To PRELIM and CATEGORICAL Applicants for INTERNAL MEDICINE RESIDENCY AT KAISER PERMANENTE LOS ANGELES. Its no longer the program it used to be
The Internal Medicine Residency Program at Kaiser Los Angeles has changed significantly in the past 3 years. Once a major attraction to both prelim and categorical applicants for its great lifestyle during residency while still providing a great educational training experience, the program director has made a number of policy changes recently that have basically negated this attraction of lifestyle. Additionally, there are major flaws in the Kaiser system that add unnecessary stress and work on the residents, and these flaws have been present for the last 3 yrs (at least!). Yet nothing has been done to correct them despite attempts at discussion with administration. See Below:
1) The program director has made 3 major additions to call responsibilities over the last 2.5 years, ALL of which were made AFTER the start of the academic year WITHOUT discussion with residents.
Call nights have increased in length with violation of ACGME regulations (for which the program director has somehow got an exemption). Residents are now required to do extra ED admitting shifts in the winter during non-call months (see #3, below). And interns are now covering easily over 100 patients when on call, with a number of these patients so unstable that they are on the brink of ICU transfer.
Regarding this last change: imagine yourself as an intern covering over 100 patients on your first call night ALONE. Some interns have completed this shift literally shaking and overwhelmed, ready to quit the program. Although you might be told during interviews that an R2 and R3 are available to help on these shifts, they are saddled with their own responsibilities covering a very active ICU and CCU. This is a program where you learn via Trial by Fire, at the expense of patient care. BTW, I would NOT advise sending loved ones to Kaiser Permanente Los Angeles between the months of July and September, unless you want inexperienced, unsupervised interns managing them at night.
What has especially irked many residents is that these policy changes are implemented during the middle of the academic year, without discussion with residents. This way, its like the program director traps residents in the program, so that they HAVE to follow these new policy changes once they sign their contract. However, he never tells the incoming interns or residents of these plans, but changes them arbitrarily. It is deceitful and dishonest.
2) Numerous BOGUS admissions to be worked up by residents without proper screening by attendings
Prior to delving into this problem, the Kaiser system of partnership needs to be explained. Newly-hired attendings need to work for 3 years at Kaiser before they can be considered to become a Kaiser Partner, which is reaped with benefits like long-term stable employment, great retirement perks, etc. For a new-hire to become a partner, the existing partners need to vote on him/her, so it behooves the new-hires to please the established partners. Many of the IM attendings that admit from the ED are new; while many of the ED attendings are already partners. AND the ED at Kaiser LAMC is notoriously bad (they dont work up patients properly, write poor incomplete ED notes, make wrong diagnoses, etc). This combination of sub-par ED attendings (who are partners) telling new IM attendings to admit certain ED patients, means that residents end up admitting things like constipation, dizziness due to decreased fluid intake, Irritable Bowel Disease, etc (ALL of which can be managed within a matter of hours in the ED or outpatient setting, WITHOUT an overnight admission). It is VERY common for residents to admit a patient one night, and then discharge that patient the next morning...thereby wasting everyones resources with the resident doing all the paperwork. If you want to be become a glorified secretary writing H&Ps and Discharge summaries all day, without the benefit of learning, choose Kaiser LA.
3) If something goes wrong at Kaiser, its always the residents fault
This may not be unique to Kaiser, but this is pretty rampant here. For example, the new policy of increasing ED admitting shifts for residents (mentioned in #1) was implemented because of a possible backup of ED admissions during the winter. However, ask any resident about the rate-limiting step in an ED admission, and that is the attending who reviews all ED admissions. Residents are known to wait 1-2 hours (sometimes even up to 4 hours) to present patients. Sometimes the attendings are so overwhelmed with admissions they get backed up. Sometimes attendings mysteriously disappear during their shifts for hours without responding to pages. Despite trying to present these problems to administration to fix this, the rule is: its always the residents fault. Theres a backup in ED admissions? Must be the residents fault. Solution? Add more shifts!!
Of course, every program is going to have its problems. This is not the worst IM program in LA. HOWEVER, this is not the internal medicine program than many of the residents signed up for. The program needs to be portrayed accurately so that applicants can make well-informed decisions about how they want to spend the next 1 to 3 years of their lives. The truth is that residents are dissatisfied, especially with the rapid changes that have increased call responsibilities over the last 3 years. To put it briefly, senior residents are glad theyre leaving; prelims are relieved its only one year; and categorical interns are not looking forward to the next 2.5 years.
The Internal Medicine Residency Program at Kaiser Los Angeles has changed significantly in the past 3 years. Once a major attraction to both prelim and categorical applicants for its great lifestyle during residency while still providing a great educational training experience, the program director has made a number of policy changes recently that have basically negated this attraction of lifestyle. Additionally, there are major flaws in the Kaiser system that add unnecessary stress and work on the residents, and these flaws have been present for the last 3 yrs (at least!). Yet nothing has been done to correct them despite attempts at discussion with administration. See Below:
1) The program director has made 3 major additions to call responsibilities over the last 2.5 years, ALL of which were made AFTER the start of the academic year WITHOUT discussion with residents.
Call nights have increased in length with violation of ACGME regulations (for which the program director has somehow got an exemption). Residents are now required to do extra ED admitting shifts in the winter during non-call months (see #3, below). And interns are now covering easily over 100 patients when on call, with a number of these patients so unstable that they are on the brink of ICU transfer.
Regarding this last change: imagine yourself as an intern covering over 100 patients on your first call night ALONE. Some interns have completed this shift literally shaking and overwhelmed, ready to quit the program. Although you might be told during interviews that an R2 and R3 are available to help on these shifts, they are saddled with their own responsibilities covering a very active ICU and CCU. This is a program where you learn via Trial by Fire, at the expense of patient care. BTW, I would NOT advise sending loved ones to Kaiser Permanente Los Angeles between the months of July and September, unless you want inexperienced, unsupervised interns managing them at night.
What has especially irked many residents is that these policy changes are implemented during the middle of the academic year, without discussion with residents. This way, its like the program director traps residents in the program, so that they HAVE to follow these new policy changes once they sign their contract. However, he never tells the incoming interns or residents of these plans, but changes them arbitrarily. It is deceitful and dishonest.
2) Numerous BOGUS admissions to be worked up by residents without proper screening by attendings
Prior to delving into this problem, the Kaiser system of partnership needs to be explained. Newly-hired attendings need to work for 3 years at Kaiser before they can be considered to become a Kaiser Partner, which is reaped with benefits like long-term stable employment, great retirement perks, etc. For a new-hire to become a partner, the existing partners need to vote on him/her, so it behooves the new-hires to please the established partners. Many of the IM attendings that admit from the ED are new; while many of the ED attendings are already partners. AND the ED at Kaiser LAMC is notoriously bad (they dont work up patients properly, write poor incomplete ED notes, make wrong diagnoses, etc). This combination of sub-par ED attendings (who are partners) telling new IM attendings to admit certain ED patients, means that residents end up admitting things like constipation, dizziness due to decreased fluid intake, Irritable Bowel Disease, etc (ALL of which can be managed within a matter of hours in the ED or outpatient setting, WITHOUT an overnight admission). It is VERY common for residents to admit a patient one night, and then discharge that patient the next morning...thereby wasting everyones resources with the resident doing all the paperwork. If you want to be become a glorified secretary writing H&Ps and Discharge summaries all day, without the benefit of learning, choose Kaiser LA.
3) If something goes wrong at Kaiser, its always the residents fault
This may not be unique to Kaiser, but this is pretty rampant here. For example, the new policy of increasing ED admitting shifts for residents (mentioned in #1) was implemented because of a possible backup of ED admissions during the winter. However, ask any resident about the rate-limiting step in an ED admission, and that is the attending who reviews all ED admissions. Residents are known to wait 1-2 hours (sometimes even up to 4 hours) to present patients. Sometimes the attendings are so overwhelmed with admissions they get backed up. Sometimes attendings mysteriously disappear during their shifts for hours without responding to pages. Despite trying to present these problems to administration to fix this, the rule is: its always the residents fault. Theres a backup in ED admissions? Must be the residents fault. Solution? Add more shifts!!
Of course, every program is going to have its problems. This is not the worst IM program in LA. HOWEVER, this is not the internal medicine program than many of the residents signed up for. The program needs to be portrayed accurately so that applicants can make well-informed decisions about how they want to spend the next 1 to 3 years of their lives. The truth is that residents are dissatisfied, especially with the rapid changes that have increased call responsibilities over the last 3 years. To put it briefly, senior residents are glad theyre leaving; prelims are relieved its only one year; and categorical interns are not looking forward to the next 2.5 years.