I came across this thread while surfing through the forums for info on fellowships. As a resident in the IM residency program at the Cleveland Clinic, I felt compelled to post a response. The timing of the OP to coincide with the start of the new residency application cycle, the glaringly convenient omissions, and the clear bias and lack of objectivity, I feel, would make this post suspect to anyone let alone someone with first-hand experience and knowledge. Not only does it reek of desperation and ulterior motives but of someone doing the program's (or program director's) bidding. I think intentionally misleading and misrepresenting the facts does future residents and this entire community--which far too often are their own worst enemy--a great disservice.
I am a Case medical school graduate...
First of all, there were no Case medical graduates in the program for the 2008-9 or 2009-10 academic years and, therefore, none of the current PGY-2 or PGY-3s are Case graduates. I don't know why the OP (if in fact they are a resident at all) felt the need to misrepresent their undergraduate medical education. It would be exceptionally rare for a Case graduate to come to the Clinic for IM training though some do stay on at UH. Many argue that UH offers the better training and educational experience. And the wide disparity that seems to exist between the reputation of the hospital and that of the Clinic's IM program is something that has been debated on SDN before. The lack of Case graduates in the Clinic's program, the fact that at least some Case graduates stay on at UH while virtually none end up at the Clinic, and the fact that none of the students (from the two classes to graduate to date) from the Lerner COM have joined the categorical IM program at the Clinic tends to support both assertions.
The fellows do not do all the work at the clinic...Renal, hem-onc, gastroenterology, hepatology, cardiology have their own services which are run by the residents. The fellows do not compromise our education."
This is true for the most part. Certain rotations such as the CICU are essentially run by the fellows. However, patient management on subspecialty services like renal, hem-onc, and cardiology teaching primarily involves the intern and senior resident in consultation with the attending on service while the fellow remains on the fringes or is not even present.
The renal (Gifford) service tends to be among the better teaching services where attending staff seem to be more interested in teaching. This stands in stark contrast to hem-onc and cardiology teaching where service is grossly disproportionate to education. For rotations such as these where patient turnover is extremely high, there is very little or no protected teaching time outside of rounds (which while presumed to have inherent educational value) are often hastily carried out with emphasis on expediency and little time for discussion due to the volume and acuity of the patients. Hem-onc is the bigger offender in that regard but that is not to say that as a rotation it is not without any benefit. You do learn to medically manage oncology patients and oncologic emergencies but do so largely through sheer volume and on your own rather than being guided in any concerted way.
The cardiology teaching service is routinely ridiculed here by the residents for its poor teaching (so much so) that I expected much worse. While the teaching wasn't as bad as I had anticipated based on other residents' feedback, I certainly would not describe it as great and it clearly suffers from the high patient turnover and slant on service versus education. One of the biggest turn-offs of the rotation is the reliance on the teaching service to "babysit" (sometimes for >1 week with little to no educational benefit) the cardiothoracic patients prior to surgery all the while waiting for them to go to the OR. This, I felt, was certainly an abuse of the medical residents. But, of course, the practice of "dumping" surgical patients on medical services is nothing new and, while rampant here, is certainly not unique to the Clinic. It just seems more magnified here due to the volume of patients. There is a virtual assembly line set up for CT surgery patients at the Clinic to take advantage of their reputation in heart care.
As an intern the educational benefit of rotating on either the hem-onc or cardiology subspeciality service is rather limited with service trumping education nearly all the time. Both services have a float system so as a senior you do not take call but are responsible for supervising two interns and up to a total of 20 patients. These services can be a nightmare as a senior since both cap easily with both high turnover and patient censuses combined with high admission complexity and acuity. Many, if not most, of the patients you manage on the floor would be in an ICU at most other institutions. The trade-off as a senior in terms of education is definitely better despite being responsible for a busy service. As a senior your hours are better and you at least have time to read about your patients where as an intern you literally have none.
While it is true that most of the subspecialty rotations are not run by the fellows, one notable exception is the Green (GI/Liver) service where the fellows figure prominently and nearly all major patient management is essentially decided between the attending and fellow on service who then, essentially, just hand down their decision to be implemented by the senior resident and intern. Some of the GI attending staff literally take it as an insult if approached by a resident outside of rounds regarding patient-care related issues and even insist that all questions/concerns be directed at the fellows and have quite limited interaction with rotating residents.
Some attendings (with the fellow present) do table rounds or "card-flip" with the senior and intern while others use the time allotted for rounds to dicuss topics in GI or hepatology. They then conduct their own rounds with their fellows on your patients. As they round on each patient, the fellow pages either the intern or senior incessantly to place orders that they have decided (but have not included you in on the decision-making process or their reasoning). Even if the attending does table rounds with the team they see the patient only with the fellow who then pages the senior or intern with orders.
"My class had a great fellowship match this year as did the year before us. We matched over 20 in cardiology. Our hem-onc applicants all matched, and at good programs as well (Hopkins, Washington, Colorado, CCF
). Pulm, GI, endocrine, allergy, renal. Only a few went unmatched. And an additional part of that myth is that the Clinic doesnt take its own residents for fellowship. The GI fellowship program took 4 Clinic residents this year. Hem-onc, renal, cards and pulm-ICU took Clinic residents as well."
The poster's attempt to dispel the "myth" that the Clinic does not take their own residents was particularly laughable in addition to being an attempt to completely misrepresent the truth. I think few would dispute the "flagship" IM subspecialty fellowship at the Clinic is cardiology. The OP while mentioning the number of residents that matched into GI at the Clinic conveniently left out the number that matched into cardiology.
The fact that the Clinic has the largest cardiology fellowship program in the country as well as one of the largest IM programs (40 per class) yet consistently takes only one (and apparently at times in the not too distant past none at all) is a testament to the "myth" that they do not take their own residents (if they can help it). The Clinic can be picky with who they choose to join their cardiology fellowship due to their large and highly-qualified applicant pool (and usually are as many of their fellows trained at top-tier IM programs). And they certainly have the right to do so but do not have the right to make the claim that they welcome their own residents.
This year there was certainly more than one highly-qualified resident in the IM program (with comparable scores, awards, research, and publications in top peer-reviewed cardiology journals) but only one was ranked highly (or high enough to ensure a match). The process of choosing the one resident from the IM program seems to be quite political (shocker, I know). The resident tends to be an IMG with the right connections or research mentor. For an IM resident in the program to match into cardiology here you have to know how to "game the system" (which is to say you need to have the right connections and be able to suck up like an industrial strength Hoover to the right people). This year it was an IMG. Last year they actually took two. One was an IMG and the other a D.O. whose father is an interventionalist at the main campus (yes, nepotism is alive and well). Both residents were good but any advantage they had over many of their fellow residents (outside of political forces) would be highly debatable.
The fact remains that (percentage-wise) the number of their own residents accepted into the fellowship program is abysmally low and has to be among the lowest, if not, the lowest. The remainder of the cardiology match list (while certainly not stellar) is actually not that bad considering the number of IMGs in the program. Last year's list was similar or slightly better (e.g UPMC, UCSD, Minnesota, Washington University). Given that it is the Cleveland Clinic, the number of residents in each class seeking cardiology fellowships is disproportionately high. Maybe slightly more so than other programs. It is probably true though, that regardless of your status as an AMG or IMG, most residents here that want cardiology have a good chance of matching into a position somewhere though maybe not at one of their top choices.
GI at the Clinic tends to be much less competitive and, comparatively speaking, IM residents fare better with the match overall than in cardiology. One resident from the past two graduating classes has matched at Mayo Clinic. This year's resident was actually a D.O. Last year was the former chief resident who was an IMG. It is true that this year they filled all 4 positions with their own residents. What the OP did not mention was that this is an anomaly and rarely, if ever, happens. They usually only take one or occasionally two. What you also were not told is that the fellowship program director apparently made it known (by actually telling a group of residents) that he did not want internal candidates. Though that may be hearsay, the fact that a supposedly top-ranked GI fellowship could only fill with internal candidates (all IMGs, two of which were Caribbean) would probably be troubling to many potential applicants and raise questions as to what problems may lurk beneath the surface particularly if one is to believe the fellowship program director's comment. One can only presume that many of the most competitive applicants did not rank the program high on their lists (or at all) for the GI program at the Clinic to end up with only internal candidates.
As for Pulm/CC, nearly all the fellows are IMGs who either did their residency somewhere else in the U.S. or at the Clinic. The truly competitive candidates elsewhere and at the Clinic go somewhere else if they can. One of the former chiefs who was an AMG went to Hopkins but, unfortunately, those are by far the exception rather than the rule.
Below is the complete fellowship match results for this year.
2010 Fellowship Match - Cleveland Clinic Internal Medicine Residency
Alphabetical list of programs where residents matched
Cardiology (20)
Caritas St. Elizabeths Medical Center (Boston, Massachusetts)
Case Western Reserve University / MetroHealth (Cleveland, Ohio)
Case Western Reserve University / MetroHealth (Cleveland, Ohio)
Cleveland Clinic (Cleveland, Ohio)
Lankenau Hospital (Wynnewood, Pennsylvania)
Maimonides Medical Center (Brooklyn, New York)
Medical College of Georgia (Augusta, Georgia)
Ochsner Clinic (New Orleans, Louisiana)
Ochsner Clinic (New Orleans, Louisiana)
SUNY at Stony Brook (Stony Brook, New York)
University Hospitals Case Medical Center (Cleveland, Ohio)
University of Arizona (Tucson, Arizona)
University of Illinois at Chicago (Chicago, Illinois)
University of Illinois at Chicago (Chicago, Illinois)
University of Kansas (Kansas City, Kansas)
University of Kentucky (Lexington, Kentucky)
University of Maryland (Baltimore, Maryland)
University of Minnesota (Minneapolis, Minnesota)
University of Texas at San Antonio (San Antonio, Texas)
University of Toledo (Toledo, Ohio)
Gastroenterology (6)
Cleveland Clinic (Cleveland, Ohio)
Cleveland Clinic (Cleveland, Ohio)
Cleveland Clinic (Cleveland, Ohio)
Cleveland Clinic (Cleveland, Ohio)
Mayo Clinic (Rochester, Minnesota)
UCLA Medical Center (Los Angeles, California)
Hematology/Oncology (6)
Cleveland Clinic (Cleveland, Ohio)
Johns Hopkins University (Baltimore, Maryland)
University of Colorado Denver (Aurora, Colorado)
University of Florida (Gainesville, Florida)
University of Florida (Gainesville, Florida)
University of Washington (Seattle, Washington)
Pulmonary/Critical Care (5)
Cleveland Clinic (Cleveland, Ohio)
Cleveland Clinic (Cleveland, Ohio)
Cleveland Clinic (Cleveland, Ohio)
Cleveland Clinic (Cleveland, Ohio)
Yale University (New Haven, Connecticut)
Rheumatology (2)
Albany Medical Center (Albany, New York)
University of Chicago (Chicago, Illinois)
Nephrology (1)
Cleveland Clinic (Cleveland, Ohio)
Infectious Diseases (1)
Cleveland Clinic (Cleveland, Ohio)
Endocrinology (1)
Tulane University (New Orleans, Louisiana)
Allergy/Immunology (1)
Albert Einstein College of Medicine/Montefiore (Bronx, New York)
"The myth of the clinic being a malignant program is also out of date. It sounds as if that may have been true several years ago, but since a new program director has taken over (Dr. Nielsen), things are no longer that way. He has made many changes in the schedule to make sure residents arent going over their hours. Problem areas have been targeted and fixed so this is no longer an issue."
While I would be hesitant to call the IM program at the Clinic "malignant", it is certainly lacking and leaves much to be desired when it comes to resident support. This is, I feel, one of the weakest points of the program. Whether it is a consequence of the program size or just sheer apathy on the program's part, this is not a program that will make you feel all warm and fuzzy inside (unless of course your temperament veers towards frosty and detached). In my experience, the aloofness and unsympathetic nature of the program's administration and many of the IM staff has been truly disappointing. The success of the residents in obtaining fellowships at all is much more a reflection of their drive, dedication, and determination than guidance and support from the program. On the other hand, one of the stronger points of the residency is the camaraderie between the residents which is pretty decent for a program this size. While the IM program has it's fair share of arrogant, haughty residents with a misplaced sense of self-entitlement, many of the residents are easy to work and get along with.
I think the perception of the Clinic as a whole as being malignant comes from their "big-brother-like" corporate mentality. You do get the sense working here that Cleveland Clinic is a "brand" and has committed itself more to that than being a research or academic teaching institution. The unceremonious dumping of several of it's most prominent staff physicians (e.g. Topol, Yadav) in recent years doesn't exactly help dispel the "myth" that this is a malignant place to work. Maybe the only people who are not made to feel expendable and who can operate with relative impunity are Cosgrove himself and possibly his fellow CT surgeons.
And as for the changes made by the current program director, I would argue that any change here is almost always reactive rather than proactive and comes slowly if at all. Yes changes have been made in recent years to services/rotations to comply with duty-hour and other ACGME requirements. But a PD deserves praise and a pat-on-the-back for making changes to comply with an ACGME mandate no more than a "competent" resident who provides just the standard-of-care. When was the last time you as a resident were praised for doing what is expected of you? Very little has been done to improve the resident experience outside of that for which an outside mandate has not been placed.
Despite the changes that have been made, the IM program here is heavily front-loaded so it is common (for interns at least) to average over 80 hours/week on certain rotations particularly GI, hem-onc, and cards teaching (and even the gen med services) where the sickest patients (outside of the ICU) tend to be. Depending on how helpful (or unhelpful) your senior is it may be quite easy as an intern to average over 80 hours on certain rotations. Many interns do not bother reporting their hours at all or underreport their hours. As an intern, I rarely reported all my hours and many others have told me the same. As a senior it is very difficult or next-to-impossible to average over 80 hours so this essentially becomes a non-issue. All of this may be a moot point if the proposed ACGME 16 hour work limit for PGY-1s takes effect next year.
"...we do have a cap on the number of patients we can admit."
This is an ACGME mandate not a perk to advertise about the program as if it doesn't exist elsewhere.
This is a large residency program, and for a while, it had trouble getting the residents it wanted because of the status. But since the change in program directors, the classes are getting stronger and stronger as evidenced by feedback from the hospital, research competitions, and fellowship matching results.
Vague comments such as "as evidenced by feedback from the hospital" do very little to support the OP's claim and are doubtful to be an accurate reflection of "class strength". So the hospital is providing residents with feedback on other residents? This would only make one suspect even more that the OP is one the program's lackeys (read chief resident, resident committee member, etc.). I didn't realize that your average resident has access to that information. And one could argue that the program under the current PD closely resembles, in many aspects, that of the former PD. In terms of the number of DOs and IMGs the composition of the current program is very similar to that under the previous administration.
For the 2009-10 academic year, the PGY-1 class was comprised of 40% U.S. allopathic grads, 35% DOs, and 25% IMGs; the PGY-2 class was 23% U.S. allopathic grads, 35% DOs, and 25% IMGs; and the PGY-3 class consisted of 33% U.S. allopathic grads, 23% DOs, and 44% IMGs. I think few would offer that those are the stats of a program that does not have "trouble getting the residents it wants". All this is not to knock DOs or IMGs. The number of DOs and IMGs definitely adds to the diversity of the program and they are as capable (if not more so) than many AMGs. Many have stellar academic records. It is remarkable to hear so many languages being spoken by staff of all levels around the hospital and it is a testament to the diversity at the Clinic even if it is not by design.
However, for a hospital with top-ranked IM subspecialties the number of DOs and IMGs is conspicuously high and it is the "elephant in the room" that few (certainly none of the residents) seem to want to acknowledge.
I highly doubt there are analogous IM programs in similar positions at other top-ranked hospitals. It is difficult to believe that it has occured of the program's own volition rather than the (more plausible) sense that the AMGs who interview here just do not rank the program highly (or at all). Whether that's based on notoriety, bad vibes, or whatever the case may be, it's something into which the program seems to have little insight.
"The fact is that the myths of the Cleveland Clinic are ancient and the residency program has greatly been revised. These myths are self-perpetuating and my classs goal is to help put an end to them...So next time you hear one of these things said of the Clinic, make sure you check your source and what specific information that person is basing their statement on"
Despite claiming to be a resident with first-hand knowledge, the OP has offered little-to-no proof or specifics to support his assertions (conveniently omitting facts and speaking mostly in vague terms) while challenging others to do better. "Myths" are by definition fictionalized accounts. The "myths" the OP has mentioned are clearly not that at all but have a basis in reality. If the OP truly seeks to dispel myths or change perceptions, they would be well-advised to take their own advice to avoid deliberate attempts to misinform others.
For those of you who have managed to read through this in it's entirety, I acknowledge that any singular post or opinion in any of these forums (including my own) is likely going to be subjective. I would never pretend to not have at least some bias but my intention was not to misinform (as it appears the OP's intent was) but present a different and (at least somewhat) more balanced view than the rather "rosy" picture painted by the OP.
Had the OP's thread never appeared I doubt this post would have ever seen the light of day. In the end, I doubt this will sway (and was not truly meant to sway) anyone's opinion who is seriously considering the IM program here. Competitive U.S. allopathic grads will continue to avoid it while DOs and IMGs looking to match into competitive fellowships (especially cardiology) will continue to come here for lack of a better option.
. Pulm, GI, endocrine, allergy, renal. Only a few went unmatched. And an additional part of that myth is that the Clinic doesn't take its own residents for fellowship. The GI fellowship program took 4 Clinic residents this year. Hem-onc, renal, cards and pulm-ICU took Clinic residents as well. 
