Residency part 1…

Today and Friday I plan to devote posts to residency. I have been asked what the reason is for devoting space and taking up your precious time with a post about residency? My thinking is that these posts serve several purposes: next week I intend to release an article with the point of view from different residents in the program—both from the then chiefs and also from the chiefs from my year. More importantly they are all close friends of mine. Their posts will focus on the various logistical hurdles that my absence created. Thus for this reason I thought it necessary to give you a taste of our program. I also wanted to provide a small sample of what our program and residencies are like. In writing this, I realize how unrealistic it is to expect to explain all of residency in one or two posts but my hope is to at least shed a little light on the inner workings of our program. In doing this, I’m hoping some of the groundwork is laid to portray the issues that my absence created.

——– Applying ————

Every year starting in the fall, medical students begin the process of applying to residencies around the country in various medical fields.  Much of the fields these future physicians hope to go into are based upon scores they achieve on the USMLE Step 1 test.[1]  This is a standardized test that all medical students take after their second year of medical school.[2]  The pass rate for this test has been sometimes cited as low as 75%.  This may seem high, but when one considers having ‘invested’ 2 years’ worth of tuition (as much as $60,000) and then having a standardized test halt a quarter of these paths, 75% doesn’t seem so high any more.  If on the day you received your score, you were lucky enough to both pass and obtain a high mark, then you would probably start thinking of the medical specialties that ‘fit’ your score. I was lucky enough to both pass and have my score fit into the range of the specialty I wished to enter: Emergency Medicine.  Then, for most, the next step in the process (after applying) is attending various interviews.  Some applicants decide before the interviews that they wish to stay within a certain radius, thus rejecting any interviews outside of this radius (or not applying there in the first place).  For me, this was a little bit more complicated as my wife was applying to various Family Medicine residencies and we had to go through what is called the Couple’s Match.[3]   It turned out that whenever I really liked a program she hated it, and vice versa—this made deciding on a place difficult.  Luckily, there was a place that we both agreed on and that was in Lansing, Michigan at Sparrow Hospital.  After a program is selected, students then create a ‘rank list’ of places they wish to attend.  Each program also creates their own ‘rank list’—ranking the applicants they desire the most.  A computer program then matches these preferences taking into account the student’s preference first.[4]  Both my wife and I liked the Sparrow programs and thus ranked them #1.  We found out on Match Day[5] that I would be training at the Sparrow Hospital Emergency Medicine program while she would be in the Family Medicine program.

Table showing the average USMLE scores divided by specialty on the Step 1 exam
Table showing the average USMLE scores divided by specialty on the Step 1 exam

In June of 2011 we moved to Lansing to begin our training.  The time of training varies from specialty to specialty.  For example, most surgery residencies require 5 years, while most Obstetrics and Gynecology residencies are 4.  For most Emergency and Family Medicine (FM) programs this number was 3.  However while the number of years to complete a residency varies, the first year of it (known as intern year) was generally the same, filled with the same month to month rotations.[6]  There are a few ‘free’ months during this year, where training typically takes place in the specialty you are in.[7] Towards the end of my intern year, after spending quite a bit of time in the Emergency Department, I made the decision that I no longer wished to practice Emergency Medicine and hoped instead to enter into FM.  After going through an application process I was welcomed in to the FM program and because most of my first year rotations were the same ones completed by the FM residents I began my journey in FM without having to repeat any rotations or years.

——– Sparrow Family Residency ————

residency

Every residency program is unique and so operates in different ways; one of the aspects of the FM residency program at Sparrow that made it unique is the fact that they run their own inpatient service in the hospital—meaning any person that is admitted to Sparrow Hospital that is a patient in any of the FM residency clinics, is managed by the FM inpatient team.[8]  This means that 24 hours every day, someone in the program must be ready to take an admission.  That also means that every day someone must be available to ‘round’ and manage the current patients.[9]  Typically, the FM residency has somewhere between 10-20 patients on their list to round on.  Logistically we have 8 residents per year, and given that the residency is three years makes for 24 available residents.  Of the 12 months in the year 3 months are devoted to our inpatient service, the other 9 months are for other ‘rotations’.[10]  The reason I go into this is to give you a taste of what it means to be a FM resident at Sparrow, and also in an attempt to give you an idea what a logistical headache scheduling can be.  The scheduling and placement of the various residents falls on the shoulders of the chief resident—in our program this is a third year resident who is voted on by both their fellow residents as well as the supervising physicians.[11] I only bring up the topic of chief resident, because in early 2013, prior to my brain tumor diagnosis I was ‘elected’ chief resident.

———- Chief ————-

The reason I put quotes around the word elected is because of the 7 other residents only 1 other person threw their hat in to the ring to be considered for the position.  We typically have two chief residents, thus no actual vote was needed.  I have no problem with this because I believe that had more residents been up for consideration I still would have been elected as one of the chiefs.  I have absolutely nothing against my fellow residents, and strongly believe that each and every one of them would have made great chiefs, but perhaps I have too strong a belief in my ability to do the job.  However, even the decision to put myself up for consideration was a struggle, and entailed many long discussions with the two prior chiefs Megha Tewari and Greg Lawson.  To me the advantages of being a chief were being able to give back to the program.  The only drawback to being chief would be the time it required: every conflict, scheduling or otherwise, would be the chief’s responsibility to ‘solve’.  With a wife and child at home (and one more on the way) I seriously wondered if I had the time to handle and properly devote to it.  But in the end, the opportunity to give back to the program outweighed any possible cons. Thus I chose to submit my name for consideration.

[1] I included a table of the average scores on this test and specialty.  Also, please know that there are exceptions to this- outliers if you will, i.e. there’ll be someone in psychiatry who scored a 250 on their Step 1 and a Plastic Surgeon who scored a 200.

[2]http://en.wikipedia.org/wiki/USMLE_Step_1.

[3] I discussed the Couple’s Match in a previous post.

[4] For example, if Jane Smith out down her top choice as Internal Medicine at UCLA but in turn was only ranked 5th by UCLA (assuming UCLA has more than 5 Internal Medicine spots) then this computer program would place Jane Smith in the UCLA Internal Medicine program.  However, if Jon Doe were to rank UCLA Internal Medicine number 5 while they in turn ranked him number 1—the program would first try to find if Jon’s number 1 ranked program was a possibility.

[5] A day in the end of March where medical students find out if and where they matched.

[6] The thinking is that every physician, regardless of specialty, should have some baseline level of medical training.

[7] For me this meant in the Emergency Department.

[8] This makes Sparrow FM unique because many programs and clinics simply ‘admit’ their patients to other services.  For example, if a patient of Dr. Doe came to the hospital and needed admission to the hospital, but Dr. Doe did not admit patients.  Dr. Doe would have made a (monetary) deal with another group, let’s call them The Doctor’s Group, beforehand that all of Dr. Doe’s patients, if requiring admission to the hospital, would be managed in the hospital by The Doctor’s Group.

[9] ‘Rounding’ is a term that denotes the daily visit and care for your patient.

[10] These other ‘rotations’ are either office months (where you are in the clinic for the month) or various other learning months where  you follow another specialty in hopes of learning from it (for example, a resident might spends a month with an orthopedic surgeon, learning some of the details of orthopedics.

[11] This works differently in other residencies- in some residencies simply reaching the final year of residency makes you a chief, in others the decision of who is the next chief is decided upon by the Program Director—the person who heads the residency program.

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