Say no to SUNY Downstate IM, too big to fail, go smaller

[FutureUfMedicin]

It is no news that SUNY Downstate is a malignant program, it has a long history of being malignant. What changed is for a time it tried to be better than that and stop being malignant. Two important departures from the leadership of the program set the program back down the road of “malignant forever”. First the former Associate Chairman of Medicine, Dr “KAPLAN guy”, left the program in the spring of 2009. Next the previous Chairman of Medicine retired the following year. Without these two individuals there is no longer a voice on the side of the residents in the leadership. If you look at the list of what makes a program malignant from other posts it is almost a blueprint of the program. SUNY Downstate IM operates chiefly out of 3 hospitals (SUNY Downstate Medical, Kings County Hospital and the Brooklyn VA).

During interview season they put on a good show, everyone is very nice and welcoming. But if you take some time to look around on your interview on the 6th floor the hospital doesn’t look like it is a big wig academic program. Hopefully the elevators are working and you don’t lose a leg (happened to a visitor). The program is very very large and they have to interview huge huge numbers of people. The program largely recruits from 3 sources; US citizens trained in the Caribbean schools, Caribbean trained foreign grads, SUNY Downstate students. The reason this is relevant is that they treat the residents like crap because they believe the residents need them more than the program needs the residents. The truth is that only residents who have little other options would put themselves in such a terrible place to face the abuse.

On interview day they will try to entice you with the idea that there are so many fellowship positions available. That is true and false. SUNY Downstate is so large that it actually has some of the largest number of fellowship spots in the country (4-5 GI spots alone). The real truth is that Dr “KAPLAN guy” promised that if you came to the program and completed the residency you are guaranteed a fellowship spot where you only compete for spots against other residents since the program promised to recruit from within. After his departure that promise is gone and buried. What has replaced it is the old “if you want a a fellowship you need to do a chief year and kiss some serious ass” game. A large plurality of residents are on VISAs which the program has no problem with; then all of a sudden the fellowship programs seem to think VISA FMG are untouchable, atleast the ones that aren’t juiced in. But you should maybe count yourself lucky if you don’t get a fellowship spot since the program is so overworked that the work load even in fellowship is huge. If you are a current resident then you should be planning on getting a fellowship at an outside program. In fact the program director has made it a point to tell many residents in the program that they won’t get a fellowship anywhere and tries to convince them not to apply. When you try to go interview for a fellowship the program won’t try to accommodate your schedule so you can interview outside the program. They are basically saying you work for them and they don’t give a crap what happens to you after you do your time there, you are on you own.

The IM residents have NO SUPPORT or backing. It is known throughout the program that you are on your own; they do not support the housestaff in any event. If there is a problem between IM and another department such as Surgery or Emergency Medicine they will not support you. Crap rolls downhill to the IM department. No matter what happens in patient care, right or wrong, the blame if laid at the feet of the IM housestaff; IM is the only accountable service in the hospital. The IM residents envy how the ER program supports their residents. In one of the worse cases of no support, without naming names, a third year resident within 2 months of completion was made to repeat the ENITRE third year and lost a fellowship spot over laying the blame at the IM resident’s feet. The story is now used a horror story to scare residents into knowing to watch your back. In such a program the morale of the housestaff is rock bottom.

An abusive high school environment is almost encouraged. In one of the earliest housestaff meetings for the new interns the program director makes the point to remind the interns not to “get a reputation” with the residents. This is important because as soon as you get a “rep” it sticks and the leadership run with it. A gossip laden atmosphere is everywhere and your career can be ruined or made pretty damn horrible if you have a “rep” and your not one of the residents above reproach because of your high internal exam score. It is not uncommon for a housestaff member to be bullied out of the program.

There used to be a belief that chief residents made a difference or could make a difference, that is not the case. It all comes from the top and they chief spots are just a way to get fellowship. And because the chiefs definitely want that fellowship they will do some unthinkable things. Once again, when Dr “KAPLAN guy” was there it would have been unthinkable of wholesale abuse of the staff, there was always the threat a housestaff member could go to him and clear up any issue. After his departure the malignancy is in full gear. THE WORST set of chief residents presided over the 2009-2010 academic year which was the year after KAPLAN guy left; rumored no one wanted the jobs that year. The following year 2010-2011 had some of the strongest residents in the program become the chief residents. The entire program awaited with anticipation thinking the 2009-2010 year was an aberration. They were wrong, even with the strong residents now chiefs the same atmosphere from the 2009-2010 year continued, only with a prettier face on it.

New York City has some horrible ancillary services but SUNY takes the cake. That may make you a better trained resident in the long run but the amount of SCUT can be overwhelming and really gets in the way of actually learning. In the past Dr “KAPLAN guy” tried to change the poor ancillary service; now that he is gone no one really cares what does or doesn’t work; save your complaints for the complaint box. Ask the St Vincent residents who came to SUNY and were in for a rude awakening.

The program is so big that is has a huge reliance on Pre-lims to help fill the intern needs; of 40-45 spots there can be 10-15 pre-lims. A good number of the pre-lims are in the pipeline to join the Neurology or Anesthesia programs. As it maybe true with most program they give the pre-lims the worst schedules, more ICU and floor months since they are disposable sine they are there only one year.

I would refer you to the long explanation of the Anesthesia program on the website, many similar issues. As suggested in that post the only way the program will change it that people stop going there and they get the idea.

The GME knows it all and is absent. As long as the program keeps moving and doesn’t stop. SUNY Downstate IM program is too big to fail. They run the state hospital SUNY and the city hospital Kings County which are two hospitals under stress due to other NYC hospital closing and the size of the Brooklyn community needing medical care. The Kings County clinics are overloaded and overbooked months out. There now maybe a shortage of attendings to man Kings County clinics and floors. The IM program may actually understaffed, it probably needs more housestaff but since they are ok with spreading the housestaff thin nothing will change; the number of spots maybe out of the control of the program.

Don’t go to SUNY Downstate if you have other choices. Rank any other program but them. If you go there you should understand fully that it is abusive, scut heavy, unsupportive and downright malignant in every way possible. Toss in the poor pay and high cost of living in NYC, why go there. There are a lot of NYC natives who can’t consider leaving so they stay. Also if you are a FMG then you have to sometimes take what you can get. But my advice is to interview at many places and place them at the bottom if you have to rank them. There is no sign it is going to change since the current leadership is not going anywhere.

What is next? SUNY Downstate is supposed to be absorbing Long Island College Hospital (LICH) as of 2011 and presumably will only get larger. That could only magnify the problems in the program.

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[jdh71]

 

[inspirationmd]

Agreed... this will be good. When I interviewed at Downstate it didn't seem that bad to me on the surface. Everyone was pleasant on my interview day and the chief residents went out of their way to accommodate a 2nd look visit I ended up doing while visiting some friends. I knew that scut work was a problem but the residents didn't hide that fact and my baseline belief is that its a problem in all NYC hospitals (maybe not HSS or Cornell). So I was not that bothered by that fact.

While I am not sure about the validity of the entire statement I will say that one thing that kind of was a bit telling to me was when I ran into some 3rd and 4th year medical students at a party I went to and asked them about the IM department. I got a few too many grimaces regarding the program (their treatment, teaching, etc) and statements that they were not planning to stay which made me a bit nervous and resulted in me ranking them lower than I had originally planned to.

 

[flipmd]

When I interviewed there, we saw this resident who was crying and wanting to quit, being consoled by the other residents. Now I know this can happen at any program, and I don't even know the circumstances behind it, but that kinda creeped me out and down and down SUNY went in my rankings. Lol.

 

[DrWBD]

As long as there are FMGs who would do almost anything to become American-trained physicians, residency programs like this will continue to exist.

 

[Jiffy1285]

i actually liked my interview there...

 

[sunydsdoc]

As a resident at SUNY Downstate, I am extremely surprised to see such a scathing review of Downstate. I do not feel SUNY Downstate is a malignant program at all. On the flipside, I think it provides excellent training in a busy, fast-paced, but supportive and friendly environment. As a senior resident at Downstate, I feel I am confident, well trained, and well prepared to manage a wide variety of patients. I had heard a lot of stuff about the program before I joined (too busy, bad area, lot of scut, etc), but I also did my homework. I spoke to the interns, the residents, and even a couple of attendings. I did a second look and my doubts were pretty much squelched. Now I have gone through most of my time here with the finish line in sight, and I couldn't be happier.
I am going for fellowship next year and I had the full support of my program director, as well as from faculty members in the field I'll be entering. I would venture to say that most, if not all, of my colleagues would feel the same way. In general, SUNY takes its own IM applicants on as fellows. However, like most programs, you have to do your fair share of the work to get the fellowship! Just because you are an internal applicant does not mean the fellowship is "in the bag." You still have to do well in your electives, do research, and make yourself a competitive applicant. As far as not being allowed to go on interviews or being made to feel that my schedule will not be accommodated, I think that is a big stretch. I think the program is interested to see its grads going on to reach their goals, and they are committed to making that happen. As a foreign medical graduate, I never got the sense from the program that "I needed them more than they needed me." I was fortunate to have many other residency options outside of SUNY Downstate, and I am thankful that I picked SUNY DS as my number one choice. It is a great program with residents from American medical schools (Einstein, Drexel, Temple, UMDNJ, SUNY DS to name a few), osteopathic schools, Caribbean medical schools, and graduates from other countries. This makes for a diverse environment with a wide range of talent, and truly reflective of NYC.
Yes, it is true that in the past couple of years "Dr. Kaplan Guy" left the SUNY Downstate family and also that there was a change in the Chairman of the Dept of Medicine. However, those changes have been mostly transparent to the residents. I personally have not felt any difference in the quality of my education or a change in the level of support from administration. On the contrary, more than ever before, I feel that IM residents are encouraged and applauded for reaching out to their residents and attendings for help. I feel the chiefs play a pivotal role in listening to any concerns/complaints and then actually doing something about it. The chiefs do procedures at the bedside, run morning reports and noon conferences, and they are pretty much there for us! There are also escalation guidelines at every hospital so patient care comes first instead of "turf battles" between services. I have never really had to use these guidelines, but they are there in case needed. Even ancillary services and social work, though never a strength at SUNY DS, have improved markedly in the time that I have been here. And in the end, these issues are not getting in the way of my day, or my education. I am learning and managing TB, DKA, glomerulonephritis, IRIS, lupus flares, thyroid storm, malaria, sickle cell, CHF, lymphoma, GI bleeds, sepsis, STEMI, and the list goes on and on. My seniors who have gone out into the work force are being applauded for how much they know and how much they can do. I am not going to be the one scratching my head or running away when a patient gets sick or things take a turn for the worse.
Some of my best friends as interns were prelims, and they came here for the same reason I did- to get a solid foundation in Internal Medicine. Their schedules were almost the same as mine, except they did not have continuity clinics and I think they had more elective time. They have now moved on to their respective fields, but some of them who did not stay on at SUNY definitely miss it.
As far as all the talk about an abusive environment, that is news to me. One of the major draws for me to want to come to SUNY DS was the camaraderie amongst housestaff. On my interview day, people seemed happy and friendly, and that is what I have experienced during my time here as well. A lot of the SUNY Downstate students who had plenty of other options specifically told me they were staying on to do residency because of how good the training was. Attendings have always been supportive, and I have felt I could go to them for help and advice. Senior residents used to seem like they knew so much when I was an intern. Now that I am going through the final year of the program, I can see exactly how that happens. You work hard when you are on call, when you are on the wards, and in the MICU. I was never kicking my feet up and waiting for the night to pass on by when I was doing my night shifts. But wouldn't you much rather actually DO a residency, work hard, and come out fully competent after 3 years instead of going through the motions and come out as a physician with no solid foundation in IM? The choice is yours. If I were you, I wouldn't let a couple disgruntled posts sway your instincts about SUNY DS. SUNY DS is not too big to fail. Rather, the program is too damn good to fail.

 

[jdh71]

 

[FutureUfMedicin]

My post comes from someone who was there, not some outsider who is taking shots, I have seen the program through the changes from top to bottom, I actually cut the post short cause I didn't want to ramble on. Everything I said is true.

In that very long post I did not once use the time to talk down the housestaff or the attendings quality. The housestaff has to support each other because of the system there, if they didn't there would be no support. Your co-intern and co-resident is the only one you can identify with since you are in the trenches together. Many of the attendings are former residents and they are good teachers but the level of scut takes away from the teaching. My post was about the actual program and how it is run and how the housestaff is treated, NOT about the housestaff itself. There are always true believers drinking the kool-aid but the word around the program from PGY1 to PGY3 is that the program treatment is horrible, hands down. In its worst days I remember talking with others and they were in disbelief how some in the program are clueless and think this treatment is normal.

YOU WILL DEFINITELY BE A COMPETENT DOCTOR AFTER GOING THERE BECAUSE THE LARGE VOLUME OF PATIENTS, THE DIVERSITY OF THERE DISEASES AND THE SEVERITY OF THEIR DISEASES. What I didn't say at the end of the post was that SUNY DS has some of the greatest potential IF AND ONLY IF the program was better run. Brooklyn offers the most diverse pathology you can see on the continental US. But due to the fact that the hospitals are held back by the ancillary services and you have to do almost every step and push for everything you spend more time on scut which could have been better spent on actually learning. There are diseases you see regularly at SUNY DS that people only read about at other places. Many a resident has lamented that only if SUNY DS could be as good as a Cornell or MassGeneral or whatever pie in the sky program you think is out there it would be top of the medical world. There are many programs out there where residents are still in medical school mode and aren't tested as much as you would be at SUNY DS but I think there are enough other choices out there that you do not need to subject yourself to the abuse at SUNY DS to be a good doctor.

Also I was never claiming the residents from any school or country they came from were sub-par; you have to be good to great to get through the program. But for the high level of work they get from the housestaff you would be surprised how badly they are treated.
The departure of Dr KAPLAN guy was NOT transparent whatsoever. Not in a million years. The fact that so much in the morale of the program changed after he left is a testament that however he was doing it his presence alone was somehow protective to the housestaff. To this day members of the housestaff still talk about what was lost when he left and how the program became full own malignant, to this day. Even some who were not even apart of the housestaff (students), talk about the good old days.

As far as patient escalation protocol, please. Of course there is some paper in some desk somewhere with the escalation protocol but that has no real world application. The buck starts and stops at the IM housestaff. The word in the past was if there is a patient escalation problem or ancillary problem, call Dr KAPLAN Guy and he will handle it; he will show up at somebody's office and make something happen. Maybe the other programs are just as overworked which could be true but let's not pretend SUNY DS is a smooth running ship, no way.

As far as felllowships the idea that the housestaff just didn't do enough to get it is crazy. You work like a bastard on your ICU and floor months. People do almost every elective and do research in the specialty and still don't get it. While spots are given to outside people and not from within. Dr KAPLAN guy said if you work here and get through the program and do great work you will get a spot if a spot is available. I personally don't care about fellowship but others do. I will use 2 examples. During the same year of fellowships the GI program had 5-6 spots, only ONE went to someone in the program. In the ENDO program with 3-4 spots in that same year, ZERO went to someone in the program, ZERO. And the rumor about the ENDO was that they didn't like VISA FMGs; amazing since 30% of the IM program is FMGs. That is when the chief year becomes so important again; what the chiefs will do to toe the line to ensure they get there fellowship either at SUNY DS or somewhere else with the help of the deparment. And many a resident has been told not to apply for fellowship, that is a fact, good candidates; I still don't understand why.

The fact of the matter is that SUNY DS is run like every housestaff member is replaceable, which is true. Since you are replaceable there is no need to improve the program. They probably easily interview 500 or more for the 100 plus spots. Since there is atleast 100 FMG applicants behind you it doesn't matter if you are treated like crap. Once they have gotten there use out of you they are done; that is the mean part about the fellowships. You suffer there, work through the scut and then someone not even in the program gets the spot. What is even worse is that fellowship is held out like carrot for all the FMGs and they know they are not going to give it to you, unless you do chief year or win some award. Your supposed to be treated like a colleague and instead your treated like a disposable sweatshop worker.

If you want to see pathology goto SUNY DS, it is there, but leave everything else behind. Don't take my word on it. Ask the St Vincent residents who came to SUNY DS after their hospital shut down. If you think a SUNY DS resident who knows the deal curse and moans too much, just ask a St Vincent transplant resident. Or any other housestaff member that worked anywhere else. Some of the housestaff who used to work through the scut of state/country owned hospitals in the Caribbean are amazed.

The issues at SUNY DS are NOT the fellow interns and residents, or even the attendings. It is the program itself. I should have titled my original post, "SUNY Downstate, a sweatshop, and not the nice kind". As with all post blasting a program, the program has some chief resident or some true believer try to run some interference, take it with a grain of salt.

SUNY DS is a throwback to an earlier time in medicine training when they just treated you like crap and you accept it cause that is how it is and you have to take the hazing to see the end of the tunnel. It doesn't have to be. But for some damn reason it is and will continue to be. You will be trained by the volume, but you maybe scarred, be warned

 

[Jiffy1285]

In the previuos post you said that 30% of the residents are FMG. I interviewed there, and they dont publicize that information so i was curious how you know that information.

Also, Suny DS retains a lot of Suny DS medical students for the residnets. If they are so miserable there, why would they want to continue residency there???

 

[infarct]

My post comes from someone who was there, not some outsider who is taking shots, I have seen the program through the changes from top to bottom, I actually cut the post short cause I didn't want to ramble on. Everything I said is true.

In that very long post I did not once use the time to talk down the housestaff or the attendings quality. The housestaff has to support each other because of the system there, if they didn't there would be no support. Your co-intern and co-resident is the only one you can identify with since you are in the trenches together. Many of the attendings are former residents and they are good teachers but the level of scut takes away from the teaching. My post was about the actual program and how it is run and how the housestaff is treated, NOT about the housestaff itself. There are always true believers drinking the kool-aid but the word around the program from PGY1 to PGY3 is that the program treatment is horrible, hands down. In its worst days I remember talking with others and they were in disbelief how some in the program are clueless and think this treatment is normal.

YOU WILL DEFINITELY BE A COMPETENT DOCTOR AFTER GOING THERE BECAUSE THE LARGE VOLUME OF PATIENTS, THE DIVERSITY OF THERE DISEASES AND THE SEVERITY OF THEIR DISEASES. What I didn't say at the end of the post was that SUNY DS has some of the greatest potential IF AND ONLY IF the program was better run. Brooklyn offers the most diverse pathology you can see on the continental US. But due to the fact that the hospitals are held back by the ancillary services and you have to do almost every step and push for everything you spend more time on scut which could have been better spent on actually learning. There are diseases you see regularly at SUNY DS that people only read about at other places. Many a resident has lamented that only if SUNY DS could be as good as a Cornell or MassGeneral or whatever pie in the sky program you think is out there it would be top of the medical world. There are many programs out there where residents are still in medical school mode and aren't tested as much as you would be at SUNY DS but I think there are enough other choices out there that you do not need to subject yourself to the abuse at SUNY DS to be a good doctor.

Also I was never claiming the residents from any school or country they came from were sub-par; you have to be good to great to get through the program. But for the high level of work they get from the housestaff you would be surprised how badly they are treated.
The departure of Dr KAPLAN guy was NOT transparent whatsoever. Not in a million years. The fact that so much in the morale of the program changed after he left is a testament that however he was doing it his presence alone was somehow protective to the housestaff. To this day members of the housestaff still talk about what was lost when he left and how the program became full own malignant, to this day. Even some who were not even apart of the housestaff (students), talk about the good old days.

As far as patient escalation protocol, please. Of course there is some paper in some desk somewhere with the escalation protocol but that has no real world application. The buck starts and stops at the IM housestaff. The word in the past was if there is a patient escalation problem or ancillary problem, call Dr KAPLAN Guy and he will handle it; he will show up at somebody's office and make something happen. Maybe the other programs are just as overworked which could be true but let's not pretend SUNY DS is a smooth running ship, no way.

As far as felllowships the idea that the housestaff just didn't do enough to get it is crazy. You work like a bastard on your ICU and floor months. People do almost every elective and do research in the specialty and still don't get it. While spots are given to outside people and not from within. Dr KAPLAN guy said if you work here and get through the program and do great work you will get a spot if a spot is available. I personally don't care about fellowship but others do. I will use 2 examples. During the same year of fellowships the GI program had 5-6 spots, only ONE went to someone in the program. In the ENDO program with 3-4 spots in that same year, ZERO went to someone in the program, ZERO. And the rumor about the ENDO was that they didn't like VISA FMGs; amazing since 30% of the IM program is FMGs. That is when the chief year becomes so important again; what the chiefs will do to toe the line to ensure they get there fellowship either at SUNY DS or somewhere else with the help of the deparment. And many a resident has been told not to apply for fellowship, that is a fact, good candidates; I still don't understand why.

The fact of the matter is that SUNY DS is run like every housestaff member is replaceable, which is true. Since you are replaceable there is no need to improve the program. They probably easily interview 500 or more for the 100 plus spots. Since there is atleast 100 FMG applicants behind you it doesn't matter if you are treated like crap. Once they have gotten there use out of you they are done; that is the mean part about the fellowships. You suffer there, work through the scut and then someone not even in the program gets the spot. What is even worse is that fellowship is held out like carrot for all the FMGs and they know they are not going to give it to you, unless you do chief year or win some award. Your supposed to be treated like a colleague and instead your treated like a disposable sweatshop worker.

If you want to see pathology goto SUNY DS, it is there, but leave everything else behind. Don't take my word on it. Ask the St Vincent residents who came to SUNY DS after their hospital shut down. If you think a SUNY DS resident who knows the deal curse and moans too much, just ask a St Vincent transplant resident. Or any other housestaff member that worked anywhere else. Some of the housestaff who used to work through the scut of state/country owned hospitals in the Caribbean are amazed.

The issues at SUNY DS are NOT the fellow interns and residents, or even the attendings. It is the program itself. I should have titled my original post, "SUNY Downstate, a sweatshop, and not the nice kind". As with all post blasting a program, the program has some chief resident or some true believer try to run some interference, take it with a grain of salt.

SUNY DS is a throwback to an earlier time in medicine training when they just treated you like crap and you accept it cause that is how it is and you have to take the hazing to see the end of the tunnel. It doesn't have to be. But for some damn reason it is and will continue to be. You will be trained by the volume, but you maybe scarred, be warned

nonsensical chicanery. i couldnt even make it through this novel of a post. please base your reviews/ranking of this program on PEOPLE YOU KNOW WHO ARE THERE. not clowns posting things on this forum.

 

[FLpk1girl86]

My post comes from someone who was there, not some outsider who is taking shots, I have seen the program through the changes from top to bottom, I actually cut the post short cause I didn't want to ramble on. Everything I said is true.

In that very long post I did not once use the time to talk down the housestaff or the attendings quality. The housestaff has to support each other because of the system there, if they didn't there would be no support. Your co-intern and co-resident is the only one you can identify with since you are in the trenches together. Many of the attendings are former residents and they are good teachers but the level of scut takes away from the teaching. My post was about the actual program and how it is run and how the housestaff is treated, NOT about the housestaff itself. There are always true believers drinking the kool-aid but the word around the program from PGY1 to PGY3 is that the program treatment is horrible, hands down. In its worst days I remember talking with others and they were in disbelief how some in the program are clueless and think this treatment is normal.

YOU WILL DEFINITELY BE A COMPETENT DOCTOR AFTER GOING THERE BECAUSE THE LARGE VOLUME OF PATIENTS, THE DIVERSITY OF THERE DISEASES AND THE SEVERITY OF THEIR DISEASES. What I didn't say at the end of the post was that SUNY DS has some of the greatest potential IF AND ONLY IF the program was better run. Brooklyn offers the most diverse pathology you can see on the continental US. But due to the fact that the hospitals are held back by the ancillary services and you have to do almost every step and push for everything you spend more time on scut which could have been better spent on actually learning. There are diseases you see regularly at SUNY DS that people only read about at other places. Many a resident has lamented that only if SUNY DS could be as good as a Cornell or MassGeneral or whatever pie in the sky program you think is out there it would be top of the medical world. There are many programs out there where residents are still in medical school mode and aren't tested as much as you would be at SUNY DS but I think there are enough other choices out there that you do not need to subject yourself to the abuse at SUNY DS to be a good doctor.

Also I was never claiming the residents from any school or country they came from were sub-par; you have to be good to great to get through the program. But for the high level of work they get from the housestaff you would be surprised how badly they are treated.
The departure of Dr KAPLAN guy was NOT transparent whatsoever. Not in a million years. The fact that so much in the morale of the program changed after he left is a testament that however he was doing it his presence alone was somehow protective to the housestaff. To this day members of the housestaff still talk about what was lost when he left and how the program became full own malignant, to this day. Even some who were not even apart of the housestaff (students), talk about the good old days.

As far as patient escalation protocol, please. Of course there is some paper in some desk somewhere with the escalation protocol but that has no real world application. The buck starts and stops at the IM housestaff. The word in the past was if there is a patient escalation problem or ancillary problem, call Dr KAPLAN Guy and he will handle it; he will show up at somebody's office and make something happen. Maybe the other programs are just as overworked which could be true but let's not pretend SUNY DS is a smooth running ship, no way.

As far as felllowships the idea that the housestaff just didn't do enough to get it is crazy. You work like a bastard on your ICU and floor months. People do almost every elective and do research in the specialty and still don't get it. While spots are given to outside people and not from within. Dr KAPLAN guy said if you work here and get through the program and do great work you will get a spot if a spot is available. I personally don't care about fellowship but others do. I will use 2 examples. During the same year of fellowships the GI program had 5-6 spots, only ONE went to someone in the program. In the ENDO program with 3-4 spots in that same year, ZERO went to someone in the program, ZERO. And the rumor about the ENDO was that they didn't like VISA FMGs; amazing since 30% of the IM program is FMGs. That is when the chief year becomes so important again; what the chiefs will do to toe the line to ensure they get there fellowship either at SUNY DS or somewhere else with the help of the deparment. And many a resident has been told not to apply for fellowship, that is a fact, good candidates; I still don't understand why.

The fact of the matter is that SUNY DS is run like every housestaff member is replaceable, which is true. Since you are replaceable there is no need to improve the program. They probably easily interview 500 or more for the 100 plus spots. Since there is atleast 100 FMG applicants behind you it doesn't matter if you are treated like crap. Once they have gotten there use out of you they are done; that is the mean part about the fellowships. You suffer there, work through the scut and then someone not even in the program gets the spot. What is even worse is that fellowship is held out like carrot for all the FMGs and they know they are not going to give it to you, unless you do chief year or win some award. Your supposed to be treated like a colleague and instead your treated like a disposable sweatshop worker.

If you want to see pathology goto SUNY DS, it is there, but leave everything else behind. Don't take my word on it. Ask the St Vincent residents who came to SUNY DS after their hospital shut down. If you think a SUNY DS resident who knows the deal curse and moans too much, just ask a St Vincent transplant resident. Or any other housestaff member that worked anywhere else. Some of the housestaff who used to work through the scut of state/country owned hospitals in the Caribbean are amazed.

The issues at SUNY DS are NOT the fellow interns and residents, or even the attendings. It is the program itself. I should have titled my original post, "SUNY Downstate, a sweatshop, and not the nice kind". As with all post blasting a program, the program has some chief resident or some true believer try to run some interference, take it with a grain of salt.

SUNY DS is a throwback to an earlier time in medicine training when they just treated you like crap and you accept it cause that is how it is and you have to take the hazing to see the end of the tunnel. It doesn't have to be. But for some damn reason it is and will continue to be. You will be trained by the volume, but you maybe scarred, be warned

cliffs?

 

[Chakrabs]

I just graduated from Downstate and I must take issue with this bizarre diatribe. Downstate IM combines three governement hospitals at from the Federal (VA), state (Univ. hospital of Brooklyn), and municipal (Kings County) level and has all the problems inherent. Yes the ancillary staff sucks, and yes there is scut to do. However, as a student there, I never saw a resident crying or being abused. Far from it, there was plenty of teaching going on, the chief residents were extremely supportive, the hours were fantastic for the residents, and the residents were by and large fairly happy. I think they generally get the fellowships that they want, and there is certainly plenty of solid research opportunities to pursue at Downstate. That said, the vast majority of people in my class did not wish to stay there, and most matched elsewhere. Is Downstate the best program around? Certainly not, far from it actually. Is it the hellhole thats described above. Again, absolutely not. I think the residency is a little more difficult than most, but you'll be very well-trained and able to handle anything that you come across as an attending. You can pursue any sort of subspecialty you want and will have plenty of job opportunities once you finish.

 

[pr20]

I just graduated from Downstate and I must take issue with this bizarre diatribe. Downstate IM combines three governement hospitals at from the Federal (VA), state (Univ. hospital of Brooklyn), and municipal (Kings County) level and has all the problems inherent. Yes the ancillary staff sucks, and yes there is scut to do. However, as a student there, I never saw a resident crying or being abused. Far from it, there was plenty of teaching going on, the chief residents were extremely supportive, the hours were fantastic for the residents, and the residents were by and large fairly happy. I think they generally get the fellowships that they want, and there is certainly plenty of solid research opportunities to pursue at Downstate. That said, the vast majority of people in my class did not wish to stay there, and most matched elsewhere. Is Downstate the best program around? Certainly not, far from it actually. Is it the hellhole thats described above. Again, absolutely not. I think the residency is a little more difficult than most, but you'll be very well-trained and able to handle anything that you come across as an attending. You can pursue any sort of subspecialty you want and will have plenty of job opportunities once you finish.

Very much agree with everything here. I am not from Downstate but do know a bit about it.

Great diverse pathology obviously. I have heard bad scut work stories unfortunately particularly Kings County. The work load can be pretty bad but that's only going to help you when you are done.

I actually would say fellowship shouldn't be a problem. In fact from what I know they actually tend to take a lot of their own.

 

[emboli]

http://www.nytimes.com/2013/01/18/nyregion/audit-finds-suny-downstate-in-dire-fiscal-straits.html

Found this on the ERAS forum. This is big stuff... Is it too big/important to go under??

 

[aznb0y129]

Downstate MS4 here. After reading this entire thread, I have to say by and large I agree with the OP except maybe not quite to the same extent. Unbelievable amount of scut, incredibly difficult patients, social issues up the wazoo. I think that Downstate as a medical school works wonders for this reason because you see so much stuff but the pressure is never really on you. As a resident that dynamic changes entirely. I have met many extremely competent residents during my time at Downstate who all advised me not to apply there for IM. Why? Because you can get a decent residency training without doing all of that other nonsense. I am proud of the fact that I went to school there but I also wouldn't touch their residency with a 10 foot pole. On the interview trail, I have been brutally honest with other applicants about this fact and I am not alone in this opinion. Most of my fellow MS4s going into IM will not be staying (except for those who need to stay in the area). My $0.02

 

[stallion859]

yikes! Its sad because I think that program could have so much potential. Thanks for your input

 

[emboli]

Downstate MS4 here. After reading this entire thread, I have to say by and large I agree with the OP except maybe not quite to the same extent. Unbelievable amount of scut, incredibly difficult patients, social issues up the wazoo. I think that Downstate as a medical school works wonders for this reason because you see so much stuff but the pressure is never really on you. As a resident that dynamic changes entirely. I have met many extremely competent residents during my time at Downstate who all advised me not to apply there for IM. Why? Because you can get a decent residency training without doing all of that other nonsense. I am proud of the fact that I went to school there but I also wouldn't touch their residency with a 10 foot pole. On the interview trail, I have been brutally honest with other applicants about this fact and I am not alone in this opinion. Most of my fellow MS4s going into IM will not be staying (except for those who need to stay in the area). My $0.02

Thanks for the feedback. Valuable information there.

 

[gutonc]

FWIW, I too am a Downstate grad. Fantastic place to be a med student, horrible place to be a resident. I didn't even apply.

 

[thierryhenry]

Dont have enough energy to write everything

this thread is pretty biased as you can tell from the OP's 2nd post by stating this was info "From a friend"

after rotating there for 22 weeks of medicine and rotating everywhere else in NYC and interviewing at some 20+ programs I dont think any program or place can hold a candle to the kind of cases you see at Downstate.

Yes there is some ancillary BS to deal with; and obviously more annoying things to deal with that isnt seen at other programs, but most other NYC programs are going to involve ALL of those things (except of NYU, Columbia, Sinai, and Cornell; and even those have their "unionized" problems as well).

The PD is a long time faculty there and a stand up guy.
The chairman of medicine is extremely approachable.

The MS4 who said "no students go their for residency" is WRONG, dead wrong can even count on both hands the # of Downstate students I 1) rotated with; 2) met on interviews that wanted to stay at Downstate for multiple reasons (not just family, or location) but because of the pathology and the fellowships for IM. I also like how you said "incredibly difficult patients," do you mean you can't deal with them or relate to them or they are non-compliant, or they have incredibly complex advanced disease fresh off the boat from another country? Either way you would be correct with answering yes on all those statements.

Do your homework, ask around, as MFDoom says "dont believe everything you read up on the message boards."

 

[thierryhenry]

I will say however reading that new NYtimes article was a bit disheartening after interviewing at both LICH and Downstate it seemed that this "financial" thing would never ever be an issue; but yes i am curious about how that will play out as well.

 

[redy]

The one thing I will say is the diversity of pathology in Kings County is extremely good. Personally I feel every Brooklyn/NY hospital will have difficult patients/ancillary stuff/Scut work/varying levels of difficulty of workload but pretty much difficult anywhere.

I think its wrong to call it a malignant program. Thats for sure.

 

[redy]

Unfortunately it looks like LICH is indeed going to close. Looks like it's all been a bit of a game played at the highest levels basically to sell the real estate and pocket the cash.

Sent from my Nexus 7 using Tapatalk 2

 

[thierryhenry]

In terms of a residency program LICH was interviewing applicants all throughout the cycle, said they had almost 20+ categorical spots. When filling out my rank list last week the quota on NRMP was 4 for LICH for categorical. After the 31st the program had withdrawn. An intern currently there told me, the hospital will close in the next month, as for the 2nd and 3rd year from LICH he stated some will be orphaned, some will "become" Downstate residents, and some will be fired...

 

[gutonc]

Interesting. When I was at Downstate, LICH was still a Continuum hospital and I didn't realize Downstate had purchased it. I will say that I was surprised that it was still open when I rotated there as an M3 8 years ago. My peds team of 6 (1 resident, 3 interns and 2 med students) took care of 14 patients all month. The ER was usually only half full. Anybody in the community who had the option had already abandoned it.

Sucks for the residents to be sure.

 

[redy]

Interesting. When I was at Downstate, LICH was still a Continuum hospital and I didn't realize Downstate had purchased it. I will say that I was surprised that it was still open when I rotated there as an M3 8 years ago. My peds team of 6 (1 resident, 3 interns and 2 med students) took care of 14 patients all month. The ER was usually only half full. Anybody in the community who had the option had already abandoned it.

Sucks for the residents to be sure.

That was probably a peds thing. I have been told that peds had closed at one point and then restarted. Either way peds is still not too busy.

IM and other specialties on the other hand are fairly busy IMO and the ED is fine too.

BTW LICH has indeed withdrawn from the match.

 

[redy]

In terms of a residency program LICH was interviewing applicants all throughout the cycle, said they had almost 20+ categorical spots. When filling out my rank list last week the quota on NRMP was 4 for LICH for categorical. After the 31st the program had withdrawn. An intern currently there told me, the hospital will close in the next month, as for the 2nd and 3rd year from LICH he stated some will be orphaned, some will "become" Downstate residents, and some will be fired...

I am not sure about some being fired, unless of course they were on probation or other issues from before hand. It appears that most are going to be absorbed into Downstate.

 

[Philosiraptor]

http://www.wnyc.org/articles/wnyc-n...tees-vote-close-long-island-college-hospital/

Looks like it's official, LICH is going to shut down. Apparently they cancelled the last bunch of interview dates. Also, people applying to SUNY Downstate ENT received an email stating that inpatient services were going to be "reduced or eliminated" at LICH some time ago.

 

[15MD]

What's the best way to be "orphaned" into another IM program if you are currently a resident when LICH shuts down? Are other programs able to easily accept these residents because they still have their acgme funding? Best to just mass email/call all programs and hope they can add a spot?

 

[rokshana]

What's the best way to be "orphaned" into another IM program if you are currently a resident when LICH shuts down? Are other programs able to easily accept these residents because they still have their acgme funding? Best to just mass email/call all programs and hope they can add a spot?

they don't actually have to arrange funding....the ACGME will allow programs to take orphaned residents without concern for funding or numbers for humanitarian reasons...maybe the funding can go with the resident.

the ones that suffer are those that matched to an advanced position (or a fellowship) that hasn't started...they are essentially screwed.

 

[emboli]

So with LICH shutting down, it obviously doesn't eliminate the debt issue and operational losses. I think the most important question is.. will it still be floating in 3 years?

Also, is Downstate state-owned?? In order words, will it always have the backing of the New York State government? When I was there, the residents don't seem to be overly concern with Downstate's stability. They think it's too important to actually be shut down by the state. All these hospitals that have been closing in NYC small community hospitals. With Downstate being tied to a medical school (and the state for that matter), does that count for anything?

 

[thierryhenry]

So with LICH shutting down, it obviously doesn't eliminate the debt issue and operational losses. I think the most important question is.. will it still be floating in 3 years?

Also, is Downstate state-owned?? In order words, will it always have the backing of the New York State government? When I was there, the residents don't seem to be overly concern with Downstate's stability. They think it's too important to actually be shut down by the state. All these hospitals that have been closing in NYC small community hospitals. With Downstate being tied to a medical school (and the state for that matter), does that count for anything?

To answer; Kings County hospital is owned by the state; I think it would be insane to close, and not feasible, so the answer to that is NO it probably will never shut down. University Hospital on the other hand could; I remember that was the discussion with buying LICH was where to move the "main" SUNY campus. Also yeah I dont think the state of NY is going to eliminate a whole public medical school so I dont foresee anything within Downstate "closing"

As another MS4 who has worked closely there and ranking them high, I have these same concerns as well.

 

[emboli]

To answer; Kings County hospital is owned by the state; I think it would be insane to close, and not feasible, so the answer to that is NO it probably will never shut down. University Hospital on the other hand could; I remember that was the discussion with buying LICH was where to move the "main" SUNY campus. Also yeah I dont think the state of NY is going to eliminate a whole public medical school so I dont foresee anything within Downstate "closing"

As another MS4 who has worked closely there and ranking them high, I have these same concerns as well.

Hey, I'm almost certain Kings County is owned by the city (like Jacobi and Bellevue), not the state.

 

[gutonc]

Hey, I'm almost certain Kings County is owned by the city (like Jacobi and Bellevue), not the state.

Correct, KCH is owned by HHC which is NYC, not NY State. Univ Hospital and the med school are owned by the State.

While I think it's somewhat naive to not be worried about Downstate at all, there's no reason to think that Downstate will close.

 

[FutureUfMedicin]

UPDATE: The Internal Medicine program director at the time of the original posting was forced aside in the Spring of 2012 because of all of the reasons I stated in both of my posts although they will never admit it. A new director has been in place since that time but I cannot speak to how that affects the program. The Chairman of Medicine is still the same.

From what I have heard SUNY Downstate closed inpatient services for the Downstate hospital. Downstate is owned by SUNY. Kings County across the street is still functioning and is part of HHC just like Harlem Hospital. When I said it "was too big to fail" I was speaking to the fact that Kings County and Downstate Medical had huge backing and would be the last hospitals standing in Brooklyn. I had no idea about the mismanagement by SUNY. Kings County will never close because of its backing from the city/state. Sad as it may be but LICH will be closing if it hasn't already.
In a strange way the closing of Downstate and LICH may benefit the residents in the sense that it will lower the number of hospitals to rotate through possibly. If the residents only have to rotate between the Brooklyn VA Hospital and Kings County it may allow better team structure for Kings County. Kings County hospital is the best hospital to learn at. Abandoned residents from closing programs can be absorbed at no cost to the accepting residency program. SUNY Downstate previously absorbed some of the residents from St Vincent when it closed so it will likely absorb as many LICH residents it can. The bigger issue facing Kings County is the higher strain on the hospital with LICH closing and Downstate Medical closing inpatient services. It will put more strain on KCH and this would likely require the consolidation of residents to Kings County.

 

[DrDudeMD]

Where did you here that from? Downstate's inpatient services are still up and running.

 

[LoudBark]

Where did you here that from? Downstate's inpatient services are still up and running.

It has been very difficult to separate truth from fact from myth in this entire thread.😱

 

[235009]

UPDATE: The Internal Medicine program director at the time of the original posting was forced aside in the Spring of 2012 because of all of the reasons I stated in both of my posts although they will never admit it. A new director has been in place since that time but I cannot speak to how that affects the program. The Chairman of Medicine is still the same.

From what I have heard SUNY Downstate closed inpatient services for the Downstate hospital. Downstate is owned by SUNY. Kings County across the street is still functioning and is part of HHC just like Harlem Hospital. When I said it "was too big to fail" I was speaking to the fact that Kings County and Downstate Medical had huge backing and would be the last hospitals standing in Brooklyn. I had no idea about the mismanagement by SUNY. Kings County will never close because of its backing from the city/state. Sad as it may be but LICH will be closing if it hasn't already.
In a strange way the closing of Downstate and LICH may benefit the residents in the sense that it will lower the number of hospitals to rotate through possibly. If the residents only have to rotate between the Brooklyn VA Hospital and Kings County it may allow better team structure for Kings County. Kings County hospital is the best hospital to learn at. Abandoned residents from closing programs can be absorbed at no cost to the accepting residency program. SUNY Downstate previously absorbed some of the residents from St Vincent when it closed so it will likely absorb as many LICH residents it can. The bigger issue facing Kings County is the higher strain on the hospital with LICH closing and Downstate Medical closing inpatient services. It will put more strain on KCH and this would likely require the consolidation of residents to Kings County.

there isn't an ounce of truth in this post. as mentioned above downstate's inpatient services are still up and running, there has been absolutely no talk about discontinuing them.

in addition LICH is still open: http://www.nydailynews.com/new-york...nts-air-provocative-tv-spot-article-1.1305087

 

[redy]

there isn't an ounce of truth in this post. as mentioned above downstate's inpatient services are still up and running, there has been absolutely no talk about discontinuing them.

in addition LICH is still open: http://www.nydailynews.com/new-york...nts-air-provocative-tv-spot-article-1.1305087

Absolutely correct. FutureUfMedicin's post appears malicious. Both Downstate and LICH are running open. LICH employeees and physicians are doing their best to save it. Right now Department of Health is assessing Downstate's request to close LICH and if I am not mistaken a decision may be due April 8th? Not sure though.

 

[rokshana]

Absolutely correct. FutureUfMedicin's post appears malicious. Both Downstate and LICH are running open. LICH employeees and physicians are doing their best to save it. Right now Department of Health is assessing Downstate's request to close LICH and if I am not mistaken a decision may be due April 8th? Not sure though.

it wasn't inaccurate to say that a decision was made to close LICH..just seems like the restraining order is making a change in that decision.

 

[redy]

it wasn't inaccurate to say that a decision was made to close LICH..just seems like the restraining order is making a change in that decision.

What do you mean by that?

He was totally wrong in saying that Downstate inpatient services has closed ("from what he heard") That is just plain rumor mongering.

 

[DrDudeMD]

What do you mean by that?

He was totally wrong in saying that Downstate inpatient services has closed ("from what he heard") That is just plain rumor mongering.

http://carrollgardens.patch.com/articles/suny-restrained-by-brooklyn-judge-for-second-time

 

[rokshana]

What do you mean by that?

He was totally wrong in saying that Downstate inpatient services has closed ("from what he heard") That is just plain rumor mongering.

what part do you not understand?

even the nytimes article said that LICH was slated to close on june 17...i made no mention of the whole downstate inpt part...

 

[yasir jawaid]

To start with i read in this extremely long thread on how suny downstate is not a program worth anybody's while. Now the entire facade with the PDs is something I am completely unaware of and frankly not very concerned about. What did catch my eye was that one of the reasons suny Ds is a program is because it Carters to a difficult patient population. You sir, are actually very wrong! A difficult population if clinically difficult makes you an astounding physician, patient population which is rude well I would advice not too rely on courtesies from terminally ill patients to feed your ego, if ethnicity and language is a problem than welcome to New York buddy!!! So a difficult patient population should be a challenge, a challenge which will make me a better physician!! As far as fellowships go it's a university hospital I'm pretty sure something can be worked, I mean if flushing can make fellows than obviously obtaining a fellowship is resident dependent not vice versa. As far as ancillary goes I think scut work since when did we become riding such a high horse we are interns for crying out loud!!! What is so bad about drawing blood or wheeling a guy to radiology!! Why is that a problem?? You know the US health care is so amazing because the doctors of yesteryear were laborious and intellectual, medicine is tough it's tougher than most things in the world; if the work load and getting yelled at is a problem please find a different career. Again before everybody starts calling me an old timer etc etc.... I am 25 and applying for the match next year and I advocate the tough residency it separates the men from the boys( sorry girls just an expression not trying to be sexist 🙂 ). Also this is New York get used to fast pace, rude people and the hard life. If you make it here you can make it anywhere but do you have the cahoonies to do that!!!!!!! My 2 cents... Be strong people!

 

[yasir jawaid]

Excuse the bad grammar hard to type when your trying to multi task

 

[Trifling Jester]

To start with i read in this extremely long thread on how suny downstate is not a program worth anybody's while. Now the entire facade with the PDs is something I am completely unaware of and frankly not very concerned about. What did catch my eye was that one of the reasons suny Ds is a program is because it Carters to a difficult patient population. You sir, are actually very wrong! A difficult population if clinically difficult makes you an astounding physician, patient population which is rude well I would advice not too rely on courtesies from terminally ill patients to feed your ego, if ethnicity and language is a problem than welcome to New York buddy!!! So a difficult patient population should be a challenge, a challenge which will make me a better physician!! As far as fellowships go it's a university hospital I'm pretty sure something can be worked, I mean if flushing can make fellows than obviously obtaining a fellowship is resident dependent not vice versa. As far as ancillary goes I think scut work since when did we become riding such a high horse we are interns for crying out loud!!! What is so bad about drawing blood or wheeling a guy to radiology!! Why is that a problem?? You know the US health care is so amazing because the doctors of yesteryear were laborious and intellectual, medicine is tough it's tougher than most things in the world; if the work load and getting yelled at is a problem please find a different career. Again before everybody starts calling me an old timer etc etc.... I am 25 and applying for the match next year and I advocate the tough residency it separates the men from the boys( sorry girls just an expression not trying to be sexist 🙂 ). Also this is New York get used to fast pace, rude people and the hard life. If you make it here you can make it anywhere but do you have the cahoonies to do that!!!!!!! My 2 cents... Be strong people!

What's so bad about wheeling a patient to radiology and drawing blood? Well, it takes up time which could be spent doing things a doctor does, rather than doing things that ancillary services should do. You'll appreciate your time more when you don't have so much of it as a resident.

-The Trifling Jester

 

[yasir jawaid]

EmapthiZing, compassion are all part of being a doctor!! You'll be surprised how effective treatment can be if you know your patients on a personal level! The doctors of the past were ancillary and they're knowledge is no inferior to ours! And I see residents spend more time writing brainless billing records than actually clinically active

 

[Trifling Jester]

EmapthiZing, compassion are all part of being a doctor!! You'll be surprised how effective treatment can be if you know your patients on a personal level! The doctors of the past were ancillary and they're knowledge is no inferior to ours! And I see residents spend more time writing brainless billing records than actually clinically active

It isn't necessary to draw blood or transport patients to show compassion and empathy.

 

[yasir jawaid]

That's not the point I don't see why drawing blood is a big deal, I am at the moment doing an observership in a big university hospital and all i see residents do is type excessively and write long notes for medical billing purposes, which I believe is scut and I worse than drawing blood and wheeling patients. Atleast that teaches you some clinical skill!!!!!

 

[HonestMD1]

I'm an intern now and when I was a student I thought that doing things like transporting patients, collecting urine and drawing blood were actually useful clinical skills but now I know differently.

When people refer to clinical skills they aren't usually referring to those menial tasks that don't actually provide you with useful knowledge. They're usually referring to things like interpreting lab work, reading CXRs/ other imaging modalities and gaining knowledge from other things (ie. physical exam) etc. Because that's is what being a doctor is actually about, that what you go to residency to do. The amount of time I wasted on doing those random tasks (that someone else is actually paid to do) takes away from the time that could be used in actually developing the medical knowledge and skill necessary to be a good doctor.