How can a 200-bed hospital be the main hospital for an IM residency program? Both COCA and AOA seem to be very lax in their requirements... I wonder if there are ACGME IM programs at 200-bed hospital...
- Joined
- Oct 25, 2017
- Messages
- 3,793
- Reaction score
- 6,037
I think there are plenty of those around actually.
ACGME?
- Joined
- Sep 7, 2016
- Messages
- 2,518
- Reaction score
- 6,176
Yeah. If you restricted all residency programs to 700+ bed hospitals you wouldn’t have that many locations to have them outside of the massive cities. I know of a few in IM and FM that are in smaller hospitals (200 ish beds) and that’s just in the area close to where I grew up
Idk what the notion is on here that all ACGME residencies are at these huge locations with amazing resources and all that, yeah they have their **** together more than COCA or whatever dumb acronym we use, but it ain’t like they’re infallible
- Joined
- Feb 25, 2018
- Messages
- 695
- Reaction score
- 2,033
There are very many. I used to scribe at one.
- Joined
- Nov 28, 2014
- Messages
- 4,236
- Reaction score
- 15,054
Yes. So many. Hospitals that size can have an IM program AND other residency programs as well. Haven’t seen fellowships being offered in hospitals that small though.
- Joined
- May 10, 2013
- Messages
- 9,082
- Reaction score
- 8,552
Go on FRIEDA and search IM programs, there are quite a few places that have always been ACGME with hospital bed sizes of 200.
Unfortunate, but I would not want to train for IM in a hospital with 200 beds...
- Joined
- Dec 27, 2007
- Messages
- 3,419
- Reaction score
- 2,536
There's so much more to a hospital's training environment than just the number of beds.
To each his/her own...
- Joined
- Jul 5, 2017
- Messages
- 1,939
- Reaction score
- 3,334
So now people still in school think they know more about the quality of residencies than actual physicians like @NurWollen. That’s nice.
I guess only attending can talk about the quality of residencies... I wonder how many of the top 50 IM programs that are in ~200-bed hospitals
- Joined
- Sep 7, 2016
- Messages
- 2,518
- Reaction score
- 6,176
does everything have to be prestige driven? I mean I bet you get a damn good education at smaller hospitals with less other docs around to take cases too
I am not saying that... Residency is mostly about exposure, and I am just wondering what kind of exposure someone is going to have at a ~200-bed hospital... Again, I am talking about IM. I might be wrong, however. It's not about prestige.
- Joined
- Nov 13, 2013
- Messages
- 3,222
- Reaction score
- 4,544
Wow this thread is way different then what I expected. I do agree that a Tertiary hospital will expose you to more stuff than a secondary 200 bed hospital. That said, you can get some strong training in the medium small hospitals in managing bread and butter. And since most hospitals that you will actually work at are small (there are a lot more small than big places), learning what you can manage and what needs to be referred can be useful.
That said, I personally would prefer to train at a larger academic center if possible.
That said, I personally would prefer to train at a larger academic center if possible.
- Joined
- Sep 7, 2016
- Messages
- 2,518
- Reaction score
- 6,176
True. I guess that depends on where you're at. My job before med school I was in a 200 bed hospital 14 miles outside chicago and we got our fair share of overflow from the city. I never knew for sure but I think we got a case of mad cow once. Those were the rumors at least. The patient was discharged on my day off. We had some other crazy cases too but I'm guessing that's not the norm. And most of the time it was pretty bread and butter stuff anyway
The only residency we had was an FM one.
- Joined
- Dec 27, 2007
- Messages
- 3,419
- Reaction score
- 2,536
Well to be fair, I'm not an attending, and I'm not an IM resident, but I am a peds resident. I think there are pros and cons to either type of institution. At smaller places, you'll have a lot more hands on experiences, and often (but not always) a lot more autonomy. (Imagine being in house at night without a fellow and with an attending on call from home.) This is very important for learning independent practice. The trade-off is that you'll likely see a lot more bread and butter stuff and a lot fewer zebras than at a huge tertiary/quaternary center. At those institutions, however, there are fellows that might be making all the big decisions, and providing close resident supervision. The residents then might be primarily there to write notes.
Now, in peds, most fellowships aren't that competitive. People match into prestigious fellowships from community programs all the time. That's probably less true in IM, where a lot of fellowships are cut-throat competitive. So if you want cardiology or GI after IM residency, it's probably best to go to a larger center. In peds, it doesn't matter so much.
@NurWollen
I am an IM resident and our main hospital is a big academic center (~1000 bed) in an inner city. We also train at 2 smaller hospitals (~ 400 bed each) that some of us might do one rotation here and there... At the smaller hospitals, patients that are in ICU would be on a med-surg or possibly on a stepdown floor.
Nothing against smaller hospitals but I feel like the exposure might be lacking. However, I guess one can get good training at smaller hospitals.
I am an IM resident and our main hospital is a big academic center (~1000 bed) in an inner city. We also train at 2 smaller hospitals (~ 400 bed each) that some of us might do one rotation here and there... At the smaller hospitals, patients that are in ICU would be on a med-surg or possibly on a stepdown floor.
Nothing against smaller hospitals but I feel like the exposure might be lacking. However, I guess one can get good training at smaller hospitals.
- Joined
- Jul 21, 2010
- Messages
- 512
- Reaction score
- 331
There is a reason DO bias exists. Question is, are you going to just propagate that stereotype or challenge it? These things don't change overnight. I would not be surprised of CU had a ton of horrific DO residents that made GME start questioning the capabilities of those who studied at DO schools. It takes time and quality students to change those perceptions. Talking about it on a forum does nothing to help your cause.
- Joined
- Dec 27, 2007
- Messages
- 3,419
- Reaction score
- 2,536
I'm sure what you're saying is true, in your case. But that doesn't mean there aren't 400 bed hospitals with higher acuity ICUs. It probably depends on what other resources are nearby.
D
deleted645092
I’m doing my best to challenge it every day by trying to blow all my tests and rotations out of the water. So far I’ve dont alright getting 80th+ percentile on USMLE and 90th+ on COMLEX, and honoring every rotation with my lowest COMAT being 75th percentile. But I brought up the cost of a single rotation there because you always see people talking about not getting residency interviews, but rarely see them talk about not even being able to set up an away because of money. I can’t exactly challenge the stereotype of poor DO education at a place that makes it prohibitively expensive to even try.
D
deleted645092
Take my opinion with a grain of salt since I’m just a DO student spending my 2rd year training at a 300 bed hospital but from what I’ve seen so far, training at a giant academic hospital is only useful if you plan on staying at a giant academic hospital for your career. The best docs I’ve worked with have been those who were forced to work with a good deal of autonomy as residents at community hospitals while the worst have been those who came from giant academic centers that only saw wild and rare cases, and can’t manage every day diseases. Nobody cares that you’ve done a hundred procedures that nobody’s ever heard of or managed rare tropical diseases if you take 2 hours to remove a gallbladder or all of your CAP patients die.
Plus it isn’t like your case volume is going to be 5x that of someone at a 200 bed hospital if you train at a 1,000 bed place. You’re going to still have your case load limited. Plus all of those patients with the rare diseases have already passed through our place. We just didn’t have the resources to manage them.
- Joined
- Jul 21, 2010
- Messages
- 512
- Reaction score
- 331
That is good, and honestly all you can really do. I definitely recall thinking how absurd it was that CU charged that much for a DO to rotate there. But at the end of the day, they are just one program of many excellent ones that would be happy to match a DO. During my radiology interview trail, I noticed that if there was a DO or two in the program I was interviewing at, they were always exceptional and highly regarded by their peers. Many of the DOs I met were also chief residents, which I think somewhat speaks to their industriousness and likability among their colleagues and attendings.
- Joined
- Dec 16, 2011
- Messages
- 1,115
- Reaction score
- 2,250
You're wildly missing the point.
I don't think you can say one is better than the other really. The two physicians work in very different settings and play different roles in those respective settings - it's impossible and pretty pointless to compare them since they literally are not doing the same job.
Ultimately you train for the job you want. Going to MGH won't make you a good community IM doc in rural South Dakota where the nearest intensivist is 200 miles away, but in the same vein training at a community site in a rural setting will not make you a good academician.
Just as an aside though - community docs not knowing how to manage complex or rare presentations is a very real thing. Many of those rare diseases that pass through your run of the mill community centre either get grossly mismanaged or are totally unrecognised.
A
AnatomyGrey12
I know of a historically ACGME surgery program in a hospital with 180 beds. They only do like 3 months of out rotations or something and almost all of their time is spent at the base hospital. Most of the residents come from well regarded schools, with a few coming from the very elite, and the fellowship list is solid.
Similar threads
