Maimonides in NY Times

[pseudoknot]

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http://www.nytimes.com/2008/05/11/nyregion/thecity/11hosp.html

A pretty good article about an EM intern there. Nothing new for regular posters here, but a nice ad for the program.

 

[Pinkertinkle]

So he eventually quit the program? That's not a great advertisement.

 

[pseudoknot]

Well, he quit for personal reasons...otherwise it sounded like a fun place to be, to me at least. I guess it's hard to resist the lure of the rattlesnakes and scorpions at LLU 😉

 

[WallowaWanderer]

Great article. He had to go through a lot to be with his sweetie - Transferring to another residency is not an easy thing to do. I hope they are happy ever after.

 

[lisichka]

wow. great article. thanks for posting it. i will def. buy the book.

p.s. someday i would love to work in such a place. 😳

 

[erdoc1234]

Maimo is a notoriously unpleasant place to work. They have a ROUGH time recruiting faculty. My impression of the article was it was saying what a raw deal docs in NYC ED's have. I get the feeling this guy HATED it but was able to bow out gracefully.

 

[Painter1]

sounds like the gf relationship is just an excuse. i don't think this dude needs to be commended in the NY Times. he was a bad pick in the end. not anyone can front coming to NY and learning EM in a zoo-of-a-place. Maimo is no joke. I here the director is particulary awesome, but the patient population can be relatively abrasive, couple this with a dreadful volume of patients--and those that can't handle the heat will find a way out.

 

[Tiger26]

It was a big turnoff for me

 

[WallowaWanderer]

sounds like the gf relationship is just an excuse. i don't think this dude needs to be commended in the NY Times. he was a bad pick in the end. not anyone can front coming to NY and learning EM in a zoo-of-a-place. Maimo is no joke. I here the director is particulary awesome, but the patient population can be relatively abrasive, couple this with a dreadful volume of patients--and those that can't handle the heat will find a way out.

That's a lot to say about a guy you don't know!

 

[EBKame]

Thanks for the link. I have no idea what I'm getting myself into and it was good to get some perspective. I'm a little disheartened by the NYC description (I'm still deciding whether I want to move there), but overall it's good to hear that there is such a wide diversity of patients and so much action in the ER.

 

[myKuduSlewaZulu]

They have translators for 67 languages...wow! For those of you who have rotated or are doing residency in a place like this, how well does that work in practice? On the surface it seems like it would be a real annoyance over time in a field where efficiency is important.

 

[GeneralVeers]

They have translators for 67 languages...wow! For those of you who have rotated or are doing residency in a place like this, how well does that work in practice? On the surface it seems like it would be a real annoyance over time in a field where efficiency is important.

I agree, that would drive me crazy to have to wait for the translator to show up every time I wanted to update a patient, or answer their questions.

Spanish is bad enough, but at least it's a single language and I was able to learn enough to get by.

 

[dmitrinyr]

They have translators for 67 languages...wow! For those of you who have rotated or are doing residency in a place like this, how well does that work in practice? On the surface it seems like it would be a real annoyance over time in a field where efficiency is important.

I worked in a hospital in NYC where about 50% of the pts spoke only spanish and no english and many others spoke various languages from french to creole to some distinct african dialect. Instead of a translator service in which case that person has to be paged and we have to wait for him to come down, what we had is a telephone with 2 handles. You just pick up one line, say which language you want to have a translation in and the operator connects you with someone that can translate in that language (i think they had like 50 to pick from). Then you give the other line to the pt and whatever you say the translator then translates it to the pts language and you can tell everything that you what to the pt this way. It is a bit annoying at times because it does take a lot longer than a regular H&P and explanations but we are here to treat the pt's problems and help them the best that we can, even if we don't speak the same language. Although, it is extremely sad and weird to have to convey bad news over a translator system like this one.

 

[jbar]

one problem with these systems is cost. They had a similar system when I was at Bellevue, but we were encouraged to first try to find a live translator for common languages like spanish or if there was family, and save the phone for those rare languages.

 

[deleted109597]

I agree, that would drive me crazy to have to wait for the translator to show up every time I wanted to update a patient, or answer their questions.

Spanish is bad enough, but at least it's a single language and I was able to learn enough to get by.

Speaking of which, do you think you habla more now that you're closer to Mexico, or less because there are fewer patients? Are you having any trouble with the local dialect?

 

[CraftyMed]

They had a similar system when I was at Bellevue, but we were encouraged to first try to find a live translator for common languages like spanish or if there was family, and save the phone for those rare languages.

There was an article in Pediatrics (i believe) several years back about how using unauthorized translators can be dangerous to the patients. They gave these great examples: (these are my loose memory of them)
--a younger sibling translated to her mother that a cream was to be applied all over the body instead of just the affected area-->the pt returned with a new rash all over the body
--a sister translated that ear drops were to be given by mouth

Just a warning to be careful when family members are translating. Sometimes it's funny, but other times, dangerous.

 

[GeneralVeers]

Speaking of which, do you think you habla more now that you're closer to Mexico, or less because there are fewer patients? Are you having any trouble with the local dialect?

Surprisingly it's the rare patient down here who doesn't speak any English. Conversely, in Los Angeles 30-40% of my patients no habla. It has to do with a different attitude towards integration in Texas vs. California.

 

[Painter1]

That's a lot to say about a guy you don't know!

I thought I had a solid arugment.

My main arugment is:

A. You leave the kitchen because you can't handle the heat

My Premesis include:

B. Maimo is no joke (tough place to work)
C. The Director is particulary good
D. The patient poplation can be relatively abrasive (e.g. have u dealt with
russian patients?)
E. They have a dreadful patient volume
F. To escape harsh situations, people make excuses

Because of B, D, E and F, A occured, eventhough B.

Follow?

 

[lisichka]

I thought I had a solid arugment.

My main arugment is:

A. You leave the kitchen because you can't handle the heat

My Premesis include:

B. Maimo is no joke (tough place to work)
C. The Director is particulary good
D. The patient poplation can be relatively abrasive (e.g. have u dealt with
russian patients?)
E. They have a dreadful patient volume
F. To escape harsh situations, people make excuses

Because of B, D, E and F, A occured, eventhough B.

Follow?

worse. i have Russian parents. they constantly tell me that American doctors are not affectionate enough, not sympathetic enough. pretty much all American doctors are BAD people. once i helped my Russian granny go to ER , she made the poor doctor cry. she had soooo many questions for her, and then she said: You are wrong about everything, i want to talk to your boss. 😳 It wasn't in NY though.

 

[lisichka]

I thought I had a solid arugment.

My main arugment is:

A. You leave the kitchen because you can't handle the heat

My Premesis include:

B. Maimo is no joke (tough place to work)
C. The Director is particulary good
D. The patient poplation can be relatively abrasive (e.g. have u dealt with
russian patients?)
E. They have a dreadful patient volume
F. To escape harsh situations, people make excuses

Because of B, D, E and F, A occured, eventhough B.

Follow?

but i agree with you. based on this article, it seems that this blue-blooded doctor's son from Nebraska didn't fit into this "immigrant" environment. so he left. seems pretty natural to me. not everyone is cut out for NY, especially this kind of NY. "If you can make it there, you can make it anywhere."😉 or smth like that... maybe Upper East Side would actually work out for him.

 

[jbar]

There was an article in Pediatrics (i believe) several years back about how using unauthorized translators can be dangerous to the patients. They gave these great examples: (these are my loose memory of them)
--a younger sibling translated to her mother that a cream was to be applied all over the body instead of just the affected area-->the pt returned with a new rash all over the body
--a sister translated that ear drops were to be given by mouth

Just a warning to be careful when family members are translating. Sometimes it's funny, but other times, dangerous.

I hear you, I don't like using family unless there is no other choice. But in the ED here awhile ago someone stole the translation phone and we were told that it was going to be an hour to get a real translator so sometimes you have to make do.

 

[GeneralVeers]

but i agree with you. based on this article, it seems that this blue-blooded doctor's son from Nebraska didn't fit into this "immigrant" environment. so he left. seems pretty natural to me. not everyone is cut out for NY, especially this kind of NY. "If you can make it there, you can make it anywhere."😉 or smth like that... maybe Upper East Side would actually work out for him.

Why the animosity towards someone just because they are from Nebraska? I went to school in Nebraska and Indiana, and have done just fine dealing with mostly immigrant populations. Oh yeah, I'm a doctor's son too.

 

[lisichka]

Why the animosity towards someone just because they are from Nebraska? I went to school in Nebraska and Indiana, and have done just fine dealing with mostly immigrant populations. Oh yeah, I'm a doctor's son too.

and where exactly did you find animosity in my post?

 

[GeneralVeers]

and where exactly did you find animosity in my post?

"blue-blooded doctor's son from Nebraska didn't fit into this "immigrant" environment:

That seemed to contain some animosity, or smugness in it. Perhaps I read too much into it.

It often appears to me that the people on the coasts (both East and West) look down on all the people in the square states with a certain degree of superiority.

 

[lisichka]

"blue-blooded doctor's son from Nebraska didn't fit into this "immigrant" environment:

That seemed to contain some animosity, or smugness in it. Perhaps I read too much into it.

It often appears to me that the people on the coasts (both East and West) look down on all the people in the square states with a certain degree of superiority.

ok. i agree. blue blooded was too much. and re: superiority, in this specific case, i think it is the other way around. but oh well, i think i also read too much into it.🙂 sorry, i didn't mean anything bad.

 

[RxnMan]

...It often appears to me that the people on the coasts (both East and West) look down on all the people in the square states with a certain degree of superiority.

Having gone from a square state -> NYS, I agree. Case in point:

 

[Mutt22]

"blue-blooded Nebraska son"

I agree with General Veers, that came across as ironically arrogant remark from somebody who hasn't spent much time in nebraska. There are a lot of Sudanese refugees in Omaha, and lots of Hispanics. I have to use the cyracom translators on a regular basis here. Omaha isn't a fraction the size of NYC, but it is still a city. All US cities, if you haven't been to many others than NYC, are melting pots of a huge diversity of people, from all over the world.

 

[lisichka]

"blue-blooded Nebraska son"

I agree with General Veers, that came across as ironically arrogant remark from somebody who hasn't spent much time in nebraska. There are a lot of Sudanese refugees in Omaha, and lots of Hispanics. I have to use the cyracom translators on a regular basis here. Omaha isn't a fraction the size of NYC, but it is still a city. All US cities, if you haven't been to many others than NYC, are melting pots of a huge diversity of people, from all over the world.

i didn't say he was "nebraska son". i said he was doctor's son🙄

I do not know why you think my remark was arrogant, i never said I hate nebraska and love NY. and certainly i do not feel superior because i live in a certain geo region. that is just a primitive/inaccurate conclusion of yours.

now back to the article: I was a bit annoyed that while visiting a NY hospital, the father was extolling his Nebraska hospital--with more $$$ investments, and lower patient volume. it honestly gave me an impression that he was looking for an easy way out for himself and his son. but that is an intuitive vibe i got from reading the article. i could be wrong of course... and also the father mentioning lands end catalogue and orthodox jews just didn't sound right to me. if anything, it is not me who is arrogant, it is him who is arrogant. he obviously liked nebraska better, and thought NY was subpar: less space and $$$, more difficult patients who bring their immigrant problems to ER(look in the article).

and please don't jump to conclusions that have NOTHING to do with what I wrote.😡😡😡

 

[jbar]

The vibe I got from the dad in the article was how impressed he was that this hospital could handle many more patients with less resources. Also seemed struck by the unfairness that this hospital needs so much more and that places without the volume are better equipped. But that's just my read.

 

[Mutt22]

Sorry I misunderstood your comments. I'm a defensive person.😳

i didn't say he was "nebraska son". i said he was doctor's son🙄

I do not know why you think my remark was arrogant, i never said I hate nebraska and love NY. and certainly i do not feel superior because i live in a certain geo region. that is just a primitive/inaccurate conclusion of yours.

now back to the article: I was a bit annoyed that while visiting a NY hospital, the father was extolling his Nebraska hospital--with more $$$ investments, and lower patient volume. it honestly gave me an impression that he was looking for an easy way out for himself and his son. but that is an intuitive vibe i got from reading the article. i could be wrong of course... and also the father mentioning lands end catalogue and orthodox jews just didn't sound right to me. if anything, it is not me who is arrogant, it is him who is arrogant. he obviously liked nebraska better, and thought NY was subpar: less space and $$$, more difficult patients who bring their immigrant problems to ER(look in the article).

and please don't jump to conclusions that have NOTHING to do with what I wrote.😡😡😡

 

[notdeadyet]

The main vibe I got from the article was that the guy was in over his head and moved to a program that was probably more to his liking.

 

[ggmk]

High volume, sick patients, immigrant population...etc sound like what EM applicants look for in a "county" like EM residency program, at places like Jacobi, Cook, USC, Downstate, Highland...etc. Maybe it's bias due to the name issue, because usually when applicants refer to those big programs, they usually refer to them positively as "busy hardcore training" but somehow Maimonides gets a "diffiicult place to work" even though it provides the same county experience like those bigger name programs. If EM applicants could get pass the name issue, they'd realize that Maimo is a great place to learn EM, in THREE years. Most of the high volume sick patients county like programs are 4 years, which gives Maimo the edge in my opinion, unless of course people really believe that an internship year with 3+ dreadful months of internal medicine will really prepare them for a career in EM. Otherwise, Maimo might be one of the best 3 year county-like program, in NYC(no other 3yr program in NYC come as close to "county" as Maimo) and also in the country if that's what an EM applicant is looking for.

 

[pseudoknot]

This seems like a great illustration of the importance of "fit" in EM residencies.

 

[banana5]

Maimo is a great place to learn EM, in THREE years. Most of the high volume sick patients county like programs are 4 years, which gives Maimo the edge in my opinion, unless of course people really believe that an internship year with 3+ dreadful months of internal medicine will really prepare them for a career in EM. Otherwise, Maimo might be the best 3 year county-like program, in NYC and also in the country if that's what an EM applicant is looking for.

I'm pre-med, so I'm just asking out of curiosity:

I was under the impression that the vast majority of EM programs are 3 years, is that not so? If anything, I would have thought that low-acuity, low-volume centers would want you to be there for 4 years so that you could see as much as someone would at a large county hospital in 3.

edit: I just read the 3 yr vs 4yr residency thread, so I think I'm clear on the difference. However, nobody addressed why some programs are 4 (i.e., doesn't it go against my original logic above?). Also, in the 3 vs. 4 thread, someone mentioned that "some of the obviously awesome" programs are 2-4; is that cause and effect?

 

[pseudoknot]

I was under the impression that the vast majority of EM programs are 3 years, is that not so?

Yes.

If anything, I would have thought that low-acuity, low-volume centers would want you to be there for 4 years so that you could see as much as someone would at a large county hospital in 3.

Even at the lowest* volume ED with an associated residency, there will be more patients coming through the door than any one resident could ever see. A place that has 100,000 patients/year will have a lot more residents as a place that sees 50,000/year, so the ratio or the type of patients seen might make more of a difference.

* There are minimum patient volumes for any EM residency, per the RRRC.

Also, in the 3 vs. 4 thread, someone mentioned that "some of the obviously awesome" programs are 2-4; is that cause and effect?

Doubtful, but others are better qualified to comment on this. The 2-4 format doesn't make a great deal of sense to me for EM. My suspicion is that a lot of the 2-4 programs tend to be that way because they are very old, and in EM the oldest programs tend to be the most famous and thus "clearly awesome."

 

[roja]

High volume, sick patients, immigrant population...etc sound like what EM applicants look for in a "county" like EM residency program, at places like Jacobi, Cook, USC, Downstate, Highland...etc. Maybe it's bias due to the name issue, because usually when applicants refer to those big programs, they usually refer to them positively as "busy hardcore training" but somehow Maimonides gets a "diffiicult place to work" even though it provides the same county experience like those bigger name programs. If EM applicants could get pass the name issue, they'd realize that Maimo is a great place to learn EM, in THREE years. Most of the high volume sick patients county like programs are 4 years, which gives Maimo the edge in my opinion, unless of course people really believe that an internship year with 3+ dreadful months of internal medicine will really prepare them for a career in EM. Otherwise, Maimo might be one of the best 3 year county-like program, in NYC(no other 3yr program in NYC come as close to "county" as Maimo) and also in the country if that's what an EM applicant is looking for.

I have friends who have been attendings there. Maimo has LOTS of sick sick patients. Hwwever, it differs from a county because of their funding. It is really not like a 'county' in the traditional sense. (a common misperception that county is synonymous with sick).

It has many many political issues as well. But you will absolutely manage very sick patients there.