an ideal residency

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skewed how?i would say that the practice of medicine consists of at least four parts; the science, the art, collegiality, and the business of medicine.depending on what one learned throughout medical education and training, and one's experience prior to medical school, would help to determine one's preparedness to go out into the "real" world.my experience is that overall, medical school and residency do not prepare one to go into practice for oneself to any meaningful degree; rather it prepares one to be taken advantage of by the sharks who are out there, ready to eat fresh meat.i had expected a collegial atmosphere; what i found were doctors who were jaded, taken advantage of, unhappy, and perfectly content, even thinking that it is right, to perpetuate that same system on new graduates, in order to push themselves up a notch.there is no preparation for the business of medicine, no training in billing, coding or accounting, and the expectation that one

will require a lot of staff in order to be the "top carnivore", a method which surely keeps one in financial servitude.wrt the art and science of medicine, i would say that most are reasonably prepared; and experience comes in time, depending on the individual's personality and desire to learn. the challenge to us, who wish to promote IMP's, and right out of residency, and those who may wish to become IMP's, some right out of residency, is to create an IMP curriculum, which specifically addresses these issues.gordon has talked about that, pam has brought that up, and we've discussed this before.the question is, how do we do that?i have tried to talk to a residency director here, and i confess i have to reply to him, but have been so busy i haven't yet.i have talked with other doctors in practice, solo and group, and they think IMP means boutique practice, which it definitely is not.it'll take time, and more publicity.the only thing i can

think of that would make a big difference is again something which some of us have talked about, and would require a brave program director, and that is to develop an IMP track within a residency.that's something i'm very interested in.other thoughts?LL Strazzullo wrote: Thanks, Lynn but there are still a few "A"s to deal with. Larry, you have a point; but that's the part of the "real" medical world that drives one toward opening their own practice.

I meant that coming out of residency, I had a skewed view of the art of medical practice; and that I learned a lot about the art of medicine from the more experienced MDs around me. Straz Straz-that is because you have already passed through the "'A" and now are onto the ''B".LynnTo: From: straz13comcast (DOT) netDate: Thu, 24 Jan 2008 10:59:01 -0500Subject: Re: In an IDEAL world . . . Depends on the point in your medical career and personal life. Financial impediments for me. Being the sole income for myself, my wife, 2 children and one on the way with all the usual costs such as mortgage, insurance, etc. etc., it's not very tempting to leave employment where I gross over 150,000/year with typical MD benefits to open an IMP. I'm determined to try because of

my sanity and the lifestyle choices for my family. I plan a 1-2 year transition. I don't want to turn any younger MDs off to solo practice, but it's just in the past year or 2 (I finished residency in 1994), that I've become consciously competent in my practice of family medicine - knock on wood. I see advantages in opening an IMP just out as residency as you are used to living on a small income, and your practice will grow financially as your financial burdens increase; but i question the competence, not the medical knowledge, of any family physician to practice solo right out of residency. Don't mean to insult anyone as I know some of you started IMPs right out of residency; I just believe that colleagues are important right out of residency to introduce one to the "real" world of medical practice. StrazThe answer is selection "a".LL <jantonuccifchn (DOT) org> wrote:1. B2. yes,maybe some In an IDEAL world . . .What do you all think is the biggest impediment to widespreadadoption of the ideal practice model in primary care?(out of these two options)A) Psychological Impediments (Fear of running a business, lack of skill,lack of IMP mentors, lack of awareness that IMPs exist, med studentsdumbed down/brainwashed to do things "the same way as we've alwaysdone things," conformist attitudes of docs, disorganization, sadistic love of suffering, enjoy assembly-line medicine, etc . . .) Financial impediments (high student loan debt, out of

controlhospital dues/malpractice, low reimbursement, etc. . .)I know you may have other ideas here, but if you HAD to choosebetween these two what would y'all say?Second question is WHAT IF there was a fund to help primary caredocs start IMP practices. Write an essay, apply for the scholarship, get5-10K for start-up costs and some IMP training? Do you reallythink this would help at all????I tend to think the impediments are primarily psychological, but quite interested in the listserv take on this. And THANKS so muchfor the hospital dues input. I'm in the contemplative stage and getting ready to meet with the hospital bigwigs. I'll closewith some good one liners on the high hospital dues:"You mean you have to pay an admission fee to takeyour admission?""I find the 233% increase inhospitable

& discourteousto courtesy staff physicians"We'll see where any of this gets me.Thanks again!PamelaNever miss a thing. Make Yahoo your homepage.Climb to the top of the charts! Play the word scramble challenge with star power. Play now!

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