Structure In Hospital, Hierarchies, Coordination...

[OttawaURookie]

I'll be working on a hospital based ga* me, and I wanted to better understand the structures/hierarchies in hospitals, and how things are coordinated. I'm more interested in smaller hospitals and mid level..I assume things are slightly different based on size of hospital.but I guess you guys can clarify.

I had some specific questions.

1. If a resident decides to take on a fellowship. who pays for all the training?

2. I'm particularly interested in the relationship between the ER, radiology, pathology, and some of the other main specialties. For example, I've always wondered if a Cardiologist is specifically assigned to be an ER Cardiologist, or do they see their regular patients and get called down for a consultation ?

If there is a resource somewhere that sort of talks about it, that be great as well..but I haven't found one.

Thanks for any info

 

 

 

[Arztin]

1- this one is a bit complex. I'll let others answer.

2- it depends on the specialty and the location. Most places have one specialist per speciality on call, sometimes more than one. These people will be the ones doing consultations, such as consultations in the ER, and on the wards, and most of the time will have to take care of hospitalized patients under the care of that service too. That specialist usually wouldn't have a scheduled clinic the same day. E.G. cardiologist X will complete the ER and ward consults for cardiology, and round on the patients admitted under the cardiology service.

In some places, there are internists (general internists) who are purely assigned to the ER at times. Other than that, I haven't heard of other specialists purely assigned to the ER in any given day, including cardiology.

Again it's very location dependant. A gigantic hospital could have multiple general surgery teams, one doing consults, the other doing trauma, while a small hospital can have one general surgeon on call during a scheduled OR day, who would have to operate + doing ER/floor consults.

Hope it helps instead of confusing you further.

[Lactic Folly]

If the fellowship is part of a Royal College program (e.g. internal medicine subspecialty match), then the provincial government should continue to fund it, same as for other residency programs.

If not, funding would come from another source, such as the department offering the fellowship.

[rmorelan]

If the fellowship is part of a Royal College program (e.g. internal medicine subspecialty match), then the provincial government should continue to fund it, same as for other residency programs.

If not, funding would come from another source, such as the department offering the fellowship.

 

yup

Often the fellowship seems to still kind of follow the provincial rules for pay increases. The group pays for the fellow and gets in turn the ability potentially to do more work. It also shields the staff from working at annoying times. 

 

Also at many places there are a lot of foreign trained fellow, some of which get funding from their own home country so they can return with new skills. 

 

It is complex  

[OttawaURookie]

Thanks guys.

 

What would you guys say are the top 3 to 5 qualities that make a great doctor? (in terms of making good diagnoses or having happy patients)

[NLengr]

Adding to the fellowship complexity, surgical fellowships are often different again. Fellows bill assist fees for operations they help with. They can then get paid via:

 

1. Giving all the fees to the program and getting paid a salary

2. Giving some percentage to the program (say 30%) and keeping the rest for themselves. No salary.

3. Getting a partial salary plus keeping some percentage of assist billings

4. Getting no salary and keeping all the assist billings

5. Getting paid extra when covering overnight call or cases off the board (plus salary and/or assist fees for other cases).

 

If you're can think of some random combo, a fellow probably is getting paid that way.

 

I know people who made less than a PGY-4 and people who made close to 300k as a surgical fellow.

[Arztin]

Adding to the fellowship complexity, surgical fellowships are often different again. Fellows bill assist fees for operations they help with. They can then get paid via:

 

1. Giving all the fees to the program and getting paid a salary

2. Giving some percentage to the program (say 30%) and keeping the rest for themselves. No salary.

3. Getting a partial salary plus keeping some percentage of assist billings

4. Getting no salary and keeping all the assist billings

5. Getting paid extra when covering overnight call or cases off the board (plus salary and/or assist fees for other cases).

 

If you're can think of some random combo, a fellow probably is getting paid that way.

 

I know people who made less than a PGY-4 and people who made close to 300k as a surgical fellow.

gosh this is confusing. Which of the pathways allows you to make close to 300k as a surgical fellow?

[NLengr]

gosh this is confusing. Which of the pathways allows you to make close to 300k as a surgical fellow?

Do large amount of assist volume (which can get to 1500+ a day if you are doing longer ORs). Do that most days of the week. Cover busy overnight call (keep all that money) regularly plus run your own "fellow" clinic a day a week (keep all that money).

 

Also in some provinces if you are assisting most larger procedures and you are a royal college specialist in that specialty, you can bill specialty assist fees (even better than regular assist fees).

 

Every none salaried surgical fellow I know makes 100k or more.

 

Surgical fellows are different than medicine fellows most of the time because they are already RC certified specialists in that specialty. They can go work as staff if they wanted. The only exception I can think of is thoracics (and people who did vascular as a fellowship instead of as a residency but I'm not sure if they are still around).