The Medical University of South The Medical University of South CarolinaCarolina

Internal Medicine Residency Internal Medicine Residency ProgramProgram

Tertiary care university hospital and research center

596 beds with >30,000 inpatients per year

13 MICU beds / 10 CCU beds

Level 1 trauma center, 24 hour Service

VETERAN’S AFFAIRS MEDICAL CENTER90 acute care beds and 28 nursing home beds

40 Internal Medicine beds and 8 MICU beds

Geriatrics Service

Full, 24 hour ancillary services

Full outpatient clinic care and Urgent Care walk-in clinic

CHARLESTON MEMORIAL HOSPITAL

Transitional Care Unit managed by Hospitalist Team

Emergency Department site for ER rotation and electives

New Hospital BuildingNew Hospital BuildingEstimated Completion: 2007Estimated Completion: 2007

Medicine HousestaffMedicine Housestaff

87 Medicine Housestaff

PGY-1: 21 Categ, 4 Prelim, 2 Med/Peds, 1 Med/Psych

PGY-2: 20 Categ, 2 Med/Peds, 3 Med/Psych

PGY-3: 21 Categ, 3 Med/Peds,

3 Med/Psych

PGY-4: 2 Med Peds, 2 Med/Psych

PGY-5: 1 Med/Psych

Chief residents: 2

2007-2008: 24 Categ, 7 Prelim, 2 Med/Peds, 2 Med/Psych

Intern ScheduleIntern Schedule

► Ward months: 8-9Ward months: 8-9

► Call RotationsCall Rotations

Gen Med (4-5 mo) Gen Med (4-5 mo)

Specialties (3-4 mo)Specialties (3-4 mo)

MICU (1 month)MICU (1 month)

► Non-Call Rotations: Non-Call Rotations: ambulatory, ERambulatory, ER

► Continuity clinic ½ day a Continuity clinic ½ day a weekweek

Inpatient ServicesInpatient Services

► VA wards (3 teams)VA wards (3 teams)► General Medicine wards General Medicine wards

(4 teams)(4 teams)

► Cardiology (2 teams)Cardiology (2 teams)► GI (2 teams)GI (2 teams)► PulmonaryPulmonary► NephrologyNephrology► HematologyHematology► OncologyOncology► MICUMICU► VICUVICU► CCUCCU

Example Intern ScheduleExample Intern Schedule

July VA wardAugust Renal wardSeptember MICUOctober Ambulatory ClinicNovember VA wardDecember VA Urgent Care* January Cards wardFebruary Oncology wardMarch Gen Med wardApril ERMay Gen Med wardJune Pulmonary ward

*Holiday off

Resident ScheduleResident Schedule

► Ward monthsWard months

PGY-2: 5 months + 2 ICUPGY-2: 5 months + 2 ICU

PGY-3: 3-4 months + 1-PGY-3: 3-4 months + 1-2 ICU2 ICU

► Night Float 1 Night Float 1 month/yearmonth/year

► AmbulatoryAmbulatory

► ConsultConsult

► Elective & researchElective & research

Call Service DesignCall Service Design

Short/Long callShort/Long call MUH GM wardsMUH GM wards VA wardsVA wards

►Specialty servicesSpecialty services Onc/Pulm/Renal/HemeOnc/Pulm/Renal/Heme GI/CardsGI/Cards

Call at MUHCall at MUH

InternsInterns

q8: General Medicineq8: General Medicine

q6: Renal, Pulmonary, Oncology, Hematologyq6: Renal, Pulmonary, Oncology, Hematology

q6: Cardiology, GI (liver & luminal)q6: Cardiology, GI (liver & luminal)

ResidentsResidentsq4: MICUq4: MICU

Night floatNight float

On ward services 1-2 overnight calls per On ward services 1-2 overnight calls per monthmonth

Call at VAMCCall at VAMC

Intern Call: q6Intern Call: q6Interns stay overnight q6 and Interns stay overnight q6 and

until 8pm q6until 8pm q6Residents stay until 8pm q 3 Residents stay until 8pm q 3

and take 2-3 weekend callsand take 2-3 weekend callsResident Night FloatResident Night Float

MICU: q3MICU: q3Beds: 8Beds: 8Closed unitClosed unit

ACGME ComplianceACGME Compliance

►Admission caps in 24 hoursAdmission caps in 24 hoursInterns 5 patientsInterns 5 patients

Residents 10 patientsResidents 10 patients

►Work hoursWork hoursMaximum 80 hour work weekMaximum 80 hour work week

Days off average 1 in 7Days off average 1 in 7

Maximum shift 30 hours (no post-call Maximum shift 30 hours (no post-call clinic!)clinic!)

Night Float Schedule Night Float Schedule (2nd,3(2nd,3rdrd year year only)only)

Week 1Week 1Float 8pm-8am, Sun-ThursFloat 8pm-8am, Sun-Thurs

Week 2 Week 2 Vacation or VA GM ConsultsVacation or VA GM Consults

Week 3 Week 3 Float 8pm-8am, Sun-ThursFloat 8pm-8am, Sun-Thurs

Week 4Week 4 Float 8pm-8am, Sun-ThursFloat 8pm-8am, Sun-Thurs

Consult OpportunitiesConsult Opportunities

► GastroenterologyGastroenterology► CardiologyCardiology► Pulmonology Pulmonology ► Infectious DiseaseInfectious Disease► HospitalistHospitalist► NephrologyNephrology► RheumatologyRheumatology

► EndocrinologyEndocrinology► Allergy / AsthmaAllergy / Asthma► NeurologyNeurology► Research electivesResearch electives► Others:Others:

DermatologyDermatology

RadiologyRadiology

Surgery, etcSurgery, etc

Ambulatory SitesAmbulatory Sites

► Continuity clinics Continuity clinics University Internal MedicineUniversity Internal Medicine VA Primary Care Clinics and Urgent CareVA Primary Care Clinics and Urgent Care

► Each location with social workers, diabetes Each location with social workers, diabetes educators, dieticians, and clinical educators, dieticians, and clinical pharmacistspharmacists

► General Internal Medicine and sub-specialty General Internal Medicine and sub-specialty clinics for referralclinics for referral

8th floor Rutledge Tower

Primarily Medicare, Medicaid and Private patients

Full service subspecialty referrals

Pharmacy

Laboratory

Radiology

PT/OT

University Internal Medicine (UIM)

Rutledge Tower

>310,000 square feet

265,000 patient visits/yr

Connected to MUSC

Patient regional attachment area >175,000 in NC, SC, and GA

Three primary care teams

Urgent Care walk-in clinic

Full Medical and Surgical specialties

Complete electronic medical record

VA Primary Care Clinics

Conferences & EducationConferences & Education

Morning ReportMorning ReportMonday, Wednesday, FridayMonday, Wednesday, Friday

VAMC MUH

Conferences & EducationConferences & Education

Attending RoundsAttending RoundsDaily, following morning report Daily, following morning report

Bedside teachingBedside teaching

Medical studentsMedical students

Pharmacists, Care Pharmacists, Care

Managers, etc. Managers, etc.

Conferences & EducationConferences & Education

Noon ConferencesNoon ConferencesAttending DirectedAttending Directed

►Emergency Lecture SeriesEmergency Lecture Series►Division LecturesDivision Lectures

Resident DirectedResident Directed►Morbidity and MortalityMorbidity and Mortality►Clinical Pathology ConferenceClinical Pathology Conference►Journal ClubJournal Club►Medicine in the NewsMedicine in the News►Senior TalksSenior Talks

Conferences & EducationConferences & Education

Medicine Grand RoundsMedicine Grand Rounds Outside speakersOutside speakers Patient case Grand RoundsPatient case Grand Rounds

Intern ConferenceIntern ConferenceBoard Review SessionsBoard Review SessionsSecond Year Leadership ConferenceSecond Year Leadership ConferenceDivision Conferences Division Conferences

Cardiology Grand RoundsCardiology Grand Rounds Pulmonary Case Conference, etcPulmonary Case Conference, etc

Average 40% graduates enter General Internal Medicine practice and 60%

enter sub-specialty fellowships

Practice Where?Practice Where?

► Charleston AreaCharleston Area► Orangeburg, SCOrangeburg, SC► Summerville, SCSummerville, SC► Florence, SC Florence, SC ► Yonges Island, SCYonges Island, SC► Columbia, SCColumbia, SC► Denver, CODenver, CO► Galveston, TXGalveston, TX► College Station, TXCollege Station, TX► Ocean Springs, MDOcean Springs, MD► Washington, DCWashington, DC

► Atlanta, GAAtlanta, GA► Tucson, AZTucson, AZ► Raleigh, NCRaleigh, NC► Durham, NCDurham, NC► Savannah, GASavannah, GA► Cleveland, OHCleveland, OH► Philadelphia, PAPhiladelphia, PA► Little Rock, ArkansasLittle Rock, Arkansas► Nashville, TennesseeNashville, Tennessee► Naples, ItalyNaples, Italy

Fellowships Where?Fellowships Where?

► MUSCMUSC► University of Virginia University of Virginia ► University of North CarolinaUniversity of North Carolina► Baylor UniversityBaylor University► Washington University, St. Washington University, St.

LouisLouis► University of ChicagoUniversity of Chicago► Indiana University Indiana University ► Ohio State UniversityOhio State University► Albert Einstein College of Albert Einstein College of

MedicineMedicine► Medical College of VirginiaMedical College of Virginia► University of MichiganUniversity of Michigan

► Temple UniversityTemple University► Louisiana State UniversityLouisiana State University► South AlabamaSouth Alabama► University of Texas, University of Texas,

GalvestonGalveston► University of South FloridaUniversity of South Florida► Wake ForestWake Forest► East Carolina UniversityEast Carolina University► Medical College of GeorgiaMedical College of Georgia► Vanderbilt UniversityVanderbilt University► UC- San DiegoUC- San Diego► Oschner ClinicOschner Clinic► University of ArizonaUniversity of Arizona

Salary and BenefitsSalary and Benefits

► Resident salaries 2006-2007 (10/1/06 – 9/30/07)Resident salaries 2006-2007 (10/1/06 – 9/30/07)PGY-1: $39,169PGY-1: $39,169PGY-2: $40,857PGY-2: $40,857PGY-3: $42,634PGY-3: $42,634PGY-4: $44,481PGY-4: $44,481PGY-5: $46,416PGY-5: $46,416

► Insurance benefitsInsurance benefits HealthHealth DentalDental DisabilityDisability

► Wellness Center membershipWellness Center membership

Salary and BenefitsSalary and Benefits

► 3 weeks paid vacation plus holiday3 weeks paid vacation plus holiday► Paid Paid

SC, DEA, DHEC licensesSC, DEA, DHEC licensesACP membershipACP membershipStep 3 USMLEStep 3 USMLE

► Parking Parking ► Embroidered lab coatsEmbroidered lab coats► On-call meals, weekend take-outOn-call meals, weekend take-out► Conference / presentation fundingConference / presentation funding► Simon-Web paging systemSimon-Web paging system

MUSC

Charleston HousingCharleston Housing

► Resident living (approximate) Resident living (approximate) 50% rent / 50% own50% rent / 50% own

► Several diverse locations close to MUSCSeveral diverse locations close to MUSC► Rental Costs by location (2 BR apt per Rental Costs by location (2 BR apt per

month):month):DowntownDowntown $1210/mo $1210/mo James IslandJames Island $950/mo$950/moMt. PleasantMt. Pleasant $1045/mo $1045/mo N. Charleston: N. Charleston: $820/mo$820/moWest Ashley: West Ashley: $960/mo$960/mo

Finding a ResidencyFinding a Residency

►““Did I like those people? Can I work Did I like those people? Can I work with them?”with them?”

►““Did I like that city? Can I live there? Did I like that city? Can I live there? Can my spouse/significant other live Can my spouse/significant other live there? How will I enjoy my days off?”there? How will I enjoy my days off?”

►““What did it feel like while I was there?”What did it feel like while I was there?”

QUESTIONS ???QUESTIONS ???