Since you asked...
I'm neither!
Not in my experience.
Sure, we have a lot of patients who've received transplants. For solid organ transplants in 2016, Mayo Arizona has the highest volume (440 transplants: 258 kidney, 112 liver, 4 pancreas, 18 kidney-pancreas, 43 heart, 5 lung) of any center in the state, the third highest volume of any center in the region and in fact the
fourth highest transplant volume in the country behind ULCA (563 transplants), UCSF (474 transplants) and Jackson Memorial in Florida (468 transplants). Data can be explored here:
View Data Reports - OPTN.
Sure, we have a lot of patients with cancer, what looks to me to be the highest volume in the state:
https://oliver.facs.org/FIPS2_Compare/index.cfm?CFTREEITEMKEY=23.
Sure, we get some weird stuff you'll have to dust off your old textbooks to understand. But these patients get pneumonia, CHF and COPD exacerbations, acute MIs, arrhythmias, cellulitis, diverticulitis, pancreatitis and all the other -itides just like internal medicine patients in any other hospital.
I have no objective evidence that the average patient complexity is high, but to me carrying six patients at Mayo felt about the same as carrying ten patients at Maricopa. One Maricopa resident told me the same thing. In general, think of patients here as having "diagnosis-plus," where "-plus" means a background history that complicates our management decisions.
Not going to argue with you here. The ICU rotation needs work. It IS a mixed ICU with both medical and surgical patients, and most internal medicine residents don't like that. For me, caring for both medical and surgical patients wasn't a problem and was educationally beneficial. What
did bother me was that the ICU culture prevented the residents from taking ownership of the patients, and not for lack of resident effort. The ICU has PAs and NPs the nursing staff and intensivists trust implicitly, and no amount of reminding by residents will get the nurses to call anybody but the midlevels or attendings. This HAS been brought to the attention of the leadership, and from what I understand it used to be even worse. Last year the residency program leadership made an agreement with Dr. Farmer, the head of the ICU, that the internal medicine residents would have our ICU rotations exclusively at Mayo Clinic--before, we had the option of Maricopa
or Mayo for your PGY-3 ICU rotation--in exchange for the ICU attempting to fix what's broken. So far, it's still broken for residents, but it
is a work in progress.
It
is challenging to do certain procedures here, in particular central venous cannulation and arterial cannulation. This has three principal explanations: first, our institution's preferred central access seems to be the PICC, and these are placed by the PICC team; second, we have a dedicated team of allied health professionals who place arterial lines on demand; third, our interventional radiologists are generally the ones to place tunneled catheters. Also, in connection with my above comments about cancer and transplant volumes, a lot of our patients have central access via ports or tunneled HD catheters placed here or elsewhere.
On the one hand, it's really nice to be able to place an order for a PICC or arterial line and have it completed within ten minutes while you attend to a different, crashing patient. On the other hand, we have to fight institutional inertia to do these procedures ourselves. There is no difficulty in fulfilling the procedural requirements of the ABIM, though admittedly they're wimpy requirements to begin with. A procedure elective at outside hospitals is in the works and will be ready for prime time either later this year or next year.
Getting only one shot at a procedure before deferring to the attending has not been my experience.
Correction: the institution calls itself the safest
teaching hospital in the
country. I think this stems from one thing in particular--some Consumer Reports rating in 2013 where Mayo Arizona ranked highest in safety by whatever criteria the authors chose to use. Otherwise, the hospital has received multiple "A" grades for patient safety by the LeapFrog Group and consistent recognition by the University HealthSystem Consortium (now Vizient) for quality, and the institution alleges it has the lowest observed-to-expected mortality ratio of any teaching hospital in the country. I don't have data to support that last one, so I think it's worth qualifying with "alleges," though for what it's worth you can see all the Mayo hospitals' O:E ratios plotted against one another here:
About Us - Mortality ratio. In short, patients generally have good outcomes here.
Not in my experience, though teaching does vary by attending. Surely it's much the same anywhere else. We have some great general internal medicine educators like Dr. Budavari, Dr. Ivanov and Dr. Charles to name a few. Outside the medicine wards, the intensivists are generally exceptional teachers. Standout subspecialty educators include Dr. Kennedy (cardiology), Dr. Vikram (ID) and Dr. Keddis (nephrology).
I don't have access to that data. For the "competitive specialties," last year I believe three of three GI applicants found themselves in GI fellowship this year. I don't believe we had cardiology applicants last year. One pulm/crit applicant matched to sleep instead. One who didn't match heme/onc last year did this year, to Mayo Arizona. This year's match results came in today and break down like this:
Cardiology: Three of three, at least two to first choice program--Mayo Arizona, University of Wisconsin-Madison, University of Kansas.
Pulm, crit or pulm/crit: Four of four, all to their first choice program--Stanford, Mayo Arizona, Saint Louis University and University of Arizona Medical Center (now Banner UAMC).
Rheumatology: one of one--Loma Linda.
Nephrology: one of one--Mayo Arizona.
Two will be hospitalists, and two will be chief residents.
Not in my experience. Dr. Blair is a bit inscrutable, but she cares for her residents and does act on their concerns. The program is continually evolving--one month of heme/onc (from an outrageous required THREE months) was dropped a couple years ago. An outpatient rotation in the second year was moved to the first year to provide more balance for our interns. Cardiology changed to senior night float from senior 28-hour shifts, per the residents' request. This year conflicting inpatient and outpatient nephrology duties were removed, and now residents have either inpatient responsibilities or outpatient responsibilities but not both (with the exception of a single attending who has received complaints), at the residents' request. A procedure elective has been arranged at another hospital where there are no roadblocks to procedures, per resident request. I'm not sure what issues you had besides the ICU rotation that weren't addressed, but odds are they were, at minimum, heard and considered.
Maybe I don't have a big enough sample. Maybe they're shielding me from the truth. Or maybe they're embarrassed to admit they're struggling. Regardless, the graduates I've spoken with have been satisfied with the training they received here. I'm also willing to bet that most newly minted attending physicians will feel scared and overwhelmed for a few months regardless of where they trained. Hell, there's one attending in another department who trained at Brigham and Women's and Stanford and was terrified for the whole of the first year as an attending here. He always ran his plans by the more senior attendings in the department.
That's a bit extreme. Let's turn it around on
you. Sounds like
you could have worked harder. Don't expect to be spoon-fed the knowledge and skills
you should be developing. The supervising staff are there to provide guidance and, yes, education, but they can't be expected to teach you everything. Similarly, the curriculum and program structure are well within the bounds of what is typical, acceptable and beneficial for resident learning. Take some responsibility for yourself, for your education and for your patients.
Ouch. Well, I'm sorry that your brief interactions with a small subset of the residents in the program weren't to your satisfaction. Best of luck in your interviews and residency applications! I hope you get that coveted spot in a name-brand, prestigious program your undoubtedly stellar medical education and USMLE scores have entitled you to. It's a shame we plebeians toil away in obscurity only to become doctors of ill repute, scoffed at and disdained by those in their thrones atop the ivory tower of St. George's University.
Edit: in all seriousness, Gavanshir, I'm sorry your uncle wound up in a hospital. I'm glad it turned out well.
