Teaching residents pays off for us

February 17, 2006

Doctors tend to shy away from resident education, thinking it takes too much time and money. In this FP's experience, it can actually save you both.

These are all common reasons why physicians are reluctant to participate in resident education. But teaching residents doesn't have to be a drain. If done effectively, it can lead to increased productivity, a fatter bottom line, and improved quality of life. And best of all, it can boost your job satisfaction.

I speak from experience. Our three-person rural family practice integrates resident education into all aspects of our practice-both inpatient and outpatient. While we may be an extreme example, other doctors can borrow pieces of our model to integrate teaching into their practices.

Here's how we do it.

We could have surrendered our hospital privileges and, instead, admitted to the hospitalist system. But our group wanted to maintain our hospital skills for job satisfaction as well as for billing purposes. To overcome this challenge, we arranged to contract with the family medicine residency program to act as adjunct faculty on weekends. We round for the faculty about half the weekends throughout the year and, in exchange, our patients are cared for by the teaching service whenever they're admitted. As independent contractors, we're paid a flat salary and are also covered for malpractice.

It's an arrangement that benefits everyone involved: We maintain hospital skills and income, the residency faculty has less weekend work, the residents see a broader spectrum of practice styles, and our patients receive more continuity of care than they would on the hospitalist service.

There are multiple ways to do this. For starters, all family medicine programs (and some other specialty programs) have resident clinics. These programs are often in need of outside physicians to precept one or two times a month. Residents seek advice on patients with complex medical problems who also often have chaotic social situations.

These clinics have a fun and exciting atmosphere that brings back memories of my own first days as a physician. The pay is certainly not the same as in private practice, but, for me, the money has been a welcome extra. What I earn on those two half days a month when I wouldn't be working anyway has been more than enough to make payments on my medical school loans.

Another option is to bring the residents to you. Primary care residency programs are frequently in search of physicians from a variety of specialties who are willing to have residents rotate at their offices. Our group has benefited a lot from these residents-and it comes at no cost to us. On days when a resident is there to help, we can see more patients or leave the office up to an hour sooner. Over time, the extra revenue and the increased time with family really add up.

The key is to know how to use trainees effectively. When residents simply shadow physicians, it's a passive experience for the resident and it can slow down the day for the physician. It's more effective for everyone if the resident is actively involved in evaluating patients. In our office, residents act almost like physician extenders.

With a resident helping me, quick and easy acute visits might take only two minutes of my time as opposed to 10 minutes. Residents can be helpful getting through complex patients, as well. They can take their time getting the patient history, and patients generally appreciate a young doctor taking so much interest. In the meantime, I can see three or four patients. By the time the case is ready to be presented to me, the history is more concise and there's a rudimentary plan in place. Everyone wins: The patient is heard, the resident educated, and a potential scheduling bottleneck is averted.

All is for naught, however, if the resident doesn't learn anything. After all, they're in your office for an education and not to be a scut monkey. So we take our obligation seriously to teach what we know to the next generation of physicians.

But we can discuss individual cases in only 2 or 3 minutes. Long lectures not only put you behind with patient care, but are a less effective teaching technique. Brief teaching points that directly correlate to the patient just seen will be more likely to stick in the resident's mind.