Mayo reputation

[baleine]

Hello, I just discovered this forum and, having just finished my interviews for IM residency, wondered if I could ask a question that I haven't been able to get an unbiased answer on at my med school. I interviewed at some really good programs on both coasts, but I really liked Mayo clinic in MN when I visited. When I tell some people at my school that, they tell me I would be closing doors for myself in terms of fellowship that maybe I could leave open by going to some elite coastal program (you name it). They say that the fellowships at Mayo are great but that the residency isn't well reputed (I think in part because they always have some foreign medical grads, which I thought would be an asset to the program but also apparently makes some people think less of them). I know that everybody has to choose for himself what would be the right "fit" in terms of residency and reputation should be low on my list of priorities, but I would like to feel like I'm going somewhere that's going to help me in whatever I decide to do (don't yet know). Also I'm kind of addicted to the great conferences and morning reports at places I've done rotations and am wondering if anybody who has spent >1 day at Mayo can comment on the intellectual rigor of day-to-day interactions. Thanks, all!

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[twizzlers]

Just wanted to add that I would love an answer to your question as well. I'm having a similar problem - except in my case it's not Mayo vs super-elite programs, but Mayo vs local S. California programs that I'm very familiar with. My dilemma is whether Mayo's rep/fellowship matches is on par with top programs to make it worth leaving Southern California...

 

[MidwestMD]

I think it honestly depends on what programs you're comparing Mayo to from the east coast ("you name it" is quite broad). If you're talking about MGH, BWH, or Hopkins, then those programs WOULD probably offer better fellowship placement and job opportunities down the road (not to mention the hotly debated/contested "prestige" factor), but there are few programs that offer what these "top tier programs" do anyways.

It also depends on what you want to do w/ your life (which also seems vague). Will going to Mayo close doors for you in an academic career...probably not. It's still Mayo! It's not like you're picking a local community hospital over MGH. Will you suffer a little insecurity and always ask yourself the "what if I would have gone to XXX?" question? Probably so based on your post Were there certain things that are pushing you away from those "elite east coast programs" or did you just fall in love w/ Mayo? If you really liked Mayo, then I say go for it! You just have to trust your gut instinct sometimes.

I personally liked Mayo quite a bit (I interviewed yrs ago) and struggled with the same things as you are. It has a great overall environment, strong fellowship placement, and a name that impresses lay people... but their selection criteria is less stringent (which essentially equals less prestigious in a lot of people's minds) than other programs. The fact is, you'll get great training from a well-respected program. Do I meet Mayo grads after they complete their training and think less of them for having gone to Mayo? No! So don't worry about it and go where you think you'll be happy. Good luck!

 

[docrocmayo]

Hello, I just discovered this forum and, having just finished my interviews for IM residency, wondered if I could ask a question that I haven't been able to get an unbiased answer on at my med school. I interviewed at some really good programs on both coasts, but I really liked Mayo clinic in MN when I visited. When I tell some people at my school that, they tell me I would be closing doors for myself in terms of fellowship that maybe I could leave open by going to some elite coastal program (you name it). They say that the fellowships at Mayo are great but that the residency isn't well reputed (I think in part because they always have some foreign medical grads, which I thought would be an asset to the program but also apparently makes some people think less of them). I know that everybody has to choose for himself what would be the right "fit" in terms of residency and reputation should be low on my list of priorities, but I would like to feel like I'm going somewhere that's going to help me in whatever I decide to do (don't yet know). Also I'm kind of addicted to the great conferences and morning reports at places I've done rotations and am wondering if anybody who has spent >1 day at Mayo can comment on the intellectual rigor of day-to-day interactions. Thanks, all!

fyi- it would be interesting for you to compare Mayo's GI and cardiology matches with "top 10" programs other than the "big four"- say UWash, Wash U or Penn for that. I have about 20 people applying from my class in to cardiology this year and we all are keeping our fingers crossed..

We do take foreign grads ( but not US IMGs). To reiterate what has been mentioned before on this forum, our IMGs are probably the best candidates from their countries in the match and among some of our best residents. And the diversity that international grads bring, definitely adds to the experience of residency training at Mayo. We are definitely less IMGphobic than some other places that claim all's well on paper.

 

[baleine]

Please forgive my ignorance, but what is the difference between US IMG and foreign grads?

I agree that it would be interesting to look at where each Mayo resident goes the year after graduation, but unfortunately they only provided the applicants with a list of all the places that at least one person has gone in the past 6 years or something. This isn't as useful as the more complete list of each grad (1 person matching to cardiology at some top program out of 6 years is very different from 4 people matching there in one year . . .)

Anyway, docrocmayo, is your point that you think that I would find the fellowship list at Mayo to be similar in caliber to WashU, Penn, etc? Or are you also asking the question?

 

[twizzlers]

This isn't as useful as the more complete list of each grad

I agree. Haven't had my interview yet, but I'm guessing they give out this same list they have online:
http://www.mayo.edu/msgme/documents/fellowships.pdf

I was looking at heme/onc, and many of the names listed are amazing: Memorial Sloan-Kettering, MD Anderson, Hopkins, Stanford, UW, etc But a list showing how many people actually go to those places each year would be more helpful. Only one person matching to Sloan-Kettering or Stanford over 7 years is different than 1-2 people matching there every other year. But you can't differentiate from this list.

 

[Linus2007]

I've been thinking about this too but I really think that if you like the program then go for it. As for the FMGs Mayo since it's inception has a policy of collecting physicians from around the world. The FMGs I met on the interview trail were really excellent in terms of knowledge. Plus one thing I haven't liked in a few programs especially UMich is that everyone is witihn the same area or even med school, different backgrounds really help diverse your experience. The fellowship match at Mayo is strong, UW sends a lot of residents to it's own program (The northwest area and UW are very difficult to leave). I think one thing that was impressive to Mayo was the amount of research they do. Haven't been to Wash U yet but I remember there being only 50% or so of UW residents doing research. It seems to be a trade off, in programs you work hard in (ie q4 call busy like UW, Ohio State) you don't have as much time to work on research as opposed to other programs where the call is easier ie q6 like Mayo.

 

[Linus2007]

I agree. Haven't had my interview yet, but I'm guessing they give out this same list they have online:
http://www.mayo.edu/msgme/documents/fellowships.pdf

I was looking at heme/onc, and many of the names listed are amazing: Memorial Sloan-Kettering, MD Anderson, Hopkins, Stanford, UW, etc But a list showing how many people actually go to those places each year would be more helpful. Only one person matching to Sloan-Kettering or Stanford over 7 years is different than 1-2 people matching there every other year. But you can't differentiate from this list.

Yeah I hate it when programs give a fellowship match for the last 5 years or so. For example the UVa website shows fellowship matches to various places like Duke, JHU etc but when you look at the individual years those seem to have occured 5 years ago with more recent matches leaning heavily towards UVa

 

[ab100]

In my experience, mayo FMGs, whether US or foreign, are highly experienced and amazingly able individuals. Most have been attendings in their respective countries, some for many years. Their hands-on experience is incredible and I have nothing but respect and reverence. Aside from the practice of medicine, it really is extremely valuable to have opinions on medical practice that are different from US-biased, especially given that this country's medical system is in shambles and less than 15% of patients are actually satisfied with the medical care they are receiving.

When I was applying, "the FMG question" was always thrown around, and I would be lying if I said that it did not initially make a difference to me, but I am glad that I chose to come here.

The positives for this program are - it is far from malignant, work-hours are best compared to every other place i interviewed, experiences are broad and unique. I think that Mayo is able to keep the patient load per resident smaller and still get an appropriate amount of experience squeezed in because of the efficiency - we never have problem getting advanced imaging, subspecialty consultation, etc. Patients don't tend to stay long.
The negatives are - while there is certainly bread-and-butter medicine in St. Mary's, it is still a tertiarry/quarternary care center, so lots of specialized questions you might not deal with later. If you are trying to go back to a small place and be a jack of all trades, it is tough to accomplish that kind of training here. Residents match well to fellowships (as people above mention, certain Boston, NYC and Baltimore programs probably do better), and if you want Cards, GI, Heme/onc (top three), you will have a good shot matching here. Those fellowships are best in the country. Sorry about the rant, hope this helps

 

[docrocmayo]

Please forgive my ignorance, but what is the difference between US IMG and foreign grads?

I agree that it would be interesting to look at where each Mayo resident goes the year after graduation, but unfortunately they only provided the applicants with a list of all the places that at least one person has gone in the past 6 years or something. This isn't as useful as the more complete list of each grad (1 person matching to cardiology at some top program out of 6 years is very different from 4 people matching there in one year . . .)

Anyway, docrocmayo, is your point that you think that I would find the fellowship list at Mayo to be similar in caliber to WashU, Penn, etc? Or are you also asking the question?

Sorry for the late reply..

A US IMG is some one who is an american citizen, but went to medical school outside US- say Carribean etc. A foreign IMG is some one who is a US alien and went to medical school outside United States, generally in his/her home country.

You are correct about Mayo's fellowship match list not being very helpful.
When I was interviewing I did look at Wash U and Penn's cards and GI match lists. What I meant was that those programs are really not very different from Mayo in terms of fellowship placements. I'd probably place them in the same tier as Mayo for fellowship placements.

I think this year we had everyone who applied in cardiology match at some program , except one person ( mentoring troubles). Interestingly 8/8 fellowship positions at Mayo in cards were filled by Mayo residents. I am not sure if this is good or bad.
I know one person matched at Kentucky, Beaumont, Vanderbilt each. I dont know about where the other two matched. Our GI match tends to be more varied.

FYI- reputationwise when I was ranking programs my adviser did warn me that coming from a "top 20 " school I was harming my chances in academics by ranking Mayo; however other faculty members in my medical school also told me that Mayo's residency program had changed a lot over the last fifteen years. According to them, it used to be more like a community program in early 1990s. However with acquisiton of Kolars as program director, Mayo did achieve the academic rigor needed for a top tier program. The program also became more hands-on than it was.

 

[lemonade02]

same tier as 'top' programs? give me a break

2001-2007 GI: mayo, brown, good samaritan, indiana, loyola, SLU, stanford, ucsd, iowa, kansas, u mass, umdnj, mich, minnesota, texas-houston

that's not exactly 'top' level matching into GI. only 'top' places on that list are mayo, stanford, ucsd, and michigan..with probably like 1 person going to the latter 3 in 7 years

 

[Linus2007]

same tier as 'top' programs? give me a break

2001-2007 GI: mayo, brown, good samaritan, indiana, loyola, SLU, stanford, ucsd, iowa, kansas, u mass, umdnj, mich, minnesota, texas-houston

that's not exactly 'top' level matching into GI. only 'top' places on that list are mayo, stanford, ucsd, and michigan..with probably like 1 person going to the latter 3 in 7 years

Good point but I got the impression that the reason for that was people moving back to their 'home' states.

 

[lucky77]

same tier as 'top' programs? give me a break

2001-2007 GI: mayo, brown, good samaritan, indiana, loyola, SLU, stanford, ucsd, iowa, kansas, u mass, umdnj, mich, minnesota, texas-houston

that's not exactly 'top' level matching into GI. only 'top' places on that list are mayo, stanford, ucsd, and michigan..with probably like 1 person going to the latter 3 in 7 years

I would not make the assumption that everyone wants to train at the "top tier programs".

Let's not forget that your perspective may change after you actually start your residency and complete your intern year. Most people will start off playing that infamous "top 20" list in the minds when they start thinking about fellowships. After an intern year, most reasonable people start to sway towards fellowship programs that afford a good education and lifestyle. Nobody wants to repeat their internship, and quite honestly, some of the more competitive fellowships at the "top 20" programs will give you 3 years of internship hours during fellowships. Personally, I'd rather not deal with the service aspect and get an education. Let's face it, compensation for academic medicine positions are not anything to write home about, hence the mass exodus to private practice, especially in procedurally oriented fields like GI and cards. If you want a decent academic spot in GI or Cards, land a university based fellowship, be productive in research, and the rest is history. "Top 20" translates into ? in the real-world. You'll get your academic or private practice position either way, once you get your foot in the door

 

[docrocmayo]

same tier as 'top' programs? give me a break

2001-2007 GI: mayo, brown, good samaritan, indiana, loyola, SLU, stanford, ucsd, iowa, kansas, u mass, umdnj, mich, minnesota, texas-houston

that's not exactly 'top' level matching into GI. only 'top' places on that list are mayo, stanford, ucsd, and michigan..with probably like 1 person going to the latter 3 in 7 years

If you look at my post, I actually said that our GI matches tend to be more vaied. just looked up Penn's this year match list- just 2 people matched in to GI. We had 10 match in to GI this year. They may not be going to stellar places. But they are atleast all going to do GI.
Look at Penn's CV match list and it would be interesting to compare it to Mayo Rochester's. I AM NOT TRYING TO IMPLY THAT WE R SUPERIOR TO PENN IN ANY WAY.
Please bring up any questions and concerns you may have.

 

[lemonade02]

and i'm just saying that mayo having fellowship matches similar to 'tier 1' programs is false and misleading. it is what it is. in GI/cardiology, the matching into 'top' programs is not at the level of 'tier 1' programs. taking your own for cardiology means very little as to how strong that residency is considered nationally. outside of mayo, where do the residents match into GI/cardiology? where do the non-chiefs go? it is what it is. i'm sure training at mayo is outanding and a previlege, but the matching is not even close to 'top' programs, sorry.

and i fully agree training at a 'top' fellowship is overrated.

 

[DaBigDawg]

I'd say training at a "top" fellowship program is actually VERY important... how you define top is up to you. There are people at MGH, Brigham, UCLA that are leaders in the subspeciality I am interested in and I would love to work with them. Benefitting from the reputation of these places is just the added bonus. I have also applied to several programs that aren't usually considered "top 5" cards programs becuase there are people at those institutions that I would love to work with.

Where you do your fellowship will play a huge role (much more than where you did your residency or medical school) on what kind (and location) of practice you eventually go into (academic vs private). As your move up the training ladder, things become less regimented and individual experiences and opportunities play a larger role in your education. Everyone learns the same things in undergrad organic chemistry, most medical schools are very similar, residencies start separating the private vs academic groups, and fellowships really define your eventual practice.

All this being said, I really liked Mayo when I interviewed there for residency. They have a great cardiology fellowship match -- not to mention their own cardiology program -- you'll have an inside track at matching at one of the top cardiology fellowship programs in the country.

A few other comments: Penn only matched two people in GI last year becasue only two people applied. Many more applying this year. The Penn GI match is usually VERY impressive -- probably stronger than our cards matches most years -- plus the GI department at Penn is one of the best in the country.

 

[tibor75]

Props to the person who brought up the point that "not everybody" wants to match into a "top" program.

If a top program is important, it's only important for academics. Private practice - nobody cares. In fact, most people who end up going to the top programs, STILL go into private practice.

Add in the fact that most top academic oriented programs are 4 years, if you know you going into private practice, find a 3 year program - why waste a year being a research bitch?

and the person who told you Mayo's IM program isn't well known, is probably some east-coast elitist. FMGs? In my class of 40, there were 3.

The nice thing about Mayo is that you get some really smart people from small medical schools - North Dakota, Oklahoma. these people are smart and know how to work hard. And they don't have an attitude.

I'd take the top student from University of North Dakota over #30 from harvard any day.

 

[MonoLoco]

Lemondade,

You seem to be so defensive about Mayo not being one of the best. What gives. Did u not get an interview there or something?

 

[lemonade02]

no i did not get an interview there and i did want one previously, before i looked at their match list and talked to some people

i have no reason to be defensive. the facts speak for themselves. simply look at where the non-chiefs match outside of mayo and you'll see its not that as good as 'top tier' programs. i'm not defensive about mayo. i'm defensive when someone makes a misleading comment on a public forum.

you'll get world class training at mayo i'm sure. but its ridiculous to say their fellowships are at the same level as true 'top tier' programs like penn. that's all i'm trying to say. which is def. a moot point b/c, i agree, you don't need 'top' training to have a satisfying career in private practice. hence my repetitive use of quotation marks around 'top' because its all in the eye of th beholder. but facts are facts.....

 

[twizzlers]

But is it so misleading to call Mayo a top-tier program? Top-tier can mean a top 20 program, which is how I interpret that expression unless otherwise specified.

Looking through SDN's always controversial IM ranking threads, people always list nearly the same top 20/25 programs (just different orders) - and these include Mayo.

 

[muscles]

I am beginning to think that many "elite" coastal programs - east or west coast- are threatened by Mayo Clinic. I have done a great deal of investigating as to why so many people have a seemingly visceral dislike for Mayo clinic; my conclusion is that programs who refer to themselves as "elite", or "top tier" are threatened by a program like Mayo. Why is that? It's not in the Ivy League; they do a great deal of research; the research they do is very good; they are ranked highly in almost every specialty; they have accrued an enormous amount of money and wealth. The list goes on...

I am fairly new to this forum and for a long time could not understand why so many people here are against Mayo clinic. I have discovered that many people who don't like it have also never been there or investigated its qualities. If you compared the statistics of Mayo clinic with that of an Ivy league school and were blinded as to which program was which, I think you would find in the end that Mayo is in no way inferior to any of them.

Just my 0.02, as they like to say

 

[0382938]

I am beginning to think that many "elite" coastal programs - east or west coast- are threatened by Mayo Clinic. I have done a great deal of investigating as to why so many people have a seemingly visceral dislike for Mayo clinic; my conclusion is that programs who refer to themselves as "elite", or "top tier" are threatened by a program like Mayo. Why is that? It's not in the Ivy League; they do a great deal of research; the research they do is very good; they are ranked highly in almost every specialty; they have accrued an enormous amount of money and wealth. The list goes on...

I am fairly new to this forum and for a long time could not understand why so many people here are against Mayo clinic. I have discovered that many people who don't like it have also never been there or investigated its qualities. If you compared the statistics of Mayo clinic with that of an Ivy league school and were blinded as to which program was which, I think you would find in the end that Mayo is in no way inferior to any of them.

Just my 0.02, as they like to say

Preface: I loved Mayo when I visited and plan to rank it very highly.

When you refer to "statistics," what are you talking about? I agree that the hospital itself is possibly second to none nationally, but the residency program fellowship match is not all that impressive.

With regard to your other comment, if I recall, one of the most outspoken critics of the program on this forum was a resident there . . . my impression is that s/he is an exception, as most people there seemed incredibly happy, but there is definitely some dissension from within.

 

[tibor75]

agreed muscles.

Anybody who suggests that Mayo grads have tough time getting great fellowships is just ignorant

 

[Linus2007]

Totally agree, Mayo did great on interview day and I really liked the program and the residents.

 

[Adcadet]

Also I'm kind of addicted to the great conferences and morning reports at places I've done rotations and am wondering if anybody who has spent >1 day at Mayo can comment on the intellectual rigor of day-to-day interactions. Thanks, all!

Generally superb, IMO. There's my $0.02.

 

[Luwi25]

Was I reading this thread correctly? Arguement as to if IM training would be good and sufficient for fellowship placement at the Famous Mayo Clinic, ranked 2nd best hospital in the nation? When I interviewed last year I did so at some referred "elite" programs like Hopkins and UCLA and also at Mayo. When I would tell people I have an interview at The Mayo Clinic many had the notion that it was a "snooty", "stringent" facility of doctors wearing suits and treating only a high SES class of white, non-diverse patients. So they asked me WHY I was ranking Mayo number 1 on my rank. These people had never been to Mayo, never learned about the history of the hospital and don't comprehend what it's like being a part of the Mayo family. When I interviewed there I fell in love. They provide a plethora of research experience, value education and teaching and are so supportive of their residents. It's not an accident that it was ranked one of Fortune 500's Best companies in America to Work For! And although you are exposed to bread and butter medicine, you get the opportunity to see some amazingly rare cases from patients that travel from around the world to be treated here. It's a program that is enriching and poorly understood by much of the medical society that has never visited or been a part of Mayo. Having been at UCLA and also rotating at some "elite" programs, I have to say that Mayo is worlds apart from these institutions. Mayo provides the same enriching education and opportunity WITHOUT the malignancy that other "elite" programs feel is a right of passage for a resident. Malignancy does not equal good training PERIOD. AND THIS is why I'm an intern at Mayo right now, have time to even be on SDN my intern year and ranked it number one on my list!

So my advice, as you enter the interview season, don't judge any program simply based on "rumors" or "elite rankings".

 

[JHopRevisit]

...treating only a high SES class of white, non-diverse patients....

I'm a medical student that stumbled on this thread, but I have heard that knock about the Mayo program. As someone who might be interested in applying there, and knowing how many nonsense rumors are floating around about everu school, I just wanted to ask, is that a fair characterization? Rochester isn't exactly a Metropolitan hub, so I'm assuming many patients fly in/drive in, correct? I would think that would skew it towards upper-middle/upper class. So what type of patient population do you get training at Mayo? And how much do they cater to foreign VIPs looking for specialty treatment?

It's not an accident that it was ranked one of Fortune 500's Best companies in America to Work For! And although you are exposed to bread and butter medicine, you get the opportunity to see some amazingly rare cases from patients that travel from around the world to be treated here. It's a program that is enriching and poorly understood by much of the medical society that has never visited or been a part of Mayo.

No offense, but this is pretty funny. It sounds like an infomercial. I'm sure Mayo is great and anyone suggesting Mayo would be a bad place to train is just being ridiculous, but every place has a few knocks on it.

 

[BlackNDecker]

Rochester isn't exactly a Metropolitan hub, so I'm assuming many patients fly in/drive in, correct? I would think that would skew it towards upper-middle/upper class. So what type of patient population do you get training at Mayo? And how much do they cater to foreign VIPs looking for specialty treatment?

Speaking of diversity at Mayo, on my first day of primary clinic I had a patient from Somalia, Denmark, and one each from Iowa and MN. They ran the full spectrum of the SES ladder.

On our inpatient service,(in addition to bread and butter local cases) we have a patient from [Arab speaking country] and one from [Latin American country]. The ethnic diversity here is incredible, slightly more so than the socioeconmic diversity...Having said that, we get a resonable # of IV drug users, chronic alcoholics, DKA'ers, etc. Mayo definitely caters to an elite clientel as well. There are certainly foreign dignitaries/world leaders here regularly but you will not be involved in their health care (until you become a consultant).

People come from all over the world to be treated at the world famous Mayo Clinic. A decent number of these individuals stay to live here. Many don't realize, but Rochester is consistently in the top 10 places to live in the US (throughout the 90s it owned the number 1 spot).

Its impossible to judge the hospital/residency based on forum rumors. If you have the opportunity to interview here then you certainly have many options to choose regarding residency...Rochester is not for everyone, and Mayo certainly has its peculiarities. I agree with the previous poster who commented that Mayo gets many of the top students from lesser know medical schools...

The nice thing about Mayo is that you get some really smart people from small medical schools - North Dakota, Oklahoma. these people are smart and know how to work hard. And they don't have an attitude.

I couldn't have said it better myself...I'm continually amazed by my intern class.

my 0.07 cents...

 

[jdh71]

Many don't realize, but Rochester is consistently in the top 10 places to live in the US (throughout the 90s it owned the number 1 spot)

Yeah . . . get back to me in February . . .

But Rochester is a really cool town, I liked it there a lot.

 

[BlackNDecker]

You got me there...

 

[JHopRevisit]

Speaking of diversity at Mayo, on my first day of primary clinic I had a patient from Somalia, Denmark, and one each from Iowa and MN. They ran the full spectrum of the SES ladder.

Really? That's pretty cool. I find it odd, however, that a lower income person would drive or get transferred to Mayo, which is hours away from where they live, not to mention the non-Americans you mentioned. How exactly does that work? I doubt a Somalian doctor is able to call his buddy in Rochester and get him into clinic or scheduled for a surgery, not to mention the enormous cost of flying around the world (unless, of course, said Somalian is pretty damn wealthy). Heck, even driving from Iowa to Rochester is pretty expensive these days. Seems like a great program overall, but I'm curious how Mayo draws its patient population since so many other major academic medical centers (both the coastal and non-coastal programs) are near large population centers.

 

[Luwi25]

JHOP I agree with you. Every program has it's flaws and since I'm new here I'm sure I'll discover them in time. And I don't have a logistical answer as to how we get a diverse patient population. In the patients I've seen it has included previous trained physicians traveling from as far as TX and CA. I also saw a Cambodian refugee with Babeosis, a farmer from the state and another farmer from central america who happened to be visiting her daughter. I mean the diversity is there. I came from UCLA where we had an incredibly diverse population consistent with Los Angeles county. BUT I never saw as much a diversity of the "world population" as I have so far vs. diversity of just a cosmopolitan large city in US at UCLA.

 

[piptaz]

It happens that the largest concentrated population of Somalians in the world outside of Somalia is in SE MN - once there was a critical mass of people here from Somalia for whatever set of historically contingent and individually idiosyncratic reasons it became a cultural center of gravity with a natural pull for family members and Somali nationals considering emmigration to chose the area. In many cases they were/are political refugees getting away from long term sectarian violence under the warlords there which I guess is why they didn't choose Baltimore since the level of violence there is a little too much like what they are getting away from. Rochester - precisely because it is not a large city has a relatively low cost of living which makes widely availible low cost or charitible short term housing a real possiblity for many rural and small town middle and lower class people (and families) seeking/needing health care. At Mayo we see and take care of a lot of these people and in a lot of ways their care is partly subsidized by the big philanthropic contributions and income we receive from patients who are much better off and better insured. It is important to never forget that urban poor is not a synonym for poor and underserved as such and given that many of the self-described great hospitals in the U.S. operate out of large metropoli there is all to often a self-serving self-aggrandizing sentiment and gesture on their part of claiming that large city hospitals are the vanguard in the social justice in medicine movement by providing care to the urban underserved but their track record with serving the rural or small town poor is terrible - often consigned to a specialty rotation/satillite facility and not part of the ongoing core function of the major flagship institution itself. There is a de facto and seldom mentioned forgetfulness and neglect of the health care needs of the rural or small town underclass which is not defensible as consistent with the mandates of social justice. Mayo and Hopkins see different otherwise underserved populations as well as each serving as tertiary or even quatenary medical centers for much larger catchment areas and its a good thing they both exist.

 

[JHopRevisit]

...which I guess is why they didn't choose Baltimore since the level of violence there is a little too much like what they are getting away from.
...there is all to often a self-serving self-aggrandizing sentiment and gesture on their part of claiming that large city hospitals are the vanguard in the social justice in medicine movement by providing care to the urban underserved but their track record with serving the rural or small town poor is terrible.

No need to get defensive (if you are getting defensive, obviously its tough to infer tone from the web, but that's the sense I got, especially that comment about Baltimore which is a little snippy, I think). I lived in St. Paul, I know Rochester is a great place, but the logistics of getting an undeserved population to Rochester were confusing to me. Obviously Mayo does have a lot of large private donations and I'm glad they use it to get people up there. I'm not saying a place like Hopkins or WashU is full of saints (certainly not, we do a better job than people expect but definitely not enough), just that's it easier for them to serve the underserved because the patients are right there. The whole reason I asked about Mayo is because I might want to go there someday, and I wanted to ask about the rumor that they only serve wealthy patients.

 

[piptaz]

Sorry about snippiness - really - just a little post-call logorrhea. I meant my last sentence which is that I'm glad both places - and many other med centers besides - exist and function at as high a level as they do and for the people that serve. In many ways each place IS its own niche - it has some more or less ill-defined (and more or less ill) geographic region and populace it serves and that populace includes wealthy and poor in some mixture - I grew up on a farm in Indiana and am very aware how limiting medical options can be for rural underclass and middle class folk - I really liked UW (I know its in Seattle but it serves a geograhic area that includes Wyoming, Montana Idaho, Alaska which would otherwise simply lack such a first rate me center) Dartmouth, and Mayo ****(this is not an exclusive list - in fact I would say high quality rural/small town service is more of a continuum along which we can distribute front-line med centers - so is care to otherwise underserved urban populations - which Mayo quite simply doesn't do nearly as well/as much as metropolitan centers - which leads me to say there is a diversity of diversitys served by differently situated hospitals but class disparities/differences are seen at Mayo as well as JH and such but they take a different form in that we have small town/rural vs inner city poor)*** which serve a section of american citizens that are not always front and center in discussions of health care equity (they are not alone in such neglect!) even when those discussions are rightly indignent of existing disparities. There is and I think can be no one paradigm of hospital that adequately serves "the poor" because the need and desires of "the poor" are not some one thing for "the poor" are not some one unified or homogenous group - JH and Mayo do it differently and taken together they do it better than if either one were to be the sole governing paradigm.

 

[BlackNDecker]

The above response seemed like a nonsensical rant due to the lack of paragraph separation, however, I didn't get the sense Piptaz was being defensive/snippy.

I'm curious how Mayo draws its patient population since so many other major academic medical centers (both the coastal and non-coastal programs) are near large population centers.

You'd be surprised by the # of people that travel to be treated at the Mayo Clinic. Seriously.

The whole reason I asked about Mayo is because I might want to go there someday, and I wanted to ask about the rumor that they only serve wealthy patients.

If it's a concern...address it on interview day or do a sub-i. I had similar concerns after reading the posts here, but in the end Mayo had the right balance of everything I was looking for. Again, Mayo is a very unique program/place and it's impossible to judge by reading the posts on SDN.

It's interesting how much controversy Mayo generates here...the reason, I believe, is that people have a hard time reconciling the fact that Mayo graduates don't place in Ivy league fellowships. To me this is a nonissue, but apparently for others it's a deal-breaker.

 

[JHopRevisit]

... however, I didn't get the sense Piptaz was being defensive/snippy.

Comparing Baltimore to a Somalian war zone is perhaps not the best tone. However, I totally understand that we can all come off as a bit defensive on a web forum, and he/she assured me no offense was intended, so I'm sure that nothing bad was meant by it. Not to mention, he/she's apparently an MD-PhD, and we all have to stick together to get ourselves out of the perpetual schooling mess we're in.

It's interesting how much controversy Mayo generates here...the reason, I believe, is that people have a hard time reconciling the fact that Mayo graduates don't place in Ivy league fellowships. To me this is a nonissue, but apparently for others it's a deal-breaker.

I'm new here, but I don't think its too much of a controversy. Few people would argue that it's not a great institution. I have only experienced one type of academic medical center, and as piptaz mentioned there's a lot of ways to do things, so I was curious about Mayo's approach and one of the knocks I keep hearing about.

If it's a concern...address it on interview day or do a sub-i. I had similar concerns after reading the posts here, but in the end Mayo had the right balance of everything I was looking for. Again, Mayo is a very unique program/place and it's impossible to judge by reading the posts on SDN.

As you know, it's impractical, and often not advantageous, to do a sub-I everywhere you're interested. As silly as the pre-allo board is, their posts helped me with med school, and I think it can gather some opinions for residency apps too. Having some opinions on hand, even anonymous message board ones, will help me be prepared to really evaluate the place if I'm lucky enough to interview. I want to know what questions to ask, and what to look for.

 

[Adcadet]

Not only is it important to have diversity in the patients you serve, but I think the institutional culture about how to care for our less fortunate brothers and sisters is also really important. "Quantity" is important, but so is "quality." Allow me to explain.

This past week I was on a very specialized consulting service, and one that draws people from around the region and world. One day I went from seeing a very rich patient from another country who I'm sure could afford to fly on a private jet to Mayo on a weekly basis for his appointments, to somebody who had to get his church to raise money for his basic medical care. The later guy, because of his deteriorating condition, needed a very expensive procedure ($150-200,000) that he and his church could clearly could not afford. After a brief discussion with the powers that be, he was offered the procedure as a charity case. And what was they key factor in making that decision? Something we call "physician support." And who were the high and mighty administrators who made the decision - physicians. I realize that non-physician administrators have a role in health care systems, but I love working at a place that is really physician-run (all staff physicians are required to serve on a certain number of committees) and who's mantra is "the needs of the patient come first." And of unless you noticed the one patient was wearing a Rolex while the poor guy's clothes all seemed to be on their last thread, you would never know who was paying a "full price" and who was "on the house."

 

[Adcadet]

Really? That's pretty cool. I find it odd, however, that a lower income person would drive or get transferred to Mayo, which is hours away from where they live, not to mention the non-Americans you mentioned. How exactly does that work?

Well, for one, Mayo is the closest large academic medical center for many people. Our geographic draw is rather large - we're the closest tertiary care medical center for most of southern MN, western WI, northern Iowa, and most of South Dakota. And believe it or not, many emergency cases fly right over the Twin Cities or bypass the University of Iowa in Iowa City. When I was in the CCU we had a guy who had a recent STEMI, in cardiogenic shock, on two pressors, with an intra-aortic baloon pump, intubated on a ventilator who was flown from Wyoming to Rochester. I forget what part he was in exactly, but San Francisco and Seattle would have been just slightly farther. I've also seen similar from Montana, and it's common to see people from North Dakota and even Illinois. Emergency cases get transfered and treated first, and we figure out the economic part later.

Of course, for some very specialized things, Mayo may be one of the few places in the US who has what the patient needs.

 

[BlackNDecker]

Comparing Baltimore to a Somalian war zone is perhaps not the best tone.

I dunno, Baltimore is pretty tough...the biggest difference probably being that you'll get shot with a Glock rather than an AK47.

I'm new here, but I don't think its too much of a controversy.

Ahh, but Mayo is quite controversial here. If you notice, it's the only institution being discussed (aside from brief mention of JHop in this thread). Note also the prior thread on Mayo's Cardiology match

As you know, it's impractical, and often not advantageous, to do a sub-I everywhere you're interested.

As I mentioned previously, the alternative is interviewing...obviously you will have much less insight with this approach. But I think you will see on the interview trail, the right program will become obvious.

 

[Danbo1957]

Mayo Clinic and Johns Hopkins, two of the most noted medical facilities; Rochester and Baltimore, two more differing places couldn't be. And, sadly, Baltimore is as close to a real warzone as one can find in the US...

 

[JHopRevisit]

And, sadly, Baltimore is as close to a real warzone as one can find in the US...

I dunno, Baltimore is pretty tough...the biggest difference probably being that you'll get shot with a Glock rather than an AK47.

Sure, especially considering that Detroit, Flint, Birmingham, and a few others have higher murder rates, and cities like St. Louis, Orlando and Memphis have higher violent crime rates. Hell, even Minneapolis is one spot below Baltimore as far as violent crime rate (My stats come from the Bureau of Justice for the latest year available, 2006). The Wire was a great show, but it was not a documentary.

Baltimore's murder rate has a lot to do with its drug trade. Most Baltimore residents, despite what you may hear or assume, are not involved in the drug trade, nor do they frequently use drugs. Occasionally a citizen will get caught in the cross-fire, largely due to poverty and inability to move to better neighborhoods (which, believe it or not, do exist in Baltimore). However, a majority of Baltimore citizens do not live in fear of assault every day of their lives.

I'm not enraged or anything, but it is slightly offensive to me when people make such statements. It's both an insult to the people of Baltimore and to anyone who has actually been in a war zone. I was in Croatia in the early/mid nineties, and at least in my view, Baltimore is not close to a war zone.

Ahh, but Mayo is quite controversial here.

And you're telling me Mayo's controversial.

But let's just leave it at that. We agree Mayo's a great school, and for now I'll take your word that it has a surprisingly diverse patient population for its location (which I'll check out if I get to interview).

 

[radslooking]

Baltimore a war zone? cummon....

 

[cleansocks]

We do take foreign grads ( but not US IMGs).

In my experience, mayo FMGs, whether US or foreign, are highly experienced and amazingly able individuals.

So... does mayo take US IMG's or not? What about a dual citizen who went to their home country instead of the US?

 

[Luwi25]

Baltimore a war zone? cummon....

oh...I need to agree about Baltimore being as close to a war zone as we have in the US. I interviewed at Hopkins and one of the primary reasons for ranking it lower was a result of location = Baltimore. Not really the burbs which are nice but downtown...it's well

Otherwise I thought Hopkins was an amazing program with much to offer. But my take on it was that it definitely seemed more "malignant" than Mayo.

 

[jdh71]

This whole "reputation" stuff is really kind of silly. I don't know if this is a pre-occupation with SDNers or people who go into medicine in general . . . or maybe just a pre-occupation with those who are more elitist with regards to their thinking about these things.

The thing I've always liked about Mayo is that they do their own thing - THEY - ARE - MAYO. And you may argue that, "blah, blah, blah, are not the very top this or blah, blah, blah are not the very top that . . ." Whatever It doesn't matter they are STILL Mayo. Is any of this sinking in?

So if you want to know if they are gangster? Oh yeah! Mayo's gangster, for sure. Now quit worrying about it.

 

[Luwi25]

LOL! I do agree with you...Mayo doesn't care about the traditional among other institutions. They stick to the "Mayo way" and do things in their own distinct way. And this has never failed them, only heightened their reputation and distinction in the worldwide medical community.

And I think it is a habit for those in medical training to obsess over reputation and rankings etc because the reality of the matter is that training at a reputable, higher ranked program allows for more open doors, whether that be for fellowship training, research and academic positions and just overall opportunities and options. Our ultimate goal is to be adequate professionals in our field and I don't think you have to go to some highly ranked and recognized program to simply be a competent physician. But it is this notion of more opportunty, more open doors and of course "recognition" that tempts us to obsess over such aesthetic elements such as rankings.

And I won't argue that you get amazing training at these highly ranked programs like Hopkins and Mayo (part of the reason I was drawn to them) but of course you'll get equally good training at programs ranked in the 30s or even 50s. Do people even KNOW what these rankings are based on? I'd put money on it that most don't.

 

[dadr]

There are a number of reasons why Mayo is so "controversial." One, as pointed out above, is that they do not adhere to the paradigm of the classical East Coast metropolitan academic medical center. Mayo just wasn't created that way. Another is its location; on a superficial level many dyed-in-the-wool East/West Coast types simply don't subscribe to the notion that a world class medical center could exist in flyover country. On a deeper level, there are geographic concerns about patient population and its effect on training exposure.

I think this concern is exaggerated. Patient population (in terms of SES, international, crime, urban, etc.) is more important in fields like EM and trauma surgery, and less so in medicine save for certain areas like HIV and maybe STEMI volumes in cards. There is plenty of variability in SES, natural history of disease, immigration (as mentioned large refugee populations from E Africa/SE Asia and also influx of farm workers from Mexico) and even trauma in the rural-exurban setting of Rochester, MN.

Finally, I just have to say that every time I look at Mayo I think of it this way: for an institution to rise from nowhere, in the middle of nowhere, to attain and maintain status of one of the top medical institutions in the world for many decades, they must be doing something very, very exceptional. They don't have the advantage of being in the middle of a large East Coast city with proximity to other large population and transportation centers, so Mayo's reputation and distinction is all the more striking.

 

[docrocmayo]

Here are my thoughts..

1. We do get to see few underserved people here; but that is mostly in the ER , sometimes in the continuity clinic and rarely in the hospital.
2. a big chunk of our patient population in medicine consists of medicare patients from mid west- they are not really wealthy; they are not super poor either.
3. People often drive great distances to get here- the main reason why they keep coming back is not because we provide "superior" care when compared to academic university hospitals; its because they feel they are "cared for" in a better way. I have had patients tell me that residents at some other big programs in mid west were not as courteous to them as residents at Mayo. But then those residents are far more overworked than we are..
Our interns now preround on 4 to 6 patients on most rotations.
4. Academic reputation is something that has a lot to do with research rigor, federal funding and perception in inner academic circles. Unfortunately Mayo does not manage to make the cut there. But things show signs of changing. Having said that I do think that we are a top 10 or 15 program or whatever that means.
6. The bit on Mayo's reputation is quite interesting. I cannot imagine Saint Marys hospital in a big inner city location- there is no way our hallways could sparkle the way they do now if our patient traffic were to increase. Our iv techs would go crazy trying to draw blood from addicts without any peripheral veins! I think being in the middle of nowhere helped Mayo clinic establish its reputation as there was not much competition. Media reports in 1940s-1960s also helped ( search on TIME archives). Mayo Clinic was projected as the place where people whose conditions were regarded as incurable would go to, get cured and actually were treated for free. The only competition was from the University of Minnesota. The U being a state school was more wired in research to begin with.