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Negative experience with Carolinas Healthcare System


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#1 NCPAS

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Posted 13 November 2016 - 04:36 AM

I had a disappointingly negative experience applying to this fellowship. Applied for the Spring 2016 outpatient internal medicine cohort. I was told to expect to hear by mid October if I would be receiving an interview in early November. In late October I was told that they suddenly decided not to enroll any primary care cohort for Spring 2016 but would allow me to be considered for another fellowship track, so I chose urgent care. There was no communication on their end until this week (2nd week of November) when I finally received an email simply stating, again, that they would not enroll any primary care fellows this spring. I emailed back stating that I had already asked to be considered for the urgent care position. I was promptly told that, in fact, urgent care would not accept my application and that if I wanted a fellowship I would have to apply again next year. The entire process left me with an overwhelmingly negative view of Carolinas Healthcare System. I am including excerpts of emails to illustrate how poorly executed the process was: 

 

So, my experience went like this:

 

Applied in mid August for outpatient Internal Medicine. Required lengthy application with personal statements, original transcripts, and three letters of recommendation.

 

Aug 30th received confirmation that my application had been received.

 

No communication until October 21st when they stated:

"We have just been notified that we will only be accepting Primary Care Fellows once a year starting in 2017.   October 2017 will be the yearly start date for Family Medicine, Internal Medicine and Pediatrics. If you would like to choose a different specialty so that you may be eligible for the April 2017 cohort-please respond back to this email with that certain specialty – no later than Monday, 10/24 noon. "

 

I replied on October 21st and asked to be considered for the urgent care fellowship.

 

No communication until November 10th when they stated: "We apologize for any inconvenience this may cause, but we have moved our Primary Care tracks to an annual start date. This meaning we will only accept applications/Fellows for the October start dates! If you would like for us to hold your application and move it to the upcoming cycle, please let us know. We look forward to reviewing your applications in the Spring(deadline April 1, 2017) for the Fall 2017 ACP Fellowship Cohort. Please let me know if you have any questions."

 

I replied and asked what was the status of my urgent care application and was told: "Urgent Care declined all Primary Care requests. Would you like me to carry your application over to next cycle?"

 

At that point, I declined to continue with the process.


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#2 RuralER/Ortho

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Posted 13 November 2016 - 02:45 PM

An urgent care fellowship? That honestly doesn't seem like a valuable use of time... outpatient IM,yes...ER, yes.... but for some reason urgent care doesn't seem like it. Just my opinion (not to mention unrelated).

Sorry to hear of your troubles.
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#3 MT2PA

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Posted 13 November 2016 - 03:56 PM

Eh, aside from some miscommunication I wouldn't get too upset over it (or characterize an entire system by those that manage the fellowships).

 

Sounds like they have some things to work out and likely there are multiple cooks in the kitchen, so to speak.  This timeline isn't so different from hearing back for healthcare positions....there's a lot of waiting without a lot of information.  You heard back in mid October as indicated.  They could have been waiting on the UC people to decide if they were going to take any additional applications.  Lots of places where this could have fallen through the cracks.  

 

Is it frustrating?  Absolutely.  


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#4 NCPAS

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Posted 13 November 2016 - 04:07 PM

Eh, aside from some miscommunication I wouldn't get too upset over it (or characterize an entire system by those that manage the fellowships).

 

Sounds like they have some things to work out and likely there are multiple cooks in the kitchen, so to speak.  This timeline isn't so different from hearing back for healthcare positions....there's a lot of waiting without a lot of information.  You heard back in mid October as indicated.  They could have been waiting on the UC people to decide if they were going to take any additional applications.  Lots of places where this could have fallen through the cracks.  

 

Is it frustrating?  Absolutely.  

 

 

Definitely frustrating to feel strung along for several months and essentially be told the thing you applied for no longer exists and the alternative option they gave also doesn't really exist. You're right, though. I can't paint the whole organization in a negative light. It seems to me that they tried to expand their fellowship program way too rapidly and were unable to manage it properly.


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#5 dphy83

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Posted 13 November 2016 - 07:59 PM

I never went through with an actual application, but I was less than impressed with my email communication with them. The individual who I contacted wrote in a very shorthanded manner without much thought put into the replies. Perhaps this is not a big deal to most, but it left me with the impression that the residencies are on the back burner and not worth a structured, thoughthe out reply to potential applicants.

Not to mention, this system seems to have a PA residency for every field of medicine under the sun. Seems to me like they are looking for cheap labor. My personal opinion is that this is somewhere to steer clear of if you want a solid educational component.
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#6 dphy83

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Posted 13 November 2016 - 08:08 PM

... and to echo a previous comment:
I, too, really do not think that a residency is exceptionally beneficial for certain fields, urgent care and primary care being two examples. You would most likely learn as much, and earn much more, going straight into the work force in these areas of medicine.

Also, to the OP, I feel your frustration. When I was applying I had an issue where a program did not inform me about my application status despite them saying they would. Then when asked about it, I was fed lies. As a result I missed their application window. Some situations suck, but there isn't much to do about it. Time to look forward and find another opportunity.
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#7 cinntsp

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Posted 19 November 2016 - 05:21 AM

UC is considered one of the primary care programs.  It's basically outpatient(primary care) vs. inpatient(acute care). Maybe that wasn't conveyed adequately.



#8 NCPAS

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Posted 20 November 2016 - 02:38 PM

UC is considered one of the primary care programs.  It's basically outpatient(primary care) vs. inpatient(acute care). Maybe that wasn't conveyed adequately.

 

They actively conveyed it differently. When they said the primary care was being moved to an annual start they told me I could still be considered for UC at the original start date. However, even though they gave no explanation about what actually happened, they didn't say that UC was being transitioned to the same annual start as the rest of primary care. They simply said that UC had declined all the people who had initially applied for primary care. So it's unclear if they actually are treating it as primary care or something else.


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#9 south

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Posted 23 November 2016 - 06:17 PM

I agree that there may be some major growing pains over there.  I was granted an interview for one of the newer fields, and with a few weeks to go I clicked through the curriculum and such to prepare, and found that it had changed radically; most of the structure and advanced stuff had been eliminated.  

 

I guess only a few people applied and the response underwhelmed the docs that supported it and they withdrew their support.  I did enough shadowing and slave labor in school, thanks very much, so I moved on.

 

One of the current (or very recent) cohort wrote on another forum that the EM fellowship has a list of pre-selected people for several cycles waiting in the wings, so not to even bother.  If you got a dismissive response, that may be the reason; no position actually exists.  


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#10 NCPAS

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Posted 23 November 2016 - 07:20 PM

I agree that there may be some major growing pains over there.  I was granted an interview for one of the newer fields, and with a few weeks to go I clicked through the curriculum and such to prepare, and found that it had changed radically; most of the structure and advanced stuff had been eliminated.  

 

I guess only a few people applied and the response underwhelmed the docs that supported it and they withdrew their support.  I did enough shadowing and slave labor in school, thanks very much, so I moved on.

 

One of the current (or very recent) cohort wrote on another forum that the EM fellowship has a list of pre-selected people for several cycles waiting in the wings, so not to even bother.  If you got a dismissive response, that may be the reason; no position actually exists.  

 

 

It's reassuring to know other people ran into similar issues. Thanks for sharing your experience; It sounds like I'm not actually missing out on anything.



#11 overthehorizen

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Posted 27 November 2016 - 03:47 PM

There are two areas that are ripe for deception in our profession. One is PA Education; the other is PA residency training. I allege widespread deception for several reasons. There does not exist any system of measuring the quality of outcomes of PA education and residency training. Additionally, the barrier for entry by schools and hospitals is almost non existent. Unscrupulous college presidents and hospital administrators have found a cash cow. Without much effort or resource, any small Liberal arts college without any history of training healthcare professionals can suddenly create a website and invite applications for their new PA program (at the typical tuition price of 30-40K/year). Where are the didactic faculty? More so, they come from part-time adjunct faculty with limited clinical experience. Where are the clinical faculty? Few schools have arrangements ahead of time for where to send students on rotations. Those sites that do accept the students would not meet the standards set by Medical schools for rotations. What has happened is the PA profession has become "Trump University." It should more aptly be named "Chump University."  The other area of deception is "residency training." One should not conclude that all programs are without merit. There are a few institutions with a long history of producing outstanding graduates and the training is superb. Those are few and rare. Today, any hospital administrator can realize that he can cut the cost of a PA salary by 75% by offering "residency." What they offer is a "residency stipend" which is half what one would make if they didn't go to residency. The other way they profit is by doubling hours from 40 to 80. So, the "pa resident" makes 25% of what he or she should earn. What do they get in return? Is there opportunity to do procedures, manage cases independently, undergo focused training for advanced skills. Rarely. These hospitals have utilized the "PA resident' as errand boys, admits/discharge clerks, equipment support technicians, and other unskilled labor. The winners is the deception game are Colleges who essentially increase revenue by $1.6 Million dollars annually by creating a web site with the faces a few "faculty." No mention of clinic sites and preceptors. No mention of specific objectives that will be documented at these sites. The hospitals (like Carolinas) are enjoying windfall profits from this scheme. No hospital or college is accountable to the student. Yet they continue to operate freely and deceive many young people anxious to start a new career. Finally, I believe this scam is not just happening to PAs but also to DO's. DO programs everywhere (and some MD) are launching "branch campuses" wherever they can scoop up tuition dollars. The support structures for didactic and clinical training is virtually nonexistent. I have come to the conclusion that one could become a PA by merely sitting in your bedroom at home on the internet and studying online for two years and then apprenticing with a PA for two years. There would be no difference in outcomes. To the point, few schools and residency programs actually produce anything of demonstrable value but they are not being asked by anyone to prove that they are. 



#12 south

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Posted 28 November 2016 - 06:10 AM

No.  Holy schlamoly, I thought I was pretty cynical.  

 

1.  I will admit that there are some crappy schools out there, in fact I may or may not have interviewed or attended some of them.  But there are standards, and anyone can look them up.  There's a mobile team that goes out and checks on programs and re-certifies them, and some of the programs - 8 or 9 at a given time, out of about, what, 180 these days - don't make it and lose their certification for a year.  Is that whole system corrupt?  oh, Maybe.  But you're talking like it doesn't exist at all.  

 

2.  I would not call the barrier for entry into PA school or residency anywhere near non-existent.  Programs take 6-8% of applicants, and residencies take ~15%.  Having interviewed for both, extensively, into the double digits, I can tell you that you're way off base.

 

3.  I will stipulate that clinical rotations often leave much to be desired, but I have seen worse - there are several medical schools where I was that make their students arrange and pay for their own rotations.  I have several of these forms in my desk someplace, because I attempted to set up a pay for play system where I was.  In case you were wondering, the ask is around $800 for an 8-week rotation for most specialties.  Can you imagine?

(having said that, there were people in my program with absolute nightmare stories and having to repeat rotations after graduation - with full tuition expense.  I may or may not be one of them.  I am not denying that it happens by any means.)

4.  To lump the rest together, you're talking as though the absolute worst case scenario is the norm.  I have personal knowledge of three programs (across three specialties) that follow the AFGCME or whatever 80 hour work week for residents, with 24 hour call and etc.  To those I have said "no thanks" and voted with my feet.  And sure, there are residencies with little to no information available on the web, and there are some (in top tier colleges) that are completely disorganized or just "moving the meat".  

But MOST of them have a stated curriculum, posted expectations around 50-55 hours / week or less, off - service rotations, and at least some protected didactic time.  Talking 90% here.  

Which is why I say to Carolinas "growing pains".  They are on the cusp of a new paradigm and are attempting to make a big splash very early - I guess their director is the president of APPAP now.  Most of their programs seem good to excellent, their interview and hiring process is very smooth and they pay more than some entry-level jobs.  Their residents - past and present - seem happy overall.  Maybe they have some problems keeping the home fires burning.  Who knows?  

If you are referring to a specific program(s), then by all means enlighten us.  That's why we are here; to get valuable information so that we may ask questions or avoid trouble. 

 

But let's not paint a gloom and doom picture eh?



#13 south

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Posted 28 November 2016 - 06:27 AM

"These hospitals have utilized the "PA resident' as errand boys, admits/discharge clerks, equipment support technicians, and other unskilled labor. "

 

I re-read your post and thought this was deserving of its own response.  I've never heard of this, and never talked to anyone who has.  Please name this program or hospital, privately if you prefer that.  This one needs to see some sunlight!



#14 LT_Oneal_PAC

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Posted 28 November 2016 - 07:27 AM

"These hospitals have utilized the "PA resident' as errand boys, admits/discharge clerks, equipment support technicians, and other unskilled labor. "

I re-read your post and thought this was deserving of its own response. I've never heard of this, and never talked to anyone who has. Please name this program or hospital, privately if you prefer that. This one needs to see some sunlight!


While disagree with his sweeping generalization, there are many places out there with a program they call a "residency." Often they are 6 months long, with a private group (not academic hospitals), and offer no off service rotations. I've definitely seen this with derm and a few EM "residencies." One needs to be careful when looking because PA residency isn't a protected term.

As far as the Carolinas system residency, I've known two people to go through them. One is hospitalist and one in critical care. Both gave overall positive reviews.
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#15 south

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Posted 28 November 2016 - 07:32 PM

While disagree with his sweeping generalization, there are many places out there with a program they call a "residency." Often they are 6 months long, with a private group (not academic hospitals), and offer no off service rotations. I've definitely seen this with derm and a few EM "residencies." One needs to be careful when looking because PA residency isn't a protected term.

That's true, and I have several friends in some of them.  What a shame.  Maybe there will be a certifying body emerge soon that will help clarify some of the waters here.



#16 LT_Oneal_PAC

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Posted 28 November 2016 - 07:53 PM

That's true, and I have several friends in some of them. What a shame. Maybe there will be a certifying body emerge soon that will help clarify some of the waters here.


APPAP does accredit them, it's just voluntary.

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#17 IDCtoPA

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Posted 28 November 2016 - 09:05 PM

I don't think APPAP accredits anyone. They are just a membership organization. ARCPA used to accredit postgrad programs but they stopped/suspended the practice a year or so ago while they re-evaluate the process. There really should be an requirement for accreditation. 

 

http://www.arc-pa.or...dited-programs/
 


My views are my own and are not representative of nor endorsed by any person, group, organization, or facility with which I may or may not be affiliated now, in the past, nor the future.


#18 sillycibin

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Posted 28 November 2016 - 11:47 PM

There are two areas that are ripe for deception in our profession. One is PA Education; the other is PA residency training. I allege widespread deception for several reasons. There does not exist any system of measuring the quality of outcomes of PA education and residency training. Additionally, the barrier for entry by schools and hospitals is almost non existent. Unscrupulous college presidents and hospital administrators have found a cash cow. Without much effort or resource, any small Liberal arts college without any history of training healthcare professionals can suddenly create a website and invite applications for their new PA program (at the typical tuition price of 30-40K/year). Where are the didactic faculty? More so, they come from part-time adjunct faculty with limited clinical experience. Where are the clinical faculty? Few schools have arrangements ahead of time for where to send students on rotations. Those sites that do accept the students would not meet the standards set by Medical schools for rotations. What has happened is the PA profession has become "Trump University." It should more aptly be named "Chump University."  The other area of deception is "residency training." One should not conclude that all programs are without merit. There are a few institutions with a long history of producing outstanding graduates and the training is superb. Those are few and rare. Today, any hospital administrator can realize that he can cut the cost of a PA salary by 75% by offering "residency." What they offer is a "residency stipend" which is half what one would make if they didn't go to residency. The other way they profit is by doubling hours from 40 to 80. So, the "pa resident" makes 25% of what he or she should earn. What do they get in return? Is there opportunity to do procedures, manage cases independently, undergo focused training for advanced skills. Rarely. These hospitals have utilized the "PA resident' as errand boys, admits/discharge clerks, equipment support technicians, and other unskilled labor. The winners is the deception game are Colleges who essentially increase revenue by $1.6 Million dollars annually by creating a web site with the faces a few "faculty." No mention of clinic sites and preceptors. No mention of specific objectives that will be documented at these sites. The hospitals (like Carolinas) are enjoying windfall profits from this scheme. No hospital or college is accountable to the student. Yet they continue to operate freely and deceive many young people anxious to start a new career. Finally, I believe this scam is not just happening to PAs but also to DO's. DO programs everywhere (and some MD) are launching "branch campuses" wherever they can scoop up tuition dollars. The support structures for didactic and clinical training is virtually nonexistent. I have come to the conclusion that one could become a PA by merely sitting in your bedroom at home on the internet and studying online for two years and then apprenticing with a PA for two years. There would be no difference in outcomes. To the point, few schools and residency programs actually produce anything of demonstrable value but they are not being asked by anyone to prove that they are. 

10 years ago PA residencies were typically paying $60-70k.  A little below average starting salaries.  Why?  Because a new PA didn't have to settle for chump change because there were plenty of new grad jobs offering real starting salaries.  Now?  They've reframed residencies and sell it as you are just like an MD resident, working alongside the MD residents and doing what they do.  And so now you get paid what they do.  $40k a year.  And guess what, you also get to work MD resident hours for that $40k.


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#19 JDayBFL

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Posted 29 November 2016 - 03:28 AM

10 years ago PA residencies were typically paying $60-70k. A little below average starting salaries. Why? Because a new PA didn't have to settle for chump change because there were plenty of new grad jobs offering real starting salaries. Now? They've reframed residencies and sell it as you are just like an MD resident, working alongside the MD residents and doing what they do. And so now you get paid what they do. $40k a year. And guess what, you also get to work MD resident hours for that $40k.


Naw. I start a residency/fellowship next month. Pay is good, > $65k. Others I was interested in all had salaries of least $55k with great benefits, relocation allowance, etc. The point of a resident is to be immersed in the hospital environment. Making clinical decisions, learning procedures, working in different sub-specialty areas on off-service rotations. All of these things are worth one year of a lower than average salary.

Reidencies only work in large, academic hospitals. Carolinas healthcare is one where it would work. The attendings are used to teaching and delegating responsibility. I have no idea about how they set up their programs though. If you are just working 12 straight months with the same service-- that's basically a job where they are paying you a below average salary. If you attend simulation, skills cadaver labs, they put you through advanced certification courses (advanced airway, ATLS, FCCS, etc), and let you work with some of the best attendings in each specialty... that's worth itself in gold. And you won't find that in any job or community hospital.
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