UNC midlevel residency program

[Tenk]

http://news.unchealthcare.org/som-vital-signs/2020/february-20/unc-hospitals-and-unc-school-of-medicine-name-hrdina-as-program-director-of-advanced-practice-provider-residency-program?utm_source=vs-email&utm_medium=email&utm_campaign=8&fbclid=IwAR3zSKxsixluq2o2xVt7GJajqsfL9lIuOtrruDIGEefROynlmv4eC8mNsd8

For all you prospective residents, may want to bail on this one. Nothing like fighting over turf with midlevel “residents.”

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[Dr Mantis Toboggan]

yup that’s horrible. I rotated there as a student and it was hardly a hotbed of critically ill patients. at least it’s out there in time for people to adjust their rank lists accordingly.

http://news.unchealthcare.org/som-vital-signs/2020/february-20/unc-hospitals-and-unc-school-of-medicine-name-hrdina-as-program-director-of-advanced-practice-provider-residency-program?utm_source=vs-email&utm_medium=email&utm_campaign=8&fbclid=IwAR3zSKxsixluq2o2xVt7GJajqsfL9lIuOtrruDIGEefROynlmv4eC8mNsd8

For all you prospective residents, may want to bail on this one. Nothing like fighting over turf with midlevel “residents.”

 

[RustedFox]

Kill it with fire.

 

[Fox800]

Shame on UNC.

 

[gamerEMdoc]

Unless they have way more patients than the number of residents can handle, or the midlevel residents will be working at a different hospital, this is insane.

 

[Torsion]

Would it be worth contacting faculty to ask how this will effect training if we interviewed and ranked this program?

 

[HoosierdaddyO]

I’m not a conspiracy theorist.... but are there people or forces out there that are almost deliberately trying to water down our specialty, or is it time for me to get my tin foil helmet out??

 

[gamerEMdoc]

I think there are people out there that dont ever want to pick up a chart on their own and will do anything to make that a reality.

 

[SXMMD]

This is nuts. Why aren't medical training programs calling this nonsense out publicly? How are there physicians who support this insanity???

 

[Dr Mantis Toboggan]

Yeah that’s what I was thinking. Maybe they’ll go Greensboro or something. Unless things have dramatically changed there is no way Chapel Hill can give away tubes, lines and sick patients to midlevels.

Unless they have way more patients than the number of residents can handle, or the midlevel residents will be working at a different hospital, this is insane.

 

[USCDiver]

Yeah that’s what I was thinking. Maybe they’ll go Greensboro or something. Unless things have dramatically changed there is no way Chapel Hill can give away tubes, lines and sick patients to midlevels.

The EDs in the hospital system in Greensboro are staffed by Wake Forest Dept of EM, doubt they’d be affiliated with UNC.

 

[Torsion]

The residents staff the Wake Med hospital system and I don't think the mid-levels do. Maybe they could shift more to Wake Med? I'd really like some more info on this.

 

[Dr Mantis Toboggan]

Yeah I know a gyn/onc attending out there who works for UNC so I was just spitballing.

You seemed plugged into the region. Any idea how this midlevel residency deal will play out?

The EDs in the hospital system in Greensboro are staffed by Wake Forest Dept of EM, doubt they’d be affiliated with UNC.

 

[Dr Mantis Toboggan]

Wake was by far the best part of the student rotation. That drive though. Yeesh. The interstate was under construction during my time there and the commute was brutal.

The residents staff the Wake Med hospital system and I don't think the mid-levels do. Maybe they could shift more to Wake Med? I'd really like some more info on this.

 

[inspirationmd]

I really doubt UNC has the volume to do this and not detract from resident experience. They are still having to use tricks to artificially increase their annual volume (ie all accepted transfers from every service come through the ED and are evaluated by the ED).

This seems like someone wanted more EM residents, UNC GME said “No” and so an end run around them was created.

Terrible idea IMO

 

[clibby]

The best part is that they get a salary of $60,000 to take learning opportunities away from a PGY3 making $57,000.

 

[alpinism]

Happy to name and shame but multiple other big name academic EM departments already run "midlevel EM residencies".

 

[deleted480308]

The best part is that they get a salary of $60,000 to take learning opportunities away from a PGY3 making $57,000.

• PGY1- $53,369
• PGY2- $55,272
• PGY3- $57,028

PA: 60k

just......damn

 

[deleted547339]

The best part is that they get a salary of $60,000 to take learning opportunities away from a PGY3 making $57,000.

Yea. If that’s not a slap in the face to their residents, I don’t know what is.

They’re training folks with half of the education (and educational debt), paying them more over half as long and preparing them to make half as much. Our speciality doesn’t need CMGs to destroy us, we’re doing it ourselves.

 

[Ludwig2000]

‘Advanced practitioner training’ is the cancer of residency, the fatal disease for which there is no cure. Residency often works beautifully at first. But once a program extends the franchise to every warm body, be they producer or parasite, that day marks the beginning of the end of the program. For when the plebs discover that they can vote themselves advanced practitioner training without limit and that the productive members of the body politic cannot stop them, they will do so, until the program bleeds to death, or in its weakened condition the field succumbs to an invader—the barbarians enter Rome.

-adapted from Robert Heinlein’s “bread and circuses” quote

 

[deleted480308]

‘Advanced practitioner training’ is the cancer of residency, the fatal disease for which there is no cure. Residency often works beautifully at first. But once a program extends the franchise to every warm body, be they producer or parasite, that day marks the beginning of the end of the program. For when the plebs discover that they can vote themselves advanced practitioner training without limit and that the productive members of the body politic cannot stop them, they will do so, until the program bleeds to death, or in its weakened condition the field succumbs to an invader—the barbarians enter Rome.

-adapted from Robert Heinlein’s “bread and circuses” quote

guarantee any resident at UNC who speaks up about this gets their ass handed to them for being unprofessional

 

[deleted941485]

UNC won’t miss a beat. They’ll be training NPs in TAVRs in no time taking cases from cards residents

 

[TysonCook]

...where is ACGME on all of this? You'd think that if people follow the trail, they'll realize not to go to med school.

 

[deleted941485]

...where is ACGME on all of this? You'd think that if people follow the trail, they'll realize not to go to med school.

I think if anything the ACGME would be more interested in reviewing the actual case logs of the residents and perhaps making adjustments to the approved number of spots

 

[jw3600]

The UNC residents should literally be striking.

 

[gamerEMdoc]

Them paying a PA “resident” more than a pgy3 is a crime. What do they pay their PA faculty? Most ED midlevels arent crushing it. Maybe making 100k or so. So if they are paying them 60, they are giving them a 50-60% of their future salary. While paying their pgy3s 15% of their future salary.

This is an embarrassment. I have no problem with educating midlevels to be better at their job to be less dangerous. But worsening their clinical experience of physicians to do so, and paying the PA students more, is such an embarrassment.

 

[emletters]

I’m actually at a loss for words on this one. It makes me feel physically sick to see this as an intern. Over the last few months I kept telling myself that I’ll work harder, be as knowledgeable as I can, and make myself valuable to set myself apart from an APP in the future. But when you’re literally training us side by side, getting the same cases, doing the same things in the ED and off service, what’s the point? Admin, the government, the public have made it clear they don’t give a flying f*** how long you went to school or what you sacrificed. I feel like they’re just spitting in my face and walking away. As someone who takes a lot of pride in being dedicated to what I do and putting in the work to stay the course, I feel really numb. This sucks.

 

[deleted941485]

I’m actually at a loss for words on this one. It makes me feel physically sick to see this as an intern. Over the last few months I kept telling myself that I’ll work harder, be as knowledgeable as I can, and make myself valuable to set myself apart from an APP in the future. But when you’re literally training us side by side, getting the same cases, doing the same things in the ED and off service, what’s the point? Admin, the government, the public have made it clear they don’t give a flying f*** how long you went to school or what you sacrificed. I feel like they’re just spitting in my face and walking away. As someone who takes a lot of pride in being dedicated to what I do and putting in the work to stay the course, I feel really numb. This sucks.

I’m sorry you feel that way but honestly nobody cares how hard you work in the world. I came to that same realization during intern year and honestly it’s helped me out for the better.

I clocked in and out and I stopped trying to impress people with my knowledge and stopped blubbering over every patient.

Humanity in healthcare is gone it’s about cheap interchangeable parts.

Best thing you can do for yourself is live cheap and refuse to be a part of stuff like this.

 

[STEMI_voy]

Yikes, now I have to recertify my ROL

 

[Listen2Savage]

Happy to name and shame but multiple other big name academic EM departments already run "midlevel EM residencies".

Which other residencies have programs like this?

 

[deleted941485]

I would also be interested

 

[qwerty89]

Which other residencies have programs like this?

basic google search...

Physician Assistant Emergency Medicine Residency Program | Duke Department of Surgery

The Physician Assistant Emergency Medicine Residency Program teaches resident PAs the advanced skills, knowledge, and humanistic qualities that constitute the foundation of a successful emergency medicine practice.

surgery.duke.edu

Vituity Emergency Medicine Physician Assistant Fellowship - APPAP

Vituity Emergency Medicine Physician Assistant (EMPA) Fellowship at Arrowhead Regional Medical Center (909) 580-2178 Arrowhead Regional Medical Center 400 North Pepper Avenue Suite 1M107 Colton, CA 92324 Application Deadline: June 2 Fellowship Start: October 30 Length of program: 14 months Class...

appap.org

Emergency Medicine Physician Assistant Program

...

www.bcm.edu

Staten Island University Hospital Emergency Medicine

The Staten Island Emergency Medicine Residency Website

www.statenislandem.com

Einstein | Jefferson Health

www.einstein.edu

Emergency Medicine PA Residency | UCSF Fresno

www.fresno.ucsf.edu

Johns Hopkins Bayview Medical Center

Johns Hopkins Bayview is a vibrant academic medical center, offering services that range from primary care and emergency medicine, to specialized centers.

www.hopkinsmedicine.org

and many more.

One PA wrote about her experience here: A Day or Night in the Life of an Emergency Medicine Fellow

"When I applied there were about 12 programs in the country that met the Society of Emergency Medicine PAs (SEMPA) Standards for Postgraduate training." That was in 2019.

I recall and old post over 10 years old now on the physician assistant forums that detailed the experiences of one such "resident".

The residency experience

Since some folks expressed interest in me doing some sort of journal of my foray into the residency world, I thought I'd keep a running post on this board as opposed to doing some sort of blog- mostly because it's easier to just post here than to maintain some separate website. I'm all about effi...

www.physicianassistantforum.com

Some pearls:

"Even though formal shifts don't start until late July, we do have some "ED-lite" shifts every so often this month, where we may work an occasional 6-hour shift during the week or a 12-hour shift on the weekends. The idea of course is that we get our feet wet without being thrown into the deep end. This is unlike the other departments in the hospital, where they immediately start their interns on shifts as soon as possible. Both the PA's and the physician interns are doing the exact same thing this month."

Of course. Every EM intern gets baby shifts to ease right into it. Standard practice. Right?!

"There is, of course, a MOUND of reading to do, but having very few shifts to do this month enables me to spend as much time as I want to review stuff while also picking up detailed facts that weren't covered in PA school."

False. PA school = medical school

"The month of orientation is now over. There had to been just a LITTLE jealously among interns on other services when they see we were only working once a week and otherwise were taking classes during the day, but this has really helped in transition into the culture here."

hmmm.


"My first full month in the ER is over...
...The senior residents, while they are adjusting to their new roles of running each area of the ER, are also very understanding of “the kids”, since they were just in our shoes a few years ago. And at no time has anyone looked down on me simply because I’m a PA- I’m seen no differently than the physician interns in regards to what patients I’m allowed to see."

Nothing to see here folks. Move along.

" In the ER, we generally work 6 days in a row, followed by three days off. The shifts vary from 9A-7P, 7P-7A, 7P-5A, 7A-7P, Noon-Midnight, or 9P-7A...so depending on the shift, it's either 10 or 12 hours. This means I never work more than 80 hours/week, but it comes close. The shifts also alternate between the three different areas of the ER."

Ok this seems legit.

"This past weekend was exactly one year since I graduated PA school, which gave me some time to reflect on where I"m at now with my career. One year later....absolutely no regrets about doing this program. I really don't know where I am in relation to a PA who just got hired on with an ER straight out of school without any prior experience....all I know is that compared to some of my physician resident colleagues, I'm doing well."

___________________________

As an non-ER doc this is incredible. Literally training your replacements.

You have an ER with 2 midlevels and 1 ED doc on during the busiest hours.

ER volumes continue to grow year after year.

When the admin finally get around to support increasing staffing what do you think they will do?

They won't add a second physician. They will add another PA. All the better if they are "residency trained".

And who do you think that new PA/NP will go to when the have a question?

"Hey doc I had this funny ECG. You mind taking a look at it?" Meanwhile you are still seeing well over 2pph on your own. If there was another doc there you know they would be able to handle their s***.

Just increased liability and another way for them to decrease your effective pay without making it look like a paycut. More work for same pay is a paycut in my books.

EDIT:

look at the Staten Island program. It pays 94k a year and is a 24 month program. At that point you are really blurring the lines between physicians and non-physicians. The Staten Island PGY-1 residents will get paid 73K as of June 2020. This is a sad joke.

 

[curbsideconsult]

This should be cross-posted in the general med student forum if it's not already.

 

[Giovanotto]

• PGY1- $53,369
• PGY2- $55,272
• PGY3- $57,028

PA: 60k

just......damn

You know we got a problem when even sb247 is upset. I hear alarm bells going off manically in my head.

 

[Lawpy]

The best part is that they get a salary of $60,000 to take learning opportunities away from a PGY3 making $57,000.

• PGY1- $53,369
• PGY2- $55,272
• PGY3- $57,028

PA: 60k

just......damn

Well that's indefensible garbage. Tired and frustrated with medical trainees keep getting shafted repeatedly in favor of midlevels and now midlevel trainees too. Shame on UNC

 

[slowthai]

This should be cross-posted in the general med student forum if it's not already.

Your wish is my command.

 

[Dantrolene FC]

Here’s my theory:

Emergency medicine is one of the fastest growing specialties right now in terms of residency seats, behind only IM and FM I believe.

On top of the residency growth is the NPP, non-physician provider, residency positions.

My theory is the large corporations that are buying out group practices want to completely flood the EM market with doctors and NPPs so they can decrease the salaries and make more profit.

 

[DrStephenStrange]

http://news.unchealthcare.org/som-vital-signs/2020/february-20/unc-hospitals-and-unc-school-of-medicine-name-hrdina-as-program-director-of-advanced-practice-provider-residency-program?utm_source=vs-email&utm_medium=email&utm_campaign=8&fbclid=IwAR3zSKxsixluq2o2xVt7GJajqsfL9lIuOtrruDIGEefROynlmv4eC8mNsd8

For all you prospective residents, may want to bail on this one. Nothing like fighting over turf with midlevel “residents.”

Did they take down the link? It gives me a log in page when I click on it.

 

[curbsideconsult]

Did they take out the link? It gives me a log in page when I click on it.

https://webcache.googleusercontent....cd=2&hl=en&ct=clnk&gl=us&client=firefox-b-1-d

[/URL]

 

[deleted547339]

Here’s my theory:

Emergency medicine is one of the fastest growing specialties right now in terms of residency seats, behind only IM and FM I believe.

On top of the residency growth is the NPP, non-physician provider, residency positions.

My theory is the large corporations that are buying out group practices want to completely flood the EM market with doctors and NPPs so they can decrease the salaries and make more profit.

How is that a theory? Its a theory in the same way that the sky being blue is a theory.

 

[EctopicFetus]

This is comical. If it wasn’t my specialty I would
Be laughing my ass off. Sadly it’s a sad pathetic reality. Own your practices and this matters a fair bit less. Our pas see 10-15% of our volume and only staff fast track. Other local hospitals it’s 1:1 hours and they see over half. Pathetic isn’t even the right way to describe it. I’m glad I’m stacking up my $$$ so when it changes I can quit.

 

[quicksilverdo]

Hilarious to see all the complaining about increasing EM grads and you got top EM programs pulling this.

 

[DrStephenStrange]

https://webcache.googleusercontent....cd=2&hl=en&ct=clnk&gl=us&client=firefox-b-1-d

[/URL]

Yeah, they definitely took it down. Error message "page not found" even when I google it and click on the link provided by google.

 

[NicksMD]

Hilarious to see all the complaining about increasing EM grads and you got top EM programs pulling this.

Is UNC really considered a top program?

 

[Torsion]

They've removed any trace of this new program from their website as far as I can tell. Interesting.

 

[DrStephenStrange]

They've removed any trace of this new program from their website as far as I can tell. Interesting.

They realized it was attracting a lot of attention lol.

 

[Tenk]

Did they take down the link? It gives me a log in page when I click on it.

Are you sure you didn’t just use the time stone to go back and fix this disaster from ever happening?

 

[deleted941485]

They've removed any trace of this new program from their website as far as I can tell. Interesting.

What the hell?

 

[curbsideconsult]

Yeah, they definitely took it down. Error message "page not found" even when I google it and click on the link provided by google.

Hmmmm...when I copy and paste the link it automatically inserts "[ U R L ]" immediately before "ht tps://ww w.med..." Take that part out and then the cached version shows up. Sorry for the weird spacing. I had to do it so they wouldn't autolink.

 

[Modanq]

Advanced Practice Provider Dermatology Fellowship - Penn State College of Medicine Residencies and Fellowships

The Advanced Practice Provider Dermatology Fellowship at Penn State Health Milton S. Hershey Medical Center is a one-year, non-ACGME-accredited program that admits one fellow per year.

residency.med.psu.edu

Totally jacked. Its all gone under.