Mt. Sinai

If I have learned nothing else from this forum, it is that Mt Sinai has a band of supporters (who I am surprised have not popped up yet) that call it one of the best programs in the country. A lot of this is apparently based on the fact that it has a huge volume and that it is in NYC, neither of which necessarily make something a good program for trainees. I don't know why their program is different, I hadn't heard that.

NYC pathology programs are in a lot of flux. Perhaps Mt Sinai is the most stable of them all. NYU is chaotic. Cornell keeps changing faculty. I think Columbia as well.

yaah said:

If I have learned nothing else from this forum, it is that Mt Sinai has a band of supporters (who I am surprised have not popped up yet) that call it one of the best programs in the country. A lot of this is apparently based on the fact that it has a huge volume and that it is in NYC, neither of which necessarily make something a good program for trainees. I don't know why their program is different, I hadn't heard that.

NYC pathology programs are in a lot of flux. Perhaps Mt Sinai is the most stable of them all. NYU is chaotic. Cornell keeps changing faculty. I think Columbia as well.

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I'm a resident in pathology at Mt. Sinai right now. Its a great program overall. Other than being subspecialized, its AP program is no different than other programs. This subspecialization brings in alot of great consult cases. The strength of this place is the volume (145,000/yr), however, approx 80,000 of these cases are biopsies. Biopsies are really the bread and butter of private practice. Also the faculty really pull strings to get their people fellowships and jobs and are very interested in teaching. We have alot of big names, but no Rosais or Fletchers. Also, we are not a very big basic science research department. However, for diagnostic pathology training, it really can't be beat. Sorry yaah, but its true. Its really an outstanding AP program. Lastly, our CP is average and could use a bit of work. I would say that 100% of our residents pass AP/yr, and 80% pass CP/yr. Our fellowships are: 2 surg/selective path, 1 derm, 1 GYN, 1 liver, 2 cyto, 1 GI, 1 neuro, 1 molecular/genetics. So, take this for what it is worth.

In years past, the only really recurring complaints were the old facilities and CP (which is adequate in my opinion). However, the floor is in the middle of renovations and will be completed by the end of the year. Also they just hired Cornell's former CP director to take over the CP program.

Mt Sinai definitely does have its supporters. Its not talked about almost anywhere west of the Mississippi river, mainly because it doesnt have the halo effect that places like Michigan, Stanford, Harvard, Duke etc can boast from having a fantastic undergrad, top class medical shcool and research community and powerhouse sports programs. It really suffers from a lack of national recognition, especially outside the NY area and a corresponding lack of highly visible academics like Epstein, Fletcher, Mihm, Kempson, Demay, Leboit and the like. That said, they definitely have a solid program from my interactions with their graduates.

LADoc00 said:

Mt Sinai definitely does have its supporters. Its not talked about almost anywhere west of the Mississippi river, mainly because it doesnt have the halo effect that places like Michigan, Stanford, Harvard, Duke etc can boast from having a fantastic undergrad, top class medical shcool and research community and powerhouse sports programs. It really suffers from a lack of national recognition, especially outside the NY area and a corresponding lack of highly visible academics like Epstein, Fletcher, Mihm, Kempson, Demay, Leboit and the like. That said, they definitely have a solid program from my interactions with their graduates.

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I agree that Mt. Sinai doesn't benefit from the Halo effect when it comes to lay people, because it is not a university with undergrad and sports, etc. However, its a pretty famous hospital and medical school. Their experts are guests on the TODAY SHOW like every week. Also, historically their path dept is well known. I say this only because my medical school actually commented in a lecture about all of the diseases discovered there (crohns, lupus, etc). But that doesn't really factor in today. I don't really know much about the path dept today except for my interview and through word of mouth. Sorry!

LADoc00 said:

Mt Sinai definitely does have its supporters. Its not talked about almost anywhere west of the Mississippi river, mainly because it doesnt have the halo effect that places like Michigan, Stanford, Harvard, Duke etc can boast from having a fantastic undergrad, top class medical shcool and research community and powerhouse sports programs. It really suffers from a lack of national recognition, especially outside the NY area and a corresponding lack of highly visible academics like Epstein, Fletcher, Mihm, Kempson, Demay, Leboit and the like. That said, they definitely have a solid program from my interactions with their graduates.

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LADoc, you make Mt. Sinai seem obscure. I'm sorry, but its far from that. Mt. Sinai is a very elite medical institution. Their path department is extremely strong in diagnostic path, maybe the best. But, I will say that it probably stops there. They are not leaders in basic science pathology research or CP. I'm not saying they are deficient in these areas, but probably average. Other than maybe 3-4 path departments in the country, nobody has more than 1 big name like Fletcher, Leboit, etc.

Also, why are you always dismissing NYC programs yaah? I used to work at Cornell and it was a very solid department. I can't say a bad thing about the place. You are always objective and diplomatic when commenting on pathology programs, but when it comes to NYC you spout hearsay like no tomorrow.

Gran Turismo said:

I agree that Mt. Sinai doesn't benefit from the Halo effect when it comes to lay people, because it is not a university with undergrad and sports, etc. However, its a pretty famous hospital and medical school. Their experts are guests on the TODAY SHOW like every week. Also, historically their path dept is well known. I say this only because my medical school actually commented in a lecture about all of the diseases discovered there (crohns, lupus, etc). But that doesn't really factor in today. I don't really know much about the path dept today except for my interview and through word of mouth. Sorry!

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They are on the today show because they are in NYC. It's the same reason why CNN always has experts from Emory in studio in Atlanta, and experts from Cornell/Columbia/whatever when they are in the NY studio. But I agree, Mt Sinai has a great history - so does Columbia as surgical path was basically founded by Stout there.

I thought Crohns was discovered at Rochester? Maybe just described?

DoubleHappiness said:

Also, why are you always dismissing NYC programs yaah? I used to work at Cornell and it was a very solid department. I can't say a bad thing about the place. You are always objective and diplomatic when commenting on pathology programs, but when it comes to NYC you spout hearsay like no tomorrow.

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You are seeing things you want to see - I give hearsay on any program when people ask - it's just that I have less direct knowledge of NYC programs than others, and to be honest, I hear more things (like at USCAP or from faculty or have some knowledge of it). In the past few months alone I have given hearsay "advice" or rumors on programs in california, carolinas, texas, midwest, etc. Just because I say "Mt Sinai has its proponents" doesn't mean I think the program is crap. I said that in the hopes of prodding people who know more to post about it, because I get sick of being the only voice on things sometimes. Especially since I have never seen anything bad posted about it.

I am not sure where you have ever seen me badmouth Mt Sinai - the worst I have ever said about it are 1) that I don't know much about it, and 2) that NYC programs in general are overshadowed. How is that badmouthing? I have also questioned some people who post about the specimen volume there as being an absolute proxy for a good program - because specimen volume is NOT a solid indicator of a good program when it is high. It helps, and it's a big benefit, but it doesn't mean it helps training. I mean - if you come here and post that "Mt Sinai is maybe the best training program in the country for diagnostics" and that only a couple of other programs have more good diagnosticians and teachers, well, sorry, I am going to call bull**** on that one. Doesn't mean it isn't a great training program - but I think there are lots of great programs out there.

I don't dismiss NYC programs - again, you are reading into things. What I almost always say is that I don't know much about them, because I don't have an interest in being there nor did I interview there. But I hear people talk, and I know people who have trained there or have a connection to them now. And that's good that you can't say a bad thing about Cornell, perhaps you should post more. I have heard a bit of the contrary from people who have a recent connection to it. I know that it has a great history and has the affiliation with MSKCC, and there are some great people there. But all I have said about Cornell is that it is in flux and some people have expressed concern about personalities and the flux. If you have a problem with that, feel free to correct me.

I have no personal axe to grind against NYC programs. I find that many New Yorkers get very defensive about their fair city and the programs within it, I am not sure why. The truth is, pathology in NYC is a bit overshadowed by programs to the east and to the south and west. And to be honest, I hear more people saying to avoid NYC programs than to consider them strongly. I do know, however, that Cornell is probably improving a lot in the last year or two, and is getting more stable, and I know there are some good faculty there.

I should add, though, that the residents I have met who have come out of NYC, despite sometimes saying bad things, are generally well trained. I think, as with anything, that every residency program experience is individual - and everyone should evaluate programs individually and objectively, and try to avoid being prejudiced in their own minds about it. Personally, the spectre of living in NYC is too awful to comprehend for me, but I know some people can't get enough of it.

DoubleHappiness said:

LADoc, you make Mt. Sinai seem obscure. I'm sorry, but its far from that. Mt. Sinai is a very elite medical institution..

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I did not intend for it to seem obscure to fellow MDs, its not, but relative to places like Harvard, Stanford, Hopkins etc... for many, it most certainly is. Mt Sinai is a fantastic regional school, but I can guarantee when a resume lands with it on it out here on the West Coast, some people are scratching their heads. I think you are looking at from the prospective of someone who may have grown up in the area or in the NE, Im an objective outsider.

As for NYC in general, Im coming from the prospective of what was happening in the late 90s and can tell you during that era, all the programs there including Cornell/Columbia had a very very sharp drop off of the most solid AMG applicants to their residencies. I was told a very short list of pathology residencies to consider coming from my medical school and none of them were in NYC. I would guess that from 1996-2001, before more AMGs started applying, most people headed towards a very small number of "salvageable" programs. In fact in 1998-1999, there was some talk of there being less than 50 or so real applicants (as in AMGs from good medical schools who hadnt failed the boards numerous times, or werent getting kicked out/leaving other specialities) across the whole NATION.

LADoc00 said:

I would guess that from 1996-2001, before more AMGs started applying, most people headed towards a very small number of "salvageable" programs. In fact in 1998-1999, there was some talk of there being less than 50 or so real applicants (as in AMGs from good medical schools who hadnt failed the boards numerous times, or werent getting kicked out/leaving other specialities) across the whole NATION.

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Am I interpreting this right? are you saying that in that year there were only 50 american allopath applicants in all of pathology? what the heck happened 10 years ago that made med students wanna get so far away from pathology?

Sorry I can't contribute to the original post - I know nothing of Mt. Sinai (including which burough it's even in).

mlw03 said:

Am I interpreting this right? are you saying that in that year there were only 50 american allopath applicants in all of pathology? what the heck happened 10 years ago that made med students wanna get so far away from pathology?

Sorry I can't contribute to the original post - I know nothing of Mt. Sinai (including which burough it's even in).

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Yes that is what I am saying. In fact, I had a brief conversation with a now deceased esteemed pathologist who said "the state of pathology had reached a point where serious students no longer considered the field a good career choice, I have been left with deciding between pure scientists and baffoons."

I will go out even further on a limb and recall a conversation with a very very accomplished Canadian MD/PhD (some 30-40 papers as a PhD, unheard of), who said "there were in fact a mere 20 solid applicants for residency from the US applying to Pathology and I know every name." He decided the state of training was in such disarray here, he was better off staying in Canada.

LADoc00 said:

Yes that is what I am saying. In fact, I had a brief conversation with a now deceased esteemed pathologist who said "the state of pathology had reached a point where serious students no longer considered the field a good career choice, I have been left with deciding between pure scientists and baffoons."

I will go out even further on a limb and recall a conversation with a very very accomplished Canadian MD/PhD (some 30-40 papers as a PhD, unheard of), who said "there were in fact a mere 20 solid applicants for residency from the US applying to Pathology and I know every name." He decided the state of training was in such disarray here, he was better off staying in Canada.

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While doing a third year rotation, I spoke with one of the pathologists at the hospital. This hospital had what would be considered a no-name program. He told me that he didn't even consider applications from AMGs as he figured something must be wrong with them. He said that in his opinion AMGs applying to his program must have been "forced" into path by their dean of students as they had too hard of a time on the wards with social interactions.

Speaking to a PD from a mid-level program, he said that in the late 90s they would get 30 applications from AMGs and maybe 10 would interview, and that only 1-2 would come. Those were the days when they would try to get applicants to sign contracts on the spot.

Many of the primary issues surrounding pathology would be solved by the simple solution of disallowing ANY Federal or State subsidizing of residency and fellowship positions by non-US citizens and US citizens educated at offshore medical schools. If local areas/counties want to fund primary care slots for IMGs then that would be their choice, but the wholesale flooding of IMGs into path that occurred in the 1990s sent the entire field straight into the shiatter, ironically funded by the US taxpayer. Of course path department PDs went laughing all the way to bank with all the free labor (figuring a solid PA is near 100K+benefits) and 1:1 matching funds from the Social Security Trust. I would even dare call this one of the greatest scams of the American public since S&L scandals and bailouts.

dermpathlover said:

Those were the days when they would try to get applicants to sign contracts on the spot.

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When I applied, I opted out of the match, went to 4 interviews and had letters of acceptance in hand before Thanksgiving of my senior year. I received phone calls from faculty numerous times asking what I needed to sign with them. I have heard legend (not verified), a program in NE offered a top MD/PhD candidate $10,000 in cash to sign a contract before going elsewhere to interview. I was a good student, but no AOA superstar or anything fo sure. Im sure lots of regular posters here could make my application and board scores look like I appropriately belonged on the shortbus and nowhere near academia! I know for a fact some programs went so far as to promising medical students in writing dermpath, hemepath and cyto fellowships to get them on board. I had one such letter, if I ever find it, I will scan it and post it somewhere. That would never happen now.

Not to veer off topic but all I remember from my interview there was that there were hardly any techs in the CP lab and every instrument was connected to a conveyer belt that went for miles.

I am actually not affiliated with Mt. Sinai. I am an attending at another NYC hospital. What I know about Mt. Sinai is from a few fellow attendings who did some training there.

I agree with LADoc that in the 90s pathology was in trouble and only a few programs were actually considered credible, but pathology is in a completely different state right now.

One thing students need to look at about pathology programs is that there are 3 different roads for an academic pathologist's career. It is my opinion that since pathology has come back to life, it has become much more fractured, not only based on organ system.

1) Big time basic science researcher- These people often focus on esoteric topics in pathology, but make a name for themselves by publishing. These people usually are not the best diagnosticians because they spend most of their time and energy narrowly focused on specific aspects of a certain disease. Sometimes these people lose sight that they are physicians and are more concerned with being scientists.

2) The politician pathologist- These people are highly visible at conferences and spend most of their efforts publishing and pushing policy onto the field (i.e. "This represents a new variant of a benign lipoma", or "my panel of immunostains is superior to the currently accepted panel", etc.). Sometimes these people greatly contribute to the field, but sometimes they tend to be more concerened with ego and having their brand of pathology practice accepted than whats actually best for the patient.

3) The physician pathologist- These people often are less visible because they don't publish as often and don't travel the country lecturing an agenda. These people usually fit into private practice, but when they are in academics are usually the rare few that just love diagnostic path and just want the added challenge of difficult cases. These people, although crazy for loving pathology that much without the perks of fame or money, are usually the best role models for resident pathology training.

Before the 80s-90s crisis, pathologists used to be able to be successful at all three of the above aspects. Some true "greats" are still able to pull this off, but there really aren't many of them out there.

Now the reason why many people say that Mt. Sinai could be one of the best programs in the country for diagnostic training is that it is a medical center with a primary emphasis on patient care. They have an insane volume with subspecialty divisions. My department loses contracts to Mt. Sinai all of the time. Most of Sinai's volume is from outreach specimens. Their faculty are obviously patient care oriented, or at least market themselves as such, because how else would an institution suck up all of the volume in NYC. Mt. Sinai is not alone in having this type of department. Look at Cleveland Clinic. Their faculty are also relatively known (but not uber-famous), they have large volume, and focus mainly on the patient care aspect of pathology.

LADoc00 said:

I know for a fact some programs went so far as to promising medical students in writing dermpath, hemepath and cyto fellowships to get them on board. I had one such letter, if I ever find it, I will scan it and post it somewhere. That would never happen now.

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What fellowship did you end up doing?
Have you had a difficult time finding work?
How would you attract better candidates to pathology.
Weren't fields like anesthesia, radiology and radiation oncology less popular years ago and therefore filled with IMG's?

Are you saying that path is unpopular because of IMG's or becasue path is unpopular we need IMG's?

If you train less pathologists will there be enough indivuiduals to do the work? Who will pick the strawberries bro?

What do you think of D.O's?

I think the main problem with pathology is greed in a free market economy. This effects the field at all levels. Maybe we should pay for medical education as a society and have all doctors making a capped 35,000 as edified servants of society. Kinda like Cuba or Russia or maybe even Canada.

Is this a plug for Pat Buchanan's new book?
http://www.amazon.com/gp/product/03...9293/ref=pd_bbs_1/104-1964522-6762318?ie=UTF8

Matte Kudesai said:

What fellowship did you end up doing?
Have you had a difficult time finding work?
How would you attract better candidates to pathology.
Weren't fields like anesthesia, radiology and radiation oncology less popular years ago and therefore filled with IMG's?

Are you saying that path is unpopular because of IMG's or becasue path is unpopular we need IMG's?

If you train less pathologists will there be enough indivuiduals to do the work? Who will pick the strawberries bro?

What do you think of D.O's?

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I never had any problem finding work, BUT I entered in era where I could handpick my credentials. Also, "work" is one thing, GOOD HIGH-PAYING work is a horse of a totally different color. Am I greedy? Maybe relative to a typical PhD who is sent scrounging for a job after their 2nd postdoc, but far less than a your typical ibanker...at least IMHO.

What happened was while Anes. had a similar situation in the 90s, they drastically curtailed the number of training slots. With a vastly decreased supply of gas specialists, the market self-corrected sometime in 2000-2001. Now its near on fire! Although some pathology programs did close completely during the "great depression", the total number of slots only minimally changed.

I have an epic thread (try searching a bit for if you are really interested in the details and the math) about why pathology didnt react to the market in the same fashion Anes. did, but suffice it to say it was pure greed on the part of academic medicine as the motivating factor.

I strongly disagree with anyone who says that somehow now the market in pathology is magically better than it was say in 1998. Its not, its the same if not worse. People that make these total B.S. statements are always the people in academia, who's very livelihood is dependant on recruiting and training more pathologists, contributing to oversupply. It's exactly like asking a realtor if now is the best time to buy a house, they will always say yes!

If we stopped ALL training in pathology for 3-5 years, the current crew could easily EASILY absorb the market share. I would guess (now this is a total out of ass estimate) there are probably far less than 2,000 surgicals/BC Anatomic pathologist in the US. A properly trained and streamlined operator could pound out 10,000 cases/year and still take 2 months of vacation, work <40hrs/week and have the weekends off. The math between what programs are training and what is needed is WAY out of whack.

As for this thread in general, I hate this kinda of pissing contest. This is just a reduplicate for the other Mayo thread anyway. Im not attacking anyone's training program or alma mater, only bringing up the OBVIOUS point that with all things being equal (which they never are anyway), if you showed up with a resume that said Stanford residency versus one that said Mt. Sinai, I doubt employers would think twice. Whether that has any real validity is besides the point, a suped up Honda Civic may very well beat a Lotus in a street race, but you'd rather show up in a Lotus to a first date with a smokin hot chick. Make sense?

yaah said:

They are on the today show because they are in NYC. It's the same reason why CNN always has experts from Emory in studio in Atlanta, and experts from Cornell/Columbia/whatever when they are in the NY studio. But I agree, Mt Sinai has a great history - so does Columbia as surgical path was basically founded by Stout there.

I thought Crohns was discovered at Rochester? Maybe just described?

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Crohn's disease was definitely discovered at Mt. Sinai.

yaah said:

I have also questioned some people who post about the specimen volume there as being an absolute proxy for a good program - because specimen volume is NOT a solid indicator of a good program when it is high. It helps, and it's a big benefit, but it doesn't mean it helps training. I mean - if you come here and post that "Mt Sinai is maybe the best training program in the country for diagnostics" and that only a couple of other programs have more good diagnosticians and teachers, well, sorry, I am going to call bull**** on that one. Doesn't mean it isn't a great training program - but I think there are lots of great programs out there.

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I don't think he/she stated that only a small few other places have better attendings than Mt. Sinai. I think the poster was stating that their department is diagnostic/patient care focused with big volume and subspecialization. That recipe sounds pretty good to me! Or just as good as looking for places with tons of BIG names and tons of publications.

LADoc00 said:

As for this thread in general, I hate this kinda of pissing contest. This is just a reduplicate for the other Mayo thread anyway. Im not attacking anyone's training program or alma mater, only bringing up the OBVIOUS point that with all things being equal (which they never are anyway), if you showed up with a resume that said Stanford residency versus one that said Mt. Sinai, I doubt employers would think twice. Whether that has any real validity is besides the point, a suped up Honda Civic may very well beat a Lotus in a street race, but you'd rather show up in a Lotus to a first date with a smokin hot chick. Make sense?

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Lol! Come on now, I think that is a bit of an exaggeration. We should re-title this thread as "East Coast path vs. West Coast path". I'm in the midwest and can say that both Mt. Sinai and Stanford can't stand up to Cleveland Clinic and Wash U. Hah hah, just kidding!!!

Gran Turismo said:

I don't think he/she stated that only a small few other places have better attendings than Mt. Sinai. I think the poster was stating that their department is diagnostic/patient care focused with big volume and subspecialization. That recipe sounds pretty good to me! Or just as good as looking for places with tons of BIG names and tons of publications.

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Yeah, but see, don't get too carried away. I am not saying this isn't a good method of training - it sounds like it is and obviously the training program works. But at many large academic programs there are superior diagnosticians who also publish and travel the country to teach. What was said above about trying to do "all three" is basically right - but most of the great diagnosticians who get all the tough consults around the country are the same ones writing the articles about them.

What I am saying is that there isn't a ton of difference (from a resident perspective) in terms of diagnostic ability and teaching ability between the academic diagnostician who publishes and the one who doesn't. To suggest that a program/department is more focused on patient care because they publish less is a bit of a stretch. I mean, at my program, the emphasis is also on patient care. I would wager that is true at every program. And Cleveland Clinic was brought up - Goldblum is there, I dare say you would have a hard time finding a more published person in the past 5 years than Goldblum. And yet he is (apparently) an amazing teacher and diagnostician.

So, every program has its benefits and its drawbacks.

One criticism I have heard about Mt Sinai - not sure if anyone here can speak to it, but what I heard was that their volume is almost too high - as if there is too much work for the residents. Perhaps that is no longer true?

yaah said:

Yeah, but see, don't get too carried away. I am not saying this isn't a good method of training - it sounds like it is and obviously the training program works. But at many large academic programs there are superior diagnosticians who also publish and travel the country to teach. What was said above about trying to do "all three" is basically right - but most of the great diagnosticians who get all the tough consults around the country are the same ones writing the articles about them.

What I am saying is that there isn't a ton of difference (from a resident perspective) in terms of diagnostic ability and teaching ability between the academic diagnostician who publishes and the one who doesn't. To suggest that a program/department is more focused on patient care because they publish less is a bit of a stretch. I mean, at my program, the emphasis is also on patient care. I would wager that is true at every program. And Cleveland Clinic was brought up - Goldblum is there, I dare say you would have a hard time finding a more published person in the past 5 years than Goldblum. And yet he is (apparently) an amazing teacher and diagnostician.

So, every program has its benefits and its drawbacks.

One criticism I have heard about Mt Sinai - not sure if anyone here can speak to it, but what I heard was that their volume is almost too high - as if there is too much work for the residents. Perhaps that is no longer true?

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Wow, I guess alot of people have opinions on Mt. Sinai!
To Yaah: The rumor that there is too much volume was very true about 7-8 years ago. There are horror stories of residents working until 1:00am every night from years past. Those days are long gone as they have hired 3 certified PAs that do about 3/4 of the grossing and also expanded the surgical path fellowship. The volume is really a benefit now for training. The program has made major efforts the make this volume educational with minimizing the mindless scut associated with it.
As for "big" names, we definitely have some visible people in GI, GYN, Heme, breast and liver. However, I don't really give a crap about big names. To me it makes no sense to swabble over whose bosses are the most elite. I'd rather make my own name than campaign and shadow someone else. All I care about is whether or not my attendings are going to make an extra effort to teach me and get me whatever fellowship/job that I want. Mt. Sinai definitley does this for its residents consistently. Or at least since I've been here. As being the only "sinai" person in here to post, I never said it is the best program in the country, and whether or not it actually is, I don't know or care. I guess I should just say that I would rate it as a 9.5/10. Anyone interested, please feel free to message me, as this thread is getting way old.

And for beetenpath: At least one person gets a dermpath fellowship every year here, sometimes two people.