My Residency Reviews

North Shore - LIJ (Northwell Health)

Interview Experience
There was a massive blizzard in New York during their interview weekend, so the pre-interview social was cancelled. They still held interviews on Saturday and Sunday, with a fairly solid turnout by applicants (about 45 of 60 made it). Not sure if they decided to have a make-up day or Skype interviews for the stranded applicants. The interview day was somewhat makeshift since everybody was arriving at different times, but overall it was still fairly organized all things considered. There were 5 rooms, each for 10 minutes, which were panel-style with 3-5 faculty each. The rooms were themed, and the theme was the only topic of conversation in the room (compared to other programs, where the room had a few themed questions but also had some general small talk). There were 2 knowledge rooms: the first had 3 brief cases where you were asked to read the X-ray and answer a few simple questions about diagnosis and management. The other room was a single case, where you were asked to read the X-ray and then talk about that topic more in depth. I didn't know a ton about the topic, but I was able to reasonably move through it. I think this is the challenge with knowledge rooms, in that the knowledge base of medical students is fairly limited and is completely dependent on the smattering of services you rotated on. The attendings were still nice about these pimp-style rooms, and I feel like they just wanted to see we had a grasp on some of the basics of orthopaedic management. There was an ethics room with a complex scenario, a research room, and a chairman's/general questions room. There was some down time between interviews to speak with the residents in the boardroom. They had lunch and then Dr. Sgaglione (chairman) and Dr. Lane (PD) made some remarks about the program.

Staff/Faculty/Chairman
Dr. Sgaglione (sports) is the chairman. He is a very personable, friendly guy, and is fairly well known in the academic community (past president of AANA). The department has grown a lot in the past few years, and he has overseen the hiring of 10+ full-time faculty members. The PD is Dr. Lane (hand), who was in private practice for 20+ years before joining the faculty 5 years ago. He has overseen a number of changes to the program, which were all in response to resident feedback, including the creation of a night float system at LIJ hospital. Since LIJ used to be affiliated with HSS, a lot of the faculty here are HSS-trained. They have multiple attendings in every subspecialty, with the exception of 1 tumor attending. They go to Memorial Sloan Kettering during the PGY4 year for 6 weeks for a formal tumor rotation. They are strongest in joints, sports and hand.

Didactics/Teaching
They have formal didactics for 2 hours on Wednesday morning, with attending-led lectures on various topics. The residents said that the lectures are good, and have improved significantly over the past few years with the addition of new faculty members with expertise in different areas. On Wednesday afternoon, the residents typically have bioskills (they have a massive new lab/sim center) or anatomy sessions. There is also a single lecture on Thursday mornings from an attending.

Operating Experience
The residents get extensive operative experience. There are more cases than the residents can cover, and they have PA's and NP's to cover the floor work during the day. The residents are almost always single-scrubbed on cases with the attending (with the exception of some trauma cases where the senior walks the junior through), and even the interns spend the majority of their ortho months in the OR. They split their entire residency between North Shore and LIJ hospitals (about a mile apart), aside from the 6 weeks at MSK as a PGY4. Most of the residents at each hospital are on the general orthopaedics service, which covers most of the trauma, recon, spine, and tumor cases at each hospital. As a PGY2/3/4/5, there is an ambulatory rotation, which mostly covers hand, sports, and F/A. There are no dedicated blocks for the subspecialty services (with the exception of hand as a PGY2/4 and tumor as PGY4), and you may be covering different types of cases each day of the week. There is generally a good amount of autonomy in the OR, and you get to operate a lot. The North Shore Hospital is their Level 1 trauma center, and while the volume isn't crazy busy, you will get a lot of the bread and butter trauma cases.

Clinic Experience
There is a resident-run clinic on Wednesday morning from 9am to noon. They hold clinic at both North Shore and LIJ hospitals, and each clinic is staffed by an attending. You get a lot of autonomy in clinic for the short time you are there. On Wednesday afternoons, if there aren't any educational activities scheduled, and there aren't any cases to cover in the OR, you get farmed out to various attendings' office hours. The hospital system has its own EMR, which can be a bit clunky, but is manageable once you get the hang of it.

Research Opportunities
The program has historically been community-focused, with limited research resources and productivity. Over the past few years, with the creation of Hofstra medical school, the growth of the orthopaedics department, and the increase in the size of the hospital system, the research has grown. They have a number of full-time research faculty (3 or 4 I think), with a lot of work in cartilage regeneration and biomechanics. There isn't a ton of outcomes research yet, but they have invested resources into creating their own data collection system. In addition, the North Shore-LIJ system became Northwell Health this year, and they have enough hospitals now throughout New York that they created their own health insurance network. There will be opportunities for a lot of research down the road, but it will likely be a few years before this is really booming. Not many of the clinical faculty are publishing regularly here, since they are basically private practice surgeons, but they will support projects if residents are interested in putting in the work. There is dedicated time for research during the PGY3 and PGY4 years.

Residents
Nice group of guys. Had a little bit of a blue-collar feel to them, not particularly "bro" though in my opinion. Only 4 per year, so they all get to work with each other and know each other. They are spread out across the two hospital sites, and are dispersed housing-wise across Long Island, but they said that it isn't too hard to spend time together outside of work. Most of the residents here do fellowships and go into private practice. A number of them have ties to the New York area.

Lifestyle
As a junior, there is quite a bit of call here. At LIJ, you have 2 months on night float as a PGY2 and 1 month as a PGY3. At North Shore, call for the PGY2 and PGY3's is q2 24-hour with post-call days. The pager isn't crazy busy during the day, but consults can add up, and you are also handling all of the floor pages overnight. The seniors are home backup call, and their lives seem fairly reasonable. This residency also has the highest intern salary in the country ($69K), so you have plenty of money to spend on educational and recreational items. They don't have any additional perks, but they will sponsor you if you present research at a major conference.

Location/Housing
The hospitals are located on the western part of Long Island, about a 45-minute drive from Manhattan and 30 minutes from Brooklyn and Queens. Some residents live in Manhattan and the outer boroughs, while others live near the hospital or in suburbs in eastern Long Island. You need a car here to get around, and the highways can get jammed with traffic during rush hours. The area near the hospital is entirely suburban, but the city isn't too far away and the beaches on eastern Long Island are great during the summer. Rent isn't quite as high as the city, and you have sufficient salary to comfortably cover your housing and transportation costs.

Limitations
I don't love the structure of the rotations, with residents placed on general orthopaedics and covering a wide range of orthopaedic subspecialties. This makes it difficult to learn in depth about a particular subspecialty, since you are constantly bouncing between them each day. While North Shore is a Level 1 trauma center, its volume isn't that high and it doesn't get much high-energy trauma. The call schedule is fairly difficult, and I would prefer a program a little bit larger than 4 residents per year. The research is solid for a community-type program, but it is mostly basic science and is lacking in the type of clinical research that I want to pursue. The suburban location is also a negative for me, and I don't love the idea of living in Brooklyn and driving 30-45 minutes every day to work. There is very little clinic here, which I think is a negative, as indicating and managing patients is just as important as becoming a skilled technician in the OR.

Conclusion
Solid community program that will only continue to improve over the next few years. You will get a strong operative experience here, and will get in the OR early and often. The research opportunities are growing, and with the hiring of more faculty and acquisition of more hospitals, the academics should continue to improve. This program has some limitations, but for me the biggest one is the location. I don't think there's that much of a difference between the training here and some of the other community-type NYC area programs. Given the suburban location and the lighter trauma experience here, it will be a tier 3 for me.

UPenn

Interview Experience
Social was held in a private room at the Penn Inn. The attire was “business professional”, meaning that you were expected to wear a suit. They make it no secret that this is a formal program, starting with the dress code. All the residents were clean shaven, and this is a requirement for residents. At the social there was plenty of space to speak with residents and attendings, with ample food and drinks to go around. The chair Dr. Levin made a brief speech in the middle of the event to welcome the applicants and talk about how they invested the resources for this venue instead of the foyer in the hospital because of resident feedback from past years. Afterwards, the residents walked the applicants to a local bar, where they had reserved a private room and we got to speak with them in a bit of a less formal setting. Interview day was broken up into AM and PM sessions. The day started with a 30-minute presentation by Dr. Levin about the program, followed by 5 minutes from Dr. Israelite (the PD). The applicants were subdivided into different groups for interviews, a resident presentation, and a tour. There was an hour of interviews, with 6 rooms for 8 minutes each. There were 4 rooms with 2-3 faculty each, a resident room, and the chairman’s room. We did not meet or interact individually with the PD Dr. Israelite, which I found to be a little bit odd, although the two associate PD’s (Dr. Mehta and Dr. Ahn) were among faculty interviewing applicants. Two of the rooms had themes (letters of recommendation and research), and there were a couple of “tell me about a time when…” questions, but no clinical or ethical questions. In the resident room, they asked me to suggest a Pandora station and tell a joke. The resident presentation was fairly straight forward, and the tour was fairly long and probably unnecessary. They hold interviews towards the end of the season, so I had already seen a ton of trauma bays, clinic rooms, and research labs. On the flip side, I will say that there was a nice view of Philadelphia from the helipad on top of the trauma center.

Staff/Faculty/Chairman
Dr. Levin (hand/plastics) is the chair. He was at Duke for 25 years before taking the chair position at Penn 7 years ago. He has a unique background, in that he is double board certified in orthopaedics and plastic surgery. He has a dual appointment to the faculty of both departments, and his clinical rotation is actually referred to as “orthoplastics”. He does so many flaps for the trauma service that he is a member of both the trauma and hand divisions within orthopaedics. He is very well known and connected within the orthopaedics community, and he goes to bat for his residents when it comes time to get them fellowships and jobs. The fellowship match list is phenomenal, and I have been told he asks you at the beginning of your PGY4 year what fellowship you want, and then he gets on the phone and gets the fellowship for you. While he seems like a great guy to have in your corner, he runs a very tight ship at Penn. All of the residents and fellows are required to wear suits and be clean-shaven while they are on his service or at an event where he will be present. Residents take every consult with a smile, and can be disciplined if they are reported as not acting “professionally”. Apparently the medicine and ER services are very influential at Penn, and they are very quick to file complaints about the residents on different consult services, so this definitely adds a stress level to daily work. From what I hear, the residency is quite hierarchical and rigid, with Dr. Levin calling the shots. That said, Dr. Levin is definitely ambitious for making the residency first-class, and is always looking for ways to make it better. He has feedback sessions with residents from each class, decides what can and needs to be changed, and then asks the PD Dr. Israelite (joints) to design and implement the changes. Dr. Israelite seems like a happy-go-lucky guy, with a dry sense of humor, who makes a lot of jokes. He has more day-to-day interaction with the residents, although it still seems like Dr. Levin is the primary decision maker for the residency program. There are also two associate PD’s, Dr. Mehta (trauma) and Dr. Ahn (trauma), who are quite involved in resident education and are the primary teachers during the trauma blocks. Otherwise, their faculty has made a lot of hires since Dr. Levin took over. About 10 years ago, they lost a lot of faculty to Thomas Jefferson, so it has taken some time to rebuild the departments. They have 5 faculty in trauma, 7 in joints, 5 in hand, and 4 in joints, which are probably their strongest departments. They have 1 tumor and 3 F/A (2 of which are new hires), and they have 2 spine (with 2 more new hires starting soon). There are also 20 affiliated peds attendings at CHOP, although they are not full-time faculty.

Didactics/Teaching
Didactics have traditionally been a weakness here, according to some residents I spoke with. They have 1-hour morning conferences 4 to 5 times per week, with an additional 2 hours of lecture and 2 hours of bioskills or anatomy lab on Thursday morning. Most lectures are resident-led, and moderated by 1 or more attendings to make sure the residents are learning the salient points. However, some residents noted that they would like more attending-led lectures, and that they often miss conferences because of work on the floor or cases to cover in the OR. Dr. Levin recently hired some additional NP/PA’s to help with floor work and cover the resident responsibilities during Thursday morning so that everyone can go to didactics, but education is still difficult, especially for the juniors. They have a month-long intern boot camp, but no dedicated OITE preparation.

Operating Experience
Generally a hands-on experience here. As a junior, you will get in the OR as a PGY2 at the VA and CHOP, but the trauma is backloaded into your senior years, with a single 6.5 week block on trauma as a PGY3, PGY4 and PGY5. There is a lot of volume and autonomy here, with PGY3 and PGY5 in one room and a PGY4 in the other room. The attendings, especially on trauma and at the VA, will let the residents fly if they come prepared and generally know what they are doing. The subspecialty rotations are set up like a mentorship model, so you get graduated responsibility during the rotation, although some attendings are more hands-on than others. I heard this is especially the case on joints and hand, with a mixed bag on sports and peds. They don’t have many fellows here, and they have good volume, so there isn’t much double scrubbing. At CHOP, there are quite a few fellows, but there is high volume and they parse out the cases at the start of the week, so the residents get to scrub on mostly basic cases and a few advanced ones. The residents said the spine, tumor and F/A experiences are decent, and will be improving with the hiring of new faculty. They do each rotation as both a junior and a senior, with the exception of a single F/A block as a PGY3. They also have a community orthopaedics rotation about an hour drive away, which they do as a PGY5.

Clinic Experience
They spend 2 or 3 days in clinic depending on the rotation. These are all private clinics, and they do not have a resident-run or free clinic at any of the sites. They are given a good amount of autonomy in the clinics though, seeing the patients, presenting to the attending, and writing the note. They are making the transition to Epic from their old EMR, which will be complete by the end of next year. The residents spoke highly of their clinic experience, and felt that it was among the most educational parts of their training. When there are extra cases in the OR where resident coverage is needed, they have PA’s who can help cover the clinics.

Research Opportunities
They take two residents per year for the 6-year research track, which is a dedicated year between PGY2/3 to work in the basic science, biomechanics, or tissue engineering labs. They have invested a lot of resources in infrastructure and full-time PhD faculty to staff the labs, and there is a lot of high quality work coming out of there. Most of the residents not in the research track, however, are involved with outcomes research. The joints and trauma attendings are the highest volume for publishing, and residents can get involved if they show interest. They don’t have a dedicated research block, so you have to find time to work on research during the lighter blocks like sports and hand. Some of the residents graduate with double-digit publications, but many do not. It is really what you want to make of it. They have some support staff to help with IRB filings and data collection, and have some affiliated biostatisticians to help with methods. They will support travel to present at conferences.

Residents
They take 8 per year, which includes the 2 research residents on the 6-year track. They seemed like a hard-working, blue-collar group, and a bit on the nerdy side. They take pride in their hard work, and according to some rotators, they are always staying late because it is expected of them and not necessarily because they feel compelled to stay to learn and help out. They are a fairly diverse group, with a number of female residents, married residents, and residents with children. Fairly hierarchical structure here, and it seems like there is good cohesion within the class, but less outside of it. I got the feeling that a lot of the residents were tired and run down, and although they expressed enthusiasm about the quality of their training, I didn’t feel like they were as fun as some of the other resident groups I have been around. It may be that the program selects for these types of people, or the program just tires them out over the years. That said, I didn’t get the sense that it was a bad or malignant work environment.

Lifestyle
Blue-collar feel here, and you will work a lot. The trauma blocks are difficult every year here. The interns are slammed with floor work on the general surgery and orthopaedic services, where they are in charge of trauma, joints, and general ortho patients. The PGY2 year has 3 months on trauma, with a combination of day/night float. They are so busy taking care of consults as a PGY2 that there is no OR time for them. The rest of PGY2 is a bit better, with decent hours and some opportunities to get into the OR, especially at the VA. The trauma rotation is 6.5 weeks for the PGY3/4/5 years, and these guys are literally at the hospital for 100 to 110 of the 120 possible hours between Monday morning and Friday night. Each trauma attending works in 24 hour shifts, and the attendings like to operate and teach for the entire time. However, the residents have to stay at the hospital when the attendings switch over in the morning, so you never go home. It sounds like a miserable existence, and Dr. Levin talked about possibly changing the structure, but the residents actually lobbied to keep it because they felt like they learned a ton. Outside of trauma and joints (80-100 hour weeks but not as insane as trauma), the other senior rotations have better hours with time for basic activities of daily life and research. Since they have night float as PGY2, the call schedule works out to q8 for the PGY2 and PGY3’s covering the orthopaedic services at the 3 different hospitals (sometimes you need to drive from hospital to hospital to see consults or floor stuff), with a separate ~q4 call pool for the residents at CHOP. The seniors have home call, but often the primary trauma team stays at the hospital and handles all the cases, so the call team just needs to get the case teed up. Overall, this is among the worst lifestyle programs that I have seen.

Location/Housing
The hospitals are located the University City area of Philadelphia, which is located by the main campus of all of the UPenn undergrad and graduate schools. Most of the residents live in Center City, which is a long walk (~20 to 30 minutes) or short drive (5 to 10 minutes) away from the hospitals. All of the clinical rotations except for the PGY5 community rotation (45-60 minute drive) are within 10 minutes of each other and within the city limits of Philadelphia. The rent is very reasonable, and you can live in a decent sized place for a lower rent than nearby NYC, DC or Boston. They have some clinics located in the suburbs, and combined with the fact that you have to travel between different hospitals while on call, you absolutely need a car to be a resident at this program. Philadelphia has all of the amenities of a modern city, with plenty of good food, beer, and entertainment. The residents seem to spend some time with each other outside of work when they have the time to.

Limitations
The lifestyle here seems pretty brutal, especially as a junior and as a senior on trauma. I am not afraid of working hard and getting my hands dirty, but it seems a little extreme here. They didn’t seem to hide the fact that they are over work hours, and I got the feeling they were kind of proud of it. It seemed like the residents were tired and I didn’t get a sense that it was particularly fun to work here. I heard from a home rotator that one of the interns is leaving, since he felt like the program was too tough; while this is probably more related to the person than the program, it still raises concerns about the work environment. The didactics here are mediocre, and there doesn’t appear to be a ton of time for research. The availability of a research block certainly would be nice. I don’t mind the formality here, but it seems like Dr. Levin really runs a rigid hierarchical system. Philadelphia is a solid location, but it’s not as fun as NYC, and I would need a car.

Conclusion
A blue-collar program with a great name to back it up. You will work hard as a resident here, but you will come out well-trained with a good pedigree and will match at the fellowship of your choice. Despite its shortcomings, I think this is one of the premier programs in the country, but you have to be okay with long work hours, high expectations, and a formal, high-stakes work environment. Unlike many other programs, orthopaedics is not the most influential department in the hospital, and you are constantly under a microscope as a resident and are expected to perform. The academic reputation here is great, and they have good basic science labs, but the clinical research seems to still be developing. While this is arguably a tier 1 program, I am going to put it at the top of my tier 2, as I just didn’t get the sense it would be as fun to work here for 5 years as some of the other places I interviewed.

No offense bro, but if you actually believe 1/2 of the things you wrote here then you were guzzling some ...s e r i o u s... kool aid while interviewing. UPenn a "blue collar" program? Rush operative experience top notch? Did you even talk to rotators? I know at least a dozen rotators whose experiences contradict much of what is written here about various programs.

While we appreciate your efforts in typing this up, readers should be aware that these reviews contain a lot of hyperbole and very little critical analysis.

@ACDF, I encourage you to share your program reviews with the readers of Orthogate. The more reviews and experiences available to future applicants, the better informed they will be in their decision making.

Like I said in my preface post, my experiences and opinions may differ from other applicants. I wrote fairly extensively in my reviews about the limitations of each program. I made a conscious effort to ask multiple residents and rotators about the things they didn't like or wish could be done better. Obviously, some residents and rotators were more candid than others.

I generally kept my written reviews heavy on objective information, because I felt I was more likely to forget those things when I was making my rank list. Feel and overall impressions are much easier to remember, and that is typically what is posted in residency review threads of years past.

I disagree with the previous posting. I am familiar with at least three of the programs (one home program) that you posted about and I think what you wrote is SPOT ON (especially about my home program). Overall, I think you did a great job providing objective info along with some impressions, which are obviously subjective to your experience. I really appreciate these detailed reviews!!

This is the most clutch thread in the history of orthogate. Thanks for taking the time to write all this up!

2nded that the review of my home program seemed pretty accurate and objective, so I'd err on the side that all these reviews have relatively good info.

Hi everyone, congrats on the Match! Excited to call some of you colleagues.

For our reviews, would it be preferred to reply to the other thread, or this one? I wasn't sure if this was just one person's personal reviews or if it was open to all.

I would say to reply to the 2015-16 one. I created my own thread because I had so much material and it was in a different format than the program reviews of years past.