Hopkins... what's the deal?

[CookWithGas]

Hi everyone,
Hopkins is a program that is going through a lot of changes...including new program director, changes in the numbers of CRNA's etc. I would love to hear from some current residents about what their experience is really like. I really liked hopkins when I interviewed, but have some concerns about resident satisfaction given the recent changes...so in short can some one comment on....

1. resident happiness/satisfaction
2. common resident gripes
3. if you had the choice would you do it again
4. how many hours are you really working
5. is baltimore really as bad as people make it out to be

and let me close by saying, hopkins is currently in my top 3 mainly because the medical students who go there speak very highly of the program and the attendings and residents seemed like great (and normal) people....

thanks for replying in advance
Cook

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[snowman8]

Most residents are happy. Great training in terms of depth and diversity of cases and didactics. Intraopertaive teaching could improve, but we are starting a keyword of the day which will be a focus of intraoperative discussion outside of what should be discussed pertinent to your cases and rotation. Our average day in the GOR is 630 to 5. Sometimes your done by three and sometimes by 6-7. Depends if the call team or CRNA can get you out if your cases goes past 5. Longest months are in the ICU and on Cards. Q3 call for ICU. Coming out of Hopkins you'll be able to do any case. Tons of peds, transplants, Livers, AAA, etc... Plenty of opportunity to experience trauma while on call. Rarely do we do bread and butter unless you are on your ambulatory month or placed in the outpatient center the day after you are post call. Our weakest area in house is regional, but have the opportunity to go to New York at HSS (meca for regional anesthesia) or couple of sister campuses which are great for upper and lower extremity blocks. Although are making huge strides in regional in house. Have a great fellowship that takes 2-3 residents a year. Our program is not malignant.

In terms of Baltimore, its an OK city. If you want to buy, downtown is pretty reasonable in cost compared to DC, NY, Boston, Chicago or any other of the larger cities. Suburbs are also affordable. Downtown is in the middle of a huge makeover. PLeanty to do. 45 min from DC. Hopkins itself is in a crappy party of the city, but also in the beginning of renovations.

If you trying to choose a program for residency most of the top programs will give you adequate training. #1, figure our were you want to live for 4 years and posably were you want to fond a job. Although the Hopkins name will help, much easier to find a job in a city were you trained. You will not have time to interview at all the jobs you want to look at and you will definitely have a better idea what’s available in the city where you want to practice if you trained there.

Oh yea, in terms of our situation for program director, we currently have an interm PD. Our past PD was great but it was time for him to move on. I think just burned out. He did many great things for the residency and is still an attending and not planning on leaving. Our current inter PD is from in house and doing a great job and huge resident advocate. Our chairman hasn't found the right person for the job. Looking for someone with masters in medical education, etc..... We have a solid program so the fact that we don't have a permanent PD right now doesn't matter. What you really need is a resident advocate who will attempt to make change, and it appears our interm PD who was head of the Peds fellowship, will be that person for now.

 

[gaspasser2004]

1. resident happiness/satisfaction

I think residents are generally happy at Hopkins. There are always a few who are more unhappy than others and hanging around them can really bring you down. I think there is a little uncertainty in the air with the new program director (Dr. Schwengel) and whether her changes will be good or bad for residents.

When I applied to Hopkins for the 2004 match, it had the reputation of having very unhappy residents and bad working conditions. The department was in flux with a new chairman. From the time I matched to the time I actually arrived as a PGY-2, all those issues had been ironed out, which I suspect will be the case for the people matching this year.


2. common resident gripes

The biggest gripe is having to stay late on non-call days. My overall perception is that things have gotten slightly worse since I was a CA-1. I think this mostly has to do with problems recruiting and retaining CRNA's, especially the ones willing to work until 7 or 9 pm - it certainly isn't because they are consciously trying to "stick it" to the residents. Historically, residents in the past have worked a lot harder than residents do currently. Six to seven years ago, 7 pm was the standard end to the day. There was also no 10 hour rule which meant that you could be in a case until 10 pm and be expected to do a first start case the next day. Some faculty are sympathetic to residents staying late and some think we are coddled too much as it is. That said, I think the typical day ends somewhere between 4-6 pm. I don't usually get stuck past 6 pm and I rarely get stuck past 7 pm. I don't recall ever staying past 8 pm on a non-call night (other than cardiac), but I know some people who have.

Another gripe is the lack of a coordinated didactic program. During the orientation month, there is a set of lectures that you get relieved for at the end of the day. After that, while well intentioned, the educational components are hit or miss. When on call, there is a morning conference where a journal article is discussed and the attending presents a case or topic. These obviously range in quality, but are mostly good. They have started a Barash chapter review this year, which is ok (main problem being unless you are on call during a particular week, you don't get the chapter review). It hasn't affected me that much personally because I find time to read on my own. Riding the train back and forth from Owings Mills every day (30 minutes each way) has allowed me to read several text books over the course of my residency. The residents who don't have built in time or don't make time are the ones who have suffered. And lets be honest, when you get to the point of being a resident, you shouldn't expect to be spoon fed all of your knowledge.


3. if you had the choice would you do it again

Without a doubt, I would train at Hopkins again. Residency is a means to a greater end, not an end in and of itself. Training at Hopkins definitely gives you an edge when looking for jobs and fellowships. Part of this is the fact that we do get really good training, part of this is just due to the name itself. But it does give you an advantage. For my job search, I received an interview at every place that was hiring and received an offer from every interview and landed my most preferred job where there was already a Hopkins alum. The feedback that I received from the interview trail was that training at a top program DOES matter if you want a really good job in a desirable location.


4. how many hours are you really working

We have to log our hours for ACGME purposes and I am fairly good about keeping accurate ones. In general operating room rotations, I average between 60-65 hours a week (usually includes a call). In the ICU's, I was averaging between 70-75 hours a week (Q3). Cardiac anesthesia is about 65-75 hours a week (can vary depending on caseload). The 10 hour rule is only relevant on the cardiac anesthesia rotation and the faculty are very good about relieving you at 7 pm if you have to be back at 5 am the next day to set up for a first start case. We get four weeks of vacation that are taken in two week blocks. We get about five or six days off in a row around the holidays (those wanting to take vacation over the holidays don't get this). For conferences, we get time off as long as we are first author on a poster or abstract (I have gone to ASA all expenses paid twice).


5. is baltimore really as bad as people make it out to be

I live in Owings Mills because I like green spaces and hate parallel parking. Taking the train every day allows me built in time to read. The distance between me and the hospital also creates a nice "buffer". That said, Baltimore does have some fun things like the Inner Harbor, reasonably good restaurants and crab. The weather is also not so bad during the winter especially if you are from the midwest like me. There are problems with crime and I know colleagues who have gotten their cars broken into in the city. However, most of the violence is not random and is mostly drug related.


I hope this helps. Feel free to PM me if you have any specific questions.

 

[CookWithGas]

thanks sooo much for replying guys...you two have definitely helped me sort out some of my thoughts regarding my rank list. yay!!!

Cook

 

[scent of a mule]

As a current Hopkins resident I will give you my perspective. I definately would not say that we are a program going through a lot of change. Yes, we do have a new program director. She has been on faculty at Hopkins for many years, was the assistant program director several years ago under the current PD at Penn I believe and was up until her new position as PD the pediatric fellowship director. PD's can't do it forever. It is a natural process for programs to change PD's. In our case, Scott Mittman wanted to focus on other things in his career. As the above post stated he is not going anywhere, he is still on faculty. He is an amazing teacher and an absolute pleasure to work with in the OR's. He did a lot to change the program for the better. I personally think it is healthy to bring new perspectives to programs over time. Deb Schwengel (the new PD) is a resident advocate and is insistent on taking what Scott has done and improving it. She believes in residency education and has sat down with all the residents on several occasions and asked for our input on what we would like to see changed or added to the program. I don't think this program will skip a beat because of the change in PD's. She is restarting the mock oral boards biannually for all residents. Every morning at morning conference we have some sort of group mock oral boards already. We have recently started daily key words which she will be pushing for every attending to discuss intraoperatively with their assigned resident. Assigned chapter discussion have been implemented from Barash on a weekly basis. These are just to name a few. An important thing to remember is that these changes are to improve an already solid program. It's not that we don't have a lecture and didactic program already established. We do, we are just asking that it's made even better.

Work hours: As stated above, cardiac and ICU's have longer hours and approach 70 hours per week. Otherwise the hours are reasonable. In the OR's I would say maybe once a month you may get stuck until 7. On average your day ends by 5 but there are many days you are done by 3:30 to 4:30. I do not feel over worked or abused. We have an extremely fair call system. As compared to the previous post I also keep accurate logs of my hours and aside from my ICU and cardiac months, I've only logged over 60 hours/week for a total of two month so far. Those were months that I took more call that usual. On average I work about 50-55 hours per week.

What are the weaknesses of the program. Again as above, regional. There are plenty of outside rotations that you can go to to make up for it in house. It is true that it is improving daily. A few years ago they lost a few throacic surgeons but recently added a few and the cases are back up. Other than that I can't think of many weaknesses for training. Peds is exceptional. Lot's of really sick kids. Transplant is great, not a ton of lungs however. Not many weaknesses I can think of. On average I bet there is 3-4 whipples a day that are done here. And yes many of these are done by Dr. Cameron himself.

As far as Baltimore, it is a large city on the east coast. If you can't find something to do here...well then I don't know what to tell you. Whether you are single, married or with a family there is plenty to do, eat and see in Baltimore and DC.

As far as the resident's, I think they are all a pretty cool and laid back bunch. Not what I expected coming here. All are fun to hang out with. Sure with 75 residents there are always going to be a few disgruntled individuals. Hey, this is residency remember.

A few things that I am not sure are emphasized during the interview day. Fellowships are a pretty sweet deal here. Outside of pain, critical care, and peds which are all ACGME regulated any other fellowship (OB, VT, VT/Cardiac, VT/regional, OB/regional, Neuro, Neuro ICU or any other combo you can possibly imagine is available to the resident at a Junior attending salary. Basically you split time between being an attending and being a fellow and are paid what a part time attending makes.

So am I glad I came here? You bet! I would do it again too. I have made some great friends and feel that I am receiving top notch training. I am confident that I will be extremely prepared to step out into the real world and I know that coming from Hopkins will open many doors for me. Graduating 25 residents a year also offers a lot of contacts from coast to coast.

Good luck with your decisions over the next few months. If Hopkins is on your list you can be confident that you could potentially train at a program that will provide you top notch training and not abuse you for it.

 

[proman]

Here's my perspective as a CA-1

1. resident happiness/satisfaction
I'm overall happy to be here. I think some in my class are not, but I think we have a better lifestyle than many other programs. It's not perfect, but no place is. One thing that separates Hopkins from many other programs is the atmosphere. Very easy going, with what I think are strong interactions with the surgical services and the OR/PACU staff. One thing's for sure, our attendings back us up. Scott and I were talking about this one day and his response was "there aren't many wallflowers here". We have a strong department and our attendings don't put up with any crap from the surgeons. Very important to me, and it sounds like it's a rare thing.
2. common resident gripes
Staying late seems to be a common one. I may have been lucky in the first 6 months, but I've stayed to 7pm once so far. The other day I was in the eye hospital at 6pm and there was still at least 1.5 hours left. A CRNA relieved me. I've stayed till 6pm maybe a dozen or so times. Most of the time I'm done from 4-5:30. We don't have many inpatient preops to do (will change next year). Another common gripe has to do with the CRNAs. Overall poor work relations unfortunately. This makes it even less pleasant to have to be done early and have to stay to get CRNAs out at the end of their shift (most of them are 5). They've demonstrated poor work ethic (refusing to start cases if they are late etc), just makes it unpleasant. But, overall I think our workload is reduced by having them around.
3. if you had the choice would you do it again
I ranked Hopkins first based on atmosphere and would do it again.
4. how many hours are you really working
I've averaged about 55 hours a week. Some CA1s are 60. ICU is as above. Obviously I haven't done the long-hour rotations like cardiac yet. CA1 call is about 5 times a month. You normally have 3 1/2 weekends off, which is really nice.
5. is baltimore really as bad as people make it out to be
Baltimore is growing on me. The more I know the city the more I like it. I like living downtown because I have a 4 minute commute. If you can tolerate longer drives there are very nice suburbs, like Owings Mills (or take the light rail paid for by the hospital).

My time here has been pretty intense. We don't do many routine cases. As a CA-1you'll get plenty of peds, major spine cases, a lot of neuro and prostate and pancreas/bowel surgeries. The surgeons here operate on patients other surgeons turn down, it makes for great learning for you. OB was good, I got half my epidural numbers in 7 days. I was disappointed in the quality of the ICU rotation that I've done (had been interested in CCM). Overall, I think the program is deserving of its reputation, and I know that 2 1/2 years from now I'll be able to handle anything that comes to the OR.

 

[militarymd]

Here's my perspective as a CA-1

1. resident happiness/satisfaction
I'm overall happy to be here. I think some in my class are not, but I think we have a better lifestyle than many other programs. It's not perfect, but no place is. One thing that separates Hopkins from many other programs is the atmosphere. Very easy going, with what I think are strong interactions with the surgical services and the OR/PACU staff. One thing's for sure, our attendings back us up. Scott and I were talking about this one day and his response was "there aren't many wallflowers here". We have a strong department and our attendings don't put up with any crap from the surgeons. Very important to me, and it sounds like it's a rare thing.
2. common resident gripes
Staying late seems to be a common one. I may have been lucky in the first 6 months, but I've stayed to 7pm once so far. The other day I was in the eye hospital at 6pm and there was still at least 1.5 hours left. A CRNA relieved me. I've stayed till 6pm maybe a dozen or so times. Most of the time I'm done from 4-5:30. We don't have many inpatient preops to do (will change next year). Another common gripe has to do with the CRNAs. Overall poor work relations unfortunately. This makes it even less pleasant to have to be done early and have to stay to get CRNAs out at the end of their shift (most of them are 5). They've demonstrated poor work ethic (refusing to start cases if they are late etc), just makes it unpleasant. But, overall I think our workload is reduced by having them around.
3. if you had the choice would you do it again
I ranked Hopkins first based on atmosphere and would do it again.
4. how many hours are you really working
I've averaged about 55 hours a week. Some CA1s are 60. ICU is as above. Obviously I haven't done the long-hour rotations like cardiac yet. CA1 call is about 5 times a month. You normally have 3 1/2 weekends off, which is really nice.
5. is baltimore really as bad as people make it out to be
Baltimore is growing on me. The more I know the city the more I like it. I like living downtown because I have a 4 minute commute. If you can tolerate longer drives there are very nice suburbs, like Owings Mills (or take the light rail paid for by the hospital).

My time here has been pretty intense. We don't do many routine cases. As a CA-1you'll get plenty of peds, major spine cases, a lot of neuro and prostate and pancreas/bowel surgeries. The surgeons here operate on patients other surgeons turn down, it makes for great learning for you. OB was good, I got half my epidural numbers in 7 days. I was disappointed in the quality of the ICU rotation that I've done (had been interested in CCM). Overall, I think the program is deserving of its reputation, and I know that 2 1/2 years from now I'll be able to handle anything that comes to the OR.

Why do people always say that?

I finished in 1997, and I'm still second guessing myself at the end of every day....thinking things over.

 

[devildoc2]

Another common gripe has to do with the CRNAs. Overall poor work relations unfortunately. This makes it even less pleasant to have to be done early and have to stay to get CRNAs out at the end of their shift (most of them are 5). They've demonstrated poor work ethic (refusing to start cases if they are late etc), just makes it unpleasant. But, overall I think our workload is reduced by having them around.

How does your program decide which cases are staffed by CRNAs vs residents?

Do CRNAs get to do the really advanced cases like heart transplants?

Are the CRNAs controlled by the Dept of Anesthesiology or do they ahve a separate nursing "dept of anesthesia" that they operate under?

Do the MDA chief residents supervise the CRNAs or what?

 

[Gator05]

What is a VT fellowship?

 

[gaspasser2004]

How does your program decide which cases are staffed by CRNAs vs residents?

There are attendings who make the schedule for the different operating room areas (one attending for each area). They decide who goes where.

Do CRNAs get to do the really advanced cases like heart transplants?

CRNA's don't do cardiac cases. The advanced cases that are good for teachign are left to the residents. That said, there are a lot of "advanced" cases at Hopkins, so a CRNA will do a whipple every now and then.
Are the CRNAs controlled by the Dept of Anesthesiology or do they ahve a separate nursing "dept of anesthesia" that they operate under?

CRNA's are under our department.


Do the MDA chief residents supervise the CRNAs or what?

Our chief residents have no supervisory role of the CRNA's

Proman and I are buddies, but I have to respectfully disagree with a little of what he said about the CRNA's earlier. By and large, they are a professional group of people who generally do a great job. Also, we are not supposed to be relieving them from their rooms if we are not on call - if that is happening, then proman should tell the PD about it. We do a lot of their inpatient pre-ops when on call and that can get frustrating, especially when given how much more money than us they make. But I don't think it is as bad as proman made it out to be.

 

[gaspasser2004]

What is a VT fellowship?

The VT fellowship is a non-ACGME fellowship where one does 6-9 months as a fellow and 3-6 months as an attending. The fellow months are in the vascular, thoracic and cardiac rooms. The attending months are in the GOR, vascular and thoracic rooms (oddly enough, you can be in the VT fellowship and "supervise" fellows in your class during your attending time). The main perk of this fellowship was to get paid more (during attending months) and TEE certification. Unfortunately, residents finishing after the class of 2009 will have to do a real one year slave fellowship to get TEE certification, so this main perk will be gone. Historically, the very strong residents from the graduating classes from Hopkins have gone on to do these fellowships and then most of them branch off into private practice.

 

[proman]

Why do people always say that?

I finished in 1997, and I'm still second guessing myself at the end of every day....thinking things over.

Introspection for continual improvement is one thing. A mark of a profession. But, what percentage of patients do you feel incapable of generating and implementing an effective anesthetic? That's what I'm thinking of. If I were to guess your answer, not many.

 

[militarymd]

Introspection for continual improvement is one thing. A mark of a profession. But, what percentage of patients do you feel incapable of generating and implementing an effective anesthetic? That's what I'm thinking of. If I were to guess your answer, not many.

You're right...not many...but enough that I review every case I did at the end of the day as I drive home, making sure that I didn't miss anything.