Rank these NYC EM Programs

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kurplunkster

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Can anyone rank the following programs in terms of reputation/training? I'm looking for honest advice detailing the positives and negatives of the New York City ER programs listed below. Hoping to get input from former and/or current residents of these programs:

SUNY Downstate
NYU
Columbia
New York Hospital Queens
Brookdale
Brooklyn Hospital
Jacobi
Lincoln
Metropolitan
Mount Sinai
Beth Israel
Staten Island
St. Luke's
St. Barnabas
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kurplunkster said:
Can anyone rank the following programs in terms of reputation/training? I'm looking for honest advice detailing the positives and negatives of the New York City ER programs listed below. Hoping to get input from former and/or current residents of these programs:

SUNY Downstate
NYU
Columbia
New York Hospital Queens
Brookdale
Brooklyn Hospital
Jacobi
Lincoln
Metropolitan
Mount Sinai
Beth Israel
Staten Island
St. Luke's
St. Barnabas
Click to expand...
This topic has been covered ad nauseam. The search button is your friend.

Compare NYC EM programs
New York EM Program Stereotypes
Best New England EM Programs
E.M. Residency Program Reviews
How Competitive are NYC EM Programs

/thread
 
You are not going to get the answer you are looking for on this board. I'd recommend looking at the residency review sticky threat. Attempting to rank programs has been frowned upon both on this forum, as well as in the EM community at large. There are a couple of reasons for this:

1) No objective metric to compare programs by. The only objective things we have numbers for (board scores/pass rates, numbers of residents/year, age of residency, visit volume, etc) do not directly correlate with the quality of training.

2) Everyone thinks their program is the best. During residency, attendings who had trained at other institutions would always tell us how the place they trained at was better in all possible ways. Graduates of my residency who would then go to those places, would say the exact opposite.

3) Rank doesn't matter as much as fit. No one wants someone to come to a residency spot because of reputation, and then be miserable because they don't like the fit. It's impossible to convince medical students that reputation is not as important as the 'personality' of a program, but it's true. So we avoid talking about reputation and emphasize fit.

4) It's going to be different for different people. One program will train happy, competent residents, but not do much research. One program will see more trauma, but not train you in a lot of the softer skills. Another will be very academic, but work longer hours.

I've personally worked with people who have either trained at or worked at each of the programs on that list. I've rotated at four of those programs. I did residency at one of them. At this point I've hear good and bad things about each of them. Most people who have spent some time in the NYC EM world have. But no one I know will rank them by quality of training (except to interject that their program was number 1). That's not to say they are all the same. They are all very different programs. But any ranking of them would be meaningless.
 
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Psai said:
Beth Israel
Brookdale
Brooklyn Hospital
Columbia
Jacobi
Lincoln
Metropolitan
Mount Sinai
New York Hospital Queens
NYU
Staten Island
St. Barnabas
St. Luke's
SUNY Downstate
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RustedFox said:
Solid alphabetical ranking, there.
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I prefer char length order personally. Alphabetical only when there's a tie.

NYU
Jacobi
Columbia
Lincoln
Brookdale
St. Luke's
Beth Israel
Mount Sinai
St. Barnabas
Metropolitan
Staten Island
SUNY Downstate
Brooklyn Hospital
New York Hospital Queens
 
BoardingDoc said:
I prefer char length order personally. Alphabetical only when there's a tie.

NYU
Jacobi
Columbia
Lincoln
Brookdale
St. Luke's
Beth Israel
Mount Sinai
St. Barnabas
Metropolitan
Staten Island
SUNY Downstate
Brooklyn Hospital
New York Hospital Queens
Click to expand...

Columbia is a combined program of New York Presbyterian so it should be just above New York Hospital Queens
 
kurplunkster said:
Can anyone rank the following programs in terms of reputation/training? I'm looking for honest advice detailing the positives and negatives of the New York City ER programs listed below. Hoping to get input from former and/or current residents of these programs:

SUNY Downstate
NYU
Columbia
New York Hospital Queens
Brookdale
Brooklyn Hospital
Jacobi
Lincoln
Metropolitan
Mount Sinai
Beth Israel
Staten Island
St. Luke's
St. Barnabas
Click to expand...
Interview and decide for yourself.
 
BoardingDoc said:
I prefer char length order personally. Alphabetical only when there's a tie.

NYU
Jacobi
Columbia
Lincoln
Brookdale
St. Luke's
Beth Israel
Mount Sinai
St. Barnabas
Metropolitan
Staten Island
SUNY Downstate
Brooklyn Hospital
New York Hospital Queens
Click to expand...

Solid ranking there, too. Either one satisfies the OP's question.
 
gro2001 said:
Only if you also expand NYU and SUNY to New York University and State University of New York. Or you can call it NYP an put it at the top.
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If we go colloquially, nyu is always nyu. No one calls it new york university. Same thing with suny, people say "soony" not state university of new york and that part is usually left out so really it's just downstate. This actually bumps it up to right below st luke's. New york presbyterian is said, people don't say nyp.
 
Psai said:
If we go colloquially, nyu is always nyu. No one calls it new york university. Same thing with suny, people say "soony" not state university of new york and that part is usually left out so really it's just downstate. This actually bumps it up to right below st luke's. New york presbyterian is said, people don't say nyp.
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Well if you’re being extra colloquial most people just say Bellevue rather than NYU, whereas plenty of people say NYP and nobody says New York-Presbyterian.
 
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I like the direction this thread took. As my contribution, I'd like to point out that the hospital's name is actually NewYork-Presbyterian, not New York-Presbyterian.
 
Where is the in n out residency? It was all the rage back in my day!
 
I thought vegas. It was ranked #1 and only interviewed aoa candidates with 4 years of research and step scores of 260+. Recognized by all as the best.
 
Damn I was hoping for actual discussion. About 90% of my interviews are in NYC and I have a rough idea of what is in the top 50% of my list and what is in the bottom 50% but thats about it.
 
Sinai/Kings/Jacobi are probably the institutions which will give you the most experience. NYU/NYP/St. Luke's second. And then the rest.

I am slightly biased against NYU as people who have worked there say they don't see as much pathology as you would at Sinai's Elmhurst or Kings or Jacobi (given their locations). That said, honestly, most of those institutions are great.

If you are looking for an academically strong program, consider Sinai, NYU, NYP and then the rest.

I know people will disagree and it's just one opinion.
 
HopefulEMed said:
Sinai/Kings/Jacobi are probably the institutions which will give you the most experience. NYU/NYP/St. Luke's second. And then the rest.

I am slightly biased against NYU as people who have worked there say they don't see as much pathology as you would at Sinai's Elmhurst or Kings or Jacobi (given their locations). That said, honestly, most of those institutions are great.

If you are looking for an academically strong program, consider Sinai, NYU, NYP and then the rest.

I know people will disagree and it's just one opinion.
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Sinai sounds pretty good. My impression is they have county style training like Kings and Jacobi but they also have much stronger academics.
 
Psai said:
If we go colloquially, nyu is always nyu. No one calls it new york university. Same thing with suny, people say "soony" not state university of new york and that part is usually left out so really it's just downstate. This actually bumps it up to right below st luke's. New york presbyterian is said, people don't say nyp.
Click to expand...

Agree with everything, except people definitely say NYP. But the acronym doesn't have as much brand recognition as NYU. Presbyterian does though. Older New Yorkers often call it Presbyterian if referring to Columbia or New York Hospital if referring to Cornell, which were their respective names before the 1990s merger that created the name NewYork-Presbyterian.
 
Kings/Bellevue/Jacobi/Sinai are all 4 top tier EM programs. I would lean more towards Kings and Jacobi because I think both those two programs see the highest degree of trauma in NYC which is relatively sterile from a trauma standpoint, but the other two are phenomenal as well (apparently Sinai sees decent trauma at Elmhurst, not sure though).

Then there's everything else. I have heard fantastic things about Maimonides and St. Lukes though.
 
HopefulEMed said:
Sinai/Kings/Jacobi are probably the institutions which will give you the most experience. NYU/NYP/St. Luke's second. And then the rest.

I am slightly biased against NYU as people who have worked there say they don't see as much pathology as you would at Sinai's Elmhurst or Kings or Jacobi (given their locations). That said, honestly, most of those institutions are great.

If you are looking for an academically strong program, consider Sinai, NYU, NYP and then the rest.

I know people will disagree and it's just one opinion.
Click to expand...

I'd highly disagree with the notion that Sinai sees more pathology than NYU. Elmhust probably sees more trauma but that's about it.
 
Lexdiamondz said:
I'd highly disagree with the notion that Sinai sees more pathology than NYU. Elmhust probably sees more trauma but that's about it.
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Does that mean that you think NYU sees a good amount of pathology as well, or that both NYU and Sinai are lacking in pathology?
 
romeosterp said:
Does that mean that you think NYU sees a good amount of pathology as well, or that both NYU and Sinai are lacking in pathology?
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They both see a good amount. All this quibbling about which hospital sees "more pathology" in NYC is silly; you'll get more than enough sick patients almost everywhere you go in NYC (I say "almost everywhere" only because I can't personally vouch for so many programs).
 
Agree with enalli. Silly to rank by "pathology". You'll see plenty in every NYC program - nearly all of which have combinations of "county" and "regular/uppity" in their training to one degree or another: Kings/Downstate, NYU/Bellevue, Sinai/Elmhurst, Montie/Jacobi, Maimo/Maimo 🙂, and so on.

Trauma-wise, wtf is with the obsession with trauma with SDNers. You'll see enough "trauma" in every NYC EM residency. If you want to become the world expert on trauma, become a trauma surgeon. If you want to be a the world ER expert on trauma, go do a Shock Trauma fellowship after residency and go work in Afghanistan or Yemen.

"Fit" is probably a better thing to look at, though it's not that easy to tell the "fit" of a program by hanging out with folks for an hour. The people that show up vary from week to week, interviewers vary, etc, etc. Still, this is a useful personal metric.

A better reason to choose one place over the other is because you really want to work with a specific researcher or well funded research shop (Sinai) or expert in tox (NYU), etc, that is a good reason. Though even with this, you can do plenty of cross-residency collaboration in NYC.

Geography - ok reason; NYC has the subway but has become pretty crappy of late...and the L train, oy the L train!

I see one person mentioning "stronger academics" at Sinai - not sure what that means.

An important question to ask yourself: do you see yourself getting frustrated by not speaking the same language of your patient X% of the time?
- Kings - not the biggest problem, some Russian in Downstate, usual NYC smattering
- NYU - usual NYC + Spanish
- Sinai - you'll learn Spanish, + some Korean, Mandarin, Hindi, etc, etc in Elmhurst
- Columbia - Habla Espanol
- Jacobi - don't know, but I'm sure lotsa Spanish
- Maimo - Yiddish, Spanish + every language under the sun
 
willow18 said:
Trauma-wise, wtf is with the obsession with trauma with SDNers
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You'll have to clarify, because any and all attendings who EVER posted on SDN have had their fill of trauma, plus some. The ONLY SDNers concerned about trauma are med students that just don't "get it" yet. Year after year, for more than a decade and a half, this has remained true.

And, statistically, Elmhurst is more diverse than Maimo.
 
willow18 said:
Agree with enalli. Silly to rank by "pathology". You'll see plenty in every NYC program - nearly all of which have combinations of "county" and "regular/uppity" in their training to one degree or another: Kings/Downstate, NYU/Bellevue, Sinai/Elmhurst, Montie/Jacobi, Maimo/Maimo 🙂, and so on.

Trauma-wise, wtf is with the obsession with trauma with SDNers. You'll see enough "trauma" in every NYC EM residency. If you want to become the world expert on trauma, become a trauma surgeon. If you want to be a the world ER expert on trauma, go do a Shock Trauma fellowship after residency and go work in Afghanistan or Yemen.

"Fit" is probably a better thing to look at, though it's not that easy to tell the "fit" of a program by hanging out with folks for an hour. The people that show up vary from week to week, interviewers vary, etc, etc. Still, this is a useful personal metric.

A better reason to choose one place over the other is because you really want to work with a specific researcher or well funded research shop (Sinai) or expert in tox (NYU), etc, that is a good reason. Though even with this, you can do plenty of cross-residency collaboration in NYC.

Geography - ok reason; NYC has the subway but has become pretty crappy of late...and the L train, oy the L train!

I see one person mentioning "stronger academics" at Sinai - not sure what that means.

An important question to ask yourself: do you see yourself getting frustrated by not speaking the same language of your patient X% of the time?
- Kings - not the biggest problem, some Russian in Downstate, usual NYC smattering
- NYU - usual NYC + Spanish
- Sinai - you'll learn Spanish, + some Korean, Mandarin, Hindi, etc, etc in Elmhurst
- Columbia - Habla Espanol
- Jacobi - don't know, but I'm sure lotsa Spanish
- Maimo - Yiddish, Spanish + every language under the sun
Click to expand...

Lots and lots of Haitian Creole at Kings/Downstate, btw.
 
willow18 said:
Agree with enalli. Silly to rank by "pathology". You'll see plenty in every NYC program - nearly all of which have combinations of "county" and "regular/uppity" in their training to one degree or another: Kings/Downstate, NYU/Bellevue, Sinai/Elmhurst, Montie/Jacobi, Maimo/Maimo 🙂, and so on.

Trauma-wise, wtf is with the obsession with trauma with SDNers. You'll see enough "trauma" in every NYC EM residency. If you want to become the world expert on trauma, become a trauma surgeon. If you want to be a the world ER expert on trauma, go do a Shock Trauma fellowship after residency and go work in Afghanistan or Yemen.

"Fit" is probably a better thing to look at, though it's not that easy to tell the "fit" of a program by hanging out with folks for an hour. The people that show up vary from week to week, interviewers vary, etc, etc. Still, this is a useful personal metric.
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Sorry but I disagree with you here. This isn't about searching for the next adrenaline high and going to a residency with a high degree of trauma for the sexiness of it. In reality, pathology is extremely important when selecting a program. If you work at an inner city county hospital, you are going to get a different experience than a top tier academic affiliated hospital. There is no "correct" choice in this matter, but it's a matter of what your preferences are.

I remember when I interviewed awhile back, one of the most common lines from programs that didn't have any appreciable degree of trauma was "What's the big deal with trauma anyways!? Trauma is cookbook! You need to get comfortable managing your chest pain and belly pain patients."

The truth of the matter is that every single program you go to that is an accredited EM residency will teach you how to manage an NSTEMI, lower GI bleed or pneumonia. But not every residency is going to going to give you the same experience from the standpoint of managing multiple critically ill trauma patients at once. When I talk to senior residents, they all state that the medicine aspect of trauma is very straightforward. But it's the cognitive load you take on when you have a crashing patient, and learning how to lead the resuscitation and manage the room in a stressful environment which takes awhile.

No question that "fit" is king, but pathology should absolutely be a part of your rank listing making process. In addition to type of pathology, I think degree of pathology is hugely important. A PA, NP, or family medicine doctor without any significant EM training can manage low acuity everyday ER complaints, but you need a physician who is comfortable managing crashing patients. Some hospitals see sicker patients than others and that is an important consideration.
 
Apollyon said:
You'll have to clarify, because any and all attendings who EVER posted on SDN have had their fill of trauma, plus some. The ONLY SDNers concerned about trauma are med students that just don't "get it" yet. Year after year, for more than a decade and a half, this has remained true.

And, statistically, Elmhurst is more diverse than Maimo.
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Yah, by "SDNers" I meant the med students who haven't 'gotten it' yet.

Agree Elmhurst is statistically a more diverse population.

TheComeBackKid - I don't see where we disagree. I wasn't saying that pathology wasn't important; my point is that I don't think any one NYC program can honestly say that they have "better" or "more interesting" pathology than the next program. All large NYC hospitals have their share of sick patients. And I agree with you re how the resident experience is designed in terms of sick trauma or medical patients in terms of training for handling the cognitive load...

In terms of trauma, the programs that don't have enough, send their residents to other programs that do. The one thing I will say about trauma is that it's not so much about "how much", but how the response is handled. I.e., who are the primary responders and who has overall responsibility for the pt. This varies significantly, and can certainly affect the trauma experience both in terms of "handling the room", as well as the actual raw number/volume of trauma pts you end up caring for during residency. For example, where I trained, 3 EM residents + an EM attending were the primary responders for most (non initially critical) traumas, and they decided if and when to call Surgery. Even for critical traumas, EM were the only people in the room for the first few minutes (a product of short or no notifications by EMS + frambulances and walk-ins). The EM attending was usually the most senior person in the room even when Surgery was involved. And EM residents were generally the primary caretakers for the trauma pts. In other programs I have experienced, EM residents rotate on the surgery team who are primary caretakers, with the EM attending only responsible for the airway. Still, I think these are not such significant factors that med students should obsess about.
 
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They will all teach you great nursing skills!

IMHO none of the NYC programs are tops, although all will train you tolerably to decently. If you want to stay in NYC, train in NYC, but if you want to live elsewhere, train elsewhere. NYC is a weird place with a different healthcare system than the rest of the country. The hospital system is completely segregated- public hospital for the poors, private for the wealthy. There's tons of pathology, little trauma outside of Lincoln, Elmhurst, and KCMC, which have plenty. Very little training in ortho and variable trauma experiences, although plenty of medically ill patients and plenty of cultural diversity, although that is declining via gentrification. Everywhere is quasi-academic, so people just get admitted if there's any question. The residencies aren't as academic as, say, Harbor or Denver except for NYU's vaunted tox programs. You really do spend much of your time doing nursing and scut, and I can't think of a single NYC program that gives residents a true community hospital experience.
 
slurpy15 said:
They will all teach you great nursing skills!

IMHO none of the NYC programs are tops, although all will train you tolerably to decently. If you want to stay in NYC, train in NYC, but if you want to live elsewhere, train elsewhere. NYC is a weird place with a different healthcare system than the rest of the country. The hospital system is completely segregated- public hospital for the poors, private for the wealthy. There's tons of pathology, little trauma outside of Lincoln, Elmhurst, and KCMC, which have plenty. Very little training in ortho and variable trauma experiences, although plenty of medically ill patients and plenty of cultural diversity, although that is declining via gentrification. Everywhere is quasi-academic, so people just get admitted if there's any question. The residencies aren't as academic as, say, Harbor or Denver except for NYU's vaunted tox programs. You really do spend much of your time doing nursing and scut, and I can't think of a single NYC program that gives residents a true community hospital experience.
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Meh. After rotating at about 4 places across the country (including NYC programs), I have realised that it's really the resident that makes the program. You could place a brilliant resident who reads on his or her own, goes out of his/her way to find learning opportunities, and gets involved in as much as possible in any program, and they will come out golden. Take a dopey one and put him/her at Denver, you get a dopey one in the end. For what it's worth, NYC/Sinai (with Elmhurst)/Jacobi/Kings will probably all give the depth and breadth of pathology to be a pretty fuc**** awesome physician.
 
GonnaBeADoc2222 said:
After doing a sub-I during medical school at a "prestigious" NYC program, I cannot say how happy I am to have matched outside of NYC.
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Oh, pray tell us more (without identifying details, of course). I agree that they are nuts, and it shocks me that at least a few don't lose accreditation. What did find the most shocking? Nursing? Patient care? Physical environment?
 
Personally went to medical school in NYC and did my away here. Most shocking to me would be the sheer volume of patients fit into the ED. It was not uncommon that patients were stacked 4 stretchers deep and people have died in the corners of the ED because they weren't examined/seen in a reasonable amount of time. Privacy is not a thing and patient's next to each other would often translate because they were just sitting in chairs next to each other, since there weren't enough stretchers. Nursing is an issue partly because of insufficient amount staffed, but also the very very strong union allows a nurse to just refuse to do anything if they wanted to outside of giving meds as it's "outside their job "(a minority of them but especially painful when it happens). Don't even get me started about nursing on the inpatient side of things... The residents and attending have almost all been great and very knowledgeable if a little over worked. Very hopeful that next Friday I see congrats you matched outside of NYC on my letter.
 
As a NYC resident I urge you to rotate at these places before considering them. Many NYC hospitals, even the "prestigious" ones are completely dysfunctional. Like a previous poster said people dying in the hallways is not uncommon. At many residents to have to start lines, draw labs and push their patients to CT. You're not training to be a nurse or transporter, you're training to be a doctor...that sht gets old fast. There are a few of these programs who have pretty functional ED's with great nursing and ancillary staff but thats hard to find in NYC and is very important IMO.
 
People justify the scut by saying that it doesn't matter because they see so much acuity. I call bull**** on that. Every IV you start, every patient you push is one less patient you see, one less procedure, and one less teaching moment. The best comment I heard on NYC hospitals was "wow, our county hospital back in (home state) gave universally better care than your world-renowned private hospitals." I would have to agree.

The trauma center I rotated through, which has a great reputation by NYC standards, was abysmally far from any standard of care normal in the USA. The docs I know who have trained and worked in NYC EDs for their whole careers (school, residency, attending) have a completely different view of what is normal. Here is what I have seem:

-pelvic exams in hallways
-unchaperoned pelvic exams by female docs considered acceptable
-docs required to put foleys in men as hospital policy
-docs start IVs
-docs start all ultrasound-guided IVs
-fractures that could be followed up outpt (which is pretty much everything except hips) are routinely admitted for no reason
-no propofol for sedations
-translators rarely/never used (in flagrant violation of federal law)
-no one seems to know how to do a reduction (ortho seems to always come in)
-general EM docs rarely/never see kids (incompetent pediatricians see them half the time, not even PEM)
-kids don't seem to get sedation for lacerations (it's all brutane)
-there appears to be no concept that the patient is actually a person/no concept of customer service, the nurses are allowed to be completely rude to the patients
- INSANE med management policies where physicians are allowed to dispense medications (this is terrible from both a safety and abuse standpoint). Unheard of and not allowed anywhere else.

How the world's most litigious city allows this to continue I don't know. Perhaps things have changed. I hope so. Any thoughts???
 
Hmm...it was more than 10 years ago for me, but, to the above poster, I didn't have to do essentially any of the things listed. Never put a Foley in a guy, didn't do a hallway pelvic, was never prevented from an interpreter, and only saw nurses treat patients (even ****bags) with at least basic courtesy (even when not deserved). I don't know what the problem is with a female doc doing a pelvic without a chaperone, but, maybe, I'm wrong with that.

Still, all the things listed sounds rather bleak. I feel for that person. Hell, my MICU rotation in residency (of what I speak is from internship) had some of the most menial, childish, assholish, schmuckish, dickish, ****ty people you'd ever meet. This was at Duke, by the way. If these people were your neighbors, you'd punch them. If they were your siblings, you would beat the **** out of them.

So, medicine is full of horrible people. I wonder if their kids know that their parents are ass holes.
 
I trained at an academic program in NYC. A lot of what the posters have said is true. If you train in NYC you will see patients in hallways, have shortage of access to interpreters, get very little penetrating trauma, push patients to CT, start IVs, occasionally encounter the "it's not my job" ancillary staff, lament your ortho experience, admit lots of people for BS reasons. And you will come out at the end better than most ER docs. You will be prepared to work at any hospital, not just a well functioning one. Remember: anyone, anything, any time. That includes knowing how to work a system that is not functioning perfectly.

I no longer work in NYC. The hospital I currently work at could never be described as a well oiled machine. These are some of the cases I dealt with on a recent shift:

-Spontaneous tension pneumo
-Seizing hyponatremic
-Dislocated shoulder
-Dislocated elbow
-Young out of hospital cardiac arrest
-Four year old trauma with a GCS of 3
-PE with heart failure and hemoptysis, hypotensive and tachycardic
-Stroke
-Septic dialysis patient

I left the shift being super thankful for the training I got in residency. I felt well prepared for this.
 
One of the biggest turn-offs for me at the particular "prestigious" place I was rotating at was the smug hypocritical attitude of "we treat any person, anytime" blah blah blah....yet those who could afford to pay got to go to the shiny private hospital while the poor went to the dungeon-esque public hospital.

Most of the above I also saw. It was so bad I went from loving EM during my home sub-I to questioning my decision to enter the field during this one.

As an aside, being from the area originally, and very much liking visiting NYC, I'll never comprehend the obsession some people have with actually living there. Any remotely nice 1 BR apartment is pushing 3k/mo, crowds EVERYWHERE, 4% local income tax, every basic life task is a hassle from grocery shopping to getting to the airport.
 
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Everything in this thread is so true. Except pelvics in the hallway. I really can't see that happening.

Nurses will spend a ridiculous amount of time paging you to do their job instead of just doing it. They are somehow overworked and really goddamn lazy at the same time. Techs and transporters will sit around watching videos on their phones rather than do the job they are paid to do.

The training seems to be good but is it worth the bull****? Hard to say.
 
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GonnaBeADoc2222 said:
One of the biggest turn-offs for me at the particular "prestigious" place I was rotating at was the smug hypocritical attitude of "we treat any person, anytime" blah blah blah....yet those who could afford to pay got to go to the shiny private hospital while the poor went to the dungeon-esque public hospital.

Most of the above I also saw. It was so bad I went from loving EM during my home sub-I to questioning my decision to enter the field during this one.

As an aside, being from the area originally, and very much liking visiting NYC, I'll never comprehend the obsession some people have with actually living there. Any remotely nice 1 BR apartment is pushing 3k/mo, crowds EVERYWHERE, 4% local income tax, every basic life task is a hassle from grocery shopping to getting to the airport.
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I am so glad you mentioned this issue with the segregated hospital system. Every hospital, by law, treats everyone, as we all know. But only in NYC do they try and segregate the poor patients out by having an entirely separate hospital system for them. The HHC system is so bad and it appears to exist only for the benefit of its administrators and its unionized employees. It should be shut down and those state dollars should go to the private hospital system so poorer folk can get the same level of care as the wealthy. What's even more disturbing is the sanctimonious view of so many docs at the public hospitals that they are oh so great for working with the poor, while not caring enough about the poor to actually challenge the segregated system that treats poor patients so badly. I wish they would be more honest "I work in this hospital because I don't care about patient satisfaction etc." as opposed to their misplaced noblesse oblige. NY is very segregated in every way.

I am a native NYer and I yearn to go back, but I actually find my current red state to be much more liberal on education, segregation, affordable housing, and of course healthcare than NYC.
 
gro2001 said:
I trained at an academic program in NYC. A lot of what the posters have said is true. If you train in NYC you will see patients in hallways, have shortage of access to interpreters, get very little penetrating trauma, push patients to CT, start IVs, occasionally encounter the "it's not my job" ancillary staff, lament your ortho experience, admit lots of people for BS reasons. And you will come out at the end better than most ER docs. You will be prepared to work at any hospital, not just a well functioning one. Remember: anyone, anything, any time. That includes knowing how to work a system that is not functioning perfectly.

I no longer work in NYC. The hospital I currently work at could never be described as a well oiled machine. These are some of the cases I dealt with on a recent shift:

-Spontaneous tension pneumo
-Seizing hyponatremic
-Dislocated shoulder
-Dislocated elbow
-Young out of hospital cardiac arrest
-Four year old trauma with a GCS of 3
-PE with heart failure and hemoptysis, hypotensive and tachycardic
-Stroke
-Septic dialysis patient

I left the shift being super thankful for the training I got in residency. I felt well prepared for this.
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OK, that's great. But you learn this in any residency.
 
slurpy15 said:
I am so glad you mentioned this issue with the segregated hospital system. Every hospital, by law, treats everyone, as we all know. But only in NYC do they try and segregate the poor patients out by having an entirely separate hospital system for them. The HHC system is so bad and it appears to exist only for the benefit of its administrators and its unionized employees. It should be shut down and those state dollars should go to the private hospital system so poorer folk can get the same level of care as the wealthy. What's even more disturbing is the sanctimonious view of so many docs at the public hospitals that they are oh so great for working with the poor, while not caring enough about the poor to actually challenge the segregated system that treats poor patients so badly. I wish they would be more honest "I work in this hospital because I don't care about patient satisfaction etc." as opposed to their misplaced noblesse oblige. NY is very segregated in every way.

I am a native NYer and I yearn to go back, but I actually find my current red state to be much more liberal on education, segregation, affordable housing, and of course healthcare than NYC.
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What do you mean challenge the segregated system? It's been like that since the beginning, when the New York Hospital would send all undesirables to Bellevue. And public hospital employees get paid way less.
 
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Well, that's a segregated system. And it's wrong. The schools in the South were segregated until the Court ruled they couldn't be. Just because it's been like that forever doesn't mean it's right.

Don't you think NYC should join the more modern parts of America by combining its public and private hospitals. Yes, it's been like that since the beginning. But it's time to change. It's not right that poor people have a separate and, by any measure less equal, hospital system.

And frankly, the HHC docs should get paid the same as everyone else. The system in NYC is set up for administrators, rich white folks who don't want to be around poor people, and nursing unions. It's not set up for doctors or patients, especially poor patients.

If the docs at HHC hospitals are so into social justice, they should challenge the unjust system. But they shouldn't brag about treating poor people while supporting a segregated system.
 
slurpy15 said:
Well, that's a segregated system. And it's wrong. The schools in the South were segregated until the Court ruled they couldn't be. Just because it's been like that forever doesn't mean it's right.

Don't you think NYC should join the more modern parts of America by combining its public and private hospitals. Yes, it's been like that since the beginning. But it's time to change. It's not right that poor people have a separate and, by any measure less equal, hospital system.

And frankly, the HHC docs should get paid the same as everyone else. The system in NYC is set up for administrators, rich white folks who don't want to be around poor people, and nursing unions. It's not set up for doctors or patients, especially poor patients.

If the docs at HHC hospitals are so into social justice, they should challenge the unjust system. But they shouldn't brag about treating poor people while supporting a segregated system.
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I agree with your criticism of insufferable virtue-signaling, but I have to completely disagree with the rest. Why do you believe that the rich and the poor should enjoy the same quality of service? If Bill Gates got cancer, would you ban him from using his billions of dollars to pursue the most over-the-top, expensive treatment options available because "the poor" would not have the same opportunities? At the end of the day, the hard truth is that there is not enough money in the world to give everyone the same level of care as the rich can buy for themselves, so if "inequality" or "segregation" is a problem for you then the only possible solution is to literally outlaw rich people from spending their own money on their own health beyond a government designated maximum "fair" amount, which is terrifying notion that leads straight to gulags eventually.

I know this is not what you're suggesting, but it's what would have to happen to achieve "equality" in healthcare access. It's a good/service like any other, in a capitalist system the rich will have better cars than the poor, they'll eat better food, and they'll receive better healthcare, unless the government steps in and in effect bans private property rights.

And why bring race into it? I'm pretty sure the hospitals look at your insurance, not your skin color, when determining where to send you. Somehow I can't picture Larry Chen, Managing Director at Goldman Sachs, getting turned away from a private Hospital in NYC because although he's one of the rich folks, he's not one of the rich white folks.
 
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I think that the issue is that the poor of New York are not offered the same level of care as usual and customary in the rest of the US.

And, I assume you think there should be limits to what the rich can do. Should the rich be able to buy humans and keep them as slaves? Buy organs? It's a matter of degree. We all have our different comfort level.

As to "why bring race into it" I'm not- race is already in it as the poor of NY are overwhelmingly nonwhite.
 
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