It is now July 2018 and I am an Internal Medicine PGY2 at Mayo Clinic in Rochester. Having just competed the categorical intern year here I figured I would add back to the SDN community and give my thoughts on the experience and address the truths and non-truths about some of the rumors that abound out there about Mayo Clinic.
I'll start off by saying that intern year is hard but it is amazing now to look at the new incoming interns and to see how much I have grown compared to my first weeks in the program. Even though it is a very tough year I feel that Internal Medicine program leadership do a great job of supporting their residents and I would absolutely rank it #1 again if I were doing the match all over. Now, that isn't to say that nothing could be improved or that there weren't some things I didn't like, but all in all, it is a phenomenal place to train.
Now that I have spent a year here I figured I can give my two cents on some of the rumors I had read about on the SDN forums concerning Mayo Clinic's Internal Medicine program.
Rumor #1 You have to wear suits every day.
This is essentially true. If you are male you have to wear a suit and tie while on the wards and in the clinic (although a sport jacket and slacks are a perfectly acceptable and cheaper alternative). Women have some more flexibility to wear a blouse and slacks, skirt, or dress. They don't have to wear a jacket or nylons or anything.
The exception to this rule is that you wear scrubs (provided by the hospital or your own light blue ones) when working in the MICU, CCU, hospital procedure service, while holding the code pager, or anytime on overnight call. While in scrubs in you can wear a white coat, a jacket without a hood, or just wear your scrubs with no jacket if you prefer.
After a week or two you really do get used to wearing a suit a lot and since everyone else in the hospital is doing the same it doesn't feel weird at all.
Rumor #2 You don't get to do procedures.
This is false. This may have been more true in the past, but the program has made changes to ensure we have access to more procedures. I honestly don't know how many procedures IM residents at other programs log, but I feel that I did as many procedures as an intern as the interns did at my med school in Texas. I felt that I did an average number of procedures compared with other interns here and I logged 4 lumbar punctures, 5 paracenteses, 3 knee arthrocenteses, 1 subacromial arthrocentesis, 3 trochanteric bursa injections, 1 bronchoscopy, some NG tube placements, and 20 or so peripheral blood draws (all 20 done on the same half day in the outpatient phlebotomy suite, residents otherwise don't need to draw blood, but it was good practice for a day). In the first couple of weeks of my PGY2 year I have done another para and placed a central line (I anticipate placing more later this year in the MICU and CCU). There will also be more dedicated time for outpatient procedures as a 3rd year resident.
As I said, I don't know how many procedures are typical at other programs, but I already feel very comfortable doing paras, LPs, knees, and trochanteric bursas by myself if needed. I will want to do a few more joints before I feel like I'll be ready to shoulders or other joints as well as central lines, but there are still 2 more years of residency ahead of me. I'm sure there are some programs that do more or less procedures than here, but all in all I have no complaints about the number of procedures available.
Rumor #3 Fellows run the show so there is little autonomy.
I don't know where this rumor came from in all honesty. Most of the services you are on as an intern don't have a fellow (the cards services you rotate through are completely resident run without a fellow even on it, just residents and an attending (Mayo calls them consultants)). You do have a fellow on inpatient Oncology (but there is no senior resident on that service and the fellow is only there some of the time). You also have a fellow on Rheumatology consults and after you see a patient you run your plan by them before they go to see the patient but this is similar to working with a senior resident. You do work with a fellow in the MICU who is involved, but I never felt like my autonomy was missing.
I will work with more fellows during my PGY2 rotations so maybe my opinion will be changed. I'll update this if it does.
Rumor #4 Rochester is in the middle of nowhere,
This one certainly has truth to it. It depends what you are looking for. Rochester has a population of about 110,000 and it is surrounded by farm land. The twin cities are about 75 minutes north of Rochester and there is plenty to do there. And considering the 4+4 schedule you have at Mayo, you actually can have time to go up and spend time (whole weekends if you like) up in "the cities" to get your city culture if you need. Although there is plenty of space to jog, bike, hike, camp, fish, kayak, etc. around. I personally am thrilled with the fact that I could buy a nice house with large yard for my 2 kids, and a garden, and only have a 10 minute, traffic-free, commute to work. Definitely less stressful than Houston's traffic was. This point is certainly something to consider when applying here though. I can understand why some people (myself included) love this area, but I can also certainly understand why some people may not be able to stand it (this is very different than New York City). Although I did talk with a co-resident from New York who though she would just come to Mayo for residency then go back for fellowship, but when interviewing there she realized she did not want to go back to the crowded, expensive, traffic and subways and decided to stay here for fellowship instead. Just some food for thought. Maybe I'll be sick of the small/medium town feel by the end of residency, who knows.
Rumor #5 Your patient volume is low and you might not be able to handle high volume practice or fellowships.
I see this one mentioned by several people on SDN who have never trained at Mayo. I don't agree with this at all, although I must admit that I can't talk from personal experience about running a busy private practice. Our general medical wards cap at 13 split between 2 residents (1 if the team is not on call that day) and the cap is higher on some of the specialty services we rotate through. I feel that I usually have time to read about and learn about my patients and their medical problems and have time to go to noon seminar and morning report and learn the didactics as well. I certainly don't feel run down all the time which is a little different than many of the interns I worked with in med school.
Rumor #6 You only see zebras, not horses.
Definitely not true. We see plenty of people from the community and surrounding towns so I feel I see plenty of bread and butter medicine (COPD exacerbations, CHF exacerbations, cellulitis, pneumonia, ACS, etc.) although I also get to see some fun zebra cases, although these are typically in the setting of someone who is visiting the clinic for their zebra condition and while in town also develop a bread and butter problem (pneumonia, etc). Now, I may only take care of 10 COPD exacerbations a year instead of 30 or 40 if I were rotating through the VA, but honestly, how many times do you need to treat one to remember steroids, antibiotics, albuterol, etc. I personally enjoy having zebras thrown in the middle of the bread and butter.
...
So, all in all, I'll just say again that even though there are some small things here and there that could be improved, and are constantly being improved, I fell that Mayo is a phenomenal place to train and I would rank it #1 again if I had to go through the match another time.
If anyone has any other specific rumors they would like addressed or questions about the program I am happy to answer them open and honestly.