@DJFresh, apologies for the long-winded answer here. A fellow colleague here from the same class, hope you are doing well now post-training! I miss our ohana, I think we would all agree and we have said regularly our colleagues were the best part of the program. I hope to paint a more positive light based on my own experiences. This is not to invalidate your experience.
I completely recall that time period when COVID hit hard and the program was struggling for funding. It was hard to see the year prior having 8-9 electives because not many fast-tracked into child psych. Then there was our class with only 1 month of elective time due to COVID/ less graduating seniors. We definitely got "selectives" where we had more limited options for things we can do based on funding sources. I think the expectation of possibly having multiple elective blocks (given what we saw for the year prior, which was even an anomaly for them) with the reality of funding/covid/management limiting opportunity is what made it difficult.
Some highlights for me were access to some amazing faculty. I think they were as invested in my learning as I bother and asked questions. It was easy to always jump on projects within the department. I also really appreciated our dynamic therapy training. Things got much harder when we hit an outpatient year, working remotely and no in-person didactics. I personally found it isolating and found myself upset about many things that typically would not have bothered me as much. Finally, something most programs don't have is our awesome culturally focused training. I really think the quarantining hit our experience and bonds within the department hard. Not just in our department but now in fellowship I see similar issues at the residency program where my fellowship is. I was so glad when my current fellowship department from the get-go said didactics are in person, period. It felt like the beginning years of our training in Hawai'i all excited and looking to the future. That being said, so glad we quarantined in Hawai'i. Still miss my poke from Ona seafood and surf-watching in Waikiki blocks away from my apartment. Work-life balance will be hard to beat anywhere else.
Even on our heavier services like ED, CL, and Inpatient psychiatry, we did not reach our 80-hour limits. I think the closest I got was 70 hours once. That being said we are all different and I appreciate that fact but I am not a fast worker, at best moderate speed.
I definitely want to echo some similar points but perhaps from a different light. Faculty retention has been difficult I think in part with salary to cost of living gap. But in hindsight now searching for jobs I see it differently. I was discussing with current and to-be faculty, it appears they have adjusted some things. Now have a flat salary upwards of 300k or the option to do an RVU-based model if heavier services where you would make much more money. I have been looking at faculty positions at various university institutions. Academic salaries are not impressive anywhere. I think this was a sobering reality, it would be difficult to compare to private or group practice income. Most academic institutions go by the 25 percentile pay level which is around 200-220k. Found it unique that UH allowed private practice without taking a cut and would waive non-competes if asked. Fancier institutions and even not as fancy state universities typically want upwards of 30% or all of the private pay (the latter) patients you would bring in.
I do think you are right about the culture, and being from outside Hawai'i it was an adjustment to how the islands were in general. I am much more blunt and to the point where as Hawai'i generally had a less confrontational stance. I recall when I first moved to Hawai'i for training someone fell asleep at a green light and no one honked. The driver woke up after some 20 seconds and cars began to drive. This more non-direct approach definitely has its negatives as well which you cited. I also think our ED rotation was probably one of the busiest I have ever seen. Definitely grateful for the faculty that took over down there, especially with their forensic backgrounds. I think one thing I would definitely like is for services to not be resident-dependent. Currently at other institutions services will be tucked away by the attending if needed and residents do not have to worry about finding coverage if they are gone. That being said, where we worked hard others did not. I hear not too infrequently at my current university program the general residents themselves sharing not feeling ready to go into full practice due to lack of experience. They got the teaching and time to learn and fancy research tracks, but they didn't gain the clinical caseload. I hope a balance is struck somewhere in between for our program and I am sure it will.
My understanding of HRP is it is an independent non-profit (which you can check online) not under the University of Hawai'i which primarily funds the resident/fellow training. Funding for the Department is a patchwork of grants, university of Hawai'i funds, Queens Medical Center, and other things. That being said the system can be confusing for us younger trainees. Given I'm still a fairly recent graduate, I believe there was one citation/warning by ACGME but no official sanctions. Proud to be corrected if wrong but unfortunately these are not open-source things we search on a database for verification. On the education side, I think didactics were slowly starting to improve. We did have significant time from 1030am to 5pm for various "learning" activities.
On a final note DJFresh, please feel free to DM. February would be a bit more than half a year past our graduation and the last thing I would want any of us to do is ruminate on these things now in the past.
For any future interested candidate for UH I would be happy to share more insights while it is worth anything given programs are changing so rapidly due to regulations, turnover, and culture. Mahalo!
