From what I’m hearing, Jacksonville’s biggest problem is the total lack of autonomy and real training. Residents are basically there to make attendings’ lives easier. Cosmetic is a joke. One junior attending is hyper-focused on cranking cases and dipping early—self-centered, focused on RVUs and moonlighting, and, on top of all of that, a gaslighter. Seniors and chiefs still aren’t allowed to do Botox because of “private/cash patients.” Friends who just graduated never injected a single unit. All that cosmetic marketing is straight BS. The whole department feels the same: leadership cares way more about optics and reputation than about actually teaching. Looks great on the outside, trash education on the inside. Head & Neck is the worst. Flap numbers have tanked, chiefs are mostly just closing donor sites while fellows retract for hours. One fellow spent 10 hours retracting, then closed the neck. Residents get zero say in VSP planning — “you won’t do this after graduation anyway.” Even in trauma cases, the chief is not alone. According to a very recent extern, these attending have an issue with giving cautery away. The current chair barely operates, encourages gossip and leaks confidential conversations, and creates no safe space to talk to anyone. The previous PD, who left 2 years ago, was the only one who was resident-oriented. They mostly hire their own grads, so anyone who speaks up gets iced out. When they didn’t match, they blamed the residents instead of fixing their shiit. Bottom line: super attending-centered, fake toxic culture, almost no real autonomy. Reputation is dropping fast, and nobody there seems happy. Stay the F away, regardless of whether you are a future resident or fellow.