Also, there is a difference in what autonomy means at different places.
For example my program is pretty autonomous but there is almost always a staff member present. Nearly All our clinics are with indigent patient populations - not much private. We see the patient first, we do exam we come up with a plan, write note and then we present. As a 1st year initially I could barely come up with a plan and I would mostly describe findings to my attending and then they would do an exam and then help with plan or ask me questions to lead me. As a second year I was much more comfortable but still spoke with my attending about my plan and depending on the clinic my attending would see the patient or not and even maybe come talk to them about the plan if it was complex. Lol we have no routine patients here honestly. As a 3rd year I often send notes to my attending and just manage patients myself. Or I sign the patient out after I've done everything and then my attending usually doesn't see the patient or just approves the cataract or whatever. As a 3rd year and even as a 2nd year a good portion of the time I pick what tests I want without discussing them with attending first. But we nearly always have a staff member in clinic or available by phone if there's an odd chance they had to leave early or come late. If there is no attending our fellows are in clinic running things.
In some programs, fellows run all the clinics or sometimes the senior resident runs things. Now that I understand the way things work, I think I like our method. I like having access to staff. I like the idea that we won't be shamed if we call or sign out to staff even on call. Some programs have this right of passage and you eventually learn and manage things but it's invaluable to have an attending examine a patient, point something out or confirm a finding or discuss the plan. I really have enjoyed the style. I also feel I had a lot of autonomy because I still did what I wanted for the most part unless I was totally stumped.
Also a lot of people complain about private clinics with attendings. Being all private based sucks cuz then you tend to have limited ownership of patients. However, there is some good about seeing private patients. You can see how it's done, with latest treatments and out of pocket treatments, which you won't often see in resident run clinics. You can observe conversations and methods or having those conversations about disease with some of the more educated patients and see what questions they might have and what that's like. This is particularly useful if you are thinking private practice or don't plan on practicing at a county or VA for the rest of your life. Obviously whether private or public we attempt to give our patients the best quality care possible, but certain things are more challenging to access in resident run clinics or free care clinics or whatever you wanna call them. Also healthcare literacy and level of education can make a difference in the way you approach a conversation and language you might choose for discussion of a disease process.
So i think we are hand held if we need it at my program, but we still had "ownership" of patients in some way. However, there are places where attending coverage is limited, your senior resident runs everything or your fellow helps out. This can work fine, but if there are a million patients in clinic it becomes hard for people to teach you and you will sometimes be teaching yourself. We are all very much responsible for supplementing education in residency through books, articles and working on simulator or whatever, but there is a difference between that and teaching yourself clinically. Doing a physical exam over and over with nobody to ever look at a weird thing you found in the retina or anyone to guide you kinda sucks. At some programs they will have guidance at some rotations and then they take what they learn there and apply it to their county or wherever they often have the least coverage and that can work too.
Autonomy is important but a broad term. Just figure out what they mean when they say this. It can be hard to do that but many people hear about which programs are historically unnecessarily gruelling and sink or swim. Like the post above says, find out if that is for you.
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