The Dartmouth-Hitchcock Medical Center is set in a beautiful area of the country and is a large tertiary center in a very small community. The town and the surrounding towns are very small, despite having a college nearby. There are two major areas for restaurants, etc - and these usually are closed or deserted by 11 pm on most nights. The closest shopping malls are 45 minutes - 1 hour away. The hospital itself is fairly new, having been built within the last 15 years; the building is big, clean, bright with many windows, and generally a nice place to work. The medical floors do seem to be overcrowded with four medical teams (each having at least 4 people on the team) sharing two team rooms.
The patients are typically white and middle or upper-class; if you do residency at this hospital, you will not see sickle cell anemia, HIV-AIDS, etc. In fact, it is very rare that you even see a non-Caucasian patient. The medicine residency has only a handful of non-white residents and faculty. If you like small towns and a specific patient set, this residency is the one for you.
While the Dartmouth name may carry some prestige, the program itself has many flaws, one being actually keeping its residents due to problems within the program. The current PGY-3 class did not fill during the match and since intern year, have had at least 4 residents leave the program. The PGY-2 class, which did fill, had 2 interns leave within the first 6 months and another 2 leaving later. Why does the program have such difficulty with keeping residents happy? Mainly because of lack of change, overworking of residents due to low numbers overall, and lack of respect for the hard-working residents in the program. One example is the appointment of a resident who had been at the program for 3 months before being appointed chief resident over the others in the class who had been in the program for > 1 year. The residents are over-worked, under appreciated, and have a low morale. Of the 8 residents applying for fellowship this year, only 2 opted to stay at Dartmouth, which is unusual for this area. The fellowships are known to take many of their own residents, but this has definitely changed.
The RRC reviewed the program last year and found several areas of deficiency, namely lack of teaching on the Cardiology service, intern and senior night float rotations. It is not unusual for residents to exceed the 30 hour work rule, the 10-hours between shifts rule. There is poor monitoring of the work hours in general and many residents are in the hospital much later than they are supposed to be. There has been once change in the Dartmouth medicine service (not the VA, Cardiology, Heme, etc) the system has changed to a no-overnight-call system, which means that teams are admitting only until 7 pm. While this sounds nice, teams are usually here much later than 10 pm and thereby violate work hour rules. In previous years (and with the previous system), there wasnt a hospitalist in-house and residents were admitting to non-teaching services overnight. Now there is a hospitalist who is admitting overnight, but there seems to be a strained relationship between the hospitalists and the housestaff. The hospitalists try to give all of the admissions to the resident services during the day and the night, thereby filling the medicine services and creating other problems. Rules for the new system are never followed as far as senior night float admitting caps, etc.; it seems that the rule is there is no rule. Unfortunately, the administration has not stepped in to protect their residents from dumping by the hospitalists and does not seem inclined to do so in the near future.
The VA service is still call q4, but it is a difficult rotation for residents. As a resident, you admit overnight, take telephone calls from patients, and cover the Emergency Department. There is a moonlighter attending on-call overnight, but many times these attendings tell the residents that they do not want to be called about ED patients or admissions unless there is a problem. In most instances, patients are never seen by anyone other than the resident or discussed with an attending before being treated or discharged from the ED. There are no subspecialties in-house overnight or on the weekends, and many of the sicker patients require transfer to Dartmouth.
The ICU is an open unit, which means that Medicine, Surgery, subspecialties are all taken care of by the same team which is composed of medicine, surgery, anesthesia, ob/gyn residents. The subspecialty teams typically want the ICU team to babysit their patients and will write orders without alerting the ICU team and will typically dictate the care of the patient.
The Cardiology service is being switched from a call q3 to a call q4 system. The Heme/Onc service is currently q4. Both of these services do not have in-house fellows and do not have admission caps.
Research time is not well-protected, as many times residents are placed on backup during their research block. In the past few years due to residents dropping out of the program, backup has been called in frequently.
One of the good things about this program is the subsepecialty services, who are all quite friendly, open to questions/consults, and are generally well-liked. It is easy, once you have found an attending, to start a research project if you are so inclined.
Dartmouth has a nice hospital, quiet surroundings, and good ancillary staff. Unfortunately, there are many problems with the medicine program; this does not mean that you wont become a good resident or get into a good fellowship. Since residents have to do so much on their own, they seem to pick up things faster and find a way to get around the lack of support from the medicine administration. If the resident is motivated, there are learning and research opportunities. Overall this program produces very qualified residents but the way in which they do so is not ideal. Many of these issues wont be discussed with applicants (for obvious reasons), as the majority of those residents unhappy with the program will not attend pre-interview dinners or interview lunches. Instead, the typical crowd for those functions are residents who want free food and alcohol, as even the alcohol is paid for by the program during the dinners - it is not unusual to see residents leaving the dinners quite inebriated. The program director promises many changes, none of which have occurred in the past few years. This program seems to be behind others as far as resident support and abiding by ACGME rules, but instead will portray a different image to applicants. Beware, not only for this program but for others as well, since residents and program administrators will not discuss the flaws of programs during interviews. All programs have their problems, but this one seems to have more than others.
The patients are typically white and middle or upper-class; if you do residency at this hospital, you will not see sickle cell anemia, HIV-AIDS, etc. In fact, it is very rare that you even see a non-Caucasian patient. The medicine residency has only a handful of non-white residents and faculty. If you like small towns and a specific patient set, this residency is the one for you.
While the Dartmouth name may carry some prestige, the program itself has many flaws, one being actually keeping its residents due to problems within the program. The current PGY-3 class did not fill during the match and since intern year, have had at least 4 residents leave the program. The PGY-2 class, which did fill, had 2 interns leave within the first 6 months and another 2 leaving later. Why does the program have such difficulty with keeping residents happy? Mainly because of lack of change, overworking of residents due to low numbers overall, and lack of respect for the hard-working residents in the program. One example is the appointment of a resident who had been at the program for 3 months before being appointed chief resident over the others in the class who had been in the program for > 1 year. The residents are over-worked, under appreciated, and have a low morale. Of the 8 residents applying for fellowship this year, only 2 opted to stay at Dartmouth, which is unusual for this area. The fellowships are known to take many of their own residents, but this has definitely changed.
The RRC reviewed the program last year and found several areas of deficiency, namely lack of teaching on the Cardiology service, intern and senior night float rotations. It is not unusual for residents to exceed the 30 hour work rule, the 10-hours between shifts rule. There is poor monitoring of the work hours in general and many residents are in the hospital much later than they are supposed to be. There has been once change in the Dartmouth medicine service (not the VA, Cardiology, Heme, etc) the system has changed to a no-overnight-call system, which means that teams are admitting only until 7 pm. While this sounds nice, teams are usually here much later than 10 pm and thereby violate work hour rules. In previous years (and with the previous system), there wasnt a hospitalist in-house and residents were admitting to non-teaching services overnight. Now there is a hospitalist who is admitting overnight, but there seems to be a strained relationship between the hospitalists and the housestaff. The hospitalists try to give all of the admissions to the resident services during the day and the night, thereby filling the medicine services and creating other problems. Rules for the new system are never followed as far as senior night float admitting caps, etc.; it seems that the rule is there is no rule. Unfortunately, the administration has not stepped in to protect their residents from dumping by the hospitalists and does not seem inclined to do so in the near future.
The VA service is still call q4, but it is a difficult rotation for residents. As a resident, you admit overnight, take telephone calls from patients, and cover the Emergency Department. There is a moonlighter attending on-call overnight, but many times these attendings tell the residents that they do not want to be called about ED patients or admissions unless there is a problem. In most instances, patients are never seen by anyone other than the resident or discussed with an attending before being treated or discharged from the ED. There are no subspecialties in-house overnight or on the weekends, and many of the sicker patients require transfer to Dartmouth.
The ICU is an open unit, which means that Medicine, Surgery, subspecialties are all taken care of by the same team which is composed of medicine, surgery, anesthesia, ob/gyn residents. The subspecialty teams typically want the ICU team to babysit their patients and will write orders without alerting the ICU team and will typically dictate the care of the patient.
The Cardiology service is being switched from a call q3 to a call q4 system. The Heme/Onc service is currently q4. Both of these services do not have in-house fellows and do not have admission caps.
Research time is not well-protected, as many times residents are placed on backup during their research block. In the past few years due to residents dropping out of the program, backup has been called in frequently.
One of the good things about this program is the subsepecialty services, who are all quite friendly, open to questions/consults, and are generally well-liked. It is easy, once you have found an attending, to start a research project if you are so inclined.
Dartmouth has a nice hospital, quiet surroundings, and good ancillary staff. Unfortunately, there are many problems with the medicine program; this does not mean that you wont become a good resident or get into a good fellowship. Since residents have to do so much on their own, they seem to pick up things faster and find a way to get around the lack of support from the medicine administration. If the resident is motivated, there are learning and research opportunities. Overall this program produces very qualified residents but the way in which they do so is not ideal. Many of these issues wont be discussed with applicants (for obvious reasons), as the majority of those residents unhappy with the program will not attend pre-interview dinners or interview lunches. Instead, the typical crowd for those functions are residents who want free food and alcohol, as even the alcohol is paid for by the program during the dinners - it is not unusual to see residents leaving the dinners quite inebriated. The program director promises many changes, none of which have occurred in the past few years. This program seems to be behind others as far as resident support and abiding by ACGME rules, but instead will portray a different image to applicants. Beware, not only for this program but for others as well, since residents and program administrators will not discuss the flaws of programs during interviews. All programs have their problems, but this one seems to have more than others.
