Most cush residency?

[Guest]

Wait, there are programs where you have to draw your own labs?

[Guest]

(09-28-2021, 10:41 AM)Guest Wrote: Meaningless scut: having to transport patients and drawing labs yourself.

Somewhat meaningful scut: discharges, clinic, floor pager.

This is the perfect way to think about it. There is good pain and bad pain.

Another way to find programs that are less painful is to see where residents are happy, where they have spouses, kids, or pets (indicates the program is supportive of life outside the hospital), and where they're friendly with the attendings. How tired do the residents look?

Call is also different by location. Q4 at a big trauma center is going to be a lot worse than q3 at a quiet academic center.

[Guest]

(09-28-2021, 09:35 AM)Guest Wrote: As someone from a busy program - there is value in the scut. I understand that to many of you who are MS3 through PGY3ish that seems like a contradiction but it is not. I grant that there are diminishing returns, but if you're not getting something out of it that's on you. It does not take much to tell the difference between people who went to a "cush" residency and people who got beaten up. You see it in patient selection, reaction to non-surgical complications, and understanding of how the hospital functions. Many people can learn to operate but that kind of stuff helps you to avoid or minimize issues that would otherwise lead to bad outcomes. Any person who thinks this is low value or that they are above it is just asking for problems.

This is right on the money. 

Transporting patients and drawing labs, yes that’s a reality at some programs. But discharging patients, carrying the pager, seeing consults, post op issues is all very valuable. I’d rather have worked up a post op PE, or fever, or HIT as a resident than as an attending. When you select a patient for surgery, you made them into a surgical patient, you should know how to handle it.

[Guest]

(09-28-2021, 10:05 AM)Guest Wrote: Vanderbilt sent one of their senior residents to do survivor. Sounds pretty cush to me

His is vandy like?

[Guest]

(09-28-2021, 07:50 PM)Guest Wrote:

(09-28-2021, 09:35 AM)Guest Wrote: As someone from a busy program - there is value in the scut. I understand that to many of you who are MS3 through PGY3ish that seems like a contradiction but it is not. I grant that there are diminishing returns, but if you're not getting something out of it that's on you. It does not take much to tell the difference between people who went to a "cush" residency and people who got beaten up. You see it in patient selection, reaction to non-surgical complications, and understanding of how the hospital functions. Many people can learn to operate but that kind of stuff helps you to avoid or minimize issues that would otherwise lead to bad outcomes. Any person who thinks this is low value or that they are above it is just asking for problems.

This is right on the money. 

Transporting patients and drawing labs, yes that’s a reality at some programs. But discharging patients, carrying the pager, seeing consults, post op issues is all very valuable. I’d rather have worked up a post op PE, or fever, or HIT as a resident than as an attending. When you select a patient for surgery, you made them into a surgical patient, you should know how to handle it.

Right, and these aren't necessarily paired together. At Mayo Rochester the residents never draw labs or transport anyone, but they carry the pager 24/7 for their patients and workup whatever postop issues come up, take outside phone calls from people who left and have issues, do discharges, etc.

[Guest]

(09-28-2021, 05:40 PM)Guest Wrote: Wait, there are programs where you have to draw your own labs?

NYC programs are notorious for this across specialties

[Guest]

(09-28-2021, 09:35 AM)Guest Wrote: As someone from a busy program - there is value in the scut. I understand that to many of you who are MS3 through PGY3ish that seems like a contradiction but it is not. I grant that there are diminishing returns, but if you're not getting something out of it that's on you. It does not take much to tell the difference between people who went to a "cush" residency and people who got beaten up. You see it in patient selection, reaction to non-surgical complications, and understanding of how the hospital functions. Many people can learn to operate but that kind of stuff helps you to avoid or minimize issues that would otherwise lead to bad outcomes. Any person who thinks this is low value or that they are above it is just asking for problems.

If you don't mind me asking, what residencies were those at?
Thank you so much

[Guest]

(09-28-2021, 09:13 PM)Guest Wrote:

(09-28-2021, 07:50 PM)Guest Wrote:

(09-28-2021, 09:35 AM)Guest Wrote: As someone from a busy program - there is value in the scut. I understand that to many of you who are MS3 through PGY3ish that seems like a contradiction but it is not. I grant that there are diminishing returns, but if you're not getting something out of it that's on you. It does not take much to tell the difference between people who went to a "cush" residency and people who got beaten up. You see it in patient selection, reaction to non-surgical complications, and understanding of how the hospital functions. Many people can learn to operate but that kind of stuff helps you to avoid or minimize issues that would otherwise lead to bad outcomes. Any person who thinks this is low value or that they are above it is just asking for problems.

This is right on the money. 

Transporting patients and drawing labs, yes that’s a reality at some programs. But discharging patients, carrying the pager, seeing consults, post op issues is all very valuable. I’d rather have worked up a post op PE, or fever, or HIT as a resident than as an attending. When you select a patient for surgery, you made them into a surgical patient, you should know how to handle it.

Right, and these aren't necessarily paired together. At Mayo Rochester the residents never draw labs or transport anyone, but they carry the pager 24/7 for their patients and workup whatever postop issues come up, take outside phone calls from people who left and have issues, do discharges, etc.

mayo has it easy. their big selling point, always mention a good work-life balance in the meet and greets. Always mention outside activities. 

To say otherwise is absurd.

[Guest]

(09-28-2021, 10:40 PM)Guest Wrote:

(09-28-2021, 09:35 AM)Guest Wrote: As someone from a busy program - there is value in the scut. I understand that to many of you who are MS3 through PGY3ish that seems like a contradiction but it is not. I grant that there are diminishing returns, but if you're not getting something out of it that's on you. It does not take much to tell the difference between people who went to a "cush" residency and people who got beaten up. You see it in patient selection, reaction to non-surgical complications, and understanding of how the hospital functions. Many people can learn to operate but that kind of stuff helps you to avoid or minimize issues that would otherwise lead to bad outcomes. Any person who thinks this is low value or that they are above it is just asking for problems.

If you don't mind me asking, what residencies were those at?
Thank you so much

OP here: It's honestly more fun to talk about the places you get rolled over at than the "cush" programs. There is a strong correlation between how much trauma a program has and how much a beating you can take. It's not r^2=1, but it is high. At Pitt, USC, UTHouston, Emory, Miami - there is a high trauma volume and those programs consistently come up as places you will grind at. They also come up as places where you will operate a ton.

If you want to gauge how "cush" a place is, look at the number of residents they have and what kind of hospitals they rotate at. Some places are more gentlemen's programs but we all hear great things about training. Carolinas stands out but I don't have any direct experience. Some places are gentlemen's programs but you will have issues on leaving. The names of those places are all over this board. An academic program that's 1/yr or 1-2-1 is not a place you'll get worked over for the most part. Places with 2 years of research also raises some eyebrows.

Never forget, every place on the trail is going to deceive you about cases numbers, papers, funding, etc. Question everything.

[Guest]

(09-28-2021, 10:40 PM)Guest Wrote:

(09-28-2021, 09:35 AM)Guest Wrote: As someone from a busy program - there is value in the scut. I understand that to many of you who are MS3 through PGY3ish that seems like a contradiction but it is not. I grant that there are diminishing returns, but if you're not getting something out of it that's on you. It does not take much to tell the difference between people who went to a "cush" residency and people who got beaten up. You see it in patient selection, reaction to non-surgical complications, and understanding of how the hospital functions. Many people can learn to operate but that kind of stuff helps you to avoid or minimize issues that would otherwise lead to bad outcomes. Any person who thinks this is low value or that they are above it is just asking for problems.

If you don't mind me asking, what residencies were those at?
Thank you so much

In general the larger the city you're in the higher volume you'll have, the more "scut" there will be, and vice versa. So the more "cush" residencies tend to be those academic centers in smaller college towns with 3 residents/year, bonus points if they have 2 protected research years (Michigan, Wisco, Yale, UF, Brown, Dartmouth). Again this is the trend and certainly programs break that norm, like UVA and Duke. Both have really high volume, large catchment areas, and don't need local trauma to have long patient lists. They also have an old school mentality so you won't get babied there.

Another thing I would pay attention to carefully is the teaching philosophy of PD and Chair. Some will make Navy SEAL references and be obsessed with Message to Garcia, those are more likely to value hard work and want to see you deal with scut efficiently, others will be more proud of how their residents get protected research time, traveled for an elective, had guaranteed leave for childcare, that program will likely be more cush. When I interviewed at Barrow a while ago Nakaji used to say up front he hated scut work and one of his main goals was to eliminate it from the residency entirely. This is one of the main reasons why Barrow is so desirable, case volume through the roof, program developed around the philosophy of zero scut

The neurosurgery community will shame you for wanting to get into residencies that are easier, so if that's a goal i would not even hint at that during the interview process, just rank accordingly. You will hear a lot about "fit" on the trail and having the self awareness to know you couldn't take the rigor of a Miami, UCSF, or Pitt is a really good start IMO, saves both parties from a potentially painful break up.