Residency Match Week 2013

Good luck to all the 4th year medical students who are matching for residency positions!

Did you get your Medical Resident FICA Refund?

Were you in residency before 2005? Did you receive your Medical Resident FICA Refund?

Here's what the IRS says about the FICA refunds:

Why are FICA refunds being paid to medical residents and their employers?

Employers (typically hospitals and medical schools) and individual taxpayers (medical residents) began filing FICA refund claims in the 1990’s, based on their position that medical residents are students eligible for the FICA tax exception under Internal Revenue Code section 3121(b)(10). This is referred to as the student exception and may apply to a student at a school, college or university who is also an employee of that school, college or university. The employer’s FICA refund claims were for both the employer share and the employee share of the FICA tax. In some cases, individual medical residents filed their own claim for the employee share of the FICA tax. The IRS held the claims in suspense because there was a dispute as to whether the student FICA exception applied. The IRS has made an administrative determination to accept the position that medical residents are excepted from FICA taxes for tax periods ending before April 1, 2005, when new IRS regulations went into effect.

AMA's Save GME grassroots campaign

The AMA's new Save GME grassroots campaign makes it easy for medical students and physicians to urge their members of Congress to preserve GME funding and lift the federal cap on residency slots.

Unless Congress acts first, GME will undergo untimely cuts in Medicare financing on March 1.

"Residency training gives new physicians hands-on experience and provides high-quality care to patients," AMA President Jeremy A. Lazarus, MD

Experts say a physician shortage is imminent as the U.S. patient population continues to age and 30 million newly insured Americans gain access to health care. Even without a reduction in funding for residency programs, the United States is expected to experience a shortage of 62,900 physicians within two years. That number is predicted to increase to 130,000 across all specialties by 2025.

Learn more about the AMA's Save GME grassroots campaign

Quality of life, debt, and burnout among doctors-in-training (residency)

The term "resident" can mean different things, so I chose to use the phrase "doctors-in-training." Didn't want to confuse people who are thinking about long-term care residents.

This JAMA article titled, "Quality of Life, Burnout, Educational Debt, and Medical Knowledge Among Internal Medicine Residents," concludes:

In this national study of internal medicine residents, suboptimal QOL and symptoms of burnout were common. Symptoms of burnout were associated with higher debt and were less frequent among international medical graduates. Low QOL, emotional exhaustion, and educational debt were associated with lower IM-ITE scores (Internal Medicine In-Training Examination (IM-ITE) scores).

Here's what the researchers found:

• Quality of life was rated “as bad as it can be” or “somewhat bad” by 2402 of 16 187 responding residents (14.8%). 
• Overall burnout and high levels of emotional exhaustion and depersonalization were reported by 8343 of 16 192 (51.5%), 7394 of 16 154 (45.8%), and 4541 of 15 737 (28.9%) responding residents, respectively.
• In multivariable models, burnout was less common among international medical graduates than among US medical graduates (45.1% vs 58.7%; odds ratio, 0.70 [99% CI, 0.63-0.77]; P < .001). Greater educational debt was associated with the presence of at least 1 symptom of burnout (61.5% vs 43.7%; odds ratio, 1.72 [99% CI, 1.49-1.99]; P < .001 for debt >$200 000 relative to no debt).
• Residents reporting QOL “as bad as it can be” and emotional exhaustion symptoms daily had mean IM-ITE scores 2.7 points (99% CI, 1.2-4.3; P < .001) and 4.2 points (99% CI, 2.5-5.9; P < .001) lower than those with QOL “as good as it can be” and no emotional exhaustion symptoms, respectively.
• Residents reporting debt greater than $200 000 had mean IM-ITE scores 5.0 points (99% CI, 4.4-5.6; P < .001) lower than those with no debt. These differences were similar in magnitude to the 4.1-point (99% CI, 3.9-4.3) and 2.6-point (99% CI, 2.4-2.8) mean differences associated with progressing from first to second and second to third years of training, respectively.

So, what does this suggest? For one thing, residency is grueling and many people burn out or feel that life is terrible. Does this change once physicians complete their residency and enter the busy working world of high-volume patients and stressful working conditions? For some, their outlook improves because their salary has significantly gone up. For others, they battle with greater stress and anxiety because they now have more responsibilities to shoulder as an attending. They no longer have that backup or safety net they used to have during residency training. 

It sounds to me like residency programs need to take a hard look at collecting feedback from their residents and implementing some new steps to boost workplace morale and to provide more emotional support. Otherwise, we'll find more residents and physicians dropping out of clinical medicine. They'll be leaving to search for alternative careers that are less stressful and that provide an improved work/life balance. Some will be drawn to jobs that pay more. Others will be drawn to career opportunities that may appear lucrative but that end up becoming enslaving in different ways. 

ACPE is looking for a chief resident to join their board

The American College of Physician Executives (ACPE) Board of Directors recently approved the addition of an Ex-Officio Chief Resident position to the board. Do you know of any Chief Residents that might be interested in a national leadership opportunity like this?

For more information, review this Call for Nominations (PDF). Please pass it along to anyone who might know of the perfect candidate. It’s a quick turnaround (due September 15).

Speaking of ACPE - I hope to see you at the Fall Institute in Scottsdale Nov 6-10, 2011. I'll be speaking there about my entrepreneurial ventures and non-clinical career opportunities.

American College of Physician Executives (ACPE) is the nation's largest health care organization for physician executives — doctors who hold leadership and management positions.

The most popular article on this website is...

The most popular article on this website continues to be this article that I wrote in 2008 titled, "Jobs for Physicians with No Residency Experience." This article continues to draw a tremendous amount of traffic from search engine visits when people type "jobs for doctors without residency."

Now that interns and residents have been in the full swing of things for roughly 2 months, it's also roughly the time when some of them seriously consider dropping out and quitting. Residency is tough, even with these new work hour restrictions.

Back in 2008, I was writing about all types of topics on a single blog. Then, on Feb 15, 2009, I created a dedicated URL for non-clinical jobs and began writing on http://NonClinicalJobs.com.

If you encounter interns or residents who are thinking about dropping out, make sure to encourage them to research all their options before they quit.

How are the new interns doing?

July 1 marks the historic day when medical school graduates start working as interns. Many start a few weeks before July 1 so that they can get oriented and so that the finishing interns can have a break before they begin their 2nd year, but July 1 is still considered the hallmark date.

So, how are the new interns surviving internship? If you're in the intensive care unit, you're caring for the sickest patients in the hospital. The new Accreditation Council for Graduate Medical Education (ACGME) Approved Standards go into effect July 2011. If you're an intern, your shift won't exceed 16 hours. PGY IIs will be expected to work up to 24 hours, but "strategic napping" is strongly suggested.

Towards the end of the summer and the beginning of the fall, I often find that a handful of interns around the country start looking for non-clinical career options because they don't see themselves surviving internship and/or residency. These interns and residents often contact me, hoping to find some answers about what they could do if they quit working in the hospital. Now that hospitals are cutting back on intern/resident work hours, I hope that you don't find the workload too demanding. Focus on caring for your patients and learning from your experiences.

Medicare Payments for Graduate Medical Education: What Every Medical Student, Resident and Advisor Needs to Know

If you're currently in residency training and you're thinking about switching to a different specialty, make sure you read this AAMC publication titled, "Medicare Payments for Graduate Medical Education: What Every Medical Student, Resident and Advisor Needs to Know."

Medicare funds a significant portion of post-graduate training and there is a limit on how much funding a single resident may receive during his or her residency training. If you want to switch from one specialty to another, consider the funding issue that you may face and speak with your program director after you read the AAMC report.

Resources for medical students who did not match this year

If you know any medical students who did not match into a residency program, you may want to point them to the following resources:

Residency Match Day is Today. Didn't Match? Here Are Some Options

 

Residency, board certification, or medical license not required for these non-clinical jobs

 

http://www.NonClinicalJobs.com/

 

"Strategic napping" for medical and surgical residents?

How would you feel if your surgeon had just waken up from a "strategic nap" before operating on your brain? Here's a snippet from a recent New England Journal of Medicine commentary titled, "The ACGME’s Final Duty-Hour Standards — Special PGY-1 Limits and Strategic Napping." You'll see that I've highlighted the section on strategic napping:

On September 28, the Accreditation Council for Graduate Medical Education (ACGME) released new standards to which residency programs must adhere or risk losing their accreditation. Recognizing societal demands for improved patient safety, the task force that developed the standards has embraced stricter duty-hour limits and greater supervision for trainees in the first postgraduate year (PGY-1). The new standards reflect many of the recommendations made by the Institute of Medicine (IOM) in a 2008 report1 but differ from them on one critical issue — how graduate medical education (GME) programs can best prevent harmful medical errors committed by sleep-deprived residents. The IOM recommended that resident shifts longer than 16 hours include an uninterrupted 5-hour sleep period. The ACGME task force concluded that such a long sleep period was unworkable, instead recommending “strategic napping” during long shifts.

Are we kidding here?  Do we really think that we're going to reduce medical errors by ensuring that our medical and surgical residents are taking "strategic naps?"

Congrats to the new interns! You've survived a month of internship!

Wow, can you believe that the month of July is finally over? Internship traditionally begins on July 1, but many hospitals start their interns in the middle of June so that the interns can get oriented. Plus, you have to give the finishing interns a break before they assume the role of a junior resident.

So, did you survive July? If you're an intern, congratulations for completing a month! You now have 11 more months to go before you complete this year-long internship. Don't worry, those 11 months will go by quickly. In fact, you'll be done with residency before you know it. After all, you don't have to work 120 hours/week and you actually get to go home to sleep because of the 80 hour work week laws. Will those hours get reduced even more?

Do you know any interns who want to quit? Do they want to drop out of medicine?  Don't encourage them. However, if they're desperate and they need some resources, then you may want to point them to NonClinicalJobs.com.

Welcome to all the new interns and residents

Today is July 1 and it's the official "start date" for interns and residents. Many interns started in June to go through orientation, but July 1 will probably always be considered the ceremonial start date for internship and residency.

Given that all university and teaching hospitals are now full of interns who graduated from medical school a few months ago, this is a time when you may want to avoid the hospital. After all, these new doctors are still trying to get accustomed to writing orders and signing "MD" or "DO" after their names. Meanwhile, those who just finished up their internships are now responsible for supervising teams of interns and medical students. Are they ready for the challenge?

Now that the interns are officially "doctors," most of them are wearing long white coats instead of the short white coats that most medical students have to wear (there are a few exceptions: some institutions make their interns and residents wear short white coats).

Here's my tip for all the new interns and residents out there: Don't be afraid to ask for help when you think you need it. 

Good luck to all the new interns and residents! 

Hospital Handoffs for Intern Orientation by @FutureDocs

This is a great video that every intern and resident needs to watch! You won't want to be in the hospital on July 1...

Hospital Handoffs for Intern Orientation

View more videos from Vineet Arora.

Doctors (and residents) often require mental health services

I've been reading several stories related to the fatal shooting of Yale Doctor Vajinder Toor. The suspect in custody is another doctor: Lishan Wang. The current theory is that Dr. Wang had a confrontation with Dr. Toor while working at the Kingsbrook Jewish Medical Center in Brooklyn. It sounds like they were in the same residency program, but it also seems like some of the emotional issues that Dr. Wang was struggling with were never resolved. Did Dr. Wang suffer from serious anger issues? Was he mentally ill? Did he require mental health services?

It's such a shame to read stories where physicians went off the deep end. Last November, a military psychiatrist was involved in a shooting at Fort Hood (Military stress and tragedy at Fort Hood). Yesterday, we heard of a tragic shooting incident of a Yale physician.

When a doctor requires mental health services, are those services readily available? Doctors are frequently so busy that they may not make time to obtain the help they need, even if the services are readily available. As a result, some physicians build up all types of emotional issues, only to display them in bizarre behavior. In the case of Dr. Lishan Wang, it seems like he had some unresolved issues stemming from residency several years ago.

Yale doctor (Vajinder Toor) fatally shot by another doctor (Lishan Wang)

This is truly a tragic story.

Dr. Lishan Wang, 44, was charged in the killing of his former colleague, Dr. Vajinder Toor. Apparently, Dr. Wang and Dr. Toor worked together at the Kingsbrook Jewish Medical Center in Brooklyn. This really is a sad story and my heart goes out to all those affected by this tragic loss.

You can read the full story here on NYTimes.com.

Should doctors be running futile codes? (Code Blue)

In the hospital, if you hear "Code Blue," that often means there's a patient who needs to be resuscitated. There are many instances when the resuscitation is "futile." You know that the patient's not going to get revived. However, you still feel obligated to go through the steps of running the code. I realize this is going to sound terrible, but I've even witnessed situations where futile codes became opportunities for medical students and interns to "practice" certain procedures (like a pericardiocentesis, a central line placement, intubation, etc.). Perhaps you've been in those situations as well. 

So why am I writing about futile codes? The other day, I was speaking with someone about advanced directives and "code status." Some people want to be a "full code," even if they're dying from a terminal disease. Others want the letters "DNR" for Do Not Resuscitate written clearly on the chart. One big problem is that many patients and family members don't discuss code status with their loved ones. As a result, family members are faced with very difficult situations when their loved one is being supported on a ventilator and when they're asked if they ought to "pull the plug." We live in a world where advances in medical technology have made it possible for medical professionals to sustain life, but is this always a good thing? 

Medical school grads who don't match

This is being republished from NonClinicalJobs.com Match Day is a ceremonial day when 4th year medical students discover where they will be doing their medical and surgical internships and residencies. Match Day is coming up in a few weeks (March 18) and I'm sure many students are anxiously waiting for the results. What happens if you don't match? You could scramble, but what if you still don't find a position? What can you do to remain productive? There are several options, including some non-clinical options.  Here are a few of my thoughts (and you could also combine some of these):

• Research job.
• One-year MBA.
• One-year MPH.
• Medical writing.
• Blogging.  
• Restaurant work.
• Consulting for a start-up.
• Travel the world (if you have the luxury)
• Volunteer.

It's important to be creative and responsible with your options. You may have student loans to repay. Not matching is both a significant burden and an opportunity for you to do something meaningful while you get ready to start a busy internship/residency.

How will medical education change in the future?

Medical school has evolved dramatically over the past few decades. Think about how many drugs medical students had to learn 50 years ago. Compare that to today, where new classes of pharmacological agents are being developed practically every year. On top of those changes, we're seeing so much happening in the world of molecular medicine, genomics, pharmacogenetics, personalized medicine, and medical devices. Plus, we're inventing new treatments and applying new strategies to treat certain diseases and conditions. The study of medicine has become much more complex over the years.

The traditional medical school in the United States if 4 years long and it's a graduate program for students who have completed a 4-year college degree. There are a handful of medical schools that combine undergrad with medical school so that you can complete your education in a shorter period of time.

Given all the recent advances in medical technology, disease management, and pharmacology, is 4 years of medical school enough? In the future, will medical school be longer than 4 years? Maybe residency will get longer. There are some people out there who are actively advocating that certain residencies should be longer because physicians who complete those residency training programs are not feeling properly equipped to practice medicine.

Former residents suing hospitals

There are two recent stories that may be interesting to you if you're going through residency, or if you're recently survived the toils of residency: (these are snippets from the actual stories)

1. Dr. Claudine Nigro is suing Dr. Francis X. Dennehy of Front Royal for breach of contract, defamation and emotional distress, according to papers filed Aug. 3 in U.S. District Court in Harrisonburg. The Appalachian Osteopathic Postgraduate Training Institute, Warren Memorial Hospital, Valley Health System and Virginia Commonwealth University Medical College of Virginia also are named as defendants in the suit. The suit claims that all defendants unlawfully refused to allow Nigro to progress to the residency program's second year. Read about this case here.
   
2. A former surgical resident (Dr. Oscar K. Serrano) is suing the Johns Hopkins Hospital for $24 million, alleging he was unlawfully fired and then defamed after he accused officials of trying to cover up problems with the residency program. Serrano is also suing Dr. Pamela A. Lipsett, director of the general surgery residency program, and Dr. Julie Ann Freischlag, chief of surgery, among other individuals. Serrano’s superiors told their colleagues and other hospitals Serrano was let go because of mental health problems, a charge denied in Serrano’s lawsuit and by his lawyer. Serrano, 30, was in the third year of his eight-year joint general surgery residency and Ph.D. program at Hopkins when he was fired. Read about this case here.
   

I don't know any of the people involved in these cases, but I think it's very unfortunate to see these types of things happening in the medical field. I'll be curious to see how things turn out for all the parties. Perhaps they will end up pursuing non-clinical physician careers. I could probably help them with that.

101.5 Degrees: The 2009 MGH Surgery Intern Music Video

These people are talented! How do surgical interns find so much free time? Watch this classic video:

The 2009 MGH Surgery Change Show Intern Music Video that rocked a nation. Shot live on the helipad, in the ether dome, in the burn unit, and in the real-life operating rooms of Massachusetts General Hospital.