UT Southwestern: An Evaluation (long)

[pufftissue]

There have been a couple questions about UT Southwestern in previous threads. Having done more than one rotation there, here's my 2cents, and I will offend some people, esp Texans:

1. Best IM program in Texas. It is true that IM rules the hospital and the med school.
2. National reputation is probably one of the top 20. Among states in the Southwest, and even Southeast, I think it could be considered one of the top 3 by reputation amongst applicants. Most of the programs with a better national rep are in New England and California.

I found that UTSW students and faculty thought of their program and med school as on par with the elite UC med schools and the Ivy league med schools when it comes to the training they receive. They probably would agree that they don't have the big name nationally like Hopkins and UCSF, but they think they aren't far behind. I disagree. In my limited experience with national perception, a suprising number of med students and attendings on the interview trail (outside of Tx) have not even heard of UT Southwestern, and do not know where it is when I pump them for info about this program. Hard to have that "elite" rep when the average joe only has a vague notion of the school.
My conclusion has been that the program is good and among the best there is in terms of training. No one can question that. But to equate that with national rep, I disagree. UTSW doesn't have the national rep that they perceive themselves to have. Regional rep yes, but not national. No way.

There are no residents from Ivy League schools nor from UC schools in the time that I encountered there. I know this because I saw a poster on the wall of Parkland hospital that lists all housestaff and their med schools. The vast majority of their residents are recruited from UTSW and texas, and are heavily weighted from the midwest, with maybe 4 from the east coast and 2 - 3 from the west coast. Remember, mind you, that there are roughly 50 in the intern class, so this is a small percentage. This fact, of course, does not correlate with quality, for many elite docs are not from the two coasts, but I include it for the sake of arguing national reputation, because if UTSW has the national reputation they perceive themselves to have (they did a lot of name-dropping during the interview, but that's to be expected) , then I would think that you could recruit some residents from the UC schools and the Ivy League schools, despite the arguably undesirable location UTSW is in.

3. The work load: you will work hard at this program. Even if you want to slack, you can't. But b/c of the new national work-hour limits, this will become more humane. The call schedule is strictly q4, with no short call or any variations. Call was from 7 am to 7 am, with a cap of 12 per team (6 per intern). 3rd year students usually can go to bed by midnight. For interns, they stop taking admissions at 2 am. I believe there is a night float system handles admissions from 2 am to 7 am or so. But interns must run crosscover all night, and I wouldn't count on getting more than one hour of sleep each call night as an intern, because the hospital is a legitimate 900-1000 bed hospital and is a circus. On paper the call schedule doesn't seem that bad, but for some reason, interns and residents work HARD.

The teams consist of an r2 or an r3, plus two interns, and two UTSW med students. The UTSW students are sharp, and the ones I saw all work hard, and they do contribute to patient care. One good thing is that interns don't have to write daily progress notes. The 3rd year students write them and the interns can co-sign them. Attendings I came in contact with were all extremely knowledgeable, and most are nice. Notable exceptions exist.

4. Teaching--it's mainly done via your patients, as it should be. You are so busy that the attendings can teach you, but not too much. And you do get the attendings who are into lab research and come out of their cave to do their 6 weeks of wards a year.
But again, this is going to happen at any university program. The pathology at Parkland is amazing. There are some weird things that walk through, yet there is still plenty of bread and butter medicine. The hospital is located near a homeless/drug/prositution rough neighborhood maybe 10 minutes from downtown Dallas, so that tells you the types of disease you'll see. Being in Texas, the Hispanic population is extremely high. Extremely. Take this with a huge lump of salt, but patients are 40% hispanic, 35% black, 20% white, 5% other.
There are no subscriptions to uptodate (I asked). Residents pay for it themselves.
One thing that was mind-boggling was the autonomy that interns and residents have. You are the physician to your patients. There are zero private patients, and if the patient does well, kudos to you. If they die, you have no one to blame but yourself. (Nurses and ancillary staff are good for a county hospital).
The clinical faculty are truly nationally known, and they do teach you. Dr. Foster is pretty well-known nationally.
5. Morale--perhaps oddly, residents are quite happy. They love their program, don't complain about working hard (at least i never heard it), and they have alot of parkland pride. Not sure if that comes from it being Texas or what, but it's definitely there. Residents are pretty nice though they work hard, but I think that's because the personalities are such that they love medicine and take pride in being tough and battle-tested. If you like being in the trenches and going through trial by fire, you have the right personality for parkland. Slacking isn't really a problem that I noticed.
6. Life outside of medicine--Dallas is a highly livable city, but it's boring. Not too much ethnic diversity compared to New England. Seems to be a prententious city. Cost of living is cheap, but it consists of lots of wide open spaces and newly developed malls and theaters. I do believe this program would be more highly regarded if it were in a more desirable location. But then again, residency is only 3 years.
7. Fellowships--a fair number stay at UTSW according to the sheet they gave us at the interview. Probably 75% go into fellowship, and the number I was told was about 18 residents applied for cardiology alone. You can definitely match into the subspecialty that you want, but not necessarily in the location you desire. But most people matched into respectable midwest programs, but there were around 35-40%% outside of the midwest. Vague, I know, but that's all I got.
8. Conclusion: best IM program in Texas, one of best outside of New England and California, lots of autonomy, work you arses off yet still are happy, bummer location, and current residents and faculty think their program is better than it is (even though the program is very good).
thanks for reading

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[task]

Pretty good assessment of the program, particularly with regards to quality of training, but I do take issue with a few points:

Let me preface this by saying that I am an R2 in IM at Parkland, and will be staying here for GI as well, so I know the program pretty well. I got interview offers for GI all over -- the name schools up East and out west, as well as here in the South/Southwest. Staying here was my first choice because I know the program, the other fellows, the residents, the hospitals, and I don't have to move!

Internal Medicine here rules the roost, and while we are the dumping ground for other services (like IM anywhere else) the IM residents here are pretty much regarded as the brightest residents in the hospital.

After my intern year, I felt like I was confident enough to take care of and stabilize any unstable patient on the floor or in the Units. I may not have been able to generate the extensive differential or have thought of every single little thing to do for the patient/ to pursue and work-up, but at least overnight when I assume care for the pt. I have the confidence to do all the right things overnight to stabilize that pt. till the AM, when smarter and more experienced doctors are around to help. I don't know of many other programs where this is the case after one year of training, let alone 3 years. This is not saying anything about me or my clinical acumen, but speaks to my training.

I thought I was going to be a Cardiologist (but was starting to consider GI), so my background before residency was optimized for Cards, and I looked for a name program that would train me to be an excellent medicine doc and get me into fellowship. I also had to go to a place that had a decent airport for my wife's job. This limited me to metro areas, at least a million in size.

My rank list out of med school was 1. Parkland/UTSW, 2. Duke, 3. Stanford, 4. UCLA. I was fortunate to have interviewed at a number of "prestige" places, including the name programs up East

1. I think if you identified the program as "Parkland" rather than "UT Southwestern" then you would have elicited more of a response from folks up East or on the coasts. I still think people "in the know" know of Parkland's reputation. Remember, if you've only lived and trained in Massachusetts and NY, then the chances of you knowing/caring about programs outside of the Northeast are slim to none. One thing UTSW loves to tout about itself is that there are four Nobel laureates on the faculty, all of whom happen to be Medicine faculty, BTW. Not that this means beans about where you should train, but people who love to throw name and repuation around like these facts.

Frankly speaking, I could give two ***** about what one of my colleagues at MGH or the Brigham think about where I train. UCSF is very academic, and frankly doesn't compare in terms of autonomy, and Stanford is nowhere in the same league in this regard. The Brigham is very much a gentleman's program, in my opinion. Mass General trains good docs. Hopkins trains good docs. Having said all this, there are Cards and GI fellows here from those places who, frankly speaking, are completely overwhelmed by the volume and pathology as well as the level of acuity of our patients here at Parkland. I always hear "why isn't this patient in the Unit" -- answer "because there are no Unit beds and I'm comfortable taking care of this patient on the floor for now." Having gone to an Ivy League school for college, I interviewed at some of the more name programs up East and found the attitudes that prevailed are still pretty archaic compared to the rest of the country.

Remember, the net growth in population in places like the Southeast and Southwest (and Cali) contrasts sharply with the
rust best states of New England and the mid-Atlantic, where populations continue to leave in droves for greener pastures.
I have a tremedously better quality of life and a monumentally lower cost of living than my friends up East. And in the end, I got the fellowship I wanted.

2. Just to clarify, other than UCSF, UCLA, and Stanford, the other Cali programs are average -- no better, no worse. And I honestly don't think the training is any better at those other places, but they do have a name and reputation to back them up. It's just that everyone from California wants to go back, so even the mediocre programs become pretty competitive.

3. As for med schools where residents come from, remember, folks from the coasts want to stay on the coasts. It's rare for programs in the midsection of the country to be able to pull people from the name schools up East, or UCSF or Stanford, to St. Louis, Chicago, or Dallas. Having said that, the 3rd year class when I was an intern had 2 folks from UCSF. The class immediately above me had a couple from Duke and one from Stanford, and my class has one from U. Chicago. Again, not a barometer of what kind of doctors these people have become, but if name is important to you, they do draw from name programs as well.

4. Dallas isn't all that bad. Big city, warm weather, two airports. MY single friends enjoy themselves in their free time, and those of us who are married like the amenities. Cost of living blows away other cities of this size.

5. The med students here have it pretty cush, and while some work hard, there are more than a few who don't quite get it and complain to no end. In my experience here, I've had probably 60-70% good students who do work and help the team out, and the rest who I suspect need to go into non-clinical areas of medicine.

6. Your comments about the ethos, the pride, and the type of people here are right-on. Very well put.

Bottom-line: If you come here and work hard and show you are a good doctor, you get training second to none and you will get a fellowship position if you apply -- it may not be your first choice, but that's a fact. That's all that matters, in my opinion.

 

[mandownunder]

I agree that the UTSW IM program is under-rated and agree with your corrections of the original post. Did you go to UTSW for medical school or were you from out of state. My wife attended UTSW and she worked her butt off. As a second year, she had to work on the phlebotomy service which meant waking up at 5 am to draw samples before classes started. She worked hard on her rotations and had to took legitimate senior rotations. I did my Prelim at Parkland and received great teaching, sometimes from Dr. Seldin. We even made rounds in the Pit (ER). I think UTSW is by far the best medical school in Texas and the graduates are the best prepared interns in the state.

 

[task]

I actually did not go to medical school at UTSW (I'm from the midwest originally) so my comments about how hard med students work here are based on comparing my 3rd/4th year with what I see of theirs. As a student I picked up every patient admitted to my intern (there were no student caps) and had to write up every patient I picked up -- not just one. We followed every patient we picked up until discharge (no capping at 5 patients to follow). So if you came in earlier and left a lot later, you did so without recourse. With regards to non-Medicine services, I did q2 on Trauma for 6 weeks as a 3rd year student (which I'm pretty certain no longer exists at my med school, but I know the students here never had anything of the sort to go through).

The students here are definitely bright and the ones who work hard are motivated, but I've also seen more than a few students are give off an air of entitlement. A little disconcerting, but probably not unusual at top ranked med schools as a whole.

What field of medicine are you practicing, if you don't mind me asking?

 

[EidolonSix]

I would beg to differ that UTSW med school is any better than the other state schools in the UT system (SW, San Antonio, Houston, Galveston). I personally went to UTHSC-San Antonio and feel that my education was at least tantamount to that at UTSW. What is different was the demographic of students...there were more women and more minorities in San Antonio's enrollment. Arguably, UTSW does have an excellent internal medicine program that could be considered underrated nationally. Still I don't hear much from UTSW grads or residents to suggest that they don't do their graduate/fellowship training where they want so it really doesn't matter what the Yanks think about the "superiority" of their Bostonian Mecca of Medical Education.

 

[Ctrhu]

I'm a radiologist.

 

[stephcf]

i'm actually a utsw med student, and from what i've heard from the interview trail, we definitely don't "have it cush". i was just interviewing at a hospital where students DON'T take call (they go home by 8-9), whereas we take overnight call Q3-4 on nearly every rotation. yes, we were allowed to sleep at midnight on IM, but really this turns into about 1am by the time you're done with your workups. Then you wake up around 4-5 to round on your patients. i know this is nothing compared with being a resident, but i would hardly say it is cush.

i do agree that there are some students that work harder than others, but that's true everywhere.