Your post and insight is absolute gold, exactly what I was hoping for. Thank you!
Your first point is actually one reason I would not mind staying in Manhattan. There is SO much to see from these patients, and they are all coming from different walks of life. I was especially impressed with NYU with Bellevue and the VA being right there (sorry I know it's not your school lol). I really like the fact that most of NYC hospitals are public and see some of the craziest stuff around. But then on top of that the social disparities between neighborhoods becomes evident... Did you find this is exaggerated based on where the clinic you were working was located? Like did moving clinics or hospitals from the east side to the west give you a completely different experience, and was the quality of care consistent or definitely worse in the more under served areas? The schools kept mentioning that they tried to give the best care to everyone even between the "nicer" clinic and the one helping lower SES, but I was somewhat skeptical of this.
Most major NYC hospitals are actually not public (NYP, NYU-langone, Sinai, HSS, MSK, etc), but most major public hospitals are affiliated with large academic centers (Bellevue [thanks
@Cyberdyne 101], Harlem, others I'm forgetting). However, because of emergency medicaid, patients who are sick will be seen at these hospitals regardless. If they need elective outpatient anything, they have to go to one of the public hospitals, but if they require hospitalization, they can very well end up in one of the big academic centers and under the care of a medical student (happened to me a LOT).
Most of my exposure is on the inpatient side of things. In terms of outpatient, Columbia's ambulatory care network where students and residents rotate is based in Washington Heights and sees uninsured / undocumented patients mostly. I did get to spend a couple of days in an outpatient surgical specialty clinic on the East side that was tangentially affiliated with Columbia and it was very different - solo cash only practice, most patients were very wealthy, no residents, but definitely not a huge part of the care at Columbia (and this was a very very loose affiliation). It's hard to make judgments in quality of care between high and low SES areas because the bulk of my exposure is in low SES patients, but I will say that I've had individual patients who were both SES disadvantaged and not at all SES disadvantaged and they got the same care at least on the inpatient side (obviously social determinants of health is a huge part, but much of that has to do with access to preventative care, which is mostly on the outpatient side). I think that if I were to make an observation, it's that the low SES patients came in generally more sick than the higher SES patients, which speaks to the SDofH issue, but they were all sick enough to be in the hospital regardless, and they were all taken care of by the same medical students, residents, and attendings. There are some private, no-med student patients at Columbia, but they're in the minority (there is a single no-med student floor at CUMC but there are comparatively very few patients there).
Obviously they never advertised the fact of how dysfunctional the hospital systems are at their school, so this is brand new to me. I guess my question here is... Is everyone on the clinical team feeling the same pressure? Like is it just understaffed, poorly organized, bad administrative policies, or what do you think are the issues here? This I want to know more just because I am curious lol.
There's a strong nurses' union in NYC (look around on SDN for better info than I can provide, I know people have posted about it) and there is just such a high burden of disease that people in all healthcare roles are a little overwhelmed. I don't know enough to say if it's an organizational problem, and generally the administrative policies are okay, I think it is just a function of how many sick people there are and how sick these sick people are. For what it's worth, I've never felt like I had to compromise on the care I was providing for my patients, just that I had to work a little harder to get there than perhaps I would in another location, which, you know, is part of the job description anyway.
The diversity of people and patients is obviously amazing, and definitely something I appreciate coming from Cali. This would be something I could look forward to as opposed to going to some of the places in the mid-west. Other than that, I would like to know what you don't like about New York, and how you adapted to that at the beginning. Talking to some of the current medical students, it seems like the transition to this kind of dense city can be pretty overwhelming, but they all seem to get over it after a while and appreciate the experience.
Basically what I said in my first post - it's crowded, dirty, smelly, big, no/few trees, expensive. I don't think I've necessarily "gotten over" those issues, but I've at least come to peace with them. I visited a few other big cities (Philly, DC, Boston, LA, etc), and although many of them have several of these problems, they don't all have all of these problems everywhere. You adapt to the whole "I'm living in the biggest city in the US now and it sure as hell feels like it) pretty quickly because a lot of your classmates have spent at least a portion of their life in the city and help you out, and you're a med student which means you're probably a pretty adaptable person in general, but you also start to think about what qualities are important to you in terms of location. I think the last component is although I did have a few friends from before med school come to NYC, they're either super busy with their own med/law/whatever school or their working 5 billion hours a week so it's difficult to hang out with them on any sort of regular basis, and the vast majority of my close high school / college friends went elsewhere, so while I love my med school friends dearly, I don't have the same "variety" of friendship in NYC that perhaps a lot of other people with more ties to the area do have. The way I've compensated for that is 1) obviously making very close med school friendships and 2) making sure I take time to visit good friends elsewhere or, if they're in the city for some reason or another, making sure I make the effort to spend time with them (for example, I hung out with one of my best college friends the weekend before my surgery shelf because he happened to be in the city).
Your post makes me feel MUCH better about giving Manhattan a second shot. I definitely at least see the value in it, since you articulated it so well. And that despite never really liking the city, you found a way to enjoy your time there! Thanks again 😀
No problem! Post here or PM me with any other questions you might have. Regardless of how you feel about, it's undeniably an experience, and if you're going to spend any time in NYC, your 20s are probably the best time to do it.
