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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.
 
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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 are frequently carrying 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.

15 patients per nurse? That answers my question in the David Newman thread below and explains why Dr. Jagoda is personally obtaining vital signs on patients. Again, I have no idea how that is tolerated, anywhere, in the US in 2019. No knock on your program, if that is truly the norm in NYC, and my hat is off to you for taking care of patients in that type of environment.
 
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miacomet

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I don't get why famously high maintenance NYers put up with the terrible emergency care in their city. I had a hospital CEO from one of the big academic medical centers come to my ER. We receive a whole lotta cupcakes the next day haha.
 
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GonnaBeADoc2222

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Because they all go to Tisch
I don't get why famously high maintenance NYers put up with the terrible emergency care in their city. I had a hospital CEO from one of the big academic medical centers come to my ER. We receive a whole lotta cupcakes the next day haha.

Sent from my Pixel 3 using SDN mobile
 

SamtheWise

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it honestly sounds like learning EM in a developing nation, good for you guys for subjecting yourself to that in a city where attendings are lower middle class and residents are on the poverty line
 
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alpinism

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Constantly seeing non emergent chronic disease patients and consulting subspecialist fellows for their recommendations.

I'm going to be brutally honest even the pros section for Mt Sinai sounds horrible.
 
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TimesNewRoman

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Constantly seeing non emergent chronic disease patients and consulting subspecialist fellows for their recommendations.

I'm going to be brutally honest even the pros section for Mt Sinai sounds horrible.

Agreed. Consulting on half of your patients sounds miserable. Also, the ACGME required procedures are pitifully low. If you’re not done with them by the end of internship, I’d be worried. And, not to say trauma is all that important, but one thoracotomy a month is a lot....I mean, I know I work at a knife and gun club, but still, a dozen a year is nothing.
 

OneTwoThreeFour

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Agreed. Consulting on half of your patients sounds miserable. Also, the ACGME required procedures are pitifully low. If you’re not done with them by the end of internship, I’d be worried. And, not to say trauma is all that important, but one thoracotomy a month is a lot....I mean, I know I work at a knife and gun club, but still, a dozen a year is nothing.

As someone who went to med school in NYC, I think things like being overworked, not having a ton of trauma or procedures, and having nurses taking care of a dozen patients are the tax you pay for living in the city. So in the context of getting to be in New York, Mt Sinai is a great program but that's a hefty caveat.
 

GonnaBeADoc2222

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This makes no sense.

As an aside, I did a sub-i at one of the "famous" NYC places and I'm so glad I didn't match in NYC.
As someone who went to med school in NYC, I think things like being overworked, not having a ton of trauma or procedures, and having nurses taking care of a dozen patients are the tax you pay for living in the city. So in the context of getting to be in New York, Mt Sinai is a great program but that's a hefty caveat.

Sent from my Pixel 3 using SDN mobile
 
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OneTwoThreeFour

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This makes no sense.

As an aside, I did a sub-i at one of the "famous" NYC places and I'm so glad I didn't match in NYC.

Sent from my Pixel 3 using SDN mobile

I mean, everybody has their own criteria for how they choose where they want to do residency. Location is a reasonable criterion.
 

gro2001

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Seeing all this hate about NYC in these threads always makes me chuckle a little. Yeah, it's not for everyone. Lots of people hate it. Lots of people clearly love it too. But the same is true about any other place as well. What I don't get is why non New Yorkers feel the need to express how they, who don't live in the city think it's not worth it. You don't see New Yorkers posting on the University of Kentucky residency program thread how much they would hate it there given the negatives, because who cares what someone who would never consider moving to Appalachia thinks? Sometimes it feels like some people are trying to allay some of the FOMO by trying to list all the objective reasons they have for staying where they are.
 
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TimesNewRoman

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Seeing all this hate about NYC in these threads always makes me chuckle a little. Yeah, it's not for everyone. Lots of people hate it. Lots of people clearly love it too. But the same is true about any other place as well. What I don't get is why non New Yorkers feel the need to express how they, who don't live in the city think it's not worth it. You don't see New Yorkers posting on the University of Kentucky residency program thread how much they would hate it there given the negatives, because who cares what someone who would never consider moving to Appalachia thinks? Sometimes it feels like some people are trying to allay some of the FOMO by trying to list all the objective reasons they have for staying where they are.

Uhhhhhh.....yes you do. All the time. Have you never read rank list thread? It’s full of “great program, I/significant other would hate living there” programs.
 
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Seeing all this hate about NYC in these threads always makes me chuckle a little. Yeah, it's not for everyone. Lots of people hate it. Lots of people clearly love it too. But the same is true about any other place as well. What I don't get is why non New Yorkers feel the need to express how they, who don't live in the city think it's not worth it. You don't see New Yorkers posting on the University of Kentucky residency program thread how much they would hate it there given the negatives, because who cares what someone who would never consider moving to Appalachia thinks? Sometimes it feels like some people are trying to allay some of the FOMO by trying to list all the objective reasons they have for staying where they are.

There are mainly two criticisms:

1. How dysfunctional the hospitals are.
2. How "little" money you make for the cost of living.

The first point is pretty valid, and impossible to argue against if you've seen how the rest of the country does it.

The second point is basically just a joke at this stage. There is a pretty vocal crowd of posters who are completely perplexed by the idea that someone would choose to take a pay cut for any reason. Any time someone posts about a possible career change, there is no shortage of posters lining up to ask "DiD yOu KnOw ThAt YoU WiLl Be MaKiNg LeSs MoNeY??!!"
 
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PharmacyStud

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As someone who went to med school in NYC, I think things like being overworked, not having a ton of trauma or procedures, and having nurses taking care of a dozen patients are the tax you pay for living in the city. So in the context of getting to be in New York, Mt Sinai is a great program but that's a hefty caveat.

I thought the tax or price you pay for working in the city was high col and low salary.

Personally, don't have an opinion about mt. Sinai
 

hundreddaysoff

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Seeing all this hate about NYC in these threads always makes me chuckle a little. Yeah, it's not for everyone. Lots of people hate it. Lots of people clearly love it too. But the same is true about any other place as well. What I don't get is why non New Yorkers feel the need to express how they, who don't live in the city think it's not worth it. You don't see New Yorkers posting on the University of Kentucky residency program thread how much they would hate it there given the negatives, because who cares what someone who would never consider moving to Appalachia thinks? Sometimes it feels like some people are trying to allay some of the FOMO by trying to list all the objective reasons they have for staying where they are.

I do think balance is very important. In fact, it's these recurrent SDN discussions of NYC as a substandard learning environment in large part that steered me away from applying to NYC programs. Am still happy I made that decision.

There is a lot of NYC hate on here, but hey, at least it's not NJ or LI, right?

- a self-exiled Upstater
 
D

deleted109597

Seeing all this hate about NYC in these threads always makes me chuckle a little. Yeah, it's not for everyone. Lots of people hate it. Lots of people clearly love it too. But the same is true about any other place as well. What I don't get is why non New Yorkers feel the need to express how they, who don't live in the city think it's not worth it. You don't see New Yorkers posting on the University of Kentucky residency program thread how much they would hate it there given the negatives, because who cares what someone who would never consider moving to Appalachia thinks? Sometimes it feels like some people are trying to allay some of the FOMO by trying to list all the objective reasons they have for staying where they are.
Two things.
Yes, New Yawkers use literally every opportunity to put down any place other than NYC.

Also, UK is not Appalachia. Not even close. Which basically proves the first.
 
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Tenk

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Seeing all this hate about NYC in these threads always makes me chuckle a little. Yeah, it's not for everyone. Lots of people hate it. Lots of people clearly love it too. But the same is true about any other place as well. What I don't get is why non New Yorkers feel the need to express how they, who don't live in the city think it's not worth it. You don't see New Yorkers posting on the University of Kentucky residency program thread how much they would hate it there given the negatives, because who cares what someone who would never consider moving to Appalachia thinks? Sometimes it feels like some people are trying to allay some of the FOMO by trying to list all the objective reasons they have for staying where they are.
Yeah sure, except Yankees fans.
 
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"The city" is a great place to visit, terrible place to live / work. I have lived and worked in "the city."

It sucks. Claustrophobic streets and subways, everything overpriced, taxes and rent out the wtffffff. Oh but you can work for 150/hr. YAY.

Same awesome food scene can be had anyplace else.

Oh and you're screwed if you're single. Good luck competing with the hedge fund managers and supermodels.
 
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scoKraz4

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I agree with the financial stuff.

In regards to food, in no way is any city comparable! The competition is just so intense that restaurants have to have ridiculous standards to survive that initial year. Order italian food at 4am? Sure. Food carts everywhere.

Also my single friends fair pretty well with dating..it usually doesn’t last but that isn’t their goal at this time...
 
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gro2001

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Not sure if your comment was directed at me. But FYI I am from NYC. I just didn't fully realize how dysfunctional some of the ERs at academic facilities were in NYC until I moved and worked elsewhere. Just to give some perspective.

Wasn't specifically directed at any one poster. There are definitely a few very vocal posters here who don't seem to have had professional experience in NYC but seem to always chime in with their opinion of how anyone considering living there is crazy. Its not that I think their opinion is invalid, but the enthusiasm behind it always surprised me.

Uhhhhhh.....yes you do. All the time. Have you never read rank list thread? It’s full of “great program, I/significant other would hate living there” programs.

I feel that's different though. People considering various options, thinking how they fit into their ROL is different from the enthusiastic attacks on anyone considering the horrible mistake of moving to NYC. Even the example you gave is much more balanced than the comments I am talking about. Perhaps I am not being clear in my description, but I don't necessarily want to call out any person in particular, so don't know how I could clarify further.

Two things.
Yes, New Yawkers use literally every opportunity to put down any place other than NYC.
Also, UK is not Appalachia. Not even close. Which basically proves the first.

New Yorkers don't really think about any other place than NYC, so they really only take every opportunity to put down New Jersey and Staten Island. Even the New Yorker cover is in that spirit. The map is blank (ie irrelevant) between the Hudson and the Pacific, not [insert whatever regional put down]. And anyway, wouldn't you agree that they typically wouldn't jump into a conversation about how no one should work in [whatever place someone is considering moving to] because its terrible and everyone should move to NYC instead?

You are right about the geography of Kentucky. My only experience is a couple of job interviews in the region. Seemed to have a lot of conversations in Lexington about what it's like working in Appalachia, so I figured people there considered themselves part of it. Guess I misunderstood.
 
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BoardingDoc

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Also, UK is not Appalachia. Not even close. Which basically proves the first.
I agree that many people from NY enjoy saying that it's the best place in the world.

As to your second point, I would argue that UK being "not even close to appalachia" is something of a stretch.

The multicolored areas are different segments of appalachia (as defined by the appalachian regional commission). I added in a little fuschia area to the left for Fayette county. I'd argue that UK is pretty damn close to appalachia.

1572728881583.png
 
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deleted109597

I agree that many people from NY enjoy saying that it's the best place in the world.

As to your second point, I would argue that UK being "not even close to appalachia" is something of a stretch.

The multicolored areas are different segments of appalachia (as defined by the appalachian regional commission). I added in a little fuschia area to the left for Fayette county. I'd argue that UK is pretty damn close to appalachia.

View attachment 285305
As close as Washington DC. Do you consider it to be Appalachia? What about Philadelphia? Nashville? Cincinnati?
I can go one for awhile here.
 
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What a weird argument. I am from EASTERN ASS Kentucky, went to school in Lexington. Everyone I know would laugh at you saying the region, including UK and the patients they serve, isn't Appalachia. FYI.
 
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BoardingDoc

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As close as Washington DC. Do you consider it to be Appalachia? What about Philadelphia? Nashville? Cincinnati?
I can go one for awhile here.
Gro had indicated that people at UK did consider themselves to be a part of Appalachia, so I decided to see how close UK is to the region. It seems very close. Hence my post.

Regarding the other areas you listed which are a similar geographic distance away: a quick search shows that unlike UK, those cities' respective universities aren't offering majors in Appalachian studies, or have an Appalachian center etc etc. In general, there appears to be a cultural commonality between UK and Appalachia that the other areas you listed do not. Other posters here who are from the region seem to feel the same way.
 
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deleted109597

What a weird argument. I am from EASTERN ASS Kentucky, went to school in Lexington. Everyone I know would laugh at you saying the region, including UK and the patients they serve, isn't Appalachia. FYI.
Also from Eastern KY (Corbin). Went to ETSU.
Lots of people I know from UK (Wife went there) don't consider themselves to be Appalachian. More equestrian, which isn't an Appalachian thing anywhere else either. Sure, there are plenty of hillfolk around (2 counties over), but the city does not consider itself mountain, unlike, say, Knoxville. But hey, we can all argue about it I suppose.
 

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I'm from NYC, I like NYC, but EM in NYC is hell on earth and basically forced me out of the city. If you want to stay in NYC and have a soul do anything, I mean anything, else. There are so many issues, and ragging on EM in NYC is totally justified IMHO. I would move back in 10 seconds if I weren't in EM. I trained there, I planned on living my whole life there, and I haven't worked there since July 1 of the year I graduated.

There are terrible issues with training; YMMV:
- Quality of emergency care in NYC is not fantastic, making it hard to learn to be a great doc.
-EM in NYC is outdated. When everyone else started using propofol, half of NYC was still using fentanyl and versed. When the rest of the universe started sending DVTs OTD with epixiban, NYC was still admitting them on a heparin drip. Sure, each place is different, but in general the practices in EM are outdated compared to other places I have practiced
-Minimal trauma training/exposure
-Medicolegal hellhole which really affects medical care (consults, admits). You never discharge anyone...
-The ERs are so dysfunctional that you learn nothing about patient satisfaction, or even being polite and professional. Patients are often treated horribly.
-I truly believe the residency is four years there in most cases because you spend so much time doing scut that you can't learn


There are issues with practice:
-Not a single democratic group that I can think of
-It's either fake academia, toxic academia, or a community shop that is so miserable they are starting their own residency, or a CMG with a residency.
-Practice is so miserable that everyone seems to be finding a niche or a way out; no one can actually stand seeing patients
-High number of clinical hours for FT- based on a 36 hour week. Insane and not standard.
-Most positions are based on an annual salary. You are working all those extra hours for free.

I'd love to hear others' experiences, but I just can't move back until retirement it's so crazy.
 
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-Most positions are based on an annual salary. You are working all those extra hours for free.

You have to look at the whole picture when referring to this. Let's look at a major employer in the area, PAGNY. These docs get about 9 PAID weeks of vacation leave per year! I am not knowledgeable about how it works everywhere else but this might makes up for those extra hours. Also I believe PAGNY does pay for extra hours worked, but that might be facility dependent.
 
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These docs get about 9 PAID weeks of vacation leave per year!

I work seven days on, followed by seven days off. That gives me 26 weeks of vacation per year. Be careful of anyone advertising job perks. The most important thing is (after-tax salary + benefits) / hours worked. Following that priority are practice environment, medical-legal environment, and location.
 
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gro2001

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I work seven days on, followed by seven days off. That gives me 26 weeks of vacation per year. Be careful of anyone advertising job perks. The most important thing is (after-tax salary + benefits) / hours worked. Following that priority are practice environment, medical-legal environment, and location.

I agree that you have to break it down to the hourly calculation as you said to compare apples to apples, but I don't know if I'd agree that everyone has the same order of priorities. People have different values, are in different financial situations, and are at different stages of their career.

Someone just out of residency with a huge student loan debt load at a high interest rate? Yeah, they should probably focus on the money. Someone who has no/few loans, or is later in their career might want to focus on practice environment. Or they might not, and continue focusing on the highest hourly rate, but either is not an unreasonable choice I think. I'd gladly take a pay cut to work in a relatively better environment in a desirable (for me) location.
 

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You have to look at the whole picture when referring to this. Let's look at a major employer in the area, PAGNY. These docs get about 9 PAID weeks of vacation leave per year! I am not knowledgeable about how it works everywhere else but this might makes up for those extra hours. Also I believe PAGNY does pay for extra hours worked, but that might be facility dependent.

PAGNY was started to essentially take away the generous NYS pension (offered to nurses and administrators) from physicians. So it's a pretty toxic entity to begin with. But let's do the math. I haven't spoken to PAGNY in a year or two, so feel free to correct my numbers.

-They wanted a 36 hour week, which adds up to 1872 hours a year. This is an insane number of hours, not "paid vacation."
-Let's subtract their "nine weeks of vacation" for 1548 hours a year. Note: that's a standard number of hours.
-Their pay was crap; I looked mostly at moonlighting, and it does vary between sites, but it looked like over 200k was a rarity. Let's say 220k. -220k/1548 is $142 an hour.
-This does not count their sick-call requirements, which are not paid, nor their teaching and conference duties, if there are any.
-$142 an hour! Are they serious?
-Let's pretend they pay 250k, which they don't, and that the hours are 1500 a year. That's $166 an hour
-THIS IS AN INSANELY LOW INCOME!!

Do they force-feed people Kool-Aid in residency in NYC? What am I missing? Don't pretend this is even remotely a good gig.
 
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Practice environment is so important. More important than money I think. After being in a few ****show EDs (not by choice really) I am taking small paycut to work in a nice place.
 
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Thanks for the post!

How much time a shift would you say you spend doing scut work?
Who manages/runs the traumas? Per your 1 thora per month, do the residents do it?
And how do the night shifts system work?

Thanks!
 
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