Residency Ranking Question

[86280]

Hi everyone,
I'm in the residency match and having a hard time ranking Wash U, Mayo, NYU and Einstein montefiore. Can anybody provide opinions as to which is the stronger and weaker programs? I want to pursue an academic career, probably an AP subspecialty, hemepath or dermpath. I live in NYC, where of course I'd prefer to stay but don't mind moving to midwest if the training would really have a significant impact on my training and future job opportunities. Thank you

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[gbwillner]

These programs are nothing alike, IMHO. As someone with an interest in academia, you should know that reputation is important, as is specimen volume, and research opportunities.

WashU and Mayo are clearly a step above the other programs. NYU is not even the best program in NYC, and Einstein- I have only met a handful of residents from that program, and admittedly I don't know if Montefiore is a different facility/program.

 

[2121115]

Hi everyone,
I'm in the residency match and having a hard time ranking Wash U, Mayo, NYU and Einstein montefiore. Can anybody provide opinions as to which is the stronger and weaker programs? I want to pursue an academic career, probably an AP subspecialty, hemepath or dermpath. I live in NYC, where of course I'd prefer to stay but don't mind moving to midwest if the training would really have a significant impact on my training and future job opportunities. Thank you

Not sure if serious.

 

[86280]

Montefiore and Einstein are the same. What about WashU and Mayo? Which one is stronger? I had a quite similar experience during my interviews, except that in Mayo almost all the internal sign outs where Frozen.

 

[Path2009]

Gotta chime in here...Mayo does have a robust frozen section. Every section seen at frozen is looked at on H&E the next day. All biopsies are done on routine H&E, and there are a lot of them. The consult service is huge, and all of those cases are H&E's generated all over the country (and world). We also review external pathology cases of patients who are referred here for definitive treatment. Mayo isn't the only good place to train, but it is a good place to train and there are a lot of misconceptions.

 

[86280]

Thanks path2009, that was very helpful

 

[Path2009]

You are welcome.

 

[Euchromatin]

I don't want any current residents from WashU to jump down my throat here, so I'll say up front that I have never had any personal experience at WashU and a lot of what I'm saying is hearsay. However, the rumor when I was interviewing in 2009 was that their program was very malignant to residents. The specific complaints I heard included excessive grossing until the wee hours and attending staff that were disrespectful and difficult to deal with. I also met one person who had transferred from WashU because they were unhappy there (specifically because they disliked the program, not because of family reasons or whatever) to a different program I was interviewing at and they were very glad to have done so.

 

[gbwillner]

I don't want any current residents from WashU to jump down my throat here, so I'll say up front that I have never had any personal experience at WashU and a lot of what I'm saying is hearsay. However, the rumor when I was interviewing in 2009 was that their program was very malignant to residents. The specific complaints I heard included excessive grossing until the wee hours and attending staff that were disrespectful and difficult to deal with. I also met one person who had transferred from WashU because they were unhappy there (specifically because they disliked the program, not because of family reasons or whatever) to a different program I was interviewing at and they were very glad to have done so.

You will hear "rumors" about programs being malignant to residents for all top programs, particularly those with really high volumes- like WashU, Hopkins, and MGH. You will also find at least 1 individual from all such programs that didn't like it. These programs have 10-18 residents per class, and are very demanding. it's easy to see that it won't be for everyone.

 

[pathstudent]

It is also important to remember that almost all pathology residents suffer from Stockholm syndrome and all think their programs are über bestest. When I was interviewing the mgh resident told me it wasn't uncommon for them to gross until midnight and then be back at 4 am to start preparing their cases. All of these practices should not be happening anymore with the ten hour in between shifts and 80 hour week rules.

My advice would be to go to a program where you work hard on ap and not on cp to have the best experience.

 

[abc123puck]

These programs are nothing alike, IMHO. As someone with an interest in academia, you should know that reputation is important, as is specimen volume, and research opportunities.

WashU and Mayo are clearly a step above the other programs. NYU is not even the best program in NYC, and Einstein- I have only met a handful of residents from that program, and admittedly I don't know if Montefiore is a different facility/program.

What would you say then is the "best" program in NYC?

 

[brainsalads]

a lot of programs with "names" treat their residents like crap and overwork them needlessly in order to process specimens. But since they have the name residents think they are getting a good experience. But then they don't have time to study or do research or do anything extra that fills up their CV. My advice would be to go to a place where you arent grossing late and have time to do projects and go on conferences. I go to a mid tier program where academic experience is stressed rather than slaving the residents and wasting their time. The upper levels are going to Harvard, Hopkins, MD Anderson, UCLA, UPenn, etc for fellowships like derm, GI, and hemepath. In todays arena, it really only matters what fellowship you get and where, and having a fat CV helps for fellowships.

 

[gbwillner]

a lot of programs with "names" treat their residents like crap and overwork them needlessly in order to process specimens. But since they have the name residents think they are getting a good experience. But then they don't have time to study or do research or do anything extra that fills up their CV. My advice would be to go to a place where you arent grossing late and have time to do projects and go on conferences. I go to a mid tier program where academic experience is stressed rather than slaving the residents and wasting their time. The upper levels are going to Harvard, Hopkins, MD Anderson, UCLA, UPenn, etc for fellowships like derm, GI, and hemepath. In todays arena, it really only matters what fellowship you get and where, and having a fat CV helps for fellowships.

This post is only one way to look at things- you can see processing lots of specimens, particularly in your 1st or 2nd year, as "overworking", or you can look at it as getting ready for the real world. People from these "top" programs are VERY well prepared to practice- and that's why going to one of them pretty much guarantees you the top fellowships and top jobs.

Having gone to one of these programs I will reiterate that I don't know anyone who hasn't gotten a job (who was looking for one). My colleagues were highly sought-after. In terms of research, these programs also are swimming in cash and have lots of projects for residents to do. Go to USCAP and see how many posters are by people from WashU/Hopkins/BWH. Those three programs alone are probably 15-20% of all the posters at the meeting.

Of course you can go to a "mid" or even "lower tier" program and be very successful. But being at one of these sets you up for future success, not the opposite. Yeah, you will need to work hard. I remember as a 2nd year resident when the new fellows came in- some from lower "tier" programs.... I remember thinking that I knew more than some of them and they were board-certified. Some were frankly clueless.

 

[lipomas]

Does NYU even have a program now? I thought the hospital was destroyed in the hurricane and flooding.

 

[Euchromatin]

This post is only one way to look at things- you can see processing lots of specimens, particularly in your 1st or 2nd year, as "overworking", or you can look at it as getting ready for the real world. People from these "top" programs are VERY well prepared to practice-

I think this entirely depends on whether the "processing" of specimens we're talking about here is grossing or microscopy or both.

I do think grossing is important and, yes, pathology attendings need to know how to handle complex specimens. However, I do NOT think it is necessary for me as a resident or a future attending to be as fast/efficient at doing it as a PA. In the "real world" attending staff generally do not gross, so any extra time spent grossing beyond what is needed to be competent is a waste of time that I could otherwise spend looking at slides, reading, working on research projects, etc. (or even sleeping so I am awake enough to actually learn while looking at slides/reading/etc.). Resident grossing should be educational, not the primary means of keeping the department running.

As far as microscopy goes, I'm more inclined to agree with gbwillner's sentiments. Although there are some differences in learning styles (i.e. some people learn better from reading, others from a more case-based style), I can't argue that the more cases you can see, the better, and learning to handle a heavy case load efficiently (a somewhat different skill than just being a good diagnostician) is very important.

 

[gbwillner]

I think this entirely depends on whether the "processing" of specimens we're talking about here is grossing or microscopy or both.

I do think grossing is important and, yes, pathology attendings need to know how to handle complex specimens. However, I do NOT think it is necessary for me as a resident or a future attending to be as fast/efficient at doing it as a PA. In the "real world" attending staff generally do not gross, so any extra time spent grossing beyond what is needed to be competent is a waste of time that I could otherwise spend looking at slides, reading, working on research projects, etc. (or even sleeping so I am awake enough to actually learn while looking at slides/reading/etc.). Resident grossing should be educational, not the primary means of keeping the department running.

As far as microscopy goes, I'm more inclined to agree with gbwillner's sentiments. Although there are some differences in learning styles (i.e. some people learn better from reading, others from a more case-based style), I can't argue that the more cases you can see, the better, and learning to handle a heavy case load efficiently (a somewhat different skill than just being a good diagnostician) is very important.

I cannot speak for ALL the "top" programs, but from what I've witnessed first-hand none of these programs ask for excessive grossing- all have PA's that do routine specimens and most biopsies. The general rule for these programs is 1: if you gross something, you will preview/sign it out, and 2: all specimens are seen by residents. With increasing volumes this becomes very difficult such that routine specimens/ditzels may not ALL be seen, but how many gallbladders and amputated toes do you really need to see?

Frankly, I think a lot of the biatching about grossing/volume at these programs is from 1st year residents, who just suck at it. They will get better and faster, but for the first few months they stay late to preview since they have to look everything up. The same resident a year later can do 2x the work at 2x the speed, and will think the new first years are just a bunch of whiners.

 

[Necromonger]

Hi everyone,
I'm in the residency match and having a hard time ranking Wash U, Mayo, NYU and Einstein montefiore. Can anybody provide opinions as to which is the stronger and weaker programs? I want to pursue an academic career, probably an AP subspecialty, hemepath or dermpath. I live in NYC, where of course I'd prefer to stay but don't mind moving to midwest if the training would really have a significant impact on my training and future job opportunities. Thank you

I interviewed at all these programs a few years ago and I ended up taking an offer at Henry Ford. What I can say is that volume is important, being beaten down by workload is actually a good thing as long as it is workload that has educational value. For example, grossing 20 normal placentas, probably not educational. Now, grossing 20 abnormal placentas, very enducational. The volume is where the learning is. I have a friend at WashU who says they have cleaned up the overwork and made it more productive. I know a fellow at Mayo who claims while they are high volume, it is interesting volume. For CP, consult training is invaluable. For example, calls for send out cases in Chemistry (you will remember most of these and the associated, or not associated, disease process throughout training), plate rounding in micro, apheresis setup (start to finish from clinical consult to post-procedure), the list goes on and on. Ideally, the depth of training should be such that if you are awoken at 2am by someone on the floor freaking out, you should have a cogent answer of what to do.

With that said, here's what you need to know:
1. Where do the residents go post-training (jobs, fellowships, etc)? This speaks volumes about reputation.
2. Board pass rates
3. The relationship between the Chair and the PD and the accessibility of both
4. The relative permanence of #3. Also, make sure there actually is a current chairman.
5. The apparent working relationship between residents. This point is huge. If the place is a passive-aggressive war zone you will either be a casualty or become a schmuck.
6. Service details. Do you sign out what you gross? How does the graduated responsibility work?

The reason for points 3 through 5 is that they determine flexibility. With flexibility, there are opportunities for research or quality projects that lead to abstracts and publications that lead to presentations at USCAP, CAP, AACC, etc that lead to fellowships/jobs (because your future employers are there).

The important thing is to find a place that you are comfortable with and that has the reputation to open doors for your future. You should have a sense of that from the interviews.

 

[KluverB]

In the "real world" attending staff generally do not gross, so any extra time spent grossing beyond what is needed to be competent is a waste of time that I could otherwise spend looking at slides, reading, working on research projects, etc. (or even sleeping so I am awake enough to actually learn while looking at slides/reading/etc.). Resident grossing should be educational, not the primary means of keeping the department running.

Define "real world". There are plenty of private practice gigs that require the staff pathologist to not only be able to handle a specimen long enough to do a frozen, but in some places they gross the more complex specimens themselves. Not everyone has the luxury of relying on cheap resident labour. Also, in this era of reimbursement cuts, depending on the case mix, I have a feeling more practices may be foregoing hiring an extra PA, for example, and doing the grossing themselves. That's easily an extra 150-200k per year that could be lining someone's pocket.

 

[Euchromatin]

Define "real world". There are plenty of private practice gigs that require the staff pathologist to not only be able to handle a specimen long enough to do a frozen, but in some places they gross the more complex specimens themselves. Not everyone has the luxury of relying on cheap resident labour. Also, in this era of reimbursement cuts, depending on the case mix, I have a feeling more practices may be foregoing hiring an extra PA, for example, and doing the grossing themselves. That's easily an extra 150-200k per year that could be lining someone's pocket.

That is a good point, KluverB, but I don't think it changes my opinion very much. Even if I was going to end up in a position where I would have to gross regularly as an attending staff, I still think I would want to focus my training on the microscopy end of things. As long as I could at least competently gross big specimens to start with, I'm pretty sure the speed/efficiency would develop pretty damn quickly if I needed it to. Even from the somewhat lighter, more educationally focused grossing that we do, I have certainly done enough to get WAY faster than I was as a first year. But am I as fast as our PAs, some of whom have been grossing for 20+ years? No, and that isn't an expectation I have for my residency training.

 

[Euchromatin]

1. Where do the residents go post-training (jobs, fellowships, etc)? This speaks volumes about reputation.
2. Board pass rates
3. The relationship between the Chair and the PD and the accessibility of both
4. The relative permanence of #3. Also, make sure there actually is a current chairman.
5. The apparent working relationship between residents. This point is huge. If the place is a passive-aggressive war zone you will either be a casualty or become a schmuck.
6. Service details. Do you sign out what you gross? How does the graduated responsibility work?

I think Necromonger makes some good points here. I asked every PD about the jobs that their graduates got...sadly most of them could only tell me about fellowships (not sure if they were hiding less-than-impressive stuff or just hadn't kept in touch with grads and had no clue). It hadn't really occurred to me before that the relationship between the PD and Chair was particularly significant, as ours get along quite well (I guess I take this for granted) - but I can totally see residents getting screwed left and right if the PD can't convince the chair to give them funding for x, y or z or if attempts to make changes get quashed regularly.

I had of course considered the relationship/culture among the residents to be important, but maybe not enough..."passive-aggressive war zone" sounds frightening. I think the fact that our program has fairly clear cut rules that the PD enforces when necessary is helpful in this regard. There are fewer opportunities for any resident (even the chief(s)) to really take advantage of or hold power over any other resident. If you're on frozens, you gross all the cases you get; if you're grossing routines, you gross all the cases that are assigned to the specific attending staff you'll be signing out with the next day. I could see if you had some system in which residents (and/or PAs) had to divide up work among themselves or you had seniors assigning cases to junior residents...that could lead to a lot of bickering and bad feelings. I've also noticed that if something goes wrong or a staff finds a particular resident to be lazy/unprepared/whatever it quickly spirals into a negative view of "the residents" in general. So we try (within reason) to do what we can to cover for each other, to help the junior residents look good, etc. so that "the residents" as a group are viewed favorably in the department.

 

[KCShaw]

A few individuals excepted, I think most of the so-called passive-aggressive war zones develop from the top down, with the Chair, PD, &/or attending staff. Even above or adjacent that sometimes, if there are significant issues with administration or other departments. If they don't get along in a professional way, it trickles down and draws out the worst in more or less everyone. Again, not saying any place is perfect, and some stuff is just always going to exist, but pay attention and ask a lot of questions and you'll often get some sense of what's what (and whether you can work in that environment).

 

[86280]

Thanks to everyone for your posts. Your replies helped me a lot.