I'm a second year resident at Baton Rouge and honestly couldn't be happier.
As far as the medicine call thing goes, you were either misinformed or misunderstood how it works.
The hospital medicine service at the Baton Rouge General where we do our internal medicine months is indeed run by a group of private physicians. They are however a group of private physicians who are very interested in our being on their service and very interested in teaching. They approach our role on their service from an EM point of view. They assign us to patients who have very EM specific problems and/or teaching points. We don't round on the rocks from day to day. Instead we take care of the MI's, CVA's, pneumonias, sepsis etc. The goal is to understand what the typical hospital course of these kinds of patients looks like. They teach from a vantage point of "What are the things you can/should be thinking about when you see this pt. in the ED that will maximize their care during their hospital stay?" It is great for continuity in a teaching sense as well as gaining a better understanding of the disease processes which we might never truely understand from our often times limited view in the ED. All of the attendings in the group are young and very well read and trained. They come from some of the powerhouse type programs in IM and truely commit alot of themselves and their time to our education. We are anything but scutmonkeys. Having residents on the service is actually less effecient from a business point of view.
Regarding the call issue. We don't follow the traditional q4 call model. We work in shifts. We will do a block of nights (usually 7) from 8 pm to 9 am after morning report. The other three residents on the service will work typically 7 am to 3-4 pm with every third day being a "late day" where we alternate staying until 8 pm, when the night resident comes on. We will also rotate weekends working 8 am to 8 pm until, again, the night resident takes over.
This model actually fosters autonomy and decision making in a great way. When we are the night resident, we are typically the only physician in-house covering a service upwards of 70 patients, including floor, ICU and skilled nursing. You get more codes than you want, more crashing patients than you need and more experience than you would typically expect. There is also a night attending on, but he is usually at the BlueBonnet campus getting killed by the ER over there. So, in essence, the MidCity campus is pretty much your show. Between admitting pts from the ED, coding pts on the floor or in the unit, you get all the experience you want! No upper level, no three levels of decision making before it is time to nut-up and do something. Of course your attending is always on the other end of a cell phone and you have fellow residents and upperlevels in the ED and in the Unit if you bite off more than you can chew, but ultimately it is your service to manage.
Those two months of hospital medicine durning my intern year did just as much as any of my EM months in fostering confidence.
The unfortunate thing about our program is how incredibly ugly the Earl K. Long medical center looks from the road. It is a state Charity hospital, a smaller version of Charity in New Orleans. Since it is on a not so great side of town, we still get our share of trauma, but we aren't innundated all night like the folks down in New Orleans. We do in fact have surgery at the Earl as we like to call it, but they take call off-campus in their apartments (they are LSU surgery residents from NO). This means that we are typically taking care of the traumas ourselves until when or if we give them a page. This is different than the typical model of a trauma team coming in and kicking you out of the way whenever some thing good comes in. Same is true at the Baton Rouge General. It is a very busy community hospital on the edge of the innercity/midcity. This provides us with a nice mix of the innercity, nearly indigent (and often times indigent) crowd and the well-insured. Here to we get our share of trauma. Since the city of Baton Rouge is lacking in a designated level one center (economics...whole other discussion) when something bad happens to someone, they go to the closest facility usually. Again, since this is a community hospital, we don't have in-house surgery. Again we handle the traumas ourselves until the decision to notfiy surgery/ortho is made. Since the large majority of those training here are intending to practice in the community setting, I am of the opinion that this is an excellent opportunity to learn how to stand on our own without the benefit of the trauma chief standing over our shoulder and initially manage the trauma and make the initial, and often times, tough decisions. This is how we will be doing it in practice in a few months. Might as well learn how now.
I could go on and on...
Cliff Notes:
Varied pathology
Early autonomy
Laid-back atmosphere
Happy residents
Quality off-service rotations
No regrets
