Sunday, April 12, 2009

What Matters When Choosing A Fellowship Program

It was an unusual week of Intensive Care Unit activity. There was atrial fibrillation, atrial flutter, cardiogenic shock, cor pulmonale and even an occasional atrial tachycardia thrown in for good measure. And while the patient issues were grave, the residents I saw seemed to take it all in stride, for they had just matched in their fellowship positions. Life was good. They were at the top of their game. They had survived Round 1.
“So where are you going?” I asked. And they proceeded to tell me, appearing genuinely excited about their upcoming adventures. Hematology/oncology. Dermatology. Pulmonary medicine. Some programs here in Chicago, some far away, but still, they were enthusiastic. It was nice to see.

I watched as they typed their notes – much faster than I could ever imagine. They stopped briefly to answer a text message on their cell phone, then continued. Streaking fingers on keyboards, multi-tasking, opening new windows to search a reference, facile at looking up who was covering infectious disease today by perusing the on-line call schedule. “The operators taught me,” she said. “They got upset I was bothering them for the information all the time.”

And so it went.

Watching this, I couldn’t help but ask: “What would you guys ever do without an electronic record, I mean, have any of you ever entered a paper-based order?”

“Oh, yeah. I’ve done it. But I don’t think I could ever go back. Oh, God, no!”

“Really? What if the computer goes down? Doesn’t it ever worry you that things might grind to a halt? What about new residents who have never seen a paper chart?”

“Oh-my-God! They’d have no clue! I heard Suzie matched at Georgetown, and they still have paper-based records – I mean – I feel so sorry for her. She won’t have a clue. I’d never go to a program with paper records any more. It would suck.”
And so, in my carefully-conduced ICU research on three current-day residents accustomed to dot-phrases and instant everything, I’d say the electronic medical record industry is secure.



OHN said...

Oh these young whippersnappers are so spoiled.

Anonymous said...

I remember Index Medicus and can't ever imagine going back after Ovid and Medline and google scholar.

rlbates said...

Wonder what they would think if they had to pay for the EMR for their own office. The cost might give them pause, especially if it won't "talk" to all the hospitals in their city.

Anonymous said...

dr bates, i would respectfully suggest they would probably pay it because they don't get enough experience with practice finances in training to understand exactly what they would be trading off for the emr (assuming they were running a solo practice). also quantifying the running costs of the emr is still difficult, even if someone were willing to subsidize the initial purchase. as you noted selection of the emr itself is an enormous challenge.

also some might not join a practice that didn't already have one. other people i see who join a practice without an emr clamor incessantly for one, but are on income guarantees. when they are asked to pony up part of their guarantee for the emr, most shut up. at least that has been my experience.