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Parent-friendly programs

Discussion in 'Internal Medicine and IM Subspecialties' started by mem141, Dec 30, 2008.

  1. mem141

    mem141 Junior Member
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    Hi all,
    I have a four-month-old son and would like to spend quality time with him over the next three years without sacrificing the quality of my training. I am wondering if anyone can provide suggestions as to what I should be looking for/what questions I should be asking when looking at programs in regard to my goals as a parent: What call schedules seem to work better with young children, who has daycare, quality of life, etc.
    FWIW, the programs I am looking seriously at are BWH, UW, MGH, UCSF BIDMC, OHSU, BU, and Stanford. I am also looking at the primary care tracks (which I know means less call at most of the above.) If anyone (especially parents!) has specific opinions regarding being a parent at those programs, that would be helpful too.
    Any thoughts?
     
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  3. nasdr

    nasdr Member
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    i got the impression that BID and michigan were family-friendly programs. in the BID packet, there is a red sheet which has things like, "planned a wedding during residency, married to someone in medicine, married to someone not in medicine, have children, etc etc." essentially, there seems to be a lot of diversity in the class for someone looking for a family-friendly program. michigan is another awesome program that is family-friendly: i would imagine that ann arbor is a great place for families. i didnt see it on your list, but vandy would be another one to consider. at their pre-interview dinner, lots of spouses and significant others were there, and they seemed to know each other as a close-knit group.
     
  4. gutonc

    gutonc No Meat, No Treat
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    I was a resident (and am now a fellow) at OHSU so can comment on that program. In my residency class, about 1/2 of the people had kids (ranging from newborn to 6 years old). My wife and I had a daughter at the end of my intern year and managed to make it work.

    The program is very family friendly and, assuming you don't abuse the system, you'll get plenty of support from the administration and your colleagues. One nice thing about OHSU is that Oregon has a more lenient FMLA law than the federal one, requiring only 6 mos of employment to qualify for it. That makes it easier to take protected leave if/when you need it.

    One huge downside is that there is no hospital/university provided daycare available. There is a daycare facility at the VA that is operated by a private provider but the waitlist is about 6-9 months long. That said, daycare close to the hospital isn't that hard to find.

    As far as the call schedule goes, there are 5 different inpatient rotations and you'll rotate on 4 of them as an intern (the CCU is all R2/3, no interns). You'll have 7-8 call months as an intern and 3-5 as an R2/3 and the call schedules vary from Q3 overnight (they're in the process of changing this one but I don't know what it will be changed to) to Q3 with night float and one 24h shift a month) to Q5 with night float and 1-2 24h shifts a month) to Q5 overnight with cross-cover at night (i.e. you only admit after 8p, all cross-cover is taken care of by someone else). On your non-call months, you will likely have to cover a weekend (days only) of whatever consult service you may be on and 1-3x/yr you'll be the cross-cover person described above.

    All in all it's a pretty good place to be if you have a family and you will be in good company.

    FWIW, I interviewed at UW, MGH, UCSF and BU (of the programs on your list) and while there were certainly married residents w/ kids in those programs, they seemed to be a distinct minority (<25% by my guess). Also, at least as an intern, the call schedules in all of those places were more intense than OHSU. Other places I looked at that were definitely family friendly were Dartmouth, UMinn, Wisconsin and U Chicago. I'm sure there are plenty more out there, I just didn't interview at them.
     
  5. drjitsu

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    We're very much in the same boat, you and I. I have a 5 month old son, and I have decided to make family number one; however, I too would like top level training.

    Just so you know where I'm coming from, I'm not 50 or 40 or even 30 years old. I'm 27 and been married 5 years. So, I'm a family man to be sure, but I'm still a young guy. (I put this here, because some of what I write below sounds older than this.... :scared:)

    You asked about call schedule. I would imagine that night float vs overnight would be the major decision here, as it is for anyone. And, I would also think that night float would be more amenable to a parent so that we may be able to see our kids to bed and such. ("may" being the operative word) That being said, I really want the experience of overnight call. Now, how often I want that experience is something I'm struggling with and may not ever really know until I'm going through it.

    Ok, so you also mentioned quality of life. Now, I don't know your situation. You may be independently wealthy, your wife may be a high powered lawyer or investment banker.... supermodel... I don't know. But, for me, I really want a city that is family friendly. I want a place that will allow a great quality of life for my wife and child and those to come. So, I really didn't apply to Boston, San Francisco, New York, etc... I'm looking at places where I can get a nice house, with room for more kids, close enough to the hospital so I'm not commuting or stuck in traffic. Again, I don't know your tastes... you may be itching for some "big city" amenities; you may have family in Boston or California. But, for us, we just would not take advantage of anything in one of these places, we don't have family their, and I'm just not willing to sacrifice their quality of life.

    So, what I'm asking on interviews. I try to get a sense of what percentage of the house staff is married and what percentage has kids. I really don't want to be with a bunch of single people who want to go "clubbing" or whatever all the time and feel like an outcast because I want to spend time with my family. I want events that people bring their kids to. I also ask about resident spouse networks. Daycare is not something I ask about, because we're not using daycare; my wife does some work from home so she can be with the kids. As I mentioned before, I ask about quality of life and cost of living quite a bit. I really want a sense of how far people are living and what kind of places their living in. I cannot live in a little one bedroom apartment thirty minutes away for $2000 a month. I also cannot live in an unsafe area. Obviously, wanting to live close to the hospital, this precludes some programs right away.... some big programs (big in name only...) that I canceled interviews at for this very reason.

    So, mainly I'm looking for a house staff that is at least 50% married with perhaps half of those with kids, a strong spousal support network, and a safe area around the hospital with affordable housing. (Is that too much to ask... :laugh:)

    Places I've interviewed at that fit the mold...
    Vanderbilt
    Michigan
    Mayo-Rochester
    OHSU a bit less so... (I didn't get the same vibe as the above places, but a resident posted above so, take their word over mine)
    I'm to Duke soon, and I'm hopeful, but we'll see.

    So, I know this is a bit long, but I hope I answered some of your questions. Please pm me with any other thoughts. It's nice to talk to someone with the same concerns.
     
  6. TommyGunn04

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    I'd strongly urge you to add Duke to your list of considered programs, both for reasons of "family friendliness" and for many others, as I'll explain. I came to NC as a med student and never expected to want to stay in "the South," but I've since fallen in love with this area and all it has to offer, along with the many unique features of Duke. I've loved it so much down here that I stayed on as a resident, and would strongly consider staying here long term. Some of the biggest factors that make a place "family friendly," in my mind, are 1) quality of life, 2) cost of living, 3) call schedule, and 4) program support of personal life.

    Our residency program tends to attract people who are perhaps more family-oriented than other top programs, either because they are already married or come here with a significant other, and there's a good percentage of residents or spouses who have children during residency. We also certainly have a decent proportion of single residents too, with lots of great night life in the Durham/Raleigh/Chapel Hill area that's very close by, but certainly less so than some of the big northeast programs. Part of this is due to the incredibly good quality of life and low cost of living in the Triangle area, which makes family life much easier. There's tons to do here, but your salary goes a very long way in Durham compared to pretty much any other top program I can think of, even places like Michigan or WashU, which aren't in big urban areas but still have higher costs of living, goods, and services than Durham. Plus, this area has undergone an incredible rejuvination over the last 5 years such that quality of life has skyrocketed even in the 6 years that I've been here, without significant increase in cost. Our program directors are also incredibly supportive of family concerns, making our daily environment one of support and a family feel, rather than one of competition or servitude.

    In addition, the residency program has undergone some fantastic changes over the last 6 months, with some even better ones in the works for July. We're basically going to a 70hr/wk maximum type of schedule, vs. the legally mandated 80hr plan, and in some blocks this ends up being more like 40-50hrs/wk with no call and free weekends. We're elimininating overnight call on 4-5 months of our rotations as well (the subspecialty service ones). The overnight call that does exist on gen med, which is incredibly valuable and I think far superior to purely night float systems, will be q5 instead of q4, and will go from 30hrs to just 24hrs. Plus, we've hired hospitalists to do much of the cross-coverage, so there will be more time to think critically about admissions instead of putting out cross coverage fires or ordering sleeping pills and laxatives all night long. Interns will also each have an elective opportunity, which most programs don't have, and they will only take overnight call on 3 months of gen med (q5) plus 1 month of CCU (q4 instead of the usual q3 ICU call). They will otherwise be working mostly days with a very small amount of night-shift work per year (2 weeks or so).

    These exciting changes serve to greatly enhance continuity and the educational value of call experiences, while greatly reducing cross-coverage, scut-work, and the overall frequency of overnight call. Interns will also have night-time one-on-one signouts with a chief resident while on gen med, which is an incredible learning experience, and also quite unique. Our program is also more focused on evidence-based medicine and learning to interpret the medical literature than many places, and the design of our subspecialty services is such that you get to round daily with either an attending or a fellow, such that you get great learning opportunities directly from someone who knows that specialty quite well every single day. This is for about 4 months of the year too, so you'll learn cardiology directly from renowned Duke cardiologists, oncology from top cancer center oncologists, pulmonary from amazing pulmonologists, etc.

    I could go on and on extolling the virtues of our program, but don't want to hijack this thread further. I ultimately wanted to convey that Duke is a wonderfully family friendly program, and to show how our recent changes will further enhance this trait, along with the overwhelming bonus of living in the Durham area with regards to family life. Just about every resident buys a home or townhome here, and it's easily affordable to do so. Everyone has a car too. And we're all living like grownups, rather than living like college students, which often happens in big urban programs where you just can't afford anything else.

    Feel free to ask me any questions you might have, and good luck with the search process! I absolutely love my program and would choose it again in a heartbeat! :)
     
  7. divel

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    Tommygun04,
    Thanks for all the posts about Duke. I loved the program and its at the top of my list. Just wondering though- the changes sound great to me from a QOL standpoint, but I was just wondering if you or any of the other senior residents or faculty have any concerns with the recent changes negatively impacting quality of education. I completely understand the argument of having more time to focus on true education vs. scut, being better rested, thus better able to think, etc. but also know Duke used to pride itself on being "hard-core" and seemed to follow more of the Hopkins mantra and to a certain extent it seems like the changes were made as a reaction to the scramble issue although the changes certainly seem well-thought out and not knee-jerk.

    sorry for the rambling- Just wondering your thoughts....
     
  8. mem141

    mem141 Junior Member
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    Thanks to everyone who responded; I appreciate it. We are limited to Boston, the Bay Area and the Pacific Northwest due to family constraints, but a little house in Durham sounds really nice right now :)
    Thanks again!
     
  9. TommyGunn04

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    Just a quick response to divel's question here. In my mind the changes strike a great balance between maintining a rigorous training environment that still consists of a significant amount of overnight call while getting rid of much of the stuff that makes people reminisce about "when I was an intern," but which doesn't in actuality teach you much. There will still be a good 3-4 mos of overnight gen med call between Duke/VA as an intern, and 1 month of q4 overnight in the CCU, so we're still talking about 4-5 months of overnight call during intern year. The difference will be that the time spent on call should be much more valuable educationally, and a bit more protected in a sense.

    In particular, the changes to the subspecialty services will greatly enhance the educational value thereof. Here's the problem: under the current system, an intern on the liquid tumor service might admit 3-4 solid tumor patients on a call night, and thus get little feedback on their overnight management, as they hand the patients off to the solid service in the AM, and only follow a fraction of the liquid patients. There have been too many patients being admitted and then not cared for by the same person. Plus, you have to go home post-call, and end up missing the great teaching by attendings/fellows on the wards. Under the new system, interns will be there throughout the day every day, and will have much more continuity, and therefore also more opportunities for great learning from the fellows and subspecialty attendings that you get to round with daily. This will improve the feedback about clinical decisions too, as you won't just be handing patients off in the AM. Should be a significant educational improvement overall.

    I also wouldn't say the changes were at all reactionary. We've basically taken advantage of the opportunity that the match provided. It costs lots of money to hire extra hospitalists and moonlighters, and the funds simply wouldn't have been available were it not for that having happened. Most places couldn't get this degree of support from higher-ups to make these types of costly changes, so we've run with the amazing opportunity.
     
    #8 TommyGunn04, Jan 9, 2009
    Last edited: Jan 9, 2009

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