Anyone familiar with gen surg programs in Texas?

icare4u said:

I'm looking at programs in Texas and trying to make the determination as to which of those are considered competitive and which ones are not so competitive. After looking at the ACS website, it seems that most of them have virtually the same stats for the profiles of their residents as far as % of their residents that were AOL or top 15% of the class. I must just be overlooking the obvious here.

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In general, Baylor-Houston and UT-Southwestern are considered the most competitive academic programs in the state, with UT-Houston and UT-San Antonio close behind and UTMB, Texas A&M and the Texas Tech programs a little further behind. When I was applying, UT-Houston used a Step 1 cutoff of 215 (not saying don't apply, just saying that is what I was told). Again, this isn't saying UT-Houston is better than Tech, there just seem to be more research opportunities there and there seems to be more of an inclination to do research there.

For the private programs, Baylor-Dallas is great and Methodist-Houston is a new and upcoming program that may overtake Baylor-Dallas in reputation once it has really established itself. I've heard the Methodist-Dallas program is also good, but it is a smaller hospital than Parkland (UTSW) or Baylor, and that has an impact on training.

In short, I don't think you can go wrong at any of them, it just depends on what you want from your training.

Out of curiosity, why Texas? Are you from there? If so, that will probably help you with the private programs (and maybe a little with the academic programs as well, though probably less).

While I agree with SocialistMD's rankings, I wouldn't say UT Houston and UTSA are 'close behind' UTSW and Baylor Houston.

UTSW is very impressive but brutal. Great academics, operative experience, but you pay for it. The residents can't even fake being happy for interview season. Irregardless, it's hard to see someone graduating from there who wouldn't be very compentent and confident. Note the recent lawsuit involving a former attending who flagged UTSW for allowing to much autonomy in the OR (i.e. attendings not present in the OR for crux of procedure). It may change the culture. Simulation/training facilities are nice. You'll need good numbers here.

Baylor has a good reputation with some big names (Chairman Dr. Brunicardi is editor of Schwartz, Dr. Mattox). Losing Methodist had to be a blow, but they're making their own hospital now. Their graduating residents average below 800 cases, but may due to some outliers (some get >1000). DeBakey really did hire and fire people at a whim, but he's gone, so the malignant stories aren't as applicable.

UT Houston has some good things, namely the Texas Medical Center. But it's a tough program. Not the best culture. If you can get into Baylor or UTSW, you should have no problems with UTH. You may sneek into a categorical spot by being a prelim here.

UT San Antonio is a mandatory 7 year program. The surgery department is running into financial difficulties. ABSITEs are a significant criteria for holding people back. Overall, low morale. Facilities/equipment/research are a step behind UTSW or Baylor (but they eventually take that step). Some good subspecialty services- transplant program performs around 100 liver transplants per year, urology dept. possesses a great chairman. Like UTSW, a 'whistleblower' called them for allowing too much autonomy as well a few years ago. If you apply, good research could make up for lack of numbers. Something to note: 3 residents come from the Air Force as it's a fully integrated program with Wilford Hall. This trims the number of NRMP slots to 3-4. The AF will move its people to Brooke Army at some point.

Baylor Dallas is competitive. They take everyone's board scores and grades, then make their rank list. Their transplant program is much bigger than UTSW (may be UTSW's only weak field). Has a rep for good resident lifestyle.

Texas A&M (Scott and White) has a pleasant atmosphere. Family friendly with above average home call. Drawbacks are you only work at two hospitals (maybe a plus) and you live in Temple, TX (good for families). Nobody has failed the boards in the past 5 or so years. This is a fairly competitive place if you've got average numbers, so I'd do an away rotation (they love people who show an interest).

Methodist Houston saved a weak St. Joseph's-Cristus program. You spend a year total in Austin. Their chairman is supposed to be very strong. Time will tell if the program lives up to its potential, but you'll need to be a decent candidate now.

Methodist Dallas takes 2 people a year and operates all the time (more bread and butter procedures). Might be one of those programs where doing an away rotation will really help.

Texas Tech Lubbock was on probation but recently got off. Don't know too much about it.

Texas Tech El Paso might be the worst. Board pass rates around 50%. I was told not even to apply there due to administrative issues. Speaking Spanish should be a prereq.

The American Board of Surgery provides an objective look at board pass rates here. UTSW, Methodist Dallas, and Scott & White lead this list.

I'm not too happy with Baylor-Dallas right now. I just found out last week I was rejected from even doing a visting rotation there, despite the fact that I'm from Texas, and my grades and step 1 are on par with the average matched applicant. I don't know what their deal is, but they said specifically that they're looking for 'more' competitive applicants in the future and I don't fit that bill. It's funny they determined that without any of my clinical grades (all honors except for family, big deal), without knowing I've published three times, and so on.

My program director called Dr. Jones for me after I heard, and what do you know, all of a sudden I was an 'attractive' applicant again.

I don't know what their deal is this year, but it's weird that I'm going to Louisville, UNC, and Emory, all more academic, reputable programs than Baylor and they didn't have a problem with my stupid away application.

46&2 said:

UTSW is very impressive but brutal. Great academics, operative experience, but you pay for it. The residents can't even fake being happy for interview season. Irregardless, it's hard to see someone graduating from there who wouldn't be very compentent and confident. Note the recent lawsuit involving a former attending who flagged UTSW for allowing to much autonomy in the OR (i.e. attendings not present in the OR for crux of procedure). It may change the culture. Simulation/training facilities are nice. You'll need good numbers here.

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After doing med school and an intern year in UTSW general surgery, I would say this is pretty accurate. Those guys are miserable. It seems 1-3 people per year get fired or have to repeat the year for different reasons. Very brutal....and the powers-that-be don't care.

toofache32 said:

After doing med school and an intern year in UTSW general surgery, I would say this is pretty accurate. Those guys are miserable. It seems 1-3 people per year get fired or have to repeat the year for different reasons. Very brutal....and the powers-that-be don't care.

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I am an R2 at UTSW and also went to med school there. I vigorously disagree with the above post. To start, Dr. Valentine (the PD) absolutely cares about the residents and the program. The previous poster, being an intern and OMFS, is likely unaware of all the political battles fought on our behalf. Further, I find the characterization of residents as "miserable" quite inaccurate. There is a good deal of camaraderie amongst the residents, and between residents and faculty, as well as a strong sense of pride in the program and the excellent training we get. In my year 5 out of 13 categoricals are UTSW grads. I know at least 4 of us ranked it first. The current intern class and the entering intern class have 3 UTSW grads each. Students wanting to stay at this institution is surely a testament to a program that takes care of its residents.

Dilettante said:

I am an R2 at UTSW and also went to med school there. I vigorously disagree with the above post. To start, Dr. Valentine (the PD) absolutely cares about the residents and the program. The previous poster, being an intern and OMFS, is likely unaware of all the political battles fought on our behalf. Further, I find the characterization of residents as "miserable" quite inaccurate. There is a good deal of camaraderie amongst the residents, and between residents and faculty, as well as a strong sense of pride in the program and the excellent training we get. In my year 5 out of 13 categoricals are UTSW grads. I know at least 4 of us ranked it first. The current intern class and the entering intern class have 3 UTSW grads each. Students wanting to stay at this institution is surely a testament to a program that takes care of its residents.

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Those were only my observations and experiences. I made many good friends from the categorical crowd but as a whole they seemed incredibly unhappy. I'm glad to hear things have changed for the better.

UTSW is a very traditional & stereotypical University surgical program. It's not for the kind of people who became interested in surgery when the 80 hour work rules came in.

I can remember rotating there 10 years ago as a student walking thru the emergency room thinking to myself "I can't believe places like this still exist!" as it looked like the kind of scene you see on "E.R."

Look here for a few views on Dallas programs:
http://forums.studentdoctor.net/showthread.php?t=384465&highlight=dallas+surgery

Also, I just started at Baylor and it's ridiculous how happy/congenial the residents/staff are. (My roommate is an intern at UTSW & it doesn't sound like much has changed, but he hasn't complained about it.) Most of the interns at Baylor are logging around 4-5 cases/week, with some as high as 8-10 (service-dependent). Of the 6 categorical interns I've discussed it with, all ranked Baylor #1. Bottom line: I couldn't be happier.

Raidergate: You'd be suprised how much weight a PDs word carries or how often a situation like yours occurs. Also, Baylor seems to be making a strong push towards recruiting staff/residents interested in research, so hearing about your work from your PD may have had an effect. Easy to understand your frustration, but I'd urge you to give Baylor a look. Most of the interns here interviewed at each of the "more academic/reputable" programs you listed (no arguement from me, they're solid) and chose Baylor in the end.

Best of luck to all!

Some actual facts and perspective from UTSW:

1) I am a 4th year resident and am very happy with my choice

2) Yes, our trauma chair left and is suing the university. Not one resident is sad to see him leave.

3) Though we did not lose anyone last year, we lose between 1-2 residents a year since I have been here. That is from a program with 65 categoricals, 9 plastics integrated residents and 15 or so non-categorical interns. If you look at the numbers from that perspective, it is no different than any other program I am aware of. To my knowledge, all of those who were dismissed were given ample opportunity to mend their ways and either did not or could not.

4) Dr. Oliver is correct. We work hard. If the most important thing for you in residency training is lifestyle, please switch to ER. If not, best of luck in your malpractice-filled, short lived career as an attending. Besides work, most of us play sports/ go to the gym, go to bars, restaurants, clubs, movies etc.. Many of us either started married, got married here or are in committed relationships (and some not-so-committed!). In the past year alone 2 residents have had babies including a chief and a third year, and we have 3 more in the oven.

5) 100% boards pass rate. That's why the conferences are tough. This is what medical students and most interns don't understand. I recently met a group of recent UTSW grads who said that sitting in the hotel room is just like sitting in Chief's Conference. If you want a residency where they coddle you in conference, look for the ones with low boards pass rates.

As the time is coming to start picking places to apply, consider where you get your advice from. I'm sure there are people in your class who are very nice, but as a physician, you wouldn't let them touch your worst enemy. They will likely get a residency in something, and likely be miserable (especially if they have to work hard, or are incompetent). They can post threads on this site just like anyone else.

Best of luck, and hope to see you come interviewing in Dallas!