Does Training Residents Cost Our Attendings Too Much?

Kathleen Satterfield DPM FACFAOM

Working with residents is a rewarding experience that most of us would not want to trade for anything. The idea of mentoring the next generation of podiatric physicians is fulfilling and generates lifelong friendships.

Gary Jolly, DPM, FACFAS, is still my mentor and friend. I will always carry with me his reassuring words, “Kath, there is nothing that you could break that I cannot fix so go ahead and start the surgery. You have to learn and I am here to teach you.”

Well, I do not know if I ever achieved that level of skill but I did impart some wisdom to a generation of residents, and I have lived to see them excel in their own practices and become academic leaders themselves.

However, a question remains about whether residents impair our own practices by:

• slowing us down and making hospitals and surgical centers reluctant to book our cases at prime times because of the slow turnovers

• making patients hesitant to be treated in our offices because these trainees will participate in their care

• running our days into the late hours because of the time that we spend between patients and after hours explaining and teaching

I would not trade my years in academic medicine for a high-dollar practice. It has all been worth it. I always tell people that my wealth is measured in the lives of my former students and their practices.

However, if I had been in one of those lucrative private practices, with five cases to get through before starting an afternoon clinic, I wonder if I would have felt differently about training residents. I applaud those who take the time and suffer any negative financial consequences in doing so.

Without Dr. Jolly, Peter Blume, DPM, FACFAS, Allen Jacobs, DPM, FACFAS, Bob Mendicino, DPM, FACFAS, Sam Mendicino, DPM, FACFAS, Jack Schuberth, DPM, FACFAS, Gary Dockery, DPM, FACFAS, and untold others, the training of so many of us by so few mentors would not have been possible.

Have we ever considered their financial and personal sacrifices?

Have we ever thanked them?

Comments

In life there are trade-offs. We do not live in a utopia. Trade-offs are in every career. And trade-offs somehow work themselves out. With this in mind, yes, it is worth the sacrifice of time and money and patient expectations to train residents. It is not only an issue in podiatric medicine, but also in allopathic (MD) and osteopathic (DO) medicine in American teaching hospitals. Simple wisdom of thought to all Americans: every licensed board ceritified physician is an expert in their field because they were once interns and residents with no knowledge and skill in patient management and practice management, only academic knowledge. That's what post-graduate training programs are for. If medical graduates already knew how to do the things that attendings know just as fast and efficient, then why have post-graduate programs in the first place? It is expected that interns and residents will be slower to perform clinical and surgical tasks in a teaching hospital. Patients need to be educated about post-graduate training in medicine to stop the unrealistic expectations of fast treatment. It just does not work that way. Each intern and resident has their own unique learning curve that must be accomodated. By the time the person is in their last two years of their residency, then the learning curve gets smaller and their treatment of patients goes faster. So, with these pointers in mind, yes, attendings need to train interns and residents with the trade-off that treatment will be slower and work time will be longer. Tolerance and patience are the key elements. Interns and residents are learning: they are not full experts!

Residents are not experts at the same level as attendings. That is why there are residencies in teaching hospitals. Residency is a time to learn new things and master them through practice. Practice makes perfect. Why can't patients understand this? Residents are learning, practicing their craft, which consumes time for the patient and for the attending. But, this is the sacrifice. So for patients and money-hungry podiatrists out there, think before you speak of inefficient use of time: residents are learning, learning consumes time, and learning means practice, and practice makes perfect. Stop blaming the residents. There is no crime for using up time for practicing until skills and knowledge are perfected!

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