Cornell IM residency program

[thedman]

Hi,
Can some people please comment on cornell. i got the feeling that its a malignant program. do others feel the same.
to the residents who are there now: how do you feel. how is life there. do you have any time for yourself.

also is it possible to have a car while there. is there parking available?

thanks

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[turkleton]

I interviewed there as well. I don't know what your definition of malignant is, but I didn't think it was. However, it certainly was very intense, and no one made any pretense about covering it up. I asked a resident if he ever felt overwhelmed- he gave it a decent amount of thought before saying very seldomly but on the whole no. Census runs usally high and it wasn't unusual for an intern to have 15 patients. Call schedule is rigorous, q4 overnight- I think through second year, but R2's probably get to home at some point at night. People seemed to like it, so I wouldn't label it malignant. But from the PD on down, everyone kind of gave you the impression that if you go there, be prepared to work. It has the perception of an elite private hospital, and they do have their private patients, but it had the work ethic/mentality of a "we'll train the hell out of you" inner city hospital.

And unless you have a spare 600 bucks a month to spend on parking, you will not be able to afford a car... nor would you need it- NYC baby.

 

[rat-tickler]

hey edman,

@ the preinterview dinner the INTERNS were fairly open about having worked a 100 hours a week and carrying upwards of 23 patients on the tele floor. not only were they honest about this activity but also didn't seemed bothered by it. the other applicants and i asked about the legality of this given the ACGME work hours and all seemed comfortable with the fact that they were violating all kinds of rules. the next day i kept asking about this hoping for a different answer. i didn't get it. i even asked one resident about the above behavior and how he felt it compromised patient care. he said, yes it does and shrugged his shoulders.

my question is does anybody know how long cornell is accredited for? when was their last visit?

i'd love to be in ny, i'd love the subsidized housing, i'd love to be branded with the cornell logo, but i have serious reservations about this program.

my advice, talk to the housestaff! they're really honest and forthcoming. they're also happy. i envy them. it takes a certain person to be happy while working that hard, if you can do it, more power to you.

oh yeah--you don't need a car! it's NYC--it's completely impracticle to have a car. i know people in manhattan with cars, they make at least 3X what a resident makes.

 

[thirdyeardoctor]

Ok... I don't know where someone got the number 23 patients on a tele floor for one intern... but that seems obviously exorbitantly high and is NOT anywhere near a normal 1 intern census. [Think about it... we have 40 tele beds.. and the census is split among 3 resident/intern teams and also a Nurse Practioner service (so there are a total of 4 teams sharing the floor of 40 beds).] I've been on the tele floor for 2 years during intern year and second year and I've never had that many patients. Usually when the census gets large, we will consider redistributing the patients. If that really was a real number then it obviously was a temporary number. The truth is that we work hard, yes, but we try to be fair as well. Occassionally there will be a bad night and the consult resident will get alot of admissions, but you also have to consider the fact that a significant portion of the patients on a telemetry census (and as an aside, this tele service is a particularly different service from all other medicine services... it also has it's own separate night float and 1:1 resident-intern system.. so you can't generalize it to the rest of your 3 years at Cornell) are really quick stays (basically post catheterization for overnight monitoring, or post-EP procedure overnight monitoring). There are many people who stay just the night for observation and then leave the next morning. You don't even need to write a discharge summary for some of these people that stay less than 24 hours. The telemetry service is a busy service, but we all get through it and it is only a month of your time during the year. There are plenty of other months when the census is low. For example on the neuro rotation where census I remember was as low as 2-4 per intern. Or during the Hospital for Special surgery rotation as a 2nd year when the census was even 2 patients to be split among 4 residents... yes.. there are seriously cush months as well. There are always harder services and lighter services during the year. Regardless, I think that the clinical training here is outstanding. There is no substitute for seeing and taking care of patients. For you medical student applying into residencies, it is often difficult to put your thoughts on anything other than a number and extrapolating how hard your year may be based upon that one number (which is not accurate). But when it comes down to it, it's the people that you work with that makes the whole experience worth it or not. I am currently a third year resident here and if i were to choose a program over again.. I would hands down pick this program. We are all friends, and I feel like the housestaff and the program faculty/leaders are all family. I have the luxury after having been through the whole experience to say such. Did I have some times when I thought I worked really hard? Yes. Did I think I was working harder than anyone else at other programs? Sometimes yes. But then I would hear from my other friends at other legit IM programs that they think they work much harder than we do. I won't name programs. I honestly can't say who works harder because I haven't been at other programs, but i think the vast majority (I can't speak for everyone obviously) of all of us would say that they would train here again. And hey, if you must know.. the R3 year is very, very nice here. Make your rank list on where you think you get the best vibes (these will be your co-residents and interns) and where you think can train you to get you to where you want to be in your medical career. Intern year will all be a memory eventually and you will periodically work hard at whatever serious IM program you choose ultimately. I love Cornell's IM program and I am sure that for the group of people that are privileged to come here... you will feel the same after your 3 years.

 

[maugham]

I am a little surprised--but then again not really surprised--that New York Hospital would put residents in the dangerous positon of routinely working as much as 100 hours/week, when it was a patient's death here caused in part by an exhausted resident that set in motion the reforms of the Bell Commision and the 80 hour rule. Even more troubling is the apparently unquestioning attitude of residents...as if being exploited is the price one pays for the "privilege" of being associated with an elite hospital program. Also, "legit" medicine programs take seriously ACGME work hour rules and shouldn't be looked down on for doing so, as the previous post seems to imply.

 

[thedman]

hey edman,

@ the preinterview dinner the INTERNS were fairly open about having worked a 100 hours a week and carrying upwards of 23 patients on the tele floor. not only were they honest about this activity but also didn't seemed bothered by it. the other applicants and i asked about the legality of this given the ACGME work hours and all seemed comfortable with the fact that they were violating all kinds of rules. the next day i kept asking about this hoping for a different answer. i didn't get it. i even asked one resident about the above behavior and how he felt it compromised patient care. he said, yes it does and shrugged his shoulders.

my question is does anybody know how long cornell is accredited for? when was their last visit?

i'd love to be in ny, i'd love the subsidized housing, i'd love to be branded with the cornell logo, but i have serious reservations about this program.

my advice, talk to the housestaff! they're really honest and forthcoming. they're also happy. i envy them. it takes a certain person to be happy while working that hard, if you can do it, more power to you.

oh yeah--you don't need a car! it's NYC--it's completely impracticle to have a car. i know people in manhattan with cars, they make at least 3X what a resident makes.

i got the same feeling as you. the program director even said straight out that "we do not follow the 80 hour rule".
i was also thinking a lot of the patients here are private so even though they are "on your list" do you really care for them?

 

[thedman]

if anyone knows the accreditation of cornell, can you please share.

 

[stoolstud]

I too am a third year at Cornell. I never had 15 patients on my service as an intern (in other words, I always had less, averaging 8-10). I am not denying that a service can get up to 15, but that is usually rare. Here is some advice that I would recommend for the residency application process.

1) Don't listen to just one person - At one program I went to, the one person I knew was the happiest person at the program, even the chief residents at that program told me that. I realized that if I only listened to her, I would have a skewed opinion.

2) Don't forget that the residency application process is competetive - in other words, there are plenty of people out there who want to go to top name programs. They will do everything they can to get a spot, including trash talking a program so that other people won't want to go there.

3) If you have questions about a program, rather than asking on SDN, why don't you go back to the program for a second look. If you go back to Cornell for a second look you can ask the intern on rounds to show you their list and you can count the number of patients they have. Do you really think that private physicians have the time all the day to hold the residents hands and tell them what they want done. Of course not! If you go to resident rounds in the morning, you can see the way the plan and the decisions are made for the private patients (...the same exact way as the service patients, by the residents!)

4) Make sure you have seen morning rounds, attending rounds, morning report, noon conference, etc. at the programs you are applying to. I remember going to a lot of places and just sitting in a room rather than actually seeing what a day really is like. If Cornell really had huge teams, you would have seen it the day you were there.

5) Don't forget NY State work hours only allow 24 + 3, where as in other states you can work 24 + 6 (do you really want to go home at 1 PM?)

Other things about Cornell:
-There is a PA that shows up at 7 AM to cover post call interns on the floors. The intern is out of the hospital at the absolute latest of 10am.

- There is not as much overnight call as you think. Sloan Kettering has a night float system (you do about 6-8 weeks there). Then when you add up your 2 months of clinic as an intern, vacation, elective, neurology & telemetry/cardiac floor (not overnight call, its a nightfloat system), that adds up to more than 6 months of non q4 overnight call. As a second and third year, you only do Q4 overnight call when you are in the MICU and CCU.

- Golden Weekends (all 3 years) - Since we do rotations with overnight call and rotations with night float, we experience both systems. Trust me, when you work 6 days a week (as you usually do in most night float type programs), you get exhausted because you never have a full weekend nor do you get a weekend where you can travel outside of NYC. Being able to leave on a Friday morning at 10 AM and not having to show up until Monday morning is a great thing.

-Education is great

-Fellowship placement is excellent (Don't forget that residency is only 3 years of your life, and is a stepping stone for the rest of your career. Most college students chose a medical school that would get them into fellowship, rather than a medical school where they wouldn't work hard....well, you are now in the same situation. Pick a residency program where you are going to learn a lot and be able to match into a fellowship program without any difficulty.

I could go on about other good things about Cornell, however, my point is, be skeptical about the rumors you here and go to the programs you are interested in and check them out a second time and see what really goes on!

 

[thirdyeardoctor]

Ok... there is no way we routinely work 100 hours a week.

Here is an example of how ridiculous that sounds.. for the ICU as an intern(which is a time intensive month):

Let's say you worked from 6AM to 7PM EVERY DAY that you weren't on call... which is an exaggeration... (this is just for illustration). Then that would be 13 hours a day times 4 days = 52 hrs.

You then have one day off per week in the ICU (this is for the ICU month only... floor schedule is different).

And on your call day... you work from 6AM till 10 AM the next day... that's another 28 hours.

That's a total of 80 hours exactly.

There is no way I worked till 7 PM every day of being in the unit. I was usually out of there by at least 6pm. That's when it's the on-call team's turn to take over... There's no way I could have spent another 20 hours there! That's like working until Midnight everynight. (Are you kidding me? The on call intern would kick your butt if you were still there at that hour.) Who ever is making up this 100 hour thing obviously didn't work here. It is impossible to work 100 hours in the Unit or anywhere close for that matter.

There are months that I have so much free time that I'm actually bored as heck.

Okay.. I finished intern year and honestly thought back to myself... "It wasn't as bad as I thought it was going to be". I did not work 80 hours a week on average--guaranteed.

If you want to hear what it's like on the floors... then read on:

So let's give the absolute worst case scenario... I will show you how we potentially could work 100 hours.. but why it would usually never happen. Let's assume the week starts on monday and ends on sunday. Let's say you are an OCD intern that gets into the hospital to preround at 5:30 (which is way early)... and let's say you work on a regular day till 6:30pm (let's assume a late day). Ok ..so that's basically 13 hours a day. And then on your call day you work overnight (unless it's on a Friday/saturday/or sunday... in which case we have an intern night float which comes on at 7pm). So your overnight lasts till 10 AM at the lastest when you finish with attending rounds (which is usually done by 9 something or so)... (it is IMPOSSIBLE to stay later than that because you already gave up your pager to the covering PA at 7AM and there is nothing else for you do to because you don't write post-call notes)... so if you got in at an ungodly hour of 5:30AM on your call morning.. that would give you a total of 28.5 hours.

If you had the WORST week... as in.... you worked monday, then were on call on tuesday overnight, were post on wednesday, then worked regular days on thursday and friday, were on call on Saturday, and then came in for your post-call day on sunday.... then you could potentially work 100 hours FOR THAT ONE WEEK if you came in early each day and stayed late even on non-call days. [Tabulating the hours, it would be Monday (13) + Tuesday Call into Wednesday morning (28.5) + Thursday (13) + Friday (13) + Saturday (...let's say you worked from 5:30 AM to MN at the worst case scenario (remember, you have a night float that starts at 7PM on the weekends).. that would be 18.5hrs) + Sunday (let's say you stayed a "full day" on your post call day... 12hrs). = 98hrs] I qualify that "ONE WEEK" because you will only have that one weekend where you work both days partially (ie.... the saturday call). In the other weeks, you will have one of the weekend days off.. and each month you will have a golden weekend and therefore not even come close to your 80 hours (think about it.... you worked only 67 hours approximately if you count a long day of 13hrs x 3 days and 28.5 hours total for your call and post call day).

So that's how you could possibly work 100 hours in our system.

Why does this really never practically happen?
1) The above schedule is obviously the worst call schedule to have... ie, the Saturday call. And this would only happen once a month and only on floor months. The benefit to this is that you will later have a full weekend off (off from Friday 10AM until Monday morning when you have to come back in for work). The other weeks, when you have a saturday or sunday completely off... means you deduct at least 13 hours in my calculation above... which brings you pretty close to 80 hrs already (the other extra hours can easily be cut by not waking up for a ridiculously early preround etc)
2) Coming in at 5:30AM is ungodly. No one does that. And I'd have to say that most do not get out at 6:30PM routinely. We probably get out more around 5:30 to 6 on a non-call day.
3) This calculation of 100 is based upon the worst schedule (working every day) AND counting the week as Monday through Sunday. But if you obviously start counting the week from Sunday through Saturday, you had that Sunday to start off the week as an "off day". It therefore only adds up to a hundred depending on how you count it up.

Obviously the vast vast majority of your weeks are not based upon a saturday call schedule (which stinks any way you slice it). So working 100 hours or close to it just doesn't happen. I'm obviously rambling at this point, but it just makes me steamed to think that people are giving the impression that we work redonculous ungodly hours all the time. I will admit that there will be a bad week here or there.. but that is because I choose to stay and take care of my patient. If my patient decides to become septic at 6pm as I'm about to sign out.... I'm going to stay, draw bloods and put in emergency access and help wheel the patient over to the MICU. And if that puts my work hours over the top, so be it. Sure you could just leave and make your 80 hour work week, if that floats your boat, but I don't care if i have to stay a few extra hours to see things through.

You know, I've heard from a lot of "old schoolers" that they think that the biggest lost to modern medical residency education is the implementation of the 80 hour work week. Of course we reflexively think that they are crazy. But some of the points that they make are that we miss out on the critical care of the patient during the post call day. And if you think about it, alot of things do happen right after you admit the person and begin treating the patient. You do miss out on the big plays during the first full day of their hospitalization. I'm not saying that we should be there forever... but I'm saying that sticking to a strict-no-exception 80 hour work week doesn't make sense sometimes when we are caring for patients. Sometimes you just can't help but go over because someone is sick.

BOTTOM LINE:
The previously made statement:"I am a little surprised--but then again not really surprised--that New York Hospital would put residents in the dangerous positon of routinely working as much as 100 hours/week, when it was a patient's death here caused in part by an exhausted resident that set in motion the reforms of the Bell Commision and the 80 hour rule." ....IS NOT TRUE. Hey, how could a program's residents and interns be happy if they "routinely" worked 100 hours? Yes it's possible to work 100 hours in the absolute worse case scenario and if you counted the week in such a way as to make it so, but practically it just doesn't happen. Again, keep in mind.. you also have 2 months of outpatient.... where you have the majority of your weekends completely off.. and when there is a Monday holiday.. you have off, which makes for a really short week. Outpatient months start at 8AM and end at 5PM. I already mentioned the intern neuro month which is super cush from what I recall. And there are a few weeks of night float per year which is just shift work... you physically can't go over in work hours. Then there's a couple of elective weeks (try working 40 hours if that many). And then there's the month or two at Memorial hospital... of which there is NO overnight call at all. I already started the posting with the ICU schedule which is clearly within the 80 hr work week.

Sorry for my rambling about the call schedule and the work hours... if it interests you.. great... I thought I'd write it for those of you who are fixated on hours.... Just remember that these sample calculations are really nothing but samples... exaggerated samples. There are so many different rotations with so many different schedules that you really can't extrapolate a sample work week to your intern/residency work experience.

By the way.... to clarify/respond to the comment: "Also, "legit" medicine programs take seriously ACGME work hour rules and shouldn't be looked down on for doing so, as the previous post seems to imply."...... I wasn't implying that programs who take work hours "seriously" should be looked down upon... what I was stating... was that of all my friends who were at competitive IM programs, all of them say they work hard at some point or another. I meant to distinguish "legit" programs from small community IM programs.

Oh yeah.. here's another thing that some people might be interested in... as third years, during our floor months we generally do not "run" floors. That is the second year's job, which makes for a nice 3rd year. We play a role of teaching and helping out on procedures etc. We do rotate q4 for admissions, but it's still the R2's job to "run" the team. I know alot of other programs have 3rd years basically acting as "second years" on the floors. I personally prefer this "front" load. Up to you if you do.

 

[stoolstud]

I am a little surprised--but then again not really surprised--that New York Hospital would put residents in the dangerous positon of routinely working as much as 100 hours/week, when it was a patient's death here caused in part by an exhausted resident that set in motion the reforms of the Bell Commision and the 80 hour rule. Even more troubling is the apparently unquestioning attitude of residents...as if being exploited is the price one pays for the "privilege" of being associated with an elite hospital program. Also, "legit" medicine programs take seriously ACGME work hour rules and shouldn't be looked down on for doing so, as the previous post seems to imply.

Get the facts straight...the Bell Commission's findings were that there was a lack of attending supervision because the attending did not come into the hospital in the middle of the night (not that the resident was exhausted). Now for all you people out there looking for a program with complete automony, you are setting yourself up for a dangerous situation.

 

[illinoise]

thanks to the cornell residents for posting. the more info, the better. as a non-new yorker, i am curious if you feel there are any generalizations that can be made about cornell residents vs. sinai vs. columbia. obviously all have smart folks, but do certain folks migrate to certain nyc programs? just curious the big 3 programs are begining to look more and more similar on paper to me.

 

[chicamedica]

i had the impression that cornell and sinai were the 2 least malignant programs in NYC. Not cush, necessarily, but friendliest and most supportive. This is what i've heard from friends doing IM residencies in NYC (at these two and other programs in the area). . .didn't interview at IM programs in NYC so I dont know the details.

 

[snoozz]

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