Nice write up. I understand these were your impressions, but I just wanted to address a couple of points to clarify so people aren't misled. I couldn't resist...
Cons:
1. Relatively weak-appearing inpatient experience (only 8 weeks total), with somewhat low volume due to the fact that residents only see patients admitted who do not already have a doctor, and of course their continuity patients from the clinic. Most patients are apparently seen by private docs..
"8 weeks of Inpatient IM with low-volume": Deceiving and in fact, very false.
1. The number of uninsured is actually quite large, and it's gotten even larger since Katrina. Add to that we see county patients who refuse to go to county because, as they say, it's nicer here. It's a very busy, high volume, high turnover service with some very sick patients.
2. Our inpatient IM service (GIM & ICU) admits every day (q1), which is different from other programs. I would say we average 5-10 patients per night (the record is 30 admits in a night). With 2 interns on service, that makes it 2-5 new patients a day in addition to your own census. By numbers our ER is the 2nd busiest in Houston only to county (Ben Taub). Additionally, we are the medicine consult service for specialists/surgeons who have uninsured on their service.
3. At other programs, you do 4-5 months of inpatient IM, but that's GIM. We split our inpatient IM months with cardiology, pulmonary, etc., where you work 1:1 with the attending which is a great scenario. In total, it is equal if not more than other services. On these specialty months, you do the attendings' clinic, inpatient consults, and inpatient service which may or may not include the ICU which is a lot.
4. You take GIM/ICU/Pedi/OB/GYN call through out the entire year, which is different than other programs where you take call when you're on their service and then you're done for the year. This was a huge plus for me because you maintain your skills throughout the year (like it or not).
5. We are first responders to all emergencies (true ones or not) for the entire hospital at night, regardless of who the attending is (private or otherwise). That includes all House Officer calls (most common ones are CP and SOB). That includes stroke codes (we are the in-house stroke team). That includes all in-house CPR (we run them, we intubate, we do the lines). I think this is standard for completely unopposed programs, but I have interviewed at some where the ER attending runs upstairs to run the code which I think is lame.
Most patients are apparently seen by private docs..
6. False. Most patients in the hospital belong to a private attending (many of whom are on our volunteer faculty list and we do see them either on their service or by request at night when they are crashing). However most patients coming through the ER are NOT admitted to private attendings. In fact, the numbers are EQUAL (1:1) in terms of insured vs. uninsured admits to General Medicine On-Call (insured patients) and us (I know, a nationwide problem). We provide a huge service to the hospital by taking their no-doc-no-pay patients that they can't exist without us and we can't without them. Administration is trying to take our model and replicate it across the entire hospital system.
Despite what you said, the residents actually think the IM component is very strong.
On a separate note, the same thing applies to Pedi, except for Pedi, we take all kids admitted through the ER (q1). Our attending is the only privileged pediatrician, so the service takes all insured and uninsured kids from the community. We have 8 of our own beds for sick kids (which is more than any other programs I interviewed at. A lot of programs send residents to a children's hospital to work under a pedi residency program. We retain our own control). We're uncapped in the nursery, which can be a lot of kids considering the number of drop-ins. We also take all kids whose moms who may have insurance, but don't have a pediatrician picked out yet. Volume is seasonal. Kids get on insurance (Medicaid, if that's insurance) easily, and so we see a lot of kids we deliver in our clinics. The downside is that, while we do have NICU, we don't have a PICU. So a lot of unstable kids get stabilized in the ER and transferred to 1 of the 2 children's hospital in town.
At night, we have a House Officer who works in the ER, an admitting intern who does GIM, Pedi, and newborn admits, a ICU resident who runs the stroke code and takes clinic calls, a OB/Gyn resident, and a senior resident who supervises everyone. That's 5 people in-house at all times. All, but the OB/Gyn resident, make up the CPR code team.
2. Many subspecialty rotations (do you really need 4 weeks of CT surgery and 4 weeks of anaesthesia to do FM??), and apparently the teaching on these rotations is hit-and-miss, with residents scutted out on some services.
I think the subspecialty rotations are actually a strength because they're all so nice (yes, even the CV surgeons), and you learn straight from the specialist who may be more up to date on literature. You also build a relationship with the attending which is a huge plus now and after you graduate and have your own practice. Do you need 4 weeks of CT Surgery? Yes and no. Interns learn how to intubate patients in the OR under controlled environment with supervision before doing it on an unstable patient as an experiment. Airway management is a basic skill that all doctors need to know how to do. In fact, private attendings call on us to come intubate their patients. Anesthesia serve as our back up, so they LOVE to teach us how to intubate so that they don't get called (despite getting paid to take call). The surgeons are the ones who teach you how to do lines and suture, again, basic doctor skills. On surgical rotations, you do both clinic, floor, OR and ICU. You're right, teaching is attending-dependent. Some surgical attending only want to see you in the OR to learn how to intubate, start lines, and suture. Others want you to do see new patients (i.e. consults). When you're in our surgical attending's office, they'll let you do office procedures (excisions) which you then do in your own clinic.
As far as scut work, well, whatever. Seeing new patients is the way we learn at our program, so we do the H&P, come up with a DDx and plan, present to the attending, get taught, and we dictate. If that's scut, fine. You know, this IS residency. I will say there are a handful who will ask you to dictate patients you've never seen. That's scut. We know who those attendings are... and we tend to avoid them.
3. Weak OB onsite, though there is a stronger intern year OB experience at another hospital--downside is that it's about 30 minutes from the program's main hospital.
The OB onsite and the intern year OB are different. Intern year OB is at county where you work under a OB residency. We do it for PURE volume. Your job is to work triage, deliver SVDs, round on postpartums. It's pretty brainless once you get the hang of it, if you ask me. We hit our RRC requirement (30 for 3 years) in that month. On that rotation, you don't manage labor which is actually the interesting part because you're making decisions. At our hospital, you manage everything starting from triage, to labor, to delivery, and to postpartum. That's where the challenge is at because you are the one who works up a third-trimester bleeder, the vag repairs, the baby who's head or shoulder is stuck. OB call here can be scary, but luckily we have 24h in-house OB attending. We take all drop-ins and no docs, many have no prenatal care because they're poor, so you don't know what's coming out of there. And during call, you take ER Gyn call and work up those patients (vag bleed, ab pain). The expectation is that all doctors need to know how to manage low risk OB. So if you're interested in high risk OB and being primary surgeon on C Sections, you need to step up and speak up.
4. This is the big one: the clinic is moving 30 minutes away from the hospital next year. Nice facility is planned, but that's at least 60 minutes a day, 2-4 x/week that you could be sleeping, relaxing, or with your family. (This is in addition to your normal commute--the neighborhood around the hospital isn't great and most people live 20-30 minutes away, downtown or in a nearby suburb).You are still expected back on the main campus for noon didactics.
We currently have 3 clinics, so 2/3 of our residents commute to the hospital anyways. We're hospital heavy during the 1st year, 50/50 during 2nd year, and less so during the 3rd year, so the amount of commuting to and from the hospital isn't as much as you would think. I don't know if you saw, but our clinics are both wired and wireless and we all have laptops with tablet features. The new clinic will be the same way. Consolidated clinic will be interesting because that entire building will be ours. The first floor will be our own radiology and daytime occupational medicine and after-hours urgent care where faculty/residents can moonlight. 2nd floor our clinics, and 3rd floor administration and education. They're talking about doing video conferencing so that you don't have to commute between the hospital and the clinic just to catch conference. Then again, this is Houston. You have to drive everywhere anyways. You're right, the neighborhoods around the hospitals aren't Beverly Hills. But if y'all are interested in the program, we can talk more about where to live on a resident's salary. It all depends on if you are a hipster urbanite wanting to be near the single's scene or a soccer mom wanting the best public school system or el cheapo looking to save a buck or two. You have all these options here in Houston.
5. Houston (sorry Houston fans). It's a hot, humid concrete jungle, with a few bright spots, mostly inside the loop or downtown (the hospital is in a southwestern suburb).
All in all, I just couldn't justify spending that much time in the car, something I detest already, especially when my time is about to become my most precious and scarcest commodity.
Yes, it's hot, humid during the summer and it is very concrete. But I don't think you can compare a city versus a small town, because those are two different things. For a city, though, I think Houston's great and people are really friendly... the snob factor just ain't there. It's diverse, it's fun, it's convenient.
Anyways, that's enough for now. Do I think this place is the best in the country? No. Because I don't think one exist. But personally, I think it's pretty good. If you ask around (faculty, alumni, doctors around Houston), Memorial Hermann's definitely the best one in Houston, and one of the better ones in Texas and the US. We've been lucky, have a really good reputation, and do very well in recruiting every year, and want to keep it that way. I'd be happy to answer questions if anyone's got any.
I'm learning Kent) attendings have privileges at the Children's Hospital? (Other Children's hospitals I've been involved with have been reluctant to grant full admitting privileges to FM). Or is the plan for the FM residents to spend a month or two rotating on service with the Peds residents at the Children's Hospital?
