I was talking to my residents, and this question came up because I may be headed to the East Coast next year. Now someone correct me if I'm wrong, but Columbia program has children's department, right? No free standing hospital?
Here are the thoughts from my residents reguarding this (if Columbia is indeed does not have free standing hospital): There are some issues you may have. First of all, the support staff/departments. The example my residents gave me is when you are on call, the people covering radiology may not be peds specialists. All support departments in fact will tend not to be heavily children's specialized...although there generally are at least a designated or fellowship trained person working during the day. Also, the volume of patients may also be smaller. However, I don't have any first hand experience with Columbia, so I don't know what the situation is exactly.
The issue with CHOP, again from what I've heard from my residents and some attendings, is that it is ranked so high because it is generally run by fellows, which can mean less teaching for residents. Of course this is all variable, but thats the consensus that I've gathered. However, I also hear that training is sufficient. More importantly though, because of the stellar reputation as well as connections of CHOP, I also hear that residents get their choice of fellowship. So it may be a trade off you are willing to take, especially if you plan on specializing.
sscooterguy