Rotations at non-teaching hospitals

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LECOM-FL is forming affiliations with many hospitals statewide that are not teaching hospitals. Would you recommend avoiding doing rotations at these hospitals? I'm interested in specializing, and therefore in competetive residencies - would LOR's from dr's at these hospitals be essentially worthless? I assume none of the dr's would be "big names." Also, anyone have any idea how such rotations would work, since there are no residents?

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It could be both good and bad.

Bad if you do ALL your rotations there... non-academic physicians aren't always the most up-to-date with treatments and such. Plus they won't be accustomed to teaching.

Good because you might get procedures that residents at a teaching hospital would do. So you might be starting more central lines and such.

I definitely would try to avoid doing ALL my rotations at a non-teaching hospital.
 
would LOR's from dr's at these hospitals be essentially worthless?

Well, not totally worthless. One of the reasons that letters from faculty at teaching hospitals are weighted more are because attendings there see LOTS of students and can give the reader an idea how you compare to them. If they're well known then that's a bonus. I have rotated at non-teaching hospitals and at teaching hospitals and I would pick teaching hospitals hands down every time. In my experience the, um, teaching, is WAY better at a teaching hospital (community OR academic) and the experience tends to be much more predictable. You'll have plenty of time to get procedures in residency so don't let that sway you too much (maybe a little).

C
 
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This is how it was explained to me. Which do you think is better. A. LOR from community private practice doc who nobody has ever heard of at the programs which you will be applying to or the cheif of the department from respected-med-school-x who everyboby has heard of(also maybe trained with or under, see at academic conferences, plays golf with, ect...)? It should be rather obvious. BTW, it is reasons like this that place DO's at a significant disadvantage(no connections, no powerful LOR, no research experience) when applying for competitive residencies more than the degree itself. You can remedy this by choosing rotations wisely. Additionally, I was told by one DO resident in a competitive MD program, that a letter from the Chief of a Department(which is not possible at a DO school thus you must rotate at an MD program for this)for the specialty in which you applying is basically a requirement(in addition to research, good grades/boards ect.).
 
southerndoc said:
It could be both good and bad.

Bad if you do ALL your rotations there... non-academic physicians aren't always the most up-to-date with treatments and such. Plus they won't be accustomed to teaching.

Good because you might get procedures that residents at a teaching hospital would do. So you might be starting more central lines and such.

I definitely would try to avoid doing ALL my rotations at a non-teaching hospital.

Don't rotations have to be done at "green book" hospitals to "count"?
aren;t green book hospitals teaching hospitals?
 
When I said non-teaching hospitals I meant hospitals which don't have residency programs - isn't that what a teaching hospital is? I might be wrong. It will also be the first year that these hospitals have had med students rotating there - so maybe they will be teaching hospitals at that point, but it would be their first year.
 
bigmuny said:
I was told by one DO resident in a competitive MD program, that a letter from the Chief of a Department(which is not possible at a DO school thus you must rotate at an MD program for this)for the specialty in which you applying is basically a requirement(in addition to research, good grades/boards ect.).

What do you mean by getting a letter from the chief of a dept not being possible at a DO school?
 
DO schools will generally a Cheif of FP, IM, maybe surgey. However, few to none wil have a Cheif of derm, or uro, plastic surgery, ect...because few/none have a teaching hospital which they run(DO students are sent to small community hospitals to rotate with private practice docs, not to academic medical centers, as you are now discovering) Even if they do have a "cheif of whatever" they will likely be unknown in the allopathic community(though they will be known in the DO community) because DO schools are are not involved in research in any significant fashion(in the scientific community you get to be "known and respected" by making significant contributions to medicine via research). At any rate your goal is to get the "known and respected" letter, so use the flexibilty DO schools usually have in in setting up your rotations to rotate somewhere good, and get a powerful letter.
 
bigmuny said:
DO schools will generally a Cheif of FP, IM, maybe surgey. However, few to none wil have a Cheif of derm, or uro, plastic surgery, ect...because few/none have a teaching hospital which they run(DO students are sent to small community hospitals to rotate with private practice docs, not to academic medical centers, as you are now discovering) Even if they do have a "cheif of whatever" they will likely be unknown in the allopathic community(though they will be known in the DO community) because DO schools are are not involved in research in any significant fashion(in the scientific community you get to be "known and respected" by making significant contributions to medicine via research). At any rate your goal is to get the "known and respected" letter, so use the flexibilty DO schools usually have in in setting up your rotations to rotate somewhere good, and get a powerful letter.

What about the hospitals at which I can rotate which have DO residencies in specialties such as derm, optho etc.? Wouldn't those hospitals, though DO, have chiefs in those dept's? If I choose one of those highly competitive specialties, it's much more likely that I'll match into one of those DO programs, so I'd think they would be the best places to rotate in said specialty. I guess bottom-line is rotate somewhere that has a residency program that's allopathic if I want a spot in an allopathic program in that specialty, or osteopathic if I want a spot in an osteopathic program in that specialty, and avoid the hospitals without residency programs altogether...
 
my impression is that there are very few "only allopathic" or "only osteopathic" hospitals out there. I'm currently doing my medicine rotation at a community hospital that is Brigham and Women's affiliated, but has both Harvard and Tufts faculty as well as MD's and DO's who are community physicians. Plus, the BWH medicine and surgery residents rotate through here. My advice would be to pick sites where you get to work with both MD's and DO's, and preferably a site with rotating residents. I feel that I am learning WAY more in the community hospital I'm in right now (could it be the residents?) than I would in the rat race of NEMC, and don't expect it will hurt my application to have done my rotation here. In fact, a # of people in the class of '03 that rotated through FH matched at the BI and NYP-Cornell. I don't think it will hurt you at all; just pick your site wisely!
 
Actually there are a large number of DO-only hospitals. There are no MD only hospitals I know of.

C
 
Fear not, young paduwan DO student to be! You are only limited to rotations your third year. If you are interested in say Gynecologic Urologic Disorders of Neurologic Space Continuum Fellowships, just do a rotation in it your third or early fourth year. Get a leader from the Starfleet Commander, or First Officer, and you'll be fine. You only need 3-4 LORs anyways, and you won't be getting all 3-4 in the same specialty you applied for... so don't worry about it.

Q, DO
 
The definition of a "teaching hospital" is nebulous. I think most people would agree that hospitals that are have the words "County," "VA," or "university" in their titles would qualify. On the other hand, plenty of private, for-profit, community hospitals host residency programs (does this make them "teaching hospitals"?). Also, plenty of community hospitals are "university affiliated," whatever that means. To complicate matters, in a given urban area, pretty much any practicing physician tends to get some sort of academic title handed to them, whether or not they ever set foot on the medical school campus. "Assistant Clinical Educator/Professor" is a common one. Does this make the hospitals in which they work "Teaching Hospitals"? Anyway, so when you say non-teaching hospital, you could mean a lot of different things.

As for learning on rotation, I can tell you that I've rotated thru a number of teaching hospitals and a number of private, community hospitals, and I've found the teaching to be better at the privates, almost universally. I think this is because the physicians tend to be less burnt out on teaching (cuz they likely make more money, work fewer hours, do less uncompensated research, and teach less). Also, the # of students around tends to be less, so there's a lot more physician:student 1-on-1 time. You tend to be more of a novelty, and people want to show you interesting things.

On the other hand, you need letters from academic dept. chairs and people who are known in the places you want to go. Lame, I know. So, to answer your question, if you know you need a letter, I guess you need to rotate thru a place that has "university" in the title. If you want 1-on-1 time with staff, go private. In something like IM, you could certainly do your intro rotation somewhere private and your sub-I at the U hospital.
 
My experience at "private" hospitals has been universally low in learning quality and high in scut/being ignored. If for no other reason but for learning (forgetting about LOR's) I would pick the university hospital any time.

My MD program is affiliated with some hospitals which accept residents but have private attendings. Who don't work at a university hospital because, guess what, they don't want to teach (among other reasons I'm sure). Also, I've felt that the private institutions have been much more reluctant to allow medical students to participate in direct patient care because the attendings are worried their patients might feel like guinea pigs. This is BS for so many different reasons. First of all, medical students generally treat their patients much better than attendings or residents do -- more respect, more listening, more explaining. And, the implication of this attitude is that only people without insurance or who are "desperate" enough to seek treatment at a tertiary care center are the only ones who should be victimized by us horrible medical students. Not that I've been jaded by my experience at community hospitals or anything.
 
Seems like the rotations I did that had residents offered more. They usually had better didactics (lectures relevant to the service you are on). Additionally, most of the teaching is done by residents. When I was with private preceptors they were often too busy maintaining their practice to really teach much. Of course there are exceptions; but this was my general feel for it.

Best advice is try to go to a facility with as many residncies as possible. Then if you know of an especially strong preceptor, a rotation with him/her would not be a bad idea.

LOR's: Best if from a resdidency program director (esp if applying to university based allopathic residencies).
 
Seaglass said:
Actually there are a large number of DO-only hospitals. There are no MD only hospitals I know of.

C

interesting.. where are these hospitals? I think it is a big disservice to have only DO or only MD hospitals (which of course are not "officially" allowed) to train students; it just perpetrates more segragation and gives both types of med students limited exposure. If you are a DO, you are going to end up working with MD's, and vice versa, it's just that simple.
 
I believe that osteopathic hospitals were set up to give osteopaths a place to practice back when there was more discrimination based on degree. In the towns near me they tend to be very small community places with ~100 beds, and for some reason are usually called Memorial.

C
 
irlandesa said:
interesting.. where are these hospitals? I think it is a big disservice to have only DO or only MD hospitals (which of course are not "officially" allowed) to train students; it just perpetrates more segragation and gives both types of med students limited exposure. If you are a DO, you are going to end up working with MD's, and vice versa, it's just that simple.

There are many "DO" hospitals. Highly concentrated in Ohio, Michigan, and some in Pennsylvania. There are others throughout the country as well (Fort Worth, Tulsa, NY, some in CA). The residencies at these institutions are exclusively for DOs, and a vast majority of attendings at them are DOs as well. But, there will always be a few MDs on the staffs.

By and large I agree that separate residencies aren't such a great idea. That said, most of the MD residencies are of higher quality (note that I said MOST), and I can't understand why, other than location (proximity to family, etc.), an MD grad would want to do a residency at a DO hospital. The only good thing about these separate programs is the opportunity for the "AOA internship" year that 5 states still require.
 
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