Private vs. County Hospital as core rotation site??

[jrdo]

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I have just been assigned a private hospital for my core rotations. I am interested in emergency or internal medicine. Since this is not a teaching hospital (no residents), I will be working directly with the attending, and I will be seeing on average 10-15 patients per day. I am in a unique situation where I can trade my spot for one at the county hospital where I will see around 20 patients/ day, be on call Q4 for most of my rotations, and am told will get to do more procedures since there is a high volume of uninsured patients.
My question is for those students who are at either type of institution. Do you learn better being extremely busy and seeing a large volume of patients? or by having fewer patients and having more time to look up information and have somewhat of a life.
I am willing to do either...
I would appreciate any info you can give me...
Thanks 😀

 

[rugtrousers]

I have just been assigned a private hospital for my core rotations. I am interested in emergency or internal medicine. Since this is not a teaching hospital (no residents), I will be working directly with the attending, and I will be seeing on average 10-15 patients per day. I am in a unique situation where I can trade my spot for one at the county hospital where I will see around 20 patients/ day, be on call Q4 for most of my rotations, and am told will get to do more procedures since there is a high volume of uninsured patients.
My question is for those students who are at either type of institution. Do you learn better being extremely busy and seeing a large volume of patients? or by having fewer patients and having more time to look up information and have somewhat of a life.
I am willing to do either...
I would appreciate any info you can give me...
Thanks 😀

I did most of my rotations at a non-private institution. I think you should compare and contrast the two sites not only in terms of workload, but also in terms of the types of patients you'll see at each place. Yes, you'll work hard at a county hospital, but you'll see sicker patients. The patients are more likely to be indigent, less likely to have received preventive care, and will have a greater scope of pathology than those at a private hospital, who will be older, have more chronic disease, more "lifestyle"-related disease (e.g. CAD, diabetes) and will not present the social challenges of those at a county hospital. There is probably a reason that there are no residents there, that is, the caseload is not sufficient for resident education. Most hospitals like having residents because they amount to cheap labor (oh yeah, there's the educational thing too), but if the hospital cannot meet ACGME guidelines, they won't be able to support a resident program. I think a private hospital is fine for a few days or weeks, but most of your core rotations should be in a faster-paced setting with greater patient diversity. If the private hospital accepts indigent patients, you may still get good case diversity, but the lack of residents to me seems suspect.

 

[jrdo]

Thanks for the advice.
The private hospital is the same size as the county hospital and is ranked in America's Best Hospitals for Urology, Geriatrics, and Surgery (3 feilds I'm not interested in). As far as indigent pt's, they are seen in the trauma center, but not in the rest of the rotations, so I'm guessing there will be less rare pathology.

 

[Dr JPH]

I have been in both situations...I have done some rotations at small community hospitals where it is the student and attending, and I have done rotations at very large university affiliated hospitals.

Now, this has just been my experience and may not be the same for others but the best teaching I have gotten is from the residents. Although working closely with the attendings is great as they have much to teach, I find that many attendings are a bit apprehensive about medical students doing procedures (particularly complicated ones) on their patients.

Perhaps with the residents there is less of a "this is my patient so I can't take the risk" attitude.

Not saying that I haven't had great rotations with attendings, but this has just been my experience.

Personally I would choose the rotation that is going to expose you to more pathology, more procedures, more patients and more work. Putting in the extra time now and making a good impression will pay off later.

 

[jennyboo]

I have just been assigned a private hospital for my core rotations. I am interested in emergency or internal medicine. Since this is not a teaching hospital (no residents), I will be working directly with the attending, and I will be seeing on average 10-15 patients per day. I am in a unique situation where I can trade my spot for one at the county hospital where I will see around 20 patients/ day, be on call Q4 for most of my rotations, and am told will get to do more procedures since there is a high volume of uninsured patients.
My question is for those students who are at either type of institution. Do you learn better being extremely busy and seeing a large volume of patients? or by having fewer patients and having more time to look up information and have somewhat of a life.
I am willing to do either...
I would appreciate any info you can give me...
Thanks 😀

I've done a little bit at both. My thought is that you can't go wrong either way, but don't underestimate those private community hospitals, especially those "America's Best" ones that have sick-as-$hit patient loads. Here, there's one private community hospital where residents work their butts off and see MUCH sicker patients than at the county.

Patients with good outpatient follow-up will be managed outpatient until they REALLY go downhill, at which point their outpatient doctors will realize, "Yeah, now it's time to admit." So ask about the private hospital -- there is a certain type of academic private hospital in which the patients are MORE sick than county, not less sick. I've seen my weirdest and most educational zebra cases at a private community hospital while my med student colleagues at the county saw non-cardiac chest pains and pneumonias day after day.

I would choose the rotation that people say is BUSY. If you're an intern you want less volume since it's less work for you, but if you're a med student you'll eventually learn to finish and tuck in your grand total of 2 patients and then stand around for the remaining 9 hours of your day. That sucks. Ask around and choose rotations that keep you busy instead of standing around. If not to learn more, do it just to prevent yourself from getting bored. There is nothing worse than having to stand around bored while your residents or attending are "rounding" on patients and calling social work consults on patients you have nothing to do with.

The less-than-complete ancillary services typical of county hospitals may give you plenty of opportunities to start IV's and do blood draws. The downside of a private hospital is that if the ancillary services are excellent, you won't learn. I did my medicine rotation at a private hospital and saw everything from pneumonias to malignant hypercalcemia to a mesothelioma, but could not for the life of me get the opportunity to start one silly IV or do a blood draw. But I haven't missed out. Everyone learns eventually and it's no big deal. Don't sweat the procedures -- you learn them on an as-needed basis, and most procedures beyond starting IV's are learnt during residency, no matter how many you get to attempt or do as a med student.