Maimonides Medical Center Program Residency Reviews

Here's some biased but honest review of Maimonides, mostly info not well known and I get asked about.

1)No Fast Track Shifts. That's right, Maimo EM residents don't do fast track shifts. The patients are already pretty sick at Maimo, and that's the type of solid EM training you get at Maimo all 3 years without any fast track shifts. The residents do see fast track patients during nights/early morning when fast track is closed, when there aren't many fast track patients anyways, and that's already enough exposure to fast track, because like trauama, how much do you really need to do? People do EM not because they want to see lots of sore throats and the simple lacs. Residency programs, both 3 and 4 years, typically provide 21 - 25 rotations in the ED, but residents commonly do 20%-30% of shifts in fast track. After subtracting the fast tract, that's like getting 15 rotations in true EM training. Fast track is part of an EM physician's job definition but it's definitely not emergency medicine. Now I can't imagine doing even a single 12 hour shift entirely in fast track, later maybe, when I'll be compensated accordingly after residency.

2)Strong Peds. Maimo houses the Children's Hospital of Brooklyn and it's the only Children's hospital in Brooklyn and the peds pathology here is excellent. Even if you're not interested in peds EM, it doesn't mean you can get away doing less peds at a program with weak peds. Weak peds is just boring and it's like fast track in a sense. Most academic programs require basically the same amount of peds exposure anyways, so you might as well learn something instead of doing boring peds. There are programs out there that don't even have PICUs in the hospital. Beware.

3)Strong specialty services, especially in Card. and Neuro. Card is ranked top 5 in the nation by healthgrades and Govt. study shows that Maimo is the only hospital in New York State that has lower mortality rates than national average in MI, heart failure, and pneumonia, and it's one of the nine hospitals in the nation with those stats in all 3 categories studied. No doubt the Maimo ED played an important role in that, but it's also the quality of the specialty services and ED's relationship with them. You feel good providing your patients with that kind of care.

4)Strong staff. Besides the nursing staff, Maimo ED hires extra people to help. An "expeditor" tracks down labs, make phone calls, schedule image studies and transport, bascially do the logistics for you. "Patient Reps" will interact with patient and their family for you, translate, get them a blanket, help you track down family member for medication list...etc bascially services that patients deserve that's not medically related. Research assocaites will do the paper work, collect data..etc in the ED for your research.

----------------------addition 09/2011

Here is some multimedia that captures the vibe at Maimo pretty accurately. The Maimo people you see in here are awesome and really are the type of bosses and colleagues you want to work with.

New York Times
http://video.nytimes.com/video/2010...ting-brooklyn.html?scp=4&sq=Maimonides&st=cse
http://lens.blogs.nytimes.com/2010/...an-emergency-room/?scp=1&sq=Maimonides&st=cse
http://www.nytimes.com/2010/10/03/nyregion/03emergency.html?_r=1

http://www.nytimes.com/2008/05/11/nyregion/thecity/11hosp.html

NY1
http://brooklyn.ny1.com/content/top_stories/146712/brooklyn-hospital-simulates-large-scale-response

Julie Salamon
http://www.ovguide.com/video/julie-...ergency-room-922ca39ce10036ba0e118e82226bee04

Dr Marshall
http://www.maimonidesmed.org/Main/VideoLibrary/Video-Profile-of-John-Marshall-MD-86.aspx
http://vimeo.com/26022711 at Graduation EM 2011

EM Class of 2009
http://www.youtube.com/watch?feature=player_embedded&v=UfW5DoyMJoI Graduation Video

EM Class of 2011
http://www.youtube.com/watch?v=UnZynl7Pzyg&feature=related Graduation Video

This is a review sent to me by a SDN user who interviewed there and wishes to remain anonymous. I am posting it verbatim as a service for the SDN community.

Maimonides (Brooklyn)

Pros: Very busy urban ED with high admission rate (their patients are sick). The ED was also redone within the last 5 years. The PD could have sold a ketchup popsickle to a woman in white gloves and was very convincing.

Cons: Level 2 trauma center. Two months of trauma spent at Shock Trauma in second year with little trauma exposure otherwise. Option between international elective or month at Downstate for trauma in third year.

Impression: Trauma definitely isn’t everything, but I’d rather have some continuous exposure to it instead of 34 months without any and then 2 months of intense trauma.

2 points.

First, trauma not only isn't everything, it's barely anything compared to the rest of EM training.

Secondly, Level I and II mean very little in NYC. Either way you're not gonna get a steady exposure to trauma. Maimo does see traumatic emergencies and arrests that are unstable to wait for level I, while all other stable traumas like a big knife lac that you'll end up spending an hour to repair with very little learning value end up at a level I.

I personally think it's a disservice If the level I trauma centers in NYC(even the big county self-proclaimed "busy" trauma centers) don't send their residents away for trauma, because there just isn't much high speed, water sports, farming, wilderness, not to mention little penetrating compared to the national level.

Many residencies can't afford to lose salaried warm bodies to outside rotations even though it's in the resident's best interet. Maimo, being a shorty 3yr resdiency, has internal debates here and there about sending their residents away for 2 months at Shock Trauma Center, but at the end the admin believes that's a worthy investment, including paying for a luxury condo with gym/doorman while there. it also pays a $1000 stipend for an optional "international trauma" month in your 3yrd year.

The Shock Trauma Center is regarded as the busiest trauma center in the nation, and I can't imagine a more complete array of traumas including all types mentioned above. I don't think it's an exaggeration that on a busy 24hr trauma call, where there can be 40 - 60 true level I trauma patients already filtered by the state system(you can't just walk in), you could probably see more and better and wider array of traumas on that 24hr call than what you could see during an entire year, or 2, or3, at many if not all so-called level Is in NYC. Personally I think 2 months is nauseatingly more than enough.

Any new reviews for this program?

kmb1908 said:

Any new reviews for this program?

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Ya. Any new Reviews?

I rotated there back in August - I go (soon to be "went!") to a school with no home EM program, so this was my very first experience. And I absolutely loved it. Like those above have said, the patients at Maimo are VERY sick, mainly due to their age - the average patient there is quite old (I think the stats they told us was avg at Maimo was 10-15 years older than national avg). More often than not, the Resus Bay acted as a makeshift ICU because of how sick they were. I learned some critical care pretty well there.

The hospital is located at the crossroads of Boro Park, which is highly Orthodox Jewish, and Sunset Park, which is mainly Chinese. Throw in some Arabic, Urdu, Russian, Spanish, etc., and you find that English is one of the less useful languages there. There's a dedicated Unit Coordinator who's great at calling translators, finding you a phone, etc. but the place is so unbelievably busy that sometimes you go with what you got. Most of the nurses speak at least one other language, and they're usually more than happy to help.

The ED has two sides, a high-acuity side and lower-acuity side. The lower acuity side is a madhouse. Beds are stacked two- to three-deep from the wall, which means nurses and techs constantly have to play Tetris to move patients in and out. The equipment and general state of the ED is old and dingy on that side - it's definitely a "do more with less" kind of place. The high acuity side was updated a few years ago, and the Peds ED just got a new Level I trauma bay. I believe that Maimo's Peds ED is now the only Level I Peds trauma center.

John Marshall, the Department Chairman, is AWESOME. I really enjoyed learning from him.

Fun extras: they do a lot of event medicine - meaning the seniors serve as medical staff at some Yankees (or Mets? can't remember) games, some Giants/Jets games, local concerts, etc. They also offer a Medical Journalism elective for PGY-3s, in which you spend a month working with a major media outlet, writing/reporting about medicine!

Changes to the curriculum not mentioned above:
-There is now only one month of Trauma at Shock
-Seniors (PGY-3s) also spend a few Trauma shifts per month at Brookdale

Maimo is a fantastic 3-year program, and even though I won't be going there, I highly recommend it to anybody looking for a strong program in NYC.

Maimo is neither a level 1 adult nor pediatric trauma center. Although, to be fair, the distinction in NY with trauma designations often doesn't make much difference.

According to the link below, Kings County is the only trauma center (regional) for peds in Brooklyn

https://www.health.ny.gov/professionals/ems/state_trauma/trauma2.htm

tastyb33f said:

I rotated there back in August - I go (soon to be "went!") to a school with no home EM program, so this was my very first experience. And I absolutely loved it. Like those above have said, the patients at Maimo are VERY sick, mainly due to their age - the average patient there is quite old (I think the stats they told us was avg at Maimo was 10-15 years older than national avg). More often than not, the Resus Bay acted as a makeshift ICU because of how sick they were. I learned some critical care pretty well there.

The hospital is located at the crossroads of Boro Park, which is highly Orthodox Jewish, and Sunset Park, which is mainly Chinese. Throw in some Arabic, Urdu, Russian, Spanish, etc., and you find that English is one of the less useful languages there. There's a dedicated Unit Coordinator who's great at calling translators, finding you a phone, etc. but the place is so unbelievably busy that sometimes you go with what you got. Most of the nurses speak at least one other language, and they're usually more than happy to help.

The ED has two sides, a high-acuity side and lower-acuity side. The lower acuity side is a madhouse. Beds are stacked two- to three-deep from the wall, which means nurses and techs constantly have to play Tetris to move patients in and out. The equipment and general state of the ED is old and dingy on that side - it's definitely a "do more with less" kind of place. The high acuity side was updated a few years ago, and the Peds ED just got a new Level I trauma bay. I believe that Maimo's Peds ED is now the only Level I Peds trauma center.

John Marshall, the Department Chairman, is AWESOME. I really enjoyed learning from him.

Fun extras: they do a lot of event medicine - meaning the seniors serve as medical staff at some Yankees (or Mets? can't remember) games, some Giants/Jets games, local concerts, etc. They also offer a Medical Journalism elective for PGY-3s, in which you spend a month working with a major media outlet, writing/reporting about medicine!

Changes to the curriculum not mentioned above:
-There is now only one month of Trauma at Shock
-Seniors (PGY-3s) also spend a few Trauma shifts per month at Brookdale

Maimo is a fantastic 3-year program, and even though I won't be going there, I highly recommend it to anybody looking for a strong program in NYC.

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AD28 said:

Maimo is neither a level 1 adult nor pediatric trauma center. Although, to be fair, the distinction in NY with trauma designations often doesn't make much difference.

According to the link below, Kings County is the only trauma center (regional) for peds in Brooklyn

https://www.health.ny.gov/professionals/ems/state_trauma/trauma2.htm

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According to that link, Kings County is adult only, from my looking.

• Kings County Hospital Center
  451 Clarkson Avenue
  Brooklyn, NY 11203
  Adult Only

In Brooklyn and Queens, there aren't any peds trauma centers. You either go across a bridge to Manhattan, the Bronx, or Staten Island (with 2!), or go east to Mineola. These all seem like substandard options for EMS. Although, as you say, the distinction doesn't make much difference.

AD28 said:

Maimo is neither a level 1 adult nor pediatric trauma center. Although, to be fair, the distinction in NY with trauma designations often doesn't make much difference.

According to the link below, Kings County is the only trauma center (regional) for peds in Brooklyn

https://www.health.ny.gov/professionals/ems/state_trauma/trauma2.htm

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Yes, Maimo is a Level II trauma center - never said it was a Level I - but when I was there, Maimo was in the process of applying to become a Level I Pediatric trauma center and they said it would come through fairly soon.

tastyb33f said:

Yes, Maimo is a Level II trauma center - never said it was a Level I - but when I was there, Maimo was in the process of applying to become a Level I Pediatric trauma center and they said it would come through fairly soon.

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Maimo was briefly a provisional level 2 pediatric trauma center, but they are no longer designated as any level of trauma center.

http://www.nycremsco.org/images/articlesserver/2015-06 Maimonides Trauma Center Closes.pdf

I rotated there as a 4th year Med student a year and a half ago, I thought the place was fantastic.
- the patients are SICK
- the critical care rooms in the ED are an awesome place to learn
- Dr. Motov is quite a character, an extremely smart attending who is a great teacher
- the residents are great, VERY nice people
- the patient population is such that a large portion don't speak English, which can be a good thing or bad thing. I think it's a good thing for training purposes, because you really have to be on point with your differentials and physical exam. I remember a guy coming in who didn't speak English, our Mandarin interpreter was tied up, and it was unclear if he had stroke-like symptoms or not, and his family members couldn't communicate with us either. The resident was on point at quickly sussing out that this was going to go down the brain attack pathway.
- Brooklyn is THE BOMB
- the NYC EM crowd in general is amazing, everybody knows each other across different programs, there's a lot of collaborations and cross-talk, meetups, etc. I can't overstate this enough and it's something I miss with my program.
- I rotated at 4 other EM programs, and I enjoyed Maimo's grand rounds days the most. It was relaxed, heavily FOAM-focused, and very geared toward teaching for day to day life as an ER doc. I compare it to my home program's (plus the other 4 programs I've visited) conference days which tend to be too academic, too formal.
- the ED is crowded, but not as bad as some of the other NYC EDs I've been to.
- I had a couple negative experiences with nursing at Maimo, likely because the nurses were just overloaded. But 95% of my interactions with nursing was great.

- my overall take: solid program, awesome location, very sick patients, great teaching, you need to be ok with very frequent use of translators, not heavy on trauma, excellent attendings, and the residents (at least when I was there) are great personalities

KCHC is still a peds trauma center (not sure if the link above is out of date or incorrect).

http://www.nychealthandhospitals.org/kingscounty/html/services/centers.shtml

When I was there last summer we saw plenty of peds trauma.

alpinism said:

KCHC is still a peds trauma center (not sure if the link above is out of date or incorrect).

http://www.nychealthandhospitals.org/kingscounty/html/services/centers.shtml

When I was there last summer we saw plenty of peds trauma.

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Whether it's listed as such or not, you will see peds and adult traumas at County (I did med school and anesthesia residency there). Trauma is pretty protocol based and GSW after Stab wound is exciting, but medicine is learned in Pod A. where the sick pts come from JFK right to good ole county (not just the Caribbean but as far as Syria, for me as an intern).

Those traumas leave the ED as fast as they come in (OR, ICU CT Scan, etc). Manage as many sick pts as possible and you'll be a better physician.

Good luck.


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Maimo is now a Level 1 Trauma center for Peds and Adults. Given the area of Brooklyn a lot less penetrating trauma, which is more likely to be around/closer and therefore goes to Kings County, but a lot of elderly falls, PED struck type trauma. The ED is ALWAYS busy. Heavy Ashkenazi (sp?) population - so a lot of genetic diseases thrown into the mix. As it has been mentioned before, pt population is sicks and ethnically diverse. Seemed like a fun place to be though and had a great vibe among residents and attendings. I can't speak from direct exp since I was rotating on the surgical service.

The difference between trauma 1 and 2 is research. So i guess they upped their research game.


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Element said:

Maimo is now a Level 1 Trauma center for Peds and Adults. Given the area of Brooklyn a lot less penetrating trauma, which is more likely to be around/closer and therefore goes to Kings County, but a lot of elderly falls, PED struck type trauma. The ED is ALWAYS busy. Heavy Ashkenazi (sp?) population - so a lot of genetic diseases thrown into the mix. As it has been mentioned before, pt population is sicks and ethnically diverse. Seemed like a fun place to be though and had a great vibe among residents and attendings. I can't speak from direct exp since I was rotating on the surgical service.

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Actually it's a provisional level 1 adult and level 2 peds.

http://www.nycremsco.org/images/art...y Maimonides Medical Center Trauma Status.pdf

Not that there's any real difference between level 1 and level 2 in NYC. It's also now the only pediatric trauma center in Brooklyn.

Any recent updates on this program?

Should EM residency applicants be worried about this?

gutonc said:

Every person in any aspect of medicine should be worried about this. While the Post is crawling up Maimo's butt, this is not unique Maimo or NYC. It's everywhere.

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Agreed, Dr. gutonc.

But specifically for Maimonides, should a fourth year medical student take this into account when applying/interviewing for residency (i.e. all other things being equal, should I rank the program lower because the hospital might fail)? Is the situation analogous to Hahnemann University Hospital?

gutonc said:

Again...there's not much unique about Maimo's situation. If you're going to ask the question about them, you need to ask it about virtually every program/hospital in the country.

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Thank you for your perspective.

gutonc said:

Again...there's not much unique about Maimo's situation. If you're going to ask the question about them, you need to ask it about virtually every program/hospital in the country.

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I disagree. some places will be fine. For example Birgham lost $430+M, others also lost money. that speaks to a temporary issue. I dont know the specifics of maimonedes but losing money for a year or 2 isnt the same as being on the verge of financial ruin. See atlanta medical center. Yes everyone is hurting for money and yes that matters BUT its not all the same everywhere. Some systems have billions in reserves and some do not. If you go to a place without a lot of reserves i would be worried about closure and/or sale.

I'd say the past few years have been particularly hurtful for the panoply of US hospital systems, academic and community alike. Way more so than then general ebbs and flows of revenue cycles when things were in a relative steady state for the past few decades. That is true at my particular hospital system. Some will do fine. Some will get F'ed up. But as a whole they have lost money. It's like the S&P 500 this past year. A few stocks have done well, some OK..but many stonks have lost value.

If they have planned well they will survive but 2022 was a bleak year.

thegenius said:

I'd say the past few years have been particularly hurtful for the panoply of US hospital systems, academic and community alike. Way more so than then general ebbs and flows of revenue cycles when things were in a relative steady state for the past few decades. That is true at my particular hospital system. Some will do fine. Some will get F'ed up. But as a whole they have lost money. It's like the S&P 500 this past year. A few stocks have done well, some OK..but many stonks have lost value.

If they have planned well they will survive but 2022 was a bleak year.

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Also while we stress about the upcoming Medicare cuts for physicians remember that over 50% of docs are now employed. Many by health systems. That’s a cut into their revenue and it’s not easy to cut someone’s pay in the setting of 7+% inflation.

Tough times ahead. Some of these systems have reserves and they will beg congress for a bailout of some sort. Others will die on the vine or sell.

I think it’s important to look at financial documents closely when analyzing the health of a hospital system. Almost all health systems are experiencing financial losses. Many large systems have experienced record losses. But you have to divide losses or profits into two categories, operating and nonoperating. Operating losses can be dangerous because they lead to erosion of reserves and reflect problems in the ability of a health system to generate long-term income. Nonoperating losses are unavoidable at the moment due to the state of the stock market.

A hospital like Maimonides has severe issues because they don’t have any reserves to fund operating losses and essentially have to either cut services and jobs or get a bailout from some governmental entity. With record budget shortfalls in NYC and a health system owned by the city with its own issues, I can’t really see a bailout occurring. There are political connections, particularly in the Orthodox Jewish community, but I don’t know where the money will come from.

Can someone shed light on why the hospital systems are losing so much money? Is it increased salary costs/FTE, decreased insurance payment, 8% inflation, mismanagement?

Covid and this yr has been a record years of inpatient admissions as it seems like any hospitals are at capacity for the past 3 years.

If it is increased Salary costs and inflation, then the only way to fix this is increase income which has to come from insurance carriers. Good luck on this. They seem to want to decrease payments every year and make it harder to collect.

If it is decreased insurance payments, well then we are essentially screwed and likely will turn into a single payer system. If carriers are making record profits and decreasing payouts, then eventually the Gov will need to take over.

If it is mismanagement, then let them burn.

If more hospitals start to go bankrupt, we are eventually going to have some form of governmental system. They are the only ones able to run anything at a perpetual loss and print money.

emergentmd said:

If more hospitals start to go bankrupt, we are eventually going to have some form of governmental system. They are the only ones able to run anything at a perpetual loss and print money.

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I'd say that's the end goal and it's intentional....but I'm not into conspiracies.

The cost of staffing has been astronomical. I have heard of large systems running their staffing costs at 60% above baseline. most hospitals run in the 2-3% margin range. Staffing is their biggest cost. While many hospitals are “full” I think this is a misnomer. Many of these “full” hospitals have beds that they closed due to staffing.
the cost of RNs is insane right now and the supply has become useless mid levels.