Securing spot without covid vaccination

[hellofrens]

Any states or specific hospitals where this won’t be an issue? Would you even need to disclose this to a program director if the hospitals you train at don’t require it or are willing to authorize a medical or religious exemption with some laxity? Inquiring 4th year wants to know. Good step2 score top quartile of mid/lower tier MD school that isn’t interested in anything super competitive.

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[LucidSplash]

How do you feel about flu shots?

 

[LucidSplash]

If the hospital doesn’t require Covid vax you’ll be fine. If they require it, it’ll be a problem.

 

[NotAProgDirector]

They are still mandated nationally in the VA system I think, so you'd need to avoid any program that rotates at a VA. You can try to get a religious exepmtion. If you are exempted, many hospitals will require you to mask all the time during flu/covid seasons. If you're found not masking, you can be terminated.

 

[rokshana]

cool. I'll try to avoid any programs that have rotations at VA hospitals. I wonder what regulations are around vaccines with WHO approval that aren't available in the states. I'd prob be willing to compromise on that if push comes to shove.

The shove could be termination…you good with that?

 

[operaman]

At this point I’m not sure how you would prove you’d been vaccinated even if you have. I got all mine but I have no clue where my vaccine card is as I haven’t touched it in years and nobody has asked. I actually think it probably got thrown away awhile back. Record keeping was so poor early on I’m not sure where I’d even go for proof if pressed.

So outside the VA which is always a paperwork nightmare, it may be less of an issue at many places. Just use common sense and avoid obvious places that will be on the far end of the covidian spectrum. Like if they’re still requiring staff to mask at all times, they’re probably more likely to make a stink about it.

I wonder if any places are accepting antibody titers yet? That’s what I’ve used in the past when I couldn’t dig up my vaccine paperwork.

 

[NotAProgDirector]

No one will care any more about original vax and boosters. But I expect a new shot this winter, and that's what may be required. But there may be an "out" if you are willing to wear a mask all the time -- but that's difficult. Would include all time in team rooms, conference, etc -- not just when seeing patients. That's our policy if you don't get the flu shot for any reason.

 

[dozitgetchahi]

Since you do flu shots, I’m going to ask the question that everyone else has dodged so far:

What is your problem with the Covid vaccine - and how do you think your fear of this vaccine squares with your role as a physician, which is to properly advocate for the health of your patients (including proper vaccinations)?

(As an aside, there are a couple of idiot PCPs in my group who are “anti covid vaccine” who go out of their way to try to convince the patients they share with me not to do the vaccines. I am a rheumatologist, and this really chaps my hide since IMO they’re essentially putting these patients’ lives at risk.)

 

[gutonc]

cool. I'll try to avoid any programs that have rotations at VA hospitals. I wonder what regulations are around vaccines with WHO approval that aren't available in the states.

So you're down with a non-FDA approved COVID vaccine produced in China or Russia, but not an FDA approved one produced in the US?

I'd prob be willing to compromise on that if push comes to shove.

You don't get to compromise as a resident. You get to fulfill the requirements of your program or leave.

SMDH

 

[gutonc]

I don't understand why titers aren't a reasonable compromise. It's not like the current batch of vaccines are all that effective in mitigating symptomatic infection with whatever generation of covid we're at. I digress, this really isn't the topic of discussion. I don't need your approval, I'm simply trying to determine my best path forward.

The second line is your path forward.

 

[operaman]

Not comfortable with mRNA technology mostly and implications of mRNA getting into circulation, being expressed in off target tissues, potential risk for auto-immune issues, the fact that it isn't consistent with how RNA viruses would infect host cells and the limited/specific immune response we'd generate to just a spike protein being expressed instead of seeing an entire viral capsid. Oh, and didn't think any additional benefit was worth the unknown risk in terms of reducing my chance of serious illness requiring hospitalization after I had contracted OG covid early January 2021 (which I had a disease course similar to that of a moderate course of flu with symptoms consisting of headache, sore throat, myalgia, low grade fever, chills, that lasted about 48 hours before I started to improve). The more the public health bureaucrats ignored the validity of naturally acquired immunity, the more reluctant I became, because I know these people know better than that. Yes, I understand that they were trying to protect people from going out and getting the infection over simply getting vaccinated, but by that time, there had been millions of people that had gotten infected and recovered without having actively gone out seeking to get it. Exceptions to the mandates should have been made for people with previous infection.

My aversion to future ones is simply that I got all the past ones, basically got knocked on my arse by every shot after the first, and have still gotten Covid 6-7x, all of which have been personally more mild for me than the 24h after those subsequent vaccines.

Flu shots have never given me any issue and in past seasons I’ve even gotten it a second time for a little Ab boost mid season if it was an especially bad year. Never more than some arm soreness.

So I’m hoping we don’t have some stupid mandate or that I can get an exemption because I just don’t want to feel like arse for 24-36 hours and still wind up getting the virus anyhow. And so far I haven’t seen any compelling evidence that another boost will make me any less likely to get my 8th Covid infection, or make it more mild, or lessen my chances of transmitting it to others.

OP- just stick with hospitals that have no mask mandate and especially any that have been Covid vax optional and you should be just fine.

 

[DrMetal]

Not comfortable with mRNA technology mostly and implications of mRNA getting into circulation,

RNA degrades very quickly (if you're ever worked with it in in a lab, that's why you have to keep it in very low temp freezers).

It doesn't remain in your circulation that long, probably on the order of minutes. In fact, it's so unstable, that people doubted it would work. Coat it in a lipid particle, and it has a better chance of getting to a cell and getting translated . . .but still, it will degrade at some point even in the aqueous portion of said lipid particle.

Know some science and biochemistry, and you can assuage your fears. [I don't blame you for thinking this way though, there are still a lot of doctors who do. And that's why I think many doctors are pretty stupid . . .despite all of their force-feed education/training.]

The COVID vaccine worked well. Period. Of the 3 things we did during the pandemic---masking, social distancing, the vaccine---the vaccine was the only clear intervention that dramatically decreased the hospital/ICU census. You can make an argument against masking and social distancing amongst the asymptomatic . . .there's no argument against the efficacy of the vaccine.

You don't get to compromise as a resident. You get to fulfill the requirements of your program or leave.

What he said. Don't be a PITA during residency. A nice target will be placed on your back. The second you forget a replete a potassium of 3.3, you'll get your a$$ handed to you.

 

[ScepticSkeksis]

It's still insane that any institutions are mandating a COVID vaccine. For my new job they did allow a religious exemption, since a science-based exemption (prior infection, low risk) is never available for reasons.

 

[DrMetal]

Regardless of the basic science and biochemistry . . .

No, not regardless of the basic science/biochemistry, it is because of the science/biochemistry. That's what we should be basing our arguments on , instead of all the BS confounded clinical 'research' we do. [Of course the risk isn't zero. Every time I step on a golf course, there's risk I might get hit by an errant tee shot. And that risk is far greater than that of harm by the COVID vaccine.]

I don't think

It doesn't matter matter what you think, it matters what your future PD will think.

Your future PD has to deal with a VA Director who has graciously allowed her 60 residents to rotate there. If one resident decides to be non-compliant with a rule and threaten that entire relationship, what do you think your PD is going to do? Cancel that entire contract with the VA depriving all of the residents of a perfectly good training opportunity, or just fire you? (after tacking on some other meaningless infractions, like the time you forgot to replete a K of 3.3, or you were a little bit snarky with nursing staff).

[replace VA above with any other clinical setup.]

C'est la vie. Go make your own bed. Sometimes people just have to learn the hard way.

 

[xffan624]

since you want to talk basic science, just how long is RNA stable within a lipid nanoparticle? Also, why are you so invested in this? I'm not applying to any program that has an affiliation or rotations through a VA hospital (or programs that have affiliations with any other hospitals that require proof of vaccination). I don't even care at the end of the day. I'll run a concierge clinic for all the untouchables that have been alienated from medicine from the likes of sanctimonious "experts" after training for a year if push comes to shove. My home program is fine too. Just like knowing what my options are.

I'm not sure how you can accurately determine this for every residency you apply, but I suppose if you could, this could work in a relatively large and/or noncompetitive residency like FM, IM, Peds, etc. Ideally, when you apply to residencies, you're making decisions based on geography, program goals/fit with your own, how much they support their residents, and what you're competitive for. Vaccine requirements usually isn't one of the factors.

Just as a note, I expect that mRNA vaccines will be the future and that flu vaccines will go this way considering how easy it is to change variants and mass produce with this technology.

 

[NotAProgDirector]

Regardless of the basic science and biochemistry, the risks aren't zero for off target tissue uptake. You also glossed over the whole infection acquired immunity thing, and the very small subset of patients in the original trials that had shown signs of previous infection prior to getting vaccinated, and whether there was an increased risk of harm in those patients relative to those that hadn't contracted covid. Nor any discussion of the NNT for a young, healthy person, much less any consideration what that NNT would be in my demographic with previous infection. There's a lot of legitimate nuance to the discussion that wasn't had. If we're going to ignore NNT and risk of harm, people should probably be taking statins from age 20 until death. There are any number of personal circumstances that would have justified me getting vaccinated. It was no doubt a good thing for many millions of Americans. At the end of the day, I made a choice I felt was best for me. I don't think I should be punished for coming to the conclusion I did.

First, I support your choice to not get a vaccine dose if that is your choice. And I think you've gotten the answer you need from this thread to proceed. It will certainly limit your options for residency - but that's your choice.

That said, I think the issue missing from your explanation is the risk to others / patients. If you get COVID, chances are you'll be fine. If you get the vaccine, chances are you'll be fine also and we have no data to suggest that the vaccine is more dangerous than COVID itself. But if you get COVID and spread it to others - whether those are your patients or colleagues -- they may not be fine. I wouldn't say that physicians need to put themselves at risk for their patients, but the risk here to you (of getting the vax) seems very small if not zero.

Prior infection is complicated. Likely protects you from bad COVID outcomes by process of selection (you would have had a bad outcome with your infection if it was going to happen). Like a vaccine, protects you in the short term from reinfection. Immunity to both native infection and vax seems to fade relatively quickly -- certainly by about 3 months and almost completely by 6. Titers are not terribly predictive of anything, and we don't have good standard to use, so are not of much help.

Anyway, best of luck.

 

[xffan624]

some quick google searches and emails to HR departments (and knowing which states have banned hospitals from imposing vaccine mandates to begin with) isn't too bad.

If that's your #1 priority, hopefully it works out for you. Just because a hospital and their affiliate hospitals doesn't have this requirement, doesn't mean it's a good place to train or a place that treats their residents well. There are other things to consider besides this and starting with this limitation severely restricts your options.

 

[GoSpursGo]

some quick google searches and emails to HR departments (and knowing which states have banned hospitals from imposing vaccine mandates to begin with) isn't too bad.

If your plan is to Google and directly contact the HR departments of prospective residency programs, then it doesn't seem like this thread is serving any further purpose. And it doesn't really seem like you were interested in hearing honest feedback anyways

Thread closed.