Family Med applicants must read!!!!!

Discuss about the Residency Match process - applications, interviews, visas, medical school transcripts, residency programs, ECFMG certificate, match strategies and post-match scramble. Meet current Residents & Fellows here and network for Residency placement. Post your opinion on specific residency programs.

Postby Guest » 26 Oct 2005, 07:13

I thought about applying. I have a strong interest in men’s health and sports medicine and I know they have a Sports med program there. Do you think I should do the residency there so I can go to there sports med program?
Guest
 

not the place for you

Postby murphy » 26 Oct 2005, 12:46

Men in general are treated poorly in the family practice program at Duke. As for the sports med program it pretty much sucks. The current fellow is last years chief resident and he, how can I put this nicely, is a horrible self absorbed, bad doctor. The residency program simply is unhealthy. Take a look at scutwork.com. Try to contact some of last years graduates or the SIX residenst who have left the program in less than 2 years. I'm sure they will relate to you the mess that is Duke Family Medicine.
murphy
 

Postby Guest » 05 Nov 2005, 14:35

:shock: :shock: :shock: :shock: :shock: :shock: :shock: :shock: :shock:
Guest
 

Postby Guest » 11 Nov 2005, 14:49

why so many problems there? :?:
Guest
 

A Paradigm Conflict

Postby Guest2 » 11 Nov 2005, 22:16

Stripping away all of the malignancy, what they have is a conflict of paradigms. The disgruntled residents, for the most part, signed on with the understanding that they would be doing a traditional hospital-based family practice residency.

Two years ago, almost out of nowhere (at least from the point of view of the residents) and with little or no input from any dissenters the program was switched to a community medicine-based program.

Community medicine sounds innocuous but in reality it is a capitualation to the perception that Family Medicine is a dying specialty and in order to survive it has to find a new mission. In our case, the new mission is to be the American equivalent of "barefoot doctors," that is, adequately trained health providers who will fan out among the poor to provide low-cost or free primary care for a low salary.

Because this is Duke with acccess to every sub-specialty known to man it is easy to believe this. In fact, at our clinic we pretty much punt every slightly complicated case to adult doctors. This allows our clinic to function with a full complement of PAs and NPs, many of whom are permitted to function as Family Medicine Physicians despite their lack of knowledge and training. In the new paradigm, knowledge and training are not required so much as a rolodex with the phone numbers of grown-up doctors.

How is this working? Well, because the program is affiliated with Duke and needs to maintain good standing with the ACGME, there is no way to prevent the residents from rotating on the big boy services. Not to mention that residents are cheap labor at the hospital and are in high demand by attendings who don't want to come in early and stay late. So we do get excellent training on almost every off-service rotation. On cardiology, for instance, our interns are fully functioning members of the cardiology service and have generally been treated no differently than any other resident.

The problem comes with the family practice elements of the curriculum.

Because Pickens runs a profit every year, the priority is production, not learning. The program is so weak and, let's face it, non-essential to the otherwise high-powered misssion of Duke that if it showed a loss that would probably be the end of it. For those of you new to medicine, you need to understand that when you are precepted, your preceptor bills for your time with the patient. They usually see the patient but only for a couple of minutes.

In a good program, the preceptor will take an adequate amount of time to let you present, propose a plan, and then discuss the patient. Profit, while never unimportant, is always secondary to teaching and most teaching hospitals understand this. At Duke, the clinic is incredibly fast paced and not in a good way. You future iterns need to know that after a couple of months your patient panel for your half-day clinic will be increased from three to five. Not a lot, it seems, but you will always feel rushed and almost never have time to think.

The rationale is that usually at least one of your patients will not show up. True, in some cases, but if your 8:15 patient doesn't show you still have four patients who are going to hit you starting at 9:00.

(to be continued)
Guest2
 

Postby Guest » 11 Nov 2005, 22:56

(cont'd)

I understand perfectly that some clinics need to be fast-paced. Out-patient surgery clinics, for example, are incredibly focused and it is not unusual for one resident to see twenty patients in a long moring. I did that as an intern last year almost effortlessly. This is because a surgery clinic is ruthlessly "problem-focused" with one chief complaint. The history and physical exam needed to formulate a surgical plan is concise but brief. Not to mention things like routine wound checks which take five minutes.

Family medcine is not surgery. The patients are generally more involved in their work-ups and even if they are not, this is where the concept of health maintenance rears its ugly head. In other words, not only do we have to elicit a chief complaint and formulate a plan for that but at every visit we are expected to address every single health maintenance issue that applies to the patient. If someone comes in for a sprained wrist it is not enough that we get an xray and treat it (by sending it to ortho, ha ha) but we have to make sure the patient is up to date on their cholesterol, colon cancer screening, pap smears, prostate, vaccinations, mammograms and every other applicable screening. And we have to offer smoking cessation, harangue them about their weight, and make disapproving noises over their drinking.

Not too complicated on a 23-year-old healthy male but very time-consuming on a typical older patient.

Thus, there is no such thing as a simple visit. Nor do we dictate simple SOAP notes but must fit our note into a incredibly cumbersome template.

In a way, however, this is a problem for all of family medicine, that is, squeezing a comprehensive visit into the time only sufficient for a focused visit. It's just that at Duke you start out rushing and only learn to rush, not how to be efficient.

I just want to mention didactics or rather the lack of didactics. The conferences are incredibly weak and are usually on some completely useless subject like anger management or self esteem. Either that or some topic on community medicine which is often taught by a social worker or someone who's medical knowldge is irrelevent to their career.

Even when on a medical topic, a rare event, because the conference includes PAs, NPs, social workers, and nurses the content is either irrelevant to physicians in any but an incidental way or sufficiently dumbed down for the benefit of those without medical degrees.

In short, very few didactic sessions are worth attending.

It has been proposed by quite a few people that we need to have a protected block of time carved out every week (like they do in Emergency Medicine) which is to be used for grown-up education. The PAs and NPs can sit at the kiddy table if they like.

The resistance to this idea is intense. Of course it would be hard ot schedule but not impossible. Surely Duke will not lock its doors if a couple of FP interns are off the wardss fro three hours on a Tuesday afternoon.

(continued)
Guest
 

cont'd

Postby Guest2 » 12 Nov 2005, 09:33

(cont'd)

You future interns also have to understand that six residents per class is not enuogh to run a primary care specialty program at a large insitution like Duke. Maybe it is at a small unopposed program but there are many service requirements at Duke which siphon off residents from things like an Inpatient Family Medicine Service which we no longer have.

Not ot mention that the reason the didactics suck is that we can seldom, it seems, get enough residents together to make a good showing for a guest lecturer.

Medicine grand rounds, on the other hand, are well attended and the conference center is usually packed. If you are a high-powered academic, where would you want to give a talk? To a standing-room-only crowd of residents and attendings or two a couple of bored FP residents and a bunch of PAs and LPNs who probably don't even understand what you are talking about.

Consequently, the conferences we do have are pretty thin gruel. I absolutely refuse now to go to any conference presented by a social worker, a midwife, a lactation consultant, or any other "physician extender" because there is nothing important in them that couldn't be jotted down on a business card and handed out in lieu of wasting an hour of my life.

Thin gruel. That pretty much sums up the whole community medicine experience. I don't see why it requires specialized training in a residency to learn how to pass out condoms at high schools, nag the poor to quit drinking, and agitate for even more social welfare. These are things which, if you believe in them you can pick up in about five minutes which is why the academic barriers to being a social worker are so low.

(cont'd)
Guest2
 

Postby Guest » 12 Nov 2005, 11:47

How does the Dept. feel about the ever increasing numbers of “mid-levels” muscling their way into the physician role? Do they encourage this? Are they not afraid that FP’s will be absolute in the future? What are they doing to protect the FP niche in the medical field?
Guest
 

Postby Guest » 12 Nov 2005, 11:53

obsolete
Guest
 

Postby Guest2 » 12 Nov 2005, 15:20

PAs have their purpose. At my current program they are used for all kinds of things but mostly to take the adminstrative burden off of the physicians.

At Duke physician assistants have their own patients and they function like residents. They didn't assist anybody per se as far as I could see.

I even had to shadow a PA during orientation which was embarrasing and just plain wrong. I mentioned this and I date my disenchantment and subsequent troubles from that complaint.

Like I said, since they punt everything complicated, it probably doesn't matter. A motivated pre-med student could probably pass himself off as a doctor. Still, this doesn't speak highly of FP as a specialty. Thankfully, it is not like that everywhere.
Guest2
 

REPLY FROM ACGME

Postby REPLY FROM ACGME » 17 Nov 2005, 13:23

I decided to email ACGME to find out about the 12 alleged violations against Family Practice residency as posted in several websites including this one. Here is the reply that I got.... RK

REPLY FROM ACGME:

"The status action taken by the RRC is posted on the ACGME website, however, any citations the program has received is not public information and is confidential. You would have to check with the program director.

Caroline Fischer
Senior Accreditation Administrator
Residency Review Committee for Family Medicine
Residency Review Committee for Pediatrics
515 N. State Street #2000
Chicago, IL 60610
(312)755-5044
(312)755-7498 fax"
REPLY FROM ACGME
 

Truly heavy stuff

Postby guest888 » 17 Nov 2005, 19:10

Strong work emailing the ACGME. You have the makings of a rebel, and I can only assume someone who does not believe everything he/she reads. If you or anyone who reads this plans to interview at Duke I urge you to learn all you can about the program. The many letters on Scutwork.com, this site, and studentdoctor.net only present a truly smelly side of the Duke Family Medicine program as you know. I would urge all of you to call or email the program director, Dr. Halstater, to hear from the horses mouth the result of this years ACGME visit to Duke Family Medicine. Ask him also if any interns are leaving the program (at least two I know are leaving). Ask him if there are plans to cut the residency to four per class. Then I would challenge you to email any of the residents and ask them their feelings concerning the program in private while not under the watchful eye of the administration (their emails can be found at: http://dukefamilymedresidency.mc.duke.e ... Alumni.asp).


Halstater's email: brian.halstater@duke.edu

Secretaries who can direct you to his phone line

(919) 681-3028, Teri Pond

(919) 681-3065, Diane Spell

We too have contacted the ACGME read on . . .
_____________________________________________________________________________

5/11/05


Dear Ms. Parsons and Ms. Miller and the RRC members of the Family Medicine RRC committee reviewing the Duke Family Medicine Residency,

We are aware that our program will be coming up for review shortly and we wanted to bring you up to date, from the residents’ standpoint, concerning the current state of our program since Ms. Gideon’s visit:

1. Two interns have decided to leave the program at the end of this academic year.
Deanne Rhodes – Matched a pediatric residency
Moira Mcquillan – Will be joining another Family Medicine Residency as a second year.
Both feel strongly that their treatment during their time at Duke Family Medicine
was inappropriate and unsupportive. This now makes five residents who have
resigned in the last two years and one whose contract was not renewed. All but
Dr. Rhodes have gone on to secure positions at other Family Practice
Residencies.

2. A current second year resident is actively seeking a position at another Family Medicine Residency Program. He has already shared this with Ms. Gideon.

3. Faculty member Dr. Vivek Padha will be leaving at the end of this year, leaving an already depleted faculty.

4. A former resident has filled a formal grievance with the US Equal Employment Opportunity Commission (EEOC) concerning the treatment and actions taken against her by Dr. John Weinerth, Dr. Lloyd Michener, and Dr. Margaret Gradison during her time at the Duke Family Medicine Residency Program.

5. The local paper has been contacted with hopes of finding a voice as the Administration at Duke continues to ignore our concerns.

6. The residency no longer has a true medical inpatient service. Attached are the details of a new IPS service that is mainly concerned with the care of OB patients. As you will see, we no longer admit or take care of our own practice patients while they are at Duke University Hospital or Durham Regional Hospital. We do “social rounds” on resident patients while they are in-house at Duke. Depending on the attending that is rounding, these “rounds” have little if any educational
value. Furthermore, we no longer see any of our practice patients in any capacity while they are inpatients at Durham Regional Hospital.

7. As before, third year residents on our new IPS service like those on the old inpatient services have only two clinics per week. This is still in direct violation of RRC requirements despite a complaint made to Ms. Miller about this very concern in December of 2004. Attached are the May and June clinic schedules, which prove this allegation. We do not know what else to do. The administration has demonstrated by their actions that it is their prerogative whether they will comply with various RRC requirements while the residents’ concerns over the curriculum are repeatedly met only with spiteful retaliation, not interest.

8. Along with the clinic violations, our clinic numbers as well as the Geriatric, Surgery, OB, MICU, Continuity of Care, Procedural, Gynecological, and Community Medicine curriculums fall well short of what is prescribed by the RRC guidelines for the minimal core curriculum elements. Dr. Halstater’s PIF and the true reality of our rotations are two very different things.

9. Dr. Vicki Saito, Associate Vice Chancellor for Health Affairs and Communications, was asked by Dr. Halstater and Dr. Gradison to come speak with the residents. She stated that it was in part her job to help fix internal problems before they went public. Aside from her visit in early April there has been no follow-up by Dr. Gradison, Dr. Halstater or Dr. Saito concerning the problems the residents elucidated. Attached, you will find a letter drafted to Dr. Saito shortly after her visit.

10. Residents have also drafted a letter to our chancellor Dr. Dzau that you will find attached. He has not addressed our concerns as of yet.

We hope this brief snapshot of events that have occurred since Ms. Gideon’s visit will help you to understand the truly destructive quality of our program. There is a blatant disregard for RRC guidelines despite specific infractions being brought to the administration’s attention by residents, faculty and even the RRC. Residents from at least the last three graduating classes under Dr. Gradison’s tenure as program director have left lacking training in several core elements of family practice. In our opinion, the Duke Family Medicine Residency Program should not be put on probation but instead, it’s credentials should be revoked and the current residents should be allowed to leave and seek other programs with full credit for their time at Duke. Similarly, the incoming interns, who were purposefully mislead on several areas of the curriculum during their interview process, also should be allowed to seek other positions.


Thank you for your time,

We realize by not putting our signatures on this that it may not be taken seriously by the RRC however, we hope you realize the huge step this was for us to send and the very real fear of retaliation and finger pointing we all feel on a daily basis. We hope the fact that it is on Duke Family Medicine letterhead, and that the schedules and IPS email by Dr. Halstater are clearly from Duke, that you will offer this letter some validity. We urge you to verify our statements of fact with Dr. Halstater.

cc: Mary Alice Parsons
Marsha Miller
Marianne Gideon


:cry: :cry:
guest888
 

Holy . . . .

Postby guest323 » 18 Nov 2005, 13:12

This is some crazy crap. :? :? :? Doe stuff like this go on anywhere else
guest323
 

right

Postby right » 19 Nov 2005, 12:59

You are right, this is "some crazy crap" until it happens to you personally (and it may -you have a 30% probability).

When it does happen to you personally, perhaps you will try to really understand what really is going on around you!!!!!!!!!
right
 

Duke probation??

Postby Cheesehead1 » 29 Nov 2005, 10:14

Called the ACGME today to confirm. If you want to know whether the program is on probation you have to ask the program director that don't give this info. out. Was told by a few residents there that the ACGME did find 12 violations, including things like not enough patients seen in clinic, which seems pretty ridiculous to me if you are primarily an outpatient specialty. They also said that they are being re-reviewed in a couple years. Appears like the scutwork.com posting is pretty on the money.
Cheesehead1
 

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