As a current BWH resident, every year around this time I log onto studentdoctor.net to read the BWH vs MGH vs Hopkins vs UCSF vs Penn vs whatever-else-is-in-vogue debate. It's incredibly entertaining, and becomes moreso as I (ungracefully) age. I'm certainly not pointing fingers, as I was as into the minutiae of "the great debate" as everyone else when I was interviewing for residency just a few years ago.
The truth is: at the end of your training, there is no difference among any of the "top" programs. It really is like splitting hairs. The "hotness" of a program's reputation is dependent on multiple factors that can change readily with time. We forget that medicine in the US was practiced for hundreds of years before our cohort decided to become physicians. If you look at the Harvard hospitals (BWH, MGH, and BID), there was a period not long ago when BID was the place to be and BWH wasn't on anyone's radar.
I argue that five things comprise a great internal medicine residency program:
(1) the ability of the training program to produce sound clinicians
(2) the ability of the program to produce leaders in medicine
(3) the ability of the program to ensure that its graduates seek the jobs/fellowships they are vying for
(4) the calibre of the residents
(5) the satisfaction of the residents with their program
While MGH and Hopkins are arguably the most well-established of the big programs, BWH and Penn emerged onto the scene largely because item #5 in the above list (resident satisfaction) prompted a boost in item #4 (resident calibre) to these programs. It's like Derm and Rad-Onc; ever since word leaked that those were relatively high quality-of-life careers, they've become two of the most competitive medical subspecialties. Hence, for example, BWH now has probably the highest percentage of MD-PhD's among any medicine residency program in the country - and while that doesn't necessarily wow everyone in the audience, it does suggest that a good percentage of BWH graduates will probably end up in academic medicine - a number that, like it or not, many residency programs use as a barometer for their success rate (item #2 above).
A few other points:
-among the top places, the average resident from one program is not going to be any more or less strong than the average resident from another. Making you take overnight call alone the moment you begin internship is not going to magically turn you into a better doctor. What it will do is get you to your endpoint faster - which is why, for example, Hopkins won't accept 2nd year transfers into their program from most other places. It's not about one place being better than another; it's about a program being front-loaded vs back-loaded or spread-even, and you have to decide which you think is better for you.
-medicine is not all about being a cowboy. Certainly we all take great pride in being able to manage a sick person alone - and the earlier in our stage of training that we can do this, the more pride we feel. Hence, there is a certain amount of ego-boost that comes with training at a place like MGH or Hopkins, where you're forced to act autonomously early on. But as mentioned in one of the earlier posts, regardless of where you train, you will ultimately get a lot of autonomy; it may come later on in your training, but it will come, nonetheless. That should be self-evident. What's not so apparent, but is equally - if not even more - important, is this: a great doctor also knows when to ask for someone else's opinion. The most effective learning comes directly from those who have more experience that we do; hence, if our learning environment is conducive to seeking such guidance and wisdom, then we stand only to gain. So it's essential to seek the right balance between autonomy and mentorship. No competitive medicine residency program would be dull enough to favor one over the other.
-remember that your cointerns and residents are the peeps you'll be working/learning/suffering with together, day-in, day-out, for the next few years, so it's important to be content with the people you work with. If you visit a program and love the residents, that should factor in heavily to your decision. Conversely, if you like a program's reputation but don't jive with the residents you meet or get a funny feeling from them, consider it a red flag.
-a few specific responses pertaining to BWH as mentioned in some of your posts:
1: I don't know where someone got the idea that we pay homage to a fellow when s/he's from Hopkins, but that simply isn't true. The worst fellow we all knew last year was from Hopkins, which was made all the worse by the fact that he'd wear his "Equanimitas" tie every Friday yet didn't know what the word meant. I have to emphasize again: there is no difference in level of clinical knowledge among fellows here who come from any of the various residency programs. (Granted, some of this is selection bias, since our fellowship programs have a specific type of person they're selecting for their programs.)
2: we aren't necessarily switching to overnight call, but there are a number of residents who would like to see such a switch, and hence we are trying to implement a trial run.
3: despite our touchy-feely reputation, we're actually a pretty intense bunch when it comes to work, and internship here, while less toxic than at MGH or Hopkins, is by and large much more difficult than the interns bargain for. Sure, the idea of not admitting patients after 9 or 10pm looks great on paper, but in practice, at this time of the year, a lot of interns end up working 6am-1am on their call days, and 6am-7pm or so on their post-call days. It is a misconception to think that our interns routinely get to go home to sleep - or, at the beginning of the year, to sleep at all. The reason a lot of people want to switch to overnight call is because they think it's easier to work a 24-30hr continuous shift than the system we have.
4: if you're using the BWH call schedule system as a factor in deciding where to put us on your rank list, you're making a big mistake. Every year, multiple times a year, we do trial runs of different plans in an elusive search for the "perfect" one. We just had a residency-wide ballot vote among three different plans, each methodically put together by a different horde of interns/residents. What will stay constant in the BWH system is a more even distribution of work among the three years than at MGH or Hopkins. It is unlikely that the BWH will become a front-loaded program, at least not anytime soon, so if you are looking for a front-loaded program, you should look elsewhere.
When I applied to residency, BWH was the rage. I found the MGH residents to be a rather subdued, almost gun-shy crowd, albeit quite animated when talking about why they were better than the Brigham. By contrast, the Brigham residents were not only smart, but also incredibly interesting, vivacious, poised, and confident without being disparaging of anyone else or any other program. It sounds superficial, but that appealed to me greatly. They looked and acted like the kind of physician I wanted to be. Like the rest of you, I had program directors from multiple places I applied to calling/emailing/writing me and saying I was ranked to match there. And I admittedly had a tough time deciding between BWH and MGH. But I'm glad that I ultimately ranked the Brigham first, simply because it was right for me.
Good luck to all of you!
