Tilted Forum Project Discussion Community - View Single Post - How different are learning/teaching hospitals?

greytone · 04-06-2010, 06:41 PM

I am a physician so I will pipe in. Teaching hospitals are a great place to get medical care, but they are not all the same. Some are privately owned and "for profit." Some are owned by a university. Some are county or state run and others are run by a non profit entity such as a church. They same differences occur among non teaching hospitals. Community teaching hospitals tend to do less research and have fewer residents (and even fewer or no medical students). Many patients in these hospitals are cared for by private physicians and never see a resident. Some community hospitals will have student nurses but no one studying to become a physician. The bottom line is that there are people having good experiences and some having bad experiences in every hospital all the time.

People enter medical school after completing an undergraduate degree. That degree can be in anything, but they need to have a year of Biology, one of Inorganic Chemistry, one of Organic Chemistry, one of physics, and one of English. The first two years are spent on the basic sciences in a large lecture hall and some smaller labs sections. Then number of hours in class is close to twice that as an undergraduate and the volume of information per hour is more like three times that you would see in a college course.

The third year of medical school is spent doing hospital and clinic rotations through most of the major specialties. It generally lasts a full 12 months and most is mandatory with little if any room for elective choices. These are the students you would have seen in hospital. They can be distinguished from graduates of medical school by their short lab coats and innocent looks. During this time the student needs to make a choice of specialty because applications for residency are due early in the fourth year, which is mostly elective and shorter than the third year. All the graduating medical students in the country find out where they will go after graduation on the same day in March called Match Day when a computer sorts out the applicant's rankings with those of the programs.

Residency programs are run by teaching hospitals and they employ newly graduated MDs or DOs on a salary that often does not add up to minimum wage. The hours are nuts but they need to be to fit in the experience needed. There are restrictions on hours worked now but there are no restrictions when you get out on your own.

The first year residents are called interns (they used to live in the hospital in the past) and they are not allowed to work on their own. There used to be three tracts to getting a license but I think they have been merged. When I went through I took Part 1 of the National Boards at the end of Med School year 2. Then Part 2 was during the fourth year. Part 3 was taken during the middle of Internship. If you passed all three you can get a license to practice medicine as soon as you finish your internship. You are then a General Practitioner. There are very few who stop there and they are not able to get hospital admitting privileges or get on insurance panels.

Upper level residents supervise the interns and medical students while being supervised by attendings. The level of supervision by the attending will depend on the individuals involved and how close they are to finishing their training.

Upon finishing residency most doctors chose to sit for specialty boards. Some are written only and some also require an oral test. Procedure based specialties have to submit procedure logs to be able to sit for the test. All boards have to be renewed (mine are every ten years). Some specialties are actually subspecialties of other specialties and are taught in Fellowships following residency.

Family Practice and Internal Medicine are 3 year residencies and are not the same thing, although they have a lot of similarities in the US. In other countries Family Docs do ambulatory medicine (outpatient) while Internists are hospitalists. There are a lot of subspecialities one can chose in Internal Med.

General Surgery is 5 years. They can then do fellowships in Vascular, Cardiothoracic, or Plastic surgery.

Surgical subspecialities like ENT, Orthopedics, Urology, and OB-Gyn are separate 4 year residencies.

This went on longer than I intended but I thought I would straighten out a few misunderstandings.

04-06-2010, 06:41 PM	#11 (permalink)
greytone Junkie	I am a physician so I will pipe in. Teaching hospitals are a great place to get medical care, but they are not all the same. Some are privately owned and "for profit." Some are owned by a university. Some are county or state run and others are run by a non profit entity such as a church. They same differences occur among non teaching hospitals. Community teaching hospitals tend to do less research and have fewer residents (and even fewer or no medical students). Many patients in these hospitals are cared for by private physicians and never see a resident. Some community hospitals will have student nurses but no one studying to become a physician. The bottom line is that there are people having good experiences and some having bad experiences in every hospital all the time. People enter medical school after completing an undergraduate degree. That degree can be in anything, but they need to have a year of Biology, one of Inorganic Chemistry, one of Organic Chemistry, one of physics, and one of English. The first two years are spent on the basic sciences in a large lecture hall and some smaller labs sections. Then number of hours in class is close to twice that as an undergraduate and the volume of information per hour is more like three times that you would see in a college course. The third year of medical school is spent doing hospital and clinic rotations through most of the major specialties. It generally lasts a full 12 months and most is mandatory with little if any room for elective choices. These are the students you would have seen in hospital. They can be distinguished from graduates of medical school by their short lab coats and innocent looks. During this time the student needs to make a choice of specialty because applications for residency are due early in the fourth year, which is mostly elective and shorter than the third year. All the graduating medical students in the country find out where they will go after graduation on the same day in March called Match Day when a computer sorts out the applicant's rankings with those of the programs. Residency programs are run by teaching hospitals and they employ newly graduated MDs or DOs on a salary that often does not add up to minimum wage. The hours are nuts but they need to be to fit in the experience needed. There are restrictions on hours worked now but there are no restrictions when you get out on your own. The first year residents are called interns (they used to live in the hospital in the past) and they are not allowed to work on their own. There used to be three tracts to getting a license but I think they have been merged. When I went through I took Part 1 of the National Boards at the end of Med School year 2. Then Part 2 was during the fourth year. Part 3 was taken during the middle of Internship. If you passed all three you can get a license to practice medicine as soon as you finish your internship. You are then a General Practitioner. There are very few who stop there and they are not able to get hospital admitting privileges or get on insurance panels. Upper level residents supervise the interns and medical students while being supervised by attendings. The level of supervision by the attending will depend on the individuals involved and how close they are to finishing their training. Upon finishing residency most doctors chose to sit for specialty boards. Some are written only and some also require an oral test. Procedure based specialties have to submit procedure logs to be able to sit for the test. All boards have to be renewed (mine are every ten years). Some specialties are actually subspecialties of other specialties and are taught in Fellowships following residency. Family Practice and Internal Medicine are 3 year residencies and are not the same thing, although they have a lot of similarities in the US. In other countries Family Docs do ambulatory medicine (outpatient) while Internists are hospitalists. There are a lot of subspecialities one can chose in Internal Med. General Surgery is 5 years. They can then do fellowships in Vascular, Cardiothoracic, or Plastic surgery. Surgical subspecialities like ENT, Orthopedics, Urology, and OB-Gyn are separate 4 year residencies. This went on longer than I intended but I thought I would straighten out a few misunderstandings. __________________ I was there to see beautiful naked women. So was everybody else. It's a common failing. Robert A Heinlein in "They Do It With Mirrors"