it a little bit like you're thinking it's invalidating, right? The title of MD, or, and saying, oh, if some other people get to call themselves doctor what's next you
know, like, like this isn't a zero sum game people.
The American board of radiology did something that I guess is radical. they initiated a residency leave policy. Oh my God. I know
Nicole, do you remember us trying out the hanger reflex?
Let's try the third hand experiment.
welcome back to the short coat podcast. The show that gives you an honest look at medical school. It's a production of the university of Iowa Carver college of medicine. That's where we're from. That's what we're doing. That's why we're here. I'm Dave Etler with me today in the SEP studio. It's M two Noah wick.
Hey, over there, we've got a physician assistant student Ariel, Nuva and Alon. joining us for the first time full name. I couldn't resist the alliteration. I love it. M to Nicole Heinz is back. What's up nerds and MD/PhD student Miranda.
Skeen also returns.
I'd like to start off today's show on a positive note and a negative note. Let's hear from you one success and one fail, from your week.
I feel that it's important that people both joyfully celebrate success and normalize failure without shame. It doesn't have to be a huge failure. It doesn't have to be like a life altering. It doesn't have to be an amazing success. Anything like, I just want to, you know, just want to hear what you've been doing this week.
That's both successful and fail your ish.
well, I'll, I'll break the ice. Why not go for it? so success is, I actually made some pretty decent, tacos this week. Cause I had some ground beef and I was like, Chuck some stuff in here and I'm like, oh look, I actually succeeded at making some passable tacos. and then my failure was I kept trying to go to bed early this week and I kept it kept not working.
So it happened
to me a few times this week, too.
And in fact, because the most recent one was last night and in my defense, the Netflix autoplay screwed me over. I've been trying to finish up star Trek, deep space nine. And I was like one episode before bed. And then the next episode started auto-playing and I'm like, well, now I'm invested.
So, and I had to stay up an extra hour to see how
ended you did. And you didn't, you didn't find the soothing tones of, Ben, Cisco lulling, you to sleep
did as the prop. But the problem is I'm like right at the end of the show. So I'm in that really long, like multi-part to season finale. And it's very exciting.
And everyone I love is in peril. So I was like kind of falling asleep, but also like, oh God, what's going to happen. So yeah,
well, okay. Thank you for sharing your, your, success and failure.
Anybody else want to. Ariel as the, as the new beam, do you want to, you want to share a success in a failure?
sure. Success. I, okay. This is not like a paid sponsorship or anything, but I went to the board game cafe yesterday night. It's definitely this for like the second time. It's one of my favorite places ever.
people. Talk about the board game cafe. Like, is that, is that the same thing as the. The sober bar or is it, those are two different things. The sober
bar it's not called the silver bar. It's called
yeah, no, the board game cafe is called Fortuna. I think in the Piedmont.
pedestrian. That's my job.
Hey, did you know that you were going to be made fun of when you come on the show? I mean,
I've listened to
more than, I mean, Noah is here, so that's, that's
really how that works. So success
going to Fortuna, failure. I didn't do most of my reading for this first week of summer class, about EKG,
Okay. okay. Who's next? No,
my success, I was just back at my mom's place in Florida for like 10 days. so had a lot of sun, a lot of drinking, espresso and coffee and. Other beverages by the
Drinking espresso, but yeah, I'm sure just drinking coffee all
day. Yeah. All day. All hours. just straight coffee, nothing else. the man, my failure was, is I just got back yesterday and saw briefly my dad lives in Cedar rapids. So I was briefly at his place and then drove back and I left like, just so much shit at his place that like I had intended to take, like I left my laptop, I left like pillowcases, like all these things that I was in Teddy to take back with me.
I just like forgot
every time I go visit my mom, she has to ship something at least one thing back to us. So
it's so, and I'm usually pretty good about that. But, at this time I was my excuse says I got like three hours of sleep for the flight. So I was like, well, but
okay. Yeah, Nicole, I
came up with two and realized they're both food related.
I love it. So the success was, On Sunday, my husband and I made like the best breakfast burritos I've ever had homemade. And I'm really excited to keep making those. And I'm kind of wishing I made one this morning. and then my failure was I got wings one night this week and I left my leftovers out overnight.
That is, that is very sad. And it was always very sad, especially when it's good. I confess that, I've been trying, I set this up without, I was like, oh, I'll come up with a success and a failure. And I did. And I, and I neglected to do that while you were talking. Cause I was so interested in your successes and failures,
Rosebud, thorn, you know, and a low, yeah.
Doesn't have to be success in failure.
so let's see. I guess a high is that I've very much enjoyed. I'm, I'm, we're making some changes to it, not to the podcast itself so much as we are to, how we do the podcast behind the scenes. And that seems to be, at least not imploding. So thumbs up
there, not better that what we're doing right now, it's not imploding.
Well, here's what I want. My goal was to give people, give students, have students more opportunities to. To, I don't know, have some CV builders and things like that that are related to the show. And also to hopefully at the same time, allow us to do more in depth stuff than we, than we usually can do because when, when it's just me running the show, so, right.
So I am excited to see how this comes out and, either way it's going to be fun. So, yeah. and, mm, yeah, I, was not able, I also had a sleep related fail, which basically is I could not sleep on Wednesday night. And so I didn't come to work on Thursday because I was a miserable bastard. So there you go.
that sounds like a success
Yeah, well, I did take care of myself and, you know, and email at 2 45 in the morning, it was like, I'm not coming to,
for reasons. I am not explaining because you can infer them.
She always knows. I mean, this is, this is, this is a problem for Dave and in general, blessed sleep, sleep deprived, Dave. so yeah. I saw on our med school. That's Reddit
slash R slash med school. I saw an R slash med school, a rant, Ooh, by user Calvin Hobbes with a three, an underscore Hobbes with a three you slash, and I wonder do people actually, people don't usually say you
slash user. Yeah.
Don't say that like tag them in the comments.
I like to just like, you know, verbatim.
Okay. I saw on our slash med school, I ran by a use lash, Calvin underscore Hobbes with, three,
is it replacing an E? Okay.
And I wonder what you guys make of it. I've given them a female voice. bullets here, the post
I used to work as a medical scribe in urgent care.
And I had shifts with this nurse practitioner. She was really good with patients and clinical medicine. She got her online DNP and now refers to herself as doctor on Instagram. And it's just so cringey law. This has been bothering me, but this person is really nice and was a cool colleague of mine. Like, am I a bad person for thinking that go to medical school, graduate land arrest.
Then you can refer to yourself as a doctor. I get that a DNP is a doctorate degree, but I don't, nor will I ever see it as an equivalent to MD slash DEO, El Mio rant over
LMI IO or a,
I was trying to get the, I was trying to get the robot voice to appropriately pronounce things.
He sounded really pissy right off.
that robot voice was very aggressive. She sounded very bossy. Robot voice
is a pay doctor.
I mean, it seemed to fit the
feel like it's a really good time
to have more
than just MD student perspective here about trying to like target or call you out right now.
And that's why I use this question.
Good conversation to have,
yeah, I mean, it's, you know, it's this person just being. Is this a snotty thing? What do you think, Ariel? I
don't know what I'm allowed to say on this pod. You're allowed to say
anything you want.
And you're saying that you want that you're okay with being on the internet as traceable.
was going to say, if I might open the door slightly, I'm going to say a friendly yes, they are being snotty. Like it's not that we could continue. Yeah,
no, I was just thinking about that. Dr. like Tik TOK recently where, the everyone's kind of gathering around and being like, oh, we should work together to improve our work conditions somewhat and like support each other.
And maybe some other words that I won't mention on this podcast were mentioned. And
I think the most egregious words, don't worry.
Starting with the you anyway.
okay. Yeah. So they were like, oh my God, like, we need to start talking about, you know, unions and better working conditions and whatnot. And then the hospital admin, I'm spoiling the tech talk for anyone who hasn't
kept up on her. I'm swirling this amazing dramatic work of art. Dr. Glenn plug-ins.
so the hospital admins like freaking out now that everyone has brought up the U word.
And, so he opens this, like he breaks this, you know, glass and like opens the emergency, like in case of emergency paper. And it's like, when they mentioned the word union, say this, and then it's like, you are all great. He says to them, you're all great providers. And then they all stopped. And they're like, half of them are like, we're not providers.
I think it's,
I just, you know, like, it's amazing to me. From an outsider's perspective, sort of outsider's perspective. I kind of wonder why is this even important? And you hear this a lot from, especially for.
I think you hear this mostly from MD doctors and I, if I might jump in here, cause I, I feel like I can also speak to this a little because I have like a foot in the MD camp and a foot in the PhD camp.
And people say this about PhDs all the time. Like, don't call yourself doctor in public, even though you have a doctorate degree, which is like, yeah, absolutely. There you professional title. That's exactly it. It's a professional title. It is. You went and got a doctorate degree. Now the reason I say it's context dependent, is it like if someone yelled, this is like the joke, like if someone yells, is there a doctor in the house?
No, I would not want the doctorate of English to stand up and be like, yes, I'm a doctor, but nobody thinks that like there's doctor the medical title and then there's doctor the academic title. And if you're talking about what is your title that you can use, you are absolutely allowed to say my, my title is doctor because I went to college for a very long time and earned the title of doctor.
I don't think that actually helps for like what, in a medical setting. Like if you have a doctorate in something that isn't an MD, should you use doctor like in a hospital? I, I'm not super sure on that one. I tend to lean towards, yes. Like if you have a doctorate, you can say doctor, like your, the initials are on your name tag.
If people are interested, like if you have MD people know you're an MD, like it's fine. There's no need to get uppity about it. Like just let people use the, thing that they earned. I guess I'm ranting. Now. I think
you're really right about the context dependent. Cause like where I've seen this brought up before will be like a DMP referring to themselves as doctor in the clinic.
But what this user was writing about was what they're referring to themselves as, on their social media. And it seems like in their interactions with them in the clinic, they weren't doing this. And so
I'm not sure that they know because of my, my reading of it was that they got their DNP after. Okay.
He or she worked with that person, but I don't know.
Yeah. And I think it's okay to say, like, if you have a DNP, I think it's okay to be called doctor. I think people call PAs doctors just because if somebody walks in, in a white coat and an authority and authoritative voice, or even scrubs in an authoritative voice, they just go, hi doctor.
And then like, it's not a big deal because really your authority will come from whatever doctor you have. Like, you know, a DNP may not have all the say I'm actually not completely sure. But think they don't have all the same privileges MDs do and all this different stuff. Yeah. It depends on the state deals on everything.
Like I just think it's one of those things where if we can put our egos aside for a second and know that like, yes, the MD is like, well done, good job for you. If the patient wants to call them, hi, doctor, whatever. And they're not MD doctor. Just let them say, doctor, it's fine. Let's not police
Do you think patients care?
I think some patients care. I think some patients do want to see medical doctors and not, you know, advanced practice providers. That's totally fine. That's the right. I mean, I do think, I don't know. I guess personally, I feel like it's fine to call yourself a doctor, as long as you specify what your role is, you know, like say I'm Dr.
Wick or whatever. or I can Mackie doctor and Alon. If I got a doctorate, I'm a physician assistant or I will be,
or I will be your nurse practitioner or you get a doctorate. Of PA hood.
I think so. I think all
the doctorate of PA hood
it's actually, it's a,
wow, that's true. That's true. well, I mean our Dean Dave Asprey, he's a doctor.
Yeah. Yeah. And then we all call him Dr. Asprey, but he's no, he's
I think, I think that's not a bad middle ground that people forget. That's like, I'm Dr. So-and-so, I'll be your PA or I'll be your like NP or whatever.
So it's like, cause you say that and like that is like, you are absolutely should be allowed to use the doctorate if you've earned it. But then also like, just to clarify, in case you're curious, this is also my role in the medical team. Yeah. Say for,
from my perspective, personally, as a patient, I recently had to change providers and.
I'm disclosing that I see a psychiatrist. And so my previous psychiatrist was a DNP and my current one is an MD and it felt really weird when I like started calling the place and asking for Dr. Blank. Whereas before I referred to my provider as first name, and as far as I know, there, there are no differences in like their Clarence in providing me care.
And she did get her doctorate level degree, and she was one of the best providers I've had. And that really kind of like opened my eyes to a lot of the nuance that exists within this.
Right. I feel like a lot of the times it's like very, it's a very artificial. I dunno, it feels like an artificial argument or manufactured, like, like we said, like, I dunno.
It's like who, I don't know, like when people post stuff, I'm not like that, like that, I'm like, why do we, are we
spoiling for a fight? Here is this
sometimes feels like it, like,
cause I get it a little bit in the sense that like you're thinking it's invalidating, right? The title of MD or like whatever, or, and saying like, oh, if some other people get to call themselves doctor what's next, you know, you
know, like, like this isn't a zero sum game people.
Yeah. I mean, this is so typical of so typical of people like, oh, the, the. The immigrants are coming and take away all our guns or whatever the fuck,
a little bit of a reach. But yeah,
but you know what I'm saying? Like, like they're coming to take our privilege. I do think that th that there is something there, cause some of this feels defensive from the MD side of the board where it's like, you know, maybe because I've seen so many patients on social media in person being like, oh yeah, my main primary care doctor for years was a PA or an NP.
And they were like the best doctor I ever had. And so I think MDs look at that and be like, they ha they almost feel the need to defend themselves. Like, well, you know, they're not real doctors, we're real doctors because, and I think it's something like we have more schooling, we have more training, like there's more time investment.
And I think it can be a little. Like when you hear stuff like that and it's like, well then why the heck did I spend like six extra years in training when I could've just done that she wanted to do,
because you want it to do a specific job that isn't those jobs. I mean,
for better, for worse, you can't go to online school usually to become an MD.
so I think the reality of the situation is too it's like you don't have enough empty is to do all those lights to be all the fill, all those primary care roles too. It's just like, I dunno, it's a little bit, I think the other thing is too. It's just like you, the people who are attracted to be an MD tend to have the personality type.
I think that would be a funded by that's a funded by like
RPA is more relaxed. Are they cool or more chill?
The PA classes infinitely more chill.
And I just say just like the only male co-host in the room to like we ask her a question. Yes. Yes, they are. Let me answer for you.
no, I mean, I don't want to malign any of my MD classmates.
they're all great
She said that while staring immediately into all of our eyes as if begging for leniency, like you can insult us, it's fine. You're not
maligning, MDs these students by calling them not chill. I mean,
to be fair, like the requirements for, for PA students right now versus MD students is like, we have licensed to maybe be more chill because it's kind of like, just get through your training and then,
And also, you know, you don't end up with so many zillions of dollars in debt and all that kind of thing. Yeah.
Versus like jump through your 20 hoops so that you can jump through 10 more hoops. Yeah.
Well, so then that like just came to mind is wasn't there a point where like the whole MD DEO was really like, People people felt like it was a very big deal and big difference.
And I think that still does exist for some people.
Yeah. I absolutely think it does because there, I think it's the same sort of territorial waging of like MDs and dos. Like what, like where the, I, I wonder too, if it's part of it's cause MD has a much more long historical title on a lot of these newer degrees or, well, newer, so it's like, you know, MDs have been around for ages and then all these other people are now in like we're also MDs and they're like, it's like, I think there is a certain amount of territoriality happening legitimate or not.
I think that that could be at least somewhat of a factor.
I think all these conflicts are symptoms of like a larger thing that that's the same at its core for all of them. Yeah.
I brought it up today because I just want to encourage people to relax a little bit. I think it's, I think it's a little, I think it's very.
I think the animosity is very much overblown. You can argue many things. but I don't think you should be focusing on, well, I did more work and so my degree is worth more.
There's like a whole suburb at two dedicated, right? It's like our doctor. Yeah. Yeah. That's like dedicated to, like this person says they're a doctor and they're not, you know,
you can hear it.
Can you hear this? That's my eyes rolling.
Yeah. I it's like, you know, I love Reddit. I love you dearly. There are some absolute sink holes in Reddit, and that really sounds like one of them. Cause it's like, I mean, I think you referenced earlier, we have a lot more other things to be concerned about in the field of medicine than who gets to say what title for what name on, in whatever context it's like, can we maybe
put a competition?
Yeah. Yeah. Not having tried all doing prior auths and knows.
C care without having to jump through 17 insurance hoops. And can I please just give them this drug? I promise I'm the doctor, not you, Mr. Insurance, man. Like there's just so many issues in healthcare that we don't need infighting. Like for example, the fact that it's apparently uncomfortable to say union on the podcast
from like, are, are some healthcare providers more able to do it.
I just feel like the discussions I've heard surrounding MD is that it would clash too much with like the oaths and for unionizing,
you're saying, I mean, I think it's just because, well, like
basically you can't like you can't do, you can't go on a strike yet. You can't go on strike and leave the patients without somebody to provide for.
Like I've seen them talk about, you could just do a paperwork strike, so then they aren't getting the billing and then they get the economic hurt, but you don't hurt your paycheck. I think
it's more because, I mean, I think it's just because there's a bigger discrepancy in the interests of every doctor, right?
Like if you look at like a health care, like you don't got UHC, right. A psych doctor versus a surgeon or an orthopedic surgeon, you know, or something, the, their interests are fundamentally very, very different. And like, I think for example, there's a lot of surgeons have the mindset and perspective of like, hell yeah, I'm going to work all these hours.
And they're like, hell yeah. And you know, they're getting compensated very well for it. Whereas like, Yeah. Like someone who's like on internal medicine or taking care of inpatients and they're like working hour, you know, however many long hours shifts and not getting compensated as well for they're like, yeah, hell yeah.
I want a union. You know? So I think that's like, perhaps the issue with doctors it's, it's harder to get a wider spread, like hospital wide union. Right. I think in that sense, because there's just so many different, whereas like shift work, perhaps there's more, ubiquity and like, oh yes. A nurses union, you know, something like that.
But that's my, how I think about it at least.
I mean, I, I would sort of say that there's some validity in the of that, but also like if you're all working for an organization, that organization is not like treating you well, then it's like, cause I would almost argue like, even in the cases of like surgeons just expect to work all the long hours, it's like, that's sort of, not that shouldn't be expected of you.
Maybe like maybe this is something that we can chat about and say, oh, maybe if I'm up for 48 hours at a time, I'm not doing the best job that I can because I'm feeling like I'm high from being away. There's research
yeah. It's almost like humans need sleep. It's so weird. I
mean, to the, to the evidence is to the contrary of all the training you.
After that point.
when you're dead,
that's perhaps coming from like anecdotal experiences I've had with talking with surgery and OB GYN attendings here that they're like, oh my God, I tell you. But I think I told you about this when it happened. But like when I was, I was getting a dinner or was like, I was present in the room, I should say, while this conversation was happening, like a student asked like this attending, like, oh, what do you think about like, limits on like 80 hour work weeks, right.
For residents and like surgery, rotations and stuff. And they were like, well, you know, like I almost don't know if it's enough time to like, learn everything, you know? And I'm like, I mean, I could kind of see like that mentality. It's like, well, make the residency longer or something because like, we have the data that's like when residents are working that long, they're making medical errors and they're making more medical errors that lead to adverse events and lead to.
Yeah. You know, like there was this one article, I think it was in, oh God BMJ or something that was like the 16 hour shift limit. Did you see that? It was like when from 2013 to 2017, the, it was a national nationwide policy that residents couldn't work more than 16 consider executive hours. And like, there was a 33, 30 3% reduction and any adverse outcome, like any medical error and a 60% reduction in medical errors leading to death of the patient.
And then it was rescinded. And so they use this, they use a reference data frame of like 2008 to 2010 when there wasn't that policy. It's like, you know, build that association. But then the policy was rescinded in 2017. It's like,
I think when, like, was this a recent article? I think when that was out, I came across conversation about it.
And I actually talked with my current research mentor about like the 80 hour limit. And I was in a thread on Reddit and people were talking about, well, yeah, it's an 80 hour limit. But like, if you write over 80 hours, then they're going to come and be like, why is this over 80 hours? And they'll be like, yeah.
And they'll be like, why is it over 80 hours basically implying that it's your job to say you did 80 or no, no, it's your job to lie about less, less hours. And I was like, what are the ethics of this, of like incoming doctors being told immediately to fudge paperwork to go beyond hours that.
I'd seen on one of my friend's private story too, that he he's a resident now.
and he had like law, like 80 and a half hours, like in the week. And so he's entering the time card and it, in like the timecard system asks you, like, why did you do this? Which now he's like, what's your
justification was like, because that's what we got scheduled.
I was like, what do you mean?
Yeah, I'm sure.
I'm sure that's also not counting like the times where you're not actually working, but you are writing notes for all of the patients that you saw and you just have to take that home because you have no time. So yeah, it's definitely a multi issue of like, it's one thing to mandate a certain amount of duty hours.
It's another thing as to how that's implemented. So, and also, I also, I fully synthesize sympathize with people that are saying like, yeah, cause I have heard anecdotally as well, that residents do feel like it cuts into training time. It's like, if you're only allowed a certain amount of time, then like what I don't get through my residency fast enough, I don't feel as qualified, but I also think that that's valid that like, well, I'm sorry, I guess you're gonna have to be in residency longer because maybe more patients will be alive.
And that feels like the better outcome.
I think also, I mean, medicine is a lifelong learning career, right? You're not done with learning when you finish your residency. And so I think, I don't know, like I'm, I, maybe I'm not smart enough to know all the, all the things that you need to. Oh, I'm definitely not smart enough to know all the things that you need to know by the time you finished with residency.
But, that's not, when it all ends, you don't like your knowledge isn't fixed at that point. and that's all you've got for the rest of your rest of your life. I mean, maybe you could, I mean, there are other structures that would compensate, for a real deficit. The question is, is there a real deficit?
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Appreciate the sport.
back in July, 2021, the American board of radiology did something that, and this is this all neatly ties into what we were just talking about.
The American board of radiology did something that I guess is radical. they initiated a residency leave policy. Oh my God. I know the new policy allows up to 32 weeks, over four years for parental and, and medical leave. And it allows program directors and trainees the flexibility to figure out how to implement it.
so on the ABR website, I read a blog post from this past April written by two women radiology residency program directors who say this has made a big difference in the lives of their trees. you know, both men and women, radiologists, both birthing and non birthing, radiologists trainees can now spend more time with their, newborns.
it means they can return to work that much less stressed about their responsibilities as parents and focus better on their responsibilities as radiologists. And I think this is very important. They say it sends a message to other members of their departments that balancing one's family goals and one's career goals are important.
And that being mutually supportive is also important. I thought that was interesting. Yeah.
I mean, I've never the biggest fan of like, oh my word,
I'm never the biggest fan of putting medical leave under the banner of like voluntary leave, just cause I feel like those are two separate things, but better than nothing. So I'm not going to criticize them too much.
Well done that top of there. Of whatever vacation time they also get. Sure. Sure. Is that what you mean by voluntarily?
No. I mean, like, I feel like medical leave should be a separate category from like, from like maternal leave or something that you like take off specifically for, you know, vacationing or something like medical leave should just be I'm sick. I need medical leave. Not like something that you cause then like how, you know, how dare you be, have a child and also be ill.
Like how could you do this? So, yeah, but again, I also like, because this is still better than other residency programs, I feel like I don't want to push too much. It's like I have one piece of feedback. Otherwise we'll done
32 weeks over four years. It's actually very generous.
Eight weeks a year. Yeah, yeah.
Yeah. It's one of those things where like, if that was like a regular job offering, that I would be like, okay,
kind of sucks. But like, I think, I mean, residency is such an interesting title.
I think it's also though, like, I mean, you're kind of thinking of it. I'm not sure. I th I'm thinking of it, like. You're probably not going to have four kids. Yeah. Over the course of your residents might have
maybe two. Yeah.
Like definitely that, because that also allows you to take, like, if you want to take, you know, half your year off to stay at home with your kids, then you can do that. And I think that that is an excellent policy of just being able to like, you know, I want to wait until my kid is like walking until I come back to work.
And for that exact reason, once you come back, you're like, aha. I feel established as a parent. I think, I think this is how parents think. I have no idea. You're never
really established as a parent, but definitely when you go back at like four weeks or whatever, ridiculous amount, sometimes people are forced to go back to work at do.
You're definitely not established as a parent then. Awake, barely
yeah. I don't know. I feel like residency is hard because you have to balance, like it's a job and you're caring for patients, but at the same, like in like a job, but also it's like crucial to you learning the skills that you're going to need to provide care in the future. And so that's, I think it, I don't know for, and I I'll, I'll sort of preface this with, I mean like granted the, the, the amount of time that residents are allowed off now is like pitiful.
And like, I think there is a little bit of a balancing act to be like, Hey, like you can't take the entire time in residency off and then just expect to be
better. Yeah. Well, I think what's another thing that's useful about this policy is, as I said, the programs and trainees themselves. Figure out like how to implement it, how to do it so that it makes sense.
And I do like that, cause it allows like, cause you know, priorities will vary program to program and structure to structure. So I do appreciate the fact that it allows programs to be like, okay, well we can't let you do it for this period of time. So we'll add it to this period of time for whatever is going to fulfill that education.
I wonder too,
like how much programs have allowances and I dunno, clauses and for like taking extra time to complete a residency, do you know?
So I don't, I