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Doing well on surgery electives


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On 4/29/2019 at 11:16 AM, 1D7 said:

With increasing healthcare costs, there is also increasing pressure to increase efficiency and midlevels are a great way to do that. On the floor, there are plenty of patients with chronic dispo issues that residents/attendings don't really want to deal with. In clinic, having more warm bodies always helps. Basically having someone who can function at the level of a resident long-term is beneficial and makes teams more efficient. On a financial level, seeing more patients = more money for the attending.

Anyway it's not really an issue physicians can oppose; doctors are rarely a united group (see OMA). If hospitals want midlevels and there's a school churning them out, then they will eventually come. To oppose it would need docs to unite, take back hospital leadership/admin, lobby effectively... essentially things that are unlikely to happen, especially since the problem of displacement may never even happen in Canada.

Exactly. In Canada, Hospitals are under pressure to keep budgets low. Doctors too are under pressure because the government is trying to reduce reimbursement for docs and so docs want to find cost savings so the government will stop chasing after them. The best way to do that is to offsource the more menial work to someone who is paid less. If you look at it from a government perspective, its fair. There is a lot of menial work that needs to be done and doesn't need a physician with 13 yrs of school and a 400k salary to do. In the past, the work would be done by overworked residents, but with work hour limitations, there is going to be more work left undone and that needs to be done by someone, enter PAs and NPs. 

The european model has way more doctors, no real such thing as PAs and NPs, but the doctors in Europe are paid less, significantly less. You also have doctors spending much more time in mid-level jobs than here in Canada. Someone has to do the scut work so you basically have to pick your poison. Either:

1. go back to 80-100 hour work weeks

2. extend residency by a few years for everyone

3. train a lot more doctors and cut the salaries of all doctors to pay for it

4. hire mid levels

5. cut the paperwork requirements, which comes at the cost of accountability of course

Take ur pick. 

 

 

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On 9/21/2018 at 7:18 PM, 726637 said:

Hello!

I'm looking for advice on what makes an excellent clerk during surgical electives. Is there anything to help make you stand out? Anything you would suggest to do differently as an elective student rather than a CC3 on a core rotation?

 

Folks above have given excellent advice. I particularly like the one that suggested you connect with residents so they can help you navigate the system. One of the things they can help you with is becoming aware of is the "culture" around certain programs. In certain programs, staying late and offering to do x and y is recommended. In others, people may find you "too keen" or "annoying"." boring" for going there to do consults when they expected you to spend time checking out their city. It really is a very fine balance of being present, but not too present. This is particularly important in certain very competitive surgical specialties since anything you do that impresses on someone (either in a positive or negative way!) will spread rapidly to other residents/staff (medicine in general, is small, and competitive specialties are usually even smaller!) 

So while we can give you suggestions, the residents within your particular discipline/location can give you more tailored suggestions. Once you gain their respect, most will help you throughout your elective (they may suggest who to work with, how to work with them, who to ask for letters, what pimp questions to read up on.. etc.), and will remember you when the programs start selecting people for interviews and ranking them post-interviews!

Good luck :D 

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