I realize this may be politically incorrect, but it's absolutely true in my experience that if you train at a place with lower SES patients then medical students (and even residents) do more. I bring this up b/c I see you are in Rochester so I'm guessing your at Mayo. Rich, privileged people feel entitled to the "best care from the best specialist" and hence no way in hell a medical student and even sometimes a resident is doing any procedure on them or caring for them in any way. Everything has to run through the attending and there is less decision making from the resident. The attending also has more heat on them b/c these rich, entitled patients are more likely to sue and also the hospital system as a whole (May0) protects their VIP patients by having less hands on care from anyone except the attending.
Some of my best learning experiences were on the poor, underprivleged patients because the vast majority of them don't care if a medical student is doing a procedure or resident running the show making decisions as they are happy to get care.
In summary, I think the type of patients (poor, middle class, rich) one is caring for plays a big role in how much hands on learning/decision making one is afforded. Yes, all patients should be treated equal, but this is the real world.
Wow. There is a lot of misunderstanding packed into a small body of text here.
You're right in that I am an attending at Mayo Clinic in Rochester, Minnesota.
I have worked in "less resourced" settings throughout Washington DC, in Jacksonville, in Ohio, etc. I can guarantee that I have never let an intubation occur on one of my patients without me or my colleague (attending) being present. I don't care if the person is homeless, or a CEO, or a famous actor / actress. Your implication that attendings will care less about the safety of a patient when it comes to life threatening procedures like intubation is generally disappointing. I am sure there are individuals who live down to your portrayal but in general every institution I have worked no matter how small or under resourced or underprivileged the patients I have seen will get the same level of attention from me during an intubation.
As for Mayo Clinic….We do care for "Rich" people. We also care for not so rich people. We care for people with insurance, we care for people without insurance. After all we have a 2200 bed hospital in Minnesota with the largest resident force in the country (probably the world) and 20-40 medical students per class. You're probably fair in saying that medical students some times don't get the same procedural opportunities because there are many residents there to step in, but its not because the attendings and hospital have unusual expectations that the attendings should see everyone to protect our standing with rich people…thats entirely the wrong motivation. Every hospital i have worked at has an expectation that an attending is intimately involved in the care of the patient. I believe this is part of Medicare reimbursement that an attending has seen and examined the patient (could be wrong on that).
Residents get a lot of decision making opportunities. Considering in our ED we have over 60 beds, and we turn them over at an average one per three hours, the resident doesn't have to transport patients, place foleys (once they demonstrate they can), place IVs (once they demonstrate they can) etc…they are only making physician level decisions. They do it over and over and over because we don't board the same patient in the ED, we don't take them away from care to do nonphysician level tasks.
About your learning opportunities being best when "resident runs the show," etc. This is again misunderstanding that getting to do procedures and make decisions with little oversight is somehow better. A resident who was taught by another resident who was taught by another resident is likely not practicing at a level of mastery. Probably they know enough to get by, but when you have an expert whose entire passion is for the case you are about to see, the procedure you are about to do, the discussion you are about to have as your coach…thats when true learning happens. Don't worry so much about procedures…they are overrated…the true art of medicine is in the way you establish rapport rapidly with someone who has never met you, the way you can distill what they may tell you in an hour long story (hopefully not in the ED) into a concise and coherent medical description, you can consider a wide but thoughtful differential and perform directed physical assessments and serum, urine, and radiographic testing to confirm or refute your hypothesis and you can communicate the findings in a way that everyone (even someone distant from medical terminology) can understand and then explain to their loved ones who ask them about it. If you can build a useable foundation of these skills in medical school (not expertise because we are always in pursuit of expertise in these things), I can teach you how to suture up a wound, place a chest tube, central line, power up an ultrasound machine…those are easy to teach someone who has put in the investment to master the more important aspects of care. I mean every word of this.
Mayo Clinic is a unique place with lots of resources but the thing that makes it special is not the resources or the rich patients…its the fact that we believe our focus should be on the needs of our patients. Every person lives this philosophy even though it may sound cheesy or unbelievable…its true, and its amazing. Because of that people (even poor people, homeless people) travel from around the country and world to come here to be seen and cared for. I routinely see people who spent everything have to travel here to get evaluated and happily do so. If you ever really want to know what its like, please have more faith in people and come visit as a rotating student and see for yourself.
Again, I hope you can stop spreading such misinformation…because my friend, you are very misinformed.