Aug 13, 2009

The hospital hierarchy: Making sense of the doctors who are treating you

I headed off to college with the intention of going pre-med, but decided that really wasn't for me when I discovered that I couldn't tell the difference between smooth and skeletal muscle cells (and that was just for starters). And while we have a bunch of lawyers in the family, there isn't a single doctor.

Which meant that when we ended up at the hospital last week, I was relying on my vague memories of medical dramas (I haven't really watched any in about ten years) and my own hospitalizations when I gave birth to make sense of the various medical staff around us. Yesterday, I did a Swag Bucks search and read a bunch of web sites to learn the following:

An intern is a doctor in the first year after graduation from med school.

A resident is a doctor who is more than one year out of med school. "Residency" is the period of training during which a doctor learns his/her specialty, so the length varies depending on the difficulty. (For example, neurosurgeons apparently have to endure an eight-year residency.)

A chief resident is a doctor who is doing an extra year of residency and in charge of the other residents. This position apparently helps lead to other, more desirable positions such as fellowships. (A fellow is a doctor who has completed residency and is currently serving a fellowship, which is often funded by a special grant and involves some kind of research.)

An attending physician is a doctor who has completed his/her residency. But there are obviously different levels of attendings, depending on experience. You definitely want to seek out the best attending you can find, because he/she will most likely have the final say about your care and treatment plan, and you want that to be as good as it can possibly be.

A final note based on personal experience: If a resident writes a prescription to be filled upon discharge, try to the get the attending's medical license information to go with it. Our insurance plan wouldn't accept just the resident's info, and the pharmacy had to wait for the attending's license number before it filled the prescription.


Theresa said...

This is a good summary. The only thing I would add is that each level is being supervised by the level(s) above. So residents supervise interns and attendings supervise everyone. The addending is the physician of record for the admission and is ultimately responsible.

Also, the medical academic year starts in July, when it's a little more obvious who the brand-new interns are.

katy said...

Thanks for the information. I was always confused about this.

EricaThomas said...

Thanks for explaining that. My co-worker's husband did his internship last night and now he is a resident, I finally understood that with your explanation.

Christy said...

While this is pretty much "spot on", I would like to clarify that a Chief Resident is not necessarily doing an extra year. In my husband's field, the Chief Residents are in their last year of residency, just like the other residents.

There is definitely a "food chain" in the medical world. If you figure it out before you are admitted, you will be more likely to understand who is caring for you.

Theresa is correct, supervision is going on at each level--and that's a good thing. The more eyes on the chart, the better the chance that nothing slips through the cracks.

Abbie said...

oh my gosh, this is so helpful!! Thank you for the review. Even with a BIL in med school and a binder of specialists for my kid's medical issues, I still didn't have this straight. I hope your son and family are doing better...thanks again for this post!