Having many neurology programs in same city, effects on lower ranked and higher ranked programs

Sep 20, 2015
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Hi first time poster here
I was just wondering what would the implications be of having so many neuro programs in one city on the lower ranked and higher ranked institutions.
For example, in Massachusetts there is MGH/BWH BIDMC TUFTS Boston university, in New york you have Cornell, columbia, NYU and SUNY. Same goes for philladelphia and i suppose in Los Angeles as well.
How does this affects the kinds of patients and the number of patients you see in the program, this is because i want to go to a program that sees a wide variety of cases to get optimal experience.
Would the lower ranked institutions deal more with stroke and acute cases, wheras the bigger institutions get the more complicated cases due to their research facilities?
Thanks!
 
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typhoonegator

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Dec 22, 2006
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I trained in Boston. I think I saw at least 5 CJD cases in my PGY2 year, and multiple NMDR encephalitis, new ALS diagnosis, heavy metal neuropathies, and god knows how many obscure stroke presentations, vascular anomalies, and neurodegnerative disease NOS. MGH has over 1000 vascular neurology admissions per year. Just vascular. Even with all of the other tertiary/quaternary centers in the area, the load is fine.

Places like NYC, Boston, LA have huge satellite populations/metro areas. They definitely aren't hurting for cases or fighting over all the "good ones" between major centers. Famous places get a trickle of quaternary referrals due to renown and expertise, but you'd be surprised how many great neurology presentations just show up at the front door when you're a major medical facility serving a large population.

Ranking has little to do with hospital catchment or hospital size. There are regional hospitals in the Allegheny region that serve enormous swaths of the population, and I'm sure great neurology rolls through there on the reg. Ranking or tier or whatever ontology you subscribe to has more to do with the availability of advanced diagnostics, regional/national/world recognition in subspecialties, research funding, etc. Sure, famous neurology departments tend to fall within big medical centers with large catchments, but being in a big medical center with large catchments doesn't make you a famous neurology department.

I think overall people overemphasize the importance of having lots of zebras and complicated/unusual presentations during residency. Those aren't always the best cases to learn from, and they're zebras for a reason. Chances are you won't end up as a neuroimmunologist, and that NMDAR encephalitis case you thought was so crazy cool during residency will be reduced to a platitude that "autoimmune encephalitis can make you crazy". I learned a lot more about neurology from progressive dementias that turned out to be AD rather than CJD, and more from ascending spinal syndromes that turned out to be GBS rather than selenium deficiency. For the boards you can just read about them anyway.

Just my two cents. I'm sure others might think differently.