Inner-city versus Private Hospitals?

[RexKD]

What are the advantages and disadvantages to doing one's ER residency in an inner-city hospital versus a private hospital?

The public inner-city hospitals which come to mind are Bellevue in NYC and Cook in Chicago. I believe Bellevue is associated with NYU while I am not sure if Cook even has residency positions.

The main advantages I can imagine for doing one's residency in an innter-city hospital would be 1) sense of gratification helping those who are the neediest 2) enormous path spectrum 3) less litigious patients 4) more variety in trauma surgery besides the bread and butter car accident 5) busier on average

The disadvantages would be 1) time lost performing FP for those without family physicians 2) more likelyhood of drug-seeking than a private hospital 3) communication differences with the patients who likely have a lower level of education 4) lack of resources

What are your views on this subject? When you were considering where to do your residency, how did you decide on which programs to rank? Did most of you prefer inner-city programs or more well to do programs?

Are there are few EM programs which are considered the most competitive?

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[Sessamoid]

2) more likelyhood of drug-seeking than a private hospital

The rest of it you pretty much have correct, but my experience is quite the opposite on this point. The more suburban hospitals I've worked at had by far the highest proportion of drug-seekers. Deep inner city drug addicts can get better stuff without waiting for hours in an ER waiting room.

 

[EctopicFetus]

FYI Cook has a residency program and it is considered to be among the best (from what I hear).

 

[Febrifuge]

3) communication differences with the patients who likely have a lower level of education

I am all for political incorrectness, but nuh-uh. Clearly you've not been sucked into a long and futile discussion with a soccer mom "cyberchondriac" who's been reading about obscure conditions on the Internet and swears she has made the diagnosis already.

Education and smarts are two totally different things (as any length of time here will very probably show).

 

[spyderdoc]

I am all for political incorrectness, but nuh-uh. Clearly you've not been sucked into a long and futile discussion with a soccer mom "cyberchondriac" who's been reading about obscure conditions on the Internet and swears she has made the diagnosis already.

Education and smarts are two totally different things (as any length of time here will very probably show).

Oh lord, this reminds me of my previous job in silicon valley, where we constantly had to explain to all these computer nerds why their 84 yo mother with fever didn't have Dengue, or some other obscure zebra that shows up as part of the "differential" on a computer search on WebMd for fever....

 

[MasterintuBater]

Yeah, I would have to agree that the easiest people to communicate with are the very intelligent, and the not-so-intelligent. The very intelligent you can scientifically reason with and explain your reasonings for decisions. The not-so-intelligent will just take your word for whatever and blindly follow your every instruction. It's those middle-of-the-road patients who are the toughest. They know just enough to think they know everything.

 

[edinOH]

Yeah, I would have to agree that the easiest people to communicate with are the very intelligent, and the not-so-intelligent. The very intelligent you can scientifically reason with and explain your reasonings for decisions. The not-so-intelligent will just take your word for whatever and blindly follow your every instruction. It's those middle-of-the-road patients who are the toughest. They know just enough to think they know everything.

That is so true.

 

[Koko]

With regard to the original question, what about ancillary staff? I'm tempted to say inner-city is less supportive vs. private, which translates into residents doing lots of blood draws, EKGs, even transport for diagnostics at times. But this impression is based on NYC vs suburbs. Does this seem to be true in other parts of the country? And yes, there are exceptions to all generalizations.

 

[FlemishGiant]

With regard to the original question, what about ancillary staff? I'm tempted to say inner-city is less supportive vs. private, which translates into residents doing lots of blood draws, EKGs, even transport for diagnostics at times. But this impression is based on NYC vs suburbs. Does this seem to be true in other parts of the country? And yes, there are exceptions to all generalizations.

Yea, after rotating on the west coast in a county vs. community ED there is a diff in ancillary staff. Its not as bad as NYC (did my own blood draws, ran Lactate levels to the lab, ekgs, made a paracentesis kit w/ one of those urine bags that hangs off the beds, etc)... But in the west coast county program you still had to do some of your own pushing of pt's if you wanted things to get done quickly. But blood draws/ekg's etc were all done by a great nursing staff. Overall I enjoyed my county experience much more. I thought I saw better pathology, trauma and got a greater level of autonomy. Good times.

 

[doc05]

The main advantages I can imagine for doing one's residency in an innter-city hospital would be 1) sense of gratification helping those who are the neediest 2) enormous path spectrum 3) less litigious patients 4) more variety in trauma surgery besides the bread and butter car accident 5) busier on average

(1) hahaha very funny.
(4) trauma surgery is handled by trauma surgeons. EM docs just do the initial triage.

The disadvantages would be 1) time lost performing FP for those without family physicians 2) more likelyhood of drug-seeking than a private hospital 3) communication differences with the patients who likely have a lower level of education 4) lack of resources

(1) even in a suburban ED, you'll see tons of crap that really should be handled in an outpt clinic.
(2) not really.
(3) when you're a physician, 99% of patients have a lower educational level.

 

[EMResident]

The main advantages I can imagine for doing one's residency in an innter-city hospital would be 1) sense of gratification helping those who are the neediest 2) enormous path spectrum 3) less litigious patients 4) more variety in trauma surgery besides the bread and butter car accident 5) busier on average

1) the neediest don't care where they are; they're needy. all patients "need" your help. a bagel-cutting laceration is just as legitimate a patient as malaria.
2) i'm always suprised by what shows up at my inner-city hospital as well as my community experiences.
3) cook county is one of the most litigious counties (2nd to wayne county, MI -- detroit to you and me) in the nation with high payouts to patients. setting offers no defense
4) trauma = trauma = trauma
5) volumes vary by center, busy has multiple definitions

The disadvantages would be 1) time lost performing FP for those without family physicians 2) more likelyhood of drug-seeking than a private hospital 3) communication differences with the patients who likely have a lower level of education 4) lack of resources

1) welcome to emergency medicine! true of any/every ED.
2) drug-seekers are everywhere, but more likely to get drugs at "fancy" places that pride themselves on their upstanding patients. Urban hospitals (whether county or private) are often more savvy.
3) communication problems abound everywhere; at a county hospital, though, you may actually find someone who speaks the language (MD, RN, janitor)
4) while varied among hospitals, on average most county hospitals will not have as many resources (ancillary staffing, endless supply of equipment, fireplaces & pianos in the lobby). most emergency departments, however, will have the supplies that enable you to effectively care for your patients in an appropriate fashion. JCAHO does a nice job of ensuring that.

As far as "competitive" residencies: If you want to go somewhere, I'd consider it competitive in that you want it and perhaps might not get it. You're going to compete to get in. There are some programs with more name-recognition and prestiege (whether deserved or not.. some places are still resting on laurels earned long ago) than others but few places are regarded as "bad." Every residency program is different -- 3 vs 4 years, community vs academic/university affiliated, large vs small, county vs not-county, accepts DOs vs doesn't accept DOs, FMGs vs no FMGs, location... get it? Figure out clear likes/dislikes and the non-negotiables -- must do 4 years and cannot possibly live east of the Mississippi, for example -- and research from there.