Match post-mortem: IM future: BIDMC review?

[vkrn]

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[merlin17]

No offense, but if you want information about a program from people who are in the know (i.e. residents at the program or HMS students) I would stay away from comments like "BIDMC is the orphan stepsister" and "BIDMC suffers from a variety of ills." Anyone who has told you those things clearly hasn't ever made it across Longwood Avenue to check out the hospital.

 

[Adcadet]

Have you tried the search feature? Try "BID" and "Adcadet".

 

[Adcadet]

Glad you found the info on BID in our little forum - only 30,000 posts, making it #4 in the internship and residency section.

 

[lurkerboy]

If you have any specific issues or questions, please post them, I'd be happy to help clear anything up. Welcome to BIDMC, you will not regret matching here.

BIDMC resident

 

[vkrn]

Acadet, love your post on BID (and yes, you're right--IM does have a robust forum).

Lurker, these are the questions I have. These have all been mentioned previously, BUT to hear from a resident who's there would be awesome.

(1) Private patients: On average, over a year, what percentage private patients will I have as an intern? I must have zoned during the interview day, because I had no idea that this was an issue until reading the threads. Are the private attendings responsive or lame? My experience with private patients has been frustrating on the whole.

(2) The PD: More than one mention of her being prickly, and I know someone who knows her SOCIALLY who says she's prickly (he really does not like her--he is a physician also). I was at the bagel table with her at one point and because I was nervous, I didn't say anything to her---she didn't reach out to me, either. How does this affect residents' abilities to have her on their side when it comes time to fellowships and research connections?

(3) What's the relationship between BIDMC and Dana Farber; BIDMC and Joslin?

(4) Do prelim interns get to rotate abroad? I'm assuming not.

(5) People say BIDMC is chock full of white geriatric patients--true?

(6) I'm assuming there's no firm system like over at MGH--No one mentioned it during my interview...

(7) What was your biggest positive realization during your time there? What was your biggest disappointment you didn't know about?

Thanks.....

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Lurkerboy, I just searched your previous posts, but would also welcome any updated thoughts.

 

[lurkerboy]

Lurker, these are the questions I have. These have all been mentioned previously, BUT to hear from a resident who's there would be awesome.

All good questions.

(1) Private patients: On average, over a year, what percentage private patients will I have as an intern? I must have zoned during the interview day, because I had no idea that this was an issue until reading the threads. Are the private attendings responsive or lame? My experience with private patients has been frustrating on the whole.

If you mean patients admitted to private attendings, then I'd say 10-15% or 1-2 patients.

I am going to copy some of this from a post I made earlier...

The majority of patients (whether they have PCP's or not) are cared for by hospitalists. Many of these "private attendings" with admitting privileges are actually attendings at Healthcare Associates (the BIDMC IM practice.) You see these same attendings every day at conferences, or they are your preceptors in clinic. A few others are cardiologists at BIDMC or internists in the neighborhood. I am trying to count them in my head, but I would guess there are only about 15-20 attendings with privs that are not stationed somewhere inside of the hospital. Compare this to about 10 or so HMED hospitalists and 5-6 APG hospitalists.

In all cases, you will get to know these attendings as well as the hospitalists. These non-hospitalist attendings do not micromanage their patients, so you have a great deal of autonomy in managing their patients.

This is radically different than the the "private patients" I took care of as a medical student at NYU or the ones you'e had at Yale where the intern might be having to page the attending to check if we could give a tylenol.


Looking at a few ward team censuses right now [nb: the breakdown is similar today ]:

Tullis A
has 8 patients, has 6 with one hospitalist, and two patients with one of the HCA attendings.

Tullis B (two interns)
has 7 patients, all of whom are taken care of by two different hospitalists ("HMED" and "APG")


Kurland A
has 8 patients. There are 6 with the HMED hospitalists, 1 with a private internist, 1 with the geriatrics team.

(2) The PD: More than one mention of her being prickly, and I know someone who knows her SOCIALLY who says she's prickly (he really does not like her--he is a physician also). I was at the bagel table with her at one point and because I was nervous, I didn't say anything to her---she didn't reach out to me, either. How does this affect residents' abilities to have her on their side when it comes time to fellowships and research connections?

Eileen, our program director, is great. Prickly might be too strong of a word. She is definitely warm and on a first name basis with everyone in the program. She just hosted all of the house staff over at her house for a catered party. It was a lot of fun. She is on the residents' side when applying for fellowships or jobs, and so is our Chair, Dr. Zeidel. I definitely felt that "they've got our back" before the fellowship match.

You can also see their commitment to building a better program. Our match list was phenomenal this year.

(3) What's the relationship between BIDMC and Dana Farber; BIDMC and Joslin?

BIDMC residents and interns rotate through Dana Farber with the BWH residents and interns. BIDMC also has its own oncology/bmt rotations, as well. BIDMC residents can do research at DFCI (or anywhere else in Boston).

Joslin and BIDMC have an even closer relationship. Besides having residents/interns rotate there for electives, the attendings (renal, endo, optho, etc..) and fellows see consults at BIDMC.

(4) Do prelim interns get to rotate abroad? I'm assuming not.

No

(5) People say BIDMC is chock full of white geriatric patients--true?

Yes, there is a fair share of the elderly. The patient population is the same as it is a BWH. There is also a large medicaid ("MassHealth" and "Freecare") patient population.

Not all of your time is spent on the vanilla medical wards. There is a liver and kidney transplant service, a lot of cardiology, and a lot of onc. Then there is also the West Rox VA. All in all, you won't feel like you are working up failure to thrive all of the time.

(6) I'm assuming there's no firm system like over at MGH--No one mentioned it during my interview...

There are "firms" but I don't think that its like MGH.

(7) What was your biggest positive realization during your time there? What was your biggest disappointment you didn't know about?

My biggest positive realization was the whole "private patient" makeup you were asking about. At my med school, there were three hospitals, a VA, Bellevue (city hospital), Tisch (private hospital). At the private hospital, private patients were a pain. Here, as I mention above, even if they are private, they are not such a pain, because they get the same care and have the same attending as everyone else.

The other surprise I had was the census. Its a big hospital but the interns generally have 4-6 patients, and there aren't big swings.

The disappointment I had is already moot. It was related to the east campus which is now a non-teaching service.

 

[vkrn]

Thanks so much--just curious, what innovations are the PD and Chair implementing or sketching out under that EIP effort?

Any big ones? I know I'm only there for a year, but am thinking of tacking on an additional residency, so this is food for future applications...

Is there a lot of flow in terms of residents becoming fellows between BID, BWH, and MGH?

I realize there's some justifiable limitations on residents going abroad, but was wondering about the BID researchers: Are they heavy into international efforts, like at BWH and UCSF?

Read your past post about BIDMC as well as others--thanks for that cardiology link!

 

[lurkerboy]

Thanks so much--just curious, what innovations are the PD and Chair implementing or sketching out under that EIP effort?

I know the whole "geographic admitting" scheme was the big innovation, because this is the first step towards ward-based quality improvements. For example, they want to track things like the (I am making this up) average fsbg for beds 1-15 is higher than for beds 16-30 and instituting measures for the nursing-resident teams to improve upon that.

Is there a lot of flow in terms of residents becoming fellows between BID, BWH, and MGH?

Yes. Especially in fellowships like pulmonary where the fellows rotate to all three hospitals.

I realize there's some justifiable limitations on residents going abroad, but was wondering about the BID researchers: Are they heavy into international efforts, like at BWH and UCSF?

i am not sure, i know jars and sars that have rotated internationally, its just the interns who stay state-side due to time constraints. cardiology is my things, the patients generally come here 😉

 

[vkrn]

Awesome info....

Another question: PLEASE don't be offended, okay? Just askin', because I've run into it often---

WHY do applicants/residents continue to yak about BIDMC being No. 3 compared to BWH and MGH? It's an attitude I keep running into all over the board.

Possibly due to stereotypes with no legs. But it had to start somewhere, with some factoid.

Bad past chair? Something of that sort?

 

[lurkerboy]

I am not going to argue with it being #3. Partners (MGH and Brigham) is a giant and wealth begets wealth. Sure, #3 in Boston is not as good as being #1, but put BIDMC in any other city, and people would look at it differently.

I think MGH was always "#1" but brigham overtook Beth Israel in the 80's - early 90's. Then BI had financial problems in the late '90's when they merged with the Deaconess, but now they are doing well.

You might want to ask a pulm fellow about what they think of the 3 hospitals, because they rotate through them. The ones I asked though BIDMC was very underrated.

Just because its #3 doesn't mean everyone walks around with a chip on their shoulder. I feel like the only time it comes up is during interview season.

Another interesting resource you might find interesting is the blog our hospital's president has been keeping:
http://runningahospital.blogspot.com

its very enlightening and he embodies a lot of the things I like about this place.

Awesome info....

Another question: PLEASE don't be offended, okay? Just askin', because I've run into it often---

WHY do applicants/residents continue to yak about BIDMC being No. 3 compared to BWH and MGH? It's an attitude I keep running into all over the board.

Possibly due to stereotypes with no legs. But it had to start somewhere, with some factoid.

Bad past chair? Something of that sort?