most malignant em program?

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I was having a discussion with some colleagues regarding this topic. we came up with LAC/USC, highland, or cook county. anyone else have thoughts on this. we considered volume, amt of scut, paucity of backup, overall hrs, etc
 
Highland malignant? It's one of my top choices. When I rotated there it seemed very mellow. Busy, poor support staff, but it seemed like the residents didn't work more than they do elsewhere. The fourth year residents work 40 hours/week! I've heard maricopa, denver, and cook county are malignant - this is pure heresay though.
 
OK, HOW ABOUT ADDING THE CHARITY PROGRAM TO THE LIST. I HEAR ATTENDINGS ARE ESSENTIALLY ABSENT FROM THE DEPT MOST OF THE TIME(WE HAVE A CHARITY GRAD HERE)
 
I always thought a "malignant" program was one where lower level residents and medical students only spoke to attendings when they were spoken too and when attendings did speak to them it was only to let them know how stupid they were or how badly they had "screwed up". The institutionalized practice of persistent, malicious pimping also makes a program malignant in my book. But that is just my humble perception.
 
I was thinking more along the lines of most hrs worked, least supervision, most call...
 
Come on, fellas, there are some "famously malignant" programs out there. Sadly, most of them are in New York. Take Lincoln, for example. Its residents' burnout and bitterness have achieved world renown.

I'd rather not badmouth too many of the other NY programs, but most of them are also known for being malignant. Malignant, meaning: extraordinarily high patient volume, poor anicillary staff (Resident conversation commonly overheard: "Lemme just wheel you to x-ray, Miss Jones"; "Oh, Mr. Johnson, you've been sitting here for three hours without getting your Lasix? Let's see if we can get this IV started on you,"), little to no teaching during shifts, residents used as slave labor to keep the hospital out of the red.

I won't name the other programs in NY famous for being malignant, but rest assured, there are many.

Don't get me wrong: I love NY and it's a great place to train in terms of the pathology and volume. However, you can learn just as much and see as much pathology under more enjoyable conditions.




My dos pesos,

hornet871 😉
 
New York programs are truly the classic malignant places...I was warned to stay out of New York City and New Jersey. A newly malignant place has to be Denver, now that they've added the required surgical PGY1. If I wanted to be a surgeon.....
 
Originally posted by Desperado
A newly malignant place has to be Denver, now that they've added the required surgical PGY1. If I wanted to be a surgeon.....
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What exactly makes this a malignant program? I think you're being a bit short sighted if the 5 months of surgery & surgery subspecialties scares you off. The perspective, knowledge, and perhaps technical skills you might acquire will make you a better doctor overall and are 100% relevant to many of the ER patients you'll see over a career. The comments of their program director on their website really seemed thoughful & they clearly set that year up with long-term education goals in mind
 
Desperado, just a point about the Denver internship year...from their website, the rotations are an almost even division between medical and surgical subspecialties, like a transition year (Gen Surg, Neuro Surg, Plastics, Ped Surg, Uro, Ortho) plus Anesthesia, Ward Medicine (2 months), EM, MICU, and CCU. Yeah, it's a lot of surgery, but not a true prelim surg year. Anyways, back to the post, can anyone comment about Johns Hopkins? What is the true story behind this "malignant, residents-never-happy" residency?
 
It may be that the program director really believes all those surgery rotations are truly beneficial for an EP. Or, perhaps he is just painting the fact that the hospital is short on slave labor on its surgical rotations in the best possible light. You can interpret it as you will....(I will admit I have not rotated, nor interviewed there.) The comments on the Denver website are very helpful for anyone going into EM, and I also recommend they be read by all.

At any rate, yes, it isn't quite as bad as a true surgical internship, but you can compare as you like.

Denver EM: Anesthesia, CCU, EM, MICU, Medicinex2, Surgeryx6 (Ortho, neuro, general, uro, plastics, peds)

University of Michigan (PGY1-4 also) EM: EMx3, Medicine, Surgery (Trauma), Peds, Peds EM, Anesthesia, CCU, MICU, OB/GYN, Neuro

Typical Transitional year: Medicinex4, MICU, Surgeryx3, EM, Ambulatory, Electivesx2

Typical Surgery year: Surgeryx9(Generalx4, Vascularx2, Uro, Ortho, Neuro,) Anesthesia, SICU, Research

You decide for yourself which one the Denver PGY1 looks most like. But anyone can see it is quite different from the PGY1 offered at most 4 year EM programs, as illustrated here by the U of Michigan. To soften my previous statement, other than this unique choice of PGY1 rotations, I haven't heard anything else that would suggest to me that Denver is malignant.
 
I see your point re. the difference with Michigan, but look a little closer. If you have a pgy 2-4 program, why put someone in the ER for 3 months during their intern year? You've got 3 years training of that + a whole career of that waiting for you. It's the same thing I try to teach my students not going into surgery
..... "You've got 3 months (3rd + 4th year med school rotations) to learn everything you will know about surgery for the rest of your life. You won't have to learn how to do an operation, but you do need to learn what we do, how we think, & when you need to call one.......".

Two of those surgical rotations in the Denver schedule are likely not some of the more rigorous rotations, especially the GU rotation @ the VAMC, which having done it a few VA's, is mostly banker's hours with clinic-based low priority urologic problems (impotence, epidiimitis, testicle masses, hernias). The Plastics rotation is also likely not going to work you that hard, and focus on soft-tissue injury & techniques which you'll use. I like the OBGYN rotation that they have @ Michigan which would also seem very valuable to you, maybe they would consider adding that @ Denver at some point. That NES rotation is a great asset & will really serve you with the dozens+ closed head injuries you'll see. I learned so much from the one month I spent with them 5 years ago that helped me be a better doctor.

As to whether you're being pimped out for manpower issues(?).... I can think of no reason why an ED department would feel an obligation to help anyone else out in that respect. Rotations that residents complain bitterly about usually get dropped or reorganized. I'm sure of they (the current residents) felt like that, it would have been reexamined.

My (long-winded) point again is that you're only likely trading some lifestyle considerations on just a few months out of your training for what is very likely to end up making you a better doctor. Couple that with the July 2003 ACGME work hour rule restrictions, & some of those 100 hr+ weeks that will have been a memory. To boot, it sounds like you'd be eliminating a very fine program from consideration over it. Just something to think about. Best of luck!🙂
 
Am I the only person who still believes that a malignant program (e.g., one that works you hard) is one that will most likely train you the best? Yes, there is a point of being overworked, but I think some people take this to the extreme.

I would rather have 3-4 years of being worked nearly to death and pushing me to the limits so I can graduate a top notch physician/surgeon than one that pampers me with 60 hour workweeks without call. Yes, those 60 hour workers (or 80 hours, whatever) will be able to read more, but there's only so much you can learn from a book. I have a feeling that with all the desires to have better family lives, more free time, etc., that the extra hours earned won't be spent reading or studying.

Maybe I'm just a glutten for punishment. Maybe it's because I'm not formally tied down in a relationship (marriage). Maybe it's because I don't have kids. My number one priority is my education, and all other things can take an aside for a few years until I complete it. I've devoted a lot of time to get to where I am, and I would like to finish as an excellent physician instead of a mediocre one. If that means making sacrifices to get there, then sobeit. However, even with 100 hours/week on a rotation as a third year, I'm still finding time to read and have a social life.

So what's my point? Some of us avoid the malignant programs, whereas some of us seek them out. I want to be pushed hard and to the limit so that I can learn as much as possible.
 
Originally posted by Geek Medic
I want to be pushed hard and to the limit so that I can learn as much as possible.
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but I think the point is that 'malignant' does not necessarily relate to #hours (as they are supposedly now limited...) but to whether residents get to learn medicine, or whether they spend 90% of their time doing scut work, whether the attendings teach you, or ignore you, whether the program is set up as both a hospital and an educational experience, or just a health-billing people factory where both education and patient care have taken a back seat to cost cutting. I don't doubt anyone wants to end up as the best physician they can be. However, there are good ways and bad ways, easy ways and hard ways to do this. It will take work, but proper teaching, residency structure, mentoring, and reasonable support facilities all aid the learning experience. You will learn more spending 100 hours being a doctor with a knowledgeable and helpful attending within call than you will spending 100 hours doing scut with unapproachable or resentful faculty.
 
Agreed. There is more to malignancy than time. True, I did eliminate Denver from consideration early on, but not necessarily because of the PGY1 year. I eliminated it because of the PGY4 year. (I only applied to PGY1-3s.) There are plenty of great PGY1-3 programs out there, and if I decide I want another year of training, I'll do a fellowship. With regards to the point about why spend 3 months in the ED as a PGY1? It guess it depends on whether you believe emergency medicine is best learned in the ED, or on all the other services. Personally, I like working in the ED, that's why I've chosen EM. I'm not saying there isn't something of value for EPs to learn on other services, just that I personally believe 6 months of surgery as an intern is too much.

Responding to geek medic, I'd rather learn a ton for 12 hours a day, 6 days a week, than learn a little for 18 hours a day 7 days a week. There is more to learning than working hard. Starting IVs, chasing down radiology reports, and other scut has limited educational yield. I intend to work hard, but I'm looking for a good balance between time to read, time to be taught by attendings, and clinical time. More clinical time does not necessarily equal better education.

Congratulations on having a social life and being able to read while working 100 hours plus. That is actually very impressive, I know I don't do it very well. Let's see, if you add 7 hours a day for sleep and 2 hours a day to read that is a total of 163 hours a week (out of 168). How are those 5 hours of social life? Luckily you don't have to eat or shower. Or perhaps you have a unique ability to stay awake and read while averaging less than 7 hours sleep a day. I'm just giving you a hard time....but I submit either you don't really work 100 hours a week, you don't really read, you don't really sleep, or you don't really have much of a social life right now. (Or if you're like most of us, you read, sleep, eat, and socialize at work.) Nonetheless, if you really want a malignant residency, I suspect it won't be that hard to match into one.
 
Maybe I'm spoiled where I am because I rarely see residents doing scut. In fact, I have never seen a resident start an IV where I am (only central lines).

To Desperado, who said anything about getting 7 hours of sleep per night? I've only slept 4-5 hours per night since I was about 13 years old. Even in high school I remembered going to bed around 2 am and getting up at 6:30 to go to school. I guess it's a genetic thing since my father is the same way.
 
Bump- any recent news of changes in historically malignant programs? And I searched, but there aren't too many specific programs named, so feel free to throw in some names. I think it's a reasonable topic given interview season is coming up and this info is definitely word of mouth.
 
As a resident at the Denver program, I'll speak to it, since it's the only one I know well. I interviewed at about 15 programs around the country, and at each one I spent a few hours observing in the ER. There are many great programs, but I saw senior residents doing lots of direct 1-on-1 patient care, and I saw resuscitations that were completely chaotic and disorganized. But when I came to Denver I saw resus that was highly choreographed, calm, & organized. I saw the senior residents oversee the 47 bed ER, teach all the interns and medical students, supervise and manage all the resuscitations, all while being medical command for the Denver EMS phone. That matched what I was looking for - mastering EM and becoming a manager. My sense is that the hours are longer here than the average EM program, standards are very high, and it's kind of intense. If you're thinking about coming here, we're looking for people who are fun-loving, easy to get along with, like working hard, and find a challenge to be exciting & fun. Those of us who choose it feel the training is worth it, the people are phenomenal, and Denver is a great place to live. Even at my most fatigued, I've never questioned the quality of training I've gotten in residency. And as for the intern year, check our website - if you wanna do a 4 year program, I think our intern year is now just about ideal in terms of preparing someone for EM. Again, there are many great programs out there, this is just my perspective on my own. Would be happy to answer any other questions.
 
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I have the experience of being at a "malignant program" (Los Angeles) and a "non-malignant" one (Texas).

As with all experiences it is what you make of it. Malignant programs tend to reward those with hardy personalities, good work-ethic and motivation. Non-malignant ones are good for people who require hand-holding and more supervision.

Your experience may vary.
 
Hornet871 said:
Come on, fellas, there are some "famously malignant" programs out there. Sadly, most of them are in New York. Take Lincoln, for example. Its residents' burnout and bitterness have achieved world renown.

I'd rather not badmouth too many of the other NY programs, but most of them are also known for being malignant. Malignant, meaning: extraordinarily high patient volume, poor anicillary staff (Resident conversation commonly overheard: "Lemme just wheel you to x-ray, Miss Jones"; "Oh, Mr. Johnson, you've been sitting here for three hours without getting your Lasix? Let's see if we can get this IV started on you,"), little to no teaching during shifts, residents used as slave labor to keep the hospital out of the red.

I won't name the other programs in NY famous for being malignant, but rest assured, there are many.

Don't get me wrong: I love NY and it's a great place to train in terms of the pathology and volume. However, you can learn just as much and see as much pathology under more enjoyable conditions.




My dos pesos,

hornet871 😉
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👍

Truer words have never been spoken. ER residency in NYC is not for people that need hand holding. The ER's are way overcrowded, shortstaffed and high acuity. That being said, the residents that train here are fully prepared to work anywhere.
 
Hornet871 said:
Come on, fellas, there are some "famously malignant" programs out there. Sadly, most of them are in New York. Take Lincoln, for example. Its residents' burnout and bitterness have achieved world renown.
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+2

The EM programs in nyc are notoriously unappreciative with horrendous staff. Your co-workers and the patients are rude and dismissive - I hated my work environment and burntout after 6 months into my intern year. Although admittedly I had some other personal things going on I ended up leaving the program even though I loved living in NYC.

Be sure to do a rotation if you're interested in a certain program in NYC and make sure its for you.
 
AnonymousEye said:
+2

The EM programs in nyc are notoriously unappreciative with horrendous staff. Your co-workers and the patients are rude and dismissive - I hated my work environment and burntout after 6 months into my intern year. Although admittedly I had some other personal things going on I ended up leaving the program even though I loved living in NYC.

Be sure to do a rotation if you're interested in a certain program in NYC and make sure its for you.
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Thanks- NYC has a lot of EM residencies. Are they all malignant? Does anyone know which have reputations of NOT being malignant?
 
calespine said:
Thanks- NYC has a lot of EM residencies. Are they all malignant? Does anyone know which have reputations of NOT being malignant?
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Just go to them for interviews and see =p It shouldn't be hard to tell if they are or are not. And besides, the post you quote doesnt' say much about whether the program is malignant or not. Just says the guy was under stress and had interpersonal/cultural issues with the people there, not the program.
 
doctorFred said:
from my own narrow experiences.. the "happiest" residents come from st. lukes-roosevelt, beth israel, and north shore.
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St. Lukes-Roosevelt has been described to me as a fast track for drunks. I hear better things about St. Lukes. I think the residents rotate through both places though.

I don't know anyone who worked at beth israel in the ER, and I haven't been in NS ER in years.
 
NYRN said:
St. Lukes-Roosevelt has been described to me as a fast track for drunks. I hear better things about St. Lukes. I think the residents rotate through both places though.

I don't know anyone who worked at beth israel in the ER, and I haven't been in NS ER in years.
Click to expand...

Every place has drunks. I'd be surprised by the ER in this country that didn't get drunks
 
NYRN said:
St. Lukes-Roosevelt has been described to me as a fast track for drunks. I hear better things about St. Lukes. I think the residents rotate through both places though.

I don't know anyone who worked at beth israel in the ER, and I haven't been in NS ER in years.
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having worked in both places, i'd say there's just about the same number of drunks as any ER in a major urban center. roosevelt's facilities are infinitely larger and nicer than lukes, but only lukes is a trauma 1. like roosevelt, i'd imagine that many ERs that aren't level 1 centers feel more like "a fast track for drunks" just because the lack of major trauma decreases the variety.
 
calespine said:
Thanks- NYC has a lot of EM residencies. Are they all malignant? Does anyone know which have reputations of NOT being malignant?
Click to expand...

I don't think they are all malignant. I am very happy with my program. I interviewed at some places where I heard a lot of complaints about the ancillary staff from the residents. I'd suggest interviewing at programs in the area and asking the residents about it. I wouldn't just write off the whole of NYC as malignant.
 
Cerberus said:
I don't think they are all malignant. I am very happy with my program. I interviewed at some places where I heard a lot of complaints about the ancillary staff from the residents. I'd suggest interviewing at programs in the area and asking the residents about it. I wouldn't just write off the whole of NYC as malignant.
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This is the key. It's not that all NYC EM (this actually applies to most other specialties as well) programs are malignant in and of themselves (although some certainly are). It's just that the ancillary/nursing services in NYC tend to be complete crap which makes the resident's job a million times harder but no more educational. There are exceptions to this however (as a general rule, programs located at HHC hospitals are much worse than most others) so you need to ask this kind of question during interviews.
 
gutonc said:
This is the key. It's not that all NYC EM (this actually applies to most other specialties as well) programs are malignant in and of themselves (although some certainly are). It's just that the ancillary/nursing services in NYC tend to be complete crap which makes the resident's job a million times harder but no more educational. There are exceptions to this however (as a general rule, programs located at HHC hospitals are much worse than most others) so you need to ask this kind of question during interviews.
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i did residency in a NYC program. got to admit, i did my share of transporting and placing IVs. the nurses where i work now as an attending (different state) seem to NOT run into the same problems placing IVs. nursing and ancillary staff is a few tiers above from what i was use to. i'm not sure why this is, i'm sure it's multifactorial. go figure. anyway, i feel that the added stress of running around doing other peoples job prepared me very well now that people do their jobs and i do mine.
 
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Painter1 said:
i did residency in a NYC program. got to admit, i did my share of transporting and placing IVs. the nurses where i work now as an attending (different state) seem to NOT run into the same problems placing IVs. nursing and ancillary staff is a few tiers above from what i was use to. i'm not sure why this is, i'm sure it's multifactorial. go figure. anyway, i feel that the added stress of running around doing other peoples job prepared me very well now that people do their jobs and i do mine.
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I do hear that there are some NYC hospitals where the nurses are lazy and don't do anything. The residents at my hospital don't realize how good they have it until they do a rotation away.

Anyone that has trained in NYC knows that the ER's here are overcrowded and high acuity. EM is tough here, but so is nursing. The former residents who now work out of state laugh when the nurses they work with now complain about having 6 patients. I would have around 8 patients on a good day and I have had as many as 22 patients myself. Keep in mind that these patients are a good mix of ICU/tele/medicine admits in addition to the endless stream of ER patients. I am only one person and I have a S-load of patients, I cannot do everything you want done for every patient RIGHT now.

A better part of my day is doing things for admitted patients that are no longer the responsibility of the EM team. I don't know of any other state where people are boarding in the ER for days waiting for a bed, which puts a burden on everyone in the ER. It's not the residents job to push patients to x-ray or to place an IV, but its not going to kill you either if you do it once in a while. IMO, no EM resident should be able to graduate if they don't know how to establish PIV access.

That being said, although our residents work hard, they have a great support system from the faculty and an awesome PD. The patient population is malignant, but the residency program isn't. The residents seem very happy here, and the former residents all say that this chaos along with the good support, really prepared them for anything they face in the future.

You have to do what's best for you. If you want to do your residency in a small community ER, it will be easier, but if you decide later that you want a job in a busy urban facility, it will make the adjustment difficult. Our new attendings who came from programs like that were bombarded and took a long time to adjust because they were not used to it. Several cried during the first week. The residents who trained here in the chaos and now work at quieter places are enjoying their careers in what they see as a relaxed environment.

Good luck to all those who are applying :luck:
 
doctorFred said:
having worked in both places, i'd say there's just about the same number of drunks as any ER in a major urban center. roosevelt's facilities are infinitely larger and nicer than lukes, but only lukes is a trauma 1. like roosevelt, i'd imagine that many ERs that aren't level 1 centers feel more like "a fast track for drunks" just because the lack of major trauma decreases the variety.
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I haven't been over to that ER is a long time, but I know 4 nurses who worked for roosevelt, two of which worked for st. lukes. Two of our former attendings worked at both places.

The nurses that have worked at various places across NYC felt that compared to other places, Roosevelt's acuity was not very high. The nurse that worked there more recently than the rest felt that there were more nights than not that the place was filled with drunks and not much else going on.

The nurses and attendings I know who worked at St. Lukes had nothing but good things to say about it. They felt the nurses and MD's worked well together, and although it was busy, it was a good experience.
 
I have to reply to this because otherwise it's unfair to the nurses and staff at Maimonides. We've all heard about the complaints in regards NY's or anyother urabn ER's nursing staff in general, but the Maimo ones are amazing. All the labs are drawn before you ask them, and they will also put in foleys, draw ABGs even without you asking them to. Being busy really is not an excuse, because Maimo ER redefines "busy" with probably the highest patient per square foot, and one of the shortest wait times for patients. It is considered "backed-up" when patients wait more than 1 hr on the board to be seen and Maimo barely sees any fast-track-ish/drunks/drug seeks/sickle cell patients. They are mostly sick, high acuity, and even the ones that're not sick have ligitimate concerns. Residents just concnetrate on seeing patients and don't deal with the typical ER scut like getting blood, wheeling patients, filling out forms/dnrs, paging pmds, finding transportation/placement/shelter, getting patients food/blankets/whatever, because there are people hired to do all that.

After having trained this way, I can't imagine what a pain and waste of precious training time (while being underpaid) it is to do all that scutwork while having to deal with fast-tracky patients. I would recommend people going into EM to shun away from programs that glorify scutwork and scut patients, like those county programs that are typically regarded as "hardcore" and sees "underserved" patients, no matter how big of a name the program might have. Because when you are starting your own iv or wheeling a drunk by yourself for the 50th time, you might start to hate yourself and maybe even start to believe that's how EM training should be.
 
nycqqe said:
After having trained this way, I can't imagine what a pain and waste of precious training time (while being underpaid) it is to do all that scutwork while having to deal with fast-tracky patients. I would recommend people going into EM to shun away from programs that glorify scutwork and scut patients, like those county programs that are typically regarded as "hardcore" and sees "underserved" patients, no matter how big of a name the program might have. Because when you are starting your own iv or wheeling a drunk by yourself for the 50th time, you might start to hate yourself and maybe even start to believe that's how EM training should be.
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However, you should be well versed in dealing with drunks and trolls during residency. Most EM attendings will see these patients in their shops, and being able to deal with them without losing your soul or your job is a learned skill.
 
I'm going to chime in here since NYC programs aren't very well represented on SDN (not sure why) so I'm sure there is a bit of a bias.

In my mind, "malignant" is more associated with a program where residents are belittled, pimped, made to feel as if they are worthless, and abused by their senior residents to do the scut, not because it is busy, but because their seniors or attendings are lazy. I don't think any of the county hospitals mentioned in NY or in other parts of the country (USC, Cook) fit that bill.

However, if you consider "malignant" as being used to describe EM programs where teaching and learning is accomplished by the "swim or drown" method as opposed to the handholding method, then yes I think that county hospitals would fit that bill. It depends on how you learn and what kind of environment you will thrive in.

At Jacobi, an HHC hospital where I am at in the Bronx, most nurses will make attempts to do the scut that you are not supposed to be doing (IV's, meds, discharges, etc). However, they are overworked and underpaid as well and they do things that are not in their job description since there is a lack of ancillary staff for things like transport or even bringing patients blankets and water. Everyone chips in to some extent because the hospital is understaffed, not because people want to make the intern suffer.

As for learning -- yes, PGY1-2 hours are rough and attending supervision can be scant at times. It's good and bad. I am not well read on the latest and greatest papers and evidence based trials. I can't quote studies or Rosens because attendings don't usually sit down with us and go over these things. I admit these things are lacking at a busy county hospital. However, people are experienced and competent here because of the volume we see. 2nd years here are comfortable enough with their central lines to walk the interns through them. PGY4's are making all attending level decisions. You realize that the skill of being able to juggle 50 patients in one ER while keeping track of all of their studies and dispo statuses is a skill that can only be learned by experience and that experience can be difficult to find. Graduates say they leave this program and feel prepared for anything.

I will echo what others have said in that it will really depend on what is right for your learning style and at the very least, one away rotation at one of these so-called "malignant" hospitals may be enlightening.
 
Also coming from an NYC residency, I completely agree with the above poster. I'm not sure what you're taking to be a malignant program. Just because all the NYC programs and doctors have to deal with the above (occasionally overwhelemed facilities, understaffing, lots of drunks, etc.) doesn't make them malignant. A malignant program to me would be where co-residents deliberately try to undercut each other in order to serve their own purposes, where nursing staff deliberately do things to undermine a resident, or where attendings themselves try to belittle or undermine residents.

Where in any ER program in the US would you find this? Through my observations, surgery programs are what I see to be as malignant, not ER. And this is me coming from a very heavily resident-run ER.

I have had my issues with a couple nursing staff who are terrible, but it wasn't difficult. I spoke up, gave my reasons why xyz nurse should not be practicing, and therefore said nurse was not asked to come back to my institution to work. It's not nursing staff in general in NYC, it's particular individuals.

If you come to any NYC residency, you should be prepared to work damn hard. Not that you wouldn't work hard anywhere else, but working here definitely toughens you, makes you more resourceful. As a matter of fact, that is expressly why I chose to do residency in NYC. They say that when you come out of an NYC program, you can work anywhere else in the world without difficulty and can handle anything thrown at you (literally and figuratively). I believe it.

Oh, I'm also at an HHC facility although one that is smaller than either Jacobi or Bellevue. HHC facilities will see more of the "underserved" population. I'll leave it at that. Good for training in "the real world."
 
Thanks a lot for the heads up guys. I definitely don't mind working my butt off, but I do want to feel supported by my fellow residents and attendings. I'm a big fan of the see one, do one, teach one learning method. I don't want my hand to be held all the time, but I don't prefer to learn everything myself for the first time.
 
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