UCSF/SFGH
A brand spankin' new 4yr EM program looking for its 1st class!
Residents: None yet, but there will be 12 residents per year. They seemed to be interviewing people with capacity for leadership, great people skills, and a passion for innovation. I really liked most people I met on interview day and have a feeling the first class will be a force to be reckoned with. 🙂 The leadership is not only flexible and open to change but are actively seeking residents whose input will help shape the program.
Faculty: Many of the faculty are super-stars - Michelle Lin, Susan Promes, Mike Callaham (one of 3 EPs in the IOM), EM journal editors, etc, etc, etc. To me the best thing about them was the dinner and the lunch the next day was so fun we didn't miss the residents! Everyone I met is so down to earth! The new program is the brainchild of Michelle Lin (who is SOOOO funny) and the recently recruited Susan Promes, who started Duke's program. I heard some interesting rumors about Dr. Promes, but I love her energy. She is clearly compassionate and excited about the program, but she is also a TIGER. Frankly, I think she is just the type of PD that is needed to help EM infiltrate UCSF.
Hospital:
There are two main sites, UCSF's hospital (Moffitt-Long) and San Francisco General. Though most faculty work at one or another, the Susan Promes splits her time between the two sites, just like the residents will do!:
Moffitt-Long - The uber prestigious hospital that is a mecca for outstanding programs in medicine, peds, surgery, etc, etc, etc.... ED visits are around 39K with a 22% admission rate and 14% peds, clerks to make all your calls, and electronic charting. It seems like a lower census but this is Cali - less urgent-seeming complaints in adults and peds get punted to urgent care, so you are only caring for the sickies that need you unless it is 2am, etc. Though all attendings are EM certified greats, most of the residents are off-service or from other sites and will be eased out as the new class eases in.
San Francisco General - A crazy county ED, the only level I trauma center in SF that boasts the highest ambulance volume in the city. Again, people get punted to primary care urgent clinic if they aren't that sick. And wowsa, are the people in that ED sick! As they were doing the tour, I saw multiple patients that obviously were in great distress and had multiple medical problems roll by. Charting is paper. There is also a mix of trauma and a lot of it - the current deal is that EM runs all minor traumas, and alternate every other day with surgery on major traumas (non-leading team does procedures). Currently, anesthesia gets most of the trauma airways (EM gets all medical and 2days/week trauma) and they are negotiating to alternate on that as well. Most residents are from medicine or highland/other site EM residents that are being phased out.
Of note, during RRC accreditation, UCSF was criticized for having too-high of an acuity, so new residents will also be going to the VA urgent care clinic and Kaiser Permanente. Not to mention Children's hospital in Oakland for more Peds exposure.
Ancillary Stuff: Ancillary is supposed to be great at both sites, but as you know county is always a bit sketchy and you might have to rise to the occasion. The RNs seem excited about having new residents and greeted us as we went by. Clerks make calls for you.
Admitting/Documentation: Not sure about admitting privileges. Electronic at Moffitt-Long, paper at SFGH.
Curriculum: 4-year curriculum with a pgy2-4 area of concentration in clinical and translational science, community health, global and public health, health systems and policy, medical education, molecular medicine, social and behavioral sciences, or something you help design, and will lead to a certificate or master's degree. These endeavors are designed to be longitudinal rather than accomplished in a paltry month or two. There is a medicine floor month, but the rest includes 3mos of ED, 2mos of urgent care, 1mo of radiology, and 2mos of ICU during intern year. There is 1 mo of vacation. Hours are currently being worked out. Right now UCSF is 20 10hr shifts and some 12s, SFGH is mostly 12s, but they are tapering the hours down with the goal of getting to 8hrs. They are trying to do this without compromising the # of EM residents in the ED.
Didactics/Research: 5hrs per week, they are working on getting residents excused from off-service rotations to come. They have also submitted an innovative web-based and simulation-containing curriculum to the RRC for approval. In terms of research, they are doing ground-breaking stuff in detecting HIV, spinal cord injury, and US, and are affiliated with an awesome research powerhouse whose faculty they often collaborate with.
City: San Francisco is wonderful of course, an active city featuring the beach, tons of entertainment, a NYC-like downtown, public transit, beautiful suburbia, fabulous food, and... crazy expensive housing! There do seem to be some affordable places around, and the med student certainly survive, but it is a matter that requires further investigation.
Extras: Salary starts at 44K (goes by UC salary which is hard to change) with a $500 housing "stipend" (added to salary) that brings you up to 50K, full health benefits, 26 days of vacation, a $2400 relocation stipend, national meetings, a PDA, textbook allowance, medical license fees, etc.
Negatives: Well, it is a new program in a super-strong academic environment. Though the faculty have trained resident before, the first class has to be ready for the turf wars and glitches. I believe Dr. Promes when she says we wouldn't have a problem finding a job, but it is tough to think of fighting external issues while trying to train.
Overall: A real new kid on the block in one of the best hospitals in the country, featuring academic, county, and community experiences and wonderful leadership, as well as an opportunity to be the first class and mold a new program. A frighteningly huge task that may none the less be very difficult to turn down.
