tag:blogger.com,1999:blog-6760873683081651675.post9222817503211608518..comments2024-01-18T04:16:57.545-06:00Comments on Orthopaedic Residency: The attending perspective: Tying the attendings hands ...Anonymoushttp://www.blogger.com/profile/18071954032609414825noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-6760873683081651675.post-88102624798574527142007-10-25T06:05:00.000-05:002007-10-25T06:05:00.000-05:00After doing it day in and day out, I can certainly...After doing it day in and day out, I can certainly understand. I wonder why it is the educational system pays so poorly to those in the trenches, yet administrative pay is most lucrative --at least in some venues.Chrysalis https://www.blogger.com/profile/00757696627388704079noreply@blogger.comtag:blogger.com,1999:blog-6760873683081651675.post-697940212762773472007-10-23T18:52:00.000-05:002007-10-23T18:52:00.000-05:00md007:good to here from you. hope all is going we...md007:<BR/>good to here from you. hope all is going well. i don't think that PA's/NP's are the answer but they do bridge the gap. problem is that they do need an experienced surgeon to watch over them because of the concerns you have listed. <BR/><BR/>i think what most residents early in there career realize is that just because you can operate doesn't mean you should. it is that clinical decision making that comes with time. it comes from developing you own style and encorperating others style. <BR/><BR/>the ineffieciency in an academic setting comes partially from the learning environment (at all levels not just physician). then there is the mindset of the institution that things just run at a slower pace. when i rotated at our private hosptial as a resident, everything was very efficient. surgeries went fast, i thought it was because of me. i realize that it actually was inspite of me. if you find a way of correcting the system, let me know.<BR/><BR/>Chrysalis:<BR/>we are not rewarded financially for teaching. reseach grants are hard to come by. so, we are evaluated base on our clinical production. there are some academic centers that have a special formula based on reseach and clinical production and amount of time teaching. that formula be comes too complicated. if you are told you take home 50-60% of you collections, that is easy math. <BR/><BR/>i personally try to teach during clinic and in the OR but sometimes it is easier and faster if i do it. the temtation to take the easier route that gets me home faster and nets me more clinical volume is hard to resist.Someonecthttps://www.blogger.com/profile/01098940208758613514noreply@blogger.comtag:blogger.com,1999:blog-6760873683081651675.post-55620534800145799922007-10-23T16:07:00.000-05:002007-10-23T16:07:00.000-05:00I hadn't thought of it this way- "What I see is mo...I hadn't thought of it this way- "What I see is more patients being seen in clinic and less time for teaching. What I see is more cases being done with a limited amount of time, requiring more attending participation" <BR/><BR/>At first I was reading and it sounded good, until I read that above. That's so true, if your clipping along and having to get patients through, you don't necessarily have time for "teachable moments".Chrysalis https://www.blogger.com/profile/00757696627388704079noreply@blogger.comtag:blogger.com,1999:blog-6760873683081651675.post-64031069395233585982007-10-23T13:21:00.000-05:002007-10-23T13:21:00.000-05:00I am currently an intern on a trauma (gen surg) ro...I am currently an intern on a trauma (gen surg) rotation with all PAs. We must do a better job at developing quality measures to determine if patients are as well off as before with PAs managing the floor. On one hand it seems that anyone (MD, PA, NP, my little cousin) could learn to manage a floor if only in a certain setting and seeing relatively the same thing over and over. I don't dislike PAs, but one could argue that by definition they aren't as motivated (or their motivation would have subconsciously driven them to med school). The quote about people who insist on knowing might apply.<BR/><BR/>It is very frustrating to have sacrificed so much, only to see people with less years of education knowing the basics of my specialty much better than my fellow residents and I. If they can, in fact, produce similar outcomes, then is there any point?<BR/><BR/>Based on the little I know, my particular program is very strong on developing the technical skills. If what is lacking is clinical decision making, then I am going to have to push for changes in the way our 80 hours are used.<BR/><BR/>I see inefficiency in healthcare around every corner. We're getting better, but we still suck. I find another year of residency a hard pill to swallow when I see so many opportunities to better manage the time we already have.Anonymousnoreply@blogger.com