My Residency Reviews

I am going to do my reviews a little bit differently from previous years. These are my personal notes on each program, which were completed on the evening after interviewing at each respective program. Obviously, they aren't perfect, as it is impossible to learn everything about a program in two days. Also keep in mind that these notes are based on my own experiences and the residents/rotators I talked to, so others may have different experiences, knowledge or opinions. Please don't take everything I wrote as gospel, but use it as a starting point to guide your own research into that program. Many of the rumors on Orthogate from previous years were true, but other rumors were outdated or simply untrue. If you are a student or resident from a particular program and something in one of my reviews is factually wrong, PM me and I will be happy to correct it. Congratulations to everyone who matched this year and best of luck to future applicants.

Med School: East Coast, not top 25
Boards: Step 1 and Step 2CK >260
Rank: top 10%
AOA: Yes
Preclinicals: honors
Clinicals: honors in surgery and medicine
Ortho: honors on home and 3 away rotations
Research: multiple ortho-related publications and presentations
Extracurriculars: ortho club, competitive athlete

What I was looking for in a Program:
-Strong operative experience with early opportunities to get in the OR
-Good trauma exposure and strong subspecialty rotations in joints and sports
-Rotations through multiple hospital types (public, private, VA), with limited travel between sites
-Hands-on learning, with a focus on resident autonomy and limited fellow encroachment
-Resources and support for resident research, preferably with outcomes and cost/quality projects
-Urban location, preferably in the Northeast
-Preference given to large residency programs (6+ residents per year)
-Good resident cohesiveness and "bro-friendly" atmosphere
-Stable program leadership (chairman, PD) that is responsive to resident feedback

How many Programs:
Applied to: 70
Offered Interviews: 45
Attended: 21

My Program Rankings:
Tier 1: UCSF, Jefferson, Rush, NYU
Tier 2: Stanford, Yale, Pittsburgh, Tufts, Hopkins, WashU, Einstein/Montefiore, Mount Sinai, Brown, UW, UPenn
Tier 3: Rutgers-NJMS, Rutgers-RWJ, Albany, Maimonides, SUNY Downstate, NS-LIJ

Matched at: my #1

Advice for future applicants:
-Be honest with yourself when it comes to choosing away rotations. These are your best chances at getting into a program. If you are a borderline applicant, don’t waste your time rotating at top tier programs.
-Once you are done with each rotation, reflect on your experience to figure out what you value in a program (i.e. program size, prestige, resident autonomy, research focus, location). There are a lot of good orthopaedic surgery residencies, and I would argue there is no “bad” residency out there. However, there are very few residencies that can offer you a perfect fit, and you need to figure out what tradeoffs you are willing to make.
-Getting interviews is fairly formulaic, since there are only a few criteria programs can really evaluate you on. Perform well on Step 1, honor you surgery and medicine rotations, and publish some research, and you will be in the conversation at every program.
-Once you get to the interview, it’s all about showing some personality. Be friendly, courteous, and humble, but personable. Obviously you don’t want to be overly talkative or obnoxious, but you want to make a good impression and not just be another generic applicant. The interview format for orthopaedics is akin to speed dating, so if you keep it super vanilla, you will blend in with the dozens of other faces from that day.
-Apply broadly. There are so many competitive applicants, that getting interviews as a non-rotator can be difficult. Don’t worry about spending a few hundred extra dollars on applications, since the opportunity cost of not matching is so high.

Stanford

Interview Experience
Interviewed during my rotation there, which consisted of 5x10-minute interviews with the faculty. One room was a chief/attending tag team. Nothing asked out of the ordinary, although some interviewers asked me specifically about the details of individual research projects that I had worked on. Had a few behavioral interviewing type questions from the PD Dr. Avedian. The chairman Dr. Maloney was not involved with the interview day.

Staff/Faculty/Chairman
Dr. Maloney runs the show. He is a big name, and is very ambitious in creating a world-class orthopaedic department at Stanford. He came from WashU a few years ago, and there has already been tremendous growth in terms of expansion of the residency (from 5 to 7 residents/year) and faculty. There is also an increasing emphasis on research and publications. Dr. Maloney has minimal interaction with the residents, even when they are on his joints service. However, all the residents spoke highly of his leadership, and said that he works in the background to build a great residency program for them. He is in the line of succession to become AAOS president next year, and he is extremely well-connected, which helps him secure good fellowships for his residents. The program director, Dr. Avedian (tumor), is a funny, relatable, down-to-earth guy who is adored by the residents. The faculty has some big names in joints, spine, and sports, and they are looking to expand the faculty in other services (hand, F/A, tumor), although these departments are still fairly well represented.

Didactics/Teaching
Wednesday morning is reserved for didactics, with 1 to 2 hours of faculty-led lecture on a given topic and another hour of related OITE questions, where the residents go down the line and read/answer questions while an attending from that subspecialty makes sure that everyone understands the reasoning behind the right and wrong answers. They have cadaver dissections in the summer/fall, where the junior resident takes everyone through various approaches to the hip/knee/ankle/shoulder and an attending/chief pimps the presenter and other residents on related clinical pearls.

Operating Experience
Variable depending on the site and service that you are on. At the main Stanford Hospital, the joints and sports services are relatively hands off, and residents are double scrubbed with fellows. Stanford's main hospital is a level 1 trauma center, so the residents are fairly busy, but they usually only run 1 trauma room, and there is a trauma fellow who can get between the resident and the knife. The residents get the bulk of their hands-on operative experience at the Santa Clara Valley Hospital, which is a level 1 trauma hospital located in San Jose (~20 minute drive from Stanford). Residents rotate here as a PGY2, PGY3 and PGY5. The hospital is busy, especially during the summer, and there are two dedicated ortho rooms with a mix of trauma and elective bread and butter cases. The operative experience at the Palo Alto VA (~10 minute drive) is also supposed to be very hands on, especially for joints.

Clinic Experience
The main outpatient center is in Redwood City (~15 minute drive). Many of the big-name attendings want the senior residents and fellows in clinic, leaving the juniors to handle floor work, cover cases for the junior attendings, or cross-cover on another service. Clinic at the Valley and VA are much more hands on, with even the junior residents seeing their own patients and making management decisions before presenting to the attending.

Research Opportunities
Research is becoming an increasing focus of the residency, although I did not come across many many residents who were particularly interested in research. Dr. Goodman, a joints attending, is well-published in basic science and biomechanics, and some of the other attendings dabble in clinical research and outcomes-based stuff. I got the feeling that residents can do as much or as little research as they want here.

Residents
7 per year. I got a West Coast vibe from the residents, even from East Coast transplants. Residents are generally laid-back, friendly, and down to earth. Many of them are outdoors-y, and a number were college athletes. However, I didn't get a strong sense of community among the residents, and many of them seem to do their own thing outside of work. The residents are spread out across a couple of different sites, and the program did not feel like it was particularly team-oriented. Many of the residents do fellowships and go into private practice. I didn't get to see the specifics of their fellowship match, but I think you can get a great one on the strength of the Stanford name and Dr. Maloney's reputation.

Lifestyle
The culture is definitely work hard. All of their call is “home call”, even at the Valley hospital, which is a scam because both of these hospitals are level 1 trauma centers. They don't have post-call days, and even though call at Stanford Hospital is ~q8 for juniors, you often will be in the OR all day after a 24-hour shift. At the Valley, the juniors (2 PGY2 and 2 PGY3) are on call q4. PGY2 and PGY3 are both busy, but the schedule lightens up quite a bit by PGY4, except for the PGY5 rotation at the Valley. There has been talk of moving to a night float system, especially since the program has expanded in recent years, but it doesn't sound like it will be happening anytime soon.

Location/Housing
Palo Alto is a suburb about 45 minutes south of San Francisco and 20 minutes north of San Jose. The city of Palo Alto and the surrounding towns are suburban paradise, but the cost of living is quite expensive. Residents can live in decent size apartments or even houses, but the rent is high, nearly as high as SF. You need a car to get anywhere, and public transportation is non-existent. Residents can trek into SF during days off, which you can get to using the Caltrain or driving. However, many residents cited that they liked Stanford because they aren't city people and they like to do outdoors-y stuff like surfing, hiking, biking, golf, running, etc.

Limitations
Call schedule and work hours are long and hard. Operative experience on many of the subspecialty services can be hands-off and subject to fellow encroachment. Cost of living is expensive, there is a considerable amount of driving, the suburbs are less desirable to me, and the Bay Area is far away from family and friends. Limited interaction between the residents and chairman, although he does seem to care about them placing into good fellowships. They also lost a few residents in recent years, and the circumstances about their departures were not entirely clear, but seemed more related to personal problems rather than program problems. Residents also didn't have a strong cohesiveness, and I felt like the residency structure was not particularly team-based.

Conclusion
Solid program, and one that I see continuing to improve over the next few years. Stanford has a great name with famous attendings, solid research resources, great bread and butter hands-on training at the Valley/VA, and shiny new facilities. That said, while I really wanted to love this program, it has a lot of limitations. On the lower end of the Tier 2 spectrum for me.

Yale

Interview Experience
Very large group, as they interview 100 applicants over 2 days for only 5 spots. Social the night before was actually a sit-down dinner with 1 resident at each table. Interview day consisted of 3 sit-down interviews for ~20 minutes each (2 faculty and 1 chief resident). Interviews were conversational and friendly, and nothing out of the ordinary was asked. The chairman and PD served as faculty interviewers, but the majority of applicants did not get a chance to meet individually with either one, which was definitely a negative.

Staff/Faculty/Chairman
Nice mix of faculty. On the academic side, there are some older, experienced, well-known attendings, as well as some younger attendings that are in the early or prime stages of their careers. The residents also work extensively with private community attendings at the St. Rafael's Hospital down the street. During third year they go to Waterburg (45 minute drive), to work with one of the pioneers in anterior hip replacement. The chairman, Dr. Friedlander (hand), has been at the helm for 20+ years, and is a funny, personable guy. However, he is likely to step down in the next few years, certainly during my potential training time. Dr. Smith (peds) is the residency director, he is smart, but reserved and soft-spoken. The residents seem to like both Drs. Friedlander and Smith.

Didactics/Teaching
There is fracture conference on Wednesday, as well as grand rounds on Friday, with a lecture given to residents by the guest speaker beforehand. Many specialties also have weekly conferences of their own. The residents emphasized how great their grand rounds speakers are, but did not speak too much about the weekly didactics. There is an anatomy course in the spring, rotating each year between upper and lower extremity. In the operating room, the faculty seem to understand that the resident education is important, and are all willing to teach.

Operating Experience
This is a strength of the program. They are a high volume trauma center, and 30% of the cases go uncovered because only 3 residents are assigned to trauma at any one time. Double scrubbing is rare, and the PGY1's and PGY2's routinely get to be 1st assist in the OR. Responsibility is gradual and there is a good balance of autonomy/skill development with instruction/supervision. The residents say they get their best operative experiences on trauma as well as joints and sports with their community attendings at St. Rafael's and the VA.

Clinic Experience
Did not hear too much about clinic. Most of the clinic sites are at Yale or within greater New Haven. There is some driving for peds and spine(?) subspecialty clinics. They have Epic EMR, so that helps with efficiency. Residents said that clinic was as enjoyable as could be and they had a good mix of teaching with autonomy.

Research Opportunities
Residents get 10 weeks during PGY3, PGY4 and PGY5 to do research or clinical elective rotations. During PGY3, there is a lot of call coverage, so research is harder to work on, but PGY4 and PGY5 are very conducive to research. Dr. Grauer does outcomes and database research with the medical students and residents and is very active with publishing. Dr. O'Connor, who is heading the new musculoskeletal center, is also interested in patient-reported outcomes and value-based orthopaedics. Most of the residents end up in private practice, but there are abundant opportunities to get involved in academics and research if you seek it out.

Residents
5 per year. Cohesive group of residents. Seemed overall to be laid-back, collegial, and fun. Spent time with each other outside of the hospital. Some had families and kids, others were single. They have a relatively diverse group, with quite a few female residents and attendings. Did not come across as particularly "bro-y" during my interview, but seemed like a great group of people I could see myself fitting in with. Fellowship match was good, but not crazy good. Many residents go into private practice.

Lifestyle
PGY3 is the hardest year for residents here, as this is their year of overnight call. PGY2 is day call, and PGY1 has night float for floor work. They have an army of PA's to help with floor stuff, allowing the residents to spend the majority of their time in the clinic and in the OR. Their weekend call schedule also seems nice, with "golden weekends" and no required rounding when you are off. PGY4 and PGY5 seem relatively easy, with the focus on operative experience. Some of the seniors use the 10 weeks for research to take vacation, hang with their families, travel, etc.

Location/Housing
New Haven is a small New England city. The downtown has gentrified in recent years, and there is an arts presence, good restaurants, and a small nightlife scene. Many of the single and younger residents live in downtown New Haven, while the older residents with families live in some of the suburban communities that are 10 to 20 minutes away from the hospital. Cost of living is cheap, and the pay is comparable to NYC programs, so you get more bang for your buck. Residents still noted that parts of the city aren't safe, and there isn't a ton to do in the greater New Haven area, but it has all of the amenities of a modern city. Would definitely need a car.

Limitations
There may be changes to the program with a new chairman in the coming years. The hospital would like to add more fellows to increase their USNWR ranking (as per Dr. Smith), but he would prefer to add more residents. Regardless of the ultimate outcome, the anatomy of the program will likely change in one way or another in the next few years. I also would prefer a bigger city than New Haven. They still are weak in some areas including joints and hand.

Conclusion
A balanced program with a great operative experience, good trauma exposure, well-rounded in most of the specialties, and with abundant time and resources for research. The program is resident-centric, and there are only 2 fellows currently, which is a big plus. The location is good but not great, with added points for the East Coast. Upper-level Tier 2 program for me, and would be happy to end up here.

Pittsburgh

Interview Experience
The day started with a presentation by the residents, with the chairman Dr. Fu personally giving his own presentation on the program during the lunch hour. Dr. Fu then met with each applicant individually for 5 minutes, and you met with either the PD Dr. Deeney or assistant PD Dr. Hogan for 8 minutes. Then you met with 4 additional attendings for 15 minutes each. Conversations were friendly with nothing out of the ordinary. They interviewed 90 applicants this year, 30 on the first day and 60 (in two groups) on the second day. During Dr. Fu's presentation, a slide mentioned they aim for 2 Pitt students, 3 away rotators, and 3 non-rotators. They take 8 residents, 4 research track (6 years) and 4 clinical track (5 years).

Staff/Faculty/Chairman
Freddie Fu is the chairman and is a very visible face of the program. He has been at Pitt since the 1980's, and has overseen a huge growth in the program. He specializes in sports, but the residents don't operate with him much. However, he is very involved in their education and the day-to-day operations of the department and the residency program. Dr. Deeney (peds) is the program director, and seems like a funny, down to earth guy, and the residents all spoke highly of him. He is planning to retire soon, and Dr. Hogan, a young foot/ankle specialist, was recently chosen as the assistant program director and is being groomed to replace Dr. Deeney. Dr. Hogan was very energetic and enthusiastic during interview day, and he is a really likable guy. During interview day, Dr. Fu made comment in passing that he might retire when his board certification is up for renewal in 2018. I think this comment was made partly in jest, although some rotators said that they heard rumors that he is considering stepping down in the near future. Another resident, when asked about this, said didn't know anything specifically, but thought that Dr. Fu has a ton of energy left in the tank and they didn’t envision him retiring anytime soon.

Didactics/Teaching
They reserve Wednesday morning from 7am to 12pm for protected teaching time. Usually they have an internal attending speak for 1 or 2 hours on a given topic, followed by senior residents lecturing on OITE-related topics for the remaining 3 to 4 hours. The sub-specialties are well-represented among the faculty, including multiple hand, tumor, and F/A attendings. I didn't get too much detail about the quality of the lectures, but two resident graduates from the program that I have worked with as fellows seem to be well-versed on book knowledge.

Operating Experience
This was a point of emphasis during interview day. UPMC is a high volume center, which means that residents aren't fighting for cases with fellows, and double scrubbing isn't that common. Trauma at Presby (the main hospital) and joints (at Shadyside, ~10 min drive) are busy services with good operative experiences. Every year or two, a resident chooses to forego a fellowship and go into community orthopaedics, which the residents said speaks to their level of comfort with bread/butter cases. At the VA (~5 min drive), the senior residents are the primary decision makers. For the residents doing the 6-year research track, they are board certified superchiefs during their 6th year and take primary trauma call at Presby. I had some concerns about the number of fellows, particularly in hand, but on interview day one of the hand attendings told me that they use a 1-on-1 mentorship model, with the attending running two rooms, one for residents and one for fellows. When I spoke with some of the rotators about their OR experience, they said that double scrubbing does happen occasionally, but it usually a PGY5/6 with a PGY2/3. They were also short one spine attending this summer, so there was a bit of double scrubbing on that service. They said, though, that the general attitude was to let the juniors get some hands-on experience and not just relegate them to watching. I didn't hear much about the sports or peds experiences.

Clinic Experience
Didn't hear too much about clinic. They use Epic EMR, and only have to login to the computer once to access all of the EMR applications. I didn't hear many complaints about clinic, and it seems like the residents get opportunities to see patients on their own and come up with their own plans, especially as seniors.

Research Opportunities
This is touted as a strength of the program. It is basic science heavy, with 4 of the 8 residents each year assigned to a laboratory where they perform bench work on stem cells, biomechanics, cartilage regeneration, tissue engineering, etc. The entire program has a basic science feel to it, and Drs. Fu and Musdahl are among the best-published sports attendings on ACL repair in the world. I am more interested in clinical outcomes and quality research, which is not a focus of their research, but Dr. Yates at the VA and Dr. Hogan (the assistant PD) are working on a new database that should create some great research opportunities. Dr. Irrgang is a PhD researcher and handles most of the clinical studies with the residents, but I did not get an opportunity to meet with him.

Residents
8 per year, with 4 doing the 5-year track and 4 doing the 6-year track. Everyone seemed very normal, friendly, and enthusiastic about their choice to do residency at UPMC. I got the feeling that you really have to buy into the Fu culture if you want to do well there, but residents said that he is a great advocate for them and is well connected within the orthopaedics community. Around half of the class is married, and some have kids. There are quite a few women in the program, and the residency won the diversity award from the AAOS a few years ago. Since the residents are spread out around Pittsburgh clinical sites (even though they are all within 10 to 20 minutes of each other), I heard from some rotators that residents don't spend a ton of time with each other outside of work. Everybody knows each other, but after intern year, everyone starts doing their own thing and the level of resident camaraderie seems to fade. One rotator said that the program forms a bunch of cliques/factions, where similar groups of people hang out (i.e. family-oriented, locals, party boys). I would describe the personality of the program as a bit nerdy, not particularly bro. The residents didn't speak about the fellowship list in detail, but said that they can get great fellowships because of the reputation of Pitt and Dr. Fu's connections. Many residents go into sports, but there is obviously variation year-to-year.

Lifestyle
This is a program where you will work hard while you are at the hospital, but they emphasized that they adhere to the 80-hour workweek. Years ago, it was taboo to take a post-call day, but now the faculty will send you home if they see you lingering around the hospital in the late morning after an overnight. PGY2 is the hardest year of residency, as is typical for most programs. PGY3 recently instituted a night-float system, which is considered an easy block since you are providing in-house assistance to the PGY2 on call.

Location/Housing
Pittsburgh was voted the most livable city in the US by Forbes(?) magazine. Housing is affordable, and many residents own homes just outside of the city. Traffic isn't bad, there is an emerging restaurant and arts scene, and there is great sports culture in town. Dr. Fu has tickets to a ton of arts and sports events and his secretary regularly sends out emails to the residents with a listing of available tickets. One negative about the Pittsburgh is its lack of diversity. Out of the 100 largest metro areas in the US, it is the 99th least diverse. There is diversity of residents in the residency program, but the patient population is almost entirely white, middle-class, English speaking patients.

Limitations
As noted above, there may be a changing of the leadership during the next 5 years. Dr. Fu has immersed himself in every facet of the residency, and it would be difficult for another chair to replicate him. The city of Pittsburgh, while affordable and livable, is relatively isolated from other major cities and is lacking in diversity and culture. Many of the residents have ties to Pittsburgh, and the lack of a cohesive resident feel is concerning, particularly since all my family and friends are far from Pittsburgh. The basic science research focus is not particularly interesting to me. Lastly, if you want to go to Pittsburgh, you are strongly encouraged to do a second look before the match list is due, and it helps if you tell Dr. Fu that Pitt is your top choice. An intern matched last year without doing the second look, but he said he is the only current resident he knows of that this happened for.

Conclusion
A balanced program with a great operative experience (especially on trauma and joints), good resident autonomy with limited fellow encroachment, and great research opportunities. Some people might consider this a tier 1 program. However, because of location, questions about resident cohesion, and the need for a second look, it is going to be a low tier 2 program for me.

UCSF (San Francisco)

Interview Experience
This was among the longest interview days of the year. Started with presentation by the chairman Dr. Vail, followed by a chief resident presentation. Then all of faculty and residents introduced themselves. The department said that the two interview days are the most important days of the year for them, so all residents and faculty cancel their clinical responsibilities to help with the day. It was a really impressive showing actually. In the morning, there was a bus tour with the residents, followed by lunch and an hour of panel interviews in the afternoon. There were 4 rooms, each with 4 to 6 interviewers, consisting of faculty and chiefs residents. The rooms were themed, including chairman/general, research, knowledge/pimping, and leadership. I was a little nervous for the knowledge room, but everyone was very pleasant and the questions were not overly difficult. After the interviews were over there was a reception at the school, where the faculty drank beers and talked casually with the applicants. The residents then hosted everyone at a beer hall in SF, which was quite the scene, but overall was a fun experience where I got to speak with a few of the chief residents who interviewed me earlier in the day. They typically take 5 or 6 rotators and 1 or 2 non-rotators for their 7 spots, but they only interview 48 applicants over 2 days, so you have good odds if you get an interview.

Staff/Faculty/Chairman
The chairman, Dr. Vail, is a joints surgeon who has been at UCSF since 2007, when he came over from Duke. He reminds me of a CEO, very professional, well-mannered and laid back. He knows all of the residents, and they speak very highly of him. He is well-connected and respected in the orthopaedic community and helps the seniors land great fellowships. Dr. Kim, the PD, is a joints surgeon and is in charge of the VA. He was unable to come to interview day, but the residents also spoke highly of him. They said that they don't work with him much until they are the senior at the VA, but said he is very available to the residents if something comes up. The faculty has seen some expansion since Dr. Vail took over, and is now >50 strong. They have multiple faculty in each department, including 2 tumor attendings and 3+ each in hand, F/A, spine, joints, and trauma. Residents have 1 clinical mentor and 1 research mentor that they are assigned at the beginning of intern year. However, residents mentioned that they are always able to reach out to any of their attendings and they can get a response.

Didactics/Teaching
They have formal didactics in the middle of week, with the bulk of the lectures on Wednesday(?) and some additional conferences on Tuesday/Thursday. They have formal cadaver sessions that are set up for them in the summer. A lot of the teaching is resident-led, but attendings are usually present to ensure that relevant topics are covered.

Operating Experience
A strength of the program. Resident autonomy is a focus, and juniors are given opportunities to fly in the OR, particularly at SF General Hospital, where they spend 4 months on trauma/general as a PGY2, PGY3, PGY4 and PGY5. The residents are split up into two teams here, with each team covering specific services (e.g. spine, hand, F/A) in addition to trauma, so you get some subspecialty exposure in the bread and butter cases. At the VA and even at the University Hospital at Parnassus and the new Orthopaedic Institute (OI) in Mission Bay, the junior residents are given ample opportunities to operate. As seniors, they are basically allowed to serve as the primary surgeon, with the attendings providing advice and appropriate supervision. There are only a few fellows (2 in trauma, 1 in joints, 2 on spine), and the residents said that the fellows do not steal cases and serve primarily as teachers on bread and butter stuff.

Clinic Experience
Usually 1 or 2 days per week depending on the site/service. They have Epic EMR at Parnassus/OI. SFGH has a patchwork system with labs/orders in the computer and paper for notes and consults. Mark Zuckerberg recently donated a large sum of money to build the new SFGH, and the rumor is that they will get Epic within the next few years. Residents spoke positively about clinic, and said they see their own patients and come up with their own management decisions before presenting to a senior resident or attending. Even for private patients at the OI, junior residents get to see the patient first by themselves.

Research Opportunities
UCSF as a whole is a research haven, and the orthopaedics department is no exception. They have a number of basic science labs, and 1 resident per class has a dedicated year to use for research. They also have a lot of outcomes-based research and cost/quality stuff, particularly in joints. Unfortunately, Dr. Bozic, who was the field leader in value-based orthopaedics, took a job as the dean of surgery at UT-Austin, so his former research team is in a transition state. However, the residents emphasized that tons of opportunities are available here, and if you have a project idea, you can definitely find collaborators at UCSF. There is an 8-week research block during the PGY3 year, which most residents use to perform the bulk of the work on projects they set up during their intern/PGY2 years. Residents are required to submit 2 manuscripts before graduation, and each resident is also required to submit a grant application to the OREF. Many of them actually get funded, and current residents have been awarded more than 200K of grant money, which is really impressive. This is also a good place to mention the international elective, which every resident is required to take during their fourth year. It is a great opportunity to teach and operate in a third-world country, and residents spoke positively about the experience.

Residents
7 per year, 1 of which is in the 6-year research track. I really liked the residents, and thought that they were a fun, energetic, cohesive group that actually spent time with each other inside and outside of work. Since so many residents from different classes rotate at SFGH at any one time, everyone in every class has worked with each other and there is a lot of between-class camaraderie. Many of the residents have West Coast ties, but they have a few East Coast transplants. About half of the residents are married, but most of them still find time to hang out with each other. Not a ton of "bros" per se, but energetic and fun city dwellers.

Lifestyle
SF is a world-class city, and is really fun place to live. Great food, culture, neighborhoods, activities, diversity, etc. Fantastic weather year-round, close proximity to the ocean, and lots of opportunities for outdoor activities. Tahoe is a 3-hour ride away. The residents said that they generally work around 80 hours, although summer at SFGH can be brutal. Their call works out to q4 at SFGH, q6 at University, and q2 home call at the VA. They get post-call days. Residents work out their own call schedules in advance, and can request specific days off at the beginning of the rotation. Residents in each class also work out their service rotation schedule at the beginning of each year. Chiefs basically run the entire orthopaedic service at SFGH, so there is still a lot of work as a senior, but it is good practice for working as an attending.

Location/Housing
SF can be expensive, but residents are given a stipend of $10K/year to help defray housing costs. Public transportation in SF is available, but not really an option for the residents given their odd hours and the distance between the clinical sites around the city. Therefore, a car is a necessity, and parking can be difficult. Street parking can usually be found in the early mornings, but is a bit of a crapshoot and can take a few minutes. You can buy garage passes at the hospitals, but they are 100 to 200 bucks depending on the site. The residents said that most of them live within walking distance of 1 of the hospitals, and then they drive 15 to 20 minutes to the other sites. The costs can add up, but the residents said it comes with the territory of living in SF.

Limitations
The cost of living is high, car is a requirement, and parking is difficult. There is some driving between the sites, although everything is within city limits. Spending 4 months at the county during years PGY2 through PGY5 is good operative experience, but can be quite tiring and sacrifices subspecialty exposure. SFGH doesn't have the best patient records system. West Coast location is far away from family and friends. I have heard reports from rotators that some of the residents and attendings can be difficult to deal with, not malignant per se, but unnecessarily anxiety-provoking. I didn't get that feeling during the interview, but the reputation is out there and must be acknowledged.

Conclusion
Outstanding program in an outstanding location. Early hands on operative experience, minimal fellow encroachment, big names in the field, stable leadership at the top, and great research experiences. Residents felt like a very dynamic and cohesive group that I felt like I would fit in well with. Fellowship list was also top notch (i.e. HSS sports, Rush sports, Harvard hand). SF is an awesome place to live, cost of living and distance from home aside. I think UCSF is in the conversation for best program in the county, tier 1 for me.