Are NYC residencies brutal for neurology?

[someqsaboutstuff]

I have heard that NYC is absolutely brutal for residents and that anyone should stay away specifically for residency. I was wondering if due to the nature of neurology cases, do neurology residents (PGY2 onward) have it better or worse compared to the average resident experience?


Also, does it make a difference what hospital/program you're at if you do residency in NYC? Like is the "NYC effect" a lot less for programs like Cornell, Columbia, and NYU etc?

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[Med_WannaBee]

Bump. I would also like to know this.

 

[Always_Eating]

If you are "young and single", then IMO there is nowhere else you should do your residency other than in NYC. There are many good programs: NYU, Columbia, Cornell, Mt Sinai, etc. You work hard in residency and also work odd hours. Doing residency in NYC is the only place where if you get off work at 22:00, you can shower and have friends willing to meet for dinner at 23:00, then have a full night out until 04:00 or later if you want. You do not have to plan things. It is the only 24/7/365 city in the United States. No other city comes close. Museums, shows, restaurants, underground music, and art scenes galore. NYC has it all. That said, if you have kids and a family, it can be prohibitively expensive to live a normal life there. Private schools are extremely expensive, 99.99% of residents will not be able to afford a house there, and you are living hand-to-mouth. If you are at that stage where investing in your kid's 529 plan is your top priority, then avoid NYC.

As to the training itself. Is it frustrating to get an ED consult where the patient speaks some obscure rural Chinese dialect that not even your phone interpreter who is fluent in Fuzhou, Cantonese, and Mandarin does not speak, so you have no way to communicate with this patient with severe progressive myelopathy? Yes. Is is frustrating to have an ED attending try and force admit a homeless person with a radial nerve palsy to your service because he can't use his wheel chair now? Yes. Would some 24 hour shifts come with 20+ consults, 8 of which are admitted to your service? Yes.

That said, in most Neuro programs you are still out the door by 16:00 or 17:00 daily, and live an awesome life. I can also attest that going through training in NYC prepares you for everything you will ever see clinically. I remember meeting applicants from major midwest academic programs during fellowship interviews, and they would see 2-4 patients in a clinic day. Carrying 4 patients on an inpatient Neuro service was a "heavy load". I have also witnessed residents in midwest programs get very overwhelmed by the type of patient load that would be a breeze for any resident training on the east coast. Lastly, I can tell you that as an attending, physicians that trained on the east coast in big cities (and physicians that trained in the stroke belt that end up doing Vascular) stand out for all these reasons. They always seem to be the ones that can get the work done.

 

[bigamygdala]

I have heard that NYC is absolutely brutal for residents and that anyone should stay away specifically for residency. I was wondering if due to the nature of neurology cases, do neurology residents (PGY2 onward) have it better or worse compared to the average resident experience?


Also, does it make a difference what hospital/program you're at if you do residency in NYC? Like is the "NYC effect" a lot less for programs like Cornell, Columbia, and NYU etc?

depends on which programs. the img friendly ones are usually full of scrut work and even as imgs we tend to rank them last.

The ones u listed don't fall in those categories.

 

[Thama]

When I interviewed there close to 10 years ago and talked to a lot of residents, the least "NYC" program appeared to be Cornell. Nurses there appeared to function as actual nurses, rather than the unionized decorative appliances that wouldn't follow an unscheduled order at other NYC hospitals. At Columbia, NYU and Sinai you got all the same issues with having to function as both a resident and a nurse, combined with the high volume you would expect at any big city hospital.

There are plenty of other places in the country where you can get the volume and experience of the big city hospital (and far more night life than you'll ever have time to enjoy during residency), without the unique abuses present in NYC. Even in the above-disparaged Midwest, Chicago and St Louis are home to 2 of the 3 or 4 highest volume academic centers in the country, and Chicago has plenty of nightlife (STL not so much). The only major neurology program that has volume anything like the above-mentioned 3-4 patient clinic day I've heard of anywhere in the country is Mayo, which obviously has a very different approach to just about everything. Train at Grady, Texas Medical, Northwestern Memorial, Barnes-Jewish, UCSF, or UCLA/Cedars and 4 patients on an inpatient service will feel like a de facto vacation, not a heavy load.

 

[Chibucks15]

If you are "young and single", then IMO there is nowhere else you should do your residency other than in NYC. There are many good programs: NYU, Columbia, Cornell, Mt Sinai, etc. You work hard in residency and also work odd hours. Doing residency in NYC is the only place where if you get off work at 22:00, you can shower and have friends willing to meet for dinner at 23:00, then have a full night out until 04:00 or later if you want. You do not have to plan things. It is the only 24/7/365 city in the United States. No other city comes close. Museums, shows, restaurants, underground music, and art scenes galore. NYC has it all. That said, if you have kids and a family, it can be prohibitively expensive to live a normal life there. Private schools are extremely expensive, 99.99% of residents will not be able to afford a house there, and you are living hand-to-mouth. If you are at that stage where investing in your kid's 529 plan is your top priority, then avoid NYC.

As to the training itself. Is it frustrating to get an ED consult where the patient speaks some obscure rural Chinese dialect that not even your phone interpreter who is fluent in Fuzhou, Cantonese, and Mandarin does not speak, so you have no way to communicate with this patient with severe progressive myelopathy? Yes. Is is frustrating to have an ED attending try and force admit a homeless person with a radial nerve palsy to your service because he can't use his wheel chair now? Yes. Would some 24 hour shifts come with 20+ consults, 8 of which are admitted to your service? Yes.

That said, in most Neuro programs you are still out the door by 16:00 or 17:00 daily, and live an awesome life. I can also attest that going through training in NYC prepares you for everything you will ever see clinically. I remember meeting applicants from major midwest academic programs during fellowship interviews, and they would see 2-4 patients in a clinic day. Carrying 4 patients on an inpatient Neuro service was a "heavy load". I have also witnessed residents in midwest programs get very overwhelmed by the type of patient load that would be a breeze for any resident training on the east coast. Lastly, I can tell you that as an attending, physicians that trained on the east coast in big cities (and physicians that trained in the stroke belt that end up doing Vascular) stand out for all these reasons. They always seem to be the ones that can get the work done.

Eh my experiences in the midwest (albiet as an visiting 4th year student at that point but still directly in several large academic centers), there was plenty of what you are saying is "only in NYC". NYC is also not the only 24/7 city, but it does have to be Chicago to be comparable. The patient load you speak of may have been quite program specific as well. I wasn't at the Cleveland Clinics or Mayos of the midwest but in other respectable university centers doesn't quite fit what you're saying. Their loads were on par with what your NYC program had and you see just about as much variety in many places. That being said, if you love NYC then aim to do residency there. There's something to be said for being in a place you actually want to live...residency is going to suck wherever you are at a mostly comparable amount (of course there are hellholes that are well documented on here, but its more program specific rather than region specific)

Just a contrasting viewpoint for those who are just browsing the forum.

 

[someqsaboutstuff]

There are plenty of other places in the country

There are other places but for my basic science research interests Columbia would awesome

 

[Thama]

There are other places but for my basic science research interests Columbia would awesome

Well, you have 2 choices then. Either you do what is traditionally considered a malignant residency with the payoff being your research interests, or you look at other places around the country that are also strong in your research interests with less malignant residencies.

 

[mrbreakfast]

Would some 24 hour shifts come with 20+ consults, 8 of which are admitted to your service? Yes.

Not here to argue, but I'm not at a NYC program and this is pretty much our daily average, not a rough night. While I agree many academic Midwestern programs (for example) are not going to be anywhere as busy as NYC programs, you might be surprised how busy the only academic center in a medium-sized city with a large catchment area (full of people who haven't been to a doctor in decades) can get.

OP, you want to train at a busy program. That's how you learn. There are both busy programs and non-busy programs in every region of the united states (including the Midwest) but generally speaking the busiest places are going to be in major metropolitan areas, and either in very large cities (East/West coast cities, Chicago, maybe Houston) or in the stroke belt. You also want to avoid a "malignant program," where you'll be working beyond your hours regularly without good reason (e.g. in a busy program you might have a stroke come in 10 minutes before call is over and stay an extra hour to convince them to get TPA and admit them; in a malignant program you might stay a few extra hours just to present a single admission in person to the attending who comes in late), doing work you shouldn't be doing (scut work), or missing out on education because you're overloaded.

The big issues I've heard from NYC hospitals specifically are issues with nursing pushback and regional cultural differences, e.g. families expecting twice-daily rounds, every patient expecting their personal definition of "VIP care." Things are different in the Midwest/South; if MRI is backed up and the patient won't get their scan until the next day, they aren't going to call the hospital director and complain about it. You probably won't get the same in terms of cultural diversity, but we see a non-English (and non-Spanish) speaker pretty much every day.

In summary, train in NYC if you want to live there, and don't if you don't want to. I agree with the previous poster in that NYC is an incomparable city in terms of things to do and could be a lot of fun for you to live in, but not everyone wants to live in NYC, and there's plenty of good training - and things to do - elsewhere. Apply broadly and see what places vibe with you the best.

One final note: when you do apply, use the reddit neurology application sheet and look at archived years for more information on programs than you'll ever find here.

 

[liquidshadow22]

Cornell has reputation as most arduous. Columbia in between. Nyu and sinai are the most cush.

 

[StIGMA]

Comparing IM to neuro at a NYC versus non-NYC program (both at major universities / top20)-

Neuro residents were less busy/stressed at NYC program compared to IM peers (who worked their tail off). In non-NYC university the neuro residents far outworked the IM residents, having sometimes over 50 patients under their responsibility (however with interns/NPs assisting). IM cap was 20 for comparison. Really need to dig into program specifics to see what things are like.

 

[deathmerchant]

I have heard that NYC is absolutely brutal for residents and that anyone should stay away specifically for residency. I was wondering if due to the nature of neurology cases, do neurology residents (PGY2 onward) have it better or worse compared to the average resident experience?


Also, does it make a difference what hospital/program you're at if you do residency in NYC? Like is the "NYC effect" a lot less for programs like Cornell, Columbia, and NYU etc?

I don't think that is true esp if you compare good university programs in other areas compared to nyc. I have trained and worked in different areas including a top program in nyc. Actually new york has a pretty decent physician/patient ratio. Many good hospitals are close to each other and they follow work hour restrictions more strictly. Many states for eg have very few tertiary/university centers. Like one or two for the whole state and they end up getting transfers from all these community hospitals (esp in the stroke belt). From my personal experience, it wasn't unusual to get > 20 admits in a 24 hour period with just one admitting resident. You get crazy clinical training in these places with very high volumes and relatively smaller resident class. But that can be good as after those couple of tough years, everything is much easier.

NYC programs are better organized and have lesser clinical workload. I felt didactics were better in nyc and generally more competitive co-residents. Most top programs are equally busy. There is more scut work and nurses/patients/staff are more difficult and rude.
Ive heard NYU and Columbia are the busiest, although I'm not sure abt that. That being said residency is almost always brutal.

Although I'm sure you are more likely to find a cushier program in areas other than NYC or big cities, if that's what you are looking for.

 

[Always_Eating]

There are other places but for my basic science research interests Columbia would awesome

I would not have the expectation of graduating Columbia's clinical Neurology residency with any kind of significant basic science research momentum, experience, or protected time. Maybe if you stay for an extra year or two after clinical residency for a post-doc research fellowship you can accomplish what you envision. That is the only way that their graduates transition into research careers, save the few with PhDs and really strong pre-residency publications.
If you want protected basic research time in residency, you need to find the most chill program possible. Some of the NYC programs are chill, but none of them are so chill that you can use them as a basic research career booster.

 

[Thama]

I would not have the expectation of graduating Columbia's clinical Neurology residency with any kind of significant basic science research momentum, experience, or protected time. Maybe if you stay for an extra year or two after clinical residency for a post-doc research fellowship you can accomplish what you envision. That is the only way that their graduates transition into research careers, save the few with PhDs and really strong pre-residency publications.
If you want protected basic research time in residency, you need to find the most chill program possible. Some of the NYC programs are chill, but none of them are so chill that you can use them as a basic research career booster.

Columbia has an R25. Unless they are flaunting the NIH's requirements regarding protected research time during residency for recipients and thus jeopardizing not only that grant's future but also the NIH's view of others in the department, there absolutely is a mechanism for enough protected time to gain momentum for basic science research during residency (which would be carried into fellowship).

 

[Always_Eating]

Columbia has an R25. Unless they are flaunting the NIH's requirements regarding protected research time during residency for recipients and thus jeopardizing not only that grant's future but also the NIH's view of others in the department, there absolutely is a mechanism for enough protected time to gain momentum for basic science research during residency (which would be carried into fellowship).

The problem with the R25, and correct me if I am wrong, is that the eligibility is so wide for the appointee. Anyone from an undergraduate to an early career investigator can get it, so there can be stiff competition with post-docs. It you look at Columbia's page on it, less than one resident per year (on average) has taken this path, and the majority of those residents (more than half) already had PhDs.
So of course if the OP is coming in with a PhD and a strong research record, this is possible as mentioned. But Columbia is not a chill clinical residency, where a resident can start fresh with no research momentum.

 

[Thama]

R25s are

The problem with the R25, and correct me if I am wrong, is that the eligibility is so wide for the appointee. Anyone from an undergraduate to an early career investigator can get it, so there can be stiff competition with post-docs. It you look at Columbia's page on it, less than one resident per year (on average) has taken this path, and the majority of those residents (more than half) already had PhDs.
So of course if the OP is coming in with a PhD and a strong research record, this is possible as mentioned. But Columbia is not a chill clinical residency, where a resident can start fresh with no research momentum.

This may differ by institution, but at the places I'm familiar, R25s offered through residency programs are generally for residents. The competition for them can be stiff within a residency class, but you aren't competing with PhD students. Also, if you're the sort of applicant likely to match into Columbia, you're unlikely to have many problems competing for an R25 or other mechanisms.

 

[sharkbaitwhohaha]

If you are "young and single", then IMO there is nowhere else you should do your residency other than in NYC. There are many good programs: NYU, Columbia, Cornell, Mt Sinai, etc. You work hard in residency and also work odd hours. Doing residency in NYC is the only place where if you get off work at 22:00, you can shower and have friends willing to meet for dinner at 23:00, then have a full night out until 04:00 or later if you want. You do not have to plan things. It is the only 24/7/365 city in the United States. No other city comes close. Museums, shows, restaurants, underground music, and art scenes galore. NYC has it all. That said, if you have kids and a family, it can be prohibitively expensive to live a normal life there. Private schools are extremely expensive, 99.99% of residents will not be able to afford a house there, and you are living hand-to-mouth. If you are at that stage where investing in your kid's 529 plan is your top priority, then avoid NYC.

As to the training itself. Is it frustrating to get an ED consult where the patient speaks some obscure rural Chinese dialect that not even your phone interpreter who is fluent in Fuzhou, Cantonese, and Mandarin does not speak, so you have no way to communicate with this patient with severe progressive myelopathy? Yes. Is is frustrating to have an ED attending try and force admit a homeless person with a radial nerve palsy to your service because he can't use his wheel chair now? Yes. Would some 24 hour shifts come with 20+ consults, 8 of which are admitted to your service? Yes.

That said, in most Neuro programs you are still out the door by 16:00 or 17:00 daily, and live an awesome life. I can also attest that going through training in NYC prepares you for everything you will ever see clinically. I remember meeting applicants from major midwest academic programs during fellowship interviews, and they would see 2-4 patients in a clinic day. Carrying 4 patients on an inpatient Neuro service was a "heavy load". I have also witnessed residents in midwest programs get very overwhelmed by the type of patient load that would be a breeze for any resident training on the east coast. Lastly, I can tell you that as an attending, physicians that trained on the east coast in big cities (and physicians that trained in the stroke belt that end up doing Vascular) stand out for all these reasons. They always seem to be the ones that can get the work done.

That line, nearly verbatim, is perpetually mentioned when promoting NYC lifestyle.

You're wrong. Sorry to burst bubble, but NYC isnt all that special and different from LA, SF, etc.

 

[Always_Eating]

That line, nearly verbatim, is perpetually mentioned when promoting NYC lifestyle.

You're wrong. Sorry to burst bubble, but NYC isnt all that special and different from LA, SF, etc.

You cleaely have not lived in these cities for 5+ years each like I and many others have. Nobody that has lived in both NYC and LA would claim that LA is a 24/7 city. Out of the numerous NYC to SF/LA transplants I know, all made the move in-part to live a more healthy lifestyle and to "slow things down".

 

[xenotype]

That said, in most Neuro programs you are still out the door by 16:00 or 17:00 daily, and live an awesome life. I can also attest that going through training in NYC prepares you for everything you will ever see clinically. I remember meeting applicants from major midwest academic programs during fellowship interviews, and they would see 2-4 patients in a clinic day. Carrying 4 patients on an inpatient Neuro service was a "heavy load". I have also witnessed residents in midwest programs get very overwhelmed by the type of patient load that would be a breeze for any resident training on the east coast. Lastly, I can tell you that as an attending, physicians that trained on the east coast in big cities (and physicians that trained in the stroke belt that end up doing Vascular) stand out for all these reasons. They always seem to be the ones that can get the work done.

This isn't realistic, and shouldn't be realistic if you want quality training. Most neuro programs you are out at 6-7PM and need to be back at 6-7AM the next morning. Night life with that kind of schedule is going to be quite infrequent. Agree a program with 4 patients per clinic day and 4 patients on inpatient service is a complete joke. These programs exist, and applicants need to know to avoid them as you won't be capable of being as busy as you need to be in private practice or even in most academic practices. My primary service rounding responsibility as a junior resident was usually 10-20 patients with an additional 40+ on consult coverage for call days/nights, and 7 patients per half day in clinic split 50/50 new and follow-up. On the other hand, having to do blood draws, IV placement, and transporting patients is a complete waste of time for a neurologist in training, and for this reason I'd never advise someone doing an NY style residency. I spent my time in training actually doing neurology instead of being a nurse/tech.

When I interviewed there close to 10 years ago and talked to a lot of residents, the least "NYC" program appeared to be Cornell. Nurses there appeared to function as actual nurses, rather than the unionized decorative appliances that wouldn't follow an unscheduled order at other NYC hospitals. At Columbia, NYU and Sinai you got all the same issues with having to function as both a resident and a nurse, combined with the high volume you would expect at any big city hospital.

There are plenty of other places in the country where you can get the volume and experience of the big city hospital (and far more night life than you'll ever have time to enjoy during residency), without the unique abuses present in NYC. Even in the above-disparaged Midwest, Chicago and St Louis are home to 2 of the 3 or 4 highest volume academic centers in the country, and Chicago has plenty of nightlife (STL not so much). The only major neurology program that has volume anything like the above-mentioned 3-4 patient clinic day I've heard of anywhere in the country is Mayo, which obviously has a very different approach to just about everything. Train at Grady, Texas Medical, Northwestern Memorial, Barnes-Jewish, UCSF, or UCLA/Cedars and 4 patients on an inpatient service will feel like a de facto vacation, not a heavy load.

Agree, except my advice is for carefully considering cost of living which often excludes some of the name brands you mention- especially NY, MA, and CA programs. There are big hospitals in SC, FL, GA, TX and the midwest with much lower cost of living that will make life a lot easier as a resident. Stipends and individual finances will affect this decision a lot, but I was quite comfortable in the southeast on a resident salary living by myself. Much harder with a family, but can be done. Safety also has to be considered as many academic hospitals are located in high crime areas.

Not here to argue, but I'm not at a NYC program and this is pretty much our daily average, not a rough night. While I agree many academic Midwestern programs (for example) are not going to be anywhere as busy as NYC programs, you might be surprised how busy the only academic center in a medium-sized city with a large catchment area (full of people who haven't been to a doctor in decades) can get.

OP, you want to train at a busy program. That's how you learn. There are both busy programs and non-busy programs in every region of the united states (including the Midwest) but generally speaking the busiest places are going to be in major metropolitan areas, and either in very large cities (East/West coast cities, Chicago, maybe Houston) or in the stroke belt. You also want to avoid a "malignant program," where you'll be working beyond your hours regularly without good reason (e.g. in a busy program you might have a stroke come in 10 minutes before call is over and stay an extra hour to convince them to get TPA and admit them; in a malignant program you might stay a few extra hours just to present a single admission in person to the attending who comes in late), doing work you shouldn't be doing (scut work), or missing out on education because you're overloaded.

Yes. My experience was you'll routinely get 15-20 new consults per 24hrs you'll be personally responsible for, roughly half in boluses of high acuity stroke with average 20% intervention (tpa/IR) rate. 'Bad nights' are 23+ and high acuity where you will have trouble completing all of it due to unstable patients, but at most programs there should be safety mechanisms to assist. A lot of applicants seem to be trying to avoid this pain rather than grabbing the bull by the horns- but in my opinion this is what you need to really learn hospital neurology cold. With that said, obviously my overall advice is for most to avoid NY style programs due to excessive non-medicine scut and the high cost of living. You can find bars and single people in any mid size city, but many cities are safer and less expensive overall than NYC presently.

 

[Postictal Raiden]

This isn't realistic, and shouldn't be realistic if you want quality training. Most neuro programs you are out at 6-7PM and need to be back at 6-7AM the next morning. Night life with that kind of schedule is going to be quite infrequent. Agree a program with 4 patients per clinic day and 4 patients on inpatient service is a complete joke. These programs exist, and applicants need to know to avoid them as you won't be capable of being as busy as you need to be in private practice or even in most academic practices. My primary service rounding responsibility as a junior resident was usually 10-20 patients with an additional 40+ on consult coverage for call days/nights, and 7 patients per half day in clinic split 50/50 new and follow-up. On the other hand, having to do blood draws, IV placement, and transporting patients is a complete waste of time for a neurologist in training, and for this reason I'd never advise someone doing an NY style residency. I spent my time in training actually doing neurology instead of being a nurse/tech.



Agree, except my advice is for carefully considering cost of living which often excludes some of the name brands you mention- especially NY, MA, and CA programs. There are big hospitals in SC, FL, GA, TX and the midwest with much lower cost of living that will make life a lot easier as a resident. Stipends and individual finances will affect this decision a lot, but I was quite comfortable in the southeast on a resident salary living by myself. Much harder with a family, but can be done. Safety also has to be considered as many academic hospitals are located in high crime areas.


Yes. My experience was you'll routinely get 15-20 new consults per 24hrs you'll be personally responsible for, roughly half in boluses of high acuity stroke with average 20% intervention (tpa/IR) rate. 'Bad nights' are 23+ and high acuity where you will have trouble completing all of it due to unstable patients, but at most programs there should be safety mechanisms to assist. A lot of applicants seem to be trying to avoid this pain rather than grabbing the bull by the horns- but in my opinion this is what you need to really learn hospital neurology cold. With that said, obviously my overall advice is for most to avoid NY style programs due to excessive non-medicine scut and the high cost of living. You can find bars and single people in any mid size city, but many cities are safer and less expensive overall than NYC presently.

When you say that the primary rounding responsibility 10-20 and consult 40+, how many residents is this divided upon?

 

[xenotype]

When you say that the primary rounding responsibility 10-20 and consult 40+, how many residents is this divided upon?

Daytime these were a couple different services with a senior and a junior each, but frequently one resident was in clinic leaving the other alone for half the day. Night and weekends- really just one junior resident with some limited help from a senior during weekend daytime. Not rare to deal with 4 acute strokes at once by yourself within a 30 minute period with tPA/IR on 1-2 out of the 4 as our treatment rate was about 20% overall. Wrote a lot of progress notes at 3am next to the neurosurgery resident...

 

[Giovanotto]

Daytime these were a couple different services with a senior and a junior each, but frequently one resident was in clinic leaving the other alone for half the day. Night and weekends- really just one junior resident with some limited help from a senior during weekend daytime. Not rare to deal with 4 acute strokes at once by yourself within a 30 minute period with tPA/IR on 1-2 out of the 4 as our treatment rate was about 20% overall. Wrote a lot of progress notes at 3am next to the neurosurgery resident...

This sounds absolutely terrible. Any rotators? Medical students? Any didactics in this program?

 

[deathmerchant]

Daytime these were a couple different services with a senior and a junior each, but frequently one resident was in clinic leaving the other alone for half the day. Night and weekends- really just one junior resident with some limited help from a senior during weekend daytime. Not rare to deal with 4 acute strokes at once by yourself within a 30 minute period with tPA/IR on 1-2 out of the 4 as our treatment rate was about 20% overall. Wrote a lot of progress notes at 3am next to the neurosurgery resident...

Sounds exactly like the program I trained at lol

 

[xenotype]

This sounds absolutely terrible. Any rotators? Medical students? Any didactics in this program?

Rarely an EM intern rotator- don't save you much time as they aren't a neurologist and can't be trusted with unstable patients (ie if they mess up and you don't catch the stroke patient that got much worse- its your butt in trouble). A midlevel was tried towards when I was finishing, but they were clueless and as a senior resident I ended up having to double check them on anything but the simplest headache patients. The midlevel also wasn't available after 3pm, wasn't available for new consults, and could only handle as much business as an intern.

Medical students do not save you time at all really. The old adage from House of God is apt. I took extra time to do a little teaching especially once I was a more senior resident as the students deserve a good experience, but this often put me far behind clinically. I always tried to include the students and spur interest in neurology, but they didn't help me as a resident at all- days without them were much smoother.

Our didactics were excellent, and as a recent post noted unprotected didactics at many programs mine were totally and truly protected- no pagers, done in the afternoon after you have signed out from all clinical duties. I believe they are better than most programs honestly.

I need to be clear- I firmly believe my training was better than a lot of places. My program was not malignant- any complaints and the PD had your back automatically. No residents ever fired except one years ago that had a massive, intentional hipaa violation against another trainee- even then reinstated and allowed to graduate later. It's a mid tier program so I am sure many would say their name brand XYZ program is better, but I had high acuity, huge breadth in training with reasonable autonomy and good didactics in a coastal city that was cheap to live in with high quality of life.

Don't be afraid of 'busy' programs. You need to be a competent neurologist when you finish. And really what I describe reflects a lot of neurology residencies. It isn't 'absolutely terrible'. You have easy rotations and weekends off here and there, and when you are on you need to learn how to handle sick patients.

 

[scoopdaboop]

Random questions Do neurology residents hit 80 hour weeks?

 

[Postictal Raiden]

Random questions Do neurology residents hit 80 hour weeks?

My program is not nearly as busy as xenotype's and deathmarchent's, and I do exceed 80hrs/week very frequently. However, averaged over 4 weeks, I'd say I do 70hrs/week when on inpatient service vs 50hrs/week when on an elective.

so yes, don't apply to neurology if you think you'd be equally as content doing something else

 

[Postictal Raiden]

Rarely an EM intern rotator- don't save you much time as they aren't a neurologist and can't be trusted with unstable patients (ie if they mess up and you don't catch the stroke patient that got much worse- its your butt in trouble). A midlevel was tried towards when I was finishing, but they were clueless and as a senior resident I ended up having to double check them on anything but the simplest headache patients. The midlevel also wasn't available after 3pm, wasn't available for new consults, and could only handle as much business as an intern.

Medical students do not save you time at all really. The old adage from House of God is apt. I took extra time to do a little teaching especially once I was a more senior resident as the students deserve a good experience, but this often put me far behind clinically. I always tried to include the students and spur interest in neurology, but they didn't help me as a resident at all- days without them were much smoother.

Our didactics were excellent, and as a recent post noted unprotected didactics at many programs mine were totally and truly protected- no pagers, done in the afternoon after you have signed out from all clinical duties. I believe they are better than most programs honestly.

I need to be clear- I firmly believe my training was better than a lot of places. My program was not malignant- any complaints and the PD had your back automatically. No residents ever fired except one years ago that had a massive, intentional hipaa violation against another trainee- even then reinstated and allowed to graduate later. It's a mid tier program so I am sure many would say their name brand XYZ program is better, but I had high acuity, huge breadth in training with reasonable autonomy and good didactics in a coastal city that was cheap to live in with high quality of life.

Don't be afraid of 'busy' programs. You need to be a competent neurologist when you finish. And really what I describe reflects a lot of neurology residencies. It isn't 'absolutely terrible'. You have easy rotations and weekends off here and there, and when you are on you need to learn how to handle sick patients.

Your program is very busy indeed. From talking to friends at different programs across the country, my workload seems to be very comparable. We have two inpatient services: General and Stroke. We don't have a dedicated ICU rotation because we see these patients on daily basis as part of the general/stroke list. We also don't have a dedicated consult service. The residents manning the inpatient service (stroke or general) see new consults as they come in, in addition to managing existing patients.

At any given time, I'd say we have about 10-15 patients on either list. Each service is manned by a senior, a junior and +/- IM/psych resident rotator. Like you said, students add to your workload not take away from it. On weekends, each service is manned by one neuro resident and it can be very hectic.

On night float, we have one neuro resident manning the whole inpatient neurology service. Hit or mess. Can be a peaceful night where you get 2-3 consults with a dozen of cross cover stuff or you can get killed with 10+ consults/stroke alerts and still get a couple dozen cross cover pages.

All in all, I feel I'm getting sufficient, if not excessive, inpatient neurology exposure (stroke, seizure, encephalopathy, headache, MS, GBS, MG). However, I'm still able to have enough downtime to read, listen to continuum audios, work on my QI project, and obsess over my Robinhood investment/losses.

 

[DrSatan]

Your program is very busy indeed. From talking to friends at different programs across the country, my workload seems to be very comparable. We have two inpatient services: General and Stroke. We don't have a dedicated ICU rotation because we see these patients on daily basis as part of the general/stroke list. We also don't have a dedicated consult service. The residents manning the inpatient service (stroke or general) see new consults as they come in, in addition to managing existing patients.

At any given time, I'd say we have about 10-15 patients on either list. Each service is manned by a senior, a junior and +/- IM/psych resident rotator. Like you said, students add to your workload not take away from it. On weekends, each service is manned by one neuro resident and it can be very hectic.

On night float, we have one neuro resident manning the whole inpatient neurology service. Hit or mess. Can be a peaceful night where you get 2-3 consults with a dozen of cross cover stuff or you can get killed with 10+ consults/stroke alerts and still get a couple dozen cross cover pages.

All in all, I feel I'm getting sufficient, if not excessive, inpatient neurology exposure (stroke, seizure, encephalopathy, headache, MS, GBS, MG). However, I'm still able to have enough downtime to read, listen to continuum audios, work on my QI project, and obsess over my Robinhood investment/losses.

Yours is more similar to mine. Not sure how old those other posters are, but I'd hope that workload would be more of a relic these days. It sounds frankly unsafe for both patients & residents.

 

[deathmerchant]

Yours is more similar to mine. Not sure how old those other posters are, but I'd hope that workload would be more of a relic these days. It sounds frankly unsafe for both patients & residents.

Yea I agree after a certain point, too much work decreases apt learning. Our program was in a transition/expanding those days and we got the short end of it. Now they have added more residents and an army of NPs.

 

[deathmerchant]

Random questions Do neurology residents hit 80 hour weeks?

We hit 80 hours frequently in PG2. Esp in the stroke month, it was 80 hours at least 3 weeks/month. Every year the load got lighter and by the end it was mostly chill electives.
Some programs are very hard and frontloaded with much more relaxed PG4, like ours. Others have a more evenly distributed pain throughout 3 years.

 

[Thama]

We hit 80 hours frequently in PG2. Esp in the stroke month, it was 80 hours at least 3 weeks/month. Every year the load got lighter and by the end it was mostly chill electives.
Some programs are very hard and frontloaded with much more relaxed PG4, like ours. Others have a more evenly distributed pain throughout 3 years.

I stopped recording duty hours after a few months of PGY2 because I was tired of having to justify violations. It was way beyond 80 hours most months if recorded accurately. This wasn't particularly long ago, and wasn't anywhere near NYC or the urban NE.

 

[xenotype]

I stopped recording duty hours after a few months of PGY2 because I was tired of having to justify violations. It was way beyond 80 hours most months if recorded accurately. This wasn't particularly long ago, and wasn't anywhere near NYC or the urban NE.

My program never had any trouble with this. The schedule and systems were well built so that the limits would never be exceeded- rarely the 1 day off in 7 averaged over a month would be borderline if a resident was out on extended leave for maternity etc. We never had to lie on the logger. However, you'd be 75-80 hours averaged as a PG2 for inpatient months every time. There were a reasonable number of lighter rotations built into PG2 to break it up. Certainly every year was a bit better than the year before with biggest improvement from PG2 to 3. My program also had a lot of full weekends off built in for PG2s including on inpatient months, which you don't often see and really improved quality of life.

 

[ronnicus]

I'm applying this year and terrified that I will end up at a malignant program. If anyone wouldn't mind DM'ing me programs known to be malignant I would really appreciate it!

 

[Captain_Falcon]

My program never had any trouble with this. The schedule and systems were well built so that the limits would never be exceeded- rarely the 1 day off in 7 averaged over a month would be borderline if a resident was out on extended leave for maternity etc. We never had to lie on the logger. However, you'd be 75-80 hours averaged as a PG2 for inpatient months every time. There were a reasonable number of lighter rotations built into PG2 to break it up. Certainly every year was a bit better than the year before with biggest improvement from PG2 to 3. My program also had a lot of full weekends off built in for PG2s including on inpatient months, which you don't often see and really improved quality of life.

What part of the county was your residency in?

 

[xenotype]

What part of the county was your residency in?

Southeast. Most important thing is to learn as much as you can about your top choices. Most neuro residencies are not malignant, are not out to get you, and genuinely want to see their residents do well and provide good care.