Cali vs. Midwest

[Salsero]

Are California programs tougher to match in than Midwest ones? For example, Stanford/UCLA/UCSF vs. Wash U/U of Michigan, which one(s) would be tougher to match at? Does the fact that a program is in Cali make it equally as competitive as a Midwest program that is "ranked" higher? What are people's opinion of Stanford IM vs. midwest programs? Just wondering about what could have been....thanks!

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[spumoni620]

stanford/ucsf/ucla are going to be more difficult to get into than midwestern programs that are as, if not better, quality. (umich is an excellent prog but suffers from its cold-as-hell depressed-economy michigan locale)

it's location, location, location. i firmly believe that you cannot underestimate the role the city you live in plays in your ultimate level of happiness....that's what made me decide to come to cali!

 

[BGriffin]

Not sure where you actually matched at, but you should have gotten emails stating that you would have matched had you chosen to at WashU and/or Michigan if you ended up at stanford/ucsf/ucla (and you had them higher on your list than washu and michigan). That said, ucsf is probably one of the most competitive IM residencies to get into--they interviewed something like 225 people to fill 50 some odd spots according to information from the last cycle.

 

[Salsero]

What are people's opinions of Stanford's IM program? How does it compare to Wash U's and U of Michigan's? I know UCSF is in a league of its own. How does Stanford compare to UCLA?

 

[dragonfly99]

UCSF would be harder to get in than any of the other programs you mentioned.

Wash U would be a little harder to get into than Michigan, but less hard than UCSF.

I'm not sure if Stanford would be harder to get into than WashU, but being a city hospital and a bigger hospital, WashU tends to be seen as providing better clinical experience for IM than Stanford, and probably has a superior fellowship match (though I'm not sure about the latter). Stanford's hospital has the reputation of being sort of a rich people hospital and it's out in the suburbs of California. It is a beautiful place, though, and it's not a bad program.

 

[P Diddy]

UCSF would be harder to get in than any of the other programs you mentioned.

I'm not sure if Stanford would be harder to get into than WashU, but being a city hospital and a bigger hospital, WashU tends to be seen as providing better clinical experience for IM than Stanford, and probably has a superior fellowship match (though I'm not sure about the latter). Stanford's hospital has the reputation of being sort of a rich people hospital and it's out in the suburbs of California. It is a beautiful place, though, and it's not a bad program.

I'm pretty sure this information is coming from someone who has no clinical experience at Stanford and prob. is based on the east coast. If you want more than hearsay, please do a search for threads on Stanford, which debunk this tired claim of it being a 'rich people's hospital', or PM me.

As for fellowship match into Cardiology, off the top of my head:

2003: Stanfordx2, Hopkins, UNC, OHSU, BU
2004: Stanfordx2, MGH, Dukex2
2005: Stanfordx2, MGH, Cornell, USC
2006: Stanfordx5, UWashington, Cleveland Clinic, Duke
2007: Stanfordx4, Yale, UTSW, UColorado
2008: Stanfordx2, UCLA, Northwestern, Emory, ?Clev Clinic, Cornell

I am missing quite a few. I doubt Wash U's match is better.

p diddy

 

[Salsero]

I'm pretty sure this information is coming from someone who has no clinical experience at Stanford and prob. is based on the east coast. If you want more than hearsay, please do a search for threads on Stanford, which debunk this tired claim of it being a 'rich people's hospital', or PM me.

As for fellowship match into Cardiology, off the top of my head:

2003: Stanfordx2, Hopkins, UNC, OHSU, BU
2004: Stanfordx2, MGH, Dukex2
2005: Stanfordx2, MGH, Cornell, USC
2006: Stanfordx5, UWashington, Cleveland Clinic, Duke
2007: Stanfordx4, Yale, UTSW, UColorado
2008: Stanfordx2, UCLA, Northwestern, Emory, ?Clev Clinic, Cornell

I am missing quite a few. I doubt Wash U's match is better.

p diddy

How many spots does Stanford reserve for its own residents in Cardiology, GI (I heard that the GI dept is not that strong, so I wonder how well they match), and Rheumatology? From the numbers you posted, it seems like consistently a couple for cardiology are reserved. Do most residents get their first couple of choices? Where do you think Stanford stands in the IM world compared to UCSF/UCLA/Wash U/Michigan?

 

[MedPassion]

I was lucky to interview at these IM programs. They are each top, outstanding programs. They each have the resources to prepare you for academic careers and competitive fellowship placement. I would rank selectivity of these programs as:

1. UCSF
2. Stanford
3. UCLA
4. WashU/Michigan: Mainly because of midwest location, not because they are not superb programs.

As for WashU vs. Stanford, they are both great medicine programs. Definitely within the top 10 in the nation. It's like comparing 2 luxury cars. No reason to split hairs. Here are some unique strengths of each. At this level of quality the most important thing is to pick program that's best fit.

WashU: Barnes Jewish is amazing. It's like a city in itself, perhaps the best facilities I've ever seen besides MGH. Both a top tier academic medical center that also cares for high volume of urban patients. Many of them are underserved. BJH is a top referal center alongside Mich getting the sickest patients in the midwest.

Very subspeciality focused with great fellowship placement. But I think you can also get strong primary care training with its incredible patient population as long as you're self motivated. Residents pleased with flexibility to take large number of subspeciality electives to prepare for fellowship applications (one intern said he made almost 50% of his PGY2 year cardiology consult electives and made it a mini Cards "fellowship" year in itself). Top tier research opportunities, strong commitment to medical education. Number of IM residents relatively large but supportive PD. Collegial attitude, residents seem to be happy, friendly, and get along.

St. Louis is not New York but felt like a great place to live. Lots of history and culture. Very affordable and weather is not bad. It's more mild than Chicago or Michigan.

Stanford: Very highly sought after, and not just for its location. "West coast" attitude so it is more laid back than midwest or east coast.
But residents work very hard. They are q4 at Stanford Hospital, county hospital, and one of the top VA hospitals in the country. Although Palo Alto has its silicon valley "rich people," Stanford hospital is usually over capacity and bursting with a diverse patient population from the CA Bay Area and Santa Clara County including San Francisco and San Jose. It cares for a high number of hispanic and immigrant patients. Not as much ID/HIV as UCSF, but few places do. Like Barnes Jewish it is also a top academic referral center.

The PD has a PhD in Education and is a national expert in medical education. Department places big emphasis on teaching residents how to teach. Attendings love to teach. Residents I have heard of seem top notch and on par with the top east coast programs. Residents were among the happiest I'd met on the interview trail. They felt very well supported.

I do think a unique strength is Stanford University, truly one of the world's great universities. Real emphasis on interdepartmental collaboration and tailoring residency to meet your career goals. Top notch research opportunities in basic science and clinical research. Also world class opportunities in health economics, health policy, and bioengineering. All the Stanford grad departments such as the Stanford Business School are also top in the nation and literally next door to the medical center. There is a special program for residents to pursue a PhD in any field from tissue engineering to health care policy with full financial support. A very rich academic environment.

Both WashU and Stanford place many of their grads in their home fellowship programs, because many are also outstanding in their own right. I'm not a Cards expert. But I do know both WashU and Stanford Cards are really good, so its reasonable to think many residents are happy to stay.

 

[Medikit]

In terms of how competitive these programs are I think the following is accurate:

UCSF
Stanford
UW = UCLA
Chicago = Northwestern
UCSD = WashU = Michigan

 

[chitown82]

In terms of how competitive these programs are I think the following is accurate:

UCSF
Stanford
UW = UCLA
Chicago = Northwestern
UCSD = WashU = Michigan

I totally disagree. My ranking for competitiveness would be:

UCSF>U Chicago>Stanford=Northwestern=Michigan>WashU=UCLA
Not sure where UW, UCSD fall.

No one will argue UCSF is the most competitive. On your list, the next best IM program is U Chicago, hands down. Its reputation (more of an academic powerhouse than Stanford) and location make it very competitive, moreso than Northwestern. You have to remember Stanford is competitive not because it is an amazing IM program (it is great, not amazing) but because of its location. The IM programs at WashU and Michigan are arguably better than Northwestern but since Northwestern is in one of Chicago's posh areas makes it at least equally if not more competitive. The same goes with UCLA - great program but made better by location.

I know at least half a dozen residents at WashU who didn't receive interviews at Chicago, Northwestern, UCSF, Stanford, or Michigan. Not that anecdotal evidence means much but it does say something.

In general, quality programs like Northwestern, UCSD, UCLA which are not as good as UCSF or U Chicago are helped by their locations in making them more competitive.

 

[Salsero]

I guess I would agree with chitown 82 although yes, it does come down to location for competitiveness because based on USNWR for both best hospitals and IM reputation, Stanford is one or two spots above U of C. On that point, Wash U and U of Michigan are better programs than all of them minus UCSF. But we're talking competitiveness on getting in, so I would say:

UCSF>UCLA>Stanford=U of C>Norhwestern>Wash U>Michigan

Based on USNWR best hospitals and IM reputation:

UCSF>Wash U>Michigan>UCLA>Stanford>U of C>Northwestern

 

[MedPassion]

The U.S. news IM "rankings" is not intended to be a ranking of quality. It ranks NIH dollars received. Granted, there is a relationship between funding and quality, but there are many more factors to consider.

Both Stanford and UChicago are ranked lower because they have relatively small Medicine departments. Stanford IM for example has only 150 full time faculty members which makes it the smallest Dept. of Medicine in the top 20 medical schools. Yet it ranks #1 in NIH dollars/faculty member. I ranked Stanford very highly because I found this size to be a strength. Everyone I met there from faculty down to residents was outstanding, super friendly, and supportive. They were also humble despite being at a place as prestigious as "Stanford." The residents appeared to be a very select group with the majority from top medical schools: UCSF, Harvard, Columbia, Hopkins, Yale, UCLA, Duke. I spoke with 8-10 residents and they each interviewed at top medicine programs. But Stanford for others may not be a good fit. Perhaps because they prefer to be in a big city or want a larger program.

This debate is getting petty. Nobody will argue that MGH, BWH, UCSF are in a league of their own. Then there's a number of programs (my Chairman called it "Tier 1A" that includes (in no particular order) Penn, Duke, Columbia, Stanford, UCLA, Michigan, WashU, University of Washington, and a few more. Our patients will care much more about how good a doctor we are rather than these tired arguments.

Most East Coast applicants will rank the East Coast programs the highest, top west coast people will rank West Coast the Highest, Duke often ranked #1 by applicants from the South, etc. At this level of quality it's about best FIT.

 

[P Diddy]

How many spots does Stanford reserve for its own residents in Cardiology, GI (I heard that the GI dept is not that strong, so I wonder how well they match), and Rheumatology? From the numbers you posted, it seems like consistently a couple for cardiology are reserved. Do most residents get their first couple of choices? Where do you think Stanford stands in the IM world compared to UCSF/UCLA/Wash U/Michigan?

I wouldn't say any spots are 'reserved' for Stanford residents, but as you can see the past few years at least 2 Stanford residents/yr have matched. keep in mind that some of those are short trackers with a history of research who came specifically to Stanford for its Cardiology dept - usually 1/yr. In fact, some internal applicants have had prior research experience within Stanford Cardiology, which as you can imagine is a great advantage, and deservedly so.

not sure about GI and Rheum since I pay little attention to those specialties. I know one resident matched at Hopkins for Rheum a couple of years back and two have matched at UCLA for GI recently. but Rheum isn't competitive, right?

in terms of IM rankings (quality, not selectivity), I would say if you want to do Cards Stanford>= UCSF at the top of your list. For all other specialties (or not), it would be:

UCSF
Stanford
U Chicago = UW
UCLA= UMich = Wash U

in general, though, I agree with MedPassion. All of these '1A' programs will prepare you well and get you where you need to go; ie, they will open, rather than close doors.

p diddy

 

[Salsero]

The U.S. news IM "rankings" is not intended to be a ranking of quality. It ranks NIH dollars received. Granted, there is a relationship between funding and quality, but there are many more factors to consider.

Both Stanford and UChicago are ranked lower because they have relatively small Medicine departments. Stanford IM for example has only 150 full time faculty members which makes it the smallest Dept. of Medicine in the top 20 medical schools. Yet it ranks #1 in NIH dollars/faculty member. I ranked Stanford very highly because I found this size to be a strength. Everyone I met there from faculty down to residents was outstanding, super friendly, and supportive. They were also humble despite being at a place as prestigious as "Stanford." The residents appeared to be a very select group with the majority from top medical schools: UCSF, Harvard, Columbia, Hopkins, Yale, UCLA, Duke. I spoke with 8-10 residents and they each interviewed at top medicine programs. But Stanford for others may not be a good fit. Perhaps because they prefer to be in a big city or want a larger program.

This debate is getting petty. Nobody will argue that MGH, BWH, UCSF are in a league of their own. Then there's a number of programs (my Chairman called it "Tier 1A" that includes (in no particular order) Penn, Duke, Columbia, Stanford, UCLA, Michigan, WashU, University of Washington, and a few more. Our patients will care much more about how good a doctor we are rather than these tired arguments.

Most East Coast applicants will rank the East Coast programs the highest, top west coast people will rank West Coast the Highest, Duke often ranked #1 by applicants from the South, etc. At this level of quality it's about best FIT.

Can I ask where you matched if it's not too personal? You mentioned ranking Stanford highly, but wondering what places you ranked above/below the program.

 

[Salsero]

Is it necessarily a bad sign that a post was put up earlier about an open PGY-2 position at Stanford? Does that spot get filled by an FMG or another AMG? Man I wouldn't want to interview again!

 

[gutonc]

Is it necessarily a bad sign that a post was put up earlier about an open PGY-2 position at Stanford? Does that spot get filled by an FMG or another AMG? Man I wouldn't want to interview again!

No, it's not a bad sign. If 12 residents were to leave, THAT would be a bad sign.

People leave programs all the time for reasons completely unrelated to the program itself. They want to do a different specialty than they originally matched in (or matched to a backup specialty and then found a spot in the specialty they originally wanted), they have personal reasons for needing to be in a different geographic area, they hate medicine and want to go on unemployment (since there are no other jobs out there right now), they have health issues, the list goes on.

As for who fills the spot, I assure you that Stanford will not be hurting for qualified candidates. They may even choose not to fill it, depending on the applicants they get. It's a lot easier to absorb an empty spot in a PGY2/3 class than an intern class.

 

[dragonfly99]

I agree it doesn't mean anything bad if 1 person leaves...sometimes people leave IM for derm, rads, etc. or they just need to move for family reasons.

 

[Salsero]

🙂

 

[Salsero]

🙂 sorry for repost

 

[tranzformer]

Rather than start a new thread, I figured I would piggy back off this one in regards to midwest programs. I looked back on some old threads about midwest programs and it seems the big three in terms of quality training are UofChicago, UMich, and WashU. Taking location out as a factor/variable, how would places like Mayo, Northwestern, CCF, Case Western, UIowa fit in? Would Mayo fit into tier 1 and Northwestern/CCF into tier 2 and the others into tier 3?


Edit: I found this good thread debating some of the midwest programs, but it focuses primarily on UMich and WashU: http://forums.studentdoctor.net/showthread.php?t=167168&page=1

 

[chitown82]

Rather than start a new thread, I figured I would piggy back off this one in regards to midwest programs. I looked back on some old threads about midwest programs and it seems the big three in terms of quality training are UofChicago, UMich, and WashU. Taking location out as a factor/variable, how would places like Mayo, Northwestern, CCF, Case Western, UIowa fit in? Would Mayo fit into tier 1 and Northwestern/CCF into tier 2 and the others into tier 3?


Edit: I found this good thread debating some of the midwest programs, but it focuses primarily on UMich and WashU: http://forums.studentdoctor.net/showthread.php?t=167168&page=1

In terms of competitiveness, I would rank them as following:
Chicago>Northwestern=Michigan>WashU>Mayo>CWU>CCF>Iowa

In terms of reputation, I would rank them as following:
Chicago>Michigan=WashU>Mayo=Northwestern>CWU>CCF>Iowa

 

[tranzformer]

In terms of competitiveness, I would rank them as following:
Chicago>Northwestern=Michigan>WashU>Mayo>CWU>CCF>Iowa

In terms of reputation, I would rank them as following:
Chicago>Michigan=WashU>Mayo=Northwestern>CWU>CCF>Iowa

Thanks for your reponse, I appreciate. No offense meant, but how are you basing this opinion? Taking location out of the equation, how did you determine that ranking? Is there really a difference between Chicago, Michigan or WashU? I know Chicago is a smaller program, but it seems these three are equally matched, no?

 

[dragonfly99]

I don't think U of Chicago's reputation is any better than WashU's...not sure it trumps Michigan either. U of Chicago's medical center is having financial problems, too, which is likely to hurt their overall reputation and faculty recruitment and retention eventually if the $ problems continue, and perhaps resident recruitment. It's still a top drawer place, however. When you are talking about places of this level there isn't much difference between one and another. U of Chicago and Northwestern are in Chicago, which makes them get more applicants and increases the competitiveness to get in over and above what it would be from just the reputation alone...

 

[tranzformer]

dragonfly, thanks for your thoughts. I have also read about about some of UChicago medical center's financial problems. I agree that might have some impact on hiring and retaining faculty, but not sure how far that goes.

 

[chitown82]

Thanks for your reponse, I appreciate. No offense meant, but how are you basing this opinion? Taking location out of the equation, how did you determine that ranking? Is there really a difference between Chicago, Michigan or WashU? I know Chicago is a smaller program, but it seems these three are equally matched, no?

Just an opinion based on talking to faculty/residents through the years. 🙂 Also, I know many residents at all of the programs and from anecdotal evidence, I know more than half a dozen applicants (friends) who received interviews at Michigan and WashU did not receive an invite from Chicago.

Chicago is certainly a smaller program but it is among the top tier ones - because of its reputation and because of location. It's a very academic program that values research probably a little more so than the rest of the programs mentioned. WashU, Michigan, Mayo while obviously great programs, are in less desired locations (to most).

It is difficult to separate location when looking at competitiveness. Some of the California programs are much more competitive simply because of location. The same goes with some programs in the Midwest.

In any case, apply to all of them and see what happens! It is hard to predict where one will interview/match...

 

[MJB]

it's location, location, location. i firmly believe that you cannot underestimate the role the city you live in plays in your ultimate level of happiness....that's what made me decide to come to cali!

I'm hoping there are a ton of people that think like this. I'm not sure someone could pay me enough to live in California. 🙂

 

[souljah1]

As someone who just completed the fellowship interview trail I have to say that the University of Chicago has taken a huge hit in reputation mainly b/c of financial debacles and internal strife. I'd love for someone from Chicago to comment on the Chair of Medicine and the reasons for him stepping down - and whether or not it had to do with the fact that U of C's financial decisions to no longer see medicare (is this true!f) patients. I've heard that U of C is farming out it's ER admissions to other hospitals.

On the fellowship trail, lots of people were staying to steer clear. Not sure how much of it was do to rumors, but the main reasons for staying away had to to with political and financial happenings within the department of medicine.

 

[dragonfly99]

As someone who just completed the fellowship interview trail I have to say that the University of Chicago has taken a huge hit in reputation mainly b/c of financial debacles and internal strife. I'd love for someone from Chicago to comment on the Chair of Medicine and the reasons for him stepping down - and whether or not it had to do with the fact that U of C's financial decisions to no longer see medicare (is this true!f) patients. I've heard that U of C is farming out it's ER admissions to other hospitals.

On the fellowship trail, lots of people were staying to steer clear. Not sure how much of it was do to rumors, but the main reasons for staying away had to to with political and financial happenings within the department of medicine.

The U of Chicago medical center in general (not dept. of IM specifically) is in financial trouble, likely because of the large number of Medicaid patients that they see. In Illinois, Medicaid reimburses very poorly, so that the hospital barely makes any money no these patients (or maybe none?). At the same time, their hospital still gets flack for not seeing enough UNinsured patients - the hospital's response to this is, "Hey! We ARE seeing a lot of poor people...we may not see the same number of totally uninsured as Northwestern, but we see a TON of Medicaid patients". Because U of Chicago is a "rich person's college" in the middle of a poor area of town, they often get flack for not doing enough for poor people. I am sure with the recent economic downturn, the investements of the university system as a whole have taken a hit, which I'm sure isn't helping them. I don't know what the answer is for their medical center. There have been some good newspaper articles written about all these issues.

I don't know anything about them not taking Medicare patients...I doubt that is true. Perhaps they decided to cap the number they are seeing? Not sure if that would be legal, though...

Because of a law called EMTALA, all ER's must stabilize any patients before transferring them. I know there was a case of a pediatric patient with a cut lip who was seen at U of Chicago and ended up being sent home (b/c the surgeon felt he didn't need surgery) and then went to another hospital and I think they decided to close up the cut in the OR. This led to charges that U of Chicago refused to treat the kiddo b/c he was Medicaid...if you read the article it sounded more like a case of honest difference of opinion about what should be done clinically (i.e. whether the injury needed to closed/sutured @that time or was it better to treat by cleaning the wound, letting the swelling go down, etc. +/- suturing it up later). There are always sensational stories like this in newspapers but not sure how much truth there is in some of them.