Perspective of a Tufts R2 below....
I have been very please by the quality of my training at Tufts over the past 18 mos. The thing you don't get at first blush looking at the program material is just how quality the attendings are for a small academic institution. I'm sure you find many similar throughout the city of Boston but our subspecialty staff (particularly in all of Cards, Renal, ID, BMT and Pulm Htn) are pretty impressive in terms of contributions to their field and involvement nationally. This was a step up for me from Med School, I know ppl on this board are generally from very competitive top programs so it may not be as impressive (or maybe thats the vocal minority). You have a good degree of autonomy with plenty of backup, and because the program is relatively small you usually have a relationship with fellows and attendings and a comfort level running things by them.
The referral base is interesting because of the above comment from OP. The bulk of patients are community hospital transfers making the hospital function more like a tertiary referral center with standard ROMI, CHF, PNA coming through the ED, the strange cases usually come in referral. I've seen Babesia, Malaria, new Dx Leukemia with Leukostasis, Invasive Aspergillosis, Myasthenia Crisis complications of AIDS, Heart Transplant and LVAD. Probably not a big deal for most academic centers, I'm just trying to illustrate a point that despite being a competitive market you get exposure to weird things as well as bread and butter cases. We are also starting an ECMO program, I've seen 3-4 ECMO cases in the last year (probably an outlier from my class). We have a lot of well off patients who are well insured (we have a mix of the BMC crowd + chinatown patients + suburban patients that get their care with one of our specialists). The thing I miss the most is the lack of acute liver failure because the liver transplant program went to Lahey so we see mostly chronic non transplant candidate cirrhotics.
The EMR is in the process of advancing to having HPI's in the computer and eventually daily progress notes, honestly I haven't been that effected by the lack of computer notes. I know it is a big deal to some, its something that is being worked on. We are also developing e-prescribing for hospital discharges and potentially a hospital wide discharge appointment programs that takes away the responsibility to call for appointments away from us. EMR isn't necessarily a disaster, I find that the order entry is pretty easy, most nurses are pretty responsive to the orders and I don't have to call and track down people to get things done unless I feel its important and is time sensitive to get done. Nurses are also largely good, friendly and responsive; you'll have your ups and downs with them and we have IV nurses and phlebotomy to fill in the gaps so I'm rarely starting IV's or drawing blood unless its time sensitive.
The small program and the 3+1 thing kinda roll together. We are small, very small compared to some other places. That said this group of people has been like a second family, we lucked out and the R2-R3 class really gets along well can't say that happens every year but its been a great experience coming to work and being with your good friends (edit: just reread this sentence, we love the R1s too
). I'm having a hard time thinking about how a 3+1 schedule would work with our numbers. The 3 week block is a good compromise and by the time you are getting really burnt out in week 6 you are shifting off service (interns to back to back 3 wk ward blocks; R2-R3 alternate on service and off service). Coverage is an issue because the pool of off service interns is very very small, and the off service R2-R3 isn't that big either. The big picture is that if you NEED to not be at the hospital we work things out and coverage gets made usually at the expense of someone's off service time so we tend to really try to be there not to screw over someone who earned their off service time. We are far from inflexible, we probably changed the delegation of admissions 2-3 times this year in response to different complaints. I was concerned about this too going in but have realized that Rick hasn't been doing this for 20+ years without being flexible, he is a huge advocate for us and having him there for so long gives his input into the hospital more weight.
The GOOD thing about the small program beyond the relationships with peers is that those odd cases I talked about above usually get discussed amonst the group of us and you learn that way as well, and there is really no competition for procedures I have many central lines, paras, LPs, a lines and feel comfortable doing these procedures without much guidance.
Tufts was the right program for me. I’ve been successful, I feel comfortable with my LORs and that the PD knows who I am and what I’m about. Our match list has been great for the last two years everyone who wanted cardiology went to a good quality program with some going to great programs (yale, upenn, upmc and BID come to mind). Our pulm match was quite good this year too (yale, ucla, nyu and one stayed on at TMC) people go into private practice or pursue translational science masters/fellowships and go into research. I’ll echo something that JDH and gutonc have been posting for years. outside of the top 10 research places most programs come down to you putting yourself in a comfortable position to succeed if thats gut feeling, geography or being the surgeon general figure it out and do it and rankings be damned.
Tldr: Tufts was the right place for me, it has good and bad aspects just like any place; YOUR job is to figure out your priorities and find the right place for YOU and I hope you have a great experience wherever you end up.
I would agree that we probably don't get paid enough, this I have no good excuse for. I'll leave my paypal data below if you wanna help a brother out
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