Effect of training in a wealthy area

[pageantry]

Anyone know? I can make assumptions but I don't really know how clinical years would differ in an area/hospital where the majority of patients have high-quality private insurance.

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[Officer Farva]

Anyone know? I can make assumptions but I don't really know how clinical years would differ in an area/hospital where the majority of patients have high-quality private insurance.

Not going to lie, but I would rather live in a nice area like the Upper East Side or San Francisco over going to a different area for "better" clinical training.

 

[pageantry]

Not going to lie, but I would rather live in a nice area like the Upper East Side or San Francisco over going to a different area for "better" clinical training.

So is your assumption that in a place where more people are poorer, sicker, and on Medicare, you'd get better training?

 

[Officer Farva]

So is your assumption that in a place where more people are poorer, sicker, and on Medicare, you'd get better training?

Not necessarily, I would look at the quality of the hospital. Using NYC as an example, Downstate always sells itself on having the "best" clinical training in NYC. However, lots of alums complained about the quality of facilities for education, so there is that. Cornell is in more of rich person area, but they have fantastic training.

At the end of the day,, don't look at the environment you are training in. But the quality of the medical school/center itself.

 

[Cyberdyne 101]

Not going to lie, but I would rather live in a nice area like the Upper East Side or San Francisco over going to a different area for "better" clinical training.

UCSF and Cornell may be in expensive areas, but they both see a variety of patients and have county hospital affiliations where students rotate.

 

[pageantry]

At the end of the day,, don't look at the environment you are training in. But the quality of the medical school/center itself.

Yeah, but it's one thing to compare a "wow!" school (I have no idea how to utilize the term "top 20" meaningfully) to a nearby non-wow. That's relatively easy. But I would still wonder in what ways the difference affects the doctors that they create. Does it make lesser clinicians? Or does it just mean you're less likely to end up in high powered academia?

That aside, when you're comparing non-wow's across the country, this still feels like a metric one might use to assess the quality of the school, don't you think?

 

[thatwouldbeanarchy]

Even if the institution is situated in a relatively wealthy neighborhood, if it's in an urban area, there's usually no shortage of low-income and underserved patients. (For example, in a place like NYC where there is extreme income inequality...) I don't know if I would necessarily say that working with the underserved gives you better training, but it does prepare you to deal with the reality of poverty and the failures of our health care system, which I personally think is extremely important.

 

[thatwouldbeanarchy]

I think environment actually does make a difference, though. My PI (an academic EM doc whose research focus is largely in underserved populations) told me right out that for residency, she passed over programs that didn't have strong connections to urban underserved communities because that's where she knew she wanted to be. But I think this probably matters a whole lot more in residency when you're really learning to do the kind of clinical work you'll be doing for the rest of your career.

 

[pageantry]

One thing I wonder is if a hospital that has mostly private insurance patients would have access to more interesting and up-to-date medical options.

Alternatively, I wonder if a wealthier hospital would underprepare students for the reality of working with underserved populations.

Or if, as has been noted, there are still enough rich and poor people everywhere that it wouldn't really make a difference.

 

[Officer Farva]

I think environment actually does make a difference, though. My PI (an academic EM doc whose research focus is largely in underserved populations) told me right out that for residency, she passed over programs that didn't have strong connections to urban underserved communities because that's where she knew she wanted to be. But I think this probably matters a whole lot more in residency when you're really learning to do the kind of clinical work you'll be doing for the rest of your career.

I feel like certain specialties might vary from different training environment. EM would benefit from trauma and emergency, which might be more prevalent in an underserved area. While specialties like oncology and endocrinology, which have a strong scientific background, require cutting edge research and clinical facilities (regardless if it is an underserved area or not).

 

[thatwouldbeanarchy]

.

 

[Med Ed]

Anyone know? I can make assumptions but I don't really know how clinical years would differ in an area/hospital where the majority of patients have high-quality private insurance.

Interesting stuff happens everywhere. At the medical school level the real question is whether the clinical education is more hands-on versus observational. In residency the precise patient mix becomes more important, not that one type is necessarily better than another, but by that point you should have some idea of your long-term goals and can tailor your rank list accordingly.

 

[pageantry]

Interesting stuff happens everywhere. At the medical school level the real question is whether the clinical education is more hands-on versus observational. In residency the precise patient mix becomes more important, not that one type is necessarily better than another, but by that point you should have some idea of your long-term goals and can tailor your rank list accordingly.

Yeah, that's a big factor I'm thinking about too, especially now that I'm also looking at a NYC school. I'm concerned that NYC hospitals will be far less tolerant of medical students trying to learn than hospitals in places where there is a shortage of medical/nursing staff.

I also happen to know that one school I'm considering has a reputation for turning out residents that are a little "soft"--to the point that they've created a committee to look into the issue. I gotta find out what that means for me as a student tho. I suspect it might mean not much hands-on time.

Another school's hospital is so huge and so busy that the students claim that by the time they hit 4th year they're expected to function as interns. Idk if that's good or bad, actually.

 

[Cyberdyne 101]

Yeah, that's a big factor I'm thinking about too, especially now that I'm also looking at a NYC school. I'm concerned that NYC hospitals will be far less tolerant of medical students trying to learn than hospitals in places where there is a shortage of medical/nursing staff.

I also happen to know that one school I'm considering has a reputation for turning out residents that are a little "soft"--to the point that they've created a committee to look into the issue. I gotta find out what that means for me as a student tho. I suspect it might mean not much hands-on time.

Another school's hospital is so huge and so busy that the students claim that by the time they hit 4th year they're expected to function as interns. Idk if that's good or bad, actually.

Which NYC school are you referring to?

 

[pageantry]

Which NYC school are you referring to?

Einstein. They recently changed their hospital affiliations too, so I really don't know how that affected students.

 

[Cyberdyne 101]

Einstein. They recently changed their hospital affiliations too, so I really don't know how that affected students.

Have you posted in the Einstein school thread?
Perhaps a current student can answer your questions.

 

[Cyberdyne 101]

@pageantry, in terms of location
Sacramento >>>>>>>>>>>>> the bronx

 

[pageantry]

@pageantry, in terms of location
Sacramento >>>>>>>>>>>>> the bronx

Lol how did I know you'd say that?
I actually live in upper-upper Manhattan and love it here, but there's no doubt it's a tough place to live. Everything takes more time and energy. But if you're used to NYC and you know how to make use of its opportunities, you can have a hell of an interesting time.

No backyard garden tho.

 

[bc65]

Another school's hospital is so huge and so busy that the students claim that by the time they hit 4th year they're expected to function as interns. Idk if that's good or bad, actually.

Exactly. It's hard to know which alternative is better. But my personal experience is that the more upscale medical centers will send residents and students out to county hospitals, so you get the best of both worlds: Close supervision and teaching at the med center, and more hands-on experience at the county hospital and VA.

I did a fellowship at a well-known county hospital, and the residents there were begging for attendings to come and help them. They had too much independence, more than they wanted.

 

[Mansamusa]

One thing I wonder is if a hospital that has mostly private insurance patients would have access to more interesting and up-to-date medical options.

Alternatively, I wonder if a wealthier hospital would underprepare students for the reality of working with underserved populations.

Or if, as has been noted, there are still enough rich and poor people everywhere that it wouldn't really make a difference.

I was actually told that having the up-to-date options isn't the best. Doctors told me to look for programs where I would really have to learn everything before I jump to the most technologically advanced techniques. It's better to know how to do more with less before you start relying on technology, if that makes sense.

I feel like the best thing to look for in med school clinicals is always a mix. You want rich and poor patients. Academic and community hospitals, etc. Since that will help you figure out where you want your career to go

 

[pageantry]

Exactly. It's hard to know which alternative is better. But my personal experience is that the more upscale medical centers will send residents and students out to county hospitals, so you get the best of both worlds: Close supervision and teaching at the med center, and more hands-on experience at the county hospital and VA.

I did a fellowship at a well-known county hospital, and the residents there were begging for attendings to come and help them. They had too much independence, more than they wanted.

A thing I keep coming back to is that there really are upsides and downsides to everywhere and everything, but it's generally possible to at least try to focus on the bright side.

...Unless you have a hospital full of abusive superiors. Nothing looks good when you feel trapped in a cycle of abuse.

That fact really does bring home the oft-cited canard around here about going to the cheapest school. But I guess I would also want it to be one where most of the residents and attendings were happy they worked there.

 

[Cyberdyne 101]

Lol how did I know you'd say that?
I actually live in upper-upper Manhattan and love it here, but there's no doubt it's a tough place to live. Everything takes more time and energy. But if you're used to NYC and you know how to make use of its opportunities, you can have a hell of an interesting time.

No backyard garden tho.

After reading your initial post, I thought you were referring to Cornell. And given what you've mentioned in prior threads, I don't see how Einstein could compete with Davis, unless they're offering you a ton of $$.

 

[pageantry]

After reading your initial post, I thought you were referring to Cornell. And given what you've mentioned in prior threads, I don't see how Einstein could compete with Davis, unless they're offering you a ton of $$.

I just want to say how much I enjoy your sincere enthusiasm for California. You seem like a lovely soul.

Not trying to make this thread just about me tho. I couldn't find another thread that asked about this topic.

 

[Cyberdyne 101]

I just want to say how much I enjoy your sincere enthusiasm for California. You seem like a lovely soul.

Not trying to make this thread just about me tho. I couldn't find another thread that asked about this topic.

Fair enough lol.

@alpinism, I'm bat-signaling you because you always offer excellent insight into the clinical aspect of medical education.

 

[piii]

Not necessarily, I would look at the quality of the hospital. Using NYC as an example, Downstate always sells itself on having the "best" clinical training in NYC. However, lots of alums complained about the quality of facilities for education, so there is that. Cornell is in more of rich person area, but they have fantastic training.

At the end of the day,, don't look at the environment you are training in. But the quality of the medical school/center itself.

UCSF and Cornell may be in expensive areas, but they both see a variety of patients and have county hospital affiliations where students rotate.

Yeah being at big urban but private hospitals like UCSF or Cornell, or the Brigham/MGH, you still see a diverse pt population. A better example may be Stanford vs UCSF. Stanford is 30 miles removed from urban SF and primarily serves a wealthy white pt population. You still see interesting stuff, and its not that dramatic of a difference, but clinical training is not what Stanford is known for.

 

[Cyberdyne 101]

Yeah being at big urban but private hospitals like UCSF or Cornell, or the Brigham/MGH, you still see a diverse pt population. A better example may be Stanford vs UCSF. Stanford is 30 miles removed from urban SF and primarily serves a wealthy white pt population. You still see interesting stuff, and its not that dramatic of a difference, but clinical training is not what Stanford is known for.

Stanford students rotate at a VA hospital and SCVMC, which is one of the largest county hospitals in California. Their main hospital may not have the same caseload as UCSF, but I'm sure the overall clinical training is excellent.

 

[utmn]

I think it has more to do with where you want to work and who you want to work with. I know that I want to eventually work with underserved populations, so I am ranking that highly in my pros/cons school choice list. Alternately, something that I value even more highly is whether or not there are multiple med schools in the same area competing for hospital spots. My assumption is that regardless of whether it is a rich or poor area, I will see more quantity of EVERYTHING if I'm not just one of 1,000 med students in the area. Does that make any sense to anyone else? Thankfully all of my choices have the benefit of being the only med schools for very long distances

 

[pageantry]

Alternately, something that I value even more highly is whether or not there are multiple med schools in the same area competing for hospital spots. My assumption is that regardless of whether it is a rich or poor area, I will see more quantity of EVERYTHING if I'm not just one of 1,000 med students in the area. Does that make any sense to anyone else?

That does concern me a little bit too, actually, but I suspect the fear is misplaced. Any given hospital can only have as many medical students as it can have, and hospitals generally exist because there's a patient population to serve. Even Manhattan has medically underserved areas (I live in one of them). There's no shortage of patients when you're in a busy metropolis.

 

[bc65]

That fact really does bring home the oft-cited canard around here about going to the cheapest school. But I guess I would also want it to be one where most of the residents and attendings were happy they worked there.

The same logic causes me conclude that going to the school which has happier students, and is in the nicer area ( not necessarily the same thing, of course ), is a better choice. It's a known quantity.

There's no shortage of patients when you're in a busy metropolis.

Correct. But it doesn't really matter where the school is, in terms of clinical material. For example, every med school in NYC has more than enough clinical material to go around, and they all serve plenty of poor patients. I wouldn't try to second guess the school too much. If a school has a good reputation ( ie is highly ranked, as all the school mentioned in this thread are ) , you can reliably assume that they have adequate clinical material for their students. Any large hospital will be filled with sick patients. Almost all university medical centers have county and community hospital affiliations, and often VAs as well. Also, there's no reason to believe that going to school in an underserved area will better equip you to work in an underserved community. If you want to serve any community, go to the best school you can and then provide the best care that you can with the resources at your disposal. Every community is different. You will have to adjust wherever you go, regardless of the socio-economic status of that particular area.

 

[honeybunnyMD]

More wealth would probably mean decent insurance and ability to afford primary care. Meaning you are not often seeing patients come in with life threatening illnesses that could've easily be been prevented had they been getting regular checkups. That would probably be one of the major differences, I would imagine. Don't know how drastic the difference would be though.

 

[Law2Doc]

Med school =/= "training"

That's called residency.

At med school level, what matters is the quality and oversight of the clerkships, not the patient/insurer mix.

Yes and no. I got to do a LOT more procedural things in med school during rotations at hospitals in less wealthy areas than I did at the wealthier community hospitals.

At places that cater to indigent and underserved populations, you will absolutely get to do more earlier, they don't get to say "no I would rather have an attending do that", they won't have the option to have male students leave the room for women's health issues (or vice versa), and will generally be happy interacting with anyone in a white coat. At the "fancier" hospitals, in my experience, you are lucky if patients let you shadow -- they sometimes expect more and aren't at the mercy of a place being a "teaching hospital", and your attendings may cater to them directly more. So yes I think your experiences in BOTH school and training will be much better if the hospital services a large poor population. If the place is full of private rooms and works of art, you probably will get pushed toward the side.

 

[alpinism]

Yes and no. I got to do a LOT more procedural things in med school during rotations at hospitals in less wealthy areas than I did at the wealthier community hospitals.

At places that cater to indigent and underserved populations, you will absolutely get to do more earlier, they don't get to say "no I would rather have an attending do that", they won't have the option to have male students leave the room for women's health issues (or vice versa), and will generally be happy interacting with anyone in a white coat. At the "fancier" hospitals, in my experience, you are lucky if patients let you shadow -- they sometimes expect more and aren't at the mercy of a place being a "teaching hospital", and your attendings may cater to them directly more. So yes I think your experiences in BOTH school and training will be much better if the hospital services a large poor population. If the place is full of private rooms and works of art, you probably will get pushed toward the side.

Agreed.

I had a very similar experience in med school.

 

[alpinism]

Overall its a complex issue that depends on many different factors.

Generally speaking hospitals in wealthier neighborhoods mainly serve patients with access to primary care and public health services. This results in a patient population suffering largely from diseases of aging and obesity (dementia, stroke, heart disease, kidney disease, hypertension, diabetes, cancer, etc...). At the same time, you're much less likely to see patients suffering from diseases of poverty and violence (infectious disease, malnutrition, poisoning, gunshot wounds, stab wounds, etc...).

That being said, on the flip side you're still going to see patients suffering from diseases of aging and obesity in poorer neighborhoods, but the main difference is that without good primary care and public health services, the diseases usually become more advanced and severe. At the same time, you're also much more likely to see patients suffering from diseases of poverty and violence.

As a result, most hospitals in wealthier neighborhoods see less diverse and less severe pathology. Which, if you think about it is a good thing since that means their patient population is overall healthier and has a better quality of life.

Now, that's not to say that places like Cornell (their main hospital, not their associated county hospital) don't see a good deal of pathology. Any hospital in a major city will get their fair share of sick patients. In addition, they also get the benefit of seeing referrals from all over the country for advanced subspecialty care. But, there's a reason why many prestigious medical centers are associated with inner city county hospitals like Lincoln, Elmhurst, SFGH, SCVMC, etc... You're just not going to see the same diversity and severity of illness on the Upper East Side that you do in the South Bronx. My best advice would be to go to a med school that offers rotations at both types of hospitals to see the difference for yourself and decide which one you like better.

 

[bumblebee611]

Not necessarily, I would look at the quality of the hospital. Using NYC as an example, Downstate always sells itself on having the "best" clinical training in NYC. However, lots of alums complained about the quality of facilities for education, so there is that. Cornell is in more of rich person area, but they have fantastic training.

At the end of the day,, don't look at the environment you are training in. But the quality of the medical school/center itself.

I had my kids at Cornell on the UES and IIRC, when you're a patient, they sell you on the fact that medical students will not see you because they ship the med students up to the Bronx to learn OB/GYN on poor women ....

 

[Officer Farva]

I had my kids at Cornell on the UES and IIRC, when you're a patient, they sell you on the fact that medical students will not see you because they ship the med students up to the Bronx to learn OB/GYN on poor women ....

Here I am thinking that medical students are welcome at their university hospital, but apparently not. All of my interviews try selling you on the varied clinical exposure, but here I am wanting only the academic hospital since I want to go into academic if I end up going to medical school.

 

[bumblebee611]

Here I am thinking that medical students are welcome at their university hospital, but apparently not. All of my interviews try selling you on the varied clinical exposure, but here I am wanting only the academic hospital since I want to go into academic if I end up going to medical school.

To be fair, this was over ten years ago. Also, it may only be for OB/GYN; I don't know about anything else.