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I wrote this review at the end of my intern year but never got around to posting it then. Now almost halfway into my PGY-2 year and everything still holds true.
Current PGY-1 wrapping up my intern year and reflecting upon my experiences with this website. I found it really helpful when there was updated information about the programs I was interested in on SDN so I wanted to pay it forward.
The overall Too Long Don’t Read (TLDR): Our residency offers a top tier critical care experience. As evidence of this, I had already completed over 50% of my required ACGME procedures (central lines, intubations, lumbar punctures, ortho reductions, paracenteses, etc) halfway through my intern year and I have not even begun the core critical care portion of my training (PGY-2 year). If you want to train somewhere where you will come out unphased by any and everything you see as an attending (I would argue even by the end of your intern year), Mount Sinai is the program for you. Understand that this comes at the cost of training in an environment much more chaotic / stressful than your “average” EM program. I still remember my first shifts at Mount Sinai and Elmhurst thinking “what did I get myself into?” comparing my experience to the more “lax” environment of the other top 25 EM programs I rotated at as a medical student. Your “average” day will be, in comparison, insane compared to most of your colleagues in other EM programs. You will get used to this and thank yourself later for training in this environment.
Overall strengths of our program: If you are a fan of critical care, I don’t know if there is a better place in NYC (or arguably the nation) where you could train. This is definitely where we shine most... Scott Weingart (EMCrit Project) trained at Sinai and produced most of his podcasts while working at our county site (Elmhurst). Some other big names are Reuben Strayer (emupdates) and David Cherkas who are both current attendings at Elmhurst. Three of our current PGY-4 residents matched at 3 of the top critical care fellowships in the nation (University of Pittsburgh, University of Michigan, and Columbia University).
Just to give you context of the other impressive achievements our graduates have, one of our PGY-4’s will be Assistant Medical Director and another will be an Associate Program Director at Mount Sinai Hospital next year. Last year one of our PGY-4’s became a Clerkship Director for his first job at LSU-New Orleans… It’s pretty common for our graduates to have their pick of whatever job or position they want upon graduation. This has a lot to do with our current Chair Dr. Jagoda who created the program back in the 90s and has a ton of connections / power in the EM world. If Dr. Jagoda wants something done, he has the power to make it happen and will advocate for you to open any door you desire.
Our program is also extremely well balanced in giving you a split between academic (Mount Sinai Hospital), county (Elmhurst Hospital), and community (Mount Sinai Beth Israel) emergency medicine. I personally love that we rotate at such drastically different sites because it keeps things exciting and different. Read below for more information about each site.
Overall weaknesses about our program: While I certainly wouldn’t call this a weakness, in comparison to other aspects of our program trauma is not our greatest strength. That being said, we get our fair share of pretty great trauma cases (to give you context I saw about 7 stabbing / shooting cases in a month there and those were just when I was on shift; thoracotomies happen at a relatively decent rate – probably 1 per month on average). In my opinion, NYC is not the right place to train if you’re looking for an elite/crazy trauma experience. If you really want a knife/gun club in NY, King’s County (SUNY-Downstate) or Jacobi/Montefiore are probably better options.
Ancillary staffing is another issue that is not unique to Sinai but is an overall NYC problem. Our nurses can carry 15+ patients in the ED (boarding patients spend an average of 12-16 hours, sometimes days, in the ED before a bed becomes available upstairs and our nurses have to take care of them). This being said, you will have to do your fair share of ancillary tasks to make up for this (placing IVs, pushing patients to CT/XR, pulling IVs on discharge, etc). From what I hear about other NYC programs we don’t have it too bad but you have to accept this will be a part of training here.
Mount Sinai Hospital (MSH)
Pros: My overall experience at Mount Sinai has been incredibly positive. I love the pathology we see at the main Mount Sinai Hospital most but could see how it’s not for everyone. People come to MSH from all over the world for their specialty care and we are the first to encounter them in the ED. That being said there’s a huge culture of consulting specialty services here. I would say about ~50% of patients require some sort of consultation because they are super specialized and plugged in to the system (i.e. – a patient with Crohn’s Disease will have a flare, you consult the IBD fellow for recs which are usually c diff culture, esr/crp, abdominal xr, stool studies, likely admit to the IBD floor. Yes, you read that right there is an actual IBD floor at Mount Sinai - that is how specialized the care is). A huge plus is that the consultants are generally really pleasant to interact with and they expect to be consulted so there is rarely any animosity about having to see patients. I’ve had some great experiences interacting with the consultants and have learned a ton from them. Admitting patients is a pretty easy process as well – we put an order in and write a handoff note explaining why the patient is being admitted. There is a MAPA (Medical Admitting Physician Assistant) who occasionally calls you to clarify where you think the patient should go (teaching service vs NP service for example) but we rarely ever get pushback on admissions.
Cons: The negative aspect of MSH is the space we work in which is actively being worked on right now. We have a very small space for the volume we see which can be incredibly overwhelming on busy days. We are actively renovating the ED to address this which will effectively double the square footage we work in. From my knowledge, it sounds like the renovation project is estimated be done in 2022. Like any NYC emergency room most patients are not on monitors, do not have their own rooms, and are on gurneys in the hallway. You will have to play tetris with the beds often to get to a patient you’re looking for. Again, I don’t think this is unique to MSH but an NYC thing. I think the scary thing about this is those patients who are subtly sick and in a hallway stretcher. Because the patients at MSH are so specialized they are prone to decompensate on the sides if you’re not on top of them. Patients who are boarding in the ED are cared for by the upstairs teams, thus we often sign these patients out to the next ED team to make sure someone knows about them in case they decompensate in the 24+ hours they remain in our ED.
Elmhurst Hospital Center (EHC)
Pros: Elmhurst is where most of our residents prefer to rotate at. The patients here are incredibly diverse (the zip code where EHC is has the most languages, 100+, spoken in the nation) and they are extremely thankful for the care we deliver for them. This is our county site and where most of our off service rotations are (the reason for this is that there is less competition at EHC for procedures and we get more autonomy on these rotations compared to MSH). We see incredibly diverse pathology here because of the patient population (mainly uninsured, poor health literacy, have not seen a physician in years). It is not uncommon to have a Bengali patient in their 20s with chest pain have a full fledged STEMI at EHC… One thing I really love about the site is that we have the ability to set up follow up for our patients within 48 hours to a PCP or specialty care. That being said, only about 50% of the patients show up for their follow up appointments but at least the ones that do show up have something established if they want/need it.
Cons: If you want to speak English with your patients and don’t like to use translator phones Elmhurst is a difficult place to work at. I would say that ~30-40% of our patients are primarily Spanish-speaking, another 25% Bengali / South Asian, 15% other (Russian, Mongolian, Cantonese, Chinese…), and the remainder speak English. There are two sides to the ED (A & B). The B side can be difficult to work in because patients are exclusively triaged there who are intoxicated, emotionally disturbed, under arrest, require psychiatric clearance, demented or an elopement risk. It can feel like you are baby sitting often times on the B side because most of the “real” pathology is triaged to side A. That being said, it is sometimes nice to get a little break from the otherwise extremely sick patients seen anywhere else in the ED.
Mount Sinai Beth Israel (MSBI)
Pros: MSBI had a residency program for more than 15 years before it was decided to end their EM residency program and have our and Mount Sinai St Luke’s-Roosevelt (SLR) residents staff their ED. As a result, the spots that used to be used for MSBI’s EM program have now disbursed between our program and SLR, making our EM program the largest in the nation (25 interns per year). This is the most functional of our sites where the nurses can place orders themselves and often draw labs before you even see the patient. This is a stark contrast to MSH/EHC where a patient is frequently waiting a minimum of 2-3 hours before labs are drawn.
One cool aspect of MSBI is that critically ill patients are triaged to the trauma/resuscitation bays and anyone can pick them up as the primary provider (in comparison to EHC/MSH where critically ill patients are exclusively seen by a dedicated resuscitation resident in the ED). Most of my intubations, central lines, and critical procedures as an intern have come from here. The number of providers to volume of patients is appropriate here in comparison to the other two sites so it can feel “slower” at times. However, I would argue the flow here is more comparable to any ED outside of NYC. Attendings love to teach and most of my core EM knowledge came from the couple of months I rotated here because there is more time to discuss patient care.
Cons: Some of our and SLR’s residents feel that the volume/acuity of MSBI is low in comparison to our primary sites (especially during the night). The MSBI leadership has been very transparent and flexible with us in this concern and have reduced the number of nights and overall weeks we work here as senior residents.
Current PGY-1 wrapping up my intern year and reflecting upon my experiences with this website. I found it really helpful when there was updated information about the programs I was interested in on SDN so I wanted to pay it forward.
The overall Too Long Don’t Read (TLDR): Our residency offers a top tier critical care experience. As evidence of this, I had already completed over 50% of my required ACGME procedures (central lines, intubations, lumbar punctures, ortho reductions, paracenteses, etc) halfway through my intern year and I have not even begun the core critical care portion of my training (PGY-2 year). If you want to train somewhere where you will come out unphased by any and everything you see as an attending (I would argue even by the end of your intern year), Mount Sinai is the program for you. Understand that this comes at the cost of training in an environment much more chaotic / stressful than your “average” EM program. I still remember my first shifts at Mount Sinai and Elmhurst thinking “what did I get myself into?” comparing my experience to the more “lax” environment of the other top 25 EM programs I rotated at as a medical student. Your “average” day will be, in comparison, insane compared to most of your colleagues in other EM programs. You will get used to this and thank yourself later for training in this environment.
Overall strengths of our program: If you are a fan of critical care, I don’t know if there is a better place in NYC (or arguably the nation) where you could train. This is definitely where we shine most... Scott Weingart (EMCrit Project) trained at Sinai and produced most of his podcasts while working at our county site (Elmhurst). Some other big names are Reuben Strayer (emupdates) and David Cherkas who are both current attendings at Elmhurst. Three of our current PGY-4 residents matched at 3 of the top critical care fellowships in the nation (University of Pittsburgh, University of Michigan, and Columbia University).
Just to give you context of the other impressive achievements our graduates have, one of our PGY-4’s will be Assistant Medical Director and another will be an Associate Program Director at Mount Sinai Hospital next year. Last year one of our PGY-4’s became a Clerkship Director for his first job at LSU-New Orleans… It’s pretty common for our graduates to have their pick of whatever job or position they want upon graduation. This has a lot to do with our current Chair Dr. Jagoda who created the program back in the 90s and has a ton of connections / power in the EM world. If Dr. Jagoda wants something done, he has the power to make it happen and will advocate for you to open any door you desire.
Our program is also extremely well balanced in giving you a split between academic (Mount Sinai Hospital), county (Elmhurst Hospital), and community (Mount Sinai Beth Israel) emergency medicine. I personally love that we rotate at such drastically different sites because it keeps things exciting and different. Read below for more information about each site.
Overall weaknesses about our program: While I certainly wouldn’t call this a weakness, in comparison to other aspects of our program trauma is not our greatest strength. That being said, we get our fair share of pretty great trauma cases (to give you context I saw about 7 stabbing / shooting cases in a month there and those were just when I was on shift; thoracotomies happen at a relatively decent rate – probably 1 per month on average). In my opinion, NYC is not the right place to train if you’re looking for an elite/crazy trauma experience. If you really want a knife/gun club in NY, King’s County (SUNY-Downstate) or Jacobi/Montefiore are probably better options.
Ancillary staffing is another issue that is not unique to Sinai but is an overall NYC problem. Our nurses can carry 15+ patients in the ED (boarding patients spend an average of 12-16 hours, sometimes days, in the ED before a bed becomes available upstairs and our nurses have to take care of them). This being said, you will have to do your fair share of ancillary tasks to make up for this (placing IVs, pushing patients to CT/XR, pulling IVs on discharge, etc). From what I hear about other NYC programs we don’t have it too bad but you have to accept this will be a part of training here.
Mount Sinai Hospital (MSH)
Pros: My overall experience at Mount Sinai has been incredibly positive. I love the pathology we see at the main Mount Sinai Hospital most but could see how it’s not for everyone. People come to MSH from all over the world for their specialty care and we are the first to encounter them in the ED. That being said there’s a huge culture of consulting specialty services here. I would say about ~50% of patients require some sort of consultation because they are super specialized and plugged in to the system (i.e. – a patient with Crohn’s Disease will have a flare, you consult the IBD fellow for recs which are usually c diff culture, esr/crp, abdominal xr, stool studies, likely admit to the IBD floor. Yes, you read that right there is an actual IBD floor at Mount Sinai - that is how specialized the care is). A huge plus is that the consultants are generally really pleasant to interact with and they expect to be consulted so there is rarely any animosity about having to see patients. I’ve had some great experiences interacting with the consultants and have learned a ton from them. Admitting patients is a pretty easy process as well – we put an order in and write a handoff note explaining why the patient is being admitted. There is a MAPA (Medical Admitting Physician Assistant) who occasionally calls you to clarify where you think the patient should go (teaching service vs NP service for example) but we rarely ever get pushback on admissions.
Cons: The negative aspect of MSH is the space we work in which is actively being worked on right now. We have a very small space for the volume we see which can be incredibly overwhelming on busy days. We are actively renovating the ED to address this which will effectively double the square footage we work in. From my knowledge, it sounds like the renovation project is estimated be done in 2022. Like any NYC emergency room most patients are not on monitors, do not have their own rooms, and are on gurneys in the hallway. You will have to play tetris with the beds often to get to a patient you’re looking for. Again, I don’t think this is unique to MSH but an NYC thing. I think the scary thing about this is those patients who are subtly sick and in a hallway stretcher. Because the patients at MSH are so specialized they are prone to decompensate on the sides if you’re not on top of them. Patients who are boarding in the ED are cared for by the upstairs teams, thus we often sign these patients out to the next ED team to make sure someone knows about them in case they decompensate in the 24+ hours they remain in our ED.
Elmhurst Hospital Center (EHC)
Pros: Elmhurst is where most of our residents prefer to rotate at. The patients here are incredibly diverse (the zip code where EHC is has the most languages, 100+, spoken in the nation) and they are extremely thankful for the care we deliver for them. This is our county site and where most of our off service rotations are (the reason for this is that there is less competition at EHC for procedures and we get more autonomy on these rotations compared to MSH). We see incredibly diverse pathology here because of the patient population (mainly uninsured, poor health literacy, have not seen a physician in years). It is not uncommon to have a Bengali patient in their 20s with chest pain have a full fledged STEMI at EHC… One thing I really love about the site is that we have the ability to set up follow up for our patients within 48 hours to a PCP or specialty care. That being said, only about 50% of the patients show up for their follow up appointments but at least the ones that do show up have something established if they want/need it.
Cons: If you want to speak English with your patients and don’t like to use translator phones Elmhurst is a difficult place to work at. I would say that ~30-40% of our patients are primarily Spanish-speaking, another 25% Bengali / South Asian, 15% other (Russian, Mongolian, Cantonese, Chinese…), and the remainder speak English. There are two sides to the ED (A & B). The B side can be difficult to work in because patients are exclusively triaged there who are intoxicated, emotionally disturbed, under arrest, require psychiatric clearance, demented or an elopement risk. It can feel like you are baby sitting often times on the B side because most of the “real” pathology is triaged to side A. That being said, it is sometimes nice to get a little break from the otherwise extremely sick patients seen anywhere else in the ED.
Mount Sinai Beth Israel (MSBI)
Pros: MSBI had a residency program for more than 15 years before it was decided to end their EM residency program and have our and Mount Sinai St Luke’s-Roosevelt (SLR) residents staff their ED. As a result, the spots that used to be used for MSBI’s EM program have now disbursed between our program and SLR, making our EM program the largest in the nation (25 interns per year). This is the most functional of our sites where the nurses can place orders themselves and often draw labs before you even see the patient. This is a stark contrast to MSH/EHC where a patient is frequently waiting a minimum of 2-3 hours before labs are drawn.
One cool aspect of MSBI is that critically ill patients are triaged to the trauma/resuscitation bays and anyone can pick them up as the primary provider (in comparison to EHC/MSH where critically ill patients are exclusively seen by a dedicated resuscitation resident in the ED). Most of my intubations, central lines, and critical procedures as an intern have come from here. The number of providers to volume of patients is appropriate here in comparison to the other two sites so it can feel “slower” at times. However, I would argue the flow here is more comparable to any ED outside of NYC. Attendings love to teach and most of my core EM knowledge came from the couple of months I rotated here because there is more time to discuss patient care.
Cons: Some of our and SLR’s residents feel that the volume/acuity of MSBI is low in comparison to our primary sites (especially during the night). The MSBI leadership has been very transparent and flexible with us in this concern and have reduced the number of nights and overall weeks we work here as senior residents.
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