academic vs community residency

[504196]

I'm getting ready to apply to gen surg this fall and will probably apply to both academic and community programs. I know academics gets you ready for fellowships while operating less while community programs have you operate more but may be less competitive for fellowship.

My question is do you have to go somewhere academic if you want a fellowship? I've heard if you want surg onc or peds then you must go academic and do research years. But I've also heard of ppl who went to community programs then did fellowship, mainly critical care or burn. Are some community programs better at sending ppl to fellowship compared to other community programs? I'm hoping to start making my school list soon and am a little overwhelmed by all the options.

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[doc05]

Very good questions. The answers aren't simple, and depend on individual programs. Do you have a surgery mentor at your home institution?

 

[Dr.LeoSpaceman]

As @doc05 says, the answer to this isn't straightforward, and depends not only on the type of residency, but also a number of factors related to what you do in residency. The generalized answer is: You can get into fellowship from community programs, but your options for type/prestige of fellowship will be broader (and potentially "easier" to obtain) from an academic program. That being said, there's not a one-size-fits-all answer.

Also, your generalization of academic vs. community programs is not accurate. I came out of a strong academic program, and while I'm pursuing fellowship, I would feel comfortable in my ability to operate independently and enter practice as a general surgeon. If you "need" fellowship to be a competent surgeon thenthere is a deficiency in the residency program. There are many academic programs with large case volumes, and the limitation to some community programs is that while there is volume complexity may be lacking.

You really need to sit down with an advisor and figure out what your career plans are, and then pick programs that will help you reach those goals. For example if you're hoping to pursue peds surgery or surg onc, a community program may not make it impossible, but would make it substantially more difficult.

 

[SLUser11]

As @doc05 There are many academic programs with large case volumes, and the limitation to some community programs is that while there is volume complexity may be lacking.

You can't take offense with an academic stereotype, then dish out a community stereotype in the same breath. Still, since I'm an attending at an academic program, I support your point, which is that plenty of academic programs have excellent clinical/technical training.

There is a lot of overlap, and programs cannot be defined into 2 black and white categories. Almost all fellowships are attainable from either type of program, with the exceptions (Peds and Surg Onc) already pointed out. Plenty of "community" programs have fellowship matches where the prestige (for whatever it's worth) exceeds that of neighboring academic programs. Plenty of academic programs have case volumes (and case diversity) that exceeds neighboring community programs....

In the old days, I would have done some searching and found threads that help explain, but I don't have time today. The sad fact is that your mentor will most likely be biased as well...use the internet, research the programs (including where their graduates go), and perhaps even do an away rotation at whichever type of program you are less familiar with, and that will help a lot.

 

[argama]

If I am interested in a fellowship that isn't Peds or Surg Onc but still moderately competitive like Plastics, CT(?), or Breast, is it still harder if I am coming from a community program versus an academic program? What about a well-regarded community program versus a low-tier academic program...should I rank that "lower-tier" academic program over the well-regarded community program if I want a somewhat competitive fellowship in the future? Excuse my ignorance, I'm also an M4 applying GS this fall...

 

[Jolie South]

If I am interested in a fellowship that isn't Peds or Surg Onc but still moderately competitive like Plastics, CT(?), or Breast, is it still harder if I am coming from a community program versus an academic program? What about a well-regarded community program versus a low-tier academic program...should I rank that "lower-tier" academic program over the well-regarded community program if I want a somewhat competitive fellowship in the future? Excuse my ignorance, I'm also an M4 applying GS this fall...

I think you should go where you think you will be happiest and where you will get to operate. I came from a quasi academic, lesser known program and know people from my program that have matched plastics, CT, vascular, breast, MIS, and surg onc. I would say except for peds, the rest are within reach. You really have to be at a serious academic program to match peds.

I shudder with PTSD every time I think about peds from my intern year, but to each his own.

 

[argama]

I think you should go where you think you will be happiest and where you will get to operate. I came from a quasi academic, lesser known program and know people from my program that have matched plastics, CT, vascular, breast, MIS, and surg onc. I would say except for peds, the rest are within reach. You really have to be at a serious academic program to match peds.

I shudder with PTSD every time I think about peds from my intern year, but to each his own.

Thanks for your insight...I don't have any aspirations for ped surg purely b/c of how much work and time and insane hoops ped surgeons have to go through. Let's say on the off chance I decided to do a competitive fellowship and I'm coming from a low-tier academic/community program..if I am able to secure 2 research years within my residency years at another high-power academic place (assuming productive years) , could that "offset" coming from a lower-tier residency program? Thanks!

 

[LucidSplash]

Thanks for your insight...I don't have any aspirations for ped surg purely b/c of how much work and time and insane hoops ped surgeons have to go through. Let's say on the off chance I decided to do a competitive fellowship and I'm coming from a low-tier academic/community program..if I am able to secure 2 research years within my residency years at another high-power academic place (assuming productive years) , could that "offset" coming from a lower-tier residency program? Thanks!

I think she already answered your question. You can do pretty much any fellowship from anywhere except the ones noted above (surg onc and peds). For the others, you can do research without taking a dedicated 2 years for bench research. Take time for bench research if you are interested in bench research, but not because you think your non-academic program isn’t well-known enough. Remember most of the Gen Surg and fellowship programs in the country aren’t ivory towers.