Advice for ranking? Struggling with my top 5.

[Path1221]

I recently finished interviews and I have been going back and fourth on my top 5 programs and rearranging them on my rank list daily. I realize I still have some time to make a decision so I was hoping to get some advice from people with more experience and insight because my institution didn't offer any. If there's something I'm not considering or I have a wrong impression of a place, please correct me.

My considerations:
1. Good reputation with good connections in case I decide I want to go elsewhere for a fellowship, right now I plan on academics and research.
2. Good AP and CP training with good volume and variety, as I'm interested in a couple of CP fellowships but want to be well trained in AP too.
3. Additional opportunities particularly in global health.
4. Location isn't particularly huge for me, although I'm not a "city" person per se - perfectly happy living in a smaller place but have done the city-life before and it's fine, just not the be all end all. However most of my family is in the south so that is playing a small role.

As far as fit - I probably felt like I fit in a little better at a couple of the "lower ranked" places but how much emphasis I should place on this vs. reputation, I'm not sure.

Anything else I should consider?

In no particular order my top 5 programs:
Emory - Pros: Good regional reputation with a good volume and variety of specimens. Several faculty with similar research interests and good CP, particularly in TM and micro and connections with the CDC. Close to home/family and I don't mind Atlanta.
Cons: Reputation isn't quite what the Hopkins/MGH rep is. Currently undergoing some changes in faculty/directorship. Multiple hospital sites across Atlanta. Traffic.

Johns Hopkins - Pros: Reputation. Incredible global health and research opportunities. Volume and variety. Excellent benefits and wellness initiatives.
Cons: Workload/schedule is grueling with more grossing than most other programs I interviewed at. Although I don't mind Baltimore, it's farther from family. Possibly weaker CP especially compared to AP.

MGH - Pros: Reputation. Research and access to all of the Boston places. Customizable tracks for starting fellowships early. Volume and variety. CP is superb. Hours seem to have improved exponentially in the past couple of years.
Cons: Boston is $$$$. Far away from family. 1 week rotations on surg path and autopsy seem like it might be difficult to ever "get in the groove."

UNC - Pros: Awesome atmosphere and probably fit in best here. Closer to home/family. Chapel Hill and the Triangle are one of my favorite places in the country. A few faculty with similar research interests. CP training seems to be improving. Connections with the public health school and global health opportunities.
Cons: Reputation might not be on the same level as the others - not sure how this might affect future fellowships/jobs? Less volume/variety compared to the programs, although not a massive difference. Fewer benefits.

Vanderbilt - Pros: Location - love Nashville with friends and family in the city. Good reputation regionally with faculty with connections/research that match my interests. CP seemed to be good and most of AP was as well.
Cons: A couple of AP services might not see as much volume or variety. Reputation not as good outside of the south. Relatively few benefits and lower salary compared to others with an ever-increasing COL in Nashville.

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[Unty]

My advice to you and all the other applicants is to go to a place where you will be happy.

Cool supportive attendings who will treat you fairly and with respect. Crazy or malignant attendings will make your life hell.

Knowledgeable teachers who enjoy teaching and who don't consider teaching as a chore. Attendings who will go out of their way to make you a damn good pathologist.

Residents who you can enjoy being around with for four years. A resident's room filled with drama and dysfunctional coresidents will make you miserable.

Four years is a long time and where you work is very important to your mental health especially when you will be incredibly busy.

Reputation is not all that important in my opinion unless you want to do academics. If you do want to do academics then I think all those programs you listed is still all good options but to me being happy is most important and trumps everything else.

Best of luck to all...

 

[pianoguy05]

My advice to you and all the other applicants is to go to a place where you will be happy.

Cool supportive attendings who will treat you fairly and with respect. Crazy or malignant attendings will make your life hell.

Knowledgeable teachers who enjoy teaching and who don't consider teaching as a chore. Attendings who will go out of their way to make you a damn good pathologist.

Residents who you can enjoy being around with for four years. A resident's room filled with drama and dysfunctional coresidents will make you miserable.

Four years is a long time and where you work is very important to your mental health especially when you will be incredibly busy.

Reputation is not all that important in my opinion unless you want to do academics. If you do want to do academics then I think all those programs you listed is still all good options but to me being happy is most important and trumps everything else.

Best of luck to all...

Agreed 100%. At the place at which I trained, I essentially had no collegiality between residents. Miserable 4 years.

 

[Dro133]

Only an MS3, but it sounds like you'd be happiest at UNC just based on your description.

Out of curiosity, what global health/public health opportunities can pathologists get involved in?

 

[ClinPathDO]

Only an MS3, but it sounds like you'd be happiest at UNC just based on your description.

Out of curiosity, what global health/public health opportunities can pathologists get involved in?

I would think a Medical Microbiology fellowship could lead to many Global health opportunities. CDC has an ID pathology fellowship too.

 

[LADoc00]

Didnt some of the folks from that epic wife swapping sex scandal at Duke's pathology program go to Vanderbilt? I dont know too much about it other than random reddit threads and bar talk at path meetings, but if so then I would pick Vanderbilt. What would be cooler than chatting with a faculty and asking them how they ended up at Vanderbilt.."you see there were these parties at Duke..."

I think we used to have a thread on that here? If not some enterprising young SDNer can google it and report back.

 

[Path1221]

Only an MS3, but it sounds like you'd be happiest at UNC just based on your description.

Out of curiosity, what global health/public health opportunities can pathologists get involved in?

For global health, med micro and other CP specialties in labs in developing countries need help being set up and personnel need to be trained. There are multiple opportunities for this type of directorship and teaching. Also in AP there are many opportunities to travel to labs in developing countries and not only help train the physicians there but also review and sign out cases as many developing countries have almost no pathologists.

 

[Path1221]

My advice to you and all the other applicants is to go to a place where you will be happy.

Cool supportive attendings who will treat you fairly and with respect. Crazy or malignant attendings will make your life hell.

Knowledgeable teachers who enjoy teaching and who don't consider teaching as a chore. Attendings who will go out of their way to make you a damn good pathologist.

Residents who you can enjoy being around with for four years. A resident's room filled with drama and dysfunctional coresidents will make you miserable.

Four years is a long time and where you work is very important to your mental health especially when you will be incredibly busy.

Reputation is not all that important in my opinion unless you want to do academics. If you do want to do academics then I think all those programs you listed is still all good options but to me being happy is most important and trumps everything else.

Best of luck to all...

I appreciate the advice and definitely agree with you. However, it seems pretty difficult to elucidate which programs have the cool, supportive attendings who enjoy teaching and will go out of their way for you based on a single interview day. Also difficult to really get a grasp of how you might get along with the residents, although definitely easier than figuring out the attendings. If there is a way to figure this info out prior to submitting my rank list, I'd love any insight.

I guess that's why I'm struggling with my top programs. All the programs I mentioned seemed to (at least superficially) have good supportive attendings who are willing to teach and I clicked with at least a few of the residents at each place. So really overall the two main differentiating factors are location/atmosphere vs. reputation. And I was hoping to get some additional opinions from people in the field as to whether going to less of a "name place" would hurt my chances at an academic career?

Thanks again!

 

[SpaghettiMeatballs]

Go to the "name place", like a trophy wife it means you made it!

 

[y2k_free_radical]

Didnt some of the folks from that epic wife swapping sex scandal at Duke's pathology program go to Vanderbilt? I dont know too much about it other than random reddit threads and bar talk at path meetings, but if so then I would pick Vanderbilt. What would be cooler than chatting with a faculty and asking them how they ended up at Vanderbilt.."you see there were these parties at Duke..."

I think we used to have a thread on that here? If not some enterprising young SDNer can google it and report back.

How the hell did i miss that-tell me more-any links

 

[deleted950463]

MGH then hopkins then the other places. No brainer really.

 

[deleted642280]

I agree with going where you will be happiest and where you felt you fit in the best. Since all of your top places are solid programs, the things that will make the largest difference is where you can make a personal connection with your fellow residents and attendings. If you are happy, close to family, and have friends nearby, you will produce better work without even thinking about it and shine in the program ultimately leading to more options and good recommendations for fellowship. If you go somewhere just on name alone where you don’t know anyone, you could just get swept away in the exhaustion and daily grind that is residency. Although MGH and Hopkins are excellent, you need a support system in residency and need to give very hard thought about what kind of lifestyle you want for the next few years. I cannot stress enough how much better residents do who are well rounded in life and happy at work. Think about how nice it would be to use your vacation time to go on actual vacation if your family is nearby and you can see them whenever you want or need. Burnout is real.

 

[Unty]

I agree with going where you will be happiest and where you felt you fit in the best. Since all of your top places are solid programs, the things that will make the largest difference is where you can make a personal connection with your fellow residents and attendings. If you are happy, close to family, and have friends nearby, you will produce better work without even thinking about it and shine in the program ultimately leading to more options and good recommendations for fellowship. If you go somewhere just on name alone where you don’t know anyone, you could just get swept away in the exhaustion and daily grind that is residency. Although MGH and Hopkins are excellent, you need a support system in residency and need to give very hard thought about what kind of lifestyle you want for the next few years. I cannot stress enough how much better residents do who are well rounded in life and happy at work. Think about how nice it would be to use your vacation time to go on actual vacation if your family is nearby and you can see them whenever you want or need. Burnout is real.

Very well said.

I was at work in fellowship from 6 am-11 pm once and came back to work to be ready for signout (getting crap ready for the attending) in the early morning.

You really are a glorified secretary during training.

 

[CDX-2]

I agree with going where you will be happiest and where you felt you fit in the best. Since all of your top places are solid programs, the things that will make the largest difference is where you can make a personal connection with your fellow residents and attendings. If you are happy, close to family, and have friends nearby, you will produce better work without even thinking about it and shine in the program ultimately leading to more options and good recommendations for fellowship. If you go somewhere just on name alone where you don’t know anyone, you could just get swept away in the exhaustion and daily grind that is residency. Although MGH and Hopkins are excellent, you need a support system in residency and need to give very hard thought about what kind of lifestyle you want for the next few years. I cannot stress enough how much better residents do who are well rounded in life and happy at work. Think about how nice it would be to use your vacation time to go on actual vacation if your family is nearby and you can see them whenever you want or need. Burnout is real.

So basically, the better lab is one that's closer to family / friends and/or easier to get along with the co-residents and attendings?

 

[deleted642280]

So basically, the better lab is one that's closer to family / friends and/or easier to get along with the co-residents and attendings?

Not necessarily the better lab, but the best chance at a fulfilling learning experience and networking opportunities during residency specifically.

 

[rhcarolina]

Can only speak for MGH.
One-week rotations are difficult initially, as you’re trying to grasp an understanding of the field as a whole, while only being exposed to small pieces. I liked the rotation schedule—I was able to focus on one subspecialty at a time. As you go through more rotations and then ultimately repeat those rotations, you become more comfortable. Daily unknowns provide helpful reinforcement, particularly if you haven’t been on a certain service in a while.
The cost of Boston is high, but the resident salary is enough to feel comfortable in the city.

 

[gbwillner]

One more voice:

Everyone's experience varies, and I think the best choice depends on your intentions for your future career. I agree that the national reputations of MGH and JHU trump the other programs and will give gravitas to your CV. However, the other programs are regional powerhouses as well, so if you intend to practice in the southeast, the relative value of these programs will not be significant compared to other things you list as important variables.

You mention academia... how confident are you? are you seeking a research-heavy career (like 50-50 or more)? If so, I would argue that programs with strong training in your field of interest should be your highest priority. From that perspective, I would say MGH is your best choice, because you could do research anywhere in Boston.

 

[rugbyram7]

One more voice:

Everyone's experience varies, and I think the best choice depends on your intentions for your future career. I agree that the national reputations of MGH and JHU trump the other programs and will give gravitas to your CV. However, the other programs are regional powerhouses as well, so if you intend to practice in the southeast, the relative value of these programs will not be significant compared to other things you list as important variables.

You mention academia... how confident are you? are you seeking a research-heavy career (like 50-50 or more)? If so, I would argue that programs with strong training in your field of interest should be your highest priority. From that perspective, I would say MGH is your best choice, because you could do research anywhere in Boston.

What if you don’t know where you want to end up in terms of geography? Would a program/hospital with a “better” ranking be the better choice?

 

[gbwillner]

What if you don’t know where you want to end up in terms of geography? Would a program/hospital with a “better” ranking be the better choice?

All things being equal, then yes. However, there is no formal "ranking" of pathology programs. All I can say is telling perspective employers you went to MGH or JHU will generally result in accolades. For some jobs, these will carry significant weight; for others (like community practice), almost none at all.

For example, if you decide you want to work at a community or regional hospital in Nashville, and there jobs available, then going to Vanderbilt and doing well is going to be your best bet, because you will have the opportunity to network with the local path societies and get recommendations from people who have direct, local connections. If you went to MGH, then you'd have the name, but likely not the connections, which I would argue is more important to land this job. I would argue the programs you mention will given you and advantage in the entire SE US, and even if you chose elsewhere, these all have a good reputation, so they won't hurt you.

However, if you decide you want to specialize in molecular pathology and work developing new bioinformatics applications at MIT, then getting a job running a molecular lab and or a research heavy academic or industry job will be much easier for you if you went to MGH and did those things. The caveat here is that if you chose to sign out breast pathology, these experiences will ultimately mean nothing.

I ended up taking such a job (running an international lab, then my own, and then a very prominent role in regulatory) because of the things I was able to accomplish at a "top-tier" institution. And everywhere I went I was reminded about the advantages I had because of my training and experience. But it worked out because I chose that path- had I wanted to sign out breast I probably would have not had much of any advantage.

 

[handel909]

1) mgh-boston is a great city
2) jhmi- be careful in baltimore.
3) vandy- if you are a family person this should be number one. edit: vandy has a great academic reputation outside of the south. IMO you would be happiest with vandy.
4) emory
5) unc

How much of a rockstar were you to interview at these places? How high was your step 1?

 

[LADoc00]

Purely as place to live, residents who I would think would be "fun" (in my defintion) etc I would probably go to Vanderbilt, if not Emory.

This would be different perhaps if I was a woman, where I would absolutely never go to JHU. Wouldnt even be on my list pretty much ever.

In Baltimore, it is a really not an IF you get assaulted, its more of a WHEN.

Bummed you didnt get a nod from BWH, that would be my own personal top even with R.C. gone..

 

[handel909]

Agreed. Had a housemate that was held up at shotgunpoint in baltimore. Had my house broken into while i was inside. A fellow classmate disemboweled a hostile intruder with his samurai sword. Had a friend that was jumped by a gang and beated to a pulp. Hopkins is for the modern Fausts- those who would sell their souls for access to a population of people exposed to lead paint and decrepit conditions in order to study and train. It is a thankless place and if you have the huevos to go there then you knew it was for you all along.

 

[Rxor49]

I must have been at JHU at the same time as handel. I was either a junior or senior when the samurai sword thing happened. It sounds made up but I knew a guy who lived with him. I also know multiple people mugged at gunpoint or burglarized. And note of course that this was at the undergrad campus which is in the GOOD part of town.

 

[deleted314957]

Amen to Baltimore! Did F.P. fellowship there back in the 80’s.

 

[handel909]

I must have been at JHU at the same time as handel. I was either a junior or senior when the samurai sword thing happened. It sounds made up but I knew a guy who lived with him. I also know multiple people mugged at gunpoint or burglarized. And note of course that this was at the undergrad campus which is in the GOOD part of town.

Yep. I wouldn’t wish the experience on an enemy. You forgot the part of your post where you emphatically say stay away unless your whole life, which you must be willing to risk, is devoted to medicine.

 

[LADoc00]

A fellow classmate disemboweled a hostile intruder with his samurai sword.

Okay actually that sounds very interesting. Im going to need more clarification, did the intruder have some type of ninja weapon? Set the stage for me here, was this like a classic Kung Fu movie duel?? because I would be down for that. Okay let's put this in the JHU training program "plus" column for now: Ninja fighting. If you were the kid who dropped 100s of hours in martial arts, stockpiled a collection of throwing stars and Japanese swords, THEN a residency match in Baltimore is sounding much better.

 

[handel909]

Okay actually that sounds very interesting. Im going to need more clarification, did the intruder have some type of ninja weapon? Set the stage for me here, was this like a classic Kung Fu movie duel?? because I would be down for that. Okay let's put this in the JHU training program "plus" column for now: Ninja fighting. If you were the kid who dropped 100s of hours in martial arts, stockpiled a collection of throwing stars and Japanese swords, THEN a residency match in Baltimore is sounding much better.

I know you’re taking the piss, but to clarify it was a decorative samurai sword that the guy had in his room and he took it down to confront an intruder who was rummaging through the house downstairs. The intruder charged at him and he took one slice from an overhead position and cut the guys arm off, sliced open his chest, and disemboweled him. The guy died on the scene.

 

[Spikebd]

I know you’re taking the piss, but to clarify it was a decorative samurai sword that the guy had in his room and he took it down to confront an intruder who was rummaging through the house downstairs. The intruder charged at him and he took one slice from an overhead position and cut the guys arm off, sliced open his chest, and disemboweled him. The guy died on the scene.

Holy s***. I’ll have to look into buying a samurai sword as I build my home defense armory in the coming years.