stanford/ucsf

UCSF - Very importantly, this was my favorite lunch hour of the dozen programs I've visited. THe residents were great, and it didn't hurt that the restaurant was fabulous and the residents are given a wad of $ to spend down to the last penny, including coffee, ice cream, whatever extras you want. I've been an SF lover all my life, so for me, UCSF > Stanford. Just depends on what you want personally. Many people I spoke with at Stanford said they preferred the more relaxed suburban life, plus the sunnier weather in the South Bay, cuz yes, SF does get very foggy esp. in summer, and esp. that part of the city. Another consideration is cost: a flat in Noe Valley/Cole Valley/surrounding areas will cost $1800 easy for 1 bdrm. The dept does give $4000/yr living stipend, which is more than the SoCal programs which give zip, but a lot less than Stanford. Anyway, I'm familiar with living in the city on a budget and don't mind cost, crime, traffic, public transit, etc....I'm just a city person. But def something to consider. Anyway, I had a great time with the residents and interviewers, and as always, loved my time in the city ...however, a couple things were a let-down: 1. Geographic schizophrenia in terms of sites, and how the residents don't all know each other because they are geographically isolated depending on whether they're on an AP or a CP year, and 2. Reseach focus. Almost had to apologize for not having a PhD, and was asked in grisly detail about my basic science research. My outlook is, if I wanted a career in basic science, I would do a post doc, not a clinical residency. JMHO. Didn't appreciate being pressured into fitting their quotas. Of course all the residents will tell you that you can certainly choose private practice or do whatever you want...but I am proceeding with caution in this area as I'm not sure the goals of the program fit my personal goals. Would I still be happy there? Yes, when the whole package is considered.

Stanford - Went in expecting it to be #1 on my ROL, left with a change of heart. Like USCF, the residents were great. But while UCSF was way into research, Stanford was the extreme opposite. I kept hearing the refrain, "The residents don't really have time to do research." Now, I do want to do some research...but even when I pushed it and asked specific questions about certain rotations and whether there would be any possible way to work it in, I was rebuffed. The PD actually told me (when I asked about post doc possibilities, as that seemed the only avenue to doing any research) that I shouldn't waste my time. In fact, I didn't visit any other program where the residents AND faculty kept repeating the mantra, almost proudly, "Well, you won't really have time to do _____." (fun stuff outside residency, etc.) They are obviously very proud of their work ethic. Some changes have indeed been made, and the residents who had done 1 yr prior to and 1 yr after the changes, were very happy with the changes. However, the culture obviously still exists, and one faculty member even made a comment about how the changes were unnecessary and ridiculous and the residents were just whining about the work hrs. This is a big red flag to me. My home institution is also very proud of its work ethic, so I'm all too familiar with what that entails. Another thing I didn't like is the 2 yrs AP/2 yrs CP thing. You could feasibly never get to know half of the residents at the program, and you have to wait 2 yrs before even getting exposure to CP. Also, living in Palo Alto for me = . I guess if you don't have any free time, it doesn't matter anyway, right? The big perks, from what I can tell, are 1. Reputation and 2. Money. The residents make - what - almost $10K more than UCSF?! Plus they get twice the living stipend! I dunno. I must admit it's an attractive offer.

Both UCSF and Stanford have general sign-out. I prefer specialty...but heck, they are still both great programs, so perhaps it doesn't matter.

I feel the training at Stanford is better, well I dont feel, I know, at least in all areas outside Cytopath, maybe liver.
Soft Tissue/Bone-Stanford
Breast/Gyn-Stanford
Heme-Stanford by a long shot and then some
Neuro-who cares, probably Stanford although the UCSF guy gives a good Osler lecture
Derm-UCSF by a long shot and then some
Cyto- UCSF
Cardiac/Lung-Stanford
Medical Autopsy-Who cares
Forensic-Stanford via Oakland Institute for Forensic Sciences (IFS)
CP-Who cares, maybe UCSF but Stanford has its own Blood center, but UCSF has the fellowship

Place to be single: UCSF.
So if I had the choice I would go UCSF, simply because I can be fairly shallow at times and I like to party.

cytoborg said:

UCSF - Very importantly, this was my favorite lunch hour of the dozen programs I've visited. THe residents were great, and it didn't hurt that the restaurant was fabulous and the residents are given a wad of $ to spend down to the last penny, including coffee, ice cream, whatever extras you want. I've been an SF lover all my life, so for me, UCSF > Stanford. Just depends on what you want personally. Many people I spoke with at Stanford said they preferred the more relaxed suburban life, plus the sunnier weather in the South Bay, cuz yes, SF does get very foggy esp. in summer, and esp. that part of the city. Another consideration is cost: a flat in Noe Valley/Cole Valley/surrounding areas will cost $1800 easy for 1 bdrm. The dept does give $4000/yr living stipend, which is more than the SoCal programs which give zip, but a lot less than Stanford. Anyway, I'm familiar with living in the city on a budget and don't mind cost, crime, traffic, public transit, etc....I'm just a city person. But def something to consider. Anyway, I had a great time with the residents and interviewers, and as always, loved my time in the city ...however, a couple things were a let-down: 1. Geographic schizophrenia in terms of sites, and how the residents don't all know each other because they are geographically isolated depending on whether they're on an AP or a CP year, and 2. Reseach focus. Almost had to apologize for not having a PhD, and was asked in grisly detail about my basic science research. My outlook is, if I wanted a career in basic science, I would do a post doc, not a clinical residency. JMHO. Didn't appreciate being pressured into fitting their quotas. Of course all the residents will tell you that you can certainly choose private practice or do whatever you want...but I am proceeding with caution in this area as I'm not sure the goals of the program fit my personal goals. Would I still be happy there? Yes, when the whole package is considered.

Stanford - Went in expecting it to be #1 on my ROL, left with a change of heart. Like USCF, the residents were great. But while UCSF was way into research, Stanford was the extreme opposite. I kept hearing the refrain, "The residents don't really have time to do research." Now, I do want to do some research...but even when I pushed it and asked specific questions about certain rotations and whether there would be any possible way to work it in, I was rebuffed. The PD actually told me (when I asked about post doc possibilities, as that seemed the only avenue to doing any research) that I shouldn't waste my time. In fact, I didn't visit any other program where the residents AND faculty kept repeating the mantra, almost proudly, "Well, you won't really have time to do _____." (fun stuff outside residency, etc.) They are obviously very proud of their work ethic. Some changes have indeed been made, and the residents who had done 1 yr prior to and 1 yr after the changes, were very happy with the changes. However, the culture obviously still exists, and one faculty member even made a comment about how the changes were unnecessary and ridiculous and the residents were just whining about the work hrs. This is a big red flag to me. My home institution is also very proud of its work ethic, so I'm all too familiar with what that entails. Another thing I didn't like is the 2 yrs AP/2 yrs CP thing. You could feasibly never get to know half of the residents at the program, and you have to wait 2 yrs before even getting exposure to CP. Also, living in Palo Alto for me = . I guess if you don't have any free time, it doesn't matter anyway, right?

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recently saw both of these programs, and wanted to add some thoughts. Positives i think are simple enough, so I'll focus on the negative, which, as cytooborg already mentioned but i wanted to reiterate the ones i thought were signficant.


Stanford: truly segregated AP/CP. You'll never see the other residents on "the other side" i was told. CP seems weak, if you're interested in AP/CP at all. Volume in many areas is quite low, ex: derm, neuro, cyto (esp. compared to neighboring UCSF). The AP's resident room is, well, nonexistent. Spoke w/a resident while at another interview who did a PSF there, and agreed, that the AP residents live "in a fishbowl," which all the attending's offices around them like pirhanas peering into the lives of their prey. Okay, maybe a bit overdone, but still, you get the message: their is no real secluded, private, PERSONAL, resident room. No place to "be collegial", no place to reflect on their work amongst peers, no place to, well, shoot the ****. I thought that was really huge. I mean surg path is big part of AP schedule, and hours are gonna be extremely long: you want a place that you feel comfortable, and i did NOT get that feeling at Stanford. Gross room is not too impressive, especially b/c i was figuring w/Stanford's $, it'd be nice! but totally typical, if not actually sub-par from ones i've seen (ex: Vandy, Iowa, NW). Also, as cytoborg mentioned, NO time for research, let alone to have fun -- you know, especially since Palo Alto is such a happenin' place and all... [sarcasm]. I really missed Northwestern's location!!! so much to do!

UCSF: agree about schizophrenic attitude in terms of hospital coverage. Their excuse/retort is that all the hospital offer a "different perspective,"....not sure if that balances out wasting much of my time traveling btw hospital to cover and/or attend conferences. (travelling too, another nuisance - if you'd like to have a car, fa-getta-boutta-it). Regarding the variant hospital coverage, i thought it was imp. to note that for frozen call, you're covering not only the main Moffitt Long, but others as well -- which blows in my opinion....but i guess if you enjoy getting paged in the middle of the night to bx a liver transplant, get there, then realize that the surgeon 'isn't quite ready for yah yet..." and hafta stick around for another several hours....then having to do the same cycle possibly again, at ANOTHER hospital - i don't think so. Abbas: research research research. they told me they're philosophy is basic science, and that's the way they see UCSF heading. Taking 2/3 md/ph'd i was told. Hours on surg path were actually fairly long from what i was told by the residents...they reiterated that being a state hospital, many times people working there (exA's), just don't give a rats a*s, and so residents do a lot of grunt work.
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So let me now speak of that many programs i saw the ones that really did impress me:
Iowa - jeff2005, you got it right, it's a well-done program. I wish all places would take a page out of their book, and really see how to make a and run a strong educational, resident-driven, friendly, program - that actually is getting quite a good name in the PATH arena (huge at recent USCAP). Super strong in both AP/CP - even if you are leaning AP or CP, you'll be more than confident in your abilities in the other field. TRULY integrated AP/CP, if that's what you're looking for, okay reallllly integrated, not 1+1+1+1 or 2+2.
Oh yah, Iowa health care pays literally for everything, down to your Tylenol.

Vanderbilt - Contrary to popular belief, residents do NOT work too hard there; they work just hard enough. Nashville area offers some the mid-size city amenities you're looking for, if you don't want the bigcity life. Many nice Vandy-related amenities too: if you're a new resident, local banks don't require a down-payment on a house. Also, Vandy offers this (i still can't believe this) a "service" ....which promotes you to be at work and not have to waste time doing errands and missing days (and vacation!!). Example: you can bring in your dry cleaning, drop them off right in the hospital, and they will take care of it, NO CHARGE EXTRA (i.e. all you pay for is dry cleaning bill). If your car is making a funny sound, needs an oil change, or whatever, simply drop off your keys (to a trusted Vandy "Service" person), and they'll take into the shop for yah. Unbelievable service, a ton of residents use it.

Northwestern: Bigcity life, Chicago food, fun, culture - need i say more? and, residents actually have time to have fun and go out. Very organized AP & CP curriculum, every attending is VVVVVVVVERY committed to resident education. Dr. Sam Rao even has a sweet eveningish conference once a week (optional) to go over tough/interesting cases, and really sit down and teach residents. NW seems like it's going big name people that actually teach, DAILY. (ex: Amin in Emory, nice guy, but soooo busy, residents hardly interact w/him). The hospital: in a word, gorgious. It should be in next month's playboy centerfold. Called the "taj mahal" of hospital, and well, it is. And that really makes you feel comfortable there too, likely you're not some gerbil on a wheel, doing nothing but work.

also liked Clev clinic: big big name, but attending are very approachable. Less factory-like than Mayo i felt. Mayo can literally operate on its own w/o the need for residents. Attendings (rather, "consultants" as they call them there in Rochester) see many many of the cases by themselves w/o residents. Good places for fellowship, as Yaah would put it. Cleveland is actually not the trashy place i perceived it to be. Weather can get a bit chilly at times, but the downtown area is really clean, and FUN! Bigname sports within the city too. Overall a strong program. Liked the 1+1+1+1 AP/CP curriculum, which offers an alternative to the standard 2+2 at many bigname places.

Great comments, med2b. I'm glad you mentioned the fish bowl at Stanford - I didn't like that, either.

med2B said:

if you're a new resident, local banks don't require a down-payment on a house.

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Nice post.

I should point out that the ability to buy a house without a down payment (100% financing) is available anywhere, as long as you qualify for the loan. You may have to call around, but banks are often happy to lend more money to someone who is going to have a lot of money later. You should be able to find a mortgage that doesn't require mortgage insurance. Most mortgages require mortgage insurance if you don't have 20% equity. This expense is not tax deductable, so it is usually advantageous to accept a higher interest rate in exchange for a waiver of the insurance requirement.

With interest rates as low as they are, you really should buy a house, if you can afford it. In both places I have trained, my monthly payment was comparable to what I would have paid in rent, but I got to live in much nicer places and my monthly payment was mostly tax deductable. Additionally, my first house appreciated 30% in the four years I lived there. Given that I only put 5% down, my return on that investment was well over 200%. Put another way, the net amount I spent on housing over the 4 years was about zero.

AndyMilonakis said:

I've asked about this when I visited NYC and Boston. It's tough to pull this off in those cities. I can imagine it's tough in San Francisco too. Oh well, things may be tough but nothing is impossible (in theory).

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Yeah, you're not going to qualify for a mortgage in cities where houses are all $500k. But there are some good programs in this country where a house can be purchased for $150k or less. If you have two incomes, you could probably afford twice the house. It was a stretch financially for my family to buy our first house (on one resident's income), but it paid off big for us. It was actually a bigger stretch for us to borrow the money than it was for the bank to lend it. Like I said, banks want to get on your good side when you are going to be wealthy in a few years.

I asked around about buying homes at both UCSF and Stanford...it's just not really done. I believe one person at each place had succeeded in buying a house pretty far from the actual campus.

cytoborg said:

I asked around about buying homes at both UCSF and Stanford...it's just not really done. I believe one person at each place had succeeded in buying a house pretty far from the actual campus.

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same sentiment i got from both...buying a home is simply NOT an option (huge, esp. for those family-minded people like myself), renting is THE only option, unless of course you've got a Hugh Jass trust fund setup in your name by Warren Buffet, after he dies of course.

also, having a car is another real problem, esp. in UCSF (even at Stanford too: many residents don't own a motor vehicle and use shuttle system). What kind of life is that? Near 30 years old, no house, no car??? Paying a buttload for renting a small apt? making me reconsider those up-and-coming programs in the midwest, East coast...

Yeah - when I was looking at programs last year I had a basic attitude to try to avoid big cities if at all possible. Almost didn't work since I ranked a place in boston #2, but it was nice in theory. But it is nice to have my own place, a car, etc. Some people just love cities, some people don't. And renting to me just feels like you are throwing money away - fine if you're only there a year or two, but once you get out to 4-5 years it's a lot more palatable to be paying money to a mortgage. Partially tax deductible and appreciating in value.

yaah, as a single guy, did you or do you plan on purchasing a house for yourself?

scootad. said:

yaah, as a single guy, did you or do you plan on purchasing a house for yourself?

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House/condo basically same thing. Condo just means you have closer neighbors and you don't have as much to worry about in regards to cutting grass, snowplowing, power and water issues, etc.

I thought about a house but condos were more appropriate for what I wanted.

Yes, I bought one. I had enough to put a bit down but new residents here and probably other places can purchase homes without significant money down - the credit unions have a lot of programs for this (home equity loans, etc).