With hospitalists all the rage, why bother studying critical care? retired doc explains:
If a residency trained internist becomes a “officist” you have to wonder what was the point of the ICU, CCU sick-patient training in the hospital that he endured and that in fact took up the bulk of his training. I suppose you could say he will be more able to recognize who needs to go be temporarily managed by the hospitalist and arguably better at zebra spotting which could be offered as one feature distinguishing the office internist from the FP physician which may well be a distinction without a difference in the eyes of the patient.
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{ 6 comments }
I can tell you what the point of CCU was- somebody had to admit all those patients for the cardiology fellows to practice their interventions on.
The point of all the inpatient rotations, in my day, was cheap labor for the hospital (it’s a little less cheap now that residents are limited to a wimpy 80 hrs per week) .
Dr. Rack makes a good point. I think the value of a rotation depends a lot on your institution.
I enjoyed my cards/CCU month. However, I did a month of bone marrow transplant – someone please tell me why an internist (even a hospitalist) needs to this as a 2nd year resident.
And I did endocrine 3 times – one month isn’t enough to get the hang of it?
So much of residency is about providing infrastructure to the hospital, the subspecialsts (GI needs an intern? why?) and the fellows. That’s one of the reasons that patients get “turfed” from one service to another.
A normal system would be like college – everyone has the same prerequisites to graduate but your major determines what courses you take. Do I really care if my cardiac electrophysiologist knows how to do work up a pituitary adenoma? Let’s be realistic about health care in the 21st century and modify training to meet the needs of the patients, not the academic institutions.
Carry that principle to the it’s logical conclusion. Why in medical school were those destined to become psychiatrists, cardiologists, radiologists, and ENT rotate through each other’s fields? Why who became urologists learn how to use the gas chromatograph in organic chemistry, and how to analyze a novel in literature.
Why not have 4 dozen different professional schools for each off the different specialties of medicine, starting right out of high school. If we cut out all extraneous knowledge, we could train everyone in 2-4 years.
Shoot, who needs senior English, “Free enterprise” or American History to be a Hypertension Management Technician or a Depression Pharmaceutical Management Specialist. We could start right out of junior high.
This whole medical professional “professiono of gentlemen” thing is soooo obsolete.
I completely disagree with the sentiments posted here, and I think the point of a variety of rotations is to prepare the generalist. This is what separates a good primary care doctor from an NP or PA. For example, some things that a good PCP will recognize vs. an undertrained mid-level:
1-neutropenic fever is emergent, ie. consider this in a patient w/recent chemotherapy
2-indigestion sometimes is best worked up as cardiac instead of just giving maalox
3- many meds require adjustment for GFR, with disastrous consequences otherwise
4-indications for URGENT pacemaker placement include some second-degree heart blocks
one can come up with hundreds of such examples, and working with mid-levels daily, I regularly see examples of what differentiates them from someone who went thru med school & residency, and it is HUGE.
And i think the 4yrs of college are a maturing experience, which has value ESPECIALLY in primary care.
If you want to be merely a technician, become a PA – they make as much as a PCP & can be highly specialized. I don’t think, for myself, that I’d want to ASPIRE to be someone’s “assistant” as my career choice, however; but to each his own.
>>Shoot, who needs senior English, “Free enterprise” or American History to be a Hypertension Management Technician or a Depression Pharmaceutical Management Specialist. We could start right out of junior high.
The way our public schools run, nobody is getting taught Free Enterprise or American History. English is long gone.
“Why not have 4 dozen different professional schools for each off the different specialties of medicine”
4 dozen different professional schools is a little excessive. However, we already have separate schools for dentists and podiatrists. We could probably split off a few more, especially psychiatrists.
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