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15+ Year Member
Mar 6, 2004
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I loved UCSF but I have a major doubt, the reputation for malignancy. One resident admitted to me that major decisions in the program were made in a top-down manner, but all the residents swore up and down that they were happy. Another resident called her intern year "gritty and painful" and said that, of course, she learned a lot. It seems like they're doing a lot to comply with the work hours, and the ICUs at two of the hospitals that the residents rotate through are no longer open. However, the computer systems are awkward, orders are on paper, and they don't provide residents with parking (unless you pay $100/month).

Any thoughts?

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Hello Questioner-

I also loved the program, but think your concerns are based in truth. I felt that they do work very hard. But, what top program doesn't provide a "gritty and painful" intern year? By the way, I noticed "gritty" is a favorite word in SF. As in, "I love the mission district, but it is kind of gritty..." Anyway, back to the point - I met an intern there who said he never imagined how tired he would be. And he had been a UCSF med student. Another tidbit, a resident at Stanford told me he has a few close friends at UCSF and while happy with their training they are clearly more tired than he is, etc. I never got the impression that they are berated by attendings or anything like that though (my personal definition of malignant).

I also agree that their computer transition doesn't appear to be progressing too smoothly, but personally wouldn't pick a program based on notes, orders, etc. I think you should go with your gut if you liked the overall feeling.

Have you heard anything from the program since the interview?
I had the same impression at UCSF and all top-ranked programs, but I think I have figured out why, at least from my perspective.

It seems to me that all of the top-ranked programs (whatever that means) might end up being malignant (depending on how you define that) to a certain extent. Even with a strict 80 hour work week, it seems that interns at some programs end up working over 80 hours on their own a lot, so other attendings might expect this kind of work ethic out of all interns. As efficient as one may be, it is hard to beat just putting in more time for detail and followup.

It also seemed to me that the housestaff at programs like UCSF were really sharp and up on evidence-based medicine. This tells me that they are not just working over 80 hours in the hospital, but it wouldn't surprise me if they are checking afternoon labs from home and reading journals at night for a few hours before turning in.

On my interviews to some well-ranked programs, it seemed to me that housestaff members at these places are just enormously talented and efficient, and can remember just about everything after hearing it once. So there is a distinct possibility that I am just not nearly as talented and would have to work a lot more to keep up, so it just seems to *me* like they are more intense, when it really is not that intense to the people there. :) This might be why I had this sense that these places were intense (or malignant, depending on how you define it), but the interns and residents there feel like it's not that intense and that they really are honestly completely happy. I think a lot of it also has to do with the fact that this is the kind of lifestyle that these housestaff really like. I think that's awesome.

In visiting a range of programs, there is definitely a different feel to programs that are not ranked as "highly" (again, whatever that means). These programs felt more easygoing and laid back, and in these programs, sometimes the interns worked an average of 60 hours/week, not even approaching the 80 hour mark. At dinner, it seemed to me that these housestaff didn't live and breathe medicine the same way (although refer back to the distinct possibility above).

That was my impression from interviews. I am going to rank programs according to what kind of person I am, and what kind of people I have as my close friends. I interviewed at UCSF too, and I really think they were being honest when they uniformly said that they were really happy. I think their happiness has more to do with the kind of people they are, and what they like to do in their spare time, rather than covering up any cutthroatness about the program.

Any thoughts from anyone else's experiences?
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Very well said Pretzel.
Great post pretzel, had the same feelings myself.