What’s next?

One week from today, I graduate medical school. I will officially be Kyle Blomgren, DO. Even writing that still feels like some form of stolen valor or hopeless imitation. And yet, in seven days, it won’t be.

As medical school ends and my career transitions into the next phase of training, I’ve received many questions about what the next phase of my career is, how it looks, and what it all means.

To relieve fears, concerns, or other questions, no, this blog is not going anywhere. It’s an easy way for me to update friends and family who may not be on social media. It’s also a convenient place for me to work through different struggles with medicine or life, to educate on topics I’m passionate about, or pontificate about medical and healthcare news and opinions.

Now, back to “what’s next” in my career-

I have to begin and give credit where it’s due; most of the people who ask about the next phase in my training are aware that I am not done with my training. Introducing myself to patients as Dr. Blomgren doesn’t mean I necessarily know the right thing to do for them. That awareness may be thanks to shows like Scrubs or Grey’s Anatomy that highlight resident life, and spotlight “doctors” who are still learning and studying on the job.

So, in TV-land terms, my next phase begins at the first episode of Scrubs.

This summer, I start residency. Residency is the training period new physicians attend in order to be board certified (more on that in a bit). This training is called “residency” because the trainees, referred to as “residents” used to work so much that they literally “reside” at the hospital. In order to learn the craft of being a doctor, baby-doctors (not to be confused with pediatricians) lived in the hospital, working day and night, in order to gain enough experience to be a fully licensed, independent physician. Now days, the American College of Graduate Medical Education (ACGME) limits work hours for residents to 80 hours per week, and no more than 30-straight without at least 12 off. So, at least I and my colleagues won’t be overworked or anything…

To be more specific, however, this summer I will be an intern. The first year of residency is also known as internship. At this phase, these brand new baby doctors have no real knowledge, experience, or confidence (at least, justifiable confidence) in how to treat patients. The ink is still wet on their diploma and their name badge. We do not have licenses to practice medicine independently, and instead have some form of a resident training license. Interns go through the most varied educational rotations, learning a little bit of everything before drilling down to the specifics and nitty-gritty of their chosen specialty in subsequent years. For example, an OB/Gyn resident may treat male patients as an intern, a pediatrics intern may treat adults, and Emergency and Family med interns… well, they treat everything anyway.

Following intern year, we must take Level or Step 3 of our certifying boards. In case you haven’t been following along, we take Step 1 at the end of the 2nd year of medical school, Step 2 early in our fourth year, and now Step 3 during or after our internship. Once we pass Step 3, we can apply for a license and work independently if we really want to. However, most insurance companies won’t pay for the services of a generalist who is not board eligible or board certified, so doing so is not advised. In fact, it is rare to find anyone that does this.

Almost every intern continues on to the 2nd year of their residency training, where they begin receiving more focused training in their specialty. Residencies can span for between 3 and 5 years (including the intern year), depending upon the specialty. During this time, residents rotate through multiple 1-month blocks of different areas of emphasis within their specialty. In many ways, it is just like medical school with a paycheck and more responsibility.

Once a resident completes their residency training, they are able to apply for jobs as an attending physician, and are eligible to become board certified in their specialty. Board certification is a complicated and controversial topic, but for now we can say that board certification is not necessarily related to state licensure, and is not necessarily required to practice. So if that’s important to you as a patient, it’s good to learn if your doctor is board certified (BC) or board eligible (BE), meaning they just haven’t taken the exams yet.

If a resident wants to further specialize in their field, for example an Internist wants to become a Cardiologist, or a General Surgeon wants to become a Cardiothoracic Surgeon, they would then go through fellowship training (and work as a Fellow). They get the respect of an attending, since they have finished residency, but are now training and focusing their career in a subspecialty (or sub-subspecialty, if they so choose). These fellowships are between 1 and 3 years in length, in addition to residency.

As for me, I matched into a Traditional Rotating Internship (TRI). I only have a 1-year residency scheduled ahead of me. My late transition back to Emergency Medicine meant I didn’t qualify to go straight in to the ED, but I didn’t want to get tied down agreeing to a 4-year training program in PM&R just to have to break the contract in a few months. As I start my internship, I will be both learning to be a baby doctor while also applying to Emergency Medicine residency. I get to go through the whole, wonderful application and interview process again… Hopefully my family will get to stay on at the institution where I’m doing my TRI. I’ll know more people, have less paperwork, and have less to learn as far as facilities, locations, EHR, etc, plus I won’t have to move my family.

So with that, guess I should start preparing for internship. Now, where did I put the first season of Scrubs?