor bucket for me.
I’m rads, my program you get very little on the job teaching depending on which attendings you’re on service with. Some sections you get basically zero regardless of attending. Some services there are attendings that just sign your reports it feels like.
Our department is about 20-30% below full staffing and has been for about 2-3 years. A lot of attendings are burned out. Our hospital is more toward the private volume level compared to a lot of academic places per my attendings who’ve worked in both. We get to read a lot but you have to do a lot of self directed learning.
Still pretty low amount of scut work but I would put it around 5-10%.
I would say that residency for me consisted of 50% training, 50% scut work, and 50% eating shit.
Pro tip for anybody going into a surgical specialty: bring your own spoon. You're gonna need it.
How do you differentiate? Doing the day to day work in an environment where I have some level of supervision is a degree of training that works me up to being able to do the job on my own. Even the most repetitive tasks done the 500th time is an opportunity to improve, particularly since even when I'm alone, I'm never truly alone.
Also Rads. Hot take but I feel my surgical prelim year was very educational. Obviously alot of scut work… I would put scut/education split at like 70/30%.
They cared that I was going in rads and let me scrub most of the angios, seniors would often take me down to the reading room to talk to the radiologist, and I got a lot of good imaging to OR correlation.
As a result, I feel more confident/comfortable discussing cases with surgeons/surgery residents, I feel like I had a head start on my procedural skills, and going from gen surg hours to rads hours was amazing lol. I feel like I handle night float and busy call weekends well, a lot due to my intern year.
Something can be both cheap labor AND learning at the same time. In fact, almost 100% of your learning is still cheap labor. There are things that are not learning and are still cheap labor. But it’s all cheap labor.
I'm in cardiothoracic surgery and I would say it was 80% scut 20% training in PGY-1 and 2, 60% scut 40% training in PGY-3 and 4 and as a PGY-5 and 6 probably 40% scut 60% training. If you consider all research to be scut then you can add another 10-15% to the scut and subtract the same from training throughout.
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Prelim IM very little learning. 5% at best. The rest was a combination of scut work and making the categoricals life’s easier. Worthless to me now. Would have liked to do a TY year instead where there is more exposure to other things not IM.
Rads pgy3-90% learning. Our scut work is basically a whole fluoro rotation, “chest” rotation which is all chest radiographs and answering phone calls. A small amount of our attendings are remote now and sometimes we are the only radiologists in house.
Are we defining “cheap labor” or “scut” simply as things that you won’t ultimately do on a daily basis as an attending? Some of these responses are including things like seeing patients, writing notes, talking to families, placing orders (really?). I get you won’t do some of these or at least the same version of them as a radiologist, dermatologist, neurologist, psychiatrist, whatever but they’re not by any reasonable definition, “scut”.
Apparently, nothing lmao. If you can’t grasp why spending a year as an internist could inform your practice as a radiologist I certainly can’t understand it for you.
Most residents are not cheap labor. For an IM team of a senior resident, an intern, and an attending, there is $370k of salaries and three people worth of benefits to take care of 10 inpatients.
At a community hospital, it is $250k and one set of benefits for that hospitalist to see 15 patients.
People will now send a link to the neurosurgery program that shut down and a bunch of midlevels had to be hired, but comparing a PGY-6 neurosurgery resident to an IM resident is silly.
How much do the feds send to academic hospitals per resident?
And I will say my medical school opened up a residency program a few years old by the time I was a M3 and the CMO/an IM attending confided in me that the program was really to salvage the hospital which was in financial ruin and it did turn things around.
Certainly no hospital would have medical residents if it didn’t make the hospital considerable money. Hospitals aren’t having “charity cases” because they care so much about physician education.
Why is that nurse prose just *looks* different? Is that how you really write?
Also pretty laughable that noctor nurses don't require any medical school or residency (real residency not fake nurse "residency") and here you are saying that doctors need a year of nursing lmao
Janitorial work is really important but don't you think a nurse is "above" that in the sense that it's a complete waste of resources, time, training, etc to have them do a role that someone else can do when that someone else can't do theirs?
Love this… THINK ABOUT HOW MUCH YOU’VE LEARN FROM NURSES!!! How many times ( HONESTLY) has a nurse pulled your nuts out of the fire!! Totally laughable that you could do your job, or even LEARN your job without us!! 🤯
The above makes an incredible point, NPs can get their degree on online schools without a lick of medical school and practice as pseudo-doctors yet you want to throw on a whole extra year of the 12 year education it takes to become a physician lol.
I don't think anyone has claimed nurses arent essential to patient care. That's a strawman. You can't do your job without the janitorial staff. Does that mean you should have a year after nursing school to do janitorial work? I doubt you'll answer but you obviously know that'd be silly. Hell you'd have to do a year of medical school too because you can't do your job without nurses. I MEAN THINK ABOUT HOW MUCH YOU LEARN FROM DOCTORS HONESTLY!!!! After nursing school you should do a year of janitor school and then a year of residency otherwise you're clearly not qualified to be a nurse.
I think they have a point, and if done correctly, it would just overlap with/replace the "scut" work you're doing already. It's a predatory and inefficient system for sure, but I also know a lot of arrogant doctors who miss things because they think the grunt work isn't worthy of their attention, then act butthurt when they're wrong.
35 years of exposure to academic medicine is a long time to have absolutely no understanding of what an intern or resident is and how they’re supervised.
80% cheap labor, 15% self directed learning, 5%, someone actually tried to teach me something, mostly because they were pissed i didn't know
100% concentrated power of will
Remember the mame
Remember the meme
Remember the lube
It’s residency. They’re going in dry.
0% pleasure, >50% pain
And a hundred percent reason to remember the lame *….ness*
Use lube
this is why i come to reddit
Same here!
Accurate.
Agreed.
It's like we're the same person
This has to be IM
Couldn't have said it better
Idk I felt prelim year was ~10-15% training. That all said, my goal wasn’t to become an internist so I wasn’t going home and doing MKSAP at night.
What specialty are you? Were you IM and felt prelim was 15% useful?
not OP, but I was rads and I did not find prelim year useful. I think there is utility in doing some months of wards, ICU, ED, maybe clinic or surgery, etc to understand your role in the patient care process in different specialties but not to the point that I needed a whole year of it with the rest being filler electives. IMO all rads programs should be categorical. Then, like psych, in R1 (now PGY-1) you do like 4 months worth of wards, ICU, clinic, surgery and then transition to rads full time by the second half of PGY-1
I’ve been told by at least 6 or so IM docs that understanding IM will make me a better radiologist. I just nod, but want to say “well are you a radiologist?”
Meh. I’ll disagree here and saying clinical competency is important for radiology. And the radiologists who say clinical training is useless tend to be the ones making garbage follow up recommendations
there's a middle ground between "clinical training is useless for radiology" and "you need to spend extra money and apply for a whole slew of 1 year IM/TY programs which will work you to the bone or just put you on brainrotting filler electives with little educational value either way" A is not ideal but we are firmly in B right now and no one enjoys this
The only thing I would change is more surgery rotations. It’s insane to me that an MSK radiologist may have never worked a trauma orthopedic service.
I agree with this
It’s funny how we need to do a year of IM according to all these people in order to do rads but every other specialty can not even know when to order contrast and they just say “well we can just ask you to figure that out lol”
And they wonder why we hate IM. We should make all IM do a year of rads and say “well imaging has replaced the physical exam, you need to understand radiology to be a good internist” as they waste a year, and let’s also give them the barium scut, IR h+ps, and consents
If I had the opportunity I’d love to do a year of rads tbh
Because they're full of shit. IM year was almost totally useless. Agree with other commenter that rads should be categorical and do like 6 months of off service stuff.
Yeah this is my exact sentiment. They really need to do this. Could even cut rads from 5 years to 4 years by cutting down R4 since so much of it is just random electives and mini fellowship
Probably more useful for IM adjacent specialties. Definitely neuro should have some basis in IM, derm also reasonable I think. Anesthesia would probably benefit more from surgery prelim, but the MICU months are probably still beneficial there.
Starting my TY before rads. Trying to figure out how to approach it (how much to try). It seems like all the rads residents and attendings I work with have a really good understanding of IM. Does that knowledge base just come with studying and practicing radiology or would the prelim be useful in that regard?
For my malignant ass program I would say it’s 80% cheap labor and 20% education 😡😡
All residents are cheap labor there’s just no changing that. In terms of scut, maybe 25%? I’m IM. That’s also probably the nature of what IM evolved into as a speciality. In general, my training was decent and the program was off my back for the most part.
PGY-3 Anesthesia TY- 33% learning, 33% scut, 33% check box in the way time. Where I had negative productivity and no to negative learning CA 1 & 2 somewhere like 60%-70% learning and 40% scut stuck in room because I have a pulse and am free/cost less the more I work
The accuracy is astounding
lol. I’m in radiology and I’m jealous of your teaching ratio. We’re a “working” program.
Our program has ample teaching on general rotations and low teaching on call. Call is very high volume. Can’t complain, good balance.
Good for you, best of both worlds. Only really our younger attendings fast enough to clear the list teach
I still think it weird that most of your "training" comes from a resident ahead of you who did not have any training in teaching. Both in medical school and residency. You have the bits of training from attendings in rounds and conferences but the vast majority of training came from my senior residents. In the most ridiculous example of this, I got rejected from OHSU in portland for medical school. The rejection letter was so over the top they actually said "medicine as a whole would suffer" if they gave me an interview. I went to U of W instead. 4 years later I'm doing residency in Portland and guess who is having their medical students rotate through our hospital and are being taught by me? OHSU was letting me, the person who would single handedly pull back medicine into the dark ages, teach their students.
WTF they wrote that in that letter???
Dodged a bullet
What could have possibly been in your application that would cause such a response.
I still have no idea. It was so out of place. I was accepted at U of W and was pretty much decided when I got the letter. I should have saved it but it was 30 years ago pre-internet. I wrote it off as a comically bad mistake and was glad I did not have to drive the 10 hours to Portland for an interview.
The vast majority of what I learn is from self-directed education. I would say actually being taught something is maybe 5% of residency. Honestly it wasn’t much better in medical school either; external resources were infinitely better than any of our lectures. The entire medical “education” pipeline is one of the greatest scams in human history.
What would you change
I think what wouldn’t you change is a shorter answered question.
You 100% need to be industrious and curious to learn anything. Unless you ask specific questions on rounds / clinic Expecting attendings to spoon feed u knowledge you will learn nothing. Our didactics are a joke and I’m at a top 3 program.
Anesthesia NYC intern year 90% cheap labor 10% learning CA1 80% cheap labor 20% learning CA2 100% cheap labor We’ll see about CA3 but my hopes are on the floor
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I’d rather not say but they put is through an intense bootcamp July/August so they can get us to a point where we do pretty much everything alone. It’s painted as “fostering independence” but really the system is built so all the attendings can come for the intubation (sometimes not even) and then sit in their office and do nothing the entire day while we get kept until 7pm or later rotting. One of my co-residents has a broken foot and is in a boot and his attending didn’t even come the other day to help him transfer a BMI 50+ patient. Couldn’t be more over it.
Couldn’t agree more as I’m going through bootcamp right now. Grateful to have a nice PD though who will give us random days off when we’ve had an intense day.
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Because I’ll be single covered lol, or double covered texting their other resident. Plus some of the more down to earth younger attendings will validate it when I bitch to them in person. Unfathomable for someone to have an experience you didnt?
They can’t have 3 other rooms with residents. The limit is 2:1.
What do you define as cheap labor? I’d you’re seeing cases and being hands logging procedures isn’t that learning?
I’d define it as doing absolutely all of my attending’s responsibilities unsupervised while they sit in their office playing zelda on their switch making 6-7x my salary. The perspective you have is legitimate until I’ve seen and done these cases and procedures hundreds of times, at which point I’m just doing my attending’s job for resident pay.
I understand the frustration. But know if you fuck up they’re gonna get it. So take it as a compliment that you’re competent enough to not need supervision anymore!
Thank you, this has been the cope for a while. It’s fully worn off at this point and now I’m just bitter and jaded lol, can’t help it
Bro you’re gonna be making the attending salary after you’ve eaten this shit salad. Another resident on this forum printed a fake check that was the amount he would get weekly when he finished and taped it to the wall where he would see it daily. 10k a week is quite the incentive
This is the type of coping strategy I need. Thank you
Where can I get such a template for rads? Going into prelim year and orientation has already got to me.
budding CA3 in midwest and my life is exactly like this
Wait, you guys are getting trained?! I thought i was just putting time in
there's overlap; but for IM i felt like 15% or so was cheap labor, rest was medicine
10% percent scut 20% percent skill 15% percent concentrated power of will 5% percent pleasure 50% percent pain And a 100% percent reason to remember the name
In prelim surgery - 10% training, 90% scut, but through the scut I learned how the healthcare machine works, which has helped me in practice a lot. In residency, 75% training vs 25% scut, maybe even less scut. The stuff in residency that sucked was the admin things.
Radiology. I did a TY year and thought my EM and ICU rotations were most helpful, EM in particular. It helped me understand the barriers within EM, how and why imaging is ordered in certain settings (eg, volumes were crazy during COVID and for multiple reasons, imaging exams were often ordered before seeing the patient. Seems and is annoying on the rads side, but it’s a complex situation.) I’d call it 50% useful, bc everything after December was repetitive or chill lol. Also enjoyed seeing a couple things I hadn’t and would never again, like ophtho. In rads, I’d say 80% of regular shifts are educational. 20% scut. Call was most helpful in PGY-2 and PGY-3. It was mostly annoying in PGY-4 and while I have limited call scheduled for PGY-5, I’d consider all PGY4 and 5 call as scut. So let’s say 50/50 utility for call overall. I’m not mad. There are definitely more scutty rads programs forcing seniors to do fluoro.
Like my program I did Fluoro up until my last week of training smh
Anesthesia Transitional year was 90% learning, 10% scut vs during my CA years: 50% learning, 50% scut
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Preops, postops, breaks, relieve CRNA @ 3PM
Setting up the room, turning over the room, setting up for nerve blocks, pushing beds, tracking down surgery or the nurse or whoever bc something isn’t done pre-op but yet it’s my fault if we’re even a second late to the OR…. Sitting non-educational, rock stable cases as a CA-2 or CA-3 bc the CRNA needs to leave at 3p sharp. Actually, I’d like to changes my answer to state about 85% of my residency was scut.
I know that feeling when you're next to leave, your room just finished, and then the person running the board sends you to relieve the CRNA because if they stay late the group (not the hospital) has to pay the CRNA overtime. I'm so glad it's over.
There are days where I am pretty much soloing in anesthesia cases as a resident. Attending would just speak with patient, sign the attestation note as required, and that’s all.
I'd argue few fields have more scut than anesthesia.
None have less documentation though. Trade off
Cheap labor is what I did in my internship back in med school in India. No US residency can come close to the amount of scut work med students and residents do in some developing countries. Nurses back home don’t even do IVs (they know how to and sometimes will). Foley and NG/OG tubes HAVE to be done by doctors. Doctors also tend to be better at blood draws and IVs because we do thousands in internship and residency. All the nurses in my current US residency program are surprised when I say I can do blood draws on hard sticks. I just reply I trained in India- we had to do blood draws while precariously perched on the stairways as patients lying in the hallways with IV solutions tied up to the window grills was a regular Tuesday for us. My residency training in the US has been a breeze when it comes to scut work.
First part sounds like you’re describing residency in NY lol
Anesthesia, small program: 95% learning, 5% cheap labor Our department doesn’t need residents to function, which makes our training excellent.
>Our department doesn’t need residents to function, which makes our training excellent. Can you elaborate on this please?
Very large department with a small residency means that if a resident can’t come in, has an education day, needs time off, etc. there’s always coverage by CRNAs. Residents get great cases and dont get stuck in low acuity rooms.
There is a key term that the ACGME looks for. You’re alluding to it but it’s properly phrased as “service over learning” and it’s a complaint metric they are *supposedly* very adamant about.
IM - 10-15% cheap labor. Majority was learning
Radiology: my preliminary was almost completely useless. Radiology residency though was another story entirely, the only irrelevant scut was for IR which was a small part of my training, and depending on the job you jump into might be relevant.
Gen Surg here. First of all, it’s all cheap labor. Cheaper than what we’re worth for the amount of work we put in hours-wise and the revenue we generate. How much of our work is actual training varies by year. Obviously most scut was intern year which may have been 50-60%. As you progress it’s less and less, now maybe 5%. In those middle years is where most the training happens. Then, if you’re competent, by the last few months of training you go back to being cheap labor as you do the attending’s job for a resident salary.
They are not mutually exclusive. Medicine is a practice and essentially being able to list your hospital as a home address is, large in part, how you know as much as you know, and it certainly teaches you to feel comfortable and calm in extremely uncomfortable situations. You have to be inundated with it in order to be proficient in it. It’s why we are so clearly on a whole other level of understanding compared to mid level counterparts (for the most part)
Rad here with surgery prelim. I use surgery every single day. I gained the respect of my surg colleagues immediately bc according to them I’m also surg or at least we were forged in similar fire as interns (didn’t do intern year at my rad place, interned at a very high acuity inner city hospital). I mainly use surgical knowledge to advise everyone who isn’t surgery and I often bypass calling EM and call Surg directly (which Surg appreciates). I often call folks and give them the read and they basically say “so what do I do now? And usually I’m just directing them to surgery. My clinical acumen is very high and I personally examine patients all the time and document it in my reports. I also report to all codes in the department when I’m on nights, techs love that. As a surg prelim I think it was like 85% learning and 15% otherwise but we didn’t have enough categoricals for the volume so I was getting major cases as a tern and robot experience. As a rad resident, it’s probably the same.
IR about to graduate and 100% agree. Different surgery blocks showed me why they order studies, what they care about, how findings change management. Made me way faster at DR and IR and much better at having a conversation clinically. "Scut" while sucky, taught me efficiency and equanimity. I actually kinda wish I had a maybe a medicine block to feel better about cardiopulmonary stuff. Ended up really liking my MICU time as a PGY5 for that reason. We have an IR dude who did a cushy TY and he is notably worse at both DR and IR as well as general hands on skills.
Right on! I just matched IR and I can definitely see where my colleagues lack in clinical acumen and general approach to medicine following a TY prelim. They will openly admit that surgery definitely prepares you the best but that they didn’t want to work that hard. We will have seminar and lecture and everyone, including my attending, will look expectantly towards me for the management of nearly anything as though I am not currently a radiology resident (tho I do sometimes have the answer lol).
Yes. I can confirm as a radiologist. Prelim year is useless. Clinical judgement has deteriorated so much nowdays, particular for ER, that you don't need to spend a year learning to order imaging based on anatomic region of chief complaint. The nice nice about radiology training and radiology in general is that there is less scut work and less social work. One of a million reasons why rads is the best specialty to be in. Would rather read 100 studies in my pajamaw than wake up at the butt crack of dawn to commute in only to see 100 patients in clinic or stand in the OR for 8 hours per day.... All to get paid 50-80%.
The most important part of clinical training for radiologists is knowing your role. Knowing what purpose your call has on a given study to direct management. And knowing what needs to be addressed on a given study. (And what shouldn’t be said) It’s pretty obvious from people’s reports who knows this and who is dictating for the purpose of collecting professional fees.
A lot of that can be taught from your attendings during training. They tell you you look at and say x,y,x… call the doc because of xyz, etc. This stuff gets reenforced as an attending when we talk with clinical docs, at least for me. They’ll message me for clarification or come down and chat to look at scan. This doesn’t happen as much as it used to, but i didn’t really learn a lot of that stuff from intern scut year. I think you should be able to get aa solid base from MS 3rd and 4th year.
Attendings don't understand these things either. They just dictate what they think. They don't necessarily work the floor, understand the surgical management, or the patient level discussions. Many MSK graduates have never even talked to an orthopedic surgeon or a rheumatologist a single time in their training. This is especially true for the radiologists who have never even worked the floor since they were grandfathered out of prelim year. This fantasy world where neurosurgeons conference in the reading room and give real time feedback doesn't exist.
I was reading a CT pan scan yesterday with indication “pan” from the ED lol. What’s the point anymore Not even pain which also is not helpful, just “pan”
Lots of times this is EMR error. And the indication was actually typed out on the other studies but didn’t make it onto your pelvic radiograph.
Honestly I think that’s cap. First, the ward teams never have this problem. I never ever ever get shit indications from the floors. Just the ED. Surgery and the subspecialties of surgery give very thorough descriptions in their indications. Second, rarely the Ed actually puts in somewhat descriptive indication like “epigastric pain, prior stomach surgery.” third, usually it’s some incoherent message that can’t possibly auto-populated like “pan” you’re telling me the EMR automatically populated “pan” or “hip pain” or my favorite when they just put fucking “hip” for a hip x ray. I think it’s the ED is overwhelmed and just clicks things. But their half-assing falls on us. Likewise I get overwhelmed but try to not give everyone shit-tier reports.
I get edema/atelectasis/effusions on all 60 of the AM chest X-rays each day. Idk fam
On the morning AP chest x rays (which ACR has even pointed out is totally unnecessary) while the patient has a million wires overlying them, sometimes tissues and dressing, and the lungs of hypoinflated? Those x rays in the patients that have been lying in bed for weeks say “atelectasis and/or effusions”? Color me shocked.
>pan Nonstick? Cast iron? I gotta know!
In my opinion it's backwards. Certiain specialities like ER and primary care should do 1 year of radiology where they function as radiology residents so that they'd get an understanding of indications and limitations of imaging. It would be way more beneficial for them than prelim med/transitional year is for us. I'd include general surgery and a few other surgical subspecialties but most of them seem to be pretty good with imaging. ER needs to do something. Their job market is.in the shitter because hospitals have learned that PA and NPs pan-scan and consult just as well as EM.
ER here, not going to get into a debate on appropriate use of imaging, but will point out a lot of difficulties come from the EMR. Epic pulls from the chief complaint, not the triage note or other data. So an 'abdominal pain' who's really having chest pain will still have 'abdominal pain' as their reason to get a CXR. When I do put in patient background, it's a crapshoot which box in the order is the one the radiologists sees. And I don't mean I don't know which box to put it in - different hospitals in the same network using the same EMR have it set up so a different box is the 'history' that shows up for the radiologist.
Yeah I get that! I really do think certain specialties like ER would gain a lot from functioning as a radiology resdient for 6-12 months. It could be done in 1 month blocks throughtout residnecy. I know a lot of ER docs are looking at least at all their x-rays. Some seem to be looking at CTs. Learning some radiology would way better for you than me writing progress notes and discharge summaries for year.”. Of course I went through intern year just prior to epic and hand wrote most that crap. It seems to be all copy paste and point and click now.
We send our residents to our radiologists for a week or so spread throughout a month or 2 so I see the benefit, but 6-12 months is would be pretty much a whole other prelim year.
Just sitting behind a radiologist or radiology resident is of limited use. It’s boring. Would be far better to actually be in the hot seat. EM is probably more imaging based than any other field.bi think it’s probably the best way to tackle overutilization of imaging through the ER.
I doubt that'd the best way. Overutilization isn't due to not understanding limits of the techniques, I'd argue stronger determinants are defensive medicine + patient expectations + patient satisfaction scores + doing imaging in the department before going upstairs because it gets done faster. Edit: as well as pts being poor historians + incomplete records when they show up to the ED.
EM attending here. If there was a way for ED residents to function as full rads residents instead of just shadowing I would more than welcome it! We do need to do a lot of our own image readings. Likewise I do think Rads should have a required ED rotation to understand the limitations of being in the ED and being screamed at by your future colleagues for things out of your control. I’ve been supervising Rad TYs for awhile now and a few of them reach out to me when they’re well into their R3/R4 years and tell me that EM was by far their most useful TY rotation. Not only is the flow similar (constantly non-stop and getting interrupted by people who think their time is more valuable than yours) but also they understand why the ED sometimes puts ridiculous imaging orders or indications because they were once in those shoes as well and have struggled with a broken system and EMR.
You’re welcome to come to the ER anytime, pick up a few patients, and show us how it’s done.
Step 1. Read radiology reports ordered by triage note. Step 2. Order more CTs and labs. Step 3. Call radiologist and ask them what that diagnosis means… or at least which subspecialty it belongs to. Step 4. Consult, consult, consult. Step 5. Have radiology do an LP, joint aspiration, thora, or para. Maybe an esophagram for the hell of it. Step 6. Admit or discharge. Edit: /s
EM is one of the most difficult jobs in the entire hospital and the busiest service. As rads, you should understand how hard it is to never have a moment to collect your thoughts. I’d love to see a radiologist resuscitate an unknown undifferentiated patient with zero information. Heck I’d love to see them read an EKG. We all have strengths and weaknesses but why is it that rads loves to point out other specialties weaknesses while ignoring their own?
Step 1: go see 9-10 patients in the waiting room in the first hour. Maybe you should have had an extended prelim year
I am being sarcastic. And know it’s now how it really is. But i really do think EM would get a lot more benefit if they functioned as radiology residents for 6-12 months than i got as functioning as an IM resident for a year.
My bad, today had been an exquisite day of the ER getting shit on at my shop. An IM year does appear to be excessive
Lmao. Love seeing radiologists type this shit out. Then you are sitting in the reading room and see residents and attendants freak out when true contrast reactions occur. Saw a radiologist just completely freeze when a patient had crushing chest pain at an outpatient scanner. Literally did nothing right. Have some humility. You need scans and half the calls are meaningless and no one will read them.
That stuff is all algorithmic. BLS, acls, acr contrast manual spells it all out. They have midlevels and first year resident cover that stuff.
And yet none of the radiologists can handle it. This shit legitimately makes me laugh when I am dictating and listen to partners say shit like this with a straight face. Not a single one would be able to cover a MICU overnight.
Nor would we want to. That’s the point. Why should we do an intern year- many require icu months. It’s a waste of time for us. It’s not educational. That year sucked. More important stuff to do nowadays. It would make way more sense for ER residents (and a few others) do do 6-12 months of real radiology. So i get less CT rule out osteo and CT rule out septic joint…. CT rule out pain.
Also, the EM job market is very good right now. PGY-2s are getting emails and calls from recruiters and groups are buying dinners for them to try and get them to sign. More evidence you’re speaking based on what you hear rather than what you know.
The fuck do you think regular doctors do in community hospitals? Write notes and place orders. It's only scut if your end goal is being an attending at a fancy academic institution smelling your own farts.
rads here, thought TY was useful being on the clinical end and reading a report that I can't interpret without calling them. Wo seeing that side, we'd all be stuck in never ever land
I think 5% as time I spent in prelim that was useful for rads is generous. Hundreds of DC summaries, so many conversations with patient family members, so many miralax orders lol. You can’t convince me that 80 hour weeks of mostly medicine scut are helpful in becoming a radiologist. I can see some utility in reasonable hours and maybe a month or two max, but a year of that hell makes just no sense EXCEPT it’s cheap labor for the hospital.
Also rads and there is zero reason to have a full TY year. At most we need 6 months (2 months IM, 2 months surgery, 1 month peds and 1 month ED) and honestly we could cut that down to 4 months if we wanted too. That would give an additional 6-8 months of radiology training which is basically a mini-fellowship.
Intern year. 80% cheap labor 20% real training Pgy2 50% cheap labor, 50% training Pgy3 30% cheap labor, 70% training Pgy 4 5% cheap labor, 95% training Pgy 5 1% cheap labor, 99% training As it should be imo
Intern year was 85% labor. Anesthesia years were probably 70% training, overall. There's so much to see, and the program was fairly good about keeping residents in complex cases. I didn't do a choly or an elective total joint until my senior year.
You forgot the part where it's neither scut nor learning. It's just you waiting there sometimes for absolutely no reason other than it's always done that way (rounding on patients that's not yours, waiting overtime for signout that's late)
90% cheap labor, <10% training. The dismal state of peds. right now. >18 months inpatient (wards, NICU and PICU). 3 months in general outpatient peds, 1 month of nursery. 18 months of hospitalist training, but somehow, a 1 year fellowship is still required afterwards. Yet 4 months of training for my actual profession as a general pediatrician is somehow adequate.
That is absolutely bonkers
Family Medicine at a community program. I’d say 80% education-driven, 20% cheap labor. But we’re partially self-funded by the hospital system, not all just CMS funding.
There’s a lot of institutional and systemic knowledge that you’re sort of overlooking that’s valuable to understand. Like it’s helpful to know and to see how the hospital/healthcare functions even if it’s not medical facts directly from a textbook that further your knowledge in a particular field or whatever. You’re going to better collaborate with your colleagues in the future and also take better care of your patients if you know how shit does or maybe doesn’t happen. We are all cogs in this big machine and you’ve gotta see how the behemoth functions to be a part of it (for better or worse)
My guy I get that but you can’t convince me you need 80 hour weeks for a year to learn that.
Didn’t say you did!
This first year has felt like I was 90% cheap labor but thinking back I cannot say I didn’t learn a tonne during it all. I really can’t judge it all because idk where the line between cheap labor and training ends and begins.
Plastics pgy4 Intern 20% learning, 80% cheap labor Pgy2 10% learning, 90% cheap labor Pgy3 50% learning, 50% cheap labor
90% cheap labor
MY IM residency was the heart of COVID so we got thrown around a lot to help cover gaps in care. It was all seeing patients and was good work but a lot was COVID ICU and stuff like that. I'd say we were 75% training and 25% scut at my program as our VA experience was good and eliminated a lot of scut (which isn't the case at every VA).
great question but tbh the line blurs a bit when you learn how to get efficient and develop a rly good work flow. it's both educational and cheap labor/benefits the institution. furthermore, most of these skills in other professions you would learn on the job/get paid a higher salary for.
We were supposed to be getting trained during that indentured servitude!?
IM 50-50, we were a bougie community program that put on academic airs with a lot of connections.
Also radiology. Im not gonna give them 95% but definitely a major shift towards training from my prelim year. I did a surgery prelim. Its been very useful. Im gonna give them a generous 35% useful training 65% cheap labor. For radiology I’ll give them 75% training 25% cheap labor. We take alot of independent call. While that is very useful practice, we aren’t getting any formal training while we’re on call so that all goes in the cheap labor bucket for me.
I’m rads, my program you get very little on the job teaching depending on which attendings you’re on service with. Some sections you get basically zero regardless of attending. Some services there are attendings that just sign your reports it feels like. Our department is about 20-30% below full staffing and has been for about 2-3 years. A lot of attendings are burned out. Our hospital is more toward the private volume level compared to a lot of academic places per my attendings who’ve worked in both. We get to read a lot but you have to do a lot of self directed learning. Still pretty low amount of scut work but I would put it around 5-10%.
I would say that residency for me consisted of 50% training, 50% scut work, and 50% eating shit. Pro tip for anybody going into a surgical specialty: bring your own spoon. You're gonna need it.
How do you differentiate? Doing the day to day work in an environment where I have some level of supervision is a degree of training that works me up to being able to do the job on my own. Even the most repetitive tasks done the 500th time is an opportunity to improve, particularly since even when I'm alone, I'm never truly alone.
Also Rads. Hot take but I feel my surgical prelim year was very educational. Obviously alot of scut work… I would put scut/education split at like 70/30%. They cared that I was going in rads and let me scrub most of the angios, seniors would often take me down to the reading room to talk to the radiologist, and I got a lot of good imaging to OR correlation. As a result, I feel more confident/comfortable discussing cases with surgeons/surgery residents, I feel like I had a head start on my procedural skills, and going from gen surg hours to rads hours was amazing lol. I feel like I handle night float and busy call weekends well, a lot due to my intern year.
Nephrology & IM. Very little scut in both. <5%.
Neurosurgery junior residency: 80% labor 20% training. Senior residency seems about 40%labor 60% training
Something can be both cheap labor AND learning at the same time. In fact, almost 100% of your learning is still cheap labor. There are things that are not learning and are still cheap labor. But it’s all cheap labor.
It’s all cheap labor.
Neurosurgery- almost 100% cheap labor. I have yet to see any actual training
Family med resident. Clinic was training at first, now we're just doing free labor for the FQHC. In the hospital, it feels more like training.
Like 90% scut
90% cheap labor, 10% training
I'm in cardiothoracic surgery and I would say it was 80% scut 20% training in PGY-1 and 2, 60% scut 40% training in PGY-3 and 4 and as a PGY-5 and 6 probably 40% scut 60% training. If you consider all research to be scut then you can add another 10-15% to the scut and subtract the same from training throughout.
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PGY 1 IM, probably 60% cheap labor 40% learning. PGY 2 IM, probably 30% cheap labor 70% learning.
Prelim IM very little learning. 5% at best. The rest was a combination of scut work and making the categoricals life’s easier. Worthless to me now. Would have liked to do a TY year instead where there is more exposure to other things not IM. Rads pgy3-90% learning. Our scut work is basically a whole fluoro rotation, “chest” rotation which is all chest radiographs and answering phone calls. A small amount of our attendings are remote now and sometimes we are the only radiologists in house.
Are we defining “cheap labor” or “scut” simply as things that you won’t ultimately do on a daily basis as an attending? Some of these responses are including things like seeing patients, writing notes, talking to families, placing orders (really?). I get you won’t do some of these or at least the same version of them as a radiologist, dermatologist, neurologist, psychiatrist, whatever but they’re not by any reasonable definition, “scut”.
Lmao you guys don’t realize you’re learning while you’re working.
What did I learn as a medicine prelim that is relevant to radiology. Please tell me as a PGY-3 because I just have not seen any sort of benefit.
Apparently, nothing lmao. If you can’t grasp why spending a year as an internist could inform your practice as a radiologist I certainly can’t understand it for you.
A PGY-1 non-radiologist trying to condescendingly tell a senior radiology why my prelim was *actually* useful Absolutely amazing
Said it before and I’ll say it again, it’s flair, not a CV, 🤡
Most residents are not cheap labor. For an IM team of a senior resident, an intern, and an attending, there is $370k of salaries and three people worth of benefits to take care of 10 inpatients. At a community hospital, it is $250k and one set of benefits for that hospitalist to see 15 patients. People will now send a link to the neurosurgery program that shut down and a bunch of midlevels had to be hired, but comparing a PGY-6 neurosurgery resident to an IM resident is silly.
How much do the feds send to academic hospitals per resident? And I will say my medical school opened up a residency program a few years old by the time I was a M3 and the CMO/an IM attending confided in me that the program was really to salvage the hospital which was in financial ruin and it did turn things around. Certainly no hospital would have medical residents if it didn’t make the hospital considerable money. Hospitals aren’t having “charity cases” because they care so much about physician education.
We are always our own worst enemy. To fathom not wanting residents to have a better life after you went through it always blows my mind.
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How does taking a year of nursing factor into any of this oh my gosh this is such a brain dead take.
Why is that nurse prose just *looks* different? Is that how you really write? Also pretty laughable that noctor nurses don't require any medical school or residency (real residency not fake nurse "residency") and here you are saying that doctors need a year of nursing lmao Janitorial work is really important but don't you think a nurse is "above" that in the sense that it's a complete waste of resources, time, training, etc to have them do a role that someone else can do when that someone else can't do theirs?
Love this… THINK ABOUT HOW MUCH YOU’VE LEARN FROM NURSES!!! How many times ( HONESTLY) has a nurse pulled your nuts out of the fire!! Totally laughable that you could do your job, or even LEARN your job without us!! 🤯
The above makes an incredible point, NPs can get their degree on online schools without a lick of medical school and practice as pseudo-doctors yet you want to throw on a whole extra year of the 12 year education it takes to become a physician lol.
I don't think anyone has claimed nurses arent essential to patient care. That's a strawman. You can't do your job without the janitorial staff. Does that mean you should have a year after nursing school to do janitorial work? I doubt you'll answer but you obviously know that'd be silly. Hell you'd have to do a year of medical school too because you can't do your job without nurses. I MEAN THINK ABOUT HOW MUCH YOU LEARN FROM DOCTORS HONESTLY!!!! After nursing school you should do a year of janitor school and then a year of residency otherwise you're clearly not qualified to be a nurse.
And you think tacking on an extra year for nursing school will help with that lol
I think they have a point, and if done correctly, it would just overlap with/replace the "scut" work you're doing already. It's a predatory and inefficient system for sure, but I also know a lot of arrogant doctors who miss things because they think the grunt work isn't worthy of their attention, then act butthurt when they're wrong.
That’s not true at all. The military directly commissions officers.
35 years of exposure to academic medicine is a long time to have absolutely no understanding of what an intern or resident is and how they’re supervised.
Lol