Gotta argue here. jdh71 what first hand experience do you have with anything you're talking about in your posts above...?
Please don't tell me you achieved this level of enlightenment from one interview day...
I would hate for someone not to apply to Mayo because they read some thing as blatantly wrong as stated in this thread. I actually applied a week late because I was initially swayed against Mayo by some of the bogus info on here back in the day.
I don't think Rochester is that big of a deal, nor "dumpy facilities". My issue is with:
1.) Essentially one demographic of patient (sick white people [who can pay, when at the clinic proper])
Most of St Mary's (the main hospital for the clinic) infirm are drawn from a large cachet (several hundred mile radius) of farmers...most of whom are on the lower end of the socioeconomic ladder. Most doc's patient panels are by and large "rural." Many of the faculty in the primary IM clinics joke that they are old country docs...and in a sense they are correct. The same goes for the subspecialty clinics. There is no argument that we have a HUGE referral base (essentially the entire country and a portion of the world sends their medical mysteries to Mayo), but the majority of patients we see are local folks...no question. Farm accidents are the number one cause of trauma seen in the ED.
Further, MN has the largest Somali population outside of Somalia...so we see plenty of latent TB and odd ball 3rd world diseases. My first day of continuity clinic as a PGY1 I had a farmer, a Somali, and an ex pat from Switzerland. That's pretty diverse IMO.
2.) Questionable amount of accuity - you'll see some, but are you seeing enough?
In regards to acuity, sick people get sicker...and the sickest get really f'ing sick. Why would it be any different here? We see the same spectrum of disease from DKA, to critical limb ischemia, to functional decline, etc. People in Rochester don't mysteriously get different accuities of these illnesses
. In addition to the normal spectrum of disease, you will see the extremes (primarily in the CCU) after the referring top 25 "academic center" has thrown their collective hands in the air.
3.) Much less autonomy than other places
The outpatient subspecialty (aka resident education) clinics are a veritable goldmine of papers and abstracts. In regards to autonomy,
there are no fellows working with residents in the education clinics, it's just you and the consultant...re-read that sentence and let it sink in. This was my experience in GI clinic, CV clinic, Pulm clinic, Onc clinic, Endocrine clinic, Rheum clinic, etc.
If you take a complete history, give a coherent presentation, and have something resembling a logical plan, then sure...you will get plenty of autonomy in the outpatient clinics. Same goes for the inservice rotations your intern year....
the senior resident and attending aren't there to stifle your independence. Quite the opposite, if the attendings get poor evals from residents they get booted from the teaching services.
Autonomy is demanded, because starting 2nd year you are alone overnight on GI and Pulm services. If you don't show that you can formulate an independent plan by mid to late intern year you may find yourself flagged for academic "oversight".
4.) Sub-specialties very fellow driven
People say the subspecialties are "fellow driven" but I'm trying to remember when and where that was the case. Only inpatient Rheum and ID actually have a fellow on the service with residents....and I was thankful to have their input.
The MICU and CCU have an abundance of fellows...but this will become more common with resident work hr restrictions. Somebody has to see the patients.
Weird cases (who can pay) go to Rochester, but SICK patients go to the Cities.
Wrong. People who live in the cities go to the "U" or the county...it just wouldn't make sense if you were sick to drive an hour north for care. Plus, if you're TRULY SICK, how exactly would you convince the ambulance driver to drive you further for some inexplicable reason. These types of comments are just ridiculous. El oh el.
On the other hand, we get alot of people who travel south from the cities because they're tired of not getting the treatment they expect or the answers they want. I'd be a fool to assume the trail of patients didn't go both ways though...I've seen patients get bent out of shape over their care at Mayo too.
