Hopkins/Brigham/MGH

Discussion in 'Pathology' started by lcase, Dec 11, 2008.

  1. lcase

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    Besides location wise, any insiders care to compare the programs in trem of training? I know there are old posts on this topic, but just wondering after several years, did things change?
     
  2. LADoc00

    LADoc00 Gen X, the last great generation
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    I dont care what anyone says BWH has always been "the" research path program. I dont think they care much about landing you a sweet gig in a privat group in Malibu as say UCLA and Stanford might but instead focus on getting you into a high powered lab asap.

    Im biased, I think BWH is the best program in the country but not for reasons one might think (as in not for research at all).
     
  3. yaah

    yaah Boring
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    Things haven't changed a ton in the past few years - old posts are still pretty accurate. MGH continues to shed the reputation for very long hours and brutal environment that it used to have ~10-15 yrs ago. Now it's probably similar to other well known programs in terms of work hours, although I would defer to someone with current experience there. You really can't go wrong with any of them, it depends on the feel you get on interview day, what your interests are and career goals.
     
  4. caffeinegirl

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    As an MGHer, I've many times lauded our program...but that being said, the choice as to where you'd like to go really depends on you...

    The workload at MGH and BWH is similar (don't know anything about JHU). The major difference between the two programs, IMHO is the subspecialty (@MGH) versus the general (@BWH) signout in AP. I also think our CP program is stronger...it's not just didactics but we also have strengths in "interpretive testing", and we have an outpatient infusion/transfusion facility supervised by the blood bank team.

    If you've interviewed at all three of these places, then what I'm telling you isn't new. It's probably the time to really sit down and weigh the pro's and con's for your interests, and if you have specific questions, ask the people you met that day (you can also PM me), and/or plan a second look if you're still wondering between programs. In my case, the second look sealed the deal :)
     
  5. Pathwrath

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    Go with the top programs that still have general signout. Subspecialty signout for residents is becoming the norm, but it was implemented to benefit academic attendings, not residents.

    I'm a dinosaur, but I'm convinced general signout training produces better general surgical pathologists (what a concept!). You don't produce Juan Rosai's with boutique pathology, IMHO.
     
  6. stickyshift

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    One of my attendings in residency graduated from the BWH program when it was run by Dr. Cotran. He told me that Dr. Cotran regarded trainees who went into private practice as failures.
     
  7. BierstiefelAndy

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    ...and those days are long gone. Many Brigham grads-to-be are pursuing private practice and Fletcher works wonders in helping set people up with those jobs.
     
  8. LADoc00

    LADoc00 Gen X, the last great generation
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    Basically, at one point Cotran heavily pushed for his best research people to do CP only, then kinda backpeddled (he himself being a nephropathologist I believe) but still highly criticized AP and CP combined/blended training paths.

    He is dead tho and I doubt much of his philosophy lingers in the new house.
     
  9. pathstudent

    pathstudent Sound Kapital
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    I was also told that cotran was responsible for all the basic science questions on the so boards. Once he died they were greatly diminished.
     
    #9 pathstudent, Dec 12, 2008
    Last edited: Dec 13, 2008
  10. Absidia

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    No one has commented on Hopkins much, so I guess I can chime in...

    The biggest discrepancy between old posts and reality is that old have mentioned in passing that JHH has a reputation for being "malignant," which I don't get at all. The cutting services can get busy, yes, but this is no different than any other high volume program, IMO, and doesn't equate to malignancy.

    The program seems pretty comparable to the BWH and MGH programs in most respects... Strong research, but big enough that there are plenty of residents not planning on going into academics. World-class attendings, general SP signout (except GI biopsies and Gyn, which are broken off), etc. You can't go wrong with any of these programs, I think... I interviewed at all 3, but went with JHH because it just "felt" right based on my interactions on my interview day. Good luck!
     
  11. lcase

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    Wow, very informative. Thanks guys. I interviewed at all three places, and I definitely felt chemistry was right at two of them. The other one I think was mainly due to my lack of sleep the night before, so at the end, I was very exhausted.

    I also felt I like general sign-out better, but agree that it can't go wrong with either of them.
     
  12. yaah

    yaah Boring
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    That's really not that accurate though - it depends on the program. Some programs make subspecialty signout work very well and integrate things well, others do not. Just like some make a mockery out of general signout. It basically all depends on your interest. I spent two years training in general signout and the remainder in subspecialty. I much prefer subspecialty (and I am not an academic). I learned much more about distinctions and subtleties, and it was easier to focus my learning. But the program has to be big enough, have enough volume, and have good teachers for it to work.

    You are right that there are a number of programs who do subspecialty signout as a convenience for the attendings and it really does not lead to quality education.
     
  13. HbyHA

    HbyHA Fellowship, take 2.
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    i've experienced both general sign out and our *unique* subspecialty model, and i definitely like subspecialty more. some of this is residency specific, depending on how the program divides everything up. we used to be on a three day cycle with splitting big specimens that came up in half. you never knew what was going to be assigned to you. now we are only responsible for a sub-grouping of subspecialties, so you know what type of specimens will be coming your way the next day. you can collect the needed clinical info as well as do any brushing up on grossing in a type of specimen that may be new to you or one you haven't seen in a while.

    our signout day is much more structured, so that we aren't at the mercy of the attendings (as much) any more. ie not showing up to signout until 10 am and not letting get any food until 2 pm when you've been waiting for them since 8 am... the trade off for this is that some times we don't finish all of the cases in our assigned block of time. but learn how to work this out when it comes up.

    i like signing out with the "experts" in the particular field. it means less "uhhh lets show this a conference" and better teaching. i even learn more from the junior attendings now, because i think they are not as overwhelmed by getting hit by any specimen that happens to come up. they can now focus on one subspecialty at a time. (they still do rotate on all the subspecialties)

    i guess it all depends on how it works for the particular program. i can see how you could do it either way and it would work or you could screw it up....

    and i am as NON-academic as they come, and i am at a traditionally academic institution.
     
  14. BierstiefelAndy

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    It doesn't really.
     
    #14 BierstiefelAndy, Dec 14, 2008
    Last edited: Dec 14, 2008
  15. Pathwrath

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    As you mention, there are too many variables that have to be in place to make subspecialty signout work for residents. A crummy teacher in general signout is (hopefully) counterbalanced by many more good ones. In subspecialty signout, that may be all you get (for that organ system).
     
  16. caffeinegirl

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    Unless you have more than one attending per subspecialty...or as is in our case more then 2! Plus, we have it set up so that every week of subspecialty signout for a resident is covered by two attendings (one attending is M-T, another W-Thurs). As yaah mentioned, I think this set up only works in high volume institutions with a large enough department such that there is enough staff to cover all of these specialties. Although we do have staff that cover more than one specialty, it is rare for them to cover more than two different specialties. And, we have weekly subspecialty consensus conferences, which keeps staff in sync. As for keeping residents in sync to other organ systems, our daily unknown conference is also subspecialized (30 min/subspecialty, which allows around 6+ subspecialties to be covered per week)...so residents don't go through long periods of time between seeing different organ systems.
    This system works really well at MGH...I think that the difference between generalized and subspecialized signout is really in the eye of the beholder, and that there is tons of bias (since most people train either one way OR the other). Everybody turns out fine in the end :)
     
  17. Pathwrath

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    I agree, but that isn't stopping lesser programs from adopting the MGH model because it is definitely more efficient for the staff. Also, programs with subspecialty signout have to ensure that residents have repeated access to subspecialty material between their subspecialty weeks. Caveat emptor.
     
  18. Path_Anon

    Path_Anon New Member
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    Dinosaur or not, you make an excellent point here.
     
  19. sternberg

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    Bump!

    So what's the consensus on these 3 these days? Talking to a recent Hopkins graduate, he actually told me pretty bluntly to stay away, that he would've probably had a better experience elsewhere, and further referred me to the last review on the now defunct and outdated scutwork.com as being the most honest, which reads



    That's awful!!





    What's the word on MGH and Brigham these days? I hear they're pretty scut-loaded themselves. My interview experience at Brigham was very pleasant and a love their vision. But what's the word? Is it worth it to go to any of these prestigious programs? I don't want to be miserable for the next 4+ years!
     
  20. Absidia

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    That scutwork review is REALLY old ('03) and not at all reflective of the program now. I would not put any stock into an almost decade old review (though it is worth noting that was the only negative one on there). Obviously I cannot speak for the "recent Hopkins graduate" you spoke to, but I am really surprised that any of our residents felt that way. I guess there are always outliers no matter where you go. But judging by my experience, almost all the current and recent graduates are quite happy with the training and the opportunities they have gotten from being there.

    You don't have to take my word for it. The JHH residency website has resident profiles that include emails that are posted primarily to allow interested parties to ask questions about the program. But take it from this recent graduate - Hopkins has a great atmosphere, and offers unparalleled training and tremendous opportunities. I would definitely choose it again.
     
  21. gbwillner

    gbwillner Pastafarian
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    Chances are, if someone isn't happy with their training at [presteigious institution X], they may have been unhappy anywhere they trained.

    I interviewed at all these places back in the day, and I also came across a resident at MGH who basically said the same thing. But who's to say he would have been happy anywhere?

    I did feel BWH was a little more laid-back and friendly. But in general, the high-pressure/high volume programs may just create stronger opinions one way or another. I feel that high-volume is a good thing- that if you learn by doing, rather than reading, it's a good fit (it was for me). But if you would rather just have more time to chat or read or whatever, it may just not be the place for you.
     
  22. KCShaw

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    As has been more or less said in another recent thread, perspective matters a lot. What is a uselessly overbearing malicious program/attending to one person is just the right kind of atmosphere/motivation/teacher for another person. Some programs pride themselves on what their residents go through, and consider it a mark of good, if intense, training. There's a line there somewhere -- unfortunately where it's drawn is going to affect different residents differently and, perhaps, is why the ACGME not entirely micromanaging every program is still a good thing.

    Meanwhile, when evaluating potential programs try to take the subjective perspective of the person or people telling you about it out of the equation where you can and do your best to understand the average schedule, workload, paperwork/secretarial responsibilities, and so on. What does "we have no time to preview!" really mean -- zero minutes of preview time, or only a 3 hour...6 hour...18 hour...window to preview? "We gross all the time!" -- 8+ hours every single day, or one 8 hour...or 15 hour...day with 2 non-grossing days before the next long one? Etc.
     
  23. Milo86

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    Can anyone give me an opinion on what they consider to be the top 10 path residency programs?
     
  24. pathmaster

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    No specific order, but here is what comes to mind:
    BWH, John-Hopkins, Pitt, Stanford, UCSF, U of Wash, Wash U, Emory, Cornell, Penn
     
  25. jp123ok

    jp123ok Dermatopathologist
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    I think that you have to add UVA to the list of best programs.

    Regarding Hopkins - I've been told by some Hopkins residents that the hours there are brutal. Specifically, they said that they work until 2 or 3am while on surgpath rotations. Even CP rotations require long hours apparently. I can understand why people might go there for a year of fellowship but not why people would subject themselves to four years of that misery.
     
  26. pathmaster

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    Agree with UVA and would add Michigan
     
  27. PathApplicant

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    I think posts like these actually have a lot of influence. I think there are a lot of applicants that lurk in these forums. I have a feeling that these anonymous posts actually can influence which programs that these people apply to and even may influence their rank lists, like it or not. Because in general, people love top 10 lists.
     
  28. Danbo1957

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    There's a list on a white board in a breakroom down in Pathology which has, in order:

    Penn
    Hopkins
    U. Washington
    Pitt
    Columbia
    Wash U.
    UTMB
    Emory
    Stanford
    Chicago
     
  29. Euchromatin

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    While it certainly wouldn't be on anyone's top 10 list for name recognition, I think that William Beaumont in Michigan would probably be in the top 10 (if not the #1) quasi-academic/private hospital residency programs. Our surgical volume is very high (second only to Stanford, last I heard) and we have a very pleasant, resident-friendly atmosphere. Just thought I would add my 2 cents for those prospective residents who may not be planning on a strictly academic or research-oriented career. As LADoc mentioned at the very beginning of the thread, many of the big name academic centers are well-equipped to get you a job at a similar academic center (which is great if that's what you want to do), but probably not so helpful in landing a private practice job.
     
  30. SeenTheLight

    SeenTheLight Junior Member
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    I agree that the easily-influenced people who are too lazy to do investigation on their own are easily swayed by these posts. Ultimately, you need to decide on a program that is best for you.

    Now that I am attending, I think my approach during the application process for residency was a bit naive. I realize that there are plenty of good programs out there where you can get solid training. If you are interested in academics, though, I think there is an upper echelon of programs that are closely tied to the upper echelon of institutions in the US:

    On the east coast: MGH, BWH, and JHU reign supreme. Perhaps add Penn and UVA to the list. Interestingly, BWH has a brand new chairman; faculty turnover is an issue (mostly junior faculty) but is an issue at many places. Senior leadership remains there so BWH will likely remain a strong program even with the changes brewing there.

    In the midwest: Michigan and WashU reign supreme. Given the leadership and the trajectories of these departments, Michigan takes the cake. That's it for the midwest.

    On the west coast; UCSF and Stanford are the two strongest programs.

    I don't believe in listing "top 10" programs. In my opinion, the above programs are the best programs given the current times.
     
  31. CocoaMD

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    Just curious to know which "top" programs you would include in the South and/or South East region of the country?
     
  32. SeenTheLight

    SeenTheLight Junior Member
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    I don't believe there are any institutions in those regions that are in the same echelon as those I've listed. I'm not saying that strong institutions don't exist in the South or SE.
     
  33. GOLJANOID

    GOLJANOID The other 1's THE OTHER 1
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    Agreed. Heard the same thing fairly recently as well.
     
  34. Enkidu

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    What are your thoughts on UW?
     
  35. gbwillner

    gbwillner Pastafarian
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    I can take a guess at which one was the "safety".
     
  36. Milo86

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    I appreciate all your comments and suggestions. Choosing a program is a difficult decision and almost any input can be somewhat helpful. I regret that my question was taken as some sort of shortcut in my process, but hopefully most people did not feel imposed upon to give their opinions.
    I have interviewed at the programs mentioned as well as some not mentioned, but sometimes the experience of others gives a different perspective.
    Thank you.
     
  37. lipomas

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    The list of "top 10" pathology programs typically includes about 30 programs. And even that 30 programs will change depending on who you ask. Like, for example, if you ask someone from Texas their list will probably include about 5 texas programs whereas anyone else's list might include at most, 1. And someone who loves all things California (they usually call it "Cali") will include more west coast programs on their list than someone from Boston.

    In fact, you can usually tell where someone is from or where they want to be by the makeup of their list.

    If you are really interested in a program, apply and try to visit. If you are limited by expenses, then you have to decide what your priorities are. Don't forget that where you live for 4 years of training is going to be very important to you, almost certainly more important than the perceived reputation of a program.
     
  38. tco

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    As someone who will be looking at programs to apply to, this will influence what programs I include in my application and research, but not necessarily where I'll go for residency.
     
  39. Danbo1957

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    There's no such thing as a "safety" in the top ten of any specialty.
     
  40. LADoc00

    LADoc00 Gen X, the last great generation
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    When I see places like UT and Pitt on a top 10 list for Pathology I immediately disregard the entire thread....

    Although UTMB has really cool resources and stuff like "Vector Biology", I wouldnt go there hoping to make an academic career in AP.

    Not saying some of these places cant train Ace pathologists, but pretty much ANY training program can theoretically do that IMO.
     
  41. Danbo1957

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    I wouldn't consider Cincinnati for Emergency Medicine or UAB for General Surgery, but both those programs are rated highly in those specialties and are considered academic pathways. And, UTMB Pathology fellows have job offers the day after they begin their first day of fellowship.
     
  42. LADoc00

    LADoc00 Gen X, the last great generation
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    Are there even good jobs in pathology in TX anymore?

    I wouldnt necessarily brag about all the fellows signing on with Ameripath D+1 after leaving UT.

    I dont think there is a state with more penetrance of corporate owned pathology in the entire US (maybe Florida?)....

    No income tax is cool though, that I can dig.

    PS- nothing personal at all, Im sure UT trains Ace pathologists. Its just that every "Top 10 List" basically takes the same 4-5 extremely well known programs like Brigham, Hopkins, Penn, Stanford and UCSF and then throws a few random places that either they applied to or graduated from. I dont understand the point of that at all...
     
    #42 LADoc00, Feb 8, 2012
    Last edited: Feb 8, 2012
  43. pathstudent

    pathstudent Sound Kapital
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    Completely agree. Ucsf, Stanford, brigham and Hopkins are unchallengeable. The five through ten spots are so random.

    How can wash u be a top ten place unless you are from the Midwest. There is a reason why Stl population went from a million to 300,000 over the last fifty years. The best med students in Stl would love to go to NYC, Boston, bay area, but no one from Boston, sf, NYC would make Stl their first choice.
     
  44. gbwillner

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    No offense, but this is ******ed. I should know better than to respond to this tired argument you've made before lots of times, but I will anyway.

    I think most people talk about "top" programs in term of quality of training. If you want to argue WashU is not a top program in terms of training, fine. But to judge it based on your perceptions of the city are way off-base. Actually, it's funny that you talk about your "top 5" as meccas of awesome cities, and yet you have Hopkins there, where you risk your life just walking through the parking lot. Really, do most people think that Baltimore is somehow better than St. Louis? Also, not everyone is looking for residency in a place where you can party till 5AM on a Monday. In St. Louis your $ goes more than twice as far as in San Fran, and you can easily buy a nice house in a nice neighborhood on a resident salary. If you really hate St. Louis and think it has nothing to offer- you've probably never been there. Fact is, all these cities have things about them that are attractive to some people and a burden to others. To think all students or residents think as you do is pretty narrow-minded.

    Lastly, the reason that the population of Stl went from 1M to 300K is only that people moved to the suburbs. The metro area has roughly 3M people in it. For all the reasons you mention that "no one from Boston, sf, NYC would make Stl their first choice" the same arguments could be made about NYC (It's too expensive and you live in a shoebox), SF (It's too expensive, you can't get a job in California, pay sucks in California, Taxes suck in California, California is bankrupt), and Boston (It's too cold, too expensive, too many students), etc. Do I even have to bring up Baltimore?
     
  45. LADoc00

    LADoc00 Gen X, the last great generation
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    WTH.
    Lets not turn this into "Stl/Midwest sucks" thread. Thats hugely dependent on personal choice.

    I personally rather live in St. Louis or Ann Arbor or Des Moines than SF, LA or NY.

    Im just not a fan of "rank these programs" threads on this site. They are totally pointless. There is ZERO correlation between training program prestige and career success. Zero.

    I fully support any and all bagging on California. California sucks. There are West African dictatorships run better than California.
     
  46. pathstudent

    pathstudent Sound Kapital
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    Ny and sf are at their historical peak in population. Stl has shed 2/3 if its historical peak Cleveland lost something like 20% of the population in just the last decade. To many bright young 20 somethings sf and ny have a lot more draw. Stl and Cleveland are regional cities. Sf and NYC are national ones. It makes a difference.
     
  47. CocoaMD

    2+ Year Member

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    Makes a difference in what?
     
  48. Ombret

    Physician PhD 7+ Year Member

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    Everyone wants to train at the perfect program (and before that, get into the med school, college, etc.) that will guarantee them the life of their dreams. But look at the golden ones around you who HAVE gotten it all and you will see that there are no guarantees. I have been lucky to have always been associated with extremely prestigious institutions, some mentioned in this thread, and yet I see many people around me whose path is not strewn with roses--they don't get the job or fellowship anyway, or their marriage is falling apart, or despite their academic promise they realize they actually just want a regular job.

    I can't, without being a hypocrite, advise anyone not to go for a fancy program, because I always did, but I'll bet in fifty years we will all agree that it doesn't matter.
     
  49. mikesheree

    Physician Lifetime Donor Gold Donor Classifieds Approved 7+ Year Member

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    I assure you, it does not matter.
     
  50. stickyshift

    10+ Year Member

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    I went to top-tier colleges, medical schools, and residency programs. Even did my surgical pathology fellowship at Wash. U. My partner (who recruited me out of training) went to 4th-tier colleges and medical school (and no-name residency) and is a top-notch pathologist. She likes to look at my degrees on the wall and say, "Hm, and we're both making the same amount of money."

    No one cares about your pedigree, and the quicker you can get over that, the better off you'll be in private practice. Just do your job as well as you can, get along with everybody, and realize that nothing succeeds like success.
     

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