Working "climate" in the northeast

[PhakeDoc]

I'm really not familiar with the working environment in the Northeast other than what I've heard second hand which is much more formal and less laid back than in the South or West. For example, in my non-Northeast program, on my primary service I can pretty much wear scrubs whenever I want to. Granted there are some attendings who prefer shirt/tie and folks try to accommodate whenever possible, but when it boils right down to it, things can be informal. Also, I can ask the attendings questions directly instead of having to go "up the chain of command." Plus, I'm a laid back sort to begin with. Medicine has enough pressure without all the additional pressure that comes with being "stiff."

So, does that mean I should not look at Northeast programs? Or, is what I've heard more of an urban legend rather than the truth? Places I'd be looking at (neurology) in that neck of the woods would be Cornell, Penn, Hopkins, Pitt, Cleveland Clinic, Case, Rochester, Michigan, U of Chicago and Mayo (yes, the latter three are midwest, but I'm just throwing them in there).

Your comments and observations are much appreciated!

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[Dejavu]

I you don't want to wear a shirt and tie, do not come to Mayo. The "uniform" for physicians here is not a white lab coat (that is for technicians and research personnel). Here physicians in contact with patients, and for any kind of meeting, are required by tradition and expectation to wear suit and tie (women-conservative business-appropriate slacks oufit or dress). It is part of the aura that patients who travel here expect. We are very rooted in tradition here. Believe me, once you get here you will see the reason this is true once you meet patients who travel great distances for your professionism and demeanor. It is a daily occurrence for a patient to tell me how glad they are that they traveled here and how impressed they are with the professionalism of Mayo. (Sorry, not to brag). Physician appearance is important to this impression.

There is a big difference between friendly, non-threatening, formality based on tradition, as opposed to stiffness and rigidity.

 

[BlondeDocteur]

Agreed. My institution isn't on your list, but shirt & tie are required for men in every non-scrubs-wearing specialty. It's not about an inability to let our hair down but rather about presenting a competent, professional image to the patients and their families. If the dude who sells you cell phones wears a tie, so should the dude explaining dad's MRI.

 

[Dejavu]

Agreed. My institution isn't on your list, but shirt & tie are required for men in every non-scrubs-wearing specialty. It's not about an inability to let our hair down but rather about presenting a competent, professional image to the patients and their families. If the dude who sells you cell phones wears a tie, so should the dude explaining dad's MRI.

Well said!

 

[dragonfly99]

shirt and tie were required for the guys in my medicine residency.
For neuro I don't see why you'd need to be wearing scrubs all day.
Whether a tie is required seems to vary institution to institution...there are places where you could get away with a dress shirt and nice pants, and no tie, most likely. It is less regional than institution-dependent.
Scrubs are usually for surgeons and ER docs.

 

[Femtochemistry]

As a medical student in London, it's tie and shirt of all of us...no exception. During my surgery clerkship it was such a pain in the *****: morning round with shirt+tie, scrub in, scrub out, then post-op rounding with shirt+tie...on any given day, I would change at least 4 or 5 times! But as I get ready to start my US residency this coming summer, I am really going to miss tie+shirt...I have acculmated over 30 ties and dozens of shirts and pants; and I plan on wearing them in the States whenever possible

 

[DarthNeurology]

I you don't want to wear a shirt and tie, do not come to Mayo. The "uniform" for physicians here is not a white lab coat (that is for technicians and research personnel). Here physicians in contact with patients, and for any kind of meeting, are required by tradition and expectation to wear suit and tie (women-conservative business-appropriate slacks oufit or dress). It is part of the aura that patients who travel here expect. We are very rooted in tradition here. Believe me, once you get here you will see the reason this is true once you meet patients who travel great distances for your professionism and demeanor. It is a daily occurrence for a patient to tell me how glad they are that they traveled here and how impressed they are with the professionalism of Mayo. (Sorry, not to brag). Physician appearance is important to this impression.

There is a big difference between friendly, non-threatening, formality based on tradition, as opposed to stiffness and rigidity.

Does this mean that resident's don't wear lab coats when doing a bedside procedure on a patient? I guess just disposable lab coats over the suit? I have seen physicians who basically just wear a suit to rounds, but they are not involved in the nitty-gritty work of central lines, etc . . . Most male residents I have seen wear a white lab coat over a shirt and tie and slacks.

 

[DarthNeurology]

I'm really not familiar with the working environment in the Northeast other than what I've heard second hand which is much more formal and less laid back than in the South or West. For example, in my non-Northeast program, on my primary service I can pretty much wear scrubs whenever I want to. Granted there are some attendings who prefer shirt/tie and folks try to accommodate whenever possible, but when it boils right down to it, things can be informal. Also, I can ask the attendings questions directly instead of having to go "up the chain of command." Plus, I'm a laid back sort to begin with. Medicine has enough pressure without all the additional pressure that comes with being "stiff."

So, does that mean I should not look at Northeast programs? Or, is what I've heard more of an urban legend rather than the truth? Places I'd be looking at (neurology) in that neck of the woods would be Cornell, Penn, Hopkins, Pitt, Cleveland Clinic, Case, Rochester, Michigan, U of Chicago and Mayo (yes, the latter three are midwest, but I'm just throwing them in there).

Your comments and observations are much appreciated!

Having to wear a shirt and tie or even a suit to be a neurology resident at Penn, Hopkins or Mayo is worth it in my opinion as they have excellent training there . . . The malignancy of a program is generally not strongly correlated the dress code of the program. However, some of the very regimented places also have very strict dress codes. You should be able to see on the interview day what the place is like, I would guess that most places with strict dress codes are OK places.

One place I interviewed at (southeastern non-neurology) they obviously didn't have a strict dress code, but did have a general internist who basically pretended like he was boarded in subspecialty x, and really bawled out interns during a morning report. You could tell that it was a routine so much that the residents were afraid to interrupt and had done a bad job presenting the patient as it looked like they felt they couldn't do anything right. So some places without a strict dress code are pretty formal in that residents are put in their place frequently. I thought I would be a good fit, it being a southern program, my feelings changed very quickly after the interview. It had the same feel of a malignant northeastern program.

There are some malignant programs in all corners of the country. Mostly because attendings move all around the country and have different personalities that is independent of the geography of their institution.

That being said, there is a northeastern personality present in some northeastern programs which makes attendings prone to have meetings on vague topics, long unproductive rounds, and to feel the need to put residents in their place. As you know, if you grew up in a southern state then you know that practicality is more important than maintaining a rigid caste system where subordinates are always put in their place, and more emphasis is placed on being a nice person in southern programs in general than in the northeast where being bluntly rude is tolerated.

Lucky for you, neurology overall is a much more congenial field than surgery and there are certainly some northeastern programs where you would feel at home.

 

[Dejavu]

Does this mean that resident's don't wear lab coats when doing a bedside procedure on a patient? I guess just disposable lab coats over the suit? I have seen physicians who basically just wear a suit to rounds, but they are not involved in the nitty-gritty work of central lines, etc . . . Most male residents I have seen wear a white lab coat over a shirt and tie and slacks.

I did my residency here and I never once put on a lab coat while wearing anything but scrubs. I put on a sterile gown for protection of my suit, or was in scrubs, but no, other than a rule about wearing a lab coat over scrubs when leaving the OR to round, I don't think I ever have seen a physician wear a lab coat. It would confuse everyone as to who you are, since physicians were suits, others wear lab coats.

 

[mig26x]

I train at a northeast program IM:

wards: dockers and shirt, tie if you want ( i dont use it) and white coat. You can come in scrubs if you are on call.

I hate using a tie, i feel like im drowning especially when you have a coat over you with 2-3 pocket books and papers!!!

and another thing, in the northeast they turn on the heaters during winter so it can get pretty warm in some place if you have a suit on, but that might be just me.

 

[Doowai]

I like wearing a shirt, tie and slacks. I wore it as a chiropractor and I wear it as a teacher. I don't like wearing a white lab coat.

There is no cool way to wear a lab coat - if it is unbuttons it flies behind you when you walk fast like a cape, one button looks feminine, completely buttoned looks crazy.

My favorite is wearing a Tux. Saturday I was looking at Tuxes. They called me yesterday to be an extra in a new TV show (starring one of the people from SCRUBS) , and wanted me to wear a tux. So if I buy a tux I could write it off as a business expense.

Would it be wrong to wear a Tux when rounding in the hospital? James Bond would do it