Best place to be a IM resident?

[socal4life]

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I was wondering if anyone had any ideas which IM programs (within the top 20) have the best combination of the following characteristics:

-great ancillary services
-least scutwork
-great morning report/teaching by attendings
-are not "thrown into the fire" programs
-minimal need to do blood draws, EKGs

Thanks

 

[wes c. adle]

Based on my impression, Beth Israel in Boston seems like a place that would meet your criteria. Morning report was fantastic on my interview day and it seemed like the residents were relatively "protected" from scutwork/being thrown into the fire, the latter point being a weakness of the program in my eyes.

 

[DrRobert]

Northwestern

 

[Mumpu]

Northwestern. Extremely cush (q5 with no overnight call except in ICU and VA, no prerounding on patients) and decent teaching.

 

[remedios]

Looks like everyone already found the joy of Northwestern:

-- q5 long call
-- nightfloat pick up at 7
-- short call = nightfloat passout (so you don't really admit)
-- great ancillary service
-- no prerounding as mentioned
-- great morning reports (they cherry pick cases most of the time; so better selection than morning reports at even places that are considered better academically)

downside is a couple months of va. the va can be a killer if you have a bad stretch of calls, but it's also not uncommon to have 2 weeks where your average census for the team is <4 patient (it's due to the funky call schedule they have and what calls falls on weekends). micu is probably same everywhere.

other top20 programs (which i don't have as much personal experience on so probably less accurate):

brigham is probably the easiest, with nightfloat and great ancillary service and support. although i hear from residents and interns there it's not uncommon to be over 80 hours.

ucsf is supportive, but it is a tougher place as, unfortunately, it is less moneyed; i believe the sf county is also a busier/tougher place to work at. their va is supposed to be one of the best in the country though.

mgh/hopkins/columbia, hard first year (intern take call solo, front loaded ward months etc), easier compared to above the second two years.

university of chicago probably somewhere in the middle. their ancillary service is said to be occasionally frustrating/va-like.

 

[souljah1]

I have to say that UCSF is by no means cush. It is a fantastic program, but the residents work really hard. Wards are q4 or q5 depending on which hospital you are in, but you admit patients until 3am, afterwhich a nightfloat takes over. If you are at Moffit, it is an open ICU so it is possible to get a 2:59am ICU admit. Bye bye sleep.

Morning report and noon conference are incredibly well run and the residents, despite working hard, are a great group of people.

Rigorous and rewarding, but not cush.

 

[BStein76]

-great ancillary services
-least scutwork
-great morning report/teaching by attendings
-are not "thrown into the fire" programs
-minimal need to do blood draws, EKGs

Thanks

When I interviewed I thought residents had a lot of ancillary support at the university hospitals affiliated with Northwestern, BIDMC, Stanford and Wash U (I don't count the VA hospitals because the federal government has somehow standardized the "VA experience" from hospital to hospital). The programs that struck me with more legwork were UCSF (SFGH, Moffitt), Southwestern (Parkland) and Baylor University (Ben Taub).

 

[APACHE3]

The place you MATCHED!! 😀

 

[ucla2usc]

When I interviewed I thought residents had a lot of ancillary support at the university hospitals affiliated with Northwestern, BIDMC, Stanford and Wash U (I don't count the VA hospitals because the federal government has somehow standardized the "VA experience" from hospital to hospital). The programs that struck me with more legwork were UCSF (SFGH, Moffitt), Southwestern (Parkland) and Baylor University (Ben Taub).

I second that...Stanford is super cush, they take excellent care of their residents. Brigham seems like they take great care of their residents too.
UCLA is a well oiled machine with fantastic ancillary support. Their patient's tend to be very sick so you still work your tail off but it's definitely not from the scut.The draw back is these "easier" hospitals is that they are private, and seem very reliant on consult services and attending input, making them a fellow's paradise but may take a little from the resident's experience.


UCSF, JHU and MGH...the scut load is higher than the above, but the residents seem to work it to their advantage... I don't know how to explain it, but they all have the appearance of "digging in and getting their hands dirty" type doctors...the kind of doctor I want to be.

 

[hemoglobin]

I was wondering if anyone had any ideas which IM programs (within the top 20) have the best combination of the following characteristics:

-great ancillary services
-least scutwork
-great morning report/teaching by attendings
-are not "thrown into the fire" programs
-minimal need to do blood draws, EKGs

Thanks

Mayo Clinic, Rochester, MN 🙂

 

[P Diddy]

I was wondering if anyone had any ideas which IM programs (within the top 20) have the best combination of the following characteristics:

-great ancillary services
-least scutwork
-great morning report/teaching by attendings
-are not "thrown into the fire" programs
-minimal need to do blood draws, EKGs

Thanks

stanford fits the bill, although there's a lot of responsibility on certain rotations as an intern (VA ICU, Onc, Heme). you're not left alone on call, which I think is a good thing.

p diddy

 

[mellow yellow]

I second that...Stanford is super cush, they take excellent care of their residents. Brigham seems like they take great care of their residents too.
UCLA is a well oiled machine with fantastic ancillary support. Their patient's tend to be very sick so you still work your tail off but it's definitely not from the scut.The draw back is these "easier" hospitals is that they are private, and seem very reliant on consult services and attending input, making them a fellow's paradise but may take a little from the resident's experience.


UCSF, JHU and MGH...the scut load is higher than the above, but the residents seem to work it to their advantage... I don't know how to explain it, but they all have the appearance of "digging in and getting their hands dirty" type doctors...the kind of doctor I want to be.

At UCSF Moffit-Long hospital, I did a rotation on the cards service and found that there wasn't very much scut! In fact, there were scheduling nurses who took care of all of the followup appointments, scheduled tests/imaging studies... I thought it was great. Moreover, the entire hospital is moving to an entirely electronic medical record which is fantastic. However, at the VA and the General, I'm sure there's a helluva lot more scut involved! But the best part of UCSF is undoubtedly the residents. Very supportive, energetic and bright bunch of people!

The ancillary services at UCLA are absolutely phenomenal. The nurses are young, energetic, and helpful. Definitely the best of any hospital that I have been to! Can't wait to start there in 2 months!

 

[BStein76]

stanford fits the bill, although there's a lot of responsibility on certain rotations as an intern (VA ICU, Onc, Heme). you're not left alone on call, which I think is a good thing.

p diddy

Of the top 20 IM programs, Stanford also has the additional benefit of not pushing their residents into only academic positions. You are not forced to do research unless you want to. From the sheets I got at the interviews, many went on into private practice-Kaiser, Palo Alto Medical Foundation after fellowship.

 

[AJM]

Believe it or not, but I think MGH fits your criteria as well. It is much less "thrown into the fire" than it used to be, but somehow the word hasn't gotten out about that. They have a lot of in-house support at night, with 4 in-house seniors (doing things like ED senior, senior back-up, stuff like that). Even though they aren't directly supervising anyone, their whole purpose is to be an additional resource for the teams. In addition, there are a ton of in-house juniors supervising the interns. The junior may not be from the same team as the intern, but every intern is assigned a junior who's supervising them and who they have to review admissions with.

Not only that, but out of the programs I'm familiar with, they seem to do the best at limiting work hours and maximizing time-off. Heck, they only have 7 months of call intern year, and almost no in-house call as a senior! The interns I know at that program have a ton of off-time to read, do errands, and enjoy their lives, at least when they're not in the MICU.

The Brigham does take good care of it's residents, especially the juniors and seniors, however on ward months it is very common to go over 80 hours or to have less than the required 8 or so hours between shifts. There's also a lot more random scut at the Brigham -- one example is that the interns have to titrate the heparin drips (you can't use a sliding scale). But they don't have to start their own IVs or anything, it's just minor annoyances. The interns are also never in-house without a supervising resident, even during the daytime (the resident can't leave until the intern signs out their pager). As an aside, the Brigham has been setting up separate PA services this year to off-load the medical teams.

Stanford has the best teaching and best ancillary services out of the programs I know. The interns are less supervised than they are at the Brigham, but I think Stanford has a good combination of independence and supervision. The interns always feel like they have adequate back-up, and they never are alone at night.

 

[BStein76]

Of the top 20 IM programs, Stanford also has the additional benefit of not pushing their residents into only academic positions. You are not forced to do research unless you want to. From the sheets I got at the interviews, many went on into private practice-Kaiser, Palo Alto Medical Foundation after fellowship.

I also forgot to mention that Wash U in St. Louis (not the program on ACGME violation) is also laid back. Not too much scut work from what I remember. Interns sleep several hours on call (I think they stop admitting on call at 8 or 9 pm) and cover their own patients at night. St. Louis is not exactly a desirable city to live (I think it was better than Camden, Flint and Detroit) so cost of living is cheap.

 

[DrRobert]

I forgot about Stanford and Mayo.

NW, Stanford, and Mayo.

Call at WashU is easy but overall I don't think it's as cush as these 3. Pushing the 80 hour week is commonplace at WashU.

 

[BStein76]

I forgot about Stanford and Mayo.

NW, Stanford, and Mayo.

Call at WashU is easy but overall I don't think it's as cush as these 3. Pushing the 80 hour week is commonplace at WashU.

I interviewed at Northwestern, Stanford, Wash U and BIDMC this year and I felt like the interns at all those institutions pushed 80 hours (and all of them managed to get more than 3 hours of sleep on call), but were all happy. Many of them showed up to the pre-interview dinner while they were on their ward months (and some even on their ICU months). However, the hours and call months dropped as junior and senior resident. I didn't interview at Mayo so I can't really comment on that program.

 

[remedios]

I interviewed at Northwestern, Stanford, Wash U and BIDMC this year and I felt like the interns at all those institutions pushed 80 hours (and all of them managed to get more than 3 hours of sleep on call), but were all happy. Many of them showed up to the pre-interview dinner while they were on their ward months (and some even on their ICU months). However, the hours and call months dropped as junior and senior resident. I didn't interview at Mayo so I can't really comment on that program.

I don't know, I go to Northwestern and I want to say that it's definitely not pushing it near 80 most of the time (except for maybe unit and cardiology and liver, but that's about 3 month out of 12). compared to the only other place i know personally (bwh), it's definitely a lot more chill.

plus the residents are chill, which is a culture thing.

AJM, I didn't realize that about the MGH. I guess in my mind I still get MGH and Hopkins mixed up *blush*.

 

[DrNick2006]

Mayo Clinic is q6 if I remember right from my interview. BIDMC seemed relitavely supportive as well.

 

[DrNick2006]

There is something to be said for being pushed during residency. Your going to practice based on your residency training, do you want to be as prepared as possible.

 

[ucla2usc]

There is something to be said for being pushed during residency. Your going to practice based on your residency training, do you want to be as prepared as possible.

Cheers to that. For example...sometimes less than ideal ancillary services makes you more cautious, you double check things, learn how to do the nurses work. That's make you fully understand how your orders translate to patient care. The same can be said for tough call nights w/ cross cover, you learn to quickly assess foreign situations and make decisions...invaluable but hard. Like I said before, the residents at MGH, UCSF, and JHU have a certain stoic type confidence factor, like they can handle anything. Maybe intangable, but in my mind it's real.

 

[BStein76]

Like I said before, the residents at MGH, UCSF, and JHU have a certain stoic type confidence factor, like they can handle anything. Maybe intangable, but in my mind it's real.

I think each person has a certain comfort level of how much they want to do their own bloodwork, get bus tokens, transport patients, start IV's, learn multiple foreign languages etc. Some of my attendings attend 6-8 months of out of the year at the VA/county hospital and other attend 1 month, but run basic/clinical labs which require lots of time to write papers, write grants, and maintain the lab. Some see a categorical residency as a hurdle to get to fellowship others see it as their transition into the world as a primary care physician. I think students will naturally gravitate to programs that serve their purpose. I don't think of anyone as a weaker person or a less competent doctor for choosing programs like Mayo, Stanford, Wash U, Northwestern, BIDMC over MGH, JHU or UCSF.

 

[ucla2usc]

I think each person has a certain comfort level of how much they want to do their own bloodwork, get bus tokens, transport patients, start IV's, learn multiple foreign languages etc. Some of my attendings attend 6-8 months of out of the year at the VA/county hospital and other attend 1 month, but run basic/clinical labs which require lots of time to write papers, write grants, and maintain the lab. Some see a categorical residency as a hurdle to get to fellowship others see it as their transition into the world as a primary care physician. I think students will naturally gravitate to programs that serve their purpose. I don't think of anyone as a weaker person or a less competent doctor for choosing programs like Mayo, Stanford, Wash U, Northwestern, BIDMC over MGH, JHU or UCSF.

No doubt...they are all great, and there is no "right way" to do a residency program. Some might argue that "scut" takes away from learning, others might say that "cush" programs aren't rigorous enough. I think the personalitities of the residents who select programs according to their own belief systems perpetuates the unique cultures of all these top places.

 

[icyhot]

Any thoughts on PENN? Am interested in applying and wanted to know about their environment...thanks!

 

[socal4life]

A lot of great advice on this thread. As the OP, I want to thank all of those that helped answer my initial questions.

 

[Mumpu]

Penn will mark you for life. I recommend PENNcil.