Stages of a Surgeon at a Teaching Hospital
Meet Our Jack.
When we found out the renowned surgeon we'd flown over 600 miles for didn't do our son's surgery, we were outraged. We felt violated. And while no should EVER be a victim of a ghost surgery, the level that it took our family psychologically and emotionally, because of our son's medical complex history is simply indescribable.
Jack is the first homosapein to be found with the spontaneous genetic mutation he has. Our VAMP2 Gene Mutation Family is now seven strong, still not one other child though in the United States yet. When he was three, he was diagnosed with a severe form of chorea, a movement disorder similar to Parkinson's but much worse. Here's a video of him trying to get a sucker in his mouth when he was four. At the time, no other hospital in the USA had put in a DBS for a child that young but Mayo. His condition, so debilitating, we were willing to go anywhere, try anything and we put all of our hope and faith into the hospital who seemed to do it all. It was so rare (at the time) for children to have the surgery done so young, our local news did a segment about Jack, our hope and excitement so strong that his quality of life could be changed. Here's a video of us going on the news, sharing how our son was going to be the second youngest child known in the world to have received the surgery at the time. Not only did the surgery work, but it was life changing.
As the years went on, Cincinnati Children's opened their own DBS program. We could have saved a lot of time, a lot of money, so many days of missed work, had we decided to allow them to take over Jack's care. But we started with Mayo, had developed what we believed was a trusting and strong relationship with his attending surgeon, that he was the one at the time we could fully trust. Dr. L. knew we came for him. Dr. L knew we came from Cincinnati and that we'd thanked him so many times for his brilliance and talented hand. But that day we met with him at preop, when he acted as though he'd being doing the surgery and gave us "his" personal infection rate of 1% or less per battery site, he purposefully left out the fact that he had no intention to do Jack's surgery that next day. We didn't know that at the time, but put it together later about the doctor needing to have two rooms next to each other because he had two surgeries. She didn't tell me they were for the same time and I had never heard of overlapping or concurrent surgeries. It was an odd statement that came out of nowhere and now we think she felt as though she was in a compromised position. She knew what we'd been led to believe, who we scheduled the surgeon with, whose name was all over everything regarding who was doing it and we call it fraud.
The famous surgeon we'd flown hundreds of miles for not only left out the fact he wouldn't be performing surgery on our son, but he also didn't tell us he would be leaving our profoundly disabled, medically complex son in the hands of a new surgeon, in residency, with limited experience, without direct supervision, or any supervision at all. (i.e. operative and anesthesia notes don't place the surgeon we hired in the surgical room at all).
Before we can teach you how to PREVENT becoming a victim, you need to know the players, the different stages that doctors go through in the course of their career. Knowing the terminology is fundamental in knowing how much experience the person has that you are working with or talking to.
Jack is the first homosapein to be found with the spontaneous genetic mutation he has. Our VAMP2 Gene Mutation Family is now seven strong, still not one other child though in the United States yet. When he was three, he was diagnosed with a severe form of chorea, a movement disorder similar to Parkinson's but much worse. Here's a video of him trying to get a sucker in his mouth when he was four. At the time, no other hospital in the USA had put in a DBS for a child that young but Mayo. His condition, so debilitating, we were willing to go anywhere, try anything and we put all of our hope and faith into the hospital who seemed to do it all. It was so rare (at the time) for children to have the surgery done so young, our local news did a segment about Jack, our hope and excitement so strong that his quality of life could be changed. Here's a video of us going on the news, sharing how our son was going to be the second youngest child known in the world to have received the surgery at the time. Not only did the surgery work, but it was life changing.
As the years went on, Cincinnati Children's opened their own DBS program. We could have saved a lot of time, a lot of money, so many days of missed work, had we decided to allow them to take over Jack's care. But we started with Mayo, had developed what we believed was a trusting and strong relationship with his attending surgeon, that he was the one at the time we could fully trust. Dr. L. knew we came for him. Dr. L knew we came from Cincinnati and that we'd thanked him so many times for his brilliance and talented hand. But that day we met with him at preop, when he acted as though he'd being doing the surgery and gave us "his" personal infection rate of 1% or less per battery site, he purposefully left out the fact that he had no intention to do Jack's surgery that next day. We didn't know that at the time, but put it together later about the doctor needing to have two rooms next to each other because he had two surgeries. She didn't tell me they were for the same time and I had never heard of overlapping or concurrent surgeries. It was an odd statement that came out of nowhere and now we think she felt as though she was in a compromised position. She knew what we'd been led to believe, who we scheduled the surgeon with, whose name was all over everything regarding who was doing it and we call it fraud.
The famous surgeon we'd flown hundreds of miles for not only left out the fact he wouldn't be performing surgery on our son, but he also didn't tell us he would be leaving our profoundly disabled, medically complex son in the hands of a new surgeon, in residency, with limited experience, without direct supervision, or any supervision at all. (i.e. operative and anesthesia notes don't place the surgeon we hired in the surgical room at all).
Before we can teach you how to PREVENT becoming a victim, you need to know the players, the different stages that doctors go through in the course of their career. Knowing the terminology is fundamental in knowing how much experience the person has that you are working with or talking to.
Know The Doctors and Their Three Stages
Attendings (link here):
This doctor has the most and highest level of experience and while on duty, is ultimately responsible for all all patients who are on their floor. Depending on what you're going to the hospital for, you may see your attending a lot or a little. For example, if you're staying inpatient for a few weeks, the attending will come by usually once a day to "make rounds." Making rounds is when all the main professionals caring for you stop by to talk about your health progress and treatment plan for that day.
Fellows: Doctor on the floor (often with a specialty) who has completed his/her residency requirements. They are usually in their 6th-8th year of their journey to becoming a full blown attending (at least for a surgeon).
Residents: YES! This these are doctors and have earned every right to be called one. He/she has completed medical school and has not just a medical degree, but a license to practice. Most surgical residencies last five years before beginning their "fellowship."
This doctor has the most and highest level of experience and while on duty, is ultimately responsible for all all patients who are on their floor. Depending on what you're going to the hospital for, you may see your attending a lot or a little. For example, if you're staying inpatient for a few weeks, the attending will come by usually once a day to "make rounds." Making rounds is when all the main professionals caring for you stop by to talk about your health progress and treatment plan for that day.
Fellows: Doctor on the floor (often with a specialty) who has completed his/her residency requirements. They are usually in their 6th-8th year of their journey to becoming a full blown attending (at least for a surgeon).
Residents: YES! This these are doctors and have earned every right to be called one. He/she has completed medical school and has not just a medical degree, but a license to practice. Most surgical residencies last five years before beginning their "fellowship."
Read the important section below which will teach you about the years and stages of residency and fellowship, as well as how to look up, by computer, the number of years your resident or fellow has held a medical license, prior to one
performing surgery on you or your loved one, especially independently.
performing surgery on you or your loved one, especially independently.
Residents and Fellows follow a curriculum set by their teaching hospital.
In general, the procedures and skills they will perform are divided into sections based on their current year of practice. "PGY" means... post graduate year.
So PGY-1 means the resident is in his/her first year. PGY-4 would mean he/she is in his fourth year of residency.
The reason this is important is because a PGY-1 should not be independently completing a PGY-3 task.
How do I find out how long a surgeon has had his/her license and why is it important?
How do you find out? Very, very, easily. Why is it important? Because if an attending throws an inexperienced resident into an operating room alone, bad things can happen.
Step 1: Just like you can go to your state's department of education to verify a teaching license, you can do the exact same thing for a physician's license. All you have to do is visit the website of your state's medical board. (I've provided a YouTube video below to show you if you'd rather not read).
Hopefully after our son's story is shared nationally, attending surgeons at teaching hospitals will begin telling patients the names of the doctors that will be helping (or doing your entire surgery by themselves). In addition, patients should be told prior to their surgery what parts of the surgery, if any, will be performed by a resident or fellow, without direct supervision.
Per the American College of Surgeons, disclosure of "the different types of qualified medical providers who will participate in [an] operation, [as well as] their respective roles," should have already been happening. But we can tell you from experience that it hasn't. And we also won't be surprised if that information isn't offered up, even after we've shared our story and you've become educated., type the name of your state and then the words, medical board. See examples below. Google...
Minnesota Medical Board, Ohio Medical Board, Pennsylvania Medical Board, New York Medical Board... you get the idea.
Step 2: Click "verify a license" and follow the prompts. Enter the first and last name of the physician/surgeon you are vetting.
Sidenote: Additionally helpful on a medical boards website is the ability to see disciplinary actions taken against a specific doctor. For example, when I went to Minnesota's medical board website to see if any of our son's surgeons had complaints filed against (looking under the tab, "Disciplinary Actions"), I stumbled upon the name of a different doctor our son had been seeing at Mayo the last five years. I had been told he resigned and moved to a different country but actually learned some sort of disciplinary action was taken against him and he surrendered his medical license voluntarily. We're not bringing this up as a dig...this doctor was amazing, always good to us and was a true mastermind in his work. He changed our son's life tremendously and we'll be forever grateful. We're sharing this example to prove TRANSPARENCY does exist when it comes to licensed providers in any state. You just need to know where to look and what to look for.
Here's a video to show the steps in more detail.
Step 1: Just like you can go to your state's department of education to verify a teaching license, you can do the exact same thing for a physician's license. All you have to do is visit the website of your state's medical board. (I've provided a YouTube video below to show you if you'd rather not read).
Hopefully after our son's story is shared nationally, attending surgeons at teaching hospitals will begin telling patients the names of the doctors that will be helping (or doing your entire surgery by themselves). In addition, patients should be told prior to their surgery what parts of the surgery, if any, will be performed by a resident or fellow, without direct supervision.
Per the American College of Surgeons, disclosure of "the different types of qualified medical providers who will participate in [an] operation, [as well as] their respective roles," should have already been happening. But we can tell you from experience that it hasn't. And we also won't be surprised if that information isn't offered up, even after we've shared our story and you've become educated., type the name of your state and then the words, medical board. See examples below. Google...
Minnesota Medical Board, Ohio Medical Board, Pennsylvania Medical Board, New York Medical Board... you get the idea.
Step 2: Click "verify a license" and follow the prompts. Enter the first and last name of the physician/surgeon you are vetting.
Sidenote: Additionally helpful on a medical boards website is the ability to see disciplinary actions taken against a specific doctor. For example, when I went to Minnesota's medical board website to see if any of our son's surgeons had complaints filed against (looking under the tab, "Disciplinary Actions"), I stumbled upon the name of a different doctor our son had been seeing at Mayo the last five years. I had been told he resigned and moved to a different country but actually learned some sort of disciplinary action was taken against him and he surrendered his medical license voluntarily. We're not bringing this up as a dig...this doctor was amazing, always good to us and was a true mastermind in his work. He changed our son's life tremendously and we'll be forever grateful. We're sharing this example to prove TRANSPARENCY does exist when it comes to licensed providers in any state. You just need to know where to look and what to look for.
Here's a video to show the steps in more detail.
I've Learned How Many Years My Surgeon Has Held a
License. HOW CAN THAT HELP ME?
We're going to just throw the elephant into the room right now so you can understand why we would take the time to explain residency curriculum to you, which you likely could care less about. Heck...up until Jack's ghost surgery, I didn't even know residents followed a curriculum. But guess what we discovered while investigating our son's ghost surgery through his medical records....
One of the resident who performed the surgery...he was listed as a First Assistant. Why is that important? Because per Mayo's own curriculum, which I found online, he shouldn't have been able to receive that title until his second year of residency. He'd only had his medical license for 6 months. The other First Assistant that did our son's surgery by himself only held his surgical license for 4 moths. We'll admit, there are going to be very few times where you'll have a need or an interest to look up residency or fellowship curriculum but when the need arises, you'll want to know how to do it.
It's easier to find this curriculum in some hospitals more than others.
For example, in February of 2020, the curriculum for Neurosurgeons was right there on Mayo's main Neurosurgery page. It took one click to access it. After my husband and I accused Mayo of giving the surgical resident a title he shouldn't have been given, Mayo's website underwent a major overhaul and the curriculum for all residency programs was removed from each department page. It's still there but is now embedded deep under their education section. So February 2020??? 1 click to access the curriculum off each department page. August 2020??? Follow the 13 steps below.
1. Google "Mayo Clinic Minnesota" or whatever state you're looking for.
2. Click on their website (not the health systems website but the state institution)
3. Click 'Education.'
4. Click 'Education' again or 'College of Medicine and Science.'
5. Drop down box: Neurosurgery
6. Drop down box: Minnesota
7. Drop down box: Residency
8. New web page will come up, it may say no positions are available so you'll have to try another state.
9. Go back to previous page.
10. Change state to perhaps Florida.
11. An open position may or may not appear. If one does, you're in luck. Click on it as though you would like to read about the position or apply for it.
12. You will now see the word "curriculum" at the top of the page. Click on it.
13. The page won't look like there is much on it but that is deceiving. Scroll down and where you see PGY-1, click the '+' sign. The curriculum will then drop down. You can continue to click on the different post graduate years to read what you need.
One of the resident who performed the surgery...he was listed as a First Assistant. Why is that important? Because per Mayo's own curriculum, which I found online, he shouldn't have been able to receive that title until his second year of residency. He'd only had his medical license for 6 months. The other First Assistant that did our son's surgery by himself only held his surgical license for 4 moths. We'll admit, there are going to be very few times where you'll have a need or an interest to look up residency or fellowship curriculum but when the need arises, you'll want to know how to do it.
It's easier to find this curriculum in some hospitals more than others.
For example, in February of 2020, the curriculum for Neurosurgeons was right there on Mayo's main Neurosurgery page. It took one click to access it. After my husband and I accused Mayo of giving the surgical resident a title he shouldn't have been given, Mayo's website underwent a major overhaul and the curriculum for all residency programs was removed from each department page. It's still there but is now embedded deep under their education section. So February 2020??? 1 click to access the curriculum off each department page. August 2020??? Follow the 13 steps below.
1. Google "Mayo Clinic Minnesota" or whatever state you're looking for.
2. Click on their website (not the health systems website but the state institution)
3. Click 'Education.'
4. Click 'Education' again or 'College of Medicine and Science.'
5. Drop down box: Neurosurgery
6. Drop down box: Minnesota
7. Drop down box: Residency
8. New web page will come up, it may say no positions are available so you'll have to try another state.
9. Go back to previous page.
10. Change state to perhaps Florida.
11. An open position may or may not appear. If one does, you're in luck. Click on it as though you would like to read about the position or apply for it.
12. You will now see the word "curriculum" at the top of the page. Click on it.
13. The page won't look like there is much on it but that is deceiving. Scroll down and where you see PGY-1, click the '+' sign. The curriculum will then drop down. You can continue to click on the different post graduate years to read what you need.
But don't worry. There is NO reason you have to go through a
fun-filled maze like the one listed above to see what tasks or titles your doctor are privy to.
In most cases, finding a hospitals curriculum, even Mayo's, only takes two simple steps.
Step 1: Go to google, type in the name of the hospital and then "residency program curriculum," and then add the division/type of surgeon that your looking for. For example, "Mayo Clinic Neurosurgery Curriculum."
Step 2: Click on the first link that appears...or maybe the second or third. You may have to play around with the wording, so it may take a few tries, but you should get there.
1. Example: Google search "Mayo Clinic Minnesota Neurosurgery Curriculum"
2. Usually you'll just click on the first link that appears.
If you really need it but can't find it, call your hospital's **patient service department. Tell them what you're looking for and ask them to email it, mail it, or send it via your patient portal. If they respond that they don't deal with matters of that nature, fair enough...Ask them to connect you to the program director of their residency program. That person will certainly have access and should have no problem sending it. Curriculum isn't a secret.
As mentioned previously, in most cases you aren't going to have a deep need or desire to seek out this curriculum but if you do, hopefully this will help w/ access.
Step 1: Go to google, type in the name of the hospital and then "residency program curriculum," and then add the division/type of surgeon that your looking for. For example, "Mayo Clinic Neurosurgery Curriculum."
Step 2: Click on the first link that appears...or maybe the second or third. You may have to play around with the wording, so it may take a few tries, but you should get there.
1. Example: Google search "Mayo Clinic Minnesota Neurosurgery Curriculum"
2. Usually you'll just click on the first link that appears.
If you really need it but can't find it, call your hospital's **patient service department. Tell them what you're looking for and ask them to email it, mail it, or send it via your patient portal. If they respond that they don't deal with matters of that nature, fair enough...Ask them to connect you to the program director of their residency program. That person will certainly have access and should have no problem sending it. Curriculum isn't a secret.
As mentioned previously, in most cases you aren't going to have a deep need or desire to seek out this curriculum but if you do, hopefully this will help w/ access.
