Applied here on a whim, essentially because it's in California. Now that I've got an invite and I'm looking into it more, the training sites look really solid and the faculty, as well. Any experience with this program?
Kaiser South California Residency
- Thread starter Wroooong
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I'm the administrator that helped start that program. You're correct. Solid program, great faculty, great rotations and TEAMWORK. If you're looking for an amazing residency and great training in Southern California, Kaiser EM San Diego is your program. Good luck!
Can you talk about the overall acuity and procedure rate? I have heard that there is high volume/low acuity and that intubations let alone other procedures are exceedingly rare.
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Does anyone have any recent reviews of this program? Wondering how it would be applying to fellowships or going into academics after training at Kaiser. Also wondering about overall acuity and procedures like previous poster. Thanks in advance!
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Can't speak from personal experience but have a good friend in the program currently about to graduate who really liked it. I think he mainly liked it because it is in San Diego. He has mentioned that it's overall pretty low acuity compared to other programs but if you know you're gonna do community practice or want to work at a Kaiser, then who cares.
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I would recommend training at a county facility. You want that crazy / "no-holds-barred" type of experience under your belt that makes you feel prepared for anything. There's plenty of time to work at lower acuity shops once residency is finished, but you may never get that same "county residency" environment again.
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I'm not sure why we perpetuate this myth that county training is the only high acuity training there is in residency. Yes, it's true, county facilities see sick patients. But they also see a lot of patients without primary care doctors who probably don't need an emergency physician in the first place. A LOT. I can speak from experience having rotated at 3 county EM programs. There are many university medical centers that see very sick crashing patients. And while I can't speak for Kaiser SD in particular, there are also many community sites that offer a high acuity experience as well.
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slurpy15
While I totally enjoyed the county portion of my training, it was not the be all and end all. Everywhere is different, but these were the negatives I perceived to a solely county program:
-A lot of the care and treatment of county patients is frankly substandard and not what any of us should aspire to, although of course we are limited by practice circumstance.
-There also seemed to be consultants everywhere, so not a ton of reductions or frankly hard decision making- you could admit anyone.
-Too much scut that interrupted actual training. I don't need a nursing degree, thank you.
-No incentive to learn to go fast. You need to learn to go fast.
-You need to learn how to deal with ornery consultants who can actually refuse, patient satisfaction, billing, and administrators.
-Trauma is cookbook and perhaps the least important part of EM.
-There is a ton of ridiculous primary care
All in all, county-trained residents don't seem much better than anyone else. YMMV
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QFT. I used to be the biggest cheerleader for County training. I rotated at 2 badass county programs. The sickest, most medically complex patients were at the super academic program I rotated at. Trauma is cookbook, and it gets old. Yeah, you get more opportunities for procedures, but you lose a lot of time in the trauma itself, the transfer, and the documentation. Lot more primary care issues at county, which was really frustrating and took away from the learning.
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slurpy15
I should add that I think a lot of healthcare is going to look like Kaiser, Geisinger etc in a few years.
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I agree. There are lots of great programs out there. Not all of them are county. If you find one in an affluent area, then great!
However look at all these threads on SDN where EM residents are complaining they're not getting enough procedures and feel they are lacking in certain areas of their bread and butter medical training. Don't do yourself a disservice and train somewhere where ortho is going to do all the reductions or where you won't put in 10 chest tubes.
If you train at a residency with a poor population with low access to health care, diseases will spiral out of control, you'll have plenty of experience in handling any physiologic response that knocks at your done, and you'll become proficient at procedures. Also low acuity non-emergency patients come into the ED in all walks of life, not just county.
Really my main point was, from my experience working training in a county facility and then in both high acuity and low acuity shops for several years after training, it is MUCH better to have high acuity experience under your belt. Training at a low acuity residency because you are planning on working in a low acuity environment is detrimental to both yourself and your future patients.
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slurpy15
I think that it's a mistake to think county=all procedures. I know in NYC, the residents rarely do reductions at any of the public hospitals- that's what ortho is for. They do see sick, but that seems to be the case anywhere.
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I agree with your main point that is higher acuity training is far better than lower acuity training. But I don't think that county facilities are the only places to get that experience. In fact, there are many county places that are quite the opposite. I find that county hospitals are inundated with poorly trained staff, lack of funding, and low acuity. The county patient is more likely to come to the ED for viral gastroenteritis than the suburban soccer mom. Yes, it's true that when it comes to penetrating trauma county hospitals provide a pretty robust training experience, but I don't think they are the end all be all.
I can think of many programs that are community/academic where residents are getting good procedural experience. I also know of many county programs (BIG famous ones, think LAC+USC or Highland) where orthopedic surgery residents train and often times take over reductions. Cincinnati is not a county program, and their residents get phenomenal orthopedic training.
Again, county training is very strong training. People who train at county facilities are some of the best in the nation. But choosing a county hospital does not equal higher acuity by default. There's a lot more complexities to it.
Sorry to derail this thread, we now take you back to your regularly scheduled Kaiser SD programming....
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slurpy15
Crappy pay, pie-in-the-sky pension, job varies depending on site. California has highly unionized nurses that run the ER, not you.
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The crappy pay may have been true in the past but is no longer true. Email a Kaiser recruiter to ask for current salary. The salary (cash pay) is on par with even well paid communities. The benefits (six figures) blow everyone else out of the water.
Now, I think the nursing comments are probably still correct.
Now, I think the nursing comments are probably still correct.
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slurpy15
Oh, wow. Tell me what you have learned re: salary? Would be silly to call a recruiter. What are they paying (hourly)?
I was not impressed by the bennies. Their pension is underfunded due to their insane nursing salaries (six figures) and their insurance means you have to get "care" at Kaiser, I believe.
I was not impressed by the bennies. Their pension is underfunded due to their insane nursing salaries (six figures) and their insurance means you have to get "care" at Kaiser, I believe.
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The Kaiser recruiters are in-house, not contract. No need to avoid calling them. They're your "in" if you're interested.
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Yup. Also not publishing the numbers on a public forum. Not wise when 1/4 of the average working mans salary goes to paying for healthcare to then publish impressive salary numbers.
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slurpy15
Why are people so freaked out by posting salaries? General EM salaries are pretty easy to find, right? Floor of $200 an hour up to about $350? Annually a floor of about $290000 up to a million or so for a director, no? Reticence to post general, non-identifying salary info has nothing to do with anything (including fears of the working man or whatever) always confuses me. I can understand not wanting to ID oneself or a specific group (if you work at the one group in Bozeman or the only SDG in your town, for example) but isn't Kaiser a huge organization with multiple divisions?
I think as a profession we benefit from knowing what other shops make- otherwise it seems like a race to the bottom. What do we gain from secrecy? Some forward-thinking health systems publish this info!
Last time I chatted with them (two years ago) I was not impressed, and a colleague dumped her Kaiser SD gig for locums in MS due to low salary. But hopefully things have changed and they've upped their game. Their pension is woefully underfunded, FWIW, so caveat emptor Longer lives, falling rates put pressure on hospital pension plans
I think as a profession we benefit from knowing what other shops make- otherwise it seems like a race to the bottom. What do we gain from secrecy? Some forward-thinking health systems publish this info!
Last time I chatted with them (two years ago) I was not impressed, and a colleague dumped her Kaiser SD gig for locums in MS due to low salary. But hopefully things have changed and they've upped their game. Their pension is woefully underfunded, FWIW, so caveat emptor Longer lives, falling rates put pressure on hospital pension plans
