Best Chicago Program

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Which Chicago program has the best overall program and reputation?

  • Total voters
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I thought I would repost morgaleese's post.

Ummm, OK, here's my take on ALL of Chicago's allopathic programs:

Fill in the blank:

If you are really concerned about or interested in ______________, _______________ is the best Chicago EM program for you.

1. International Medicine and/or Public Health; UIC
2. Flight Medicine; U of C
3. Clinical Medicine/Education; Christ
4. Clinical Research; Resurrection
5. Customer Service; Northwestern (sorry, can't think of a better way to say it but they have some really demanding/entitled patients)
6. Serving the underserved; Stroger Hospital

Fair assessment? After 9 years in Chicago Emergency Medicine, I think so. Honestly all of the Chicago programs rock, and my wish for you is that you get your #1!!! Best of luck!
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This is the basics of it. I think most would agree that Res probably doesnt have the "best" reputation in chicago.. IMO neither does UIC but I think NW, Cook, Christ and U of C are all up for debate..

FWIW I would then kick out NW only because of the "cush" reputation. So you have my top 3, I have worked with EM residents from the other 3 programs and I have nothing but admiration for their work.

Now I think NW, Res and UIC all will provide GREAT training.. I just think they are missing something the other 3 have.. Just my opinion people!
 
EctopicFetus said:
I thought I would repost morgaleese's post.



This is the basics of it. I think most would agree that Res probably doesnt have the "best" reputation in chicago.. IMO neither does UIC but I think NW, Cook, Christ and U of C are all up for debate..

FWIW I would then kick out NW only because of the "cush" reputation. So you have my top 3, I have worked with EM residents from the other 3 programs and I have nothing but admiration for their work.

Now I think NW, Res and UIC all will provide GREAT training.. I just think they are missing something the other 3 have.. Just my opinion people!
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I am currently in fellowship and have worked with residents from most of the above programs.

My observation, coming from outside of Chicago, has been that County and Northwestern actually produce the most clinically and professionally sophisticated residents. That several UIC grads have opened a variety of hair-removal practices in the suburbs rather than practice emergency medicine speaks to something, I'm sure. I've not had as much interaction with the U of C folks, but they seem very cerebral yet function in a very confident and competent manner. Res makes hard-working, personable doctors; Christ produces similarly competent physicians however there is an attendant sense of entitlement.

This is my opinion, take it as that only. I'll be leaving Chicago to head west so it's all a moot point.
 
EMresident, where are you heading to? Do you know yet?
 
reposted below, sorry about the double submit
 
EMResident said:
I am currently in fellowship and have worked with residents from most of the above programs.

My observation, coming from outside of Chicago, has been that County and Northwestern actually produce the most clinically and professionally sophisticated residents. That several UIC grads have opened a variety of hair-removal practices in the suburbs rather than practice emergency medicine speaks to something, I'm sure. I've not had as much interaction with the U of C folks, but they seem very cerebral yet function in a very confident and competent manner. Res makes hard-working, personable doctors; Christ produces similarly competent physicians however there is an attendant sense of entitlement.

This is my opinion, take it as that only. I'll be leaving Chicago to head west so it's all a moot point.
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I am currently a resident at UIC. To an extent, I take some offense to the comment you made about our residents. I know of one grad that is doing "hair removal" which is fine if he wants to do this, it's not our place to judge him or our program based of an individuals career choice. The vast majority of grads I know are working in EDs throughout the country. A number of us have gone on to make contributions in Academic EM. PD's at Res, MCOW, UCI, Regions are all grads of our program. In the last three years we have had grads go into International Medicine, Toxicology, Ultrasound, and Sports Medicine. I think our program does not come of as too cerebral. I would put us into a category similar to the Christ Residents they are hard working but like to have fun as well.

I would have to agree with Morgaleese's posting. Each program has it's individual strengths and weakness. I would consider us the "Top" program in Chicago if you are interested in International Medicine or Toxicology. I would also argue we have one of the best peds experiences in the city we see peds at all three of our sights. In addition, we do two PICU months (no floor months) and two dedicated Peds ED months. I feel that we offer a broad clinical experience that will provide our graduates to work in a variety of EDs. Every year, we have this same discussion. Just like the "top EM program" discussion. I don't think there will ever be consensus on what is the "top program" in chicago

my 2 cent diatribe

pinbor1
 
EM Resident, I find it unfortunate that you seem to have not gotten along with the resident(s?) from Christ you have met. I hope that the next one you meet leaves you with a different impression. I find it wrong to judge a whole program (be it UIC, Christ, or any other) based on the actions of a single person (excepting the PD). Your assesment is your opinion, which you are certainly entitled to, but it seems to me that you are basing your judgements of Chicago's programs more on whether or not you liked the residents you met than on clinically relevant factors, so I caution readers of this sight against basing their own judgements on your interpersonal relationships.

That being said, even though my program is currently in the lead, I must caution all applicants about attaching much signifigance to anything on this thread/poll. I know it is tempting to let public opinion sway you - especially so close to the date that rank lists are due - but personal fit is of much greater importance than any poll results (even if they were to approch statistical signifigance, which this one has yet to).
 
Long time listener, first time caller. Want to thank everyone who puts it out here regularly

Now that interview season is over (I think), thought I'd put down some of my thoughts, mainly because i was suprised when I interviewed in Chicago

1. Only went to U of C, NW, and Cook (didn't know much about the other programs and didn't apply - which means absolutely nothing)

2. Cook - great residents, seemed happy. Didn't like the fact that the rate limiting step in my clinical training might be how fast I can convince the radiology techs to do their job. Great volume, but didn't get the impression the number of pts/resident was really high. Also alot of primary care included in that volume (more than usual). Positive - good people, good path, solid program

3. NW - suprised - judging from the facade of the hospital and the location I expected the a much more "priveledged" population than I saw while observing for a shift. Lots of "variety" lining the hallways. Residents argue that although they do see some of the affluent given location, it isn't the majority, and there is a significant number of uninsured, working class, homeless to balance it out - my observations supported that, it is an ED afterall. Almost the opposite of Cook in terms of ancillary services. Nice residents, seemed happy as well. Lots of ICU time

4. U of C - suprised - Heard a lot of good chatter about this program, but the interview day/program didn't really live up to the reputation. heard that the PD is a little "weird" and I agree. Also rumors that multiple established faculty are leaving (3?), one or two going to Penn, can't confirm. Also have a friend who rotated there for a month and said the acutity is overstated, not much different than most decnt size urban EDs. Flight program is a + if that is your schtick, nice residents, solid program, only 3 yrs instead of 4

These are only observations, and they are worth what you paid for them - I'm posting because I didn't find what I expected when I interviewed

All of the programs are great and the best one for each individual person will probably be different (and should be)

It's almost over (or just beginning?)
 
WatterFly said:
Long time listener, first time caller. Want to thank everyone who puts it out here regularly

Now that interview season is over (I think), thought I'd put down some of my thoughts, mainly because i was suprised when I interviewed in Chicago

1. Only went to U of C, NW, and Cook (didn't know much about the other programs and didn't apply - which means absolutely nothing)

2. Cook - great residents, seemed happy. Didn't like the fact that the rate limiting step in my clinical training might be how fast I can convince the radiology techs to do their job. Great volume, but didn't get the impression the number of pts/resident was really high. Also alot of primary care included in that volume (more than usual). Positive - good people, good path, solid program

3. NW - suprised - judging from the facade of the hospital and the location I expected the a much more "priveledged" population than I saw while observing for a shift. Lots of "variety" lining the hallways. Residents argue that although they do see some of the affluent given location, it isn't the majority, and there is a significant number of uninsured, working class, homeless to balance it out - my observations supported that, it is an ED afterall. Almost the opposite of Cook in terms of ancillary services. Nice residents, seemed happy as well. Lots of ICU time

4. U of C - suprised - Heard a lot of good chatter about this program, but the interview day/program didn't really live up to the reputation. heard that the PD is a little "weird" and I agree. Also rumors that multiple established faculty are leaving (3?), one or two going to Penn, can't confirm. Also have a friend who rotated there for a month and said the acutity is overstated, not much different than most decnt size urban EDs. Flight program is a + if that is your schtick, nice residents, solid program, only 3 yrs instead of 4

These are only observations, and they are worth what you paid for them - I'm posting because I didn't find what I expected when I interviewed

All of the programs are great and the best one for each individual person will probably be different (and should be)

It's almost over (or just beginning?)
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Watterfly,

I hope you are not trying to say that NW has as sick of patients as U of C or Cook??? :laugh: :laugh: :laugh:

In my opinion those are the 3 best programs in chicago because they hold the best national reputations; however, cook and U of C actually see sick patients, so they are in another teir. Christ is really only a regional/midwest/illinois known program (for the most part--granted it is still one of the best overall clinical programs). I did an away rotation at Northwestern, and it is just too cush, and there's a reason you need 4 years there--the patients are just not that sick.
 
let's ask the real question

which residents can piss farther?

and yes, i will continue to ask and assert that county residents can piss the furthest each time this thread is brought up.

i think the reason why so many of us give hte answers we do is because we know the residents at the other programs, many of us have gone to the same school or have rotated at the same place, and we have a great deal of respect for each other. well, everyone except wilcoworld. i hate that guy... 😀
 
willynilly how is the TY at Swedish coming along.. I was the EM student on the MICU rotation with you and c.p. Hope you are having fun there.
 
WilcoWorld said:
EM Resident, I find it unfortunate that you seem to have not gotten along with the resident(s?) from Christ you have met. I hope that the next one you meet leaves you with a different impression. I find it wrong to judge a whole program (be it UIC, Christ, or any other) based on the actions of a single person (excepting the PD). Your assesment is your opinion, which you are certainly entitled to, but it seems to me that you are basing your judgements of Chicago's programs more on whether or not you liked the residents you met than on clinically relevant factors, so I caution readers of this sight against basing their own judgements on your interpersonal relationships.

That being said, even though my program is currently in the lead, I must caution all applicants about attaching much signifigance to anything on this thread/poll. I know it is tempting to let public opinion sway you - especially so close to the date that rank lists are due - but personal fit is of much greater importance than any poll results (even if they were to approch statistical signifigance, which this one has yet to).
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I think you were probably nicer than I would have been in your reply considering the verbal lashing you and your fellow residents got from this guy above. If its any consolation, I think Christ has the absolute best resident class of any program I looked at anywhere in the nation. You guys were the most outgoing, the all around nicest, and arguably one of the most qualified in terms of entry statistics. And the fact that Christ was like 3rd in the nation in the inservice exam grades speaks volumes. Sounds like this guy was just bitter for whatever reason. I met nearly every one of you guys you were all cool as hell.
 
If lightning is your thing, then UIC is your place...... 👍 😉
 
willlynilly said:
let's ask the real question

which residents can piss farther?

and yes, i will continue to ask and assert that county residents can piss the furthest each time this thread is brought up.
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And that's just the FEMALE residents...... :meanie:
 
corpsmanUP said:
I think you were probably nicer than I would have been in your reply considering the verbal lashing you and your fellow residents got from this guy above. If its any consolation, I think Christ has the absolute best resident class of any program I looked at anywhere in the nation. You guys were the most outgoing, the all around nicest, and arguably one of the most qualified in terms of entry statistics. And the fact that Christ was like 3rd in the nation in the inservice exam grades speaks volumes. Sounds like this guy was just bitter for whatever reason. I met nearly every one of you guys you were all cool as hell.
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There was a verbal lashing? I missed it! Darn it I love verbal lashings. Oh wait there wasn't one. Stop makin trouble corpsman.
PS the best chicago program is the one that's not in Chicago.
 
hey willlynilly, i can spit pretty far too! the other girl in our class doing the prelim year would put her "balls" up against anyone too!
 
drkp said:
There was a verbal lashing? I missed it! Darn it I love verbal lashings. Oh wait there wasn't one. Stop makin trouble corpsman.
PS the best chicago program is the one that's not in Chicago.
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I'll continue to speak my mind as I choose KP, so I suggest you spend time trying to control something more controllable like your pets, or your weight!This "fellow" was mature enough to state that the residents at Christ have a sense of "entitlement". I found that bordeline...and another person above found it offensive. He also stated that another program was churning our questionable residents because one of them opened a hair removal clinic in the burbs. His post was not received well, just as I am not receiving your post well. You'll know it when I am making trouble, and if you are wondering, just flat out ask me. 😉
 
r54918 said:
Watterfly,

I hope you are not trying to say that NW has as sick of patients as U of C or Cook??? :laugh: :laugh: :laugh:

In my opinion those are the 3 best programs in chicago because they hold the best national reputations; however, cook and U of C actually see sick patients, so they are in another teir. Christ is really only a regional/midwest/illinois known program (for the most part--granted it is still one of the best overall clinical programs). I did an away rotation at Northwestern, and it is just too cush, and there's a reason you need 4 years there--the patients are just not that sick.
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If you actually read the post I don't think I said anything about the acuity at NW - just stated an opinion based on an observation that I had that was differnet than what I expected. I did not rotate at Cook or U of C, nor did I report any first hand knowledge of the acuity at those programs - I have, however, rotated at other "county" programs (i.e. Denver) and wasn't that impressed with the acuity period. Depends on your perspective I guess. My post was only to report observations - As I said before you can take it for what it's worth...

If you have something specific to say about a program I'm sure you don't need my help to do it... I have no doubt that all three of these programs see sick, ill, (insert adjective here) patients, but to make the statement that U of C and Cook are in another "tier" is going a little far

Have a nice day
 
Hey corpsman speaking of controlling animals how is your cat problem coming along? :meanie:
 
corpsmanUP said:
I'll continue to speak my mind as I choose KP, so I suggest you spend time trying to control something more controllable like your pets, or your weight!This "fellow" was mature enough to state that the residents at Christ have a sense of "entitlement". I found that bordeline...and another person above found it offensive. He also stated that another program was churning our questionable residents because one of them opened a hair removal clinic in the burbs. His post was not received well, just as I am not receiving your post well. You'll know it when I am making trouble, and if you are wondering, just flat out ask me. 😉
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OOOOH crap now I am getting a verbal lashing. hehehe By the way do you know me? How do you know I'm a fatty with pet problems? Sorry you took my post even remotely seriously. I didn't mean to tick you off. I will humbly suggest you switch to decaf and then leave it be as I know zip about the Chicago programs and will be the first to admit I have nothing constructive to add to this thread.
ps. THAT"S DRKP to you pal 😛
 
drkp said:
OOOOH crap now I am getting a verbal lashing. hehehe By the way do you know me? How do you know I'm a fatty with pet problems? Sorry you took my post even remotely seriously. I didn't mean to tick you off. I will humbly suggest you switch to decaf and then leave it be as I know zip about the Chicago programs and will be the first to admit I have nothing constructive to add to this thread.
ps. THAT"S DRKP to you pal 😛
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Decaf? Surely you are kidding? I don't take all those trips to the head not to at least get a buzz! Just like weekends with my Pale Ale. I would no more waste a molecule of ATP trying to swallow near beer!

You didn't tick me off; you just made the hair on my back stand up. Another reason to succumb to the waxing my wife would prefer!

Fatty?? Doesn't the KP stand for kitchen patrol? 😉


Ectopic....the score is like cats 35, me 2. I spent 10 bucks on Vienna Sausages last week and no dice. But, its turned out well anyway because I decided to put the trap right in my front yard for the neighbor in question to see, bolted with a cable to my gutter lid so he couldn't steal it, and then within a day he had stopped publicly feeding the ferels. And now he gets his own cat and puts him in the house every time he leaves. Its funny as all hec! I guess it also could have been the fact that I bought my son a BB gun and set him up with a nice target alley in plane view of the neigbor's porch (although in my backyard). Bottom line is it seems to have worked. I am glad too because I just started showing my house this weekend and I don't want to have 15 cats in the street when the people come with the realtor.
 
corpsmanUP said:
You didn't tick me off; you just made the hair on my back stand up. Another reason to succumb to the waxing my wife would prefer!

Fatty?? Doesn't the KP stand for kitchen patrol? 😉

.
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Sorry I made your back hair prickly (like a wild cat eh?)
Stay strong on the waxing. Tell her your like Samson only all your strength comes from your body hair.

Sadly you pretty much pegged me in your preceding post. Med school, laziness, and too much caribean beer helped me tack on about 30-40 lbs over the past 4 years. Wish me luck in losing it before July. 🙂
 
Yeah even though I have been consuming etoh I am working out to get in decent shape by the time residency starts..
 
Corpsman.. as far as the cat thing.. congrats esp in time of selling your home. we have an unwanted problem as well. Me and the wife live in a highrise and about 2 months ago some guy moved in and is a smoker.. well not much we can do about it.. it makes our house smell like crap... gonna have to figure out a way to show the house when the guy isnt home.. 👎
 
I'm gonna have to go with the university of chicago. Strong academics, big name, flight program, and solid reputation. But any program in Chicago would be awesome. The city ROCKS!
 
Hey guys...

so, aside from the weird digression into kitty litter, methinks this is a good thread (albeit one that pops up, inevitably, every year... one might think to use the search function. but oh well)...

I think all the chicago programs are "the best" programs in chicago, depending on what you're looking for, what you need, and what your personality is. The chicagoland programs (oak lawn is NOT chicago) are a pretty good spread in terms of academics, special opportunities, faculty, research, and clinical experience.

Personally, I'm biased toward UIC (but that's b/c they sign the checks). Then again, I'm at the program I felt I needed to be in... the multiple sites might seem to be an issue, but when I apply for a job, I can pretty much work within any charting system. I get experience with many different/divergent patient populations, as well as with community/community-academic/academic ED's. we're heavy on ultrasound in the ED, much of our faculty is well-known within the EM community, and we as residents get along pretty well together. our PD is very protective of us, but not to the point of mollycoddling (unlike what i've heard of other programs here in chicago).

Ultimately, to the o/p, you've gotta sit down and really figure out what you want out of residency. if you want the country club, go to NW. if you don't want to drive to a bazillion places, go to Christ. if you want to fly, go to U of C. if you want good research as well as a good grounding in community EM, go to resurrection. if you want to get your butt kicked (in a totally positive way), go to cook. if you are somewhat self-directed and want to see a lot of different patients, come to UIC. if you're a DO, don't forget about olympia fields. d=)

just my $0.02 (actual cash value 1/20th of a cent).

-t, md
 
WatterFly said:
If you actually read the post I don't think I said anything about the acuity at NW - just stated an opinion based on an observation that I had that was differnet than what I expected. I did not rotate at Cook or U of C, nor did I report any first hand knowledge of the acuity at those programs - I have, however, rotated at other "county" programs (i.e. Denver) and wasn't that impressed with the acuity period. Depends on your perspective I guess. My post was only to report observations - As I said before you can take it for what it's worth...

If you have something specific to say about a program I'm sure you don't need my help to do it... I have no doubt that all three of these programs see sick, ill, (insert adjective here) patients, but to make the statement that U of C and Cook are in another "tier" is going a little far

Have a nice day
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To respond to your assumption that all the programs in chicago (or at least the 3 programs you mention) see the same level of acuity, here is the info posted on the SAEM website. I think this shows that there is a pretty drastic difference, which I also felt was apparent when I observed in the various ER's.

Hospital ----------- Volume/year ---- Admission rate ---- % admit to ICU ----
Univ. of Chicago ----- 80,000 ------------- 25% ----------------- 33%
Cook County ------- >125,000 ------------ 21% ----------------- 25%
Christ ----------------55,000 ------------- 29% ----------------- 18%
Northwestern -------- 74,000 ------------- 28% ----------------- 15%
UIC ------------------ 52,000 ------------- 20% ---------------- 10%
Ressurection --------- 37,000 ------------- 27% ----------------- 5%

The average % admit rate to the ICU is about 10-15%. Many of the community hospitals have an ICU admit rate of <5%. The University of Chicago is only topped by UCLA Harbor (#1), and the University of Florida--Jacksonville (#2) in % of patients admitted to the ICU, both of which are inner city county programs.
 
Christ actually saw more like 80k patients last year. I'm not sure who is to blame for the misinformation up at SAEM. Regardless, I think a more intresting number to consider than total patients per year is the ratio of patients to residents, for that would give a better picture of what each individual resident experiences. At 11 residents/class x 3 year residency - Christ comes out to 80k/33 = 2424 patients/resident/year, which is not too shabby.
 
The above numbers were from SAEM and didnt include Peds. The SAEM site has Christ with 55K adult and 25K kids.. For the record Cook County states 125k+, from their web site,
We serve over 130,000 adult, 30,000 children and 4,500 major trauma patients per year.
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But I digress...

So for County Ill just add they have 165K visits and 18 residents x 3, - 165k/54 = 3055 patients/resident/year. Not that it matters I just thought I would put in a good word for County.
 
In response to the data you posted, you forgot that UIC is a 3 hospital system. At UIC we see 52K pts (a smaller percentage go to ICU, but I have admitted some real sick people, ICU worthy, to step down and the liver service). At Mercy and Masonic, each sees around 40K+, I don't know the percentage to ICU, but it ~10-20%. So as a residency we see around 130K+/- patients a year. By your calculation, 130000/42 residents (37 categorical + 5 IM/EM on EM side at a time)/yr = 3095 pts/resident/yr.

Christ sees a lot more than 55k patients a year. I don't know the true number. Their ED is hopping most of the time and they get a lot of high acuity patients. Many are ICU worthy who are down-graded because they sit in the ED for so long.

also, almost all of the above EDs have fast tracks and in most programs the EM residents don't see those patients, except may be overnight. So your calculation for patients/resident/yr is inflated.
 
I am concerned about the importance of the calculations above and the validity of "patients per resident." I did not rotate at any of the Chicago programs, so I am not sure how they are run. However, in my New York county hospital rotations, I experienced two very different programs with similar numbers. In the first busy county program, about half (estimation based on observation) of the patients were seen by attendings without resident involvement; while at the other busy county program (slightly higher volume ER), almost every patient was seen by a resident. Additionally, I would have to think that things like obs units, step-down, etc. will influence ICU admit numbers, and hospitals can play with those as seen fit.

I totally zoned out whenever a program mentioned numbers like "volume, % admitted, or % to the ICU" during the interview season, because I really think they reflect very little of the real resident experience. I highly doubt that the patients seen at U of C are 6.6 times sicker than those seen at Resurrection (ICU admits), just like I don't think Cook residents see 3 times as many patients as UIC residents (volume/year). Now, let's get down to real numbers that matter - I peed 10 feet this morning from my hallway into the bathroom toilet.
 
jashanley said:
Christ sees a lot more than 55k patients a year. I don't know the true number. Their ED is hopping most of the time and they get a lot of high acuity patients. Many are ICU worthy who are down-graded because they sit in the ED for so long.

also, almost all of the above EDs have fast tracks and in most programs the EM residents don't see those patients, except may be overnight. So your calculation for patients/resident/yr is inflated.
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Oops, didn't read this post before writing mine. Jashanley wrote it a lot more succintly than I did, although urinating wasn't even mentioned once in his/her post.
 
emmd06 said:
Now, let's get down to real numbers that matter - I peed 10 feet this morning from my hallway into the bathroom toilet.
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Hah I peed 15 ft this morning from my bed into the bedroom toilet, ah the power of flomax and lasix. That's why I went into medicine
 
pinbor1 said:
Hah I peed 15 ft this morning from my bed into the bedroom toilet, ah the power of flomax and lasix. That's why I went into medicine
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You have a bedroom toilet?! You are clearly at the pinnacle of laziness. I humbly and admiringly admit defeat. What the hell was this thread about again?
 
EctopicFetus said:
The above numbers were from SAEM and didnt include Peds. The SAEM site has Christ with 55K adult and 25K kids.. For the record Cook County states 125k+, from their web site, But I digress...

So for County Ill just add they have 165K visits and 18 residents x 3, - 165k/54 = 3055 patients/resident/year. Not that it matters I just thought I would put in a good word for County.
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Now I know that two others have "corrected" your numbers already but there is another point they missed. How many "off-service" rotators and students come through the ED? Here is the number that matters: how many patients per hour do EM residents see and what is the ICU and admit rate for those patients. In my opinion, a senior resident should see at least 2.0 patients per hour with 15-25% level one or two trauma or admits and at least 1x / shift on average should be an ICU admit. Even if a hospital has "only" 40k visits annually, if the residents see a good number of patients who cares what the annual total is.

For me, in Chicago, I rotated at Res. As an M4 I was seeing ~1.5 pts/hr with ~20% admit (little or no trauma), and I did not go a shift all month without an ICU admit. The senior residents were seeing more than 2.0 pts/hr. It would be great training. If you get much above 3.0 - 3.5 pts/hr learning will drop off a bit. There comes a point at which "moving the meat" becomes a priority.

But again, the actual annual visits means far less than the number seen on average, per hour, by a resident.

- H
 
FoughtFyr said:
Here is the number that matters: how many patients per hour do EM residents see and what is the ICU admit rate for those patients.
But again, the actual annual visits means far less than the number seen on average, per hour, by a resident.

- H
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Oh crap!! 😱 You always have a way of reassuring me and then letting me hit hard with some reality based residency info! That avg. # per hour is nowhere I have ever seen posted on a residency website but now I'll end up looking for some old thread that posts them or something!! Nice Fyr, just like a typical psychologist...you give us a wealth of info about our problem but in traditional chiropractic style, no good solution is given. I'll be up all night over this one.........wondering why I didn't ask this at my 15 interviews!! :laugh:
 
Ok, I believe that the real issue isn't PPH, but RVU's/Hr. We track all these parameters with our residents, additionally they are well aware of their hcarges/hr, PPH, RVU/Hr etc. given that we are a private group. The reality is that most programs probably have this information, it depends on if they disseminate it or not.

I do agree that there is less an issue about volume to some degree, however my personal opinion and prefference is for high volumes for training (eg > 75K visits at a single location).

Paul
 
peksi said:
Ok, I believe that the real issue isn't PPH, but RVU's/Hr. We track all these parameters with our residents, additionally they are well aware of their hcarges/hr, PPH, RVU/Hr etc. given that we are a private group. The reality is that most programs probably have this information, it depends on if they disseminate it or not.

I do agree that there is less an issue about volume to some degree, however my personal opinion and prefference is for high volumes for training (eg > 75K visits at a single location).

Paul
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I have to agree with Fyr though on this one, that you can't judge a program simply by numbers. You can on one hand of the numbers are just huge! No one is going to argue that Indy sees enough patients to worry about. Between both sites it is some 200K plus. But Scott and White where there is less than 60K sees lots of patients per resident per hour. They have few if any off service rotators, and students never really see patients and present to the attendings to take patients away from the resident. Even places like Vandy and Geisinger have what look at forst glance to be low numbers but you have to factor lots of other things in. To say you need 75k rather arbitrarily seems to be somewhat like saying you can predict the kinetic energy of a projectile based solely on its velocity. But in fact you can't figure out the real KE unless you know the mass as well. One variable alone can't tell you enough, but coming from Christiana I don't think you guys are exactly lacking any volume 😉
 
peksi said:
Ok, I believe that the real issue isn't PPH, but RVU's/Hr. We track all these parameters with our residents, additionally they are well aware of their hcarges/hr, PPH, RVU/Hr etc. given that we are a private group. The reality is that most programs probably have this information, it depends on if they disseminate it or not.

I do agree that there is less an issue about volume to some degree, however my personal opinion and prefference is for high volumes for training (eg > 75K visits at a single location).

Paul
Click to expand...

Paul,

With all due (and considerable) respect, I have to disagree. Using RVUs would favor interns given the skewing of RVU towards inefficiency in choice of diagnostics. Inefficient residents could maintain average or above-average RVU/hour figures as a result of liberal diagnostic testing. ACEP would suggest this could be addressed by measuring patient/hour parallel with RVU/hour data. "If a particular EP consistently is one or two standard deviations below the group mean on patient/hour data, the EP group may choose to set a benchmark patient/hour ratio necessary to share fully in the RVU profit distribution." (from: http://www.acep.org/webportal/Pract...ergencyPhysicianProductivityAreRVUsAnswer.htm) I personally don't think this would work for residents however. I think that learning to "keep it lean" during residency is the way to go. If we assume in a given area of the ED, on a given shift, patient acuity averages out over time, improvements in efficiency are the only way to increase PPH. If you gauge acuity by looking at admit rates and ICU admit rates, then I think PPH matters.

For the applicant, having the patient population "available" for a resident to increase PPH without "watering down" that population with "fast track" type patients should be a good measure of a caseload sufficient to learn. Remember, the question is one of "are there enough patient at program X for me to learn from?" I fully believe if senior residents are averaging 2+ PPH while maintaining a good rate of admits and ICU patients, the answer is "yes"!

But I do view this from a resident's perspective. Things might change if and when I become faculty.

- H
 
Now this is getting to the meat of the issue.. Since I am in no mood to discuss these "serious" topics right now.. Ill be off to do some padding. BTW I was just simply using the other guys info for reference. There are a TON of ways those numbers could be messed around with not the least and obvious of which is using PAs in fast track. Heck I would see over 2 patients per hour in fast track basically with little to no Attending involvement. When I was in Orlando the PAs basically ran the fast track with little to no resident time there.
 
The real issue at heart for private groups tends to be "Charges/Hr" aka how much do you pull in for the group. The new buzz in "pay for performance" is just that, performance in all measures, volume, charges, staisfaction, risk reduction.

My point is that in general residnents should be able to see a patient per hour then up to the golden 2.2+ prior to graduation. I'm not sure how these numbers really play out for residents until they are upper years, .

Additionally, Since there are several ways to skin a cat, and the guru's of EM performance can't clearly define the ideal, how can an MS4 looking at a program make sense of this data? 😱

The Conclusion of John Proctors information paper from ACEP is:

Conclusion:

"The application of RVU generation to EP compensation is growing in prevalence. While not a perfect tool for equitable EP compensation, the RVU is superior to traditional profit after expense distribution. Certain weaknesses in RVU compensation methods may be overcome by tracking other EP metrics (e.g., patients/hour, NPP oversight, night shift work) with alteration of the RVU conversion factor accordingly. Overall, the application of an RVU-based compensation system likely produces a positive influence on EP efficiency and productivity. This assertion is not proved through evidenced-based medicine to date. Ultimately, the enhancement of EP efficiency and productivity positively impacts patient care through reductions in delays to diagnosis, delays in management, and patient departures prior to completion of care."

Our feeling is that having resdents know ALL these variables is critical, we track this data, and can splice it/provide it by reisdent, week, month, year etc.

Additionally I should add that ICU admits on their own are no longer an absolute gauge of critical disease exposure. A number of hospitals have moved to the "airline upgrade model" where empty ICU beds are filled with less critical cases. Not an issue for us or many others given our acuity and volume, but several lowver volume/acuity centers have moved to this model allowing for increased patient satisfaction, less ICU RN burnout as they see a variety of pathology etc, and a potential sqewed ICU adminssion rate.

Well off to pack for AAEM!

Paul
 
WilcoWorld said:
Christ actually saw more like 80k patients last year. I'm not sure who is to blame for the misinformation up at SAEM. Regardless, I think a more intresting number to consider than total patients per year is the ratio of patients to residents, for that would give a better picture of what each individual resident experiences. At 11 residents/class x 3 year residency - Christ comes out to 80k/33 = 2424 patients/resident/year, which is not too shabby.
Click to expand...

Christ definitely does see more than 55,000 pts/year in the ER. The peds numbers were not included like they were on the other programs webpages, so it is more like 80,000 per year according to SAEM.

As far as using this "patients/resident/year"... this is a little tricky, and inaccurate how you calculate it. Nobody can truly predict this number b/c nobody knows what percentage of patients are seen in fast track, by NP's or PA's, or are seen by off service rotators in the the ER (i.e. medicine residents). Plus, not every ER resident is in the ER every month b/c many of the ER residents are doing off service rotations themselves.

I do however feel that the "overall admit rate" and "ICU admit rate" are definitely applicable--but only to guage the overall patient acuity of the people who walk through the ER doors. This can reasonably tell us how sick the population is.

These figures are not distorted/diluted by NP's, PA's or fast track b/c these sick admit/ICU patients will NEVER be seen in fast track. Programs with fast track will only INCREASE the % of sick patients that the RESIDENTS see by alleviating the B.S. patients.
 
FoughtFyr said:
Here is the number that matters: how many patients per hour do EM residents see and what is the ICU and admit rate for those patients. In my opinion, a senior resident should see at least 2.0 patients per hour with 15-25% level one or two trauma or admits and at least 1x / shift on average should be an ICU admit. Even if a hospital has "only" 40k visits annually, if the residents see a good number of patients who cares what the annual total is.

For me, in Chicago, I rotated at Res. As an M4 I was seeing ~1.5 pts/hr with ~20% admit (little or no trauma), and I did not go a shift all month without an ICU admit. The senior residents were seeing more than 2.0 pts/hr. It would be great training. If you get much above 3.0 - 3.5 pts/hr learning will drop off a bit. There comes a point at which "moving the meat" becomes a priority.

But again, the actual annual visits means far less than the number seen on average, per hour, by a resident.

- H
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Well... Since it seems like there are a few people who feel PPH (patients per hour) seen by the senior resident is a better guage of a residency program, I thought I would share them. These numbers are also available for public viewing and updated by all program directors on the EMRA website. Here are the stats for the "senior resident Patients Per Hour seen" along with the admit and ICU admit numbers.

Hospital ------- Volume/year ---- Admission rate ---- % ICU admit ---- PPH seen by senior
Univ. of Chicago ---- 75,000 ----------- 26% -------------- 30% ------------ > 2.5
UIC ---------------- 54,000 ----------- 15% -------------- N/A ------------- 2.5
Cook County ------- 170,000 ---------- N/A --------------- N/A ------------- 2.0 - 2.5
Christ -------------- 107,500 ---------- 30% -------------- 25% ------------ 1.5 - 2.0
Ressurection ------- 43,000 ------------ 27% -------------- 5% ------------- 1.0 - 1.5
Northwestern -------- N/A ------------- N/A --------------- N/A ------------- N/A


The volume numbers vary a little, especially in regard to volume at christ, but for the most part, they are pretty consistent between the 2 websites (which they should since the info is posted by PD's and/or Dept chairs).

As a disclaimer, I only include the info for the Primary Hospitals of each program where the majority of resident training occurs. All the programs in chicago have multiple hospitals (except cook--but who needs another hospital with volume like that).
 
Just to let you know we spend practically equal time in all three of our EDs at UIC.

Mercy tends to be higher acuity similar to Christ or Univ Of Chicago in terms of patient populations. We probably have a good number of patients that end up on tele or step down after boarding in the ED. One limitation to ICU admission is the number of ICU beds you have. Basically if our patients aren't intubated you have to fight tooth and nail to get them to the unit.

Illinois Masonic has a comprable acuity to the University hospital. In Addition as a senior you have to evaluate the traumas atleast the airway and you do any procedures if they need help. Here we get a chance to move that patients because the patient flow is a lot better than our other three sites. I would estimate that as a senior here you see 2.5 to 3 patients an hour.

My 2 cents about our other sites, sorry I don't have any stats to back it up
 
r54918 said:
Well... Since it seems like there are a few people who feel PPH (patients per hour) seen by the senior resident is a better guage of a residency program, I thought I would share them. These numbers are also available for public viewing and updated by all program directors on the EMRA website. Here are the stats for the "senior resident Patients Per Hour seen" along with the admit and ICU admit numbers.

Hospital ------- Volume/year ---- Admission rate ---- % ICU admit ---- PPH seen by senior
Univ. of Chicago --- 75,000 ---------- 26% ------------- 30% ------------ > 2.5
UIC --------------- 54,000 ---------- 15% ------------- N/A ------------- 2.5
Cook County ------ 170,000 --------- N/A -------------- N/A ------------- 2.0 - 2.5
Christ ------------- 107,500 --------- 30% ------------- 25% ------------ 1.5 - 2.0
Ressurection ------ 43,000 ----------- 27% ------------- 5% ------------- 1.0 - 1.5
Northwestern ------- N/A ------------ N/A -------------- N/A ------------- N/A


The volume numbers vary a little, especially in regard to volume at christ, but for the most part, they are pretty consistent between the 2 websites (which they should since the info is posted by PD's and/or Dept chairs).

As a disclaimer, I only include the info for the Primary Hospitals of each program where the majority of resident training occurs. All the programs in chicago have multiple hospitals (except cook--but who needs another hospital with volume like that).
Click to expand...

Umm yeah, except that I know that during an M4 rotation 2 years ago I averaged 1.5 pph at Res. And I know I was slower than the senior residents. And don't push the volume issue so much with Cook, there is a great deal of primary care there and trauma is separated out. I'm not saying that it isn't a great place to train, it is. But your "over the top" support of it (and denigration of the other Chicago programs by default) is a bit biased and inaccurate.

BTW - While I'm not in a Chicago program, I am from there. I was intimately involved in Chicago (and area) EMS for many years. I'm actually as about unbiased as you can get with regard to the Chicago programs.

- H
 
While it is true that they dont go elsewhere they flat out tell you how crappy the Peds is at Cook.. They end up going to U of C and Childrens to get their Peds experience. Just thought I would throw it out there..
 
I think r54918's points are valid. The numbers can be a very rough guide for overall patient acuity, although they should only be loosely interpreted, and with caution at that.

I do find it a little suspect that every person is trying to justify their stats on here. If the stats are wrong on these websites, they should have a talk with their PD's to have the stats updated or corrected. It is your own programs fault if your stats are incorrect on these nationally known and reputable websites. It's not like these are made up numbers or coming from a google search with a hocuspocus.com web address.

Just my observations.
 
EctopicFetus said:
While it is true that they dont go elsewhere they flat out tell you how crappy the Peds is at Cook.. They end up going to U of C and Childrens to get their Peds experience. Just thought I would throw it out there..
Click to expand...

Cook isn't the only residency program which goes elsewhere for peds. Ressurection and UIC residents also rotate through U of C for their peds experience.
 
placebo_B12 said:
Cook isn't the only program which goes elsewhere for peds. Ressurection and UIC residents also rotate through U of C for their peds experience.
Click to expand...

At UIC we do go to U of C or Childrens for a dedicated peds ED elective during our second year. But we do see plenty of integrated peds at UIH, Mercy, and Masonic. I think it is a strength that we have peds integrated into our ED months because it is a lot harder taking care of a sick kid at a community ED with RNs that are not dedicated peds RNs. In all honesty, I think I would be fine just seeing kids in our ED months, but I think it is nice from an educational standpoint to have a month dedicated to learning about and caring for kids.

That said, I think everyone just has to find the program that fits for you. We all have our strengths and when it comes down to it the intangibles is what draws you to a program.
 
cook does do 2 months in the EM1 year at county... tertiary care peds is pretty much nonexistent there and it's generally less acute stuff than at U of C and CMH. there are rumors they might axe peds at county anyway, but i hear that's been going around for a while.
 
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