Columbia

Sylar11 said:

Anyone have a good feel for the Columbia program? I'm having a hard time getting a good handle on it, with a reputation for being stiff and somewhat malignant, with an interview day of people trying to convince me of the opposite (fairly believably.)
On a related topic, is it well above Cornell in prestige?

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"well above"? depends on how you define that, but generally, no, I wouldn't say, "well above"

Columbia is generally considered a top 10 program. Cornell is not, though it's not that far behind. It's in the top 20 pretty easily I think. Will it make a s huge difference? Probably not.

Go to Columbia if you want to work in a hospital that does not work well, where attendings don't provide a lot of supervision, where residents would never want their own families to be treated. Otherwise, a great program.

filritchie said:

Go to Columbia if you want to work in a hospital that does not work well, where attendings don't provide a lot of supervision, where residents would never want their own families to be treated. Otherwise, a great program.

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I think this goes for all New York programs. The hospitals are a disaster and the patient population is an even bigger disaster.

filritchie said:

Go to Columbia if you want to work in a hospital that does not work well, where attendings don't provide a lot of supervision, where residents would never want their own families to be treated. Otherwise, a great program.

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Heard the same.

Ruh roh.

giorbust said:

You don't want to go to Cornell either.

The program director only cares about ACGME requirements, yet refuses to fix several highly dangerous rotations for patients (mainly the CCU), while other services are supersaturated. She refuses to listen to residents and their concerns. Ultimately, the hospital will be sued for malpractice and things will change.

Internship is an extension of medical school now. The program leadership seems to think it is dangerous for interns to make ANY decisions. You will do more call as a PGY-2/PGY-3. The residents do nearly all admissions. On nightfloat, there are two residents admitting every patient to the general medicine service, while the interns are capped at 1 admission each per night (3 interns total).

Our outpatient clinic is atrocious. We have to take our own vitals, do our own EKG's, etc (there are zero ancillary services for residents) - even Bellevue has ancillary services for their residents. Patients are allowed to show up at any time no matter what time their appointment was and we are still required to see them. They cram as many patients on to your schedule as they possibly can. In nearly two years, I've learned next to nothing about outpatient medicine because I spend the majority of my time filling out paperwork (once again, because we have no staff to help us).

Cornell will hopefully get me into the fellowship that I want, but I think there are a lot of places that would accomplish the same goal.

Do yourself a favor - avoid Columbia and Cornell all together for internal medicine.

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Funny, I come from a program with a VA, Private hospital, and a County hospital. We sometimes feel that (aside from the nursing care and of course the cutting edge stuff) the county hospital provides the best *medicine* care among the 3. It's just scary how some private hospitalists manage their patients. At least in the county, people get called out if they're doing something wrong. In the private hospital, everyone is too scared of hurting each other's feelings.

I'm sorry, but threads like this are shocking (Re: giorbust's post).

Holy hell. So glad I don't go to a program like that.

daaaaaaaammmmmmmn

I'm an intern at Columbia, and I can share my thoughts. I would offer the preface that I am extremely biased in that I am happy at Columbia, and I really do love the program.

Regarding malignancy - I heard this when I was on the interview trail, and I heard it from applicants this year. I honestly don't know what it means because I think "malignant" can mean different things to different people.
One interpretation is that the program is full of gunners and residents aren't supportive of each other. This is flat-out not true. I feel like my co-interns are my family, and in the short time that I have worked with them I have formed numerous friendships that I believe will last beyond residency. To be fair, I think people going into IM in general are nice and fun to be around, but this certainly holds true for Columbia.
As far as support/autonomy goes, I think Columbia is structured to prioritize intern autonomy as much as possible, but the support is definitely there. If you feel like you need help, you ask a resident or an attending, and they are happy to help you. I have never heard of anyone getting shot down for asking for help. In my experience, residents take the quality of life of their intern as a point of pride; they want you to get out on time, and will actively work to make this happen.
One anecdote about support that sticks with me happened when I was working nights in the Allen Hospital ICU (an intern-run ICU at the smaller, community-style hospital affiliated with our program located at the northern tip of Manhattan). This is generally considered one of the most fun rotations of intern year. During the day, you are supervised by a 3rd year resident, and at night by a hospitalist. One of our patients was very sick, and there was an ongoing discussion about goals of care between the ICU team and the family. This night, the patient's daughter told the nurse she wanted to discuss further something that she had talked about with the day team, and the nurse relayed this message to me. I told the daughter I would page the hospitalist, and she should gather other family members, and we could have a family meeting. The hospitalist was in the ICU within 2 minutes, and we had a family meeting with 15-20 family members. Afterwards, the hospitalist told me he was happy that we did that because it was obviously helpful for the family. This is just one example: in my experience our attendings are always this willing to help you if you ask, but the program is set up to make you feel like you as the intern actually have responsibility.
Maybe "malignant" means we violate work hours? This is also not the case. I have not gone over 80 hours per week so far this year (it does happen occasionally), and I have only come close a few times. Our program director actually believes in the rules, he doesn't just see them as a constraint that he has to work around. Also, although our program is clearly front-loaded, the tough rotations during intern year are interspaced with numerous more laid-back ones (outpatient, geriatrics, elective, ambulatory oncology).
As to ancillary services in New York City, what everyone says is true: they are not as good as elsewhere. I'm perfectly willing to accept that our hospital does not run as smoothly as many in the country, and that as the intern, it is often my responsibility to make sure that things are happening. I draw labs rarely, but I do have to make sure that they are drawn. I don't transport the patient, but I have to make sure that someone comes to do it. To me, this doesn't mean that the program is malignant, but I do see it as a potential downside of the program. It frustrates some people more than others. Overall, I think it is good experience managing people and making a system work, but it can be trying, I'm not going to lie.

I believe our hospital does offer great medical care, and I would want my family treated there, but I think that this is so difficult to asses that I won't belabor the point.

I love our patients, hands down. We get a big variety, of course, being a tertiary/quaternary-care referral center. In the ICUs and on the floors, there are many patients from all over New York City and the surrounding area. In clinic, it is predominantly Washington Heights residents, who are predominantly Dominican and Spanish-speaking. These patients are friendly and grateful for the care you provide. Compliance and patient education is a challenge, as I believe it is in any Medicare/Medicaid-based primary care population. We obviously have access to in-person and telephone interpreters, but nevertheless if you don't speak Spanish, the language barrier could be a turn off for you.

Sorry for the lengthy response, but I'm passionate about the program.