Hospitals where the ED dominates

[mvemsnp]

I'm looking for a list of programs where the emergency department has the largest role within the institution. In other words, where is it that EM is a "big fish in a small pond" rather than a "small fish in a big pond" of surgery, IM, ortho, etc?

I tried doing an extensive search and couldn't come up with much. I'd imagine the smaller, more "county" programs have a bigger influence and carry a bigger stick in the overall hospital hierarchy than in the large prestigious academic centers, but im basing that on nothing. Any opinions on specific hospitals, and how the setting influences hospital hierarchy (ie urban vs rural, community vs academic, wealthy vs indigent populations).... thanks!

---

Members don't see this ad.

 

[RockfordWF]

I'm looking for a list of programs where the emergency department has the largest role within the institution. In other words, where is it that EM is a "big fish in a small pond" rather than a "small fish in a big pond" of surgery, IM, ortho, etc?

I tried doing an extensive search and couldn't come up with much. I'd imagine the smaller, more "county" programs have a bigger influence and carry a bigger stick in the overall hospital hierarchy than in the large prestigious academic centers, but im basing that on nothing. Any opinions on specific hospitals, and how the setting influences hospital hierarchy (ie urban vs rural, community vs academic, wealthy vs indigent populations).... thanks!

Looking at the county hospitals I have visited only, it seems that Maricopa Medical Center in Phoenix, AZ would fit your description of EM having the largest role.

In comparison, a program like UT-Southwestern in Dallas, TX would be the opposite. This may be due to that fact that the ER is part of the department of surgery there.

 

[southerndoc]

I interviewed at small programs and large programs that have strong surgery and IM departments, and it's all variable by the institution, not the type of hospital. You can easily find a large hospital where the ED dominates, and you can find a smaller academic hospital where an IM or surgery department dominates.

Regarding being part of surgery, that may be institution dependent as well. For instance, I am a resident in a program that is a section of surgery. However, you can't tell we are because we operate independently. We don't answer to a surgeon, and we don't have surgeons pulling the "I'm your boss" card. In fact, we only answer to one surgeon -- the chief of surgery.

Being in a large academic center with strong surgery and medicine departments does have its advantages though. We have joint trauma conferences with surgery and quarterly EM/IM conferences with internal medicine.

You'll just have to get a feel for what a program is like when you interview.

 

[RockfordWF]

I interviewed at small programs and large programs that have strong surgery and IM departments, and it's all variable by the institution, not the type of hospital. You can easily find a large hospital where the ED dominates, and you can find a smaller academic hospital where an IM or surgery department dominates.

Regarding being part of surgery, that may be institution dependent as well. For instance, I am a resident in a program that is a section of surgery. However, you can't tell we are because we operate independently. We don't answer to a surgeon, and we don't have surgeons pulling the "I'm your boss" card. In fact, we only answer to one surgeon -- the chief of surgery.

Being in a large academic center with strong surgery and medicine departments does have its advantages though. We have joint trauma conferences with surgery and quarterly EM/IM conferences with internal medicine.

You'll just have to get a feel for what a program is like when you interview.

When being recruited for a residency, I've heard of the argument that a surgery-run EM program has to run everything by the chief of surgery, including equipment, scheduling, raises, etc. I don't know anyone who would want to have the surgeon personality running their lives....

 

[GeneralVeers]

A few with strong, dominant EM programs:

East Carolina
Carolinas
University of South Florida
Indiana (dominant at Methodist, while IM controls Wishard)
Kalamazoo, MI
Beaumont at Royal Oak, MI


In my own hospital, unfortunately Family Practice dominates because they were unopposed for 20 years. We are rapidly whittling away at that, and they now see us as a serious threat. Hopefully it will continue that way.

 

[FoughtFyr]

A few with strong, dominant EM programs:

East Carolina
Carolinas
University of South Florida
Indiana (dominant at Methodist, while IM controls Wishard)
Kalamazoo, MI
Beaumont at Royal Oak, MI


In my own hospital, unfortunately Family Practice dominates because they were unopposed for 20 years. We are rapidly whittling away at that, and they now see us as a serious threat. Hopefully it will continue that way.

St. Vincent's in Toledo, OH is an "EM dominated" program.

- H

 

[Dr. Will]

Alameda County/Highland
USC/LA County

 

[Mighty Mouse]

I second St. Vincent's in Toledo, OH.

This is a program where the ED dominates the entire hospital. Anywhere in the hospital, when the **** hits the fan, everyone breathes a sigh of relief when the EM resident shows up. I honestly seen a code blue where there was a bunch of people doing there thing, were they all parted like the red sea when we showed up. We had to expand our class size just to have enough residents to run all the things we essentially have ownership of at our hospital.

The EM residents run the following services
1) The ED (duh)
2) trauma (no lost procedures)
3) neurosurgery
4) neurology
5) ICU
6) LifeFlight

this is a program that rocks. a true diamond in the rough because people have no desire to go to toledo. if its in another place, i think people are falling over themselves to get in.

 

[EM_Rebuilder]

A few with strong, dominant EM programs:

East Carolina
Carolinas
University of South Florida
Indiana (dominant at Methodist, while IM controls Wishard)
Kalamazoo, MI
Beaumont at Royal Oak, MI


In my own hospital, unfortunately Family Practice dominates because they were unopposed for 20 years. We are rapidly whittling away at that, and they now see us as a serious threat. Hopefully it will continue that way.

I second Kalamazoo... I interviewed there and it seemed like EM was the king... The program up in Saginaw, MI was much the same way as I recall....

 

[seldomseen]

I think Christ and Maricopa are two programs where the ED residents are widely viewed as being the strongest residents and where the ED programs are subsequently more dominant.

 

[drakken]

Second on ECU for dominant ED status. They are top dogs there and highly respected.

 

[awdc]

Both of the Wayne State University programs, Detroit Receiving and Sinai-Grace. Detroit Receiving because it's claim to fame is emergency and trauma services. Sinai-Grace because the EM residents run every trauma code and do all procedures in the ED and are supposedly the go-to people in the ICU's.

Also St. Luke's in Bethlehem, PA gave me the impression that they were also a dominant department.

 

[AmoryBlaine]

I guess I need to back up a bit on the OP's question and figure out what they are asking.

There are probably multiple hospitals where the EM residents are the strongest in the hospital and therefore "run" alot of the other services as well as the department.

There is probably no hospital were the Department of EM "dominates" the rest of the hospital. It's pretty hard to argue for domination when you are rarely the site of definitive care/management.

 

[corpsmanUP]

I think it likely parallels the length of time that the program has been in existence in that institution. Programs where I felt like EM was a powerhouse in their own institution (based on my interview experience there) included:

Indiana
Illinois-Peoria
Texas Tech
Geisinger
Christ Advocate
Metrohealth/Cleveland
Maricopa
LSU Baton Rouge

Other places I have heard about where EM dominates:

Butterworth in Grand Rapids
Toledo
Akron
York/Pa
Kalamazoo
Allegheny
Hennepin
Regions
Palmetto

DO programs:
CCOM

 

[Hayduke]

I'm surprised nobody has put UMass on the list.
From the trail last year, I can say that no program impressed me more from a monetary pov. The ED is gorgeous. The entire dept. screams "we got coin!"

This was largely emphasized by the PD who unabashedly described how much pull they have in the institution.

It went farther down my list for other reasons, but it sure felt like they could buy a lot of influence.

That's my .02

 

[TylerDurden]

I would add BIMDC to the list- When the EM program split from the BWH/MGH and came to BIDMC, they were basically given the keys to the whole hospital. As a result, the EM program is quite strong.

 

[FoughtFyr]

There is probably no hospital were the Department of EM "dominates" the rest of the hospital. It's pretty hard to argue for domination when you are rarely the site of definitive care/management.

I disagree. There are hospitals, both with residencies (MetroHealth in Cleveland) and without (Mount Sinai in Chicago) where the ED dominates the hospital by virtue of income, being a portal to the majority of the processes in the facility and by being the "face" of the hospital. Metrohealth got their new ED planned for and built despite the need for new surgery suites that was arguably more pressing. The Chair of the ED actually "allowed" a late redesign so that surgical suites could be built on the floors above the new ED. You can do that when you are the Chief of Staff. Likewise Mt. Sinai's new CEO is a former EP. He basically "proved" to the entire staff that when the ED suffers, the institution suffers. The entirety of the hospital has ben operationally shifted to support the ED at all times. And what do you know, the institution has returned to profitability for the first time in many years.

As EM matures as a specialty, I think we will see more and more "EM controlled" institutions. This will coincide with senior EM staff working up the ranks within their institutions.

- H

 

[SolidGold]

A few with strong, dominant EM programs:

East Carolina
Carolinas
University of South Florida
Indiana (dominant at Methodist, while IM controls Wishard)
Kalamazoo, MI
Beaumont at Royal Oak, MI


In my own hospital, unfortunately Family Practice dominates because they were unopposed for 20 years. We are rapidly whittling away at that, and they now see us as a serious threat. Hopefully it will continue that way.

USF is still a division of IM. While good, I don't know if the program is considered to be "dominant" yet, especially since it's a newer program. They're surgery program is very strong though. UF-Jax fits the bill though.

 

[RockfordWF]

If you want to talk about DO programs, then it would be:

-OSU/Southwest Medical Center - Oklahoma City, OK

 

[tkim]

If you want to talk about DO programs, then it would be:

-Arrowhead - Colton, CA

I'd have to disagree with this. FM rules Arrowhead. Clearly the strongest program in the hospital. With FM's 16 positions per class year compared to EM's now 6 - up from 4 last year, FM is more established and has more influence.

For a DO program, I'd go with OSU and also Lehigh Valley. LVH is top-notch, IMO.

 

[GeneralVeers]

USF is still a division of IM. While good, I don't know if the program is considered to be "dominant" yet, especially since it's a newer program. They're surgery program is very strong though. UF-Jax fits the bill though.

Surgery seemed strong too in Jacksonville, and EM/Surgery would take turns running the trauma codes.

 

[13770]

okay, this must be a test......

In the history of emergency medicine, according to my program director, there are 4 allopathic medical school deans: not vice deans or associates - the full monty: Dean.

Of those, there is only one who is an Emergency Medicine residency trained physician - a landmark achievement for the specialty.

And where is this person: Albany Medical Center, Vincent Verdile, MD.

Our program director talks about this in his intro to the progam...., and fortunately, this is my program.

In addition, we also have an associate Dean of GME and associate medical director in the institution: all residency trained in EM. I think that would qualify in any measure for your thread title

 

[ditch doctor]

So yesterday, I totally wanted to admit someone in renal failure, and medicine balked, so I poked him with my fingers in the neck and said, "shhh, shhh, shhhh" really loud until he fell on the floor and showed me his belly. I totally dominated. We were taught that by our program director, Dr. Cesar Milan. 'Cause we dominate. We always enter the doors first, we don't pay attention to services when they are acting poorly, we make other specialties walk behind us, we eat first and make other speciaties wait their turn to eat. You see, dominating other services is about excercise, discipline and only then can you give affection. But it has to be in that order. We rehabilitate other services, but we train residents.

 

[DrQuinn]

So yesterday, I totally wanted to admit someone in renal failure, and medicine balked, so I poked him with my fingers in the neck and said, "shhh, shhh, shhhh" really loud until he fell on the floor and showed me his belly. I totally dominated. We were taught that by our program director, Dr. Cesar Milan. 'Cause we dominate. We always enter the doors first, we don't pay attention to services when they are acting poorly, we make other specialties walk behind us, we eat first and make other speciaties wait their turn to eat. You see, dominating other services is about excercise, discipline and only then can you give affection. But it has to be in that order. We rehabilitate other services, but we train residents.

Dude, that is so funny. I was watching that last night with my wife on National Georgraphic HD, and for the past 24 hours I have been poking her in the shoulder and doing the shhh shhh shhh.

I'm waiting for her to pee on the floor.

Q

 

[DrMom]

If you want to talk about DO programs, then it would be:

-OSU/Southwest Medical Center - Oklahoma City, OK

They're the only residency in the hospital, which helps in domination.


(they are a good program, though)

 

[RockfordWF]

They're the only residency in the hospital, which helps in domination.


(they are a good program, though)

I heard from someone that they have residents from OB/GYN and Ortho there.

 

[EMCC]

Hey! I am at St. Luke's and wanted to echo what a previous poster said. Yes, we are "top dog" at our facility. We are the largest residency by far. We currently take 8 allopaths and 4 osteopaths, and are upgrading to 8 and 8 starting next year. The closest any other residency at our instution comes is at 8 residents total per year...

Also, we run pretty much every relevant service to EM--trauma, SICU, MICU. You rotate on trauma as a 2nd year, and as a 3rd year. You run the SICU all three years. YOU are the airway EVERYWHERE in the hospital--codes, rapid responses, etc. YOU are the airway in the trauma bay (level I trauma center).

We have no subspecialty residents (e.g. Ortho), so we do virtually every ED procedure--reductions, splints, thoracostomies [not thoracotomies], paracentesis, etc. BTW, yes, we do thoracotomies, but 90% of the time they are under a trauma surgeon's supervision.

We ultrasound most things that need to be/can be ultrasounded (new word??) Yes, we are a community program. But, we see an extremely large spectrum of pathology. We see as much pathology as any other program.

We see 85000 patients plus per year--in our one ED!!! So, as you can tell, I love my program. If anyone has any questions, please contact me. I would love to answer any questions you may have. Also, we have an EM/critical care fellowship at our institution. And yes, we are seperate from the Dept. of Surgery...

 

[DrMom]

I heard from someone that they have residents from OB/GYN and Ortho there.

Southwest Medical Center only has EM. St. Anthony (also in OKC, but a separate facility) has FM, OB, & Ortho.

 

[bulgethetwine]

Hey! I am at St. Luke's and wanted to echo what a previous poster said. Yes, we are "top dog" at our facility. We are the largest residency by far. We currently take 8 allopaths and 4 osteopaths, and are upgrading to 8 and 8 starting next year. The closest any other residency at our instution comes is at 8 residents total per year...

Also, we run pretty much every relevant service to EM--trauma, SICU, MICU. You rotate on trauma as a 2nd year, and as a 3rd year. You run the SICU all three years. YOU are the airway EVERYWHERE in the hospital--codes, rapid responses, etc. YOU are the airway in the trauma bay (level I trauma center).

We have no subspecialty residents (e.g. Ortho), so we do virtually every ED procedure--reductions, splints, thoracostomies [not thoracotomies], paracentesis, etc. BTW, yes, we do thoracotomies, but 90% of the time they are under a trauma surgeon's supervision.

We ultrasound most things that need to be/can be ultrasounded (new word??) Yes, we are a community program. But, we see an extremely large spectrum of pathology. We see as much pathology as any other program.

We see 85000 patients plus per year--in our one ED!!! So, as you can tell, I love my program. If anyone has any questions, please contact me. I would love to answer any questions you may have. Also, we have an EM/critical care fellowship at our institution. And yes, we are seperate from the Dept. of Surgery...

Huh. I'm surprised to find that people are equating quantity of residents with dominance in the hospital....

Anyway, regardless, I would add Albuquerque NM to the list of programs that are dominant within their hospital. And their numbers are relatively small (8, I think, last time I checked).

 

[hyperbaric]

Dude, that is so funny. I was watching that last night with my wife on National Georgraphic HD, and for the past 24 hours I have been poking her in the shoulder and doing the shhh shhh shhh.

I'm waiting for her to pee on the floor.

Q

I foresee blunt trauma in your future.

 

[PowderHound]

Um, how about EVERY hospital, because EM residents are the best hands down

On a serious note, I just rotated at Loma Linda and their EM residents were by far the strongest of all the others. They always asked the EM residents to put in lines, etc. before the patient was transferred up to the floor.

 

[RxnMan]

- 13770 - I just heard that story at the EM interest meeting . It's true, though. AMC's EM program has got a lot of support from the top-down from some great people.

 

[DelawareEMIM]

Christiana Care in Delaware. Not only is the EM program the largest of the programs, I do not think any of the other residents would object to the statement that it is the most competitive. The fact that we have EM/IM and EM/FM residents allows for greater integration than I think would otherwise occur. I'm happy to talk about the place to anyone interested.

 

[ditch doctor]

I'm kinda curious if there is anyone that's going to chime in and go, "Yeah, at my hospital we're the choads of the hospital. We get stepped on by everyone. We alternate days with anesthesia for tubes, but at least they let us do trauma every third Tuesday. Also, we check out to medicine interns instead of EM attendings."

 

[sarahinromania]

I would say that, along with other Detroit programs, Henry Ford does this as well. Our program started in the mid 1970's with its own department and fought turf wars with the start of the specialty. On many off-service rotations the floor/L&D nurses and others have made comments multiple times about our EM department having the strongest residents. (And for some reason, the medicine and surgery seniors seem to refer to us as "procedure jockeys" in a positive fashion.)

In the trauma bay, the second year always gets first shot at the airway, and the EM residents get first shot at all procedures including chest tubes, thoracotomies, etc. Surgery is there if we need them to take the patient to the OR.

Wanting to be the strongest program in the hospital is a double-edged sword, however--you don't want to work with low-quality residents in other programs and have to clean up after them on off-service rotations, get their crappy sign-outs when they rotate in your ED, or have to call them as consultants for your patients, either.

I think the best balance is to be at a hospital of high enough quality that all the residents in all programs are relatively strong but the ED makes enough money/does enough research that they have the ear of the hospital administration while the EM program is attracting residents and staff of a quality that is respected by other departments. That shuts conflict down before it starts 95% of the time AND keeps the entire hospital a pretty benign environment when you're off-service. That's something I really appreciate about my program.

 

[Hayduke]

Wanting to be the strongest program in the hospital is a double-edged sword, however--you don't want to work with low-quality residents in other programs and have to clean up after them on off-service rotations, get their crappy sign-outs when they rotate in your ED, or have to call them as consultants for your patients, either.

I think the best balance is to be at a hospital of high enough quality that all the residents in all programs are relatively strong but the ED makes enough money/does enough research that they have the ear of the hospital administration while the EM program is attracting residents and staff of a quality that is respected by other departments. That shuts conflict down before it starts 95% of the time AND keeps the entire hospital a pretty benign environment when you're off-service. That's something I really appreciate about my program.

Well said.
For you guys interviewing this year, this last last paragraph is good question fodder. I have 8 off-service months this year as an intern. The seniors at my relatively new program have gone to considerable effort to ensure we have good rapport with our 'out' rotations.
This has already paid dividends for me. There is a decent amount of respect and collegiality when starting a new rotation. More importantly, when I call my former rotation colleagues with a consult from the ED, our established relationship decreases the balk factor to a significant degree.

I question the desirability of a facility in which EM is the only strong team. I learn a lot from my EM seniors. My education is also increased by the folks a year or two ahead of me on Peds, IM etc. They are pursuing their own specialty and have a lot to share.

I hate being out of the department, and scutting on floors, but this is part of the deal. My training in these other specialties is dependent to a large extent on how well my department has played along.

Dos centavos.

 

[FoughtFyr]

I'm kinda curious if there is anyone that's going to chime in and go, "Yeah, at my hospital we're the choads of the hospital. We get stepped on by everyone. We alternate days with anesthesia for tubes, but at least they let us do trauma every third Tuesday. Also, we check out to medicine interns instead of EM attendings."

Well, I wouldn't go that far. But I can tell you at the Mayo Clinic (and I'd have to imagine this to be true at Yale, Hopkins, University of Chicago, etc.), the EM residents are only "the best" inside the ED. Off-service, competing with those who are "at home", we are not "the best" - they are. What do I mean? At some programs (as I said before, St. Vincent's in Toledo comes to mind) EM "runs" ICUs, are the recognized experts for codes anywhere in the hospital, and based on the relative strength and quality of their residents compared to the residents of other programs in the institution, are seen as "the best" the institution has to offer. Now, at a full academic powerhouse (like Mayo), no single residency program is universally seen as the "best" in the institution. But does that matter? Nope! Anything "given up" in this dynamic is (IMNSHO) offset by the amazing quality of the "off service" education.

- H

 

[Hercules]

Well said.
I question the desirability of a facility in which EM is the only strong team. I learn a lot from my EM seniors. My education is also increased by the folks a year or two ahead of me on Peds, IM etc. They are pursuing their own specialty and have a lot to share.

I agree completely. I think it's very important to have strong programs around you to help make you better. I actually dropped a program to the bottom of my list when I interviewed, because I could tell the other programs at the institution were so weak.

 

[southerndoc]

Well, I wouldn't go that far. But I can tell you at the Mayo Clinic (and I'd have to imagine this to be true at Yale, Hopkins, University of Chicago, etc.), the EM residents are only "the best" inside the ED. Off-service, competing with those who are "at home", we are not "the best" - they are. What do I mean? At some programs (as I said before, St. Vincent's in Toledo comes to mind) EM "runs" ICUs, are the recognized experts for codes anywhere in the hospital, and based on the relative strength and quality of their residents compared to the residents of other programs in the institution, are seen as "the best" the institution has to offer. Now, at a full academic powerhouse (like Mayo), no single residency program is universally seen as the "best" in the institution. But does that matter? Nope! Anything "given up" in this dynamic is (IMNSHO) offset by the amazing quality of the "off service" education.

- H

I will say that it is extremely hard to keep pace with our internal medicine colleagues at Yale. They are extremely intelligent and know medicine very well. EM residents are by no means better than them on rounds. They can come up with some really thorough and good differentials on patients that leave our EM interns in the dust.

However, we are by far the best proceduralists in the hospital. Nearly all patients that need central lines get them while in the ED (>90%). We are only one of four specialties allowed to intubate in the hospital (EM, ENT, pulm/crit care, and anesthesia). Medicine residents barely get three of four LP's before the end of their training because we do them all in the ED.

I knew emergency medicine didn't run the show in every aspect of the hospital when I ranked it. However, that's ok with me. I wanted a place that had exceptionally strong medicine programs with great attendings. It now shows. I learned a lot through the numerous fellows, attendings, and even fellow residents on all my off-service rotations. One of our recent graduates who went to practice at a large academic hospital was complaining that his residents didn't know anything about medicine and how to treat patients (his words, not mine). Perhaps going to a program with a strong medicine or surgery program is not a bad idea at all. It certainly shows by the amount of knowledge our residents have in medicine, surgery, and critical care.

Please do not interpret my post as trying to say that programs without strong medicine/surgery programs are inferior. This is something that is dependent on the future resident. For me, strong off-service programs was what I wanted. It's not the perfect situation for everyone though and individuals should evaluate for themselves what they want to get out of residency.

 

[megawhizz]

I disagree. There are hospitals, both with residencies (MetroHealth in Cleveland) and without (Mount Sinai in Chicago) where the ED dominates the hospital by virtue of income, being a portal to the majority of the processes in the facility and by being the "face" of the hospital. Metrohealth got their new ED planned for and built despite the need for new surgery suites that was arguably more pressing. The Chair of the ED actually "allowed" a late redesign so that surgical suites could be built on the floors above the new ED. You can do that when you are the Chief of Staff. Likewise Mt. Sinai's new CEO is a former EP. He basically "proved" to the entire staff that when the ED suffers, the institution suffers. The entirety of the hospital has ben operationally shifted to support the ED at all times. And what do you know, the institution has returned to profitability for the first time in many years.

As EM matures as a specialty, I think we will see more and more "EM controlled" institutions. This will coincide with senior EM staff working up the ranks within their institutions.

- H

IAWTP. Being a big fish has way more to do with administrative leadership rather than money, and very little to do with the residency. Pulmonary/Critical Care probably has the most leadership positions out of any single specialty.

 

[8744]

Sparrow Hospital Program, Lansing.

Although I'm not sure what you mean by "dominate." We have thirty residents and 10 DO "trackers" so I believe we are the largest residency program at either of our two hospitals (Ingham Regional and Sparrow).

Earl K. Long in Baton Rouge cuts a wide swath. I don't think any of the other residency programs at E.K. Long of Baton Rouge General are nearly as big. (36 residents?)

 

[bulgethetwine]

Sparrow Hospital Program, Lansing.

Although I'm not sure what you mean by "dominate." We have thirty residents and 10 DO "trackers" so I believe we are the largest residency program at either of our two hospitals (Ingham Regional and Sparrow).

Earl K. Long in Baton Rouge cuts a wide swath. I don't think any of the other residency programs at E.K. Long of Baton Rouge General are nearly as big. (36 residents?)

Again, what does quantity have to do with quality? I didn't think Panda would adopt this view (BTT sits back and gently needles his buddy Panda)

 

[tkim]

Again, what does quantity have to do with quality?

Depends on how you interpret the OP's question: "dominates" or "have a bigger influence and carry a bigger stick in the overall hospital hierarchy" means quality or quantity. When I see the word dominate, I equate it with either large numbers of people, or people who have an inordinate amount of influence.

It's harder to gauge the latter without some intimate knowledge of the program and it's relative strength compared to other programs, and nearly impossible to do so from the outside looking in.

Usually larger numbers of residents means larger budgets, allocation of resources, more involvement in other programs. I see the OP's question having more to do with control and influence than quality.

 

[141837]

I wanted a place that had exceptionally strong medicine programs with great attendings. It now shows. I learned a lot through the numerous fellows, attendings, and even fellow residents on all my off-service rotations... Perhaps going to a program with a strong medicine or surgery program is not a bad idea at all. It certainly shows by the amount of knowledge our residents have in medicine, surgery, and critical care.

Bravo southerndoc (and Foughtfyr, too). Wise, mature and humble words, my friend. Your patients will be (are) in good hands with just this mindset. You've obviously risen above your pride for the greater good. A sincere thanks for that.

Take care (and great thread gang!).

 

[Emergen-C]

I would add BIMDC to the list- When the EM program split from the BWH/MGH and came to BIDMC, they were basically given the keys to the whole hospital. As a result, the EM program is quite strong.

I totally disagree. Boston and the Harvard programs in particular is still totally dominated by the Surgery and Medicine depts. On an interview there one of the residents said they call ENT down to control epistaxis. At MGH there is a Surgeon's desk in the ED where the Surgery residents screen the ABD pains surgical vs nonsurgical prior to ED seeing them.... ????!?!?!?

In my humble opinion, EM dominates at programs where nothing else dominates (i.e. EM is strong at programs that are not Harvard, Johns Hopkins, Mayo, etc). I found that the places it dominated tended to be the places your friends and family will ask "Where?" when you tell them you are ranking it high on your list...such as Hennepin, Denver, Highland, Harbor.

 

[southerndoc]

I totally disagree. Boston and the Harvard programs in particular is still totally dominated by the Surgery and Medicine depts. On an interview there one of the residents said they call ENT down to control epistaxis. At MGH there is a Surgeon's desk in the ED where the Surgery residents screen the ABD pains surgical vs nonsurgical prior to ED seeing them.... ????!?!?!?

In my humble opinion, EM dominates at programs where nothing else dominates (i.e. EM is strong at programs that are not Harvard, Johns Hopkins, Mayo, etc). I found that the places it dominated tended to be the places your friends and family will ask "Where?" when you tell them you are ranking it high on your list...such as Hennepin, Denver, Highland, Harbor.

I don't think we're on the "Where?" list. We do not call ENT down for every epistaxis. We deal with them ourselves unless it is a prior ENT patient or the patient will need admission for posterior packing. I get aggravated when interns call ENT for draining paratonsillar abscesses. It seems they do it because they don't want to deal with them (primarily medicine residents rotating in the ED). Sometimes people take the easy way out. It's easier to have someone else deal with a procedure when it's busy. However, this is primarily a concern with off-service residents rotating in the ED.

That is interesting that MGH has a surgeon screen patients prior to the ED seeing them. That is very odd, to say the least.

 

[Vera18]

I second St. Vincent's in Toledo, OH.

This is a program where the ED dominates the entire hospital. Anywhere in the hospital, when the **** hits the fan, everyone breathes a sigh of relief when the EM resident shows up. I honestly seen a code blue where there was a bunch of people doing there thing, were they all parted like the red sea when we showed up. We had to expand our class size just to have enough residents to run all the things we essentially have ownership of at our hospital.

The EM residents run the following services
1) The ED (duh)
2) trauma (no lost procedures)
3) neurosurgery
4) neurology
5) ICU
6) LifeFlight

this is a program that rocks. a true diamond in the rough because people have no desire to go to toledo. if its in another place, i think people are falling over themselves to get in.

What about The Toledo Hospital (ProMedica)? Do you know anything about that hospital? I've researched it online, but all I've been able to find is that it has 700+ beds, it's currently being renovated, and it's in Toledo laugh. That's about it =/

ANY info about this hospital (especially from Toledoans) is greatly appreciated - I'm really interested in it

 

[grEMreapin]

Any chance I could get a quick residency review on the MetroHealth program? You seem to know a lot about the program...

I have an interview there in Jan. and from their website they look pretty solid...any additional information ie. EM vs. Surg regarding procedures, etc.? Thanks!

 

[grEMreapin]

Hmmm...wrong thread.

 

[roja]

Hmmm, dominates? well, we kind of do that by our nature.

I think a better question (and maybe what is being gotten at?) is: well respected? direct admitting privelages (ie do you have to fight to admit patients)? are procedures snaked?

For my hospital? Yes. yes. no.

and we have the best looking residents and the best parties.