Residencies: doctors have it figured out - page 3

After chatting with a fourth year med student today at clinical, it occurred to me how vastly different the physician career-path is from our own. Fourth year medical students are undergoing the process of being matched to a... Read More

  1. 0
    I was hired into a nurse residency program as a new grad at the hospital where I work now. It was 16 weeks and I floated and was precepted in their "critical care track"... they have other tracks as well like med-surg, home health, OR, Psych, etc... I floated on the telemetry, PCU, CCU, and ER. At the completion of the residency I was eligible for hire on any of the units I floated to- I was picked for their telemetry unit, and I continue to work there today. This hospital has a very successful nurse residency program, and they bring, on average- 40 new grad nurses into their hospital per year. I think more hospitals SHOULD implement this into their hospitals and as it really builds a close knit nurse culture in the hospital. Many of my preceptors had been through the residency themselves!

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  2. 0
    Quote from Rhody34
    I was hired into a nurse residency program as a new grad at the hospital where I work now. It was 16 weeks and I floated and was precepted in their "critical care track"... they have other tracks as well like med-surg, home health, OR, Psych, etc... I floated on the telemetry, PCU, CCU, and ER. At the completion of the residency I was eligible for hire on any of the units I floated to- I was picked for their telemetry unit, and I continue to work there today. This hospital has a very successful nurse residency program, and they bring, on average- 40 new grad nurses into their hospital per year. I think more hospitals SHOULD implement this into their hospitals and as it really builds a close knit nurse culture in the hospital. Many of my preceptors had been through the residency themselves!
    ^So was my preceptor in the program I am in.
  3. 12
    OK. Here is something not all of you probably know.

    First, the process of applying for physician's residency costs A WHOLE LOT of money. There is an organization, popularly known as "The Match" which takes from about $50 for each application prospective candidate sends to a particular hospital. Counting that for most competitive specialties even the cream of US grads have to apply for every single program in the country, and that no program will put the candidate in its "list" without a formal interview, the total lump can easily go over a few thousands. And that's not paying for the residency - just for a mere chance to get into it. There is absolutely no chance to avoid this money sucker.
    Second, the "match" is, basicaly, all about math and stats. Whatever "they" are saying (and they LOVE to say about inherent beneficiency of the process, blah, blah...) it really cares only, and ONLY about programs' interests. Only one way for an applicant not to end in some God-forsaken place in the middle of nowhere is not to apply in this place, or not to put it into "his" Match List. If, as it quite commonly happens, applicant still put one or two not-so-good places there, then.... well, nobody cares. You're bound for "X" years to be a resident there, and nobody cares that you may have, for example, something named "family". Also, nobody cares if after slaving out years in there everything you can get is local family medicine practice (all residency programs are known for training and connections they provide; usually applicants know exactly from the very beginning where they can get jobs and fellowships and where they can not).
    Third, as it was mentioned here already, residency trainign programs bring money in hospitals. The money are paid by All Mighty Medicare in amount approximately $200000/year/resident's head. The hospital has absolute freedom in how to spend these money. They not only pay less than $10/hour (counting the real time worked), they laso charge residents for things like parking, meals and sometimes library using. Recently there appeared a trend to increase training time for family practice residents from 3 years to 4, with presumption that the time can be used for learning "management skills"... got the idea??
    Fourth and the worst of it. The problem is, the resident is, like a slave, personally bound with the program for the time of his or her training while the program is not. Not only resident cannot immediately leave program and just join another, in some specialties he has to stay in the place for "X" years just in order to be, with time, eligible for Boards and license. After that condition, the absolutely, bloody worst kind of "nurses eating their youngs" looks like innocent babies' play comparing with what is considered to be a norm in medical residencies, including things like sabotage, diversions and physical aggression for those unfortunate ones who didn't figure out immediately that 75% of residency is about politiking and not about medicine. The attendings who know that their behavior will one day or another bring them loss of their licences tend to gather in residency programs because there they can do whatever they like and be happy with their reputation of "strong guys" and because, once canned out (for whatever reason, legal or not), a resident has close to 0 chance to get into another program. And that's the main difference. A newly graduated nurse can switch floors, hospitals, specialties and states as often as he/she wishes, and unless there were VERY dubious circumstances, his/her licence looks nice and blemish-free. A resident who switched programs within the same specialty just in order to be able to visit his dying mother once every week can be legally denied licensing simply because of it, or can be "sentenced" to repeating couple of years of training... again, because of it, alone.
    I'd known a guy who managed to go through surgical residency (5 years) traume fellowship (2 years) and thoracic surgery (3 more years) and broke his spine while skiing during his second year of practice, ending with his both legs paralyzed. Everybody though that, after reading thousands upon thousands of X-rays of every kind, he would do just fine as radiologist. But in order to do so he must complete another full residency (4 years, if not more) in order to become qualified to, basically, read chest X-rays and the like. The doctor carefully collected his pain and sleeping pills for a while, went home and took them there all at once. He left a note mentioning, among other things, that he was dying happy knowing that his widow and three small kids won't carry his $$$$$ educational debths.

    Nursing has a whole lot of problems of its own, and to copy blindly a system widely recognized as arcane, wasteful, deceptive and inherently prone to supporting the worst features of human nature would be the worst mistake possible.
    Last edit by KatieMI on Mar 13, '13
    spitcher2, ThePrincessBride, morte, and 9 others like this.
  4. 0
    You didn't complete a nurse residency? I did. Nurse residency in Critical Care. Nurse residencies already exsist. Obviously not wide spread and what some organizations call "residency" can be something pathetic like meeting for 4 hours a week or some brief four month orientation.
    Last edit by PMFB-RN on Mar 13, '13
  5. 3
    Quote from KatieMI
    OK. Here is something not all of you probably know.

    First, the process of applying for physician's residency costs A WHOLE LOT of money. There is an organization, popularly known as "The Match" which takes from about $50 for each application prospective candidate sends to a particular hospital. Counting that for most competitive specialties even the cream of US grads have to apply for every single program in the country, and that no program will put the candidate in its "list" without a formal interview, the total lump can easily go over a few thousands. And that's not paying for the residency - just for a mere chance to get into it. There is absolutely no chance to avoid this money sucker.

    Second, the "match" is, basically, all about math and stats. Whatever "they" are saying (and they LOVE to say about inherent beneficence of the process, blah, blah...) it really cares only, and ONLY about programs' interests. Only one way for an applicant not to end in some God-forsaken place in the middle of nowhere is not to apply in this place, or not to put it into "his" Match List. If, as it quite commonly happens, applicant still put one or two not-so-good places there, then.... well, nobody cares. You're bound for "X" years to be a resident there, and nobody cares that you may have, for example, something named "family". Also, nobody cares if after slaving out years in there everything you can get is local family medicine practice (all residency programs are known for training and connections they provide; usually applicants know exactly from the very beginning where they can get jobs and fellowships and where they can not).

    Third, as it was mentioned here already, residency training programs bring money in hospitals. The money are paid by All Mighty Medicare in amount approximately $200000/year/resident's head. The hospital has absolute freedom in how to spend these money. They not only pay less than $10/hour (counting the real time worked), they also charge residents for things like parking, meals and sometimes library using. Recently there appeared a trend to increase training time for family practice residents from 3 years to 4, with presumption that the time can be used for learning "management skills"... got the idea??

    Fourth and the worst of it. The problem is, the resident is, like a slave, personally bound with the program for the time of his or her training while the program is not. Not only resident cannot immediately leave program and just join another, in some specialties he has to stay in the place for "X" years just in order to be, with time, eligible for Boards and license. After that condition, the absolutely, bloody worst kind of "nurses eating their young" looks like innocent babies' play comparing with what is considered to be a norm in medical residencies, including things like sabotage, diversions and physical aggression for those unfortunate ones who didn't figure out immediately that 75% of residency is about politicking and not about medicine.

    The attending's who know that their behavior will one day or another bring them loss of their licenses tend to gather in residency programs because there they can do whatever they like and be happy with their reputation of "strong guys" and because, once canned out (for whatever reason, legal or not), a resident has close to 0 chance to get into another program. And that's the main difference. A newly graduated nurse can switch floors, hospitals, specialties and states as often as he/she wishes, and unless there were VERY dubious circumstances, his/her license looks nice and blemish-free. A resident who switched programs within the same specialty just in order to be able to visit his dying mother once every week can be legally denied licensing simply because of it, or can be "sentenced" to repeating couple of years of training... again, because of it, alone.

    I'd known a guy who managed to go through surgical residency (5 years) trauma fellowship (2 years) and thoracic surgery (3 more years) and broke his spine while skiing during his second year of practice, ending with his both legs paralyzed. Everybody though that, after reading thousands upon thousands of X-rays of every kind, he would do just fine as radiologist. But in order to do so he must complete another full residency (4 years, if not more) in order to become qualified to, basically, read chest X-rays and the like. The doctor carefully collected his pain and sleeping pills for a while, went home and took them there all at once. He left a note mentioning, among other things, that he was dying happy knowing that his widow and three small kids won't carry his $$$$$ educational debts.

    Nursing has a whole lot of problems of its own, and to copy blindly a system widely recognized as arcane, wasteful, deceptive and inherently prone to supporting the worst features of human nature would be the worst mistake possible.
    Well said.
    anotherone, nursel56, and llg like this.
  6. 1
    Quote from PMFB-RN
    You didn't complete a nurse residency? I did. Nurse residency in Critical Care. Nurse residencies already exist. Obviously not wide spread and what some organizations call "residency" can be something pathetic like meeting for 4 hours a week or some brief four month orientation.
    Nurse "residency" programs are the exception and not the rule and I have found they are "offered" by the larger academic type facilities almost exclusively.

    They don't offer new grads positions because they are too cheap to train them. They staff poorly on purpose and complain about a nursing shortage that doesn't exist.

    A simple orientation to new grads isn't an unfair expectation and if they are so afraid to train them and loose them I do think it is reasonable to have them sign a contract that put a time limit on how long they must stay top "pay for" the education.
    anotherone likes this.
  7. 0
    Why not revert back to a more diploma-based education where nurses actually trained in hospitals and not in skills labs?
  8. 5
    Quote from dirtyhippiegirl
    Why not revert back to a more diploma-based education where nurses actually trained in hospitals and not in skills labs?
    Nursing needs more education not less.
  9. 2
    Quote from Amistad
    Meanwhile, new graduate nurses face roadblock after roadblock to becoming an experienced nurse. As nursing students approach graduation, they frantically begin the job search, only to encounter "__ years experience required" on almost every job posting.
    One of the main differences is there are federal (?) regulations on how many new docs are made each year, in order to ensure that there are enough residency spots for all of them.

    No such regulations exist for new nurses or nursing schools. As a result, you see lots of for-profit and fly-by-night "schools" churning out new grad nurses by the thousands, and not enough new grad programs or residencies to accommodate them all.
    anotherone and llg like this.
  10. 2
    Quote from nursel56
    I think part of the problem is that medical schools limit the numbers and nursing schools are constantly trying to flood the market with as many nurses as they can.

    Are new nurses willing to work for dirt cheap wages and be on call for lengthy periods of time and submit to the hierarchical nature of medical residencies? It doesn't seem so.
    Or I could have just kept reading and saved a lot of typing.
    anotherone and nursel56 like this.


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