old school community programs

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PostCall

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i know this may sound weird to some but i want to do my gen surg residency at a real old school program. i don't mind being worked extra hard or taking in-house q3 call all 5 years. i'm a single guy so having time for a family is not an issue and neither is location. i've heard of the old school university programs but i'd like to hear about the old school community ones. the community programs where you get to operate A LOT (with good autonomy) and when you finish you're a stud technically and clinically. pm me if you'd rather.
 
Not sure how "old school"
But the highest operative numbers I saw on the interview trail were from:
UCSF FRESNO. They operate like machines out there. The surgery residents are the only show in that whole central valley. They seem to operate with all the subspecialties too. If you wanted to do surgical relief work (Africa, Doctors without Borders), this place seemed like the ideal training ground. However you are shipped off to UCSF for transplant and peds I think.
 
Didn't actually interview there myself, but from the sounds of it, Gunderson Lutheran program in La Crosse, WI is a pretty solid community program. They only take 2 residents/yr & DO NOT interview DO's (too bad for me). Their operative numbers are pretty solid & I don't think their call schedule is too bad.

If you aren't a DO, I would look into it.
 
bump for more suggestions

I'm not sure a lot of "old school" community programs exist, at least by using your definition. There are plenty of community programs with great operative numbers, which is the generic advantage to a community program.

The less common quality in community programs is a strong curriculum. My personal bias is to try and find a "Hybrid Program" that can balance the pros and cons. I'll throw out a few so-called hybrid programs, but really it sounds like you should be aiming your masochistic sights at academic institutions.

Baylor-Dallas
Virginia Mason
Scott and White
Iowa Methodist
Mich State- Grand Rapids
KU- Wichita (shout out)...but you don't want to go there.


Hope that helps.
 
Solid community programs that I am aware of:

New Hanover Regional --> Wilmington, NC
Carolinas Medical Center --Charlotte, NC


Just curious but isn't Scott and White an academic program? I thought it was the teaching hospital for Texas A&M. Just curious about that...
 
postcall:

as an almost pgyIII, i can see myself as a medical student making the statement you made, don't care about q3 call 5 yrs, (i bet my operative hand you won't find a chief in the country that would make that statement), long hours at work wear on you and your personal life, regardless if u r single, your college buddies will get married, siblings will have kids, funerals will occur, general relationships with family,friends ect need to be maintained. your life outside the hospital will become more important when its gone and you are absent for the things i mentioned above.

if you are anything like i was as a MS4, you will blow me off , i can't fault you for that, but do remember to pass this info on to the next generation as they make decisions without much insight.

in respect to your question "old school programs" i think you just want a high volume center. look at numbers outpatient/inpatient surgeries, frieda has it listed. i would definitely do community program for tons of sbo's, colectomy, lap chole, hernia repairs, appi's, and breast.


good luck
 
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i hear what you're saying and it's weird for me to say this but i think being a surgeon will pretty much be the main thing in my life. i'm an introvert, don't really have an outside hobby and i get super bored when i go out with people to do the social stuff everyone else seems to live for (parties, clubs, bars, just hanging out chilling etc). never had the desire to get married either. in fact when i'm doing those social things my thoughts are on surgery believe it or not. when everyone takes off as early as possible on a friday i'm the one who stays to scrub in on cases for as long as it takes. true maybe a woman will come along and i'll decide to get married and my perspective will change in the future but for now that's how i feel about surgery. which is why i don't mind going to a program that'll work you super hard but the finished product will be an awesome all around surgeon.
 
well, with that said, i respect that 100%. i guess a good inquiry for you will be what programs fly under the radar as far as duty hours. not sure how easy it will be to find that out, but programs that are busy with few residents for coverage i.e accept 1-3 categorical residents each year, such as carolinas medical center, not sure about how strict they r w/ respect to hours.
 
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...i think being a surgeon will pretty much be the main thing in my life. ...don't really have an outside hobby ...maybe a woman will come along ...and my perspective will change... a program that'll work you super hard but the finished product will be an awesome all around surgeon.
Programs are actually AVOIDING individuals (like you self-describe) with such a... for lack of better words... narrow perspective and functionality. It is quite common for high-end programs to force some residents to get a hobby! Two points;

One, patients spot the "life-less" and socially inept from a mile away.... so do hospital administrators; neither are good for a career. Without intending to be mean, you describe yourself as socially dysfunctional. Socially dysfunctional and/or inept are easy targets for misunderstandings and/or lawsuits. Five or more years of self imposed social isolation (or at least isolated from the non-clinical) will asure you do not improve socially.

Two, programs "that'll work you super hard" traditionally do NOT train "awesome all around surgeon". A program that hires a surgical robot is looking for man/woman power and not for someone to train.

As for your original question, bravado aside, if you want technical exposure, as was mentioned earlier
a high(er) volume program would be good. However, excessively high volume can impinge on any actual science education...critical to "awesome all around surgeon". Training just like living one's life is about ...balance. We all love the OR. But, the less enjoyable academic type teaching is actually crucial for providing awesome care for our patients.

JAD
 
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Programs are actually AVOIDING individuals (like you self-describe) with such a... for lack of better words... narrow perspective and functionality. It is quite common for high-end programs to force some residents to get a hobby! Two points;

One, patients spot the "life-less" and socially inept from a mile away.... so do hospital administrators; neither are good for a career. Without intending to be mean, you describe yourself as socially dysfunctional. Socially dysfunctional and/or inept are easy targets for misunderstandings and/or lawsuits. Five or more years of self imposed social isolation (or at least isolated from the non-clinical) will asure you do not improve socially.

I've got to follow up on this. OP, I've got to agree that you came off as fairly dysfunctional in your posts here. Aside from patient likeability, etc., you seem ripe for burnout early in you career. Humans are social creatures, and it's actually pathological not to want to associate with other people. As much as you like being in the or, being a surgeon is not going to fill these voids in your life. I'd actually recommend counseling and not putting yourself in a situation that will just reinforce your psychopathology.

Also, editing to add that the surgery residents I'm with seem pretty social with each other, and it looks like they rely on each other a lot for emotional support during their pretty grueling training. I wouldn't think other residents would want someone so disinterested in social interaction in their program. So even if you don't change, keep these thoughts on the downlow during interviews.
 
out of curiosity has anybody done in-house q3 call for 5 years? i did q4 during my surgery rotation for three months and had no prob handling it. i realize three months is different from 5 years, and as a med student vs. a resident to boot. does that call schedule drain you out or is it something you get used to?
 
out of curiosity has anybody done in-house q3 call for 5 years? i did q4 during my surgery rotation for three months and had no prob handling it. i realize three months is different from 5 years, and as a med student vs. a resident to boot. does that call schedule drain you out or is it something you get used to?

It does drain you but I also think (and this is somewhat of a controversial opinion here) that you can get used to it. Getting used to is does not imply that you feel well but rather you are not as exhausted as you were once. At least that was my experience that I was much more tired doing weekly in house call as a Chief resident than I was doing it more frequently as a more junior resident. Then again, I had more responsibility so perhaps that was the reason for the exhaustion.

And please do not assume that your experience as a medical student doing q4 call is ANYTHING like doing it as a resident. You had no responsibilities, no threat of being sued, no real fear of being yelled at and humiliated or perhaps hurting someone if you forgot to do something or somehow screwed up. And yes, doing call every 3rd night (or more frequently in the old days), does take it toll month after month, year after year.

I was somewhat like you as a student. I wanted an academic career, didn't really care about anything other than being a surgeon (although I was still fairly social). Come residency, I met someone very important and suddenly, being in the hospital wasn't so stimulating. I wanted to be home with him. Perhaps you just haven't had that sort of relationship yet, or as others have stated, perhaps you do have schizotypal personality traits. It doesn't matter the reason, but excluding those experiences from your life do not make you a good surgeon. A good surgeon is not only a good technician, but a good physician who can relate to his patients, interact and sympathize with them.

Finally, Doctor Bagel makes a good point about social interaction. My residency colleagues (in addition to my SO, a surgery resident at another program) were an immense source of support. We supported each other during times of fatigue, humiliation, family crises and joys and you cannot underestimate how valuable that is. Be a resident who isolates themselves from the rest of the "team" and you will find that no one is willing to help you when you might need it.
 
At least that was my experience that I was much more tired doing weekly in house call as a Chief resident than I was doing it more frequently as a more junior resident. Then again, I had more responsibility so perhaps that was the reason for the exhaustion.

can u elaborate on that? i've heard that several times but not the explanation behind it. because as an intern you're expected to know everything about all the patients and you're always getting asked by the upper years this and that about the patients so you have to be on top of it all. plus the constant paging. not to mention all the floor/scut work you have to do because you are the intern that the seniors don't have to do.
 
can u elaborate on that? i've heard that several times but not the explanation behind it. because as an intern you're expected to know everything about all the patients and you're always getting asked by the upper years this and that about the patients so you have to be on top of it all. plus the constant paging. not to mention all the floor/scut work you have to do because you are the intern that the seniors don't have to do.

Good Chiefs know everything that the intern knows. Just because the resident asks the intern something doesn't mean he doesn't already know the answer; this is ONE reason why you never lie.

Secondly, work =/= responsibility. Yes, as an intern you are responsible for getting the work done, but if it doesn't get done, or you make a mistake, you are given leeway as the intern.

It is the Chief's responsibility to make sure that the intern is doing his work, doing it correctly, learning, etc. If something goes wrong, it is the Chief's fault, not the intern - fair or not, that's how its perceived.

The Chief is responsible for running the service, placating all the attendings and operating while still making sure that everything that is supposed to be done for the patients is done. That' why we get so upset with interns who aren't doing the work - WE get yelled at by the attendings.

Interns are almost never named in surgical lawsuits, despite the fact that floor care is almost always up to them. Chiefs and senior residents are responsible for their oversight and are therefore, usually seen as being more responsible and of course, being closer to having an income against which a suit can be brought.

Believe me, having a lazy, stupid or worthless intern makes the Chief resident's job much much harder, as all the problems will come down on YOU to fix. Maybe in your experience the senior residents were just sitting around eating bon bons while the interns were running around doing all the work but in my program, senior residents with that princess attitude were knocked down a peg. It was a team effort and I didn't give a damn if you were a 4th year resident, medical student or an intern when someone's drain needed to come out...SOMEONE did it. Even me.

Is the intern's life hard? Absolutely. I am not minimizing that but many students and junior residents also misunderstand the level of responsibility, ownership of the patient and general anxiety prevalent amongst senior level residents and Chiefs.
 
out of curiosity has anybody done in-house q3 call for 5 years? i did q4 during my surgery rotation for three months and had no prob handling it. i realize three months is different from 5 years, and as a med student vs. a resident to boot. does that call schedule drain you out or is it something you get used to?

Just for reference in the late 1990's early 2000's we used to do Q2 in house for 2-3 month stretches doing trauma/emergency general/burn. That turns you into walking corpse. I can remember being excited when we added a cross-cover service and it broke the Q2 up every 3rd call to go Q2-Q2-Q3.😱

I think we used to have 40% of our 5 years on that Q2 schedule, 50% Q3, and the other 10% maybe q3-4 depending upon how many bodies were on certain services. Q3 is managable, but tends to wear you down over time if you don't get a weekend here or there off completely. Q4 is pretty "comfortable" (if you can say that about being a resident)
 
Just for reference in the late 1990's early 2000's we used to do Q2 in house for 2-3 month stretches doing trauma/emergency general/burn. That turns you into walking corpse. I can remember being excited when we added a cross-cover service and it broke the Q2 up every 3rd call to go Q2-Q2-Q3.😱

I think we used to have 40% of our 5 years on that Q2 schedule, 50% Q3, and the other 10% maybe q3-4 depending upon how many bodies were on certain services. Q3 is managable, but tends to wear you down over time if you don't get a weekend here or there off completely. Q4 is pretty "comfortable" (if you can say that about being a resident)

And you might want to add that in the old days we didn't always go home post-call. You went home after evening rounds and the work was done...the next day.
 
...I've got to agree that you came off as fairly dysfunctional in your posts here. Aside from patient likeability, etc., you seem ripe for burnout early in you career...I'd actually recommend counseling and not putting yourself in a situation that will just reinforce your psychopathology...
agreed:claps:
...in the old days we didn't always go home post-call. You went home after evening rounds and the work was done...
Yep, home by 8:30pm post-call on vascular service.... had to love the learning:smack:
 
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yikes easy there with the armchair psychoanalysis. i get along fine with patients and colleagues. no complaints there. just i don't hang out with people much and rather chill by myself. cordial to everyone at work but i'm not the type that's going to grab a drink with you or come to your get together.
 
agreed:claps:Yep, home by 8:30pm post-call on vascular service.... had to love the learning:smack:

Ha ha...that's exactly the service and in particular, one Chief I was thinking of.

MG/Chief - "I'm going home for dinner and when I get back, we'll round."

Intern: "Do you know when that will be? I'd like to let my SO/wife/family know about what time I'll be home."

MG/Chief - "No, I DON'T know and you don't need to know either. I'll be back when I'm back."
🙄
 
yikes easy there with the armchair psychoanalysis. ...i don't hang out with people much and rather chill by myself...
Like I said, my (probably "our") intentions are not to be mean in this respect. Your posts do come accross as either a socially dysfunctional person or uninformed attempts at bravado.
...i want to do my gen surg residency at a real old school program. ...being worked extra hard or taking in-house q3 call all 5 years...
...i think being a surgeon will pretty much be the main thing in my life. i'm an introvert, don't really have an outside hobby and i get super bored when i go out with people to do the social stuff everyone else seems to live for ...never had the desire to get married either. in fact when i'm doing those social things my thoughts are on surgery ...when everyone takes off ...i'm the one who stays to scrub in on cases for as long as it takes...
Take this as you see fit. It is actually offered as well intentioned advice from someone that has done surgery and seen numerous applicants to surgery over many years and spoken with attendings and program directors on said applicants.

The sure way to NOT get into a residency is to provide the programs with the impression that you are "not fun" and have no life outside of surgery. If your representation of yourself is correct, I would imagine an application with good scores and NO hobbies or extracurricular activities. Programs do actually look at that. It is just like the advice of getting into Universities and med-schools. Residencies in general want a "well-rounded" human being. During those late nights or long cases, the attending discussion may be about social activity/ies and hobbies. Telling an attending, "I don't socialize with others....I rather chill by myself".

If you really want to get in a surgery program of any quality and substance, I would suggest you not give the line..."I live for surgery, everything I do is about surgery, I eat, breath, sleep for surgery..."

If you self described isolation type behavior is real (not bravado to somehow impress anonymous folks on a forum), I concur with what is said.... in short, you should avoid surgery and obtain counseling.

JAD
 
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just i don't hang out with people much

i'm not the type that's going to grab a drink with you or come to your get together.
One of the reasons that some programs have an evening get-together or party for interviewees isn't just to show them a good time and increase where they're getting ranked, but also to gauge applicants' social interacting skills. If you're going to be the guy who's obviously uncomfortable, or not having a good time, you're probably also going to be the guy to skip out on departmental and service outings, and hence may be identified as someone who may have difficulty gelling with the program. Being sociable is important in building comradery in just about any team. This isn't as black and white as say the guy who just hides in dark corners, but if you're obviously the kind of person who'll only interact with others because you "have" to, programs can spot that. Even if you have excellent numbers and are 99% committed to the field, you still may end up having trouble matching.
 
ok i hear what u guys are saying but i think you're overemphasizing it. yes my stats are very good and believe it or not i've been told by attendings and residents where i did my surgery rotation that they'd love for me to apply and be a resident there. as i said before i get along just fine with people at the hospital so i dont see what the big deal is if i'm not all buddy buddy with them outside the hospital. i keep to myself and i was never into the social scene in high school or undergrad anyway. and i totally dislike small talk, like i care what you did on the weekend or whatever, i'll humor you and listen because i'm not rude but i'm not going to further the convo. besides i know residents/attending who are not social and they've done fine. there's some surgeons, some of them very renowned, who don't even acknowledge med students and lower level residents inside let alone outside the hospital. not saying that's cool but just saying that's sort of proof u don't have to be mr. charismatic to do well.
 
...i know residents/attending who are not social and they've done fine...some of them very renowned...just saying that's sort of proof u don't have to be mr. charismatic to do well.
:beat:probably. There are numerous examples of successful senior surgeons with significant dysfunction. You will ultimately do as you choose. If you can get a residency in which the traits you espouse and/or value are supported, by all means go for it. After all, no matter what we say, residency success is in many ways dependent on a "good match" or "good fit".

I will just close by saying the old-model surgeon, non-social, if not down right robotic, is not where things are and probably not where they are going.
With all sincerity, good luck.

JAD

PS:
One of the reasons that some programs ....programs can spot that. Even if you have excellent numbers and are 99% committed to the field, you still may end up having trouble matching.
how do you know this stuff? are you on the admissions committee? Based on your previous posts, you weren't even a medical student in 2006/2007!!!
 
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