Residency programs do not prepare doctors for the real world

According to a recent editorial from Emergency Medicine News, emergency residency programs are doing a poor job preparing their emergency residents for the real world.

The authors note that a typical, large urban academic emergency department comprise less than 5 percent of U.S. ERs, and that “residency programs train physicians in some of the most inefficient EDs in the land. Relative value units of emergency medicine work per hour in the teaching hospital setting is typically half that seen in private practice.”

I think this applies to primary care residencies, as well. Many academic medical practices cannot replicate the pace and volume that a typical private practice experiences. Compounded with the lack of any formal business training that doctors today need, it’s no wonder that newly graduated primary care doctors are woefully ill-equipped to practice real world medicine.

It’s surmised that this may be a reason why “nearly 50 percent of new graduates do not survive their initial practice choice for even five years. Perhaps they simply are not sufficiently prepared to deal successfully with the realities of the community emergency medicine practice.”

There’s no question this also explains the high primary care attrition rate for new doctors.

(via GruntDoc and Movin’ Meat)

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  • jsmith

    You have to walk before you can run. Is it appropriate that a family medicine intern should see as many pts per day as a doc who has been in the game for a decade? Of course not. That said, the real world can come as a slap in the face to a lot of newly graduated residents. This is inevitable. Should we make the last year of training community-based with virtually no supervision? Doubt this would help much. Life is full of hard transitions. This is one of them and people just get through it.
    Fifty percent of docs quit before 5 years are up? Maybe something can be done about the quality of jobs instead of about the preparation of residents. That’s where the problem lies.

  • Vox Rusticus

    You could just as easily re-title thus: ” Most Community Emergency Departments Report Doing a Poor Job of New Physician Orientation.”

    Whining that residents aren’t fully acclimated to a community hospital work environment and thus require training to succeed there implies that the hiring workplace has no responsibility to introduce graduates to their facility. As if it were residency training programs responsibility to prepare them instead.

    Residents are trained at residency training programs because they have broad exposure to many things and many resources. That is really ideal. If a community has poor or very limited supporting resources, that is probably an adjustment but certainly no standard to train by.

    As far as job turnover, please. The reasons for physician job churn has so many causes: family preferences, costs of living, community opportunities, opportunities for equity in the practice organization (or lack thereof), pay, collegiality, and changes in practice preference. Pretending that it is because residents aren’t trained for working in a resource-constrained facility is something that begs proof. Is there any?

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