SUNY Downstate/Kings County Residency Reviews

[papichulodoc]

Kings County Interview Review

The interview day was scheduled to start at 8:30 AM, but the applicants just sat around and had coffee and donuts before the Program director arrived. Dr. Doti actually started the intro to the program at 9AM.

Traffic on Flatbush avenue can be tricky. Give yourself enough time to arrive because you can spend up to 1/2 hour driving from the Brooklyn Bridge.

Parking is a problem. There is virtually no parking available on the street because of street cleaning regulations. THey do have valet parking but there are no signs clearly marking the area. The only clue to the valet "dropoff" point is a long line of cars and drivers in black unlabeled jackets getting into the drivers' seats. Bring ten dollars in cash with you, because they ask you to pay upfront. The Program coordinator will reimburse you in the morning. The valet parking can be found behind the University Health Sciences Building (about a block away from Kings County hospital where your interview is).

Dr. Doti's overall presentation was very effective. During waiting periods a slide show with very sensational and gruesome photos (that belonged in an EM hall of fame) was shown. I've seen many of these photos on some sick websites. It's nice to know that some of them were taken at King's County. Of course, this "sick" show failed to gross any of us "gung ho" EM applicants, instead it evoked the inquisitive "oooo" from the audience making us salivate for more.

After Dr. Doti's presentation half of the group went on the tour while the other half interviewed. A total of four interviews were conducted. Some of the offices were VERY COLD because the heating system is atrocious.

Residents came and went to give us their perspective on the program. Try and go out to the dinner on the night before for an honest opinion. Lunch was given at 12:30 - 1. Afterwards you can leave.

+++ Brooklyn.....possibly the highest concentration of immigrants (legal and illegal) in all of NYC. Highly dysfunctional area...lots of gang and drug related violence hence the biggest "knife and gun club". Dr. Doti proudly boasts that king's county has been the #1 in the country for gsw's. During the tour, a gs victim was brought in.

++ Aggressive, young leadership. There is no doubt you will come out of here an EM animal as Locchesi would like to scream at you. Their residents are known to be slightly on the "cocky" side since they can handle virtually anything. Even an NYU-Bellevue trained new attending admitted to relying heavily on her EM-4's because she was not ready for it coming out of NYU. When asked to compare other notable programs in the city to King's County, Dr. Doti replied he wasn't interested in working for the J.V. team!

++ You get the opportunity to go for your MPH at Downstate during your residency. No extra years, you have to let them know in the beginning and they will fit a two year MPH plan into your schedule. Tuition is not reimbursed.

+ Smart residents, all who wanted to be there. Kings County is a competitive program. It has convinced 30 Downstate students to go into EM and 29 of them want to stay at Downstate. They also have a very competitive EM/IM program who spend a total of three years in the ED.

+ Training during off service rotations. Most residents enjoyed their learning experience. They said (generalizing) that the Carribbean people usually do not come in unless they are very sick and a limb is falling off.

+ Brooklyn is an interesting place to live. The downside is most residents do not live in the area (because it is the #1 knife and gun club in the city, you don't want to come in to work BIB EMS.) So most live in Park Slope which is a trendy very diverse area. Most who work in Manhattan but cannot afford to live in Manhattan have settled in this area, gentrifying it raising the cost of living. If you have a family you may want to consider moving to Queens but you'll have to commute (20- 30 minutes each way).

++ Brand new building should be operational in the fall. Kings county layout and facilities STINK! The ED has outgrown it's space. Trauma bays are all over, fast track rooms look like old operating rooms, and asthma room is across a series of hallways and resembles a ward. So the new building will definitely be a plus. Expect some delays though with NYC contractors.

+ Great contact with med students. All Downstate med students rotate through the ED. The ED is very involved with the med school curriculum and probably the best department in the hospital.

+ Good fellowships and job prospects. Most of the graduating residents went to good places.

+ Increasing the research being conducted through the program.

+/- 1-4 year program.

- Ask about the contract issue. They say that they are able to have 17 residents becuase away institutions have agreed to support the salaries of a few residents. During the first two years, you will be expected to sign at least two one year contracts with their affiliated hospitals. They have five in total, and you are expected to go through the whole new employment process each time. Your salaries and benefits will change accordingly depending on where you sign the contract.

- Very limited community setting exposure. They spend a few months in some community settings but since the Kings County experience is so overwhelming and independant some residents have admitted that they still don't feel comfortable consulting PCP's and specialists.

- Expect to commute, because the away institutions can be up to one hour away. They rotate through the Northern section of the Bronx (45 minutes away by car, 1 1/2 by train) Brookdale hospital in Brooklyn, and Staten Island University (tolls are expensive.

- Insurance disparity. Uninsured Brooklynites and trauma go to Kings County, the insured with PCP's go to University Health Center RIGHT ACROSS THE STREET! The population is from the same pool, only difference is esthetics and insurance.

-- Even though they have the highest concentration of immigrants in the city, there is not much diversity in the population. Most of the immigrants come from the Western Carribeean and include Jamaica, Haiti, Trinidad and a small amount from Africa and eastern European. This allows you to see a lot of diseases endemic to those regions that most of us read about but will never see. Harldy any Latinos, Asian or Caucasians.

--- Ancillary services. Arguably one of the worst in all of the city hospitals. One of the residents said there is usually only one nurse on staff at night, and sometimes there is no clerk at night so the nurse gets spends a consderial amount of time doing secretarial duties.

Overall...another great program. You will no doubt be prepared to handle anything. The only issues are the lack of true diversity and where you live because commuting into Brooklyn can be tough. There is a train station about 3-4 blocks away but not advisable once the sun goes down.

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[amojan99]

I was just wondering what you all thought about the SUNY Downstate/Kings County EM residency program in NYC. Has anyone here interviewed there or considered applying/have applied there? What were your impressions? Thanks.

 

[Arsenal FC]

I am a resident at Kings county, and I love it here. I moved from San Diego (where I had spent most of my life) and have not regretted that once so far- I mean sure, there are days when I come home from work disgruntled and tired, but overall, this is a phenomenal place to do EM residency. The faculty and residents here are exceptional, the patient exposure is awesome. We definately work hard, and it is rather scut intensive, but all county programs in NYC will work you like that (that said, we probably have the worst ancillary support in the world). Our schedules are not bad (i have many buddies from school at other programs around the US who work more than I do) and we just opened a new ED, so our facilties are alot nicer. Also, they've really stepped up the 'academic' aspect of our program over the past few years, our research director is very proactive and we've had some decent studies published to show for it.
If you want to know more, contact me off list

 

[aequanimitas]

I was just wondering what you all thought about the SUNY Downstate/Kings County EM residency program in NYC. Has anyone here interviewed there or considered applying/have applied there? What were your impressions? Thanks.

I was a med student at Downstate. The EM department is one of the most active in med student education; they have a preclinical EM rotation for 1st & 2nd year students, EM is a required rotation for all med students, and I also did the EM elective there. I interviewed at most of the NYC programs, other east coast programs, and west coast programs. Based on my experience, I can say that Downstate is a great program that'll prepare you exceptionally well clinically. By that I mean you'll feel confident and above average anywhere you go. That may partly be because you know you'll seldom be at another place where the volume is higher (there are only a handful), where they get more trauma (penetrating), and where you get to do many things/procedures that at other places may be more "graded"--some procedures are more R2 or R3 procedures, etc.

A few years ago, Downstate may have suffered from some disadvantages in that because of the volume and the clinical setting--urban, COUNTY ED--they might not have had the time or resources for bedside teaching (not for lack of intent or motivation). But I truly believe that's changed. They hired a bunch of new attendings a few years ago, and the department seemed to have made a commitment to have more teaching. In fact I felt the difference between my third-year and fourth-year as a med student. Also, the faculty appear to be publishing a lot more; the new attendings (not that the old-guard are unproductive; Sinert publishes all the time, Baron writes trauma in tintinalli) are all over tintinalli and other reference books. Basically, they have one goal--to train clinicians who would be considered above average anywhere (per program director).

Plus, they just moved to a brand spanking new ED, which is absolutely sprawling; I think it has ten trauma bays when I did the tour.

Are there still things that might not appeal to everyone? sure. The ancillary staff has improved dramatically, but I'm not sure it's at the same place as some other programs, especially outside of new york/northeast coast. Is it still a very urban/county, gritty environment? Yes. But that works both ways--some will love it and some won't. If I may be bold and compare it to some of the county programs in NYC, I'd say that it is not as hectic as Lincoln, and about the same as Jacobi; they seem similar to me, mirroring each other in the bronx and brooklyn.

Everyone's rationale in ranking is different, some may consider me crazy for ranking downstate above a traditional powerhouse like Bellevue, but it made sense to me.

Anyway, not sure how helpful this was, but feel free to let me know if you have any questions. Good luck.

 

[Dr. Will]

Residents: 13 residents per year in a PGY1-4 format, with another 4 in the EM/IM program. This is the most diverse group of residents I have seen, and from many places all over the country. This is a very self-selecting program. They all states that they work, very, very hard, although they are all very happy, and it shows. The most consistent negative about the program was county hassles. The residents here knew what they were going into, so otherwise, everything else isn’t really a “negative” to them.

Faculty: Very diverse group that trained all over the country. They churn out plenty of research, also. Many of the pictures in the EM atlas were taken by faculty members here. The residents praised the faculty and it’s diversity. Everyone I met was very down to earth and extremely excited about the program. It is a very young and energetic group, reminding me of the faculty I encountered over at Highland. There is plenty of teaching that goes on, even when it gets busy, which is the usual.

Facilities/Ancillary staff: Very high volume and high acuity patients seen here. The facilities were opened up over the summer, and it is a HUGE improvement over what the old ED looked like. It is very modernized and split up into two sides. It was quite small, however, with 16 rooms that always have 2 patients in each. There are two very modern resuscitation bays (overhanging radiology, etc.). The peds ED is also new with many of the same perks.

Ancillary staff, what can I say? Probably the worst in the country? Everyone I spoke to said there have been many changes, which have ended up providing many positive changes in this area. Blood draws are often, but not always done now, transport services are improved as well. Overall, much better than before, but still a long way to go. There is only so much educational value that can be obtained from starting IV after IV.

Curriculum: Overall, I think this is a great curriculum, but weaknesses do rear their ugly head. PGY 1 is very off-service heavy, allowing you to learn the basics. You work 12’s and it tapers to your second year. PGY 2 is ICU heavy, including a NICU, but no PICU month. 12’s are also the shift length here. As a PGY 3 and PGY 4, you delve more into the sub-specialty area. You work 8’s, with 4 12’s over the month.

Peds: We were told there were 7 months of peds exposure, but I only counted 5 dedicated months including the NICU month. PGY 3 and up, however, you are working a peds shift q4-5 (this may have recently changed giving way to only 5 dedicated months as opposed to 7). No PICU month, which is otherwise strange considering there is a NICU month.

Trauma: ED run with plenty of procedures to go around. Knife/gun club of the east coast and only rivals LA county in terms of trauma and overall

Didactics: Protected unless in ICU. Plenty teaching going on including morning report, bedside teaching, opportunities to teach also.

Sub-specialty: 1.5 months of US (including gyn US). I think they just purchased a bunch of new US (could have been another program, can’t remember), month of tox, EMS exposure, international opportunities, disaster medicine fellowship (with tox/peds/international in development), opportunity to get an MPH during your residency. Plenty to do here!

Electives: Only 2 months, which is nothing for a 4 year program. But you do get a taste of just about everything within the curriculum.

Location: Brooklyn, NY. NY is very expensive as you all know. The hospital is very land locked, so you’ll be doing a lot of city driving or taking the subway to get to work. Not the best area to be taking the subway, esp. at night. Parking is almost non-existant for residents, so this is an issue. There are 4 other associated hospitals, (one across the street, one in staten island, the other two in the Brooklyn)…so there is a lot of commuting.

Other: Any one of the hospitals can pick up your contract, so residents may have different overall pay, benefits, etc. This could be annoying as hell, especially when it comes to receiving your own medical care.

Overall: I was really impressed with the program and the faculty I met. I was surprised as to how happy everyone is here. It’s the perfect mix of academics and an underserved population. I feel the curriculum is strong, with a few minor issues like the 2 months of electives. My biggest negative is the location. I love NY, but I’m not sure how excited I am about living there. Getting over that issue, this could be a program I rank highly.

 

[Dr. Dukes]

Sorry...I think I should have asked better questions.
What are the best and worst parts of the program? Where do residents end up afterwards (academia, big hospitals, small hospitals, fellowships)? How competitive is it to get in (do you need AOA, what are step I scores)? How good is the clinical training (I assume pretty good)? What are the popular elective options?
...and, anything else that people want to add would be very helpful.

 

[f_w]

> What are the best and worst parts of the program?

+++
-faculty
-pathology
-war-zone experience. It is one of two or three level1 trauma center for a state of 3.x million.
-unionized residents, good selection of health plans, meal allowance, book allowance etc.

------
-absence of support staff, you will wheel patients over to radiology at times or walk specimens to the 'K-building' (through a maze of tunnels with alien life forms)
-dysfunctional administration
-no exposure to the 'real world' of community hospital medicine (what I mean is that you live in a bubble. everyones salary comes from the city, patients don't pay, you don't learn a lot about issues like coding/management)

> Where do residents end up afterwards

Wherever they want to.

> How good is the clinical training (I assume pretty good)?

Your assumption is correct.

Kings County vs. Methodist: Not even in the same league.

 

[2008 EM Reviews]

SUNY Downstate/Kings County
4 year program

I did an away rotation here so I will share from this perspective. Will be interviewing there in a month so I will add thoughts as they come.

Residents: 13 residents per year with an additional few in the EM/IM program. Large and diverse group of residents, many from NY medical schools but many from other areas as well. They all seem very laid back and go-with-the-flow type of people, which is probably a necessity to work at a county hospital. You get the sense that they are the strongest residents in the hospital and the PGY4's definitely seem very confident in their management of patients.

Faculty: Large group of faculty with a lot of women and minorities. Many attendings are young, recent grads from Downstate and many others trained or worked at Jacobi, Maimonides, NYU, Sinai, or other area hospitals. One thing to note about the faculty here is that because it is so busy, they are expected to see patients on their own, not just supervise residents. This is a plus in the sense that you have faculty who still continue to be very clinically oriented and hands-on. On the other hand, they are often seeing their own patients when you need them for help.

Hospital: The away rotation is based out of Kings County, the county hospital, and University Hospital (UHB), the private hospital owned by Downstate across the street. The residents also rotate through a few other hospitals in Brooklyn and one in Staten Island, but I didn't get to see those.

Kings County has been recently renovated with new rooms, trauma bays, bright lighting, and glass doors. The facilities are actually quite nice to work in. The ED is divided into Critical Care Trauma, Pod A, Pod B, Fast Track, and Pediatrics. Critical Care Trauma is where the traumas and severely ill patients (MI, stroke, etc) come in. It is crazy and exciting and you can expect that every single patient who comes in to this area will need lots of care. The ED sees the traumas first and calls the trauma surgery team if needed.

Pod A is the regular ED and has too many half-curtain-rooms to count. It's kind of a mess there because there may be 3 attendings and 4 residents (and 5 medical students) there, but there is no system as to who takes what patient. Pod B is essentially the holding area where admitted patients go to wait for their bed upstairs. It's not really staffed by the ED residents (I'm not really sure).

The attendings and residents are very confident at Kings County. Conscious sedations, chest tubes, intubations, and central lines are very common.

There are certain bureacratic things set by the county hospital system that can limit what you would like to do for your patient. For example, doctors and nurses are not allowed to perform urine hcg's or dipsticks. When you have a 25 yo with dysuria, you need to send her urine to the lab and wait 2 hours for the result because someone officially needs to read it. There is no cath lab at Kings County and STEMI patients need to be transferred to the university hospital across the street or Bellevue over in Manhattan for caths.

I did not spend much time at UHB, but the residents do spend a fair amount of time here. It is smaller, older, but runs a bit more smoothly because it is a private hospital. The attendings split their time between both hospitals.

Patient Population: Mostly Black patients, many of caribbean origin at both hospitals. I would not call this "diverse" because I did not see many Hispanic, Asian, or Caucasian patients while I was there. Many often are quite sick as they are recent immigrants and have undiagnosed diseases that have gone on for years. Many are not sick as use the ED as their source for primary care.

Ancillary Stuff: Kings county has horrible ancillary services. Expect to put in IV's and draw the blood for all of your patients. Transport is sometimes there, but sometimes not to cart patients for X-rays. I could visibly see certain residents get frustrated by this, as they are constantly busy not because of the number of patients they are seeing, but because they are busy doing scut work.

As a medical student, you are truly a blessing to the resident if you know how to do stuff. If you do a rotation here, it is not even a question that you will be a pro at IV lines by the end of your block.

Documentation: Paper charting with T-sheets at Kings County, electronic charting in T-sheet like style at UHB. UHB has these cool tablet laptops that doctors can take carry to round, chart on patients, etc. Lab orders at both hospitals are entered electronically, but medication orders are put in on paper. There has been some talk that this may change in the near future.

Curriculum: 1-4 curriculum with not as many electives as other 4 year programs include. First year is very off-service heavy, and few residents have complained that the quality of the off-services rotations is not great. As one resident put it, "when you are the strongest residency in the hospital, it gives you a big ego boost, but you lose a lot when you cannot learn from your residents on your MICU rotations." I believe PGY4's are supposed to act as pre-attendings (I'm not sure if this is written anywhere in their curriculum), but I did not see this occur anytime during my rotations. Everyone is so busy that I guess it's a waste of time for the junior to present to the senior and then for the senior to talk to the attending. Residents are afforded a lot of autonomy, though, and they seem very capable of doing many things as once and taking care of sick patients.

Didactics: As a fourth year medical student, you sit in on the lectures that the MS3's get for their core clerkship. We were scheduled for shifts during resident lectures, so I'm not sure how good they are. Residents do get time blocked off for Wednesday didactics though.

City: Located in Flatbush in Brooklyn, which is not the safest area, a 5 block walk to the nearest subway station. During rush hours, it takes 30-40 minutes to get into lower Manhattan. Most residents live in Park Slope which is a nicer area of Manhattan. There are few highways nearby and driving is kind of a pain, especially since they do not offer residents free parking.


Positives: Truly great exposure to many very sick patients and incredible amounts of trauma. Junior residents get a lot of procedures and see a lot of sick patients that might typically go to senior residents at other programs. Large group of faculty and residents who seem committed to urban emergency medicine and there is a great sense of solidarity among the group. You learn to be very self-dependent as a resident, not relying on many consults or radiologist reads to determine a course of action.

Negatives: You waste a lot of your time being the nurse, phlebotomist, tech, and transport. I think although the hospital sees 100,000+ patients, add together the larger number of residents, the fact that attendings see patients on their own, and the scutwork, I think the residents do not see that many patients in a given shift. Multiple residents expressed that teaching is not often a priority during shifts and they were often too tired to read at night.

Overall: Although my review might seem to highlight a lot of the programs shortcomings, I think this is a great residency program due to the many dedicated residents and attendings who work there. It is a good program for people who learn best from exposure. Personally, I don't believe this is the best program for me as I think I need a mix of both exposure to patients, direct teaching, and time to read.

 

[Terzodado]

SUNY Downstate/Kings County
4 year program or 5 year EM/IM

Did a sub-I here, did a sub I a lot of other places. Ended up ranking this #1 and matching here. Now I'm an intern here and can share some perspective.

Residents: 16 Categorical EM, 4 EM/IM. It seems as though it's about 50/50 people from California and people from New York who end up here, with a smattering of people from the middle. Everybody is super friendly, non-malignant and fun to be around. The racial diversity in the department is simply the amazing, both in the faculty and resident cadres. Its a tough county program and everybody knows it so everybody has a go-getter attitude, which can come off as edgy sometimes, but its a natural result of working in a crazy busy hospital in New York City.

Faculty: Huge faculty. Seriously theres like 100 of them. Very very diverse, theres attendings of every color, every shape, men and women, old and young attendings alike. Really energetic dynamic group. Interestingly a lot of PDs of other programs end up here. Dr. Legome, who was PD at Bellvue in the 90s / 2000s is now the Cheif of ED at Kings, Dr. Gernscheimer who was PD up at Lincoln for a few millenia is one of the faculty as well. That combined with a lot of young and energetic attendings makes a good mix of experience and chutzpah. There's the research wonks (Dr. Sinert), the community outreach wonks (Gore) and people in ultrasound, palliative care, wilderness, international all sorts of stuff. Many are either King's Grads, or from the area, Jacobi, Lincoln, Bellevue etc.

Hospital: You get three hospitals at this residency. King's County, UHB (university hospital brooklyn or "downstate") and Long Island College Hospital or LICH. King's County is the backbone, and UHB and LICH add in their own ways. I have not been to LICH yet, so I will reseve comment on that one for another day.

Kings County. Split up into fast track, peds, Pod A, and CCT. Fast track is mostly staffed by PAs, and the residents do not do many shifts there, although I here it is a good place to pick up moonlight shifts later on. Peds is a very busy, full level 1 trauma peds ED. 30k+ visits a year, with more patients here than some programs have at their whole ED. Mostly primary care stuff but occasional very sick kids, mostly trauma or asthma, sometimes sepsis, and then the lurking unknown diagnoses. Pod A is the real gravy mill. In Pod A, there is a huge range of acuity from "totally fine" to "crashing and burning". Lots of chest pain, abd pain, vag bleeding, syncope. Also pleanty of "metabolize to freedom" types. Bread and butter. CCT is the super critical patients and trauma. Can be slow, can be an absolute crush of patients. Either way people are VERY sick here. Its not unusual to have multiple GSWs or stabs coming in simultaneously. I walked through here the other night and counted 6 people on the vent. Real critical care medicine experience here. I think trauma here speaks for itself. Overall at King's, you have to know you're at COUNTY. Ancillary services are not what they will be at shiny private hospitals, that said, I think it is important to say that the nursing here has improved DRAMATICALLY over the last year. You may have heard you spend a lot of time drawing labs, pushing patients around. That still happens, but now its something you do to help things speed along, not because if you don't do it, it won't happen.

UHB - this is where the super duper sick undifferentiated hypotensive circling the drain medical patient is the norm. Lots of transplant and ID patients. Lots of just very old very sick people. My MO at UHB is usually "Sepsis until proven otherwise" for most patients. Great ancillary staff. Cath center, lots of big MIs, several STEMIs every week, maybe even every day.


Patient Population: Mostly people of west indian extraction. Haiti, Trinidad, Tobago and Jamaica make up the majority with a growing latino population as well, and the inbetween of Dominican Republic. Usually very working class, underseverd, underinsured patients.

Ancillary Stuff: As noted above. Ancillary at King's is not amazing but it is soooooo much better than it used to be. UHB is great. Admin still sucks at county, but they don't really make a big impact on your day to day life.

Documentation: EMR on both sides. King's uses the Quadramed system that is in all HHC hospitals. There is a paper chart that goes with every patient as well. UHB is on a "T-system" EMR which is not beautiful but really pretty functional. Everything is electronic now at UHB.

Curriculum: Has changed a lot in the last few years. Less off-service, more EM. Lots of good conference materials and good asynchronous learning. I can update this section more later in the year, but it seems like its going to be very thourough.

City: Its brooklyn man. If you love it, then you love it. Most of us consider it to be our favorite borough in NYC. I live a 5-10 minute bike ride away, in a safe nice neighborhood. Not cheap to live in NYC, but the salary is good.


Positives: If you believe, like I do, that your patients are the thing that really matters in residency, then this place is simply a gold mine. between the three hospitals you get 200k+ visits a year. Tons of Peds, amazing trauma and then lots of super duper sick people of all stripes as well as pretty basic primary care stuff too. You really have the opportunity to take ownership of your patients here and make a real difference as a resident because these patients are so underserved. Massive improvements in ancillary services have made a difference here in the last few years and the energy of the faculty is pretty amazing.

Negatives: Consulting services can sometimes be Sub-Par. Neurosurgery in particular is a joke. It's county so work is hard, and theres not money floating around in every corner to buy new toys or make projects happen. The leadership is going through transition right now with Doty heading to Kentucky. That said none of us are too worried, the program can carry itself and will attract a good new PD, but we are sad to see him go.

Overall: Very happy that I am here. Would rank at top again. If you want to be at a 4 year academic program with an amazing patient population in NYC, then this is where it's at.