Rank these NYC EM Programs

[Psai]

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.

They get the same doctors and access to procedures as everyone else. You seem pretty desperate to come back to New York for someone who is so disdainful of the care provided.

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[slurpy15]

There are tons of jobs available in NYC. Columbia, Cornell, all the PAGNY sites, Mount Sinai, Montefiore, Kings County, Flushing, Jamaica...they are all hiring except for Northwell, which is non NYC-based and appears to have better pay and a higher standard of care. I think a lot of people in NYC have realized the paltry salaries, high liability, and poor care are not worth it. I would love to come back to NYC, but the level of medical care and the dysfunctional system admittedly make it hard. It's a tough dilemma. You are correct. I would love for someone to prove me wrong, but every time I look in NYC it's the same issues.

-I don't think any HHC in NYC offers cancer care on the level of Sloan Kettering.
-Last I checked, only Bellevue among all the HHCs offered CABGs, although that may have changed
-Even Kings County, which is huge, doesn't offer CATHS. That's absurd.
-I have worked in both public and private hospitals in NYC, and while the level of care is universally low (and docs are not encouraged to practice to the top of their license, sadly), the HHC hospitals seemed much more dysfunctional.
-There have been many scandals at HHC hospitals and fewer at private hospitals. Remember the lost stress tests at Harlem Hospital? The midwives at North Central Bronx?
-They still have six bed rooms at some HHCs. I am not aware of private hospitals doing this.
-It's unclear how patients at the HHC hospitals have access to the same doctors. Are the cardiac surgeons at Columbia working at Harlem Hospital? No. Are the oncologists from MSK working at Bellevue? No.
-If the care were the same, why wouldn't the wealthy go to the HHC facilities?

I realize there are many fine docs in NYC fighting the system. But saying I'm desperate to come back to NYC doesn't solve the dysfunction, the segregation, the unequal care, and the nursing issues.

Do you get your care at an HHC?

 

[Money Moniker]

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.

Wow, so it seems you really do think the rich should be banned from spending an "unfair" amount of their own money on their own health. I hope you're joking and that you're not actually trying to insinuate that a rich entrepreneur using his own hard-earned money to buy premium healthcare is on a spectrum with freakin' slavery, but I can't interpret your post any other way.

Also, it's not 1965 anymore where everything is black and white. In NYC particularly, the financial pecking order goes something like Asian>= South Asian>White>Hispanic>Black. That's if you look at median earnings at least. Sure, the very top level CEOs etc are likely to be white guys like Lloyd Blankfein and Michael Bloomberg but what do you expect in a country where the overwhelming majority of the population in the over 50 demographic is white? Might as well complain that the leader of China is an old Chinese guy lol.

 

[HopefulEMed]

There are tons of jobs available in NYC. Columbia, Cornell, all the PAGNY sites, Mount Sinai, Montefiore, Kings County, Flushing, Jamaica...they are all hiring except for Northwell, which is non NYC-based and appears to have better pay and a higher standard of care. I think a lot of people in NYC have realized the paltry salaries, high liability, and poor care are not worth it. I would love to come back to NYC, but the level of medical care and the dysfunctional system admittedly make it hard. It's a tough dilemma. You are correct. I would love for someone to prove me wrong, but every time I look in NYC it's the same issues.

-I don't think any HHC in NYC offers cancer care on the level of Sloan Kettering.
-Last I checked, only Bellevue among all the HHCs offered CABGs, although that may have changed
-Even Kings County, which is huge, doesn't offer CATHS. That's absurd.
-I have worked in both public and private hospitals in NYC, and while the level of care is universally low (and docs are not encouraged to practice to the top of their license, sadly), the HHC hospitals seemed much more dysfunctional.
-There have been many scandals at HHC hospitals and fewer at private hospitals. Remember the lost stress tests at Harlem Hospital? The midwives at North Central Bronx?
-They still have six bed rooms at some HHCs. I am not aware of private hospitals doing this.
-It's unclear how patients at the HHC hospitals have access to the same doctors. Are the cardiac surgeons at Columbia working at Harlem Hospital? No. Are the oncologists from MSK working at Bellevue? No.
-If the care were the same, why wouldn't the wealthy go to the HHC facilities?

I realize there are many fine docs in NYC fighting the system. But saying I'm desperate to come back to NYC doesn't solve the dysfunction, the segregation, the unequal care, and the nursing issues.

Do you get your care at an HHC?

I share your frustration, my friend. It takes a certain kind of person to work in the HHC system. That said, some of us want to train in that chaos and work with those underserved communities. I specifically sought them out because it's my calling. And it's not for everyone. And I am very hopeful and optimistic to slowly change that system. It will take decades, but hopefully, if we can rally more healthcare professionals together...maybe we can change it a little. Use it a motivating factor rather showing disdain for the entire system. Work toward improving it, despite the immense challenges. It takes a patient, suave, energetic, outgoing, and really nice/smart person to work and to survive within the HHC system. If you can survive training in NYC, you are bound to survive any other health system.

 

[slurpy15]

Wow, so it seems you really do think the rich should be banned from spending an "unfair" amount of their own money on their own health. I hope you're joking and that you're not actually trying to insinuate that a rich entrepreneur using his own hard-earned money to buy premium healthcare is on a spectrum with freakin' slavery, but I can't interpret your post any other way.

Also, it's not 1965 anymore where everything is black and white. In NYC particularly, the financial pecking order goes something like Asian>= South Asian>White>Hispanic>Black. That's if you look at median earnings at least. Sure, the very top level CEOs etc are likely to be white guys like Lloyd Blankfein and Michael Bloomberg but what do you expect in a country where the overwhelming majority of the population in the over 50 demographic is white? Might as well complain that the leader of China is an old Chinese guy lol.

So, as you note, there are racial disparities in income. So race is already there.

No, I'm not suggesting that. But the wealthy already buy kidneys in other countries. Should we allow that here? The wealthy used to own people. We could allow that here, too. My point is that you obviously think there should be limits on what the wealthy can buy. So do I. I just have a different notion of the limits.

 

[slurpy15]

I share your frustration, my friend. It takes a certain kind of person to work in the HHC system. That said, some of us want to train in that chaos and work with those underserved communities. I specifically sought them out because it's my calling. And it's not for everyone. And I am very hopeful and optimistic to slowly change that system. It will take decades, but hopefully, if we can rally more healthcare professionals together...maybe we can change it a little. Use it a motivating factor rather showing disdain for the entire system. Work toward improving it, despite the immense challenges. It takes a patient, suave, energetic, outgoing, and really nice/smart person to work and to survive within the HHC system. If you can survive training in NYC, you are bound to survive any other health system.

Agreed. But why not dismantle the HHC system and make a better system, like the rest of the US seems to have? Why are people in NYC so attached to an inefficient, two tiered system with many redundancies that serves no one very well? That's what I don't understand.

 

[Money Moniker]

So, as you note, there are racial disparities in income. So race is already there.

No, I'm not suggesting that. But the wealthy already buy kidneys in other countries. Should we allow that here? The wealthy used to own people. We could allow that here, too. My point is that you obviously think there should be limits on what the wealthy can buy. So do I. I just have a different notion of the limits.

Do I believe people should be allowed to sell themselves into slavery? Absolutely not. Do I believe people should be able to sell their own kidney, potentially for millions of dollars? I'd have to think long and hard about that, and I can definitely see arguments both ways. But both of those situations are qualitatively different from what you're suggesting. In the case of slavery and organs, laws exist banning financial transactions in order to protect vulnerable individuals from harm. This is qualitatively similar to the basic precepts of criminal codes since Hammurabi, where murder or theft etc are crimes because they impinge on the basic rights of others. Just because you're rich, you're not allowed to pay to have someone murdered.

You're arguing against something totally different. You want to ban rich people from using their money on their own healthcare not to prevent harm to others, but to enforce equality. Why is this completely different? Because if a rich person buys an organ, a poor person suffers direct physical harm from that transaction via hyperfiltration injury down the line. If you make such a transaction illegal, the direct physical harm cannot occur. On the other hand, what harm results to poor people if the rich guy uses money that would otherwise go to buying the newest Bugatti Chiron to instead check himself into a ludicrously luxurious private hospital? There is no direct harm to anyone, which is why making laws to prevent such a thing is completely outside the Western tradition and only exists in Marxists hellholes (and even there only in theory, since Dear Leader and his pals get privileges Western fat-cats can only dream of).

 

[slurpy15]

Do I believe people should be allowed to sell themselves into slavery? Absolutely not. Do I believe people should be able to sell their own kidney, potentially for millions of dollars? I'd have to think long and hard about that, and I can definitely see arguments both ways. But both of those situations are qualitatively different from what you're suggesting. In the case of slavery and organs, laws exist banning financial transactions in order to protect vulnerable individuals from harm. This is qualitatively similar to the basic precepts of criminal codes since Hammurabi, where murder or theft etc are crimes because they impinge on the basic rights of others. Just because you're rich, you're not allowed to pay to have someone murdered.

You're arguing against something totally different. You want to ban rich people from using their money on their own healthcare not to prevent harm to others, but to enforce equality. Why is this completely different? Because if a rich person buys an organ, a poor person suffers direct physical harm from that transaction via hyperfiltration injury down the line. If you make such a transaction illegal, the direct physical harm cannot occur. On the other hand, what harm results to poor people if the rich guy uses money that would otherwise go to buying the newest Bugatti Chiron to instead check himself into a ludicrously luxurious private hospital? There is no direct harm to anyone, which is why making laws to prevent such a thing is completely outside the Western tradition and only exists in Marxists hellholes.

Actually, I'm not suggesting any of that. All I'm suggesting is that we merge HHC hospitals with the voluntary hospitals. I would argue this would not prevent the wealthy from using their money as they see fit (they can have their fancy floor with what are always the worst nurses), but that it would immeasurably improve the care of poor patients, who suffer in third rate hospitals for no real reason than a dysfunctional, old system. . I don't see why or how this would hurt anyone except the ludicrously corrupt unions of HHC and the insanely dysfunctional bureaucrats. The vast sums used to support HHC would be better used elsewhere.

 

[engineeredout]

I'm from New York, rotated through several NYC hospitals as a student, interviewed for residency and fellowship at NYC hospitals, and am infinitely happy not to be or going to be in NYC. I trained in a major east coast city with tons of poverty, drugs, knife/gun club, pathology, real busy places. And you know what I don't do? Wheel my patients to CT, put in IVs on everyone, personally discharge patients, and all the other non-physician things that get done in NYC hospitals. You can get damn good training elsewhere without dealing with the complete cluster**** of NYC hospitals, and you can certainly get better compensated for your work elsewhere as an attending.

Oh by the way,

After 3 Physician Suicides, Mount Sinai Is Increasing Rent on Resident Housing By 40%

For buildings that Mt. Sinai itself owns:

Presently, studio apartments in the building range from $1,402 to 1,607 a month. The most expensive two-bedroom units go for $3,800.
Under the new rent hike, incoming residents will pay $1,947 to $2,224 for a studio and up to $4,500 for a two-bedroom apartment, documents obtained by Refinery29 confirm.

 

[Lexdiamondz]

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.

you'd think that were true but interestingly that's not the case...

 

[slurpy15]

you'd think that were true but interestingly that's not the case...

Lex, you are wise. Thank you.

 

[Money Moniker]

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.

you'd think that were true but interestingly that's not the case...

Lex, you are wise. Thank you.

Wait, are you guys making the claim that private hospitals in NYC will turn away well-off minority patients and only take money from well-off white patients? I hope you realize that's an extraordinary claim to make in this day and age and would cause a huge shtstorm if it was true and were to come to light.

Who exactly at those hospitals would make the decision to turn away a Wall Street executive with top notch insurance as a patient for being of Asian (or whatever) ethnicity? Does the hospital CEO have nothing to do and makes these decisions on a case by case basis, or are the $15/hr administrative staff given marching orders of "whites only" and empowered to turn away minorities at the door with the full confidence of senior leadership that none would ever blow the whistle to the press? Furthermore, are all the doctors at these hospitals white? Surely if a place refuses to take minorities as paying customers, they'd never think of hiring one as a highly paid doctor to treat their presumably just as racist patients?

I'm sorry, but this claim is too fantastic to believe without some serious evidence.

 

[InternistDO]

I guess all those Dominicans in Columbia's ED must be white finance executives cunningly disguised as immigrant workers...

Don't get me wrong, NYC healthcare has flaws, and many HHC hospitals are dumps, but some of these claims are a little ridiculous.

 

[enalli]

I guess all those Dominicans in Columbia's ED must be white finance executives cunningly disguised as immigrant workers...

Don't get me wrong, NYC healthcare has flaws, and many HHC hospitals are dumps, but some of these claims are a little ridiculous.

Glad you pointed this out. Whoever implied that Columbia doesn't take care of underserved patients has never been to Washington Heights.

 

[slurpy15]

Glad you pointed this out. Whoever implied that Columbia doesn't take care of underserved patients has never been to Washington Heights.

I don't think uninsured patients can get nonemergent surgery or attend outpatient visits at Columbia (or any other private hospital in NYC),but would love to learn I'm wrong.

 

[slurpy15]

I guess all those Dominicans in Columbia's ED must be white finance executives cunningly disguised as immigrant workers...

Don't get me wrong, NYC healthcare has flaws, and many HHC hospitals are dumps, but some of these claims are a little ridiculous.

As you point out, in the ER. Not at the outpatient clinics. Not getting their hips replaced.

 

[InternistDO]

I know that NYP has a charity care policy at many of its clinics, but I have no experience with them.

I'm not suggesting that the public/private model is perfect by any stretch, and I honestly don't know the policies behind non-emergent surgeries and stuff at the private hospitals for uninsured patients, but some people were suggesting that private hospitals are throwing people out on the street based on race and income, which is untrue (and in New York, of all places, would probably lead to protests in the streets). That was my main point of contention.

 

[slurpy15]

Agreed. I just see no reason for two separate and unequal systems, aside from lining the pockets of the nursing union and some corrupt administrators.

 

[gro2001]

I don't think uninsured patients can get nonemergent surgery or attend outpatient visits at Columbia (or any other private hospital in NYC),but would love to learn I'm wrong.

Columbia runs sliding scale internal medicine and primary care clinics, which I believe are open to noninsured patients. And if their income is low enough, they pay very little if anything. You are probably right about non-emergent surgery and specialty outpatient visits though. Pretty sure you can't get an appointment with most subspecialists at Cornell, Columbia, or any other private university affiliated clinic in NYC without insurance.

At the risk of exposing my ignorance: is that different at other private university affiliated clinics though? Do, say, Vanderbilt or Stanford open their clinics up to everyone regardless of their ability to pay? That would be a big surprise to me.

 

[slurpy15]

Where I live the private hospitals and clinics have assumed care of the uninsured. It's not perfect, and there are some access issues, but the standard of care is certainly higher.

Don't know about the others. I wouldn't have a problem with HHC if the administration felt the patients deserved a higher standard of care. But they don't seem to care at all.

 

[Psai]

Where I live the private hospitals and clinics have assumed care of the uninsured. It's not perfect, and there are some access issues, but the standard of care is certainly higher.

Don't know about the others. I wouldn't have a problem with HHC if the administration felt the patients deserved a higher standard of care. But they don't seem to care at all.

What standard of care is being missed? What do these patients not have access to?

 

[slurpy15]

1. Not a single HHC hospital does organ transplants, as far as I know.
2. They don't have the breadth or depth of specialists that academic medical centers do, or even larger community hospitals.
3. Very few HHC hospitals have a cath lab- at Kings County, which is ginormous, patients wait ages to go across the street to Downstate.
4. Seemingly disproportionate number of scandals- NCB midwives, Harlem hospital echo scandal, Kings County Psych unit scandal etc.
5. The ERs are inefficient and unsafe at many (not all) facilities.
6. Shorter time to file a medmal claim than at private hospitals (90 days vs 2.5 years). Not that I want to increase malpractice claims, but it should be the same for both systems.

I just don't see a reason for a totally different system that offers fewer services than at local academic and community hospitals.

Modern Healthcare's take: New York City's segregated hospital system They note it is segregated, too. It's the title!

 

[slurpy15]

Here are some takes on the situation. Obviously many will disagree, but this is an ongoing concern for many. New York in general is very segregated, so it's not surprising to me. Just sad.

NYC's Hospital System Works In "Jim Crow-Style Racial Segregation," Study Shows

Black and Poor New Yorkers Largely Shut Out of Major Academic Hospitals | SPH | Boston University

https://www.institute.org/wp-content/uploads/2011/06/Seperate_Uneaqual_Care_in_NewYorkCity.pdf.pdf

Study points to segregated hospitals in New York City, and other regional news

Hospitals in New York City segregated by race and insurance status: new study | Physicians for a National Health Program

Fighting to Make Health Equality a Reality | HuffPost

 

[Lexdiamondz]

Wait, are you guys making the claim that private hospitals in NYC will turn away well-off minority patients and only take money from well-off white patients? I hope you realize that's an extraordinary claim to make in this day and age and would cause a huge shtstorm if it was true and were to come to light.

Who exactly at those hospitals would make the decision to turn away a Wall Street executive with top notch insurance as a patient for being of Asian (or whatever) ethnicity? Does the hospital CEO have nothing to do and makes these decisions on a case by case basis, or are the $15/hr administrative staff given marching orders of "whites only" and empowered to turn away minorities at the door with the full confidence of senior leadership that none would ever blow the whistle to the press? Furthermore, are all the doctors at these hospitals white? Surely if a place refuses to take minorities as paying customers, they'd never think of hiring one as a highly paid doctor to treat their presumably just as racist patients?

I'm sorry, but this claim is too fantastic to believe without some serious evidence.

No, what I'm saying is that EMS will "street triage" patients who fit the "profile" of certain hospitals over others. Black people and "foreign" appearing people in particular get disproportionately shunted to HHC hospitals by EMS even when they are insured.

I guess all those Dominicans in Columbia's ED must be white finance executives cunningly disguised as immigrant workers...

Don't get me wrong, NYC healthcare has flaws, and many HHC hospitals are dumps, but some of these claims are a little ridiculous.

Columbia literally gave no f*cks about that ED until recently. Of the major academic centres in NYC Columbia had the reputation of having the worst Emergency Department for many years. The only reason those dominicans are there is because Columbia is in a heavily dominican neighborhood and is the only hospital there in a 50 block radius. If there was a HHC hospital nearby they'd be shunted there.

 

[bengaltiger211]

I came into the interview process targeting NYC for residency, and did an away last summer at an NYC academic hospital to be sure I would feel comfortable there. When I was making my list, location was the highest priority for me. I loved living in the city during my away, and my SO lives in the city along with many of my close friends. So, that had a big impact on my decision. I was only really looking at large cities for residency, so the COL was really not that different (excluding Philly).

I have thought about the hospital segregation issue, though it didn't play a huge part in my decision. Many large academic centers do this - they have the big house which is new and shiny, and a community site a few miles down the road. In an effort to optimize the payer mix at the large academic center, they will shuffle the uninsured to the community site. For example - Johns Hopkins vs. Johns Hopkins Bayview. That's just to say NYC is not the only place this sort of thing happens.

Maybe the market could come up with a better solution than HHC. I'm not sure access problems would actually get better, though quality might. In the mean time, I've prioritized programs where faculty attend at both a underserved site like HHC and the private hospital, so we know that at least the department recognizes that physicians shouldn't be segregated. At NYU, faculty are required to attend at both Tisch and Bellevue. At Mount Sinai, many faculty are credentialed at both Sinai and Elmhurst, but they are certainly separate departments. NYP is more segregated, clear Weill attendings and Columbia attendings. Just depends what's important to you. I enjoyed my time in New York, and I don't think this thread represents an accurate general opinion of those who are looking at NYC for residency. Working as an attending is a different story, of course.

 

[slurpy15]

No, what I'm saying is that EMS will "street triage" patients who fit the "profile" of certain hospitals over others. Black people and "foreign" appearing people in particular get disproportionately shunted to HHC hospitals by EMS even when they are insured.



Columbia literally gave no f*cks about that ED until recently. Of the major academic centres in NYC Columbia had the reputation of having the worst Emergency Department for many years. The only reason those dominicans are there is because Columbia is in a heavily dominican neighborhood and is the only hospital there in a 50 block radius. If there was a HHC hospital nearby they'd be shunted there.

So true. I chatted with a former chair about why he left, and it was because the ER and the patients it served were so neglected by Columbia.

 

[slurpy15]

I think what should matter is what's important to the patient. I think the difference at JHU is that those are both Hopkins facilities. New York is uniquely segregated. Boston, for example, is much better.

 

[slurpy15]

I came into the interview process targeting NYC for residency, and did an away last summer at an NYC academic hospital to be sure I would feel comfortable there. When I was making my list, location was the highest priority for me. I loved living in the city during my away, and my SO lives in the city along with many of my close friends. So, that had a big impact on my decision. I was only really looking at large cities for residency, so the COL was really not that different (excluding Philly).

I have thought about the hospital segregation issue, though it didn't play a huge part in my decision. Many large academic centers do this - they have the big house which is new and shiny, and a community site a few miles down the road. In an effort to optimize the payer mix at the large academic center, they will shuffle the uninsured to the community site. For example - Johns Hopkins vs. Johns Hopkins Bayview. That's just to say NYC is not the only place this sort of thing happens.

Maybe the market could come up with a better solution than HHC. I'm not sure access problems would actually get better, though quality might. In the mean time, I've prioritized programs where faculty attend at both a underserved site like HHC and the private hospital, so we know that at least the department recognizes that physicians shouldn't be segregated. At NYU, faculty are required to attend at both Tisch and Bellevue. At Mount Sinai, many faculty are credentialed at both Sinai and Elmhurst, but they are certainly separate departments. NYP is more segregated, clear Weill attendings and Columbia attendings. Just depends what's important to you. I enjoyed my time in New York, and I don't think this thread represents an accurate general opinion of those who are looking at NYC for residency. Working as an attending is a different story, of course.

All faculty? Or just EM faculty?

 

[GonnaBeADoc2222]

I came into the interview process targeting NYC for residency, and did an away last summer at an NYC academic hospital to be sure I would feel comfortable there. When I was making my list, location was the highest priority for me. I loved living in the city during my away, and my SO lives in the city along with many of my close friends. So, that had a big impact on my decision. I was only really looking at large cities for residency, so the COL was really not that different (excluding Philly).

I have thought about the hospital segregation issue, though it didn't play a huge part in my decision. Many large academic centers do this - they have the big house which is new and shiny, and a community site a few miles down the road. In an effort to optimize the payer mix at the large academic center, they will shuffle the uninsured to the community site. For example - Johns Hopkins vs. Johns Hopkins Bayview. That's just to say NYC is not the only place this sort of thing happens.

Maybe the market could come up with a better solution than HHC. I'm not sure access problems would actually get better, though quality might. In the mean time, I've prioritized programs where faculty attend at both a underserved site like HHC and the private hospital, so we know that at least the department recognizes that physicians shouldn't be segregated. At NYU, faculty are required to attend at both Tisch and Bellevue. At Mount Sinai, many faculty are credentialed at both Sinai and Elmhurst, but they are certainly separate departments. NYP is more segregated, clear Weill attendings and Columbia attendings. Just depends what's important to you. I enjoyed my time in New York, and I don't think this thread represents an accurate general opinion of those who are looking at NYC for residency. Working as an attending is a different story, of course.

I trained at the large academic center. Completely mixed population. One day I had a tenured professor next to a homeless drunk.

If you want to train in NYC, you should train in NYC. However, realize the following facts:
-You will do scut...lots of it.
-You will deal with unionized nurses
-Your trauma experience will be weaker (excluding some places like Kings)
-You will pay more for rent and a 4% income tax

Everyone's different. Personally these factors made this training environment untenable. If you want to train there however you should train there.

 

[bengaltiger211]

I'm only referring to EM faculty. Though, quick Google search seems like the same for IM.

Above poster got it right - everyone's different. I rotated there and a lot of these classic NYC criticisms didn't really bother me, coming from a more classic academic home program.

Residents definitely do more scut than my home program. Wasn't really that bad on day shifts, but when coverage wears thin overnight it can slow you down. Of course, census is generally a bit lower overnight. Residents as a result were way better at certain basic procedures like US guided pIV than at my home program. You might say that gets old after the first year or two, but upper level residents are really not doing as much scut in supervisory roles.

Trauma was something I thought about. When I compared the actual activation numbers to my home program, was actually more... so doesn't really bother me. It's not going to be knife and gun club, but knife and gun club vibe isn't high on my priority list.

I did have some nursing issues at HHC sites. This was more due to patient ratios in the ED rather than people refusing to do things. I hear that's more a problem on the floor. Nursing at the academic sites was great.

It is definitely expensive. Again, was looking at high COL areas anyway.

There are real downsides. The challenge is that no one can make such a personal decision for you - it's about what's important to YOU. I felt like I had a connection with New York, loved being able to still see my friends after an evening shift, was exposed to exciting people/things/experiences every day. And guess what? The residents coming out of NYC were some of the brightest and well prepared I have seen anywhere. That's what made it worth it to me. You gotta do you.

 

[HopefulEMed]

I'm only referring to EM faculty. Though, quick Google search seems like the same for IM.

Above poster got it right - everyone's different. I rotated there and a lot of these classic NYC criticisms didn't really bother me, coming from a more classic academic home program.

Residents definitely do more scut than my home program. Wasn't really that bad on day shifts, but when coverage wears thin overnight it can slow you down. Of course, census is generally a bit lower overnight. Residents as a result were way better at certain basic procedures like US guided pIV than at my home program. You might say that gets old after the first year or two, but upper level residents are really not doing as much scut in supervisory roles.

Trauma was something I thought about. When I compared the actual activation numbers to my home program, was actually more... so doesn't really bother me. It's not going to be knife and gun club, but knife and gun club vibe isn't high on my priority list.

I did have some nursing issues at HHC sites. This was more due to patient ratios in the ED rather than people refusing to do things. I hear that's more a problem on the floor. Nursing at the academic sites was great.

It is definitely expensive. Again, was looking at high COL areas anyway.

There are real downsides. The challenge is that no one can make such a personal decision for you - it's about what's important to YOU. I felt like I had a connection with New York, loved being able to still see my friends after an evening shift, was exposed to exciting people/things/experiences every day. And guess what? The residents coming out of NYC were some of the brightest and well prepared I have seen anywhere. That's what made it worth it to me. You gotta do you.

You nailed it. Thank you. Besides, if you are young and single, might as well live in NYC now and get it out of your system. And then move somewhere a little more cozy with better ancillary support.

 

[slurpy15]

I agree it's better to do residency in NYC than work as an attending, if only for liability reasons. The lawsuits there seem constant and ridiculous.

 

[chillaxbro]

Which NYC programs are considered the most "badass"?

 

[slurpy15]

Which NYC programs are considered the most "badass"?

I think what's considered tough vs what is tough are actually very different. The county programs have a tougher reputation, but they can also run wild and they have residents in other departments at their disposal.