New York Presbyterian Hospital Residency Reviews

Pros:
-The residents are just about the nicest group of people you will meet; everyone is so friendly and excited about teaching the more junior residents and students. It almost felt like the fourth year residents devoted their time to teaching. The classes are extremely diverse, think every possible color and sexual orientation! It's a very interesting group of people who are both fun to work with, and fun to hang out. They also have a day a week where they all try to go out together!
- The program director is awesome. He's the perfect person to have in such a new residency. He seems to really have the residents' back and he's also a nice person.
- It's NY, which means there's always something to do and always good food to eat.
- The housing is spectacular, subsidized and right next to Cornell
- Two campuses with two very different population bases , the uptown campus was almost like stepping into the DR, and the ratio of nurses to docs is a little skewed so you get to do more and have more responsibility uptown whereas downtown, there's a richer population with a different set of problems!
- They have a day reserved for conferences, and the conferences themselves are excellent, very well put together and interesting


Cons:
- Still a very new program that is working on ironing out the kinks
- Its in a hospital with other great residency programs, and it's still a new department, which means that they still are not getting the respect they deserve from the other departments and the residents in those departments.
- I didn't really like the computer system or the documentation, I felt like it was really hard to get to the old records, and you had a different system for everything (i.e one for clinic visits, one for radiology, etc)
- Not a level 1 trauma so you won't see very many stab wounds and gunshot wounds
- Columbia is a little bit of a commute from Cornell, so if you live near Cornell, when you do your Columbia time you spend a fair bit of time commuting. It can add up to 2-2 1/2 hours to your day
-It's NY which means that the cost of living is crazy. While the housing is subsidized, the cost of eating and going out is much higher than in other places

Grays:
- 12 hour shifts, I didn't feel like this was a problem, the shifts were fun and went by fast, but I know a lot of people would rather go to a program with 8s
-it's a 4 year program. Most people I talked to felt like this was a plus, and after talking to them, Im starting to lean in that direction as well.
- A large portion of the patients at the columbia campus only speak spanish, so depending on how fluent you are, that might be a hinderance.


I'm sorry this isn't the most coherent, but I'm on nights and the sunlight hasn't been letting me sleep to well, so I decided I would write one of these, if nothing else, this thread needed to get started!! I hope we have mroe people posting, I can't wait to read what people have to say

sleepymed said:

Pros:
-The residents are just about the nicest group of people you will meet; everyone is so friendly and excited about teaching the more junior residents and students. It almost felt like the fourth year residents devoted their time to teaching. The classes are extremely diverse, think every possible color and sexual orientation! It's a very interesting group of people who are both fun to work with, and fun to hang out. They also have a day a week where they all try to go out together!
- The program director is awesome. He's the perfect person to have in such a new residency. He seems to really have the residents' back and he's also a nice person.
- It's NY, which means there's always something to do and always good food to eat.
- The housing is spectacular, subsidized and right next to Cornell
- Two campuses with two very different population bases , the uptown campus was almost like stepping into the DR, and the ratio of nurses to docs is a little skewed so you get to do more and have more responsibility uptown whereas downtown, there's a richer population with a different set of problems!
- They have a day reserved for conferences, and the conferences themselves are excellent, very well put together and interesting


Cons:
- Still a very new program that is working on ironing out the kinks
- Its in a hospital with other great residency programs, and it's still a new department, which means that they still are not getting the respect they deserve from the other departments and the residents in those departments.
- I didn't really like the computer system or the documentation, I felt like it was really hard to get to the old records, and you had a different system for everything (i.e one for clinic visits, one for radiology, etc)
- Not a level 1 trauma so you won't see very many stab wounds and gunshot wounds
- Columbia is a little bit of a commute from Cornell, so if you live near Cornell, when you do your Columbia time you spend a fair bit of time commuting. It can add up to 2-2 1/2 hours to your day
-It's NY which means that the cost of living is crazy. While the housing is subsidized, the cost of eating and going out is much higher than in other places

Grays:
- 12 hour shifts, I didn't feel like this was a problem, the shifts were fun and went by fast, but I know a lot of people would rather go to a program with 8s
-it's a 4 year program. Most people I talked to felt like this was a plus, and after talking to them, Im starting to lean in that direction as well.
- A large portion of the patients at the columbia campus only speak spanish, so depending on how fluent you are, that might be a hinderance.


I'm sorry this isn't the most coherent, but I'm on nights and the sunlight hasn't been letting me sleep to well, so I decided I would write one of these, if nothing else, this thread needed to get started!! I hope we have mroe people posting, I can't wait to read what people have to say

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Like sleepy I also rotated here and I wanted to add some stuff. I agree with almost all that is written and wanted to hit on my personal highpoints.

Negatives-

Workload: The residents gripped about this to me several times. Problem is that in the first to years you are swinging 20 12's. One resident's exact quote to me was "By the time we are out of here we have done a full residency and a half". What I observed was that the 3rd years looked tired and frustrated at the amount of work they had put in and what they still had to take on.

Two hospitals: In some ways this is good but in others......thing is that they routinely take 30-45 minutes to sign out and when you add that to the travel time between the Cornell campus and the Columbia campus you are looking at 14+ hour days.

Columbia ED: It is crowded and oftentimes the nurses were at a ratio of 12:1 with the patients. Thus, things take for ever and consequently it reduces the number of patients that the residents see in a shift.

Random Quickies: Pay is less than other programs...Housing is subsidized but taken out of post not pre-tax...no trauma: I was there a month and saw ONE trauma call for a guy that got stabbed in the arm. This is a problem across manhattan.

Positives-

In addition to what sleepy has:

Academic atmosphere: You really feel like you are part of something special. It is no BS that you are on 2 Ivy league campuses and that there are leaders in respective fields all around you. The residents are all brilliant and you really get the feeling that standards are high but performance is equally high.

PD: While I had limited contact with Dr. Carter, all the residents and attendings swear this guy is reason alone to come to the program.

Conclusion:

Disclaimer: I am deciding between 3 and 4 year programs and wether I want an academic career or not.

I am confident that this place will be the premier program in NY and is certainly going to be my most highly ranked 4 year program. The training will be outstanding, but it comes at the price of four very tough long years.

NY Presbyterian

Sorry I got behind with the holidays but I am committed to reviewing ALL programs I attend in detail.

A relatively new 4yr EM program looking for its 6th class.

Residents: 10 residents per year. Dinners were thrown together at the last minute and none were the week I visited, so I didn't get to go. I met a variety of PGYs, from interns to 4th years. The interns were tired due to their grueling schedule, but the 4th years were feeling confident and ready to do their own thing. There seems to be a decent mix of single and marrieds, some live in housing owned by the hospital in the Upper East Side, while others are new yorkers who already had places.. Some of the residents were a little strange while others were really fun.

Faculty: They have a number of great faculty here involved in research, running the EMS system, and more. Their PD is Wallace Carter, who helped start the program at Bellevue. Frankly, he is a bit strange. He has a withdrawn affect and talked at length about the restructuring of the hospitals to join Columbia and Cornell.... The residents say he is a great advocate, though.

Hospital:
There are two main sites, Cornell and Columbia's campuses (both are called NY-P, however because of the merger). They are about 30 minutes away from each other by shuttle. You will visit both sites during the interview day, and almost 50/50 during your training to get a balance of community and county-type EDs.

Cornell is a fancy Level I ED frequented by the wealthy, who usually have their own private docs, etc. It is nearly all electronic and features free coffee in the waiting room.

The Columbia campus is another Level I, but is a distinctly more inner city experience. The ED is often packed and very busy, the facilities there aren't as nice. There are often free meals, however.

Ancillary Stuff: Ancillary is supposed to be great at both sites, but you may have to throw in some IVs at Cornell. A great feature of their interview day is that you have an interview with a charge nurse. Both groups say they have a great relationship and are on a 1st name basis.

Admitting/Documentation: I think the ED has admitting privileges, but not sure on this one. Ultimately, the documentation at both sites is paper.

Curriculum: 4-year curriculum featuring rotations on "classic" services such as surgery and medicine, and 4mos of ICU, including PICU. EMS is longitudinal during PGY2-4. PGY1s and 2 work 20 12hr shifts and are pretty tired, this drops down to 10s in the latter two years, and you run the ED as a junior attending in the 4th yr.

Didactics/Research: In addition to the 5hr conferences, there is noon conference at Columbia and morning conference at Cornell. Scholarly activity is a requirement. There are a good number of clinical researchers, and one faculty member is Co-PI on a grant looking at translational research in stroke. They recently hired a PhD to head up their research dept and intend on growing in this capacity.

City: It's NYC, baby! Both campuses are in nice areas and you can get around without a car (you can be reimbursed for a taxi when the shuttle isn't running)

Extras: Salary starts at 46K. As a resident, you can live in subsidized housing in the Upper East side ( a safe, cush area of manhattan) that is across the street from the Cornell campus. You tour the housing while you are there - a studio (for single people) costs around $1200, a 1BR is like $1500, and a 2BR is about $1700. This comes out of your paycheck before taxes!

Negatives: There is a lot of floor work. Also, some off-service stuff is not worked out (there is no ortho experience outside of the ED in part because Special Surgery doesn't like EM). Travel between sites can be painful when you are already working an insane 20 12hr shifts (it takes about an hour to go back and forth)

Overall: The combination of sites offers exposure to community and county-type hospitals, both with an academic bent. The program is up and coming and expanding with great benefits, but currently the residents are paying the price in terms of long hours and off-service rotations. However, the clinical training appears to be excellent and many residents felt it was well worth the extra effort [/QUOTE]

Seems like I'm always following someone up with these, but I guess it's good to post different viewpoints!

New York-Presbyterian

Residents: 10 Residents per year, likely to increase eventually. The pre-interview events were set up kind of last minute, but I was able to attend one. There is a group of residents that are very social and go out, but also a group that didn’t seem too interested. They come from all over. Some have kids - this place seems more kid-friendly than the others I’ve been to in NYC (multiple female residents have had children during residency and those with kids can get 2 and even 3 bedroom apts).

Faculty: The program may be relatively new (graduated one class so far), but the leadership certainly is not. The PD, Wally Carter, has been a PD before at Bellevue, and worked at Jacobi. He began his medical career as a paramedic in the Bronx, he is on the hospital’s GME committee, and will be on the RRC next year. Dr. Flomenbaum is also an NYC EM old-timer, and both have tons of connections. Another faculty member recently won an EMRA teaching award. About half of the first graduating class took jobs at here, and Carter essentially said he likes keeping his own residents as faculty. The residents report a first-name basis with faculty.

Hospital:
There are two main sites, Weill-Cornell New York Hospital and Columbia Presbyterian Hospital. These two enormous institutions merged to form New York-Presbyterian Hospital – a singular entity with two sites. Carter went into a lot of the financial and economic details about this, but it seemed fairly inconsequential to me. When it comes down to it, there are 2 sites with a combined >2300 beds, >150,000 ED visits, and an annual operating budget larger than 5 of the mid-western states! Time is split equally between the two. Unfortunately, they are not particularly close to each other or accessible, and it takes 40min-1hr to get between sites.

New York Hospital: Located in the heart of the old-school Upper East Side, in one of the wealthiest zip codes in the world, right up against the east river. Level 1 trauma center, regional burn center, and world-renown tertiary medical center. The hospital is really nice, but the ED is pretty standard (although they are in the midst of expanding). They see a lot of VIPs here. Ancillary help is better. On-site CT. There are no real trauma bays, just sort of critical care areas. Paper charting with some electronic ordering.

Columbia Presbyterian/Children’s Hospital of NY: Located way up town in Washington Heights, serving a more county-type patient population that is largely Spanish-speaking. Level 2 trauma center (level 1 peds), also a world-class tertiary referral center. The ED here has a standard physical plant that is crowded and busy. Ancillary staff is not quite as good. On-site CT as well. Paper charts, switching to the same system as Cornell soon. More autonomy for residents here.

Ancillary Stuff: May have to place IVs and push patients around at Columbia, but not likely at Cornell.

Admitting/Documentation: Not sure if ED has admitting privileges. Documentation as above.

Curriculum: 4-year curriculum with more ED time than any other place I’ve ever heard of – maybe even too much (20 12’s for the first 2 years!). Interns do 7mo in the ED (pretty awesome), but 3mo of floors (Medicine, Peds, and Surgery). Residents do 30 total months in the ED – plus 3mo dedicated Peds ED – and 4mo of critical care. Four months of electives split among the latter years. There is very good Peds exposure, considering both sites are in Manhattan. They do a good job of playing to the strengths of each site – Peds is always done at Columbia where there is a Children’s Hospital, Critical care largely at Cornell, etc. Off-service rotations are tough but likely rewarding, considering the caliber of the residency programs at these institutions. There is graduated responsibility – although interns do see sick patients – ending up with the PGY4 “junior faculty”-type thing. There is no “specialty track” in the pGY4 year. The philosophy here is geared toward “adult learning” – there are a lot of opportunities, but you have to go after them yourself – it’s less structured.

Didactics/Research: Standard didactics, one morning a week. They do a morning report at Cornell and a noon report at Columbia daily. The program is new, and they haven’t really discovered a research focus yet, but the resources available between 2 Ivy League Medical Schools are pretty amazing. Currently very little basic science research, but they are willing to support anyone who is interested. They have some interesting fellowships and special programs, specifically in International EM, Wilderness EM (cool stuff), and Geriatric EM.

City: Two campuses, two very different parts of town. Cornell is in the nicest part of the UES (upper 60s/low 70s), which is where most of the residents live. Columbia Presbyterian is in Washington Heights, a vibrant, predominantly Dominican area that is pretty far uptown. Apparently a few residents have chosen to live up there because it’s cheaper and/or they went to med school at Columbia and already had a place. If you’ve read my other reviews, you know my feelings about NYC.

Extras: Salary is marked up a bit for NYC, but actually less than most (starts at >46,000). However, the best benefit of this program is the beautiful subsidized housing – the nicest buildings of all the NYC places I’ve interviewed (and that’s saying a lot since I’m not a big fan of the UES). They own a number of buildings with some different pricing ranges, and if you have kids you can even get a 2-bedroom. There is a shuttle between the campuses every hour. Good insurance, retirement with no matching of funds. If you don’t want the housing, they offer free parking for those who live outside the city, and there is free food and coffee M-F at Cornell.

Negatives: The combination of the number of shifts and the long distance between sites could pretty much own your life. Essentially, if you live in the housing and work 8am-8pm at Columbia, you have to catch the 7:15am shuttle, work, possibly miss the 8:15pm shuttle (residents said they rarely leave on time) and either not get home until 10:00pm or have to take a cab. They reimburse for cab rides, but it’s still a pain. Do that 20 times a month for 2 years, and you may feel like you’re doing a general surgery residency. The actual number of shifts isn’t that bad, but the distance between sites and rarity of the shuttle makes them more like 20 15’s a month. Some of the residents seemed a bit anti-social, and a lot of them seemed tired. The ED-heavy curriculum will definitely train you well, but I’m not sure if I see the need for 4 years – there’s no real innovation in the 4th year (specialty track, tons of electives, etc). They claim to have enough trauma, but I’m sure it’s much less than places with comparable volume outside of Manhattan.

Overall: Great leadership and amazing resources. Between the two world-class institutions and patient populations I think that this program might eventually be the cream of the crop in NYC – especially once they get their research started up. It seems like a lot of work, and it’s not for those who want hand-holding. 90% of the first class went into academic jobs last year, so if that’s what you are looking for, they are obviously doing something right.

NY Presbyterian Cornell/Columbia

4 year academic program in Manhattan. Although it's pretty new (it's only been around for 5 or 6 years), it's generally regarded as one of the top programs in NYC. Although this probably has a lot to do with the "name", it does come off as one of the strongest academic programs around. That being said, there are many negatives to be aware of...

+++ Lots of money/resources - if you want to do a project, you'll have a lot of support
+++ Great if you're interested in research, international opportunities (though limited elective time)
++ Housing, but it's not cheap; expect to pay $1100 and up for a studio, but at least it's across the street from the hospital (you can get housing on either the Cornell or the Columbia campus... but that also means that half the time you're commuting between the two)
++ Overall, some incredible faculty with diverse interests and a lot of connections. If you're interested in research and are thinking about pursuing an academic career, this is a great place to be
++ Very cool residents that definitely have a social life outside of work. The majority are very smart, very well-read, and about half go into academics.
+ Good ancillary staff, but not the best... it's not a draw-your-own-labs kind of place, but I have definitely seen more efficient nurses elsewhere

+/- NYC - Manhattan - love it or hate it
+/- Two different locations, one on the upper east side (rich, quiet, white) the other in Harlem (poor, chaotic, hispanic). You spend half your EM time at each site, with significantly different patient populations and pathology. On the plus side, this arrangement provides for reasonable variety; the negative is that it's an hour commute between the two.

-- Low salary for a NYC program - PGY1 starts at around $49,000
--- VERY long hours and a lot of shifts. 20 12's with one less each year, but ALWAYS 12's. And those 12's aren't really 12 hours - expect to stay at least an hour longer each shift, and with the commute you're easily looking at 14 hour days, ugh
--- A lot of off-service months, even in 3rd and 4th year - and don't expect a lot of respect while you're doing them. Columbia and Cornell still have quite a ways to go before they really establish themselves as a department in the two hospitals, and even the senior residents definitely don't run services they're rotating on.
--- Way, way too many consults to be called - and you WILL be calling them. This is probably the antithesis of a county program... but some may like that.
--- Not much trauma AT ALL (some senior residents have done less than 10 chest tubes... I mean... seriously?!) Cornell is a Level 1 trauma center, but there's not much trauma on the upper east side (elderly ladies and preppy moms just don't go around shooting each other). Columbia is a Level 2.
-- No real graduated responsibility - everyone presents directly to the attending. Also not as much autonomy as other places, probably because 'fancy' patients expect 'fancy' treatment. Expect a lot of defensive medicine - you'll be ordering loads of unnecessary tests because "we're Cornell"
-- Too much time in urgent care
-- No community rotation, and no outside county-style rotation. Even though Columbia feels a little more 'county', and has better pathology, it still can't hold a candle to places like Jacobi, Cook County, etc.

This is definitely not a "hardcore" place, and those that salivate over knife and gun clubs will run in the other direction. But if you want to be (have to be?) in Manhattan and are looking for a solid academic program, then it may be a contender.

EvoDevo said:

NY Presbyterian Cornell/Columbia
+/- Two different locations, one on the upper east side (rich, quiet, white) the other in Harlem (poor, chaotic, hispanic).

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Minor detail, but please note... as a former P&S'er, I feel obliged to point out that Columbia is actually in Washington Heights... about 50 blocks NORTH of Harlem. It is, as mentioned, a very hispanic community... densest population of Dominicans outside the DR.

Yup, agree with Pinner Doc, Columbia is in Washington Heights. Also, as someone who did the Cornell sub-I, I'll agree about the hours - they are all 12's, and you pretty much always stay overtime to finish up/round/etc. Still had a pretty good experience though, but even as a 4th year, you'll work hard. That being said, the residents are very friendly and are honestly some of the smartest i've met.

As a senior resident at the New York-Presbyterian Cornell/Columbia program, I have to clarify a few misguided statements in the review of our program that was posted a year ago. While hearing others' opinions of residencies through the interview process is clearly valuable, it pains me to see factually untrue information floating around, especially on a forum that people may be using in their decisionmaking process.

EvoDevo said:

--- VERY long hours and a lot of shifts. 20 12's with one less each year, but ALWAYS 12's. And those 12's aren't really 12 hours - expect to stay at least an hour longer each shift, and with the commute you're easily looking at 14 hour days, ugh

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Shifts are not always 12's. Interns and second years work 20 12's. Third years work 18 shifts per month, a roughly equal mix of 8's, 10's, and 12's. Fourth years work between 16 to 17 shifts per month, and these are a mix of 8's and 12's. Yes, this is more than most programs. The way I see it, if you work more, you see more patients.

--- A lot of off-service months, even in 3rd and 4th year - and don't expect a lot of respect while you're doing them. Columbia and Cornell still have quite a ways to go before they really establish themselves as a department in the two hospitals, and even the senior residents definitely don't run services they're rotating on.

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This is actually the opposite of true. During intern year, you spend less than half of your time on non-ER rotations. In third year, there is one off-service rotation (PICU), and none during fourth year. With few exceptions, our ER residents are greeted with excitement by off-services, particularly off-service fellows and attendings, as we've established ourselves as far more facile and experienced in resucitations and caring for critically ill patients than most of the residents on the services on which we're rotating. As a second year resident, I taught critical care *fellows* how to intubate, place chest tubes and put in subclavians.

--- Way, way too many consults to be called - and you WILL be calling them. This is probably the antithesis of a county program... but some may like that.

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Not sure what observation this is based on... there is certainly a difference between calling consults and calling *inappropriate* consults. If someone's appendix needs to be removed, however, you kind of have to call a surgeon.

--- Not much trauma AT ALL (some senior residents have done less than 10 chest tubes... I mean... seriously?!) Cornell is a Level 1 trauma center, but there's not much trauma on the upper east side (elderly ladies and preppy moms just don't go around shooting each other). Columbia is a Level 2.

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True to a certain extent, and if an applicant is looking for an extremely high-volume trauma center, I would go a step further and urge them to not apply in Manhattan, period. However, we see plenty of trauma - more than enough to be well-versed in running a trauma resuscitation - and if you met a senior resident who had put in fewer than 10 chest tubes, let me know because that is just crazy.

-- No real graduated responsibility - everyone presents directly to the attending. Also not as much autonomy as other places, probably because 'fancy' patients expect 'fancy' treatment. Expect a lot of defensive medicine - you'll be ordering loads of unnecessary tests because "we're Cornell"

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Also the opposite of true... as a 4th year resident you hear direct presentations from all of your juniors and are fully responsible for the flow and disposition of your side, similar to any other program with a "pre-tending" year. Again, not sure where the "loads of unnecessary tests" observation comes from.

-- Too much time in urgent care

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On average, we do anywhere from 0 to 3 urgent care shifts a month, the average being around 1.

Again, great to see opinions, good and bad, aired on this forum, but I just had to clear up a few factual misconceptions. If anyone is interested in learning more about the program, come and visit - we'd love to meet you and have you hang out in the ED for a few hours.

1. Brigham/MGH: POS: Two amazing institutions, The Name (Partners) which helps if you want to do something in addition to medicine, faculty, resources, admitting powers, off-service education, true SIM-lab along with true integration into curriculum, fellowship in US (not that i'm interested in doing US fellowship, but having a fellowship makes it more likely that we will get a good ultrasound experience), getting an expanded ED at MGH, impressed with 4th years (they get experience running obs unit and getting presentation from PAs- say what you will about the importance of knowing how to run OBS unit and PAs, but all you need to do is look at the news and realize the possible future of EM), can use propofol, You get bread and butter at both hospitals (albeit, you're more likely to see zebras at these hospitals). NEG: Surgery floor rotation (I don't mind medicine floor), only 4 ICU months (I wish there was one more instead of surgery floor), slightly worried about admission pushback (but ED has admitting powers, so it's okay).
2. BMC: POS: "Boston City Hospital"- so many people have trained there, admitting powers, ED is powerful there, trauma is truly run by ED, largest ED visits in the New England area, largest number of trauma (penetrating) in Boston, sees the most number of patients in the New England area, Boston EMS medical control, great number of fellowships. NEG: Ortho experience is what you make of it, POTENTIALLY a weaker peds experience as it's a Level II peds center, limited propoful use, trauma is run sort of inefficiently (3rd year does tube AND leads the trauma, which is contrary to the principles of leadership)
3. UPenn: POS: this place has everything I want (perfect number of ICU rotations), true integration with trauma, residents can use propofol, admitting powers, great off-service rotations, great airway toys, Pharmacy is in the ED to help with codes (drug calculations) and drug questions. NEG: The number of ED visits they see seems a little low, weaker/building from scratch a SIM lab curriculum.
4. NYP (columbia and cornell): POS: Two great hospitals, best peds experience in NYC (which is tough in NYC), subsidized housing available, resources, admitting powers, can use propofol. NEG: relatively new (that being said, it's made a name for itself). High cost of living in NYC
5. Beth Israel Deaconess Medical Center: POS: Academic, 3+1 option, the name, the residents, the faculty. NEG: lower number of ED visits compared to other programs in Boston, many off-site rotations (which are worth it for this program, but driving can be a hassle)
6. UMass: POS: Great toys, helicopter- TRUE integration of residents and nurses as a team, residents, the BEST facilities of any program on my list, PD is AMAZING, busy level 1 adult/peds, great number of fellowships, ED is very powerful here. NEG: location in Worcester (but that being said, cost of living is great with it still being relatively close to Boston)
7. Brown: POS: Amazing number of fellowships in everything you could want to do in the future, VERY busy with large volumes of patients (second largest in New England), Large sim lab, has access to basic science research (if you're into that thing). NEG: location
8. Northwestern: POS: perfect number of ICU rotations, well known, great facilities, great location in Chicago, gets a lot of trauma from the South side of Chicago (since U. Chicago is not a level I trauma center). NEG: No fellowships, except a research fellowship (I'm worried I won't get a good US experience if there is no US fellowship)

hey... so I'm one of the current juniors and I thought I would throw a few updates out there. I was looking through some of this stuff and it's pretty outdated. Happy to answer any questions people may have in response.

1. Schedule has changed for Juniors - We do have "20" shifts a month when in the ED. One of those shifts is a reading shift where you go to wednesday conference and have the rest of the day to do your other residency necesities --- like grab lunch and wine with friends. Another shift is a sono shift 10a-6p. The rest are 12 hours. It may sound like its still a lot compared to other programs, and it may be, but the resounding philosphy that most of us are comfortable and happy with is that we see a ton of patients.

2. First years - 3 off service - gen med - ID service this year, gen surg - Acute care surgery - basically the ED admits, and MICU. Tons of ED including a dedicated peds ED month. 12 hour shifts

Second years - more off service but tends to be the "other" off service - Burn ICU, Neuro ICU, OB, Toxicology, Anesthesia, Peds Anesthesia. Also have a dedicated Peds ED month. 12 hour shifts

Third year - lots of sick ED patients and PICU - mix of 8,10,12 hour shifts and fewer

Fourth year - all ED and now with "Evidence" shifts which are basically a chance to look up evidence and get a chance to do some more in depth teaching while on shift. - mix of 8/10/12 hour shifts and even fewer

3. If you're into trauma, trauma in manhattan in general is low, like someone else mentioned. That said, Columbia is level 2 and we had 3 penetrating traumas walk in last week just while I was there, so it is not like you dont see it. People don't always get to the hospital via EMS, as much as we wish they would. I'll admit though, you dont see the crazy trauma you may see elsewhere. However, you will see your thoracotomies. Admin is also always willing to help set up outside electives in your 3rd or 4th year.

4. What you do see a lot of is the complicated medical cases, tons of sepsis, a lot of respiratory failure and arrests. Since the hospitals are both quaternary centers, you see a lot of interesting, rare, and complicated disease, Peds included.

5. The heights... I love it. Many do. Some dont. It is a very dominican neighborhood. If you don't know spanish, there are ALWAYS interpreters in the ED - at least 1 often 3. Plus, can pretty much gaurantee you'll have a decent command on the language by the time you graduate.

6. Admin is always trying to update things and change things to better our experience. They will listen and change rotations if too many people are unhappy. Definitely possible that some of what I just wrote will be outdated by the time you come to interview. They are genuinely interested in us being really good at what we do. Lots of the teaching that we do is also undergoing constant renovation to help us get the most out of putting together lectures and honing our own teaching skills.

7!! All this stuff is all well and good, but I think most importantly I'm happy. I'm very happy. I don't think it's unreasonable to say that the majority of my colleagues feel the same way. We are a pretty tight knit group, enjoy the sense of family, and look out for each other.

Hope this helps and gives people a sense of some of the new things that have come up since some of the posts. Happy to answer questions.

nycem2014 said:

3. If you're into trauma, trauma in manhattan in general is low, like someone else mentioned. That said, Columbia is level 2 and we had 3 penetrating traumas walk in last week just while I was there, so it is not like you dont see it. People don't always get to the hospital via EMS, as much as we wish they would. I'll admit though, you dont see the crazy trauma you may see elsewhere. However, you will see your thoracotomies. Admin is also always willing to help set up outside electives in your 3rd or 4th year.

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Nycem, correct me if I'm wrong, but when I was a student at P&S we were told that the only reason Columbia is a level 2 is because the ER is in the old Presbyterian building, but the ORs are over in Milstein. So really, a technicality!

I am a resident at NYP and I like my program. Thought I should clear up some things. Obviously I am going to be biased in my point of view, but I will try to be as objective as possible:

NYP is both Cornell and Columbia. You CAN NOT do a residency at either campus alone. It is 1 program. We spend about 50% of our time at either campus. They are very different experiences and complement each other nicely.

Columbia: very busy ER. One of the busiest in the city. Fairly sick population as no one has a PMD or gets any care for chronic illnesses. The 'warzone' description is accurate, though I am surprised it seemed to be stated in a negative way. Most people who like EM kind of relish that sort of experience. I definitely enjoy working at Columbia in a large part because it is so overwhelming.

Cornell: lower volume, sometimes fairly busy, sometimes slows down. Mostly an Upper East Side population, so you get some 'boutique medicine' aspect to the place, but between it being a burn center, and all the super sick MSK patients from across the street, its actually a fairly sick patient population.

We do a couple of things better than I've seen any other place do:

Ultrasound: we do 1 shift a month where we don't see patients but only go around the department doing ultrasounds. This builds up your ultrasound skills very quickly. Any images we file count towards RDMS certification. I expect to be RDMS certified by the time I graduate.

Peds: we do Peds ER at MSCHONY, which is phenomenal. So many places have a sub par peds experience, and it tends to be underemphasized, but this is super important especially for anyone who wants to work in the community.

Didactics: senior resident lectures and noon reports were better than at any place I've seen. May not sound that important, but considering you have so little time to read intern year, its kind of nice to get such high quality teaching.

To be fair, here are a couple of things some people may consider negatives:

1) We work a lot. 18 x 12 hour shifts in a 28 day block for the first 2 years. That's more than many places, especially more than most 4 year programs. Part of that comes from the philosophy of 'you learn by doing' that is prevalent here. It's true for me, so I think of it as a plus. However, I can see how some people would be put off by this.

2) For complicated historical reasons, we are not allowed to moonlight. I will not go into a discussion of how necessary that is at a 4 year program with a 'pre-attending' year.

In summary, pros and cons:
+ 2 campus experience
+ amazing off service rotations
+ procedure rich and interns get first crack at every procedure
+ PD is spectacular
+ good didactics
+ ultrasound experience
+ housing
+/- resident run (I always thought of this as a plus, but apparently some posters here are discontent that residents are "pawned off all the work and thinking"… I honestly don't know what to say to that. If you don't like to think or work, don't go here)
+/- learn by doing approach (I love it personally, but I know some people like their hands held)
- Columbia sort of forces you to pick up at least some Spanish
- a lot of shifts
- can not moonlight

If you have any questions about the program feel free to ask me on this thread or PM me.

As an afterthought, another potential negative is that we see fairly little trauma. We definitely see enough to become comfortable with it very quickly, but not as much as, say, King's County. I think the very sick patient population more than makes up for it, but if trauma is your academic interest, might be an idea to look outside of NYC.

Can someone please clear up the scheduling during the first 2 years for me? Which of the following is it?

1) 18 x 12s in ED, 1 sono 10a-6p, 1 reading shift after conference in a 28 day block
2) 18 x 12s in ED, 1 sono 10a-6p, 1 reading shift after conference in a full month/30 day period
3) 16 x 12s in ED, 1 sono 10a-6p, 1 reading shift after conference in a 28 day block
4) 20 x 12s in ED, 1 sono 10a-6p, 1 reading shift after conference in a full month/30 day period

Also, are shifts only 7a-7p and 7p-7a, or is there a swing shift as well? I know there's another NY program with a 7a-7p, 11a-11p, and 7p-7a.

Got Em said:

Can someone please clear up the scheduling during the first 2 years for me? Which of the following is it?

1) 18 x 12s in ED, 1 sono 10a-6p, 1 reading shift after conference in a 28 day block
2) 18 x 12s in ED, 1 sono 10a-6p, 1 reading shift after conference in a full month/30 day period
3) 16 x 12s in ED, 1 sono 10a-6p, 1 reading shift after conference in a 28 day block
4) 20 x 12s in ED, 1 sono 10a-6p, 1 reading shift after conference in a full month/30 day period

Also, are shifts only 7a-7p and 7p-7a, or is there a swing shift as well? I know there's another NY program with a 7a-7p, 11a-11p, and 7p-7a.

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It's option 1).

In the first 2 years the shifts are 7:30 AM - 7:30 PM (or 8:00 AM-8:00 PM, depending on which campus you are at that month) as well as occasional noon-midnight shifts.

Forgot to ask this during the interview. Is moonlighting still not allowed?

Got Em said:

Forgot to ask this during the interview. Is moonlighting still not allowed?

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Bump. I'd like to know this as well

UrbanEM2 said:

Been a while since anyone updated info on this program. Any new insights? New chairs at both campuses, looks like they are bringing in some all star faculty.

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All star faculty, maybe. I'm not a resident, but I know docs who work there. Great training, a complete and utter disregard for patient satisfaction, and a totally dysfunctional department that fries many to a crisp. A year ago they had over 15 openings for faculty at one campus alone and had a hard time hiring anyone. One doc they did hire quit after three months.

Great training if you can handle the dysfunction.

miacomet said:

All star faculty, maybe. I'm not a resident, but I know docs who work there. Great training, a complete and utter disregard for patient satisfaction, and a totally dysfunctional department that fries many to a crisp. A year ago they had over 15 openings for faculty at one campus alone and had a hard time hiring anyone. One doc they did hire quit after three months.

Great training if you can handle the dysfunction.

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For those not in the know, NYP is a two campus program at Columbia and Cornell, with time split 50:50. The above is clearly a description of Columbia. Can confirm, it's gritty. But Cornell is the polar opposite of that. Actually I think that's one of the strengths of the program: you get to experience two very different sides of EM.

gro2001 said:

For those not in the know, NYP is a two campus program at Columbia and Cornell, with time split 50:50. The above is clearly a description of Columbia. Can confirm, it's gritty. But Cornell is the polar opposite of that. Actually I think that's one of the strengths of the program: you get to experience two very different sides of EM.

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This is true, and I apologize for not clarifying, although Cornell has also had a VERY difficult time hiring faculty, and while the hospital is more functional, the wait in the ER for patients is interminable.

I should add that the general dysfunction, lack of patient-centered care, difficulty hiring faculty, and crazy internal politics are endemic to NYC EM residencies. If you want to practice in NY, train there, but the system of care is so different from the rest of the country that it probably does not make sense if you are planning on settling elsewhere.

I trained here several years ago. They are undergoing changes now. The PD is changing which is too bad. The old one is retiring. He was the absolute best in my opinion. If any of you have questions about the residency program please PM me.

I don't necessarily endorse the views above, unless they were generated based on experiences over the past 1-2 years for which I can't comment as I was there several years ago. But I know many of the attendings at both campuses.

Overall a very, very, very good program!

Any new updates regarding this program? Seems to get a bad rep sometimes which I don't know why?

Like all NYC programs, great training to be a nurse....

I rotated here, was my least favorite rotation. Many of the residents felt like they didn't want to be there, and their reasoning for being there was a combination of location and "columbia cornell name". Training also wasn't great, didn't see much significant pathology particularly at Cornell. That in combination with the inconvenience of the two sites being far and high COL in NYC, not much is going for the program other than the name honestly.

That’s too bad....I always thought the medical training was superb. I left that program with such an extraordinary wealth of ER and medical knowledge. I remember one of the attendings there also did some part time work at a hospital in Queens/Long Island that also had a residency program, and I remember him saying that we know so much more about advanced topics in EM, critical care, and other areas of medicine.

Unless something has changed drastically in the past few years....I can’t imagine it being that bad. You are at a top 10 hospital in the nation. People fly into NYC to get their care there. They will get on a bus and ride for over an hour to go to the Cornell ED. You have the very best in just about every academic discipline at New York Presbyterian. The access to knowledge and experience is second to none in my opinion.

Are they using propofol yet there? It always seems like the EM care in NYC is a decade out of date; maybe CPMC is different.

miacomet said:

Are they using propofol yet there? It always seems like the EM care in NYC is a decade out of date; maybe CPMC is different.

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Not sure if serious question, but yes.

emthrowaway13579 said:

I rotated here, was my least favorite rotation. Many of the residents felt like they didn't want to be there, and their reasoning for being there was a combination of location and "columbia cornell name". Training also wasn't great, didn't see much significant pathology particularly at Cornell. That in combination with the inconvenience of the two sites being far and high COL in NYC, not much is going for the program other than the name honestly.

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Sorry about your rotation. I did residency there and have no complaints about the quality of the training. Definitely not about pathology. Actually Cornell had amazing pathology (both in terms of severity and weird cases) and they see far sicker patients than is typical of an ER in most places. I currently work at an ED ICU type set up and I would say my Cornell/Columbia experience has prepared me extremely well for this. The only things I see routinely that I did not get a lot of in residency are just not super common anywhere in the US: sick malaria patients, organophosphate poisonings, neurocystercosis. Our peds experience is second to none. I am very confident that NYP residents get way more of the core procedures than the vast majority of places.

The things I thought we were weak in while I was a resident (ortho and ophtho) turns out we are not weak in at all, and this is comparing to attendings from a lot of different settings. It's true that the program does not see a lot of trauma. For some reason, I am still a more comfortable with trauma airways and chest tubes than at least some attendings who came from supposedly more trauma heavy places. Did I crack a lot of chests in residency? Not at all. If that's a goal, I'd recommend an away elective in PGY3/4. The "learn to be a nurse" line is true. Yeah, I got good at peripheral IVs and pushed a bunch of patients to CT when it was urgent. I don't see it as a bad thing, but I know some folks do. I just don't see it as beneath me. Its not like it takes away so much time from your training that you don't see enough patients. We crunched the numbers some time ago, and the typical NYP resident sees well over 10,000 patients over the course of residency. I feel that's plenty.

NYP is a resus heavy program and will teach you how to handle sick. People who say otherwise don't know what they are talking about.

I'm asking because we have a per diem who trained at a renowned NYC program (not Columbia) who is still using fentanyl and versed for sedation and had no idea how to reduce fractures.

miacomet said:

Are they using propofol yet there? It always seems like the EM care in NYC is a decade out of date; maybe CPMC is different.

Click to expand...

They were able when I was there. Did they change it?

I dunno...I felt the ophtho and ortho was weak as well...I had to relearn it.

Problem was you are so busy...that the attending would say "Just call Ortho" for that ankle or wrist fracture and they would come down. "It's a better use of resources." Same with ophtho...I think I removed one corneal FB while there. I've removed 50 since being out.

Can anyone who is a current resident or recent graduate comment on whether dictation is available to residents at either campus (Dragon or whatever software doesn't matter, just whether residents can dictate notes)?

longtimelurker2015 said:

Can anyone who is a current resident or recent graduate comment on whether dictation is available to residents at either campus (Dragon or whatever software doesn't matter, just whether residents can dictate notes)?

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dayum you guys are getting serious about your ROLs, i was mainly just going off location and "feels"

Listen2Savage said:

dayum you guys are getting serious about your ROLs, i was mainly just going off location and "feels"

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Lol. Those are big factors for sure, but to me, dictation is a BIG deal cuz it saves you so much time. But true, besides gut feel, I do have an Excel spreadsheet with 106 factors comparing my top 3, some of us can't help but be cerebral nut cases lol...

longtimelurker2015 said:

Lol. Those are big factors for sure, but to me, dictation is a BIG deal cuz it saves you so much time. But true, besides gut feel, I do have an Excel spreadsheet with 106 factors comparing my top 3, some of us can't help but be cerebral nut cases lol...

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jesus man

drink 3 or 4 beers then do it

longtimelurker2015 said:

Lol. Those are big factors for sure, but to me, dictation is a BIG deal cuz it saves you so much time. But true, besides gut feel, I do have an Excel spreadsheet with 106 factors comparing my top 3, some of us can't help but be cerebral nut cases lol...

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You know this is the EM forum not IM or Neuro right?

longtimelurker2015 said:

Lol. Those are big factors for sure, but to me, dictation is a BIG deal cuz it saves you so much time. But true, besides gut feel, I do have an Excel spreadsheet with 106 factors comparing my top 3, some of us can't help but be cerebral nut cases lol...

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When I was a resident (a few years ago now) Dragon was available to PGY4s. Maybe they've expanded it since then, but I wouldn't know.

Don't take this the wrong way, and I see the craziness of saying something like this based on one comment, but honestly it doesn't sound like NYP is the best fit for someone for whom such details are important. Actually, all of NYC is going to drive you crazy. If you think that the presence or absence of dictation is a factor that will affect how happy you are at a place, there are so many things about EM in NYC that you will be so severely disappointed with... Read some of the other threads about New York programs. And I am one of those who love and defend NY EM, but dictation software should definitely be way down somewhere low on the list of things to care about.

gro2001 said:

When I was a resident (a few years ago now) Dragon was available to PGY4s. Maybe they've expanded it since then, but I wouldn't know.

Don't take this the wrong way, and I see the craziness of saying something like this based on one comment, but honestly it doesn't sound like NYP is the best fit for someone for whom such details are important. Actually, all of NYC is going to drive you crazy. If you think that the presence or absence of dictation is a factor that will affect how happy you are at a place, there are so many things about EM in NYC that you will be so severely disappointed with... Read some of the other threads about New York programs. And I am one of those who love and defend NY EM, but dictation software should definitely be way down somewhere low on the list of things to care about.

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I appreciate your feedback, it is invaluable. If dictation is way down on the list as you mentioned, what should those higher up factors be in wanting me to match at a NYC program? Your help and perspective are much appreciated

longtimelurker2015 said:

I appreciate your feedback, it is invaluable. If dictation is way down on the list as you mentioned, what should those higher up factors be in wanting me to match at a NYC program? Your help and perspective are much appreciated

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Have you rotated at a NY program? If you haven't, one of the differences from EM elsewhere is that it's generally under resourced in terms of support staff/services and space. This ends up with patients in hallways and residents doing non medical stuff like starting IVs, drawing blood, and moving patients. That either makes you feel good (because you are in the thick of things and value that kind of work) or it makes you feel bad (because you want to just be doing the doctor stuff). Being honest with yourself about which category you fall into is important. Most people on this board, judging by what they say, fall are in the second category.

The other key difference about NY EM is that it's in New York. That's also either a good thing or a bad thing. For me, it was awesome. I love New York. But not everyone feels that way. Certainly it's expensive, crowded, dirty, loud, and in general, hard. Liking or not liking NYC is going to be a huge factor on your happiness. Are you OK living in a tiny studio, not having a car, falling asleep to sirens, and paying premium for everything in exchange for being at the center of the universe?

Also, fit with the people at your program is probably the single most important factor, but that's true everywhere.

gro2001 said:

Have you rotated at a NY program? If you haven't, one of the differences from EM elsewhere is that it's generally under resourced in terms of support staff/services and space. This ends up with patients in hallways and residents doing non medical stuff like starting IVs, drawing blood, and moving patients. That either makes you feel good (because you are in the thick of things and value that kind of work) or it makes you feel bad (because you want to just be doing the doctor stuff). Being honest with yourself about which category you fall into is important. Most people on this board, judging by what they say, fall are in the second category.

The other key difference about NY EM is that it's in New York. That's also either a good thing or a bad thing. For me, it was awesome. I love New York. But not everyone feels that way. Certainly it's expensive, crowded, dirty, loud, and in general, hard. Liking or not liking NYC is going to be a huge factor on your happiness. Are you OK living in a tiny studio, not having a car, falling asleep to sirens, and paying premium for everything in exchange for being at the center of the universe?

Also, fit with the people at your program is probably the single most important factor, but that's true everywhere.

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Damn. This is keeping it real, as it were. And thanks for that! Much appreciated and important. Were you a resident at NYP proper? The ONLY NYC program I applied to, and interviewed at, is NYP. Single-handedly loved it. Loved the program, Faculty, leadership team, residents, name it.

I HATE big cities... Interviewed in LA, Atlanta, Chicago, Miami, all those places are wayyyy down on my list. But NYC? That's a whole different story. Love it. Been there 55+ times in my life, and there's no place like it. It's... There are no words. I just can't explain it, it makes me full, fulfilled, happy... It is what it is. I love it.

So not sure this helps me, but essentially, of all the programs I interviewed at and am ranking, this one is the outlier, that is, I felt like, hmm, there's gonna be a factor of starting IV's, being more hands on, working harder... But dam* I love the people, the Faculty, the City, it gives me chills, goosebumps, makes me feel a whole world of possibilities, gets my blood going, tunes me in, and there's no other program/place like it...

... thoughts? Can you relate? And what's your advice formed by experience now that you're out of it?

dude not trying to rain on your parade but nyc is the worst *unless your rich*

and as far as saving time with dictation, thats not gonna matter when you are the MD, RN, CNA, PCT, pt transport all rolled into one.

Sounds like you rotated at this spot so maybe this program is different? doubt it but maybe?

Thinking about matching in nyc makes me effing internally scream

Listen2Savage said:

dude not trying to rain on your parade but nyc is the worst *unless your rich*

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I lived in NYC while making less than a resident salary and loved it. Now that I'm an attending, I agree that I'd rather live somewhere else unless I was making a LOT more money. But that's now. That doesn't mean that I didn't love being in NYC when I was broke.

BoardingDoc said:

I lived in NYC while making less than a resident salary and loved it. Now that I'm an attending, I agree that I'd rather live somewhere else unless I was making a LOT more money. But that's now. That doesn't mean that I didn't love being in NYC when I was broke.

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i cant pay 3k for a shytbox appartment and be happy, if you can that cool but just not for me

longtimelurker2015 said:

Damn. This is keeping it real, as it were. And thanks for that! Much appreciated and important. Were you a resident at NYP proper? The ONLY NYC program I applied to, and interviewed at, is NYP. Single-handedly loved it. Loved the program, Faculty, leadership team, residents, name it.

I HATE big cities... Interviewed in LA, Atlanta, Chicago, Miami, all those places are wayyyy down on my list. But NYC? That's a whole different story. Love it. Been there 55+ times in my life, and there's no place like it. It's... There are no words. I just can't explain it, it makes me full, fulfilled, happy... It is what it is. I love it.

So not sure this helps me, but essentially, of all the programs I interviewed at and am ranking, this one is the outlier, that is, I felt like, hmm, there's gonna be a factor of starting IV's, being more hands on, working harder... But dam* I love the people, the Faculty, the City, it gives me chills, goosebumps, makes me feel a whole world of possibilities, gets my blood going, tunes me in, and there's no other program/place like it...

... thoughts? Can you relate? And what's your advice formed by experience now that you're out of it?

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Yes, I was a resident at the Cornell/Columbia program. I loved it. Pretty much the same reasons you mentioned. Clicked with the people (my residency class was super close, still doing regular class reunions) and the city is definitely where my heart's at.

The negatives have all been talked about. Of course I am biased, but having at this point worked with residents from all over the country and many other places in the world, I'd say the training at NYP is going to be second to none. There are some gaps, but those are true of most EM programs. I was concerned about my skills in ophtho and ortho, but turns out they are just fine. The trauma training is light, being NYC, but so are most jobs right now. The airway and resus training is second to none. The Peds training is really good. On the balance I am very happy with the training I've received.

It's a great program as long as you know what you are getting into with living in NYC and training in EM in NYC in particular. Sounds like you are. Don't hesitate.

gro2001 said:

Yes, I was a resident at the Cornell/Columbia program. I loved it. Pretty much the same reasons you mentioned. Clicked with the people (my residency class was super close, still doing regular class reunions) and the city is definitely where my heart's at.

The negatives have all been talked about. Of course I am biased, but having at this point worked with residents from all over the country and many other places in the world, I'd say the training at NYP is going to be second to none. There are some gaps, but those are true of most EM programs. I was concerned about my skills in ophtho and ortho, but turns out they are just fine. The trauma training is light, being NYC, but so are most jobs right now. The airway and resus training is second to none. The Peds training is really good. On the balance I am very happy with the training I've received.

It's a great program as long as you know what you are getting into with living in NYC and training in EM in NYC in particular. Sounds like you are. Don't hesitate.

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1. How did you justify the cost of the extra year? Do you have loans?
2. Can you talk a bit more about your ortho skills? We've found residents from NYC programs to be particularly deficient in this area.
3. Did you do a fellowship? If so, what kind?
4. What kind of job do you have now? NYC? Non-NYC? Academic? Community?
5. FYI if you plan on practicing outside the tristate area, NY programs in general have a fairly poor reputation.

miacomet said:

1. How did you justify the cost of the extra year? Do you have loans?
2. Can you talk a bit more about your ortho skills? We've found residents from NYC programs to be particularly deficient in this area.
3. Did you do a fellowship? If so, what kind?
4. What kind of job do you have now? NYC? Non-NYC? Academic? Community?
5. FYI if you plan on practicing outside the tristate area, NY programs in general have a fairly poor reputation.

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1) My loans situation is pretty good compared to most US med students. Have loans, but they are manageable. So the cost of the extra year wasn't a major consideration.

2) I felt somewhat anxious about my ortho skills when I graduated residency. Except for shoulder reductions, those I was super comfortable with (as most ER docs are of course). I felt my fracture reductions wouldn't hold and everyone would know how bad I am at ortho by how ugly my splints are. I have since had the opportunity to work with EM attendings from all over the US and internationally and no longer feel that the skills I graduated with were noticeably different from the mean. If anything, some things I felt I did significantly better than average. Maybe I faced a sampling bias or am deluding myself, but having seen the quality of the work of people from various settings I've become skeptical of the claim that folks who train at places without ortho consults readily available come out significantly better prepared for practice. I think they suffer from overconfidence and lack of exposure to what's the actual standard. Basically, ivory tower residents tend to suck at ortho because it's too tempting to call a consult and they don't get enough practice, and community/unopposed residents tend to suck at ortho because they haven't seen enough of the work done by ortho docs to have a good sense of what they don't know. Please don't take this as me bashing on community programs, I am not saying they are worse than academic ones, just that there are pros and cons of both.

3) I am actually going back to fellowship in July! Neurocritical care.

4) I currently work outside of the US. Academics. The clinical side of the job is running a resuscitation bay (which also handles anything requiring procedural sedation in the ED).

5) I'll take your word for it. I've been around a bit and being from NYC didn't seem to hold me back job search/offers/recruitment wise. If anything, people seemed really into the Cornell/Columbia brand, even though I wouldn't say the residency is a Big Name in the EM world.

1. This seems to be the case in NYC. EM folks seem to either have generational money or be first generation college grads with major scholarships. The salaries are so low docs seem to either need to be grateful for an indoor job or wealthy enough money is irrelevant.

2. You do your own splints? As an attending? That's a poor use of resources IMHO. Ortho is pretty easy to pick up in any case. Glad it worked out.

3. Congrats. EM in NYC is def a losing proposition. A much better choice. Good for you.

4. That sounds fun and I want to work there.

5. Might only be true in certain markets. Don't know. We haven't had any C/C applicants, but have had trouble with grads from other "renowned" NYC programs. Glad it worked out for you.