medical student engagement

Hi,

Not sure about the medical student part but you mentioned residents attended as well. I find that a lot of FM programs are not supportive of FM residents who want to pursue HM as a career. When I decided to apply for a HM fellowship I got some flack for it. Things have changed somewhat now and there are progressive FM programs that now offer "HM tracks" during training for those who are interested.

So I think part of it starts with our FM residency programs being receptive and supportive to HM as a career path and building it into the curriculum. To be honest in the working world FM and IM grads are doing the same thing as outpatient docs. Not many FM grads practice full scope and a lot only see kids over the age of 5. It is hard for FM grads to get OB privileges at hospitals as well. Our training programs have not kept up with what is happening after graduation outside of the academic world (those of us who practice in community settings).

-Atul
 

Atul,  
thanks for your reply. I agree that there definitely seems to be a range in terms of residency interest in providing more hospitalist medicine care: some programs do provide hospitalist training or are able to better support, while others are focused on helping their residents obtain experience with clinic numbers and care while in residency. I suspect that at least in part this stems from distinct program resources, faculty experience and current resident interest, fueling the direction of individual programs.  

Currently, it seems that if an MS4 knows that they want to continue to practice 'broad spectrum' family medicine when they are done with residency, they will try to seek out a program that provides this extra training, thereby allowing them to get the preparation they would need for practice after residency. The challenge is that not everyone knows that FM can do Hospital work, OB or Peds inpatient while they are applying to residency.
I would argue that at least part to changing the awareness of what's going on in the real world should start with better modeling to medical students the full breadth of what we can do as Family Medicine..so that they demand more of these specific trainings when they are in residency. I know at my current institution the perceptions of the practice Family Medicine often communicated to the medical students by other departments is one that is narrow, which tends to select out those who would be interested in hospitalist medicine, etc. It's a framework that my FM department has to work against intentionally, and it's tough to combat years of assumptions made about what is within our purview as FM docs.

Beyond the minimum ACGME requirements for Hospital/crit care patient care while in residency, Atul, do you see there being a better way to prepare or at least to expose residents or at least support those seeking training in hospital medicine? 

What are others' experiences in this? How did any of you learn that hospital medicine could be done after graduating with Family Medicine training?

Tori

Tori,

My experience was different than a lot of other FM in a way. I went to an un-opposed program. We had to do everything. We had our own FM service we admitted for but we also had dedicated night float and when you did that you did all the admits for the hospitalist group (which was 8-20 per night). We also did all the crit care admits. There were no crit care docs in house after 7pm so we did all the rapids and codes at night as house officer. During the day we also ran the rapid response team and were involved in codes. We rounded in the ICU all 3 years. There was no one else to compete with so it was a great experience. In addition we were very OB intensive. My only issue was that maybe the last 6 months those of us who were not going to practice OB maybe should not have to do anymore deliveries (I had already met my requirement) and pick a "track." So we can do more inpatient if we were going the HM route. I would say same for those that want to do OB. Let their last 6 months by more focused on that.

When I went to SC for the fellowship they too had a FM program. I got know a lot of the residents. Their experience was very different than mine. At SC they had transitional year and Gen Surg residencies to compete with. Their crit care experience was wholly lacking. They did the bare minimum and Im not sure they got much out of it. They did not have any formal ICU rounds or presentations. Ours was multi-disciplinary formal rounding and presentation. It was then I learned that no 2 FM programs are the same. And that is also part of the problem. But as you said that's an ACGME issue.

I learned that FM grads can do HM bc I had a couple seniors who did it. And by the time my 2nd year was over I realized I loved acute inpatient medicine and the ICU. I couldn't stand the office anymore. I was bored. I learned about HM fellowships on my own with the help of SHM who maintained a list although "back in those days" the list was incomplete and had a lot of errors so I did the a lot of the legwork myself with Google searches and then calling and emailing programs.

Im glad I went to the program I did but as we approach 2020 I fear that FM has been slow to change. Medicine is changing dramatically and we have not kept up. In community settings mid-levels are being taught to run ICUs at night in places that cannot fully staff Intensivists  (which is a common problem). We are being shut out. To me that is scary. But we have only ourselves to blame. Our training has not evolved. In SC I was the 1st FM hospitalist the group hired after fellowship. Previously they still carried that stigma that only IM docs can be hospitalists bc FM have inferior inpatient experience.

I have written this on many other sites on SHM and also AAFP MIGs- I fear by 2025 FM will cease to be a viable option for residency for US grads. We need to evolve our training and our access to fellowships. That's just my opinion from what I see happening in the suburban and urban community setting.

-Atul

Great discussion!  In terms of interesting medical students in HM as a career via the FM pathway:  I find that most of my students first encounter this option when they are doing their subinternship (acting internship).  At our institution you can do your subI/AI on our family medicine hospitalist service.  This is the first time most of them have seen FM-trained docs doing exclusive inpatient work and several have voiced interest after this experience.  I still think that's too late and so my colleagues and I (we are an FM only hospitalist group) have started getting involved in earlier clinical exposures for med students.  There are two main programs:  as longitudinal preceptors who work with a singular student 6 times a year starting in the 1st year of med school and as a flexible clinical experience (FCE).  The FCE program provides space for 2nd and 3rd year students to explore sites where they may never rotate.  We have just started in these efforts in the last two years so no outcomes to share yet.  I think it is on us to reach out to students and show them what we do and how passionate many of us are about hospital medicine!

 

Patricia,

I 100% agree and glad you mentioned it- we need to get to them before med school. A very close friend of mine is director of HR for one the largest scribe companies in US. Most scribes are pre-med or already in enrolled in med school but doing a "gap" year. They have poor outlook on PCP. I hear it from my friend and also when I talk to the scribes who work in our ED. I cant blame them for not wanting to do Primary Care.

This is what they see and hear:
1. Primary care is dead. Midlevels are the new PCPs.
2. PCP now stands for Primary Care Practitioner (not Physician anymore bc need to be inclusive to midlevels)
3. Low pay for PCP
4. Bottom of totem pole in terms of colleague respect
5. PCPs are just referral machines

and the list goes on...

I don't blame a US grad for not wanting to do FM. They have seen it de-valued. Low pay and saddled with large student debt and over burden of admin. Why would they go into it?

So yes before they get to med school is where need to make more of an impact as well.

-Atul

Currently, it seems that if an MS4 knows that they want to continue to practice 'broad spectrum' family medicine when they are done with residency, they will try to seek out a program that provides this extra training, thereby allowing them to get the preparation they would need for practice after residency. The challenge is that not everyone knows that FM can do Hospital work, OB or Peds inpatient while they are applying to residency.
I would argue that at least part to changing the awareness of what's going on in the real world should start with better modeling to medical students the full breadth of what we can do as Family Medicine..so that they demand more of these specific trainings when they are in residency. I know at my current institution the perceptions of the practice Family Medicine often communicated to the medical students by other departments is one that is narrow, which tends to select out those who would be interested in hospitalist medicine, etc. It's a framework that my FM department has to work against intentionally, and it's tough to combat years of assumptions made about what is within our purview as FM docs.

Beyond the minimum ACGME requirements for Hospital/crit care patient care while in residency, Atul, do you see there being a better way to prepare or at least to expose residents or at least support those seeking training in hospital medicine? 

What are others' experiences in this? How did any of you learn that hospital medicine could be done after graduating with Family Medicine training?

Tori