UTMB students and doctors rotate through the TDCJ Hospital(Texas department of criminal justice) which takes care of 90% of texas inmates and also takes care of federal and galveston county inmates. I heard that hospital is a mecca of disease and always full to capacity. You get to see lots of Hep C, HIV, Stab wounds, advanced cases.............. So u probably get to have the best autonomy in such a hospital.
I don't know about San Antonio, but they likely have pretty good programs from what i have heard. San Antonio is a bigger city though.
I am a fourth year in San Antonio. It is a great program. The reputation is about equal to that of UTMB I would say. Fellowship opportunites are great, with well respected fellowships in ID, Endo, and Neph and very good ones in GI and Cards. They take a lot of their own residents, so you should not have much of problem (though I have heard that a lot of residents end up doing a year or two in the Hepatology or Liver transplant clinic b/f GI residency). Clinical training is amazing, with a broad range of pathology considering the underserved population of hispanics from south texas and mexico (Tb, parasites, diabetes galore...) Lots of bread and butter. Not too much outpatient experience but I feel you would be a superb hospitalist coming out of this program. Hospitals are about average. The VA is a VA, not like the one in Temple TX or Palo Alto, but decent. University Hospital is a typical county facility, but the nurses are ok.
San Antonio is an extremely cheap place to live and the pay is decent. Some fun stuff to do with the TX Hill Country surrounding it (fishing, hunting, hiking, vinyards, camping, etc) and Austin to the north. It is my opinion that Austin is the best city in Texas hands down. Overall, SA is nice, but just not for me.
We just go a new chair, some bigshot cardiologist from UTSW and our PD is a really nice guy (not very helpful with residency applications though). Schedule is great (NO overnight call at UH and only overnight at VA on the weekend)... not so hot for those out there that are not for the night-float system. Teaching is good with conference every day and grand rounds wednesday morning, decent speakers and food provided (crappy food.. they put out deli meat, cheese, bread, and mayo and let you do the rest).
Overall I would rather go here than UTSW or Baylor IF I was staying in Texas, but I didnt apply to any programs here. Why? There is a good fellowship opportunity in a warm and supportive environment that responds to the needs of its residents. About 50% IMGs from Columbia, but they are excellent residents and great to work with. Spanish is a plus but not a requirement.