Don’t Trust the Website

The process of interviewing for residency is a long one. You fill out pages and pages of applications, then wait for programs to invite you to interview. In my case, I researched the programs extensively before my interviews, so I knew a lot of the numbers before walking through the door: how many residents, how many deliveries, how many faculty. What amazed me about the process was how different programs can be in person, when they look the same on paper.

For example, I interviewed at two programs of the same size. Both hospitals have nurse-midwives on staff, employed by the academic OB/GYN department. Both allow patients to labor in a jacuzzi tub (a special, medical jacuzzi tub, of course), and neither allows water birth – the patients labor in the tub, then deliver in a bed.

At the first program, the residents gushed about how much they love working with the midwives. “They’re a really great resource,” one resident told me. “They teach us so many tricks for managing labor, and for helping patients push.” Another explained how the midwives actually teach the interns (first-year residents) how to manage uncomplicated labor and delivery. If a patient needs a c-section, the midwife (who has, by that time, earned the patient’s trust) gives the patient that news, and by the time the doctor walks into the room, the doctor-patient interaction can be a positive one. The midwives came to the “meet the faculty” events, and I could see that they had built strong working relationships with the residents.

At the second program, it was an entirely different story. One resident described the midwives as a source or significant frustration. He said his only interaction with the midwives comes when a midwife’s patient needs an intervention that requires a physician, such as placement of an invasive internal monitor, or a c-section. Invariably, patients who choose to have a midwife attend their labor are trying to avoid these interventions. An attending at this program told me that he feels like Darth Vader every time he enters the room of a midwife patient: the guy in the funny outfit who has come to force the patient to do his bidding. A resident described the relationship simply: “We clean up their messes.” When the midwife allows the patient to labor for too long and the patient develops an infection inside the uterus (chorioamnionitis) as a result, the resident is the one managing both the infection and the severe bleeding that is likely to result. When that infected baby has to go to the neonatal intensive care unit, it is the resident who takes the blame. An attending described fighting with the midwife (not discussing or collaborating, but fighting) over the care of a patient.

So what is the point of this post? If you want to know about a department, don’t trust the website. No matter what it says in the brochure, each hospital and department has a distict culture, and you need to go there to see it. Let us consider a third program where I interviewed. There are no tubs and no midwives, but they allow wireless monitoring (intermittent monitoring in some cases), and encourage patients to walk the halls. They have a very low c-section rate despite a very high risk population. The residents do all of the same “midwife-y” stuff that midwives would do, and there is no fighting between providers. As a patient who wants a low-intervention birth, would you rather be at the second program, or here? As a provider, I know where I would rather be!

What do you think? Have you been surprised on the interview trail?

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