County programs

[trisomy55]

What are the 'County' programs in the US besides, Cook, Hennipen, Maricopa and Alameda? Can we start a list?
Thanks for this.

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[emmd06]

The big northeast ones I looked at were Jacobi, King's County (Downstate), and Boston Medical Center.

 

[la gringa]

add emory (grady) and LA county/USC, UT-southwestern (parkland)

 

[GeneralVeers]

Indiana

Jacksonville

 

[igcgnerd]

I love alameda county at highland
ive been there a couple of time transporting patients and from what the residents tell me, what ive seen, and my love for the inner city, it kicks a$$

 

[monkeyarms]

cleveland metrohealth

 

[pseudoknot]

Harbor/UCLA is also a county hospital, and you'll graduate 33% faster than if you go to LAC+USC.

 

[Ceez]

usc
highland
harbor
cook county
king/drew

 

[guts]

Orlando

 

[BKN]

Orlando

The sponsoring institution Orlando Regional Medical Center lists itself as a private not-for-profit.

I've been wondering what the point of this thread was.

Do we mean inner-city hospitals? Not all are county institutions. Many are city sponsored, some are not for profits, some have been sold by governmental institutions to for profits corporations. Hopkins has been a charitable trust since it's inception.

Do we mean not "academic"? Most are associated with and are primary teaching institutions for medical schools.

I'm thinking what the O.P. and others were trying to establish is which are the Large Inner-City Hospitals serving a Sick Impoverished Population with an Emergency medicine Residency hereafter called LICHSIPERs. At least one other characteristic that LICHSIPERs share is that they take care of many SOCMOBS.

So a quick listing of some LICHSIPERs off the top of my head:

NYC: Bellevue, Kings County, Lincoln
Chicago: Cook
Boston: MGH, Boston City
D.C.: Washington Hospital Center
Atlanta: Emory
NOLA: Charity (old form, not sure it still qualifies)
Dallas: Parkland
Detroit: Detroit Receiving (if that's still the name), Henry Ford
Baltimore: UM, Hopkins
LA: LAC, King (for a short period)

and dare I say it: El Paso: Thomason/Texas Tech

I'm not saying this list is complete or correct. Want to add or diasgree with my choices- take your shot.

BTW: Places I considered but left off on purpose: Hermann (Houston), GW (DC), UCLA_Harbor, Many other NYC programs and Chicago programs. My reasons were that I had the impression that these hospitals served a mixed poor and middle class population.

 

[JackBauERfan]

The sponsoring institution Orlando Regional Medical Center lists itself as a private not-for-profit.

I've been wondering what the point of this thread was.

Do we mean inner-city hospitals? Not all are county institutions. Many are city sponsored, some are not for profits, some have been sold by governmental institutions to for profits corporations. Hopkins has been a charitable trust since it's inception.

Do we mean not "academic"? Most are associated with and are primary teaching institutions for medical schools.

I'm thinking what the O.P. and others were trying to establish is which are the Large Inner-City Hospitals serving a Sick Impoverished Population with an Emergency medicine Residency hereafter called LICHSIPERs. At least one other characteristic that LICHSIPERs share is that they take care of many SOCMOBS.

So a quick listing of some LICHSIPERs off the top of my head:

NYC: Bellevue, Kings County, Lincoln
Chicago: Cook
Boston: MGH, Boston City
D.C.: Washington Hospital Center
Atlanta: Emory
NOLA: Charity (old form, not sure it still qualifies)
Dallas: Parkland
Detroit: Detroit Receiving (if that's still the name), Henry Ford
Baltimore: UM, Hopkins
LA: LAC, King (for a short period)

and dare I say it: El Paso: Thomason/Texas Tech

I'm not saying this list is complete or correct. Want to add or diasgree with my choices- take your shot.

BTW: Places I considered but left off on purpose: Hermann (Houston), GW (DC), UCLA_Harbor, Many other NYC programs and Chicago programs. My reasons were that I had the impression that these hospitals served a mixed poor and middle class population.

LICHSIPERS haha big enough acronym! I agree I think the OP meant innercity, since I think all residencies have an affiliation with a university.

 

[trisomy55]

I guess I was referring to 'LICHSIPERS' in my original post, interesting term! Can I break that one out on the interview circuit? Thanks to all for the great info. What about programs in Philly and Chicago (besides Cook)?

 

[la gringa]

philly has no true "county", closest thing is temple.

next closest to "county" in chicago to cook is probably U of C, maybe christ after that. chicago hospitals do a lot of punting to county...

 

[FoughtFyr]

The sponsoring institution Orlando Regional Medical Center lists itself as a private not-for-profit.

I've been wondering what the point of this thread was.

Do we mean inner-city hospitals? Not all are county institutions. Many are city sponsored, some are not for profits, some have been sold by governmental institutions to for profits corporations. Hopkins has been a charitable trust since it's inception.

Do we mean not "academic"? Most are associated with and are primary teaching institutions for medical schools.

I'm thinking what the O.P. and others were trying to establish is which are the Large Inner-City Hospitals serving a Sick Impoverished Population with an Emergency medicine Residency hereafter called LICHSIPERs. At least one other characteristic that LICHSIPERs share is that they take care of many SOCMOBS.

So a quick listing of some LICHSIPERs off the top of my head:

NYC: Bellevue, Kings County, Lincoln
Chicago: Cook
Boston: MGH, Boston City
D.C.: Washington Hospital Center
Atlanta: Emory
NOLA: Charity (old form, not sure it still qualifies)
Dallas: Parkland
Detroit: Detroit Receiving (if that's still the name), Henry Ford
Baltimore: UM, Hopkins
LA: LAC, King (for a short period)

and dare I say it: El Paso: Thomason/Texas Tech

I'm not saying this list is complete or correct. Want to add or diasgree with my choices- take your shot.

BTW: Places I considered but left off on purpose: Hermann (Houston), GW (DC), UCLA_Harbor, Many other NYC programs and Chicago programs. My reasons were that I had the impression that these hospitals served a mixed poor and middle class population.

Indy does 1/2 time at Wishard (definite LICHSIPER), Cleveland MetroHealth (LICHSIPER), U of Chicago (the time spent at Lutheran General in the suburbs nowithstanding), Hennepin in Minneapolis and St. vincent's in Toledo would boarder on LICHSIPER except the surrounding cities are smaller, and you also excluded Detroit Recieving...

Just my thoughts,

- H

 

[FoughtFyr]

chicago hospitals do a lot of punting to county...

I spent a great deal of time in Chicago, never really saw any "punting" other than trauma (which is because of the trauma center set up in Chicago, not actual need).

- H

 

[Daiphon]

LICHSIPERS isn't as poetic as SOCMOB (sock-mob) - first time i heard it, i thought of a gaggle of young girls in poodle skirts...

yes, i'm slightly deranged.

as for the chicago programs, has been discussed elsewhere. i'm @ UIC. we staff 3 city ED's - UIH, Mercy, and Illinois Masonic. The U has a pretty sick patient population, with a high proportion of indigence (lots of transplant people still like their crack). Mercy patients are also largely lower SES, and ridiculously sick; although the area is gentrifying and more middle class people are coming in. Illinois masonic is northside, some indigent but not as much; but is a Level 1 trauma center so still get our random gsw/stab by the 2-dudes brothers.

The thing about the ED is that it's an "all-comers" thing; every program in any major city is going to have a large proportion of their patients be the indigent/uninsured/underinsured/etc. as the ED is, for better or worse in the current system, the safety net.

As an aside, sometimes the patients @ UIH will have multiple armbands on - we're around the corner from cook and rush - as they are moving from ED to ED looking for the shortest wait time for their 10/10 excruciating pain.

just my $0.02; other chicago peeps should chime in.
-t

 

[la gringa]

well fought, i've been at county for over a year now, and from what i have seen, a lot of hospitals are not very interested in a lot of charity cases. i'm not talking about medical punting, i'm talking about financial punting. i have seen handwritten notes like, "you have a mass in your pancreas, go to cook county". have also seen one followup written on a chart but the pt was told to go to county rather than f/u with that hospital's drs. having spent my life in another state and working at 2 other hospitals, i have never seen such a thing so blatantly done.

 

[BKN]

and you also excluded Detroit Recieving...

Just my thoughts,

- H

Fought, read my post again.

Also for those who argue for other hospitals with "pretty big indigent populations", such as Daiphon, let me refine the definition.

A pure LICHSIPER is a hospital whose ED sees >80% poor population. It may be a tertiary referral center as well (that leaves Hopkins and maybe a few others in).

Other hospitals can have a LICHSIPER index from 0 to 80 depending on the proportion of poor ED patients.

Gotta be Inner City. That give gives LICHSIPER indexes of 0 to Scott & White and Mayo, although there is a certain charm to the rural poor as well.

Daiphon, I thought of a SOCMOB as a bunch of pugilists hired as strikebreakers. Anyway, anybody who can suggest a better acronym than mine is welcome to. It doesn't trip off the tongue.

 

[kbrown]

Truman Medical Center in Kansas City, MO
Maine Medical Center in Portland, ME

Only two that I can remember that haven't already been mentioned.

 

[deleted52758]

well fought, i've been at county for over a year now, and from what i have seen, a lot of hospitals are not very interested in a lot of charity cases. i'm not talking about medical punting, i'm talking about financial punting. i have seen handwritten notes like, "you have a mass in your pancreas, go to cook county". have also seen one followup written on a chart but the pt was told to go to county rather than f/u with that hospital's drs. having spent my life in another state and working at 2 other hospitals, i have never seen such a thing so blatantly done.

i just came off a shift and had two patients like this. seriously, it's an everyday occurence. outside primary's sending patients to county with a prescription form for a freaking ct scan.

 

[FoughtFyr]

well fought, i've been at county for over a year now, and from what i have seen, a lot of hospitals are not very interested in a lot of charity cases. i'm not talking about medical punting, i'm talking about financial punting. i have seen handwritten notes like, "you have a mass in your pancreas, go to cook county". have also seen one followup written on a chart but the pt was told to go to county rather than f/u with that hospital's drs. having spent my life in another state and working at 2 other hospitals, i have never seen such a thing so blatantly done.

Is it from PCPs or hospitals? That makes a huge difference. I've not seen the transfers into county. That said, I could see PCPs and other physicians dumping in this way. If it is happening from other ED or hospitals, it is an EMTALA violation and if your leadership wanted to, they could stop it tomorrow - personal fines of 50K tend to do that.

- H

 

[FoughtFyr]

Fought, read my post again.

Also for those who argue for other hospitals with "pretty big indigent populations", such as Daiphon, let me refine the definition.

A pure LICHSIPER is a hospital whose ED sees >80% poor population. It may be a tertiary referral center as well (that leaves Hopkins and maybe a few others in).

Other hospitals can have a LICHSIPER index from 0 to 80 depending on the proportion of poor ED patients.

Gotta be Inner City. That give gives LICHSIPER indexes of 0 to Scott & White and Mayo, although there is a certain charm to the rural poor as well.

Daiphon, I thought of a SOCMOB as a bunch of pugilists hired as strikebreakers. Anyway, anybody who can suggest a better acronym than mine is welcome to. It doesn't trip off the tongue.

I'd still argue for - Wishard, Cleveland MetroHealth, U of Chicago (in the arguably worst area of Chicago) and St. Vincent's depending on your definition of "City".

 

[FoughtFyr]

Gotta be Inner City. That give gives LICHSIPER indexes of 0 to Scott & White and Mayo, although there is a certain charm to the rural poor as well.

I'd never consider Mayo as a LICHSIPER. While we have our own unique problems ("Let me get this straight, you are on the faculty of the College of Medicine at a Large Well Known Medical School, yet, when you got your 10/10 substernal CP with diaphoresis and SOB, you felt chartering a jet to fly 3 hours to Rochester was the right move? Or "yes sir, I do realize that your doctor "sent" you here, and that you drove from Anchorage Alaska, but your inguinal hernia is easily reducible, and I can't admit just because you took a long drive...") the amount of resources we have to assist the indigent would keep them from ever really being a problem for us. No way we make LICHSIPER even with the rural poor.

- H

 

[BKN]

I'd still argue for - Wishard, Cleveland MetroHealth, U of Chicago (in the arguably worst area of Chicago) and St. Vincent's depending on your definition of "City".

Fine. I'd never say that I know all the hospitals that qualify. i was just pointing out that I included Detroit Recieving in the original post.

 

[BKN]

I'd never consider Mayo as a LICHSIPER. While we have our own unique problems ("Let me get this straight, you are on the faculty of the College of Medicine at a Large Well Known Medical School, yet, when you got your 10/10 substernal CP with diaphoresis and SOB, you felt chartering a jet to fly 3 hours to Rochester was the right move?

Or "yes sir, I do realize that your doctor "sent" you here, and that you drove from Anchorage Alaska, but your inguinal hernia is easily reducible, and I can't admit just because you took a long drive...") - H

I always say that if the doctor on the other end of the phone thinks the patient needs a doctor, he's probably right.

 

[Jeff698]

Amen. Yet another reason I'm glad to be where I am.

We certainly have our share of inner city-like crap, it is well, well diluted with lots and lots of old, very sick suburban and rural types.

While I didn't know of BKN's LICHSIPER index during my 4th year, the concept was very much a part of my decision matrix when applying to programs. I rotated at UNM and S&W to get a feel for both ends of the spectrum. Both types of programs had lots to offer but I realized which part of the LICHSIPER index was for me.

Leave it to BKN to come up with a scale for this previously vague concept. Any minute now, I'm betting we'll see some nasty looking statistical formual from El Paso that let's us assign a specific value to each hospital.

Take care,
Jefff

 

[roja]

St. Luke's- Manhattan

 

[dchristismi]

Orlando

Mmm, I'm going to disagree. While we do see a hell of a lot of trauma (our penetrating: blunt ratio has shifted pretty dramatically in the last year...some dude has learned how to aim), we're pretty comfy in the community. As BKN pointed out, we are privately owned and part of a multi-hospital system, which is very un-county-ish.

Some shifts, everybody has United or Aetna. Some shifts, everyone has the elusive "SP" insurance - but certainly not close to 80%. Plenty of homeless (well, it's warm here), but we are also where the CEOs go for their STEMIs.

 

[FoughtFyr]

I always say that if the doctor on the other end of the phone thinks the patient needs a doctor, he's probably right.

Yeah, but our phone room (referral) nurses are pretty good at injecting a sense of reality. This guy actually drove 3000+ miles over 5 days to get to us - without a referral. Now, while I admire his tenacity, he was understandably upset when we couldn't admit him and do the surgery right then, but a non-incarcerated, non-infected inguinal hernia in the patient without so much as a mild co-morbid condition just doesn't warrant it. Even worse, we could only get him into the "chief's service" in any reasonable timeframe. So the benefit of his journey? An experienced resident performing the surgery.

Oops...

I mean our surgery residents are GOOD, don't get me wrong, but for a procedure like this I'm not sure any surgeon is "drive 3000+ miles in five days" good.

- H

 

[The White Coat Investor]

I'd never consider Mayo as a LICHSIPER. While we have our own unique problems ("Let me get this straight, you are on the faculty of the College of Medicine at a Large Well Known Medical School, yet, when you got your 10/10 substernal CP with diaphoresis and SOB, you felt chartering a jet to fly 3 hours to Rochester was the right move? Or "yes sir, I do realize that your doctor "sent" you here, and that you drove from Anchorage Alaska, but your inguinal hernia is easily reducible, and I can't admit just because you took a long drive...") the amount of resources we have to assist the indigent would keep them from ever really being a problem for us. No way we make LICHSIPER even with the rural poor.

- H

You know, I have met a lot of narcissistic patients in my life who indicate they went to Mayo about their problem. They probably saw one of the interns in the ED!

 

[Daiphon]

Daiphon, I thought of a SOCMOB as a bunch of pugilists hired as strikebreakers. Anyway, anybody who can suggest a better acronym than mine is welcome to. It doesn't trip off the tongue.

fair 'nuff; i like the revision of the LICHSIPER definition to have the index of >80%. certainly filters the hospitals in a given demographic area in a more useful (in terms of the discussion) manner.

also, 'pugilist' is a word that just doesn't get used enough anymore. d=)

-t