Re: Identity defacing. Another problem with blogoverse discussion.

James A. Donald wrote re. improving the US healthcare system:
> The single biggest supply side measure would be to abolish internship
> which is a multi year non stop savage hazing of would be doctors,
> extremely dangerous to both the doctors and the patients they treat.

You don't know much about "internship" in the U.S. nowadays, do you?
The term refers to the first year of the residency, which generally
lasts three or four years. The purpose of the residency is not savage
hazing; it's to let trainee doctors practice under the close
supervision of experienced practictioners - the hands-on learning to go
with the book-learning of med school. The number of years varies
according to the discipline - it's shorter for primary care doctors
than it is for heart surgeons, who commonly also do one or more
fellowships (extra post-graduate study) after they complete their
residencies. During the residency the doctors move through increasing
levels of responsibility for patient care and clinical procedures; in a
more academic residency program, they may focus in whole or in part on
research. Duty hours are limited nowadays, and programs that don't
comply with those limits are subject to investigation and accreditation
difficulties. (Whether these limits are a good idea is a whole other
topic.)

Competency tracks pretty closely with amount of practice; you really
don't want to be experimented on by doctors fresh out of med school
doing things for the first time with no supervision. Do you really
think that's less dangerous to patients than having new doctors
supervised by experienced attendings? Around here they don't even let
PGY-1 residents ("interns") do autopsies without supervision, and those
patients are presumably beyond caring if the scalpel slips a bit.

It's also not unheard of for doctors who have been practicing for years
but want to take up another discipline to go back for a second (or
more) residency - I can think of three examples within 500 feet of me
right now.

> Its primary purpose is to stop people from becoming doctors.

Rubbish. For starters, they are already doctors. The entire faculty
and staff of a residency program along with the assorted supporting
bureaucracies (the ACGME and its RRCs) are oriented toward making sure
they become well-trained and successful and they have various measuring
systems for both the concrete (minimum numbers of procedures completed
during residency) and the abstract (development of effective
relationship skills and professional ethics). The object is not to
weed out the idiots; that was hopefully done during med school. Any
program residents drop out of regularly or whose residents don't pass
licensing exams is going to have its accreditation looked at very, very
carefully and possibly yanked, since it's obviously doing something
wrong their training and support. Any program whose residents say
during their confidential conference at an accreditation visit that
they are mistreated and unhappy is likewise going to have problems.
Residents can take their case entirely out of their program and to the
ACGME if their concerns aren't addressed - this has been done by some
affected by Katrina who felt their programs weren't meeting their
training needs.

> Another
> supply side measure would be fair testing of doctors trained and
> accredited in foreign institutions.

What do you feel is unfair about the current ECFMG process?

Susan

.

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