How is post-residency doctoring different from residency?

[IonClaws]

Just as the title says.

I've read that while medical school/residency tends to make the impression that academic hospitals are the majority of hospitals in the country, in reality they're the minority. I've also read that rounding as a team (like, attending, residents, med students, etc.) are not a thing outside of academic hospitals, or hospitals that don't have associated residencies.

I guess I'm saying as a current intern, I really dislike academia and the job structure it forms in residency training. I find rounding as a team to be really inefficient and much of the time I'm twiddling my thumbs and not learning or doing anything. Things have to be communicated and written down multiple times by multiple people on the same service. Also not a fan of lecture style teaching as it is even more inefficient.

So how different is being an attending practicing in the community with no academic responsibilities (other than board re-certification and the annual conference)? You obviously don't have to round multiple times with a team, right? Unless there's a clear reason to round multiple times or there are multi-disciplinary rounds, but that doesn't happen very often AFAIK.

Yeah so how do things change when you finish residency?

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[jurassicpark]

It depends on your style and hospital requirements really. Some ICU docs I know will still round as an entire team, resp therapists, dietitians, nursing, pharmacy etc.

But as a hospitalist, for the most part I will preview my patients and round with nurses or other staff members as needed. Most hospitals I go to make it a requirement that the nurses will round with you so they know the plan too instead of calling you or waiting for the note. This is actually quite an asset, the nurses will often dig up information for you or take orders so you don't forget, or RT will adjust something right there, etc.

You still will go do you rounds with Case Management, you will discuss your patients with them so they can help you get everything ready for a speedy discharge. Oftentimes the CM will come with me on patients they know will have significant barriers to discharge.

Some hospitals will make it a requirement to do large multi-disciplinary meetings daily too.

The only difference is you don't have to stop and teach students or interns.

 

[mvenus929]

I did time as a neonatal hospitalist in several community hospitals, which I realize is different than IM, but...

I’d get there and look over the charts of my patients. I’d go examine the discharges first and get their orders and whatnot together. Then, I’d go and round on the rest of the patients and out my notes in. I let the nurses know if I needed something on a patient and any updates to the plan I had when I saw them.

No students, no formal rounds, just going around and talking to patients and following up in labs, imaging, etc. I’d go back and see the patients in the afternoon if I needed to.

 

[Winged Scapula]

Just as the title says.

I've read that while medical school/residency tends to make the impression that academic hospitals are the majority of hospitals in the country, in reality they're the minority. I've also read that rounding as a team (like, attending, residents, med students, etc.) are not a thing outside of academic hospitals, or hospitals that don't have associated residencies.

I guess I'm saying as a current intern, I really dislike academia and the job structure it forms in residency training. I find rounding as a team to be really inefficient and much of the time I'm twiddling my thumbs and not learning or doing anything. Things have to be communicated and written down multiple times by multiple people on the same service. Also not a fan of lecture style teaching as it is even more inefficient.

So how different is being an attending practicing in the community with no academic responsibilities (other than board re-certification and the annual conference)? You obviously don't have to round multiple times with a team, right? Unless there's a clear reason to round multiple times or there are multi-disciplinary rounds, but that doesn't happen very often AFAIK.

Yeah so how do things change when you finish residency?

In residency we rounded twice a day, even on the "rocks" on the service.

Now I round once a day (if an when I have inpatients obviously) and do it on my schedule. I don't have a team to round with and in fact it can sometimes be impossible to find the nurse taking care of my patients. If someone wasn't doing well, I'd see them more often. Some of my surgical colleagues consult the Hospitalist service on every patient admitted, some just on critically ill patients. I only do it in the latter case as I find that in the community other consultants often make decisions on my patients without running it by me (even though it should be quite easy to ask nursing staff for my cell #, or ya know, check the orders where its written, or even perhaps call med staff office and ask for it).

I do attend community tumor boards but obviously not required in most specialities.

You can teach or not. You can do everything yourself or not (ie, you could have a midlevel do the discharges, etc. on your patients).

FYI: "the annual conference" isn't really a thing. Most specialties will have multiple conferences, and one might be more important than the other, but if I only went to one conference a year, I wouldn't have enough CMEs toward my license, so I attend more than one. YMMV. Some never go to conference and do on-line CME