May, 2008 Archive

I was sure we were missing something!

jpoole — Mon, 05 May 2008 00:00:00 -0600

I am excited about my future. I will be starting as a hospitalist with Southwestern Vermont Health Care in July. Currently a 3rd year Internal Medicine Resident, and chief resident, at Stamford Hospital in Stamford, Connecticut, I started considering positions last summer. I was considering a fellowship and other hospitalist positions when I received an email from VISTA’s Search and Consulting division about an opportunity in Bennington, Vermont. The opportunity appealed to me because of its location and the drastic change of pace from Fairfield County and I am looking forward to the challenges of a rural hospital, working in an area in need of physicians, and being in a nice community to raise a family.

As for my experience with VISTA, it was so easy, I was sure we were missing something! From the beginning, I was partnered with a dedicated recruiter, Kelley Hekowczyk, who walked me through every step. Kelley helped me prepare for interviews by briefing me on what to expect so there were no surprises. I appreciated Kelley’s knowledge of the job, position, and hospital and I felt that her relationship with the hospital was almost as if she were one of their employees. Her knowledge and the fact that she kept in constant contact with me made the interview and hiring process an easy and pleasant one.

Bennington, here I come!

ALASKA IN THE SPRING Well…it was supposed to be…

kgudiksen — Mon, 12 May 2008 00:00:00 -0600

I went off to Anchorage to work for three weeks and to find out what spring was like in Alaska. I had been there twice before in August and September and had seen late summer and early fall and had watched the snowline gradually move down the Chugach Mountains. Yes, break-up is over and spring will be getting going, they assured me. Well…

The last 20-30 minutes of the late afternoon flight into Anchorage were past range on range of rugged snow-covered mountains. There was still lots of snow around on the ground, including those dirty late season heaps piled along the roads and at the edges of parking lots. The woman who let me into my apartment, when I made some comment about it looked like a lot of winter was still around, said, “At least the light is back…”

As the days went by things gradually got warmer. The first nights were nearly in the teens but some of the days were getting well into the 50’s. I am still amazed how quickly the days lengthen – more than 5 min. 30 seconds each day. You can notice from day to day. I am also amazed how warm 40-50 can feel. I never would think of walking around here when it is in the 40s with my jacket unzipped. And locals would be appearing in T-shirts and shorts exposing very white legs. Last Thursday I thought I saw the first sprigs of green along the road as I drove home after work.

Then Friday, April 25th dawned. There were a few flakes of snow beginning to come down as I drove to work. It was hovering just about at freezing. They were those big, fat, sloppy flakes we are all familiar with from western Washington. And they kept falling and they kept falling and they kept falling …They stuck to the bushes and the trees and the cars and everything. The parking lot looked like a lot of overstuffed marshmallows when I went out to drive home. I’m not used to driving in snow and ice. We don’t go off to the mountains in the winter here. It was 40+ years ago we moved to California. And, in fact, I had never driven in that much snow. I was scared – even for the 3 or so miles I had to drive to get home. It still was not freezing so there was not any ice down on the road surface. Lots of slush. All seemed to be driving slower and I did get home uneventfully.

Turns out that all this snow is not at all the Anchorage-rule. It kept snowing until there was 15-16 inches in the bowl where most of the city of Anchorage is located It was the most snow ever to fall in an April day and the third most snow to fall in Anchorage in a single day ever in the nearly 100 years they have been keeping track of such things. And it was late. The snow plows had been put in the yard for the summer. They got them out and went to work. Not surprisingly my week-end plans were cancelled. I got my exercise by leaping over ankle deep and more slushy curbside puddles. The days and nights kept warming, most of the snow is now melted and I think that I saw those blades of grass again as I drove home my last afternoon...

And, so it went for another short stay working in Alaska. Thought you might be interested. I certainly find it interesting. Alaska is a different place. They say the rest of us live Outside. We do.

A peek at O&G as practiced in NZ

amoore — Mon, 19 May 2008 09:44:13 -0600

"I have loved working in New Zealand! My two stints have been in very different settings. The first experience was in a small rural hospital. Well-seasoned GPs provided most of the obstetric care. They did operative vaginal deliveries and assisted at cesareans. Midwives were involved in a smaller portion of the cases. I really appreciated not having to do normal deliveries, but only being involved in complicated OB cases, or cesareans. There was a reasonable flow of GYN surgery. The GPs do routine Paps and provide contraception. They refer "interesting" cases to you, the specialist. This system had obvious advantages and disadvantages.

This time, I am in a setting with a higher volume of patients. It is a district hospital. The pathology is stimulating (two cases of malignant pleural effusions and a couple of ectopics this week. And a leiomyosarcoma last month). I also love teaching the new "house officers." Their training is very different from the ob/g residents at home. Most of them will become GPs, not OB/GYNs. This system is much more closely aligned with British practice than with American traditions. As a result, I have learned many new approaches to O&G. There is an enormous cross cultural to medicine, not only to life and times in NZ.
I have worked in both urban private/ academic and rural/non-academic settings in the States. There is a greater difference in practice patterns within the States than there is from the US to NZ. Some differences are frustrating, while others are joyous.

New Zealand Medicine from an American Perspective, Part 1

sherring — Tue, 27 May 2008 08:10:36 -0600

Medical Training – Based on the UK system for obvious reasons.

Medical Student – Medical school is an undergrad program – you are accepted either from high school or after one year of undergraduate scientific studies. It takes six years to finish medical school.
House Officer – Equivalent to Intern, but at least two years. Also known as House Surgeon regardless of affiliation with any actual surgical practice. Their work is supervised by Registrars. A House Officer may work in any major field – meaning he/she may work in Surgery/Medicine/Peds or a combination, depending on the needs of the hospital. So an MD working as a House Officer in Surgery may actually have no intention of completing training in that field.
Registrar – Equivalent to Resident, except training lasts longer. Registrars have completed their House Officer years and have applied for their Registrar position. They practice fairly independently at times and are sometimes allowed to perform surgery without their Consultants present, etc. Training as a Registrar typically takes five years or longer, even in primary care fields like internal medicine. They also generally must re-apply for a new position every year, often moving to a new hospital every year. They typically do not finish training at the same hospital where they started. Also, not all Registrar positions are actual training programs, so working these jobs does not necessarily mean you advance up the totem pole the next year. This means you can be a Registrar for the rest of your career, which some MDs apparently don’t mind.
Medical Officer – A Medical Officer has completed some type of training program but has not reached the level of Consultant and must still be supervised in some aspect.
Consultant – Equivalent to Attending in that you are allowed to practice independently without ‘supervision,’ except it takes about 10 years of training after Medical School to attain this status. If you train in surgery, it is considered an honor when, at some point, you graduate from ‘Dr.’ to ‘Mr.’