personal opinions wanted: malignant programs

Started by PFCortex
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PFCortex

PFCortex

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15+ Year Member
yes, i know, everyone's definitions of a "malignant" program is different...but despite that, many programs have the reputation for being "malignant"...so...

what's your opinion/definition of a malignant program? what programs have the malignancy reputation? any friend-of-a-friend's-sister's-brother 😉 at a rumored malignant program and wanted to confirm or deny such rumors??
 
Malignancy is in the eye of the beholder. There are programs with longer hours, more abrasive attendings, higher expectations. Some consider that malignant. I'm not sure. Most places, there are probably rotations that would be considered to be more of a malignant variety than others. Surg path rotations, often. Or even blood banking. I don't recall hearing any chemistry rotations being considered that.

A lot of the larger programs will have reputations for this. I will mention a couple of names, but everyone promise not to get upset because these are just rumors and experiences culled from interviews, ok? Like I said, I don't really consider any path programs malignant. I think it's just a different style of teaching. MGH is notorious for being a program that the 80 hour work week was going to cause changes to. Often residents used to work about 7am to midnight every day, at least on certain rotations. BWH and BIDMC, while not to that level, are still fairly intense places expecting a lot out of their residents. Wash U has a reputation. Vermont has something of a reputation. Hopkins has a reputation. I am sure there are many others.

Like I said though, be careful about what you mean by malignant and try to find out for yourself. I ranked MGH #2 because I enjoyed my interview day so much and felt the training would be high caliber, so I was willing to put up with more intensity.

In actuality, many of the smaller programs are often "more malignant" because they have the residents doing more of the grunt work (fewer PAs or support staff). Larger programs often have many dedicated teachers, solid procedures for making things flow easily, etc.

You will find disgruntled residents at every program. And you will find happy residents at every program. Try to get a sample. Some people feel they should never be made to do anything "beneath their level" and don't want to move a muscle to help anyone out. They often feel that their program makes unreasonable demands, coincidentally.
 
PFCortex said:
yes, i know, everyone's definitions of a "malignant" program is different...but despite that, many programs have the reputation for being "malignant"...so...

what's your opinion/definition of a malignant program? what programs have the malignancy reputation? any friend-of-a-friend's-sister's-brother 😉 at a rumored malignant program and wanted to confirm or deny such rumors??
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None, it is path...but I sure wouldn't want to go to a program where I had to gross all small biopsies.
 
yaah said:
Vermont has something of a reputation.
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Vermont, really? Huh. I'd be curious to know what their reputation is since I'm very interested in going there. I don't see malignancy necessarily as a problem, at least not for a Path program. For OB/GYN or similiar, I would definitely worry.
 
Please can anyone give details or examples of the Vermont reputation?
Are the attendings unwilling to teach, for example?

Hard work doesn't scare me, but I'd like to avoid a place where the attendings treat residents like annoying underlings who are a waste of their time.
 
Vermont's Surg Path Director is exceptional (A South African guy, I heard him speak at Harvard some years ago), although I couldnt recommend the program. Definitely malignancy is in the eye of beholder, and we are talking about surg path here b/c almost no one can make CP malignant (although WashU tries)
My top 5 malignant programs:
1.) WashU-L. Dehner can be explosively temperamental and thats an understatement. I fear that man.
2.) MGH-Legendary for 16 hour days, but that has come to end, in the 1990s this would be #1 far and away above the rest, but the place has changed alot. More PAs etc.
3.) Stanford-Massive volume, lots of junior people running around making your life difficult, used to be far worse, wouldve been #2 about 5 years ago but theyve hired more PAs
4.) BWH-high volume and sky high expectations for research, I wouldnt even apply without at least 3 publications to my name these days
5.) Hopkins-last of five because overall JHU path is no where the intensity of their other residencies, the volume is high but services are well organized with lots of exceptional staff to show cases to.

Top 5 Party Residencies:
1.) UCSF-The surg path director buys beer for the residents every Friday and gets plastered occasionally with them, need I say more?
2.) UCLA-Good looking residents, reasonable work load and a life filled with partying amongst the stars, personally Im sick of all the "I saw Cameron Diaz at the Viper Room" crap
3.) Miami-Also party central, reasonable work hours and has the tradition of attracting those residents who organized all the parties in your med school class
4.) UCSD- low volume, very reasonable hours and life at the beach, overall nice, any program which features sailing and surfing in their recruitment material rather than stuff actually pertaining to PATHOLOGY makes the list
5.) NYC programs (NYU/Cornell/Columbia)- have to throw these guys on the list somewhere, I know the workload for residents (not counting Sloan) is reasonable, NYC is well NYC.

Overall I would attend the malignant programs before the party ones (and I did) because in the end I want a job and you have a better credential from a grinder program than other types (I grew up fairly poor and am quite sick of having to worry about money). I think if you are independantly wealthy, have a spouse who is an ibanker or simply dont care, then I would go to the party programs.

Most underrated programs:
1.) WashU
2.) Cleveland Clinc
3.) Virginia
4.) Emory
5.) BID-Harvard

Most overrated programs:
1.) Mayo
2.) Yale
3.) UW
4.) UT
5.) Baylor

Great All Around Surg Pathologists (non fellowships) to Work With
1.) Goldblum -Cleveland Clinic
2.) Wick/Mills -UVA
3.) Epstein- JHU
4.) Kempson- Stanford
5.) Weiss- Emory
 
Thanks for all the info LADoc...it's nice to have more veterans in the profession speaking of their experiences and observations.

BTW, are there any "malignant" programs that have residents that can still leave their serious-face at the hospital and throw some wicked, kickass parties?
 
LADoc gives a nice summary - I caution people about the U Miami program. They are not very resident friendly, from what I have heard (minimal autonomy, no previewing slides, etc). And their program is very organ transplant heavy.

In terms of Mayo, it is definitely not for everyone. IMHO, a great place for a fellowship, perhaps. If you want to work at the Mayo, definitely go there, but they have a very different style (detailed elsewhere) that many say is not that applicable to other programs.

And BIDMC I think is underrated for a reason. Solid program, no doubt, but I'm not sure I would include it on that list. But I defer to you as you have more experience.

I too heard great things about Virginia. My interview was scheduled for end of January and I was frankly interviewed out at that point and didn't think anything would convince me I liked it more than the places I visited.

And don't forget, everyone, that where you do your residency and where you do your fellowship do not have to be the same. If you do a fellowship at MGH you will attain similar advantages to having done your residency there (at least from what I've heard) although many programs do take lots of their own residents for fellowships.

Vermont isn't really malignant, it just has had a lot of long work hours in the past on surg path and they have high expectations. It's probably far from malignant. But LA Doc is right, Dr Cooper is the head of surg path and he is fantastic. He was one of the main reasons I ranked VT so high.

For your list of surg pathologists I would add in Dr Krausz at U of Chicago - the most impressive person I met on my interview trails (and I met some impressive folks). UMass, BTW, has a couple of fantastic surg pathologists although the program doesn't have the volume or variety that many do.

Andy the UPenn folks seem to have lots of fun. That isn't really a malignant program either but they do have high expectations for their residents.
 
yaah said:
Andy the UPenn folks seem to have lots of fun. That isn't really a malignant program either but they do have high expectations for their residents.
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Well it's a good thing that I applied there 🙂

I'm get the impression that people at Michigan have lots of fun too. Are you having fun here? 🙂 That's a rhetorical question as I'm sure you're having a pretty good time here.
 
Yes, we have fun. Most of the 1st year residents all went out to breakfast today. We met at 6:30. If you don't like having breakfast at 6:30 and would rather sleep in, well, you're missin' out.

And we are learning a lot. Good combination! I picked it for a reason, you know.
 
Wow 6:30! Gosh I consider waking up at 6:30 to be an honorable achievement! Oh well, I was never a morning person. Nowadays, I do have to wake up around 6:30 so that I can get to campus on time to get a parking spot. Hence, I reward myself with a cookie every morning.

Whereas 6:30 am is not TOO early to grab a wholesome breakfast, 6:30 pm isn't too early to grab a brew at the local pub 🙂
 
I would add Ulbright at Indiana to the list of great pathologists to work with. He's brilliant and a very nice guy.

I interviewed with Goldblum and heard him speak and he seems like a great guy as well.

One thing I found at many programs is that they have great resources but you have to be self-motivated to take full advantage (something I'm terrible at). Programs deemed malignant may suck but I bet some of them push you hard enough that you really learn the material.
 
Doctor B. said:
I would add Ulbright at Indiana to the list of great pathologists to work with. He's brilliant and a very nice guy.

I interviewed with Goldblum and heard him speak and he seems like a great guy as well.

One thing I found at many programs is that they have great resources but you have to be self-motivated to take full advantage (something I'm terrible at). Programs deemed malignant may suck but I bet some of them push you hard enough that you really learn the material.
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I think that statement is about 100% correct. Friendly doesn't always translate into giving a damn if you know your pathology after 4 years.
 
I completely forgot about Ulbright (he might be tied for #1 or 2), probably the single greatest gonad pathologist of all time, and Indiana has some incredible renal guy too, blanking on his name though. They had at one point a very famous derm fellowship as well (but they director left).

Someone emailed me about why I bagged on UCLA. Its not personal or anything. Im just unimpressed with their staff, I had never even heard of or read anything by J. Said and he's the surg path director. The most famous IMHO UCLA faculty are retired but they do have one guy I forgot: Vitners, who is very well known in Neuro. IMO UCSF>>UCLA. I have no idea who even is chair at UCLA, and Abbas (UCSF chair, former Brigham) is near diety status in immunology. In terms of UCs: UCSF>UCSD>UCLA>UCI>UCD
 
LADoc00 said:
I completely forgot about Ulbright (he might be tied for #1 or 2), probably the single greatest gonad pathologist of all time, and Indiana has some incredible renal guy too, blanking on his name though. They had at one point a very famous derm fellowship as well (but they director left).
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Eble is probably the renal guy you're thinking of. He's be quite involved with the WHO classification of renal and urothelial stuff. We used to have Farmer and Hood for derm here but they left before I started residency.
 
I just attended the CAP meeting in Phoenix. I talked with residents from all over the country. Every program has it's strengths and weaknesses.

Some common themes I heard:

The clinical path part of the program is just following a tech around and doing scut.

There is no management training. (big part of the final test and practice)

We work more on surgical path than we tell our applicants in order to get good ones.

We do not get to preview slides and spend most of our time in the gross room.

We have very little elective time, because we have to cover the gross room and other critical services.

One resident mentioned that on CP call they have to approve all platelet orders. (ouch, can you say no sleep ever on CP call)

One resident mentioned that they have to incorrectly log the time they are in the hospital in order to have time to look at the slides. (so they do not go over 80 hours a week on paper)

I will specifically mention Hopkins and MGH and say, be sure you want that lifestyle for 4 years.
 
What are some tactful questions one can ask on the interview trail to get at the malignancy issue? Any advice would be appreciated. Thanks.
 
AndyMilonakis said:
What are some tactful questions one can ask on the interview trail to get at the malignancy issue? Any advice would be appreciated. Thanks.
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A wise thing to do would be to ask multiple people at the same program the same questions and see if there are huge variations in answers (ask a variety of people from first years and up). It does not all have to be on the interview day; you could try to discreetly contact residents later on. Could ask about turnaround time to signout surgical cases and when slides come out for preview. Ask about typical day on surgical path frozens or cytology; how many residents rotate on a particular surg path rotation (including specifics on what they gross/signout each day) and compare with the annual number of cases. Ask if there are pathology assistants and what they do.
 
Exactly, ask multiple people the same question. You will catch them if they are lying eventually. Also, talk to support staff, they will tell you how it is as well.

If a program does not give you anytime with the residents then "BIG RED FLAG" should go up.

Also, emailing residents questions is a great way to go. You can find almost everyone's email address these days on the program web site.
 
AndyMilonakis said:
What are some tactful questions one can ask on the interview trail to get at the malignancy issue? Any advice would be appreciated. Thanks.
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I think you learn a lot by keeping your eyes and ears open. When you see the residents, what are they doing? Are they hanging around in the residents room previewing slides? Holding the door for attendings? Looking at porno? Do you see attendings and residents together?

How do the attendings and residents interact? How do people respond when you ask them questions about interactions, teaching, etc?

Ask about previewing and signouts. Daily schedule. The points made about support staff are key. I know many programs will not introduce you to support staff except perhaps during a tour when you say hi, but you can ask about them.
 
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