IM PGY-1 = glorified secretary?

[neutropenic]

Talked to yet another person I know who is finishing PGY-1 at a three letter acronym "major teaching affiliate" of Harvard University and they think that being an intern is nothing more than being a glorified secretary. Following on "scut" mostly and arranging social services, PT/OT, and discharge planning. To think, years of school to do a job they think "anyone could do."

Is there anyone who has an alternate viewpoint regarding this?

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[Leo I]

How many secetarys have to stick their fingers up stranger's butts on a regular basis?

 

[radonc]

you are a glorified transporter, secretary, social worker, med student, scut monkey, respiratory therapist, nurse all rolled into a fresh newbie intern.

 

[Attila]

you are a glorified transporter, secretary, social worker, med student, scut monkey, respiratory therapist, nurse all rolled into a fresh newbie intern.

What are you talking about?? No one has EVER glorified an intern.

 

[Blade28]

That's why you go into surgery, when you actually do more than just scut. Occasionally.

 

[Hova2005]

Doubt this applies to just IM....interns in most specialties end up having to do a lot of scut for their patients.

 

[MirrorTodd]

It's your job training, so it's all worth it. I know it sucks, but for now more gruntwork = less responsibility. At this point, people have so little experience that they're relieved by the lack of responsibility. I know what you're thinking, "he's not even in med school yet, wtf is he talking about?" Trust me I know what I'm talking about. This same thing happens in the army. Privates always complain that they have to do shlt details, but putting them in charge would be a huge disaster when they're not ready for the responsibility. Sometimes you have to take a step back and think about what you're doing, is it really as bad as it seems. I mean it's your job, you're getting paid for that work done, no matter how trivial it is.

 

[GammaRay]

...I know what you're thinking, "he's not even in med school yet, wtf is he talking about?"

Not at all. You're absolutely right...

 

[bigfrank]

How many secetarys have to stick their fingers up stranger's butts on a regular basis?

I prefer to think of it as "get to."

 

[Blade28]

Lots of scut and rectal exams in surgery too - but we also get to go to the OR.

 

[CANES2006]

Lots of scut and rectal exams in surgery too - but we also get to go to the OR.

OB/GYN interns also get to go to the OR to perform minor surgeries and deliver babies (yay! ) along with doing our fair amount of scut work.

 

[Reaganite]

I prefer to think of it as "get to."

LOL!

Regarding the original post, at some of the affiliates of my school's residency programs, I can assure you that IM residents are not glorified secreteries. Particularly at some of the county affiliates, the residents (and even the students) are functioning like attendings. I was on an outpatient rotation at one of the county hospitals and "consulting" with the attending on a patient you just saw was simply the attending signing any order you wrote. I think what you are saying, at least in my experience, is more true for some of the community programs (where we all want our TYs, right? ). When I was there, the residents didn't do anything without talking to the attending. We didn't even round half the time since it was so pointless as some attendings didn't want med students or residents touching certain patients.

 

[Blade28]

OB/GYN interns also get to go to the OR to perform minor surgeries and deliver babies (yay! ) along with doing our fair amount of scut work.

True!

 

[Hoo\/er]

OB/GYN interns also get to go to the OR to perform minor surgeries and deliver babies (yay! ) along with doing our fair amount of scut work.

Yay! Babies!

I was always the last one to get my protective gear on while on my OB/GYN rotation so I wouldn't have to deliver $hit. I couldn't get far enough away from that crap spurting all over the place. Same deal for the OR - I let the more "enthusiastic" students take all of the cases. **** it, gimme my C.

 

[glorytaker]

Does the program director have any say in how much scut work interns do? What if a PD really doesn't like his interns to do scut work, can an anti-scut policy be implemented or is it just inherent in the system that there's no way around it?

 

[outofhere]

I think this is very institution-specific. At my program, m RD is just awesome. I have done NO scut, okay, okay, an exaggeration, nearly no scut since I started. Sometimes, I choose to be a scut monkey to just get on the good side of the nurses, but, that is my choice. My RD is always asking if I am finding my experience educational. As an intern, even while on internal medicine (I am in psych), I never even had to do blood work... My supervisors are trying to get me to use the social worker, nurses, on my team to do more for me. She doesn't want me to fill out housing stuff...etc. I know my experience has been nearly too good to be true...

 

[8744]

It's your job training, so it's all worth it. I know it sucks, but for now more gruntwork = less responsibility. At this point, people have so little experience that they're relieved by the lack of responsibility. I know what you're thinking, "he's not even in med school yet, wtf is he talking about?" Trust me I know what I'm talking about. This same thing happens in the army. Privates always complain that they have to do shlt details, but putting them in charge would be a huge disaster when they're not ready for the responsibility. Sometimes you have to take a step back and think about what you're doing, is it really as bad as it seems. I mean it's your job, you're getting paid for that work done, no matter how trivial it is.

You don't know what you're talking about. The amount of scutwork one during intern year is more a function of the general inefficiency of residency training coupled with a general disregard for the value of your time.

I repeat. You have no idea what you are talking about. Most medical paperwork is extremely redundant, serves no real medical purpose, and is never read by anyone. It's just in the chart to cover somebody's ass.

 

[PickyBicky]

That's why you go into surgery, when you actually do more than just scut. Occasionally.

That's just BS. Surgery interns are the biggest scut monkeys around. How many times have you been in the OR this year? You probably can recall each time in detail.

-PB

 

[remedios]

Talked to yet another person I know who is finishing PGY-1 at a three letter acronym "major teaching affiliate" of Harvard University and they think that being an intern is nothing more than being a glorified secretary. Following on "scut" mostly and arranging social services, PT/OT, and discharge planning. To think, years of school to do a job they think "anyone could do."

Is there anyone who has an alternate viewpoint regarding this?

Most of the juniors I just met are happy internship is done but definitely do not feel like they were just glorified secretaries. If anything, the program I'm entering have been hiring care coordinators to help more with the discharge scut. I think there are definitely unhappy people in every program, but you can easily find programs where a majority of residents feel that the internship was a valuable learning experience with rewarding opportunities for patient contact and being patient advocates.

(Also, in addition to scut, IM programs also differ in terms of intern autonomy. So a fellow-run hospital might make someone feel like a glorified secretary even more; but the flip side is there is a more team-feel and more teaching a lot of times...)

Don't get discouraged by the horror stories you hear... like in most things there are people with the complete opposite experiences too...

 

[MirrorTodd]

You don't know what you're talking about. The amount of scutwork one during intern year is more a function of the general inefficiency of residency training coupled with a general disregard for the value of your time.

I repeat. You have no idea what you are talking about. Most medical paperwork is extremely redundant, serves no real medical purpose, and is never read by anyone. It's just in the chart to cover somebody's ass.

Unfortunately, I do know. I'm a medic in the army, and we do a rediculous amount of B.S. training that all needs to be documented. Military=Documentaton. I'm sure that's it's nowhere near the amount that interns do, but that's how it is everywhere. Everyone has to do more work than the other guy.

 

[deleted4401]

I think secretary is right. H&Ps. Progress notes. Phone calls for consults, scheduling, radiology, dispo, etc. Only on a few floor months, when I had a resident who just 'let me be', did I feel like a doctor. The attending would come for an hour, just nod her head and agree with us, and I could continue doing whatever I had to do.

Most of the time, there's a resident adjusting your 100cc/hr to 125cc/hr and saying you should start the lisinopril at 5mg instead of 7.5mg. And there is attending forcing you to call an ID c/s when you already have sensitivities. And there is some fellow who wakes you up to put in a catheter for plasmapheresis at 2am, but makes you just watch him do it.

I have 6 days. I will never look upon this wistfully ... it was a year of plain suck.

-S

 

[8744]

Unfortunately, I do know. I'm a medic in the army, and we do a rediculous amount of B.S. training that all needs to be documented. Military=Documentaton. I'm sure that's it's nowhere near the amount that interns do, but that's how it is everywhere. Everyone has to do more work than the other guy.

I was an infantry marine many years ago and as a Platoon Sergeant I had to do my fair share of paperwork. Doesn't even compare to the paperwork you will do as an intern. I spent most of my time as a Marine dong marine things and the paperwork was a burden but it only occupied a small fraction of my time. Paperwork will eat up most of your time during intern year. At an institution like Duke which I have just escaped where they have a form for everything and the bureaucracy is incredible.

Wait and see. Meaning no disrespect but you ain't seen nothing yet.

 

[Blade28]

That's just BS. Surgery interns are the biggest scut monkeys around. How many times have you been in the OR this year? You probably can recall each time in detail.

-PB

I'm very aggressive about getting into the OR. I have the most logged cases of any of my year's interns - 223 and counting (two more weeks left).

So not really BS.

BTW, I see you're a medicine resident - are you just relating tales from your instutition? It can definitely depend on the program.

 

[mdnsw]

I mostly have to do scut and to make sure the translators are around when the big dogs show up.

 

[Dunce]

Yay! Babies!

I was always the last one to get my protective gear on while on my OB/GYN rotation so I wouldn't have to deliver $hit. I couldn't get far enough away from that crap spurting all over the place. Same deal for the OR - I let the more "enthusiastic" students take all of the cases. **** it, gimme my C.

Judging by the looks of your avatar I think I can understand why you were anti-baby.

just kidding

 

[sacrament]

That's just BS. Surgery interns are the biggest scut monkeys around. How many times have you been in the OR this year? You probably can recall each time in detail.

-PB

When I did my surgery rotation in med school, my intern made it into the OR a grand total of one (1) time that entire month. She was jealous that the med students clocked in more OR hours in one rotation than she'd get all year.

 

[sacrament]

I'm very aggressive about getting into the OR. I have the most logged cases of any of my year's interns - 223 and counting (two more weeks left).

Wow. Who is taking care of the patients on the floor during this time?

 

[neutropenic]

Wow. Who is taking care of the patients on the floor during this time?

At our place they usually have the MLPs doing that so the residents can be in the OR more.

Everyone gets in to the OR from PGY-1 and up. Many times PM "scut rounds" are done by a chief + a MLP only, everyone else is in the OR. Many people are done their minimal number of cases by mid PGY-4 or earlier.

 

[Blade28]

Wow. Who is taking care of the patients on the floor during this time?

I am. If things are taken care of, I'll run to the OR for a few quick cases. I also had lots of cases on rotations when the patients were relatively stable, e.g. ortho, GI surg (lots of bariatric surgery), plastics, surg onc.

It also helps to have nurses who will return your pages while you're scrubbed.

 

[PickyBicky]

When I did my surgery rotation in med school, my intern made it into the OR a grand total of one (1) time that entire month. She was jealous that the med students clocked in more OR hours in one rotation than she'd get all year.

Sorry Blade, perhaps I over generalized. Like Sacrament, my statement was based on my observations and experiences as an MS3. I agree, there is probably a great deal of institutional variability. It also seems that you were particularly aggressive in getting to the OR your PGY1 year. My overall feeling, based on a very limited n of 1-->2 institutions plus anecdotes from others, is that surgery PGY1s rarely get time in the OR.

-PB.

 

[Blade28]

Sorry Blade, perhaps I over generalized. Like Sacrament, my statement was based on my observations and experiences as an MS3. I agree, there is probably a great deal of institutional variability. It also seems that you were particularly aggressive in getting to the OR your PGY1 year. My overall feeling, based on a very limited n of 1-->2 institutions plus anecdotes from others, is that surgery PGY1s rarely get time in the OR.

-PB.

At many institutions, yes, the junior residents don't get into the OR as much. My program tends to be top-heavy, so we don't operate as much as those at a busy community program, for example. But I'm damn aggressive about getting into the OR (if all the work is done, of course, and I'd never cut ahead of the residents above me), and the other interns know this (and are jealous ).

Of course, there's a fine line between being assertive and eager, and just being plain annoying.

Let's also not forget that what you may see as an MSIII is not always indicative of what goes on in surgery residency. Usually students rotate on the busy general surgery services, which have larger teams - so the more senior residents will do a lot of the bigger cases. Move over to a lot of the subspeciality rotations (ortho, plastics, peds surg, etc.), and you may find the junior residents operating a lot more.

 

[Idiopathic]

Oops, nevermind.