Those anxiety attacks are fueled by a fact known to all subscribers of the Match. Unlike normal job offers, the Match assignments are binding. Unless there are major extenuating circumstances, there’s no chance of changing once an assignment to a hospital has been made.
Why fourth-year medical students put up with this system has something to do with the whole mentality that supports internship. “It’s the way it’s always been done,” “it’s accepted,” “there’s nothing we can do about it,” are the usual responses when the question of why it continues to be done this way is raised.
Well, that explains how the interns got into our program. I probably should next explain a little about the composition of our program.
The Schweitzer School of Medicine’s pediatric training program is made up of two campuses. The one that’s presently referred to as “the east campus” is composed of two hospitals: Jonas Bronck, a part of New York City’s municipal hospital chain that provides primary care to the poor and not-so-poor of the northern reaches of the South Bronx; and University Hospital, a voluntary facility that mainly acts as a tertiary-care center for patients referred for consultation to the school’s subspecialists by private physicians in the North Bronx and in lower Westchester County. University Hospital is located about a half mile south of Jonas Bronck.
“The west campus” is also made up of two hospitals: the Mount Scopus Medical Center, a huge voluntary hospital that, like University Hospital, serves as a base for subspecialists; and the West Bronx Hospital, sometimes referred to as WBH, another municipal facility that, like Jonas Bronck, provides all medical services for the indigent families of the western region of the borough. Mount Scopus and West Bronx are literally attached to each other. Although the Mount Scopus–WBH complex is immense, filling four square city blocks, the pediatric services in the two hospitals are adjacent to each other and conveniently connected by a bridge. The east and west campus hospitals are separated from each other by about five miles.
The program, with over a hundred house officers, 120 full-time faculty members, four chief residents, and over two hundred inpatient beds spread over the four hospitals, is one of the largest pediatric training programs in the country. Our interns rotate through three emergency rooms, six primary-care clinics, seven general pediatric wards, two pediatric intensive-care units, three neonatal intensive-care units, and three well-baby nurseries. If you’re confused reading this, just think what it must be like for the interns who have to become familiar and comfortable with the nursing staffs, ancillary services, medical forms, and peculiar habits of the laboratory personnel in all these different hospitals before they can even think about taking care of patients.
So the question naturally must be asked, why would anyone electively want even to attempt to deal with all this? Internship is difficult enough, what with the long hours and the frequently depressing subject matter; what would possibly motivate someone to want to come to our program, where the difficulty seems to be compounded by the massive size and complexity of the place? Well, probably the main reason medical students want to train at the Schweitzer program is because of the amazing variety of experiences to which they will ultimately be exposed. Our residents see asthma and pneumonia, ear infections and lead poisoning, the mundane, “bread and butter” of pediatrics at West Bronx and Jonas Bronck, the municipal hospitals; but they also see the congenital heart disease and the renal transplant patients, the craniofacial cases and the weird metabolic diseases, all of the rarer medical and surgical problem patients who wind up being referred to Mount Scopus and University Hospital, the voluntary hospitals in which the subspecialists lurk. So when a resident finishes three years in the Bronx, it can safely be said that he or she will have seen every kind of pediatric patient who exists. Our graduates know that nothing will ever surprise them; they’ll have had experience with anything that might darken the threshold of their medical offices.
That’s why Mark Greenberg came to the Bronx. He told me he wanted to get as much experience with as many types of patients as possible during his training. After meeting him for the first time at orientation, I got to know Mark a little better this month. He told me he had chosen pediatrics because it was the third-year clerkship he had enjoyed the most. He had liked it for the same reason most people are attracted to the specialty: He said it seemed to make more sense to watch sick children get well than it did to watch sick adults get sicker and die.
Mark told me his biggest problem with being an intern is that his brain is always tending toward entropy. Unless he tries very hard to keep his life controlled, he becomes exceedingly disorganized. Disorganized is not a great way to be during internship. All interns share a common short-term goal in life: to get out of the hospital as soon as possible. One must be very organized to accomplish that. If Mark continues to be disorganized, he might have to consider permanently moving into an on-call room.