Glenn Ellis

*As always, I can count on the support of my trusted mentor from my days as a Pre-Med student at UPENN: Dr. Wesley collier.

Each week, like clockwork, he’s going to send me an article of interest, to make sure he does what he started doing for me over three decades ago. That is to make sure I don’t miss out on anything that might help me on my journey.

This week, he sent me an article on something called, The July Effect.

That’s the notion that deaths go up in July, the month that just-graduated medical residents start their new jobs, likely because of mistakes caused by inexperience.

In one recent study, researchers from the University of California at San Diego found that fatal medication errors rose 10 percent in July in U.S. counties with teaching hospitals, giving credence to what’s long been known as the “July effect.”

This information reminded me of some writing I did a couple of years ago, so I decided it might be useful to share some of it again.

If you’ve made it halfway through July without being hospitalized, and avoided the ICU on a weekend, consider yourself lucky.

More and more, many of us are finding ourselves, when we need to hospitalized, in a “teaching hospital”. Many of us have had the experience of being in a hospital bed, and all of a sudden 5, 10, or sometimes 15 doctors come into the room. They surround your bed, and listen while one of them shows you off like you’re a used car for sale. They point out your flaws, and your good points.

They then leave as quickly as they came in. you lie there wondering, “who were all of those people”?

You have just been “rounded” at a Teaching Hospital.

The U.S. health care system relies on teaching hospitals for the clinical education of medical students and residents. Teaching hospitals are essential “classrooms” for physicians, nurses, and other health professionals and providers.

Teaching hospitals are providers of primary care and routine patient services, as well centers for experimental, innovative and technically sophisticated services.

Additionally, teaching hospitals are special places that help the underserved and provide comprehensive and unique services for the general population. For many people, this concept of “teaching” is the notion that leads one to think, “They aren’t real doctors, they are practicing on me”.

A teaching hospital is a hospital which provides medical training to medical students and residents. Residents are physicians who have recently completed medical school and are in training.

After graduating from medical school, doctors must complete a training program. This is called a “residency.” During the first year of residency, a doctor is called an “intern.” After the first year, interns become “residents.” Both interns and residents are members of the hospital house staff. They are employed by the teaching hospital and are supervised by a hospital staff doctor.

Also called a hospital doctor or “staff” doctor, an attending physician is the doctor in charge of the patient’s care. The attending is a senior doctor in general medicine or in a medical or surgical area. An attending in a teaching hospital supervises interns and residents.

Your Primary Care Doctor (also, known as your PCP) is who you see at your regular office visit. He/She sees patients in the office setting and on “rounds”, the examinations of patients in the hospital.

Many teaching hospitals have strong links with a nearby medical school.

Residency is a 3-year or more training program in a medical specialty. The first year of training after medical school is called internship, or more commonly it is called first year of residency. Much of what your doctor will learn in a chosen specialty will be learned in their residency.

After 12 years of school, 4 years of college and 4 years of medical school, there is still so much to learn. The first 20 years of school are the foundation and the tools your doctor will need to learn his/her specialty. During residency they will learn medicine by caring for patients with a variety of diseases. The more patients they care for, and the more disease and variations of disease that they see and treat, the more proficient they will become.

Here is a synopsis of different medical specialties and subspecialties and the length of their training programs (internship and residency) after medical school:

  • Anesthesiology – 4 years
  • Dermatology – 4 years
  • Emergency Medicine – 3-4 years
  • General Surgery – 5 years; Subspecialties of Surgery require an additional 1 to 4 years after the 5 year residency, they include: Vascular Surgery, Cardio-Thoracic Surgery, Pediatric Surgery, Colon and Rectal Surgery. Some surgical specialties require 1-2 years of General Surgery, then an additional 3-5 years of specialty training, they include: Neurosurgery, Orthopedic Surgery, Ophthalmology, Otolaryngology, Plastic Surgery, and Urology.
  • Internal Medicine – 3 years; subspecialties of Internal medicine require an additional 2-3 years after the 3 year residency, they include: Cardiology, Endocrinology, Gastroenterology, Geriatrics, Hematology, Oncology, Infectious Diseases, Nephrology, Pulmonary, Rheumatology
  • Neurology – 4 years
  • Obstetrics and Gynecology – 4 years
  • Pathology – 4 years
  • Pediatrics – 3 years; subspecialties of Pediatrics require and additional 2-3 years after the 3 year residency, they include: Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Infectious Diseases, Pediatric Critical Care, Neonatology, Pediatric Nephrology, Pediatric Pulmonology, Pediatric Rheumatology
  • Psychiatry – 4 years
  • Radiology – 4-5 years; subspecialties of Radiology require and additional 1-2 years after residency, they include: Neuroradiology, Vascular and Interventional Radiology, Pediatric Radiology.

Most doctors are doctors of medicine (M.D.). They treat all kinds of diseases and injuries. Some doctors are doctors of osteopathic medicine (D.O.). They focus on muscles and bones. Both are able to do a residency at a teaching hospital.

So don’t panic, studies show that if you have to be in a hospital, it’s safer in a teaching hospital. They have lower death rates for certain complex surgeries than non-teaching hospitals do, according to a study in the Archives of Surgery. One of the fears that many people have is that going to a teaching hospital with medical students and residents might hinder their care because the attending physicians have to teach rather than perform surgery. This study showed that perception is completely wrong. Undergoing surgery at teaching hospitals is perhaps more safe than at non-teaching hospitals because of the increased volumes of complex cases seen at these centers.

Thanks again, Dr. Collier…keep ‘em coming!

Remember, I’m not a doctor just sound like one.

Take good care of yourself and live the best life possible!

The information included in this column is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice

Glenn Ellis,  is a Health Advocacy Communications Specialist. He is the author of Which Doctor?, and is  a health columnist and radio commentator who lectures, and is an active media contributor nationally and internationally on health related topics.

His second book, “Information is the Best Medicine”, is due out in Fall, 2011.

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