Best Emergency Medicine Residency County Programs

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hsanz

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There are a lot of Emergency Medicine residency programs out there but which ones are the best? The specialty of Emergency Medicine started in inner-city, resource-poor, high-volume hospitals. Here is a list of EM programs that are the best "county" / "safety-net" / "LICHSIPER" programs in my opinion.

Boston Medical Center (Boston City Hospital)
Cincinnati
Cook County Hospital
Cooper Camden
Detroit Receiving
Grady Memorial Hospital
Hennepin County Medical Center
Highland (Alameda County Medical Center)
Jacobi
Kings County/SUNY Downstate
LA County (LAC+USC)
LSU (Charity Hospital)
Maricopa Medical Center
NYU/Bellevue
Parkland Memorial Hospital (UT Southwestern)
University of Maryland
Temple University

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There have been many many threads on a 'good EM' program. And while county usually has good EM, doesn't mean there aren't good EM programs that are non-county. And I'd argue that your +/- list includes some pretty respectable 'county' programs, so i'm sure why you're stratifying them as you are.
 
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1) I agree In-N-Out is by far #1

2) Princeton is number two (always plays 2nd fiddle to the great I&O)

3) One of the programs you list no longer exists

4) The premise of this thread is ridiculous
 
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Good input. Charity=LSU. Updated list.
 
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The obsession with "County" programs is kind of funny because programs at true "county" hospitals run the spectrum of patient populations and resources. Manhattan or Boston are hardly resource-poor cities, and they are now treating populations that are largely NOT poor. (Does Boston actually have any public hospitals now?) Non-county hospitals also run the spectrum of resources and patient populations. Private hospitals still serve poor populations and many are defacto safety net hospitals.

I know for a fact that there are patients transferred past 4-5 tertiary care centers to mine because the others won't accept the patient for admission to a specialty service. My hospital is a private not-for-profit university hospital just like the others being by-passed (though 1 or 2 are for-profit). It just happens to be part of the hospital system's mission to accept any patient from anywhere at anytime (it's not solely out of the goodness of their heart, mind you; they want the insured patients from those sending hospitals more than anything).

Anyhow, a number of those hospitals listed are no longer "County" and are now in fact private institutions (e.g. BMC, UMaryland, and Cinci). And as far as I know, Cooper was never a public/county hospital. Detroit Receiving Hospital is now part of a FOR-PROFIT system (Tenet).
 
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The obsession with "County" programs is kind of funny because programs at true "county" hospitals run the spectrum of patient populations and resources. Manhattan or Boston are hardly resource-poor cities, and they are now treating populations that are largely NOT poor. (Does Boston actually have any public hospitals now?) Non-county hospitals also run the spectrum of resources and patient populations. Private hospitals still serve poor populations and many are defacto safety net hospitals.

I know for a fact that there are patients transferred past 4-5 tertiary care centers to mine because the others won't accept the patient for admission to a specialty service. My hospital is a private not-for-profit university hospital just like the others being by-passed (though 1 or 2 are for-profit). It just happens to be part of the hospital system's mission to accept any patient from anywhere at anytime (it's not solely out of the goodness of their heart, mind you; they want the insured patients from those sending hospitals more than anything).

Anyhow, a number of those hospitals listed are no longer "County" and are now in fact private institutions (e.g. BMC, UMaryland, and Cinci). And as far as I know, Cooper was never a public/county hospital. Detroit Receiving Hospital is now part of a FOR-PROFIT system (Tenet).

LSU is also run by a For-Profit corporation now.

On the whole I agree, there are very few "true" county hospitals left.

A better classification would be busy inner city residencies.

Also, OP left off harbor-UCLA??
 
I trained at one of the programs listed and I think this thread is bogus. And Charity Hospital doesn't really exist any more.
 
There are a lot of Emergency Medicine residency programs out there but which ones are the best? The specialty of Emergency Medicine started in inner-city, resource-poor, high-volume hospitals. Here is a list of EM programs that are the best "county" / "safety-net" / "LICHSIPER" programs in my opinion.

Boston Medical Center (Boston City Hospital)
Cincinnati
Cook County Hospital
Cooper Camden
Detroit Receiving
Grady Memorial Hospital
Hennepin County Medical Center
Highland (Alameda County Medical Center)
Jacobi
Kings County/SUNY Downstate
LA County (LAC+USC)
LSU (Charity Hospital)
Maricopa Medical Center
NYU/Bellevue
Parkland Memorial Hospital (UT Southwestern)
University of Maryland
Temple University


Since we are pointing out which programs on the list are not really county, Detroit Receiving doesn't qualify as county, either. They are a privately owned hospital now, owned by Tenet Healthcare Corp.
 
Instead of "County"... let's say high volume, low resource, guerrilla warfare style medicine
Having trained at one of these places, I agree that it was an awesome experience and I came out of residency with no fear. However, not all hospitals practice guerrilla medicine and a civilized program will train you well for the real world.
I still like the list though.
 
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So I have been meaning to create a profile and update the Receiving thread for a little while, I guess now is as good as ever. While Detroit Receiving is no longer technically a county hospital, it is still a safety-net hospital in Detroit. There aren't any county hospitals in the city any longer either, Receiving was the last. The hospital's patient population has not changed, they still have the "inner-city, resource-poor, uninsured, under-insured, high-volume, high acuity" patient population. So it not technically county, but it is a 'county-like' program. It's still nuts.
 
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Baylor College of Medicine, Ben Taub Hospital and LBI Hospital, county as it gets.
 
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Baylor College of Medicine, Ben Taub Hospital and LBI Hospital, county as it gets.

Yes, I was going to throw in Baylor for Ben Taub. LBJ hospital is actually part of UT Houston's residency program-- it's a fairly busy county shop, with less trauma than Ben Taub (non-Level I), but it definitely gives the county experience for UTH trainees who are getting plenty of trauma at MHH. I would also add San Francisco General and Harborview to this list, both are high-volume or high-acuity (or both) public hospitals affiliated with fairly new residencies.

But all of this discussion is worthless, given the irrefutable primacy of In-N-Out's training program, which balances academic prowess with the best clinical training on the planet in a setting valuing both resident quality of life and autonomy. I hear the department is heavily resident-run, and that their relationship with trauma surgery is almost weirdly collegial.
 
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There are a lot of Emergency Medicine residency programs out there but which ones are the best? The specialty of Emergency Medicine started in inner-city, resource-poor, high-volume hospitals. Here is a list of EM programs that are the best "county" / "safety-net" / "LICHSIPER" programs in my opinion.

Boston Medical Center (Boston City Hospital)
Cincinnati
Cook County Hospital
Cooper Camden
Detroit Receiving
Grady Memorial Hospital
Hennepin County Medical Center
Highland (Alameda County Medical Center)
Jacobi
Kings County/SUNY Downstate
LA County (LAC+USC)
LSU (Charity Hospital)
Maricopa Medical Center
NYU/Bellevue
Parkland Memorial Hospital (UT Southwestern)
University of Maryland
Temple University

I don't consider all those hospitals to be resource poor.
 
Yes, I should have been more clear above, UT-Houston and LBJ (level 3), and Memorial Hermann (level 1). All of the major Texas EM programs are affiliated with county hospitals.
 
Scott and White?

Scott & White Memorial Hospital is the designated public medical facility for Bell County residents and receives county funds and financial support for the costs of uncompensated care. EM residents there see county hospital level of pathology for sure...
 
I'm an intern at the LSU EM residency program, and to clarify a few things:
1) Charity the building no longer exists, that's true. It was shut down after Katrina and the money from the insurance was used to build a new building, University Hospital which is due to open August 2015. Currently the EM residency runs primarily from the LSU Interim Hospital Emergency Department, which is near the university hospital. We are the only level one trauma center in the city, and this is where all the traumas come. It is a smaller hospital and smaller ED than charity and what university will be in a few months but we are still able to handle all of the cities traumas, and the high acuity and patient load that we receive (granted its cramped at times and the ED wait time can be long).
2) The faculty here are amazing, many were graduates of the old "charity" EM residency that everyone talks about and they are bad ass emergency doctors who are not only compassionate but are fantastic teachers and physicians. They can literally handle ANYTHING but yet they give residents a lot of freedom to make decisions and "run the show", they will only step in when necessary, but they are always there to have your back.
3) The residents are unlike any other emergency medicine program I interviewed at. Many residents here have their MPH and they are truly invested in helping out the community in which this hospital serves. This residency is not about going to the hospital for your required shifts and leaving, there is a broader line of thinking here and that's what I love most about the program. There is a dedication and responsibility to be leaders in care of the LARGE underserved community here in new orleans.
4) The pathology of the patients we see here is unmatched. we see more penetrating trauma here than anywhere in the country (only secondary to Americans who served the Iraqi war !!). We have the second highest rate of HIV in the country (secondary to baton rouge louisiana), and as a result we see TB, advanced syphillius, mycobateria mengitis/pneumonia, PCP and disseminated HSV on a fairly regular basis. It is comparable to a war zone in a third world country down here and literally you will leave this program able to handle anything!

I cant say enough amazing things about this program. Yes, we are underfunded and have been working out of a sub par building for many years, but that is soon to change. And yet, even despite all of the things that have been working against this residency program since Katrina, it has not only survived but flourished. They have had to deal with every bad thing that could happen to a residency program, so yes it is flawed but amazing it is a well run machine that keeps on going. It is a superior EM program, with kick ass residents and faculty, who are as awesome as this city is.
 
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To go along with Detroit Receiving Hospital which is mentioned in the OP, I'd add Sinai-Grace Hospital in Detroit. DRH and SGH are sister programs (both part of the Detroit Medical Center system). SGH actually sees more patients (110,000+) and more trauma than DRH. Many of the faculty are shared between the two programs. Having been a student at DRH and a current resident at SGH, I prefer SGH as EM residents do literally everything in the ED, including thoracotomies and peds codes. There are no rotating procedure days with trauma surgery as you find in many other programs. You have enormous autonomy as a resident and are running your own mod/codes at the end of intern year. In my intern year I ran at least 50 codes (including Peds and traumas), placed 6 chest tubes and 1 transvenous pacemaker, and performed countless other lifesaving procedures. At Grace, performing a procedure does not mean 'watching while the senior resident or attending does it.' It means you physically doing the procedure. You will work your tail off, and you will be expected to come to work prepared to work hard. If you're looking for heavy pathology amongst appreciative patients, heavy workload, and want to graduate as a knowledgeable, calm, and competent attending, you MUST check this place out.
 
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Heh SGH has a brand new 77 million dollar ED with private patient rooms and a 29 minutes or less guarantee.

Not exactly "county" by many people's standards. Its basically a community program that serves an inner city population and sees lots of trauma.

Also I wouldn't be bragging about only performing 6 chest tubes all intern year.
 
Why do community EM programs get no love??
 
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Heh SGH has a brand new 77 million dollar ED with private patient rooms and a 29 minutes or less guarantee.

Not exactly "county" by many people's standards. Its basically a community program that serves an inner city population and sees lots of trauma.

Also I wouldn't be bragging about only performing 6 chest tubes all intern year.
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I rotated as a Sub-I at one of those programs. Let me tell you, putting in all my own peripheral IVs and transporting all my patients to radiology myself was pretty not awesome...

I am at a quarternary center for residency now with jacked resources, skilled nurses. However, we serve a primarily medicaid population - lots of pathology. Still need to obtain my own IV access from time to time when the RNs can't get it; whether it be an EJ or a u/s guided extremity line - you need to be good at this but you don't need to do it for EVERY patient. You will get good at procedures no matter where you go. Anyone can learn a procedure. Developing clinical judgement and efficiency is much harder.

Trauma....yawn....I find it boring. Scan em up, get em to OR/IR or discharge/admit for obs. Cookbook. Sometimes you'll get the interesting one that requires cordis, intubation, chest tube (easy procedure - don't worry about getting a billion). The complex medical cases are where your metal will be tested.
 
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There are a lot of Emergency Medicine residency programs out there but which ones are the best? The specialty of Emergency Medicine started in inner-city, resource-poor, high-volume hospitals. Here is a list of EM programs that are the best "county" / "safety-net" / "LICHSIPER" programs in my opinion.

Boston Medical Center (Boston City Hospital)
Cincinnati
Cook County Hospital
Cooper Camden
Detroit Receiving
Grady Memorial Hospital
Hennepin County Medical Center
Highland (Alameda County Medical Center)
Jacobi
Kings County/SUNY Downstate
LA County (LAC+USC)
LSU (Charity Hospital)
Maricopa Medical Center
NYU/Bellevue
Parkland Memorial Hospital (UT Southwestern)
University of Maryland
Temple University

Wow you must have worked at a lot of hospitals to formulate such a strong opinion!
 
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