What’s everyone’s impression of BCM in Houston?

(My) Disclaimer: these are the notes that I wrote immediately post-interview; they merely represent my impressions and are being posted solely as an attempt to help future applicants…

Pros
-Outstanding, diverse surgical experience at 5 major hospitals: St Lukes Episcopal, MD Anderson, Ben Taub, VA, Texas Children’s (ranging from very independent/heavy trauma @ bt, pp model @ sleh, unbeatable neuro-onc @ mda, largest peds hospital @ tch), rotate each location 2x as jr then again as sr resident
-Impressive facility: a city of hospitals and research buildings
-Chief experience at BT considered “jewel of the program:” opportunity to run busy county hospital relatively independently
-Large faculty: ~28 neurosurgeons, high volume, many complex/rare cases as referrals
-Houston is affordable, ? easy place to live and train
-Recent expansion to 7 yrs with 1 y protected + 3/3 mos before/after, incredible research potential, strong faculty support of research, significant research w/in dept (esp neuro-onc) administrative support
-Yoshor is building a substantial epilepsy program, curry = peds epilepsy (and dbs), new fxnl guy (former resident) finishing fellowship @ ohsu
-More focused on cranial than spine
-Very collegial group of residents
-Faculty members that are described as extremely patient with jr residents in the OR (gopinath, ehni)
-Well-respected program
-Leader in neuro-oncology, emphasis on complex cases and endoscopic approaches
-Pgy1 year emphasizes didactic learning over scut work (interns described as “easy,” minimal call)

Neutral
-4 onc fellows, 1 peds fellow
-considered to be a “workhorse” program by some
-slep only recently incorporated into residency
-opportunity to work with pp providers at sleh
-rotate from hospital to hospital often, infrequent interaction with peers (generally positive ? no competition for cases)
-Busy periph nerve experience w/ Kim

Cons
-Political environment in Houston is dicy (loss of Methodist w/ old chair, sawaya came on and added sleh)
-Financial issues for BCM—may merge w/ Rice
-Limited open vascular—recently hired Duckworth
-Houston is hot and humid in the summer

Since the Rice merger fell through BCM has had to go back to Baylor in Waco asking for money to cover their expenses. Word on the street is that they have lost a significant proportion of their research faculty in the ensuing chaos and the school is scrambling to keep everything moving. If you talk to a med student there the scene is pretty grim. This does not mean that the residency program is going down, but there is a significant amount of academic and financial turmoil there right now (understatement) - there is still a gleaming new hospital building that has no plans for completion and no foreseeable funds to start moving on it again. Much of this is easy to hide to people on the interview trail while distracting them with the surrounding Texas Medical Center.

Disclaimer: All impressions here are based on my imperfect memory of a very brief and limited interview experience.  It is nevertheless presented so that other medical students can still benefit, prepare, and make better decisions for residency.  If anything has been misrepresented as of 2009-2010, feel free to post or PM me for corrections.  Thanks, and goodluck.

PROS:
- Faculty are approachable and down to earth, residents also a good down to earth group, appear easy going and good to get along with.  Chairman and program director truly care about making this the strongest program it can be.
- 12 MD Anderson neuro-oncology faculty, around 5 Texas Children’s pediatrics faculty, three spine guys, 1-2 functional guys, 1 vascular guy and they are actively trying to recruit another one.
- Rotations are through Ben Taub General Hospital, Texas Children’s, MD Anderson Cancer Center, St. Luke’s, and the VA.  With the exception of the VA which is about 2-5 miles east, all the other facilities are within the same medical complex.  In terms of cases, there are: BTGH 1000, TCH 800 (peds only), MDACC 1500 (tumor only), St. Luke’s 1000, and VA 550. 
- In terms of starting OR’s: BTGH 2-3, MDACC 5, TCH 1-2.  Unsure about the others.  Surgical independence as a resident at the BTGH is a strength.
- Good fellowship placements with recent OHSU skullbase, Miami vascular, Seattle spine.
- Collaboration in basic science labs with Baylor, UT Houston, and Rice.

NEUTRAL:
- Moving to 7 years with a dedicated research year.
- Although they see rotating at 5 hospitals as a strength in terms of experiencing different practices and patient populations, others may think differently.
- Houston, TX has great weather in the winter but awful humid weather in the summers.  Thankfully, most of the medical complex is connected through tunnels that are forever climate-controlled.

INTERVIEW:
- Dinner the night before with a few of the residents, interviews the day of with 4-5 faculty at Baylor (Sawaya, Yoshor, TCH faculty, BTGH chief) and 4-5 faculty at MDACC (3-4 of their faculty + 1 PhD).  Laid back, no pimping.
- How did you get involved in XYZ hobby?  What else do you do for fun?  Any particular clinical interest?  Why Baylor?  Why neurosurgery?  Tell me about your life.

What are the chances that Baylor loses its MD Anderson affiliation if Sawaya is no longer chairman? Do you think UT-Houston may assert itself as the “primary” MD Anderson partner since they are both part of the same system?

Kind of a strange question but I’ll offer another perspective.

MD Anderson is a separate, independent entity. I also know that residents and fellows in other specialties from UT Houston, UTMB, Methodist, Baylor can all do rotations at the hospital. Maybe its up to whoever is running the department at MD Anderson to decide.

During interviews at BCM I was told that non-BCM neurosurgery residents rotate at MDA only infrequently. Also, Sawaya has only recently taken over as chair/PD, I am unaware of any plans for him to leave in the near future.

When I rotated at Baylor couple years ago, the Baylor residents rotated at MD Anderson 4 months as a PGY4 and 4 months as PGY6 (chief). There were also at that time 3-4 fellows, in addition to a resident rotator from UTMB.

"pretty grim"… sounds like an exaggeration from a UTH med student.

"pretty grim” is a description of an institution that lacks the operating funds to pay benefits. it is also the description that was given to me by several friends at baylor.

As a resident at bcm I can tell you the nsurg program is doing fine. Dr sawaya is not leaving anytime soon. Feel free to ask me program specific questions

This is based upon my 2 day interview, having multiple friends who are medical students there, and my second look.  I did not match there but wanted to.
BOTTOM LINE:  Probably the best general exposure to neurosurgery out there with a patient volume and exposure to pathology which is second to none.  The program’s “specialty hospitals” (such as Cancer, Trauma, Peds, etc) are larger than the main university hospital at nearly all other programs.  More hands-on operative and patient management and autonomy than most other programs.  For all that good stuff, you will be required to work HARD (not for the faint of heart)!
GOOD:  For those of you who have not been in the Texas medical center before, you have got to see this place.  It is like a metropolis of hospitals, schools, and health care related places.  The atmosphere alone is breathtaking and alluring as a place to “absorb” medicine.  Despite this appeal, many applicants show up to this interview with mixed expectations, given recent rumors of instability due to the Methodist split (which was actually now nearly 5 years ago; BCM is neurosurgery is much more stable than MNI neurosurgery) and the recent program focus from purely clinical towards academics.  Most will be presently surprised and find Sawaya’s leadership settling while being both an academic leader as well as “down to earth.”
The Baylor program is comprised of multiple specialty driven hospitals, all of which are larger than my home university program. 
Cancer/Tumors: MD Anderson is a monstrosity (takes up a few blocks literally) and obviously is their cancer hospital.  Its beauty and technical/operative facilities are second to none.  6-7 ORs daily with intraoperative MRI and capabilities to do neuronavigation in all the OR rooms at the same time.  Obviously tons of tumor cases including all the difficult and “inoperable” tumors from the local community and from other academic centers around the world.  2 skull base surgeons (very big whacks including also neuroendoscopy), 2 spine surgeons (nearly all these cases are vertebrectomies, spondylectomies, and sacrectomies with associated instrumentation) and 8 other neurosurgical oncologists performing both simple and complex tumor cases.  The residents spend 8 clinical months at MD Anderson during their senior and chief years and at the end of their training they feel they basically come out with a fellowship in neurosurgical oncology.
Trauma: Ben Taub General Hospital.  Average sized hospital which serves the Houston area for trauma and indigent care.  This hospital is famous for its neuro-ICU and trauma research from Claudia Robertson and while always busy with trauma, the impressive part is what the residents say about the elective care.  Their autonomy here is complete including operative, neuro-ICU, floor, clinic and elective case selection.  Attendings are apparently always available, but there is an understanding that the residents run the show.  Residents book, plan, and perform from skin-to-skin cases such as clipping aneursyms, removing AVMs, doing EC-IC by-passes, performing complex skull base cases, performing vertebrectomies and complex spinal instrumentation.  Chief is the law here. The ICU is neurosurgery resident run.  My take on it is that they work VERY HARD there and that they have or had some hour compliance issues but the junior residents I spoke with all said they had a day off a week and were on call Q3 on that rotation.
St Lukes: Basically their university hospital.  More bread and butter neurosurgery with simple to complex tumors, degenerative spine, peripheral nerve, and functional neurosurgery.  There is a mix of private and academic neurosurgeons there.  Dr Yoshor is their epilepsy neurosurgeon and he also does cases at the children’s hospital.  Dr Kim is a world class spine and peripheral nerve neurosurgeon with tons of publications and books.  Dr Comair was an excellent epilepsy and functional neurosurgeon who also had training in vascular and skull base and performed many of the tumor surgeries in addition to bread and butter cases, but apparently recently left to go back to Lebanon (per residents it was family issues).  Apparently they have a new open vascular and skull base surgeon from Chicago (vascular with Batjer and skull base with Van Loveren) to fill their major void of open vascular neurosurgery.  He is apparently a good teacher and has excellent hands.  Unfortunately, they have a world class neuroradiologist named Mawad who coils 80-90% of what goes into St Lukes and this drove away a recent faculty hired to do both endovascular and open vascular (he went to Herman but per the residents he didn’t allow the residents much hands on experience anyway).
VA: The largest VA hospital in country with a fully functional neurosurgery service. 2 full time faculty at VA: Ehni and Tatsui both are excellent teachers and the residents love this rotation.  The PGY-5 is the chief there and he is there with a PGY-2.  The PGY-2 has his own operating room 1 day a week and the other days he assists the PGY-5.  The attendings are “hands off” but always available and are supportive.  Before a large, complex case the attendings take the residents to the anatomy lab and teach the residents how to do the approach. The attending are well trained and Tatsui did a spine fellowship in Miami and oncology fellowship at MD Anderson and Ehni did some vascular training with Drake and was in private practice at Methodist for ~20 years.  Essentially, most cases are spine and the Houston VA is the major VA referral center for the whole south.  According to Dr Tatsui, after the residents rotate at the VA there is no need for a spine fellowship due to their experience.
NEUTRAL: Research: There are innumerable resources and opportunities for the academic at heart applicants.  Unlike many programs with a long history of academic neurosurgery, Baylor (the medical college itself) has untapped world class scientists who have not been corrupted by previous neurosurgery residents, “virgin territory” if you would.  Lets face it, if you go to an academic powerhouse you basically have a handful of labs you can work in and you wait your place in line until your turn comes up and then you work on projects similar to all the residents before and after you.  This is an opportunity for something else. Also, there are academic affiliations between the medical college, MD Anderson, and Rice University.  MD Anderson (for those of you who don’t know it) is the best cancer hospital in the world- it is also ginormous.  There are endless cancer and tumor related projects which can be completed there in both the clinical and basic sciences.  Rice University has an excellent bio-engineering department and also many investigators into nanoparticles and nanoresearch.  All of these resources are untapped.  It would be fairly easy to come up with a world class project which could make significant impact just by taking an expert in their field from Baylor and collaborating with an expert from MD Anderson and from Rice.  Anyway, the plan apparently is that the residents will complete a full year of research in their 4th year (the program was increased to 7 years total from 6) but have a 4 month preliminary data rotation in their 3rd year and a “finish-up” 4 month rotation in their 6th year.  That amounts to nearly 20 months.  They are not joking around about it either and expect their residents to apply for and receive NRSA or other competitive grants.  As far as they are concerned, internal fellowships will not be allowed and they want to attract those applicants interested only in academic neurosurgery- again a huge focus shift. While all these things are perceived by me at least as positive and VERY attractive, the problem is that the process is still untested and unproven.  As they said on Jerry McGuire, “show me the money.” While I have no doubt that they will be successful and have the potential to be one of, if not the strongest programs in the country, they are not there yet and each individual applicant needs to decide if he/she is willing to take that risk on an untested program.  Could pay off extremely well or backfire.  Keep your eye on those residents who are the first few to go through the research and see how they do.
LOCATION: Again, a pleasant surprise at least during interview season.  I did not see anyone on horses or any cowboy boots or any cowboy hats and the weather was mild at that time of the year.  I suspect, as everyone tells me though that the weather is horrible throughout the summer months.  The medical center as stated above is world class, even their county/trauma center was better than my home university hospital.  The Rice village area and uptown areas which were shown to us and where we had dinner were younger hipper areas of town with a 20-30 yo population and feel.  Definitely liveable.  Housing is affordable and many of the residents who are married +/- kids live in nearby suburbs (~15 minutes) and the others live in nearby condos or apartments (there is a light rail nearby).  About ½ residents married and ½ not.
Environment/atmosphere/support: Questions as to financial stability of BCM; however the department seemed to be doing quite well.  Faculty and residents for the most part seemed extremely collegial and at dinner the resident got along well and joked around with each other. I heard very consistent reports from faculty and residents about happiness with the current leadership and program stability despite rumors on the trail. 1 senior faculty (Comair) has left, however, no one else (contrary to rumors) appears to have any intention of leaving.
BAD:No handson endovascular experience. No option for infolded fellowship. Program doesnt give residents book fund/annual educational allowance. Residents teach residents (few of own faculty give formal presentations). Coverage issues!