This is a little bit late, but hopefully it still helps next years’ class. If you happen to find this helpful, please pay it forward and share your insights once your turn comes.
Background:
My ranking was heavily influenced by personal factors, which may be entirely different from yours. My filters included family preferences on locale, basic science opportunities, opportunities in stroke/critical care, and comfort with the program leadership. I would point out that I would be happy going to every program I ranked, each with its own perks. The only piece of advice I could share (gained from graduate school, not medicine) is this: don’t overlook the leadership/mentors. When life happens, they will be the difference between you negotiating a way to happiness or being miserable.
Duke
Pros:
-Guaranteed intern year (if you want it). The medicine program seems awesome, I have friends in it who are very happy, but they definitely work hard.
-Particularly strong neuro-onc, neuro-critical programs. Living in the stroke belt doesn’t hurt, nice cachment area in NC/parts of SC/parts of VA.
-Very heavy emphasis on epilepsy and neurophysiology training (EMG, EEG, etc), moreso than other places, if that’s your thing.
-Beautiful new facilities.
-The residents seemed happy.
-The triangle (Raleigh, Durham, Chapel Hill) is an awesome place to live—cheap, beautiful, and accessible to both mountains and beach. May not be the best place if you’re single (Raleigh might be better), but I’m not sure about that. I personally loved it.
Cons:
-This is a relatively small program in transition. They recently transitioned from 4 residents per year to 6 per year. Research/elective time was limited and not protected; residents reported getting pulled with frequency but as the class size increase, that’s expected to decrease.
-They are just transitioning from a medicine division to a department, and (at the time) were looking to hire a new chairman/woman and down to three candidates. The new Chair had not yet been appointed when I interviewed/ranked, meaning no one knew what if any change in direction the department would be taking.
-Based on a few odd/abrasive interactions, I don’t think I fit into the culture cultivated by the current leadership.
-Limited track record of R25 supported trainees transitioning into independent investigators.
-The hospital is beautiful, but it’s absurdly large in horizontal, not vertical, terms, meaning it takes forever to get around.
-Finally, I found it kind of overwhelming how often people reminded me of how well respected Duke is. Despite preaching to the choir, I still found it distasteful.
Impression: had high hopes coming into the interview, but I did not rank this program after interviewing. This was a very poor fit for me. There is pretty limited elective/research time in comparison to similarly impressive programs, and they explicitly say that their goal is to be the anti-Wash U, Hopkins model of early specialization and research in training. They want you to come out comfortable as a generalist, so that if you’re stuck in the middle of nowhere, you’re ready to go. Then you can specialize. While this is reasonable if you’re interested in mostly private practice, general neurology, etc, I still don’t understand why this is the model at Duke. A residency program like that can be anywhere. If you have great research opportunities in house, I don’t understand why you don’t leverage that to make your program unique and attractive. The limited support for research, ambiguity regarding future direction, and my lack of comfort with the culture led me to not rank Duke at all. I would point out while this was a poor fit for me, there are plenty of happy residents there who have great opportunities in a variety of other interests. It was just a poor fit for me.
Wash U
Pros:
- Awesome program leadership. Chairman, PD are both incredibly nice and personable. My favorite chairman interaction of any interview. I felt totally comfortable counting on them to guide me through residency and help me transition into independence.
- Residents give tPA, not fellows or attendings. Lots of autonomy (and responsibility), with senior and fellow support, but you make the decision unless you call for help. They’ve also studied the safety/efficacy of this and published it. Seems like great stroke training, and the residents all report that as a big perk of training there.
- Insane volume. Wash U alone has >1600 beds in one giant complex. That’s roughly equivalent to MGH and BWH combined. As a testament to their volume/referral base, they saw 13 new cases of CJD in the prior 13 months when I interviewed.
- Great NCC program, big names in critical care. They have an on-site radiology suite for physiology research in comatose/vegetative/etc patients and lots of really cool techniques/strategies. They have one of two MRI/PET scanners [aside from MGH] next door to the ICU. Incredible NCC research opportunities.
- Radiology support is outstanding—very strong neuroradiology program for support, collaboration, research, etc.
- Categorical program—intern year is integrated into the neurology curriculum, and they squeeze the psych requirement into your intern year.
- Tons of elective time (10-11 months).
- Wide-open fellowship opportunities afterwards
- Very affordable cost of living.
- The administrator for the program was great, nice and helpful in sorting out details, schedule, etc.
Cons:
- Students and residents shared with me that in the past, Wash U had a reputation of being super intense. But they’ve since changed the service structure (ie- stroke and general service used to be one service…). It still seems very rigorous, but at least to me, not qualitatively different from the experience at other big name institutions.
- Very front-loaded 2nd year experience, very demanding year
- No option to do intern year elsewhere (if that matters to you, it didn’t to me)
- STL for some, not for others
Impression: I almost didn’t go to this interview because I didn’t think I’d like STL, but I went and it was awesome. Out of family/geographic considerations, I ranked this program a little lower than I would have based purely on fit and interest in the program. Regardless, a wonderful a training environment and opportunity. Great volume, great mentorship, and outstanding research opportunities.
Johns Hopkins
Pros:
- Great program leadership and rich history to the program
- Beautiful new facilities. Really really nice new Sheikh Zayed center.
- Great NCC & Stroke programs, lots of experience and history, very active research department.
- Outstanding basic science opportunities. The department is very focused on developing researchers (basic/clinical, whatever). This is not a good fit if you’re interested in private practice, but a great opportunity for academics.
- Lots of elective time: PGY4 is like 10 months elective or something to that effect. Good history of getting people R25 funding, great track record of trainees ending up as independent investigators.
- Unusually warm and friendly department. I was really surprised by how nice and engaging everyone was. Really impressive.
- Reasonably affordable cost of living
- Residents know their stuff very well; highly regarded residency training with wide-open fellowship opportunities afterwards
- The leadership and administrators for the program are great—personable, helpful, and very affable.
Cons:
- Baltimore depending on your taste/interest
- Very limited elective time before 4th year, not sure how that affects your ability to inform your fellowship decision/application. That said, folks do very well, so it may not matter, but if you didn’t know what you wanted, I’d see that as a potential issue.
- Intern year setup (at least for me) was kind of a mess. You should know that you can apply to JHU Osler and separately JHU Bayview as the associated intern years (not categorical, just same hospitals). You’re not guaranteed consideration. The Osler intern year seems overly intense—I did not get the feeling that it was going to be supportive or a good fit for me. That said, those interns knew their stuff. Rounds and the ACS mentoring model was extremely impressive, but I just didn’t fit into the culture that well. I also didn’t know about Bayview at all, so I didn’t apply. I looked at Maryland and Mercy (nearby) as backups, just FYI in case you are as uninformed as I was.
Impression: I ranked JHU highly. Would be very happy there. Baltimore left something to be desired, but overall, there are outstanding training opportunities here, and JHU keeps all doors open moving forward.
Emory
Pros
- Brand new Marcus Stroke Center at Grady, beautiful facilities, CT and angio on the same floor.
- Huge vascular program in the stroke belt. Extraordinary stroke volume, huge referral cachment in the South, and elite vascular neurosurgery at Emory.
- Program leadership is really nice—the PD in particular is a really great guy and huge resident advocate. He has won AAN PD of the year and is very intentional about crafting an educational and not work experience.
- Very aggressive neuro-IR (at Grady, not Emory), so lots of experience with post-procedure management.
- Multi-hospital system gives you an academic, county, and priv-ademic experience—you get a sense of all the main environments. I don’t remember if they cover the VA or not, I seem to remember no.
- University service at EUH is now transitioning to a consult-only service. Good and bad, although probably mostly good (no diarrhea management, etc there). It’s principally run by 2 neurohospitalists.
- Atlanta is a great town, affordable, green, great food, tons of stuff to do, etc.
Cons
- 4 Hospital System for some leads to dispersed residents, fair amount of driving/commuting. It can detract from resident cohesion.
- It’s hit or miss with such a limited snapshot of the didactic time, but I didn’t like it as much as most places I visited.
- Limited exposure to NCC at University hospital, almost all at Grady.
- This could be just me, but I didn’t get a great sense of the program on the interview day, I had to do a lot more investigation to get a sense of the priorities and kind of vision and priorities in terms of program design.
- Significantly less elective time than other places (~6 months), with an increasing emphasis on outpatient experience of things like vestibular clinic, neuro-optho clinic, etc. The vision from the program is that they have access to a lot of sub-sub-specialists that aren’t available elsewhere, and they want to give you a wide exposure before you self-select off in a direction to keep you as informed as possible. If you’re interested in general neuro, PP, or more outpatient based career, this could be a great asset. If you want to leverage time towards a particular sub-specialty academic career, this may be a competitive disadvantage when compared to other big centers.
- Limited track record of independent investigators coming out of the program. Fairly new R25 status (not long enough to see a lot of faculty on the other side of it), and (historically, not presently) limited number of interested trainees makes it hard to interpret their numbers. As a potential corollary, MD/PhDs are under-represented in the entering classes as compared to the overall percentage of MD/PhDs in neurology.
Impression: Historically, this has been a very clinical, and less research, oriented program. The program has been actively moving away from this, but since it takes years for trainees to go through and become independent, the results have yet to pan out. Currently, trainees are 50-50 pp vs academia. Up to 1 per year are involved in basic science. It’s a big program (8-9/yr) with a big network across the southeast. I think if you’re interested in either private practice or mostly clinical work, you can’t go wrong. Great opportunities and clinical training, with somewhat of a question about the research opportunities.
Partners
Pros
- Huge program, 18 residents/year over two big hospitals. Big community, but also dispersed.
- Huge network of PIs/Attendings, etc to network and develop mentoring relationships. This has led to a great track record of producing independent investigators with unparalleled post-doc opportunities
- The variety and frequency of didactics was very attractive. @ BWH, Morning Report with Samuels every morning, pretty awesome learning opportunity. Other examples include (MGH) have brain cutting pathology correlation every Friday—so they take a fresh case, present/discuss it, then walk next door and cut that patient’s brain and do more focused teaching.
- MGH has a new clinical center that is the nicest clinical facility I saw anywhere, and houses 3 floors of neurology. BWH is currently building a dedicated clinical neuroscience center (similar to their cards center) for neuro, psych, neurosurg, neuro-IR, etc, supposedly to open in 2015.
- Lots of elective time to specialize or lump for research (~11-12months)
- Wide-open fellowship/post-doc opportunities afterwards
- Boston is a great town, lots of things to do, great culture, pretty diverse, solid public transportation, and accessible to the New England outdoors.
- The administrators for the program are outstanding. Extremely efficient, timely, and helpful in terms of coordinating visits, etc.
Cons
- This is a huge program, and you’re essentially splitting time at two hospitals. To that end, folks have said one drawback is that you don’t know your department(s) as well, and there isn’t the same kind of camaraderie that you’d have if you were all corralled into one hospital.
- The research spaces/opportunities are dispersed around Boston, making collaboration physically harder than it is in most institutions. There’s also a fairly distinct research culture here.
- The density of Boston in terms of academic centers leads to interesting issues. Because there are so many hospitals, and not NYC numbers of people, there are a TON of drip&ship stroke patients. One attending told me at least half of the strokes did not come through the ED, and maybe that’s normal for a referral center, but that seemed to be higher than other places. Not sure how to interpret that (or how true it is), but it seemed notable.
- Current residents had varying views on the front-loadedness of the program. Some 2nd years wished they had a couple of reprieves to pursue some of their interests, while 3rd/4th year were grateful 2nd year was over and now they have lots of flexible time to have kids and use a lot of elective time to pursue their interests/research. Depends on who you ask and where they are in the program. On the spectrum of intensity I saw on the trail, it’s very demanding.
- As nice of a city as it is, Boston is ridiculously expensive, and your salary is pretty fixed.
- Intern year at MGH or BWH is not explicitly guaranteed, although the neuro program coordinates your prelim interview the day before your neurology interview. In practice, I have no idea what percentage of neurology trainees who want to go to BWH/MGH prelim are unable to do so (it may be zero, I have no idea).
- A particularly tough academic ladder to climb if you have an interest in staying as an assistant professor.
Impression: This is a great program. The didactics/learning opportunities are really well crafted and considered, and you have an opportunity to learn from leaders in the field. The research milieu is outstanding with tons of opportunities. My principle concern would be the risk of feeling lost in a huge department, and the very clear sense from the residents that they got worked really hard. That said, it’s a demanding experience, but it seems like if you can take advantage of the situation, you could do really well to launch your career from here.
Yale
Pros:
- New program leadership in the past 5 or so years that quickly grew the department both clinically and scientifically. Strong cadre of attendings, bolstered by a mass exodus from Partners when the new leadership came on board.
- Really nice, engaging PD.
- Particularly strong in epilepsy
- Outstanding research opportunities. This is the only fast-track like research setup I saw anywhere (separate track you can apply for). Intern year is 8 months medicine, 4 months research. PGY2 and 3 is purely clinical. PGY4 and PGY5 is one or two half days of clinic and the rest is protected time for research, all supported by the department. The program leadership is very keen about this setup as a tool to encourage physician-scientists and recruit junior faculty. It’s pretty tough to beat in terms of launching a career. The neuroscience community is outstanding.
- New clinic space, nice NCC space, emerging dedicated inpatient stroke service.
- New Haven is a cool town; not glamorous/ritzy (although CT shore is), but it’s a got a ton of culture and is a unique melting pot.
- Yale recently bought up a neighboring community hospital and recently built a cancer hospital. So now it went from being a (historically) smaller academic hospital ~10 years ago to the 5th biggest hospital system in the country. They work with the university hospital, the community hospital, and the local VA.
- Unusually high pay-scale. They sent out an e-mail post-ranking highlighting the payscale for next year, interns started at 60k.
- Residents seem happy and not overly-burdened.
Cons:
- New Haven for some, for others, it’s a great spot. If you have a spouse, depending on their job there may be limited work opportunities in the area—folks have lived in Stamford and commuted to NYC/New Haven. Very different lifestyle if that’s what’s required.
- Younger fellowship programs in Stroke and ICU in terms of fellows produced, but very experienced and established fellowship directors (former directors elsewhere).
Impression: This is a great program, and I ranked it accordingly. I really liked the PD and all the energy behind the program. It’s a fairly big sized program (7-8/yr, I cant remember), and I got the sense that the residency experience is crafted around a learning experience and not getting scutted out. All the major subspecialties are available, and it’s the only place with anything like a fast-track approach for research in neurology. In my mind, this program is a great opportunity and provides wide exposure.
