As my time in residency passes I grow increasingly weary that the goals & foundation of graduate medical education will only be a forethought in the corporate pursuit of healthcare profits. The worst part of my day on the medicine service is Case Management rounds. Reason being that I stand there justifying to people who aren’t physicians just why a patient of mines is either leaving or not. It’s usually during this time I'm reminded that a patient I'm caring for doesn’t have insurance, hasn’t been here long enough or that a person I am taking care of has been deemed to be in the hospital for longer than expected. Just to give some background on my thought process I am doing residency at a smaller community program which just happens to be owned by one of the largest hospital corporations in the nation. Our medicine months are divided by either working with the hospital’s own hospitalists group versus working with our associate program director who happens to still be old school in his ways regarding doing both inpatient & outpatient care. The teaching philosophies are almost night & day. When working with our hospitalists group many more of our “interesting” cases are regulated to be worked up on an outpatient basis which is always funny to me since I am sure that it never ends up being worked up versus when we are with our other attending he actually prefers that everything that can be done in the hospital be done because he understands the lack of outpatient care is likely the reason why they are here in the first place. The cost of patient care is of premium focus on our hospitalist service which I think sometimes cripples our management because were really not allowed to educate ourselves in patient diagnostic care.
Even now discussion regarding a patient cap on our residents has become a drawn out issue but I am certain its not because the hospital is concerned that we would learn less from patient care (medical education perspective) but really because the hospital would have to foot the bill in hiring another hospitalists or physician extender to make up for the overload(corporate perspective). I come from the mindset that an intern having to deal with 12-15 patients is NOT a good idea because they only learn what to do for the patients but not really why.
Again I come from a small community program so maybe the dynamics are different at a bigger hospital or even a educational institution but its hard for me to believe that hospitals are only focused on the dollar bill at small hospitals but not larger ones. My attending jokes all the time that they aren’t making doctors like they used to & I am inclined to believe that this is one of the biggest reasons why.
Feel free to give feedback especially if you happen to be at a bigger institution.