Malignant programs

[sapience8x]

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So I was reading the thread with the resident from Upenn and the hours he/ she is working and some people expressed their surprise over those hours. What programs are known to work hours like this and is this just on the surg path rotation?
From that thread I know of 2:

U Penn
JHU

any others?

 

[cytoborg]

Hard work doesn't necessarily equal malignant! To learn pathology well, you need to see a lot of cases. That's just a fact. Sometimes that is going to entail working your a$$ off, but that doesn't mean the program is malignant - just busy. Yes at times you will be feel exhausted, overwhelmed, and frustrated, especially at first, but you can't expect residency to be entirely painless. If the residents watch out for each other and have fun together, and the attendings are humane, you can work hard while still enjoying a supportive and collegial atmosphere.

There are path programs out there where you won't work hard - I interviewed at one where the residents said they leave around 3 pm on surg path! Of course, they loved the time with their kids or on the slopes. But one said to me, "The scary thing is, I probably could escape from this residency without learning a thing!" Scary...

 

[b&ierstiefel]

So I was reading the thread with the resident from Upenn and the hours he/ she is working and some people expressed their surprise over those hours. What programs are known to work hours like this and is this just on the surg path rotation?
From that thread I know of 2:

U Penn
JHU

any others?

I wouldn't conclude that Hopkins is a malignant program from that thread. The only reference to JHU was in my post and I certainly didn't label that program as malignant. Maybe others know more about Hopkins than I do (and of course, they haven't really posted anything specifically about JHU yet).

I dunno if you're gonna have too many folks posting and flat out saying that such and such program is malignant. I would suspect that the majority of the posts would be from people who aren't at those programs...hence, those opinions would be classified in the "hearsay" category. But who knows. I'd be curious to see what's posted here 🙂

I'm at BWH and first years work harder because a) our program is front-loaded and b) first years are just new to pathology. I worked much harder first year but due to efficiency, my hours are much better now (what 80 hour rule? oh wait, it's the 60 hour rule!). So what if PGY1's here work hard? Does that necessarily make our program malignant? I don't think our program is malignant at all. And plus, if one works hard, one will only get more efficient, faster, and more knowledgable even faster. I'm pretty happy with how things have shaped out for me here so far (although, I do admit that I did post like some cranky little turd last year )

 

[b&ierstiefel]

Hard work doesn't necessarily equal malignant! To learn pathology well, you need to see a lot of cases. That's just a fact. Sometimes that is going to entail working your a$$ off, but that doesn't mean the program is malignant - just busy. Yes at times you will be feel exhausted, overwhelmed, and frustrated, especially at first, but you can't expect residency to be entirely painless. If the residents watch out for each other and have fun together, and the attendings are humane, you can work hard while still enjoying a supportive and collegial atmosphere.

I totally agree. I remember interviewing at your program two years ago...I thought the folks there were cool as hell. I think one's fellow residents and the attendings around really make a huge impact on one's residency experience regardless of how hard you work.

I mean, hell, if you're surrounded by a bunch of inhumane folks who don't help each other out, only care about themselves, and don't know how to be collegial, residency is not gonna be pleasant.

Oh, and plus, beer is nutritious and satisfying.

 

[cytoborg]

I totally agree. I remember interviewing at your program two years ago...I thought the folks there were cool as hell. I think one's fellow residents and the attendings around really make a huge impact on one's residency experience regardless of how hard you work.

I mean, hell, if you're surrounded by a bunch of inhumane folks who don't help each other out, only care about themselves, and don't know how to be collegial, residency is not gonna be pleasant.

Oh, and plus, beer is nutritious and satisfying.

Yeah, we have a good group here - nice atmosphere. We work hard but in general people help each other out, keep the mood light, socialize outside of work.

 

[Mindy]

Andy's sentiments about Brighams mirrors mine about the General to a tee (or is it "T" in boston?) And I wholeheartedly agree with cytoborg as well.

What is "malignant" in your first year as a resident, is "thank [inset deity of choice]" by your last year.

Mindy

 

[kittykat]

Having come into Pathology as a second career I am amazed at how much people whine about doing their job. I saw another post where someone did not get PGY3 after failing step 3, of course everyone started throwing out the word malignant---totally disregarding the fact that your resident contract/manual states you have to complete step 3 by a certain time to progress. This along with the level of insubordination and disrespect is really appalling at times.

Our new generational theme in America is as follows: Fresh out of the crib I knew more than you; I refuse to work/think as hard as my forefathers; My leading role in life is to play the victim and if you pi** me off enough I will tell everyone that it was all your fault.

Lest, I digress...I will get off my soapbox now, sorry.

 

[deleted113029]

Let's be a little kind to each other. Some people just need a friendly reminder that they are adults and expected to act/perform as one in residency (and beyond). If that reminder includes the back of one's hand, then so be it.

To the OP: Also, as cheesy as this sounds, if one truly has chosen their proper residency, then one would look at work a lot differently. They might ENJOY it! Foreign concept to others, i know.

 

[kittykat]

Thanks Villin....I too deserve a spankin. I must remember to be nice and play well with others.

Hey, I'm in Path.....what others?? Oh yeah, they are in their little cubicle pumping their fists like UCSFbound's avatar (I love that thing).

 

[b&ierstiefel]

Let's be a little kind to each other. Some people just need a friendly reminder that they are adults and expected to act/perform as one in residency (and beyond). If that reminder includes the back of one's hand, then so be it.

To the OP: Also, as cheesy as this sounds, if one truly has chosen their proper residency, then one would look at work a lot differently. They might ENJOY it! Foreign concept to others, i know.

Villin, you got 15 interviews. Congrats. Are you seriously gonna interview at all of them? be prepared to drop a lot of cash.

 

[ermonty]

Nah, Villin is gonna be a good SDN pal and pass the UVA and Duke interviews to me 👍 🙂 Ya know I'm just thinking of your budget constraints Villin 😀

E-Mo

 

[1Path]

It's not suprising that no one came here to "bash" their programs (although I admit to being alittle suprised notign negative has been said) because to do so would probably be something close to career suicide with the world of pathology being so small. I thought "malignant" programs were those that had many combos of the following:

1)A PD from hell
2) Gives no/little previewing time for slides on a surg path rotation.
3) Doesn't listen to the concerns of its residents
4) Gives it's residents a lot of scut work
5) Doesn't have enough PA's around to do the "scut work'.
6) Makes you pay your way to travel to meetings
7) 100$ book allowance
8) No dedicated time off to prepare for boards
9) Residents work well over 80 hours/a week and not only on busy rotations (from what I OBSERVED, not heard about Hopkins).
10) Requires you do research/expects you to publish but doesn't provide time away from clinical duties to do it (I've seen this too).
11) Attendings that don't seem to care much for teaching

As a premed/path observer I could go on and on. But I guess if ALL programs are wonderful and provide great training without being jerks about it, maybe you guys wouldn't be in path! But having worked for almost 20 mainly in academia, I find that a bit hard to believe.😕

 

[sapience8x]

Also, not knowing too much about this stuff just what I am hearing from talking to residents and this site, i was going by what others were calling malignant and it seemed to be linked to unreasonable hours espeically without guidance and aslo unreasonable expectations. I don't know too many people who aren't hard workers who have made it this far.
also like 1 path said i am surprsied there hasn't been more specific program-based discussion thus far. you must think I'm 5-0 or something. 😀

 

[kittykat]

Yes, path does have its' problems, but you have to understand that while there may be some frustration some days, we still have it better than most. I can't speak for other residencies, but looking on while I was a med student....some fields' residents were a bunch of whiny brats with EGOs that were so ridiculous it was laughable. When people say "malignant" I don't think "Path"...I reflect on my med school moments in surgery, obgyn....areas where you were treated like pions, the language was extremely abrasive, everything was MICRO-MANAGED, your peers and residents were back-biting gunners and the attendings were clueless jerks. Stuff rolls downhill; working 80 hours in this type of environment is miserable to some (myself included) and appealing to others.

I can only speak for me, but I don't compare a small family-type work environment where most of your work is done off on your own (grossing-in, previewing at your scope) as Malignant. What attracted me and my peers to path in the first-place was the autonomy (lack of hand-holding)...we like being off on our own, researching problems, figuring stuff out, having access to books you could NEVER afford as a resident regardless of your book allowance, and great roundtable discussions. The case-load perception of the glass half-empty or half-full will be on a person to person basis depending on someone's personal desire to be exposed, their technique/ability to handle the workload...etc.

The problems you have with Path, don't seem to bother me. What does bother me is the influx of people expecting an easy-sailing, cush speciality that they only entered for its reported lifestyle and not because of a passion for the work. Bottom-line, its' a job with important ramifications; in the end I would take my 65 or so hours learning/working in a nice, friendly, intelligent environment anyday over the alternative. Book-allowances, PAs, teaching didactics vary from program to program with info stated on some of their websites or maybe you can search the prgram reviews at Scutwork.com.

 

[deleted113029]

Villin, you got 15 interviews. Congrats. Are you seriously gonna interview at all of them? be prepared to drop a lot of cash.

Thanks Andy! I can't wait to see the Brigham soon.

Interviews on the coasts were scheduled so that one trip would cover all schools, mainly Boston and SF.

I think when all is said and done I will be down ~3g's. Oh well, takes money to make money. (I am in the process of cancelling 4-6 programs over the next week so I don't have to prostitute myself for too long.😳 )

 

[cytoborg]

Gotta agree with kittykat.

I think there are 3 main reasons we still complain about path.

1. We tend to have a lower tolerance for misery, which is a good thing. Many of us chose path partly because we saw the brutality that abounds in other specialites, and wanted no part of it. So when the inevitable occasional misery of residency does occur, we are less apt to put up and shut up.

2. There's a widespread misconception among, well, pretty much everyone who isn't a path resident, that our residency is "easy," so reality can be jarring the first year. We have it better than most, but it's not always peaches and cream, and I don't think incoming first-years are always totally prepared for that reality.

3. Human beings in general just enjoy complaining. I know I do.

 

[b&ierstiefel]

Very true.

Of course, it does beat being on Q3 or Q4 call 🙂

 

[sapience8x]

What does bother me is the influx of people expecting an easy-sailing, cush speciality that they only entered for its reported lifestyle and not because of a passion for the work.

I have seen people post this theme quite a bit recently and am not sure why. do you all see residents with this attitude alot? And then it seems to me that there is the assumption that when asking about malignant programs, one wants to steer clear of them. i know a few people who would select these programs. i guess it's because the word malignant has a negative spin.
but what I'm getting from the responses now is that there are no malignant programs in path and that many people just like complaining especially since people choose this caareer thinking they are going to work from 10-2 but when they have to stay until 5 this is is a shocker and they complain. are you gusy getting a run on residents who feel like this?

anyway sorry to bring it up.

 

[beary]

I don't think our program is malignant at all. And plus, if one works hard, one will only get more efficient, faster, and more knowledgable even faster. I'm pretty happy with how things have shaped out for me here so far (although, I do admit that I did post like some cranky little turd last year )

Really interesting to hear you say that Andy, and I am glad that things are going better for you. I have felt "cranky" at times this year too - maybe PGY-1 is just a big adjustment.

 

[LADoc00]

Having come into Pathology as a second career I am amazed at how much people whine about doing their job. I saw another post where someone did not get PGY3 after failing step 3, of course everyone started throwing out the word malignant---totally disregarding the fact that your resident contract/manual states you have to complete step 3 by a certain time to progress. This along with the level of insubordination and disrespect is really appalling at times.

Our new generational theme in America is as follows: Fresh out of the crib I knew more than you; I refuse to work/think as hard as my forefathers; My leading role in life is to play the victim and if you pi** me off enough I will tell everyone that it was all your fault.

Lest, I digress...I will get off my soapbox now, sorry.

I have a totally different perspective on this and it has nothing to do with work ethic. It has to do with GREED. Greed is driving pathology, I fear, to a much larger extent than other areas of clinical medicine.

Greed drives pathology programs to employ more residents and less PAs to do scut in order to increase profit centers.

Greed drives pathology partners to turn over junior staff and deny equity share, time and time again and often to the blind eye of hospital adminstration.

Greed drives the ABP to increase the fail rate for certification to some of the highest levels of any ABMS field and at the same time raise the price for a fully automated platform to several times what the cost would dictate.

Greed drives academic pathologists to testify against and thus terrify into submission their local community pathologists.

Greed drives the state of California to invest into a multibillion dollar project with little to no public accountability to research "stem cells."

Greed keeps the number of med students high so HMO and Insurance payors can always have a constant supply of cheap labor.

Greed keep the faucet of foriegn medical grads wide open and the myth of physician shortage alive.

Someone once said 'Greed is Good' and it seems many took that to heart.

Its funny how some can convince the masses that concepts like "sacrifice" and "duty" are valid while they themselves steal with BOTH HANDS. Personally, Im done turning the other cheek.

...off soapbox.

 

[kittykat]

I agree...greed and also whiners who just wanted to fish/ski starting at 3.

So, what are you saying La Doc...when you stop turning the other cheek, are you going to jump on the greed bandwagon? I think a person can still be successfull without selling out. What are you proposing?

 

[LADoc00]

I agree...greed and also whiners who just wanted to fish/ski starting at 3.

So, what are you saying La Doc...when you stop turning the other cheek, are you going to jump on the greed bandwagon? I think a person can still be successfull without selling out. What are you proposing?

I have no less than 5 billable hours of legal advice PER WEEK for the better part of the last year. Healthcare is war, especially when large amounts of $$$ are at stake. Trust no one and find the best Consigliere you can. Develop relationships with hospital admin, clinicians even local attorneys, politicians and law enforcement. Get everything in writing. Keep a journal. Make mental notes of your associates who meet with the group's auditors, accountants and legal team. Ask for past hospital contracts to review. Get a list of every pathologist who has left the group and find out why. Ask as many questions as you can. Dont reveal any personal details, to anyone. Dont tell your employer if you bought a house, you have kids in school or even kids at all, or a potentially pregnant spouse. Be an enigma.

As the entitlement programs like Medicare become overwhelmed by the retirement of the baby boomers who have saved almost nothing, medicine will evolve into a complex legal and business battleground. Only the strong will survive.

Professor Clive Taylor spoke at my Osler review course. He said once the boards and your residency are over, the real trial will begin. He said we hadnt even arrived at the first battlefield yet. I nearly crapped myself that day.

 

[kittykat]

I know I will have my own issues with politicians and law enforcement a few years from now as an ME....but I have always feared practice management. After watching some of my friends in FM enter their practices so blindly you realize smart people make dumb decisions sometimes all because we don't consult with the right people. We invest so much in our medical education, but them try to shortchange the important things in real-life to protect it. It takes a little bit more than completing your management rotation to get the job done. Hopefully, the majority of us won't go bust before we figure that out.

Thanks for the insight.