Parents unhappy with my specialty choice. Wat do?

[fancymylotus]

Funny you say that. I was at my dentist a few weeks ago and we got on the topic of Botox. I was telling her how to get it started in her practice.

I can do it.

I just won't do it on myself

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[Dral]

I just thought you were comparing who saves more lives, since you quoted jdh and the whole context of the convo.

Oh, pssht, I would NEVER make that comparison. One of our sayings to lower residents when they are getting stressed about a case: "Chill. It's Derm...nobody is going to die." People of course can and do die from Derm diseases sometimes, but I definitely do not consider myself someone who keeps people alive on any sort of routine basis.

I like it that way.

 

[Priapism4tooLong]

You're a Pulmonary/Critical Care specialist. In the ICU you are a specialist -- Critical Care (intensivist).

Yeah i wouldn't consider an ICU doc a specialist, you still consult every department. You cater to all systems.

 

[fancymylotus]

Oh, pssht, I would NEVER make that comparison. One of our sayings to lower residents when they are getting stressed about a case: "Chill. It's Derm...nobody is going to die." People of course can and do die from Derm diseases sometimes, but I definitely do not consider myself someone who keeps people alive on any sort of routine basis.

I like it that way.

I like you.

As long as you don't grouch at my bff JDH

 

[Cytarabine]

Since I cannot Botox myself in however many years I need to, I have deemed dermies acceptable

I want mohs monies

Also stop grouching at @jdh71 everyone. Now.

You most certainly can. I know someone who does their own lips.

Funny you say that. I was at my dentist a few weeks ago and we got on the topic of Botox. I was telling her how to get it started in her practice.

Speaking of, know a dentist that did his own forehead for practice

 

[JP2740]

I just thought you were comparing who saves more lives, since you quoted jdh and the whole context of the convo.

And I agree a life saved is a life saved no matter how it's done.

And i will never hate on derm. A few of my family members were dermatologists. I know it's a lot of complex things involved. Also it got me lots of awesome toys growing up.

What you goin into?

 

[Priapism4tooLong]

What you goin into?

Im in a IM/EM program. I am debating on going into pain fellowship or critical care, i still have a few years to decide.

What about you?

 

[Dral]

I like you.

As long as you don't grouch at my bff JDH

To be fair, if they wouldn't have given a smart assed response to a positive post I made, they wouldn't have to worry about it.

But it's fine, no hard feelings. I'm sure they don't take it personally, nor do I...it is the internet after all.

 

[Priapism4tooLong]

I know this conversation has steered away from the original topic at hand, but I wanted to respond to the OP since I went through the exact same thing last year when I was applying for residency. I too am Asian (Indian to be exact), my parents supported me part of the way through med school, and we have a close relationship as well. I chose psychiatry and my parents were PISSED. We fought for months about this, my parents thought I was throwing my career away to be what they basically considered a "guidance counselor". They also thought I was lazy and was shying away from other fields like med and ob/gyn because I didn't want to "work hard". They also had a LOT of stigma towards mental health. But I stuck to my guns and I kept re-iterating to my parents that I had done my research into various specialities and busted my ass on each of my core rotations before deciding upon psychiatry. I calmy and clearly explained my reasons for wanting to do psych. I also explained to them what it is exactly, that a psychiatrst does. I showed them TED videos about the importance of mental health. Sent them articles written by Indian psychiatrists. Did everything I could to show that I was serious about my chosen field. Eventually they came around. By match day, my parents were actually happy for me. Every now and then they still make cracks about me going "crazy" in the future from dealing with all my patients but I think they are generally pretty proud. My advice to you OP, is to stick to your guns. Do not apply to a field that you wouldn't be happy in. Don't get into arguments with your parents, just keep your cool and keep educating them on why you choose IM. Eventually they will come around. Good luck OP

I hope i have a son like you.

 

[fancymylotus]

I hope i have a son like you.

You don't want a daughter like me?! Sad

 

[Priapism4tooLong]

You don't want a daughter like me?! Sad

Lol he's the exact opposite of you. (NO offense) he stands up to his parents. If my child had so much passion about something I'd want him to stand up to me no matter how much against it I was. Not that I know you, but from your posts it doesn't seem like you would do that.

On a side note I would be happy if my daughter was a dentist and marrying a vascular surgeon, as long as they were good people.

 

[KinasePro]

If someone could theoretically get into any specialty, what reasons do you think would be reasonable/justifiable to go into IM over a specialty like derm, ophtho, rad/onc, etc

The reasons you listed for ruling out ENT and Ophtho made perfect sense to me. I have the numbers for derm/ent/ophtho as well, and passed them over for the same reasons.

If I didn't hate writing long notes, I'd be happy in any of the IM specialties. I actually really liked learning about IM. I just hated DOING medicine, so it was easy for me to check it off the list. Like all of SDN, there is a ton of melodrama in this thread about IM subspecialty lifestyles. Jdh71's perspective meshes best with what I've seen on the wards adn gathered from talking to residents/fellows/attendings.

Also, I think we can't have a conversation about "real doctors" in medicine without mentioning trauma-critical care. They routinely snatch people from jaws of death multiple times per day and also perform heroic surgeries on the regular. Fixing perfed viscus, removing bullets from vessels, repairing liver lacs, popping tension pneumos, running codes, etc... And sometimes it's just regular ol' general surgeons on call doing all that ish. In some ways, I think gen surg are the only "real" doctors left who can handle everything from the mundane to the terrifying.

 

[Priapism4tooLong]

The reasons you listed for ruling out ENT and Ophtho made perfect sense to me. I have the numbers for derm/ent/ophtho as well, and passed them over for the same reasons.

If I didn't hate writing long notes, I'd be happy in any of the IM specialties. I actually really liked learning about IM. I just hated DOING medicine, so it was easy for me to check it off the list. Like all of SDN, there is a ton of melodrama in this thread about IM subspecialty lifestyles. Jdh71's perspective meshes best with what I've seen on the wards adn gathered from talking to residents/fellows/attendings.

Also, I think we can't have a conversation about "real doctors" in medicine without mentioning trauma-critical care. They routinely snatch people from jaws of death multiple times per day and also perform heroic surgeries on the regular. Fixing perfed viscus, removing bullets from vessels, repairing liver lacs, popping tension pneumos, running codes, etc... And sometimes it's just regular ol' general surgeons on call doing all that ish. In some ways, I think gen surg are the only "real" doctors left who can handle everything from the mundane to the terrifying.

Gen surgeons? or do you mean trauma surgeons?

Oh i guess you are right, some rural hospitals must have gen surgeons doing that.

 

[Winged Scapula]

Gen surgeons? or do you mean trauma surgeons?

Oh i guess you are right, some rural hospitals must have gen surgeons doing that.

Nope outside of major AMCs (and even in some), trauma is covered by non fellowship trained general surgeons quite commonly without it being a rural community.

 

[Priapism4tooLong]

Nope outside of major AMCs (and even in some), trauma is covered by non fellowship trained general surgeons quite commonly without it being a rural community.

ah ok, we have a trauma surgeon , ortho trauma and ortho that normally cover it. one of them is always there.

we are a trauma 1 center, i'm not sure if thats a req. General surgeons are always called if needed ofc. Most hosp around me have at least one trauma surgeon at all times.

 

[Nasrudin]

I could give 2 ****s about being a real doctor. At least in the sense that medical students get taught to masturbate to. I enjoy talking to people not adjusting vent settings on half-people-half-medical-device patients. And I have no interest in chief complaints that involve a gun shot to the face. But...it's a wide medical animal kingdom I suppose.

 

[KinasePro]

I could give 2 ****s about being a real doctor. At least in the sense that medical students get taught to masturbate to. I enjoy talking to people not adjusting vent settings on half-people-half-medical-device patients. And I have no interest in chief complaints that involve a gun shot to the face. But...it's a wide medical animal kingdom I suppose.

Personally I'm of this mindset as well, but I respect gen surg for their ability to stomp out practically any fire outside of the head bleeds/ brain trauma.

But I'm perfecty comfortable in a consult/support role myself. I'm going into ortho, and to me there's aren't many things in medicine more satisfying then seeing a patient walk into clinic 6 months after they were rolled into the OR looking like a life-sized Gumby doll with bones sticking out of it. Or seeing a patient in tears of joy because they're no longer paralyzed from the waste down and defecating/urinating all over themselves. But I have no interest in managing all the nitty gritty physiology of sick patients. Ortho has its own world of nuance and absurd complexity, and I'm happy getting lost in that world instead.

 

[KinasePro]

Gen surgeons? or do you mean trauma surgeons?

Oh i guess you are right, some rural hospitals must have gen surgeons doing that.

I kinda meant both. Like WS said, gen surgeons are capable of doing a lot of trauma/CC work when on call. And every time I've been on a gen surg service, half of our patient list were trainwrecks in the SICU. Trauma/CC docs work exclusively in that realm, but general surgeons are capable of taking care of those patients as well.

 

[Winged Scapula]

ah ok, we have a trauma surgeon , ortho trauma and ortho that normally cover it. one of them is always there.

we are a trauma 1 center, i'm not sure if thats a req. General surgeons are always called if needed ofc. Most hosp around me have at least one trauma surgeon at all times.

Level 1 trauma centers are not required to have a fellowship trained trauma surgeon; general surgeons meet the ACS Trauma Center criteria. You must have either an attending in house or a senior surgical resident with attending within 15 mins. We have a mixture of fellowship and non fellowship trained surgeons taking trauma call; all are general surgeons. You can call yourself a trauma surgeon if that's the bulk of your practice but I assume you are using it to denote the fellowship trained surgeon who is only doing trauma.

That isn't to say that many trauma centers don't preferentially staff with fellowship trained surgeons but that's often for marketing more than anything. Any GS should be capable of doing Trauma and CC.

Here are the ACS requirements for a Level 1 trauma center: https://www.facs.org/~/media/files/quality programs/trauma/vrc1.ashx

 

[Priapism4tooLong]

Level 1 trauma centers are not required to have a fellowship trained trauma surgeon; general surgeons meet the ACS Trauma Center criteria. You must have either an attending in house or a senior surgical resident with attending within 15 mins. We have a mixture of fellowship and non fellowship trained surgeons taking trauma call; all are general surgeons. You can call yourself a trauma surgeon if that's the bulk of your practice but I assume you are using it to denote the fellowship trained surgeon who is only doing trauma.

That isn't to say that many trauma

haha now I'm debating if he did his fellowship. I'm pretty sure he did.. i know gen surgeons do trauma, i think i underestimated how often they do it.

 

[Winged Scapula]

haha now I'm debating if he did his fellowship. I'm pretty sure he did.. i know gen surgeons do trauma, i think i underestimated how often they do it.

It's easy to forget that there's a big old world out there outside of our own academic community and that the old fashioned GS is doing a fair bit of trauma.

 

[DermViser]

Since I cannot Botox myself in however many years I need to, I have deemed dermies acceptable

I want mohs monies

Also stop grouching at @jdh71 everyone. Now.

Have you not heard of Botox parties?

 

[DermViser]

I just thought you were comparing who saves more lives, since you quoted jdh and the whole context of the convo.

And I agree a life saved is a life saved no matter how it's done.

And i will never hate on derm. A few of my family members were dermatologists. I know it's a lot of complex things involved. Also it got me lots of awesome toys growing up.

No, Dral was following up on the snarky comment he made previously regarding titration of cholesterol meds. Dral wasn't even close to making the assertion you were saying she was making.

 

[DermViser]

Yeah i wouldn't consider an ICU doc a specialist, you still consult every department. You cater to all systems.

And yet there is a fellowship made for it. You just happen to use your residency knowledge base as well.

 

[Armadillos]

Not sure why people on SDN get so up in arms over attendings who think that their specialty is the best specialty in medicine, medicine would be a lot better place if every attending thought like that. Some of the attendings that have been most influential to me have been in fields completely unrelated to my field, but seeing how much they loved what they do and wouldn't trade it for any other job was inspiring. It encouraged me to make sure I chose the field I enjoyed the most and not be overly influenced by things like earning potential or comparative prestige between specialties.

 

[Cytarabine]

Not sure why people on SDN get so up in arms over attendings who think that their specialty is the best specialty in medicine, medicine would be a lot better place if every attending thought like that. Some of the attendings that have been most influential to me have been in fields completely unrelated to my field, but seeing how much they loved what they do and wouldn't trade it for any other job was inspiring. It encouraged me to make sure I chose the field I enjoyed the most and not be overly influenced by things like earning potential or comparative prestige between specialties.

Because loving your specialty doesn't necessitate chitting on others

 

[oldbearprofessor]

And yet there is a fellowship made for it. You just happen to use your residency knowledge base as well.

There is a fellowship for "General academic pediatrics" which is a 2 or 3 year fellowship. Also, many of our pedi hospitalists are doing two year fellowships. So, doing a fellowship doesn't make you a "non-generalist". I think the point is that intensivists are using a broad range of clinical knowledge in patient management that goes beyond ventilators and drips. Also, much like ER docs taking care of not sick patients, not infrequently, a not very sick person slips into any ICU, even NICUs, and requires "general skills."

Over the decades, I increasingly value the role of primary care docs in managing our patients after they get home. I know that some might feel that this is easy, but the patient (in may case an infant, but age isn't that relevant), who goes home with a trach and/or g-tube and/or home TPN, etc may get multi-specialty f/u, but the patient who has a really good primary care doc on their side does better. They just do and this is from decades of experience and quite a few complex patients sent home.

Edit to fix details of Academic General fellowship training

 

[greg1184]

Not sure why people on SDN get so up in arms over attendings who think that their specialty is the best specialty in medicine, medicine would be a lot better place if every attending thought like that. Some of the attendings that have been most influential to me have been in fields completely unrelated to my field, but seeing how much they loved what they do and wouldn't trade it for any other job was inspiring. It encouraged me to make sure I chose the field I enjoyed the most and not be overly influenced by things like earning potential or comparative prestige between specialties.

Medicine would be a much better place if doctors would have pride for their own specialties without taking potshots or making smartass remarks about colleagues in other specialties. Note: not necessarily talking about posters in this thread, I observe this generally through my experiences and articles I have read online.

 

[jdh71]

Because loving your specialty doesn't necessitate chitting on others

Who did that? Because I didn't. If you think I did you don't read good and might need to visit a school for kids who don't read good and want to do other stuff good too.

Paying attention when your knees are jerking can be hard but I believe in you.

Of course I also never said my specialty was the "best" specialty. There is no "best" specialty. I do think my particular specialty rocks very hard and just because I think it rocks very hard is NOT an indication that any other specialty does not. I just got off another night shift and I admitted a couple of serious crumpers. I was up all night. It wasnt boring. It was, in fact, ****ing cool. This **** turns my crank. That's what I think about my specialty.

Furthermore too many read too much into a couple of comments that in no way were intended to crap on anyone or any specialty. I mean I'm not sure how many times I need to say EVERYONE has an important role before people will get it through their silly heads I'm not crapping on anyone. Anything you read into the comments is probably speaking to your own insecurities and isn't my fault or business but I do make a convenient target for your ego defense mechanisms.

Some days. Man. It's like you can't even have a conversation around here without someone not reading and getting outraged.

 

[DermViser]

There is a fellowship for "General academic pediatrics" which is a 3 year ACGME boarded fellowship. Also, many of our pedi hospitalists are doing two year fellowships. So, doing a fellowship doesn't make you a "non-generalist". I think the point is that intensivists are using a broad range of clinical knowledge in patient management that goes beyond ventilators and drips. Also, much like ER docs taking care of not sick patients, not infrequently, a not very sick person slips into any ICU, even NICUs, and requires "general skills."

Over the decades, I increasingly value the role of primary care docs in managing our patients after they get home. I know that some might feel that this is easy, but the patient (in may case an infant, but age isn't that relevant), who goes home with a trach and/or g-tube and/or home TPN, etc may get multi-specialty f/u, but the patient who has a really good primary care doc on their side does better. They just do and this is from decades of experience and quite a few complex patients sent home.

It's a travesty that Pediatrics wishes to waste the naming of extra fellowships (and more importantly taxpayer money for that matter) to fund fellowships that are utterly useless and should have been taught in residency. If Pediatrics has to have a 3 year fellowship for General academic Peds (as if a 3 year residency is not enough) or Pediatric resident graduates are doing 2 year fellowships to just to become competent hospitalists, there are some inefficiencies in teh system. Every Pediatric resident should be competent in general academic Peds or in being a Pediatric hospitalist upon graduation from Pediatrics residency.

 

[Mad Jack]

Alright, I've finally come up with a way to resolve this.

Kill your parents and become Batman.

 

[Cytarabine]

Who did that? Because I didn't. If you think I did you don't read good and might need to visit a school for kids who don't read good and want to do other stuff good too.

Paying attention when your knees are jerking can be hard but I believe in you.

Of course I also never said my specialty was the "best" specialty. There is no "best" specialty. I do think my particular specialty rocks very hard and just because I think it rocks very hard is NOT an indication that any other specialty does not. I just got off another night shift and I admitted a couple of serious crumpers. I was up all night. It wasnt boring. It was, in fact, ******* cool. This **** turns my crank. That's what I think about my specialty.

Furthermore too many read too much into a couple of comments that in no way were intended to crap on anyone or any specialty. I mean I'm not sure how many times I need to say EVERYONE has an important role before people will get it through their silly heads I'm not crapping on anyone. Anything you read into the comments is probably speaking to your own insecurities and isn't my fault or business but I do make a convenient target for your ego defense mechanisms.

Some days. Man. It's like you can't even have a conversation around here without someone not reading and getting outraged.

Totes mcgotes wasn't directed at anyone in particular brochacho, just a response to the comment and what I've seen among physicians. Does make your post kind of meta though

 

[oldbearprofessor]

It's a travesty that Pediatrics wishes to waste the naming of extra fellowships (and more importantly taxpayer money for that matter) to fund fellowships that are utterly useless and should have been taught in residency. ......Every Pediatric resident should be competent in general academic Peds or in being a Pediatric hospitalist upon graduation from Pediatrics residency.

Oh my, it's so much worse than what you think. The purpose of the academic general medicine fellowship (which I've corrected the details about in my original post), is not to make the graduate more skilled at general pediatrics, but to train pediatric leaders in a range of academic pursuits. I've cut and pasted from one such program, but all are similar...I'm sure everyone can appreciate the importance of specific advocacy training related to the needs of underserved children. BTW, I'm not sure any of these programs receive much of any federal $$, but don't know the details for sure. They certainly aren't funded at the same level as residents if at all by Medicaid.

Our fellows have the option to obtain specialized training in health services research, educational scholarship, or other primary care areas such as telemedicine, child abuse, or global health. Our graduates are prepared to assume academic, policy making, or community leadership careers and have the ability to do any and all of the following:

• Conduct research directed to primary medical care issues as independent, extramurally funded investigators
• Teach future primary care pediatricians to recognize and address the multifaceted issues that affect children’s health
• Participate actively in clinical care, program innovation, policy development and advocacy that addresses the needs of underserved and minority children and families

 

[mercaptovizadeh]

Oh my, it's so much worse than what you think. The purpose of the academic general medicine fellowship (which I've corrected the details about in my original post), is not to make the graduate more skilled at general pediatrics, but to train pediatric leaders in a range of academic pursuits. I've cut and pasted from one such program, but all are similar...I'm sure everyone can appreciate the importance of specific advocacy training related to the needs of underserved children. BTW, I'm not sure any of these programs receive much of any federal $$, but don't know the details for sure. They certainly aren't funded at the same level as residents if at all by Medicaid.

Our fellows have the option to obtain specialized training in health services research, educational scholarship, or other primary care areas such as telemedicine, child abuse, or global health. Our graduates are prepared to assume academic, policy making, or community leadership careers and have the ability to do any and all of the following:

• Conduct research directed to primary medical care issues as independent, extramurally funded investigators
• Teach future primary care pediatricians to recognize and address the multifaceted issues that affect children’s health
• Participate actively in clinical care, program innovation, policy development and advocacy that addresses the needs of underserved and minority children and families

This is ridiculous, especially for a field that is as ill-paid and as subspecialty driven (on the inpatient side) as pediatrics. Doing 6 years of residency and fellowship training to then be paid ~100K as an outpatient pediatrician in the community or similar as an academic hospitalist is a joke.

 

[oldbearprofessor]

Doing 6 years of residency and fellowship training to then be paid ~100K as an outpatient pediatrician in the community or similar as an academic hospitalist is a joke.

So much for trying on this thread not to have blanket condemnations/criticisms ("is a joke") of medical fields that physicians choose. But if it's so terrible to do 5 or 6 years in training to be a leader in pediatrics, what do you think drives people to do it?

 

[mercaptovizadeh]

So much for trying on this thread not to have blanket condemnations/criticisms ("is a joke") of medical fields that physicians choose. But if it's so terrible to do 5 or 6 years in training to be a leader in pediatrics, what do you think drives people to do it?

I didn't condemn pediatrics. I'm a med-peds resident myself. I'm condemning the absurd training times with downward pressures on salaries which teach the fellowship trainee little new or unique in the way of clinical skills. There are ways for general internists and pediatricians to engage in public policy and research without having to do an extra fellowship, and creating these "general medicine" and "general pediatrics" fellowships seems like a scam to get yet more cheap labor.

 

[jdh71]

Totes mcgotes wasn't directed at anyone in particular brochacho, just a response to the comment and what I've seen among physicians. Does make your post kind of meta though

This place gets so passive aggressive sometimes. Needed to clear that air.

 

[fancymylotus]

This place gets so passive aggressive sometimes. Needed to clear that air.

Allo? Passive aggressive? Never

 

[oldbearprofessor]

and creating these "general medicine" and "general pediatrics" fellowships seems like a scam to get yet more cheap labor.

You didn't answer my question as to why if it is such a bad idea, then folks are willing to do them. The answer is not that they are weak residents without better choices. In my experience, the opposite is true of them.

However, to assist those who are interested in understanding, not just describing this training as being a "joke" "scam" "useless" and "ridiculous" to mention a few recent adjectives used specific not for general pedi or IM but to academic general fellowships, let me explain SOME of the reasons that they might be selected by very smart people who understand the personal and financial aspects of the training and the ultimate career.

Doing this type of fellowship serves as protected time to begin an academic career doing things that are more difficult to get started in as a new attending. In these fellowships, the fellow has 80-90% protected time to do things like take a class or get a degree (usually MPH, but not always), develop curriculum, and set up a range of Qi projects amongst many things. Although there is some aspect of having more training/mentorship time, it is actually the protected time that matters the most. Those who would like to have a career in academic pediatrics (prob true of IM, but I don't know that world) as a primary career goal will want this ramp up time. Institutions get relatively little patient care time from them, but support them for the long-term benefits of having new faculty up to speed at the start of their attending career when they will need to see more patients.

Now, why do they want this career? I suspect you would get better answers from them directly, although I also suspect you know what you'd hear.

Note that the issues for hospitalist fellowships are different and best left for elsewhere. This is specific to academic general fellowships.

 

[DermViser]

This is ridiculous, especially for a field that is as ill-paid and as subspecialty driven (on the inpatient side) as pediatrics. Doing 6 years of residency and fellowship training to then be paid ~100K as an outpatient pediatrician in the community or similar as an academic hospitalist is a joke.

Thank goodness.

 

[SouthernSurgeon]

You didn't answer my question as to why if it is such a bad idea, then folks are willing to do them. The answer is not that they are weak residents without better choices. In my experience, the opposite is true of them.

However, to assist those who are interested in understanding, not just describing this training as being a "joke" "scam" "useless" and "ridiculous" to mention a few recent adjectives used specific not for general pedi or IM but to academic general fellowships, let me explain SOME of the reasons that they might be selected by very smart people who understand the personal and financial aspects of the training and the ultimate career.

Doing this type of fellowship serves as protected time to begin an academic career doing things that are more difficult to get started in as a new attending. In these fellowships, the fellow has 80-90% protected time to do things like take a class or get a degree (usually MPH, but not always), develop curriculum, and set up a range of Qi projects amongst many things. Although there is some aspect of having more training/mentorship time, it is actually the protected time that matters the most. Those who would like to have a career in academic pediatrics (prob true of IM, but I don't know that world) as a primary career goal will want this ramp up time. Institutions get relatively little patient care time from them, but support them for the long-term benefits of having new faculty up to speed at the start of their attending career when they will need to see more patients.

Now, why do they want this career? I suspect you would get better answers from them directly, although I also suspect you know what you'd hear.

Note that the issues for hospitalist fellowships are different and best left for elsewhere. This is specific to academic general fellowships.

It doesn't seem that much different from the tendency among general surgery residents to take 2 years mid-residency to pursue full time research and/or additional degrees.

 

[DermViser]

It doesn't seem that much different from the tendency among general surgery residents to take 2 years mid-residency to pursue full time research and/or additional degrees.

With an actual underlying purpose, for the ability to match into a particular subspecialty fellowship -- Plastics, Peds Surgery, etc.

A lot of residencies are now having their residents take part in a Qi project (might be an ACGME mandate, but I'm not sure), so that's no big whoop. Same for taking classes or getting an MPH, which they can do on their own (and not get paid for thru taxpayer dollars since they are ACGME fellowships).

 

[SouthernSurgeon]

With an actual underlying purpose, for the ability to match into a particular subspecialty fellowship -- Plastics, Peds Surgery, etc.

A lot of residencies are now having their residents take part in a Qi project (might be an ACGME mandate, but I'm not sure), so that's no big whoop. Same for taking classes or getting an MPH, which they can do on their own (and not get paid for thru taxpayer dollars since they are ACGME fellowships).

My point was that the point of these fellowships seems to be protected time to build your academic career. It's like the Robert Wood Johnson program. I'd be interested to see if these fellows have a good track record of securing NIH funding post-fellowship.

And yes, QI is an ACGME mandate now.

 

[DermViser]

My point was that the point of these fellowships seems to be protected time to build your academic career. It's like the Robert Wood Johnson program. I'd be interested to see if these fellows have a good track record of securing NIH funding post-fellowship.

And yes, QI is an ACGME mandate now.

We have those too - they're called clinician-educator fellowships - Penn has one, I believe essentially for those who want to work their way eventually up to Chairman of the department. Of course, it is appropriately non-ACGME accredited as apparently this Pediatric academic fellowship is not, and is funded fully by the department itself.

I would also be interested as well if they actually contribute in a meaningful way or if it's more just to go up the tenure ladder and not see patients full-time.

 

[oldbearprofessor]

I would also be interested as well if they actually contribute in a meaningful way or if it's more just to go up the tenure ladder and not see patients full-time.

Although I may not agree with a few of them, I usually understand your posts. I do not understand this one. What do you mean by "meaningful way" and what metric (NIH funding is not the best for this training) would you use to evaluate them? Also, I'm not sure I understand what you intend by "tenure ladder" as at many institutions, clinician-educators are not on the tenure track.

Also, I have corrected my earlier post, academic general pedi fellowships are not ACGME as best I understand it.

With regards to Qi project, it is an ACGME mandate, at least for pedi and I assume that it is true for other fields. However, the mandate is to participate in Qi and understand the Qi process. The goal of these fellowships as related to Qi is often to LEAD Qi programs and participate in Qi leadership on a national level. Very different.

 

[DermViser]

Although I may not agree with a few of them, I usually understand your posts. I do not understand this one. What do you mean by "meaningful way" and what metric (NIH funding is not the best for this training) would you use to evaluate them? Also, I'm not sure I understand what you intend by "tenure ladder" as at many institutions, clinician-educators are not on the tenure track.

Also, I have corrected my earlier post, academic general pedi fellowships are not ACGME as best I understand it.

Ok, they're not ACGME accredited - didn't read that change. That makes a lot more sense.

 

[mercaptovizadeh]

To be quite honest, I think all these extra requirements are silly. QI projects, gen surg being required to do 2 extra research years, etc. Enough already! It's hard enough to be a good generalist with the current residency timeline and work hour restrictions, adding these extra bits and pieces only prolongs training with little benefit in terms of expanding clinical knowledge base and scope of experience.

The "research requirement" has also led to the nonsensical BS situation where everyone is doing research yet very few do it beyond their terminal residency/fellowship. People are doing this because it is essentially a requirement, not because they care. It's just like volunteering in high school and college. I don't think that on it's own it can do much to stimulate interest and perseverance (in research OR altruism).

 

[mercaptovizadeh]

Thank goodness.

Not sure why you say that. I mean, sure, we should probably consult neuro for AED management, but I think there should be more autonomy for basic issues in peds, like insulin dosing diabetics, working up TB without necessarily consulting ID, etc. I think peds should operate much more analogously to medicine, especially as the degree of complexity and comorbidity in most patients is far lesser (the breadth is arguably equivalent, with more genetic zebra stuff).

 

[DermViser]

All those gold doubloons...damn. Why on earth didn't Kaus do derm instead being so hellbent on surgery?! Argh

I still personally think he should do Radiology.

 

[fancymylotus]

Well yeah, then we could count gold doubloons in our massive mansion in Greenwich. Or maybe inside one of our four ferraris.

(Totally kidding. If I bugged him to do something he wasn't happy doing, it would make for one very miserable Kaus. I'm glad he found something he loves.......

AS LONG AS I DONT HAVE TO EVER WAKE AT 4AM TOO!)