Bunch of questions I couldn't find the answers to..

[Caretaker22]

Hi guys,

I'm sorry if this is a really stupid question but i've been super curious about it. Basically, I wanted to ask:

1) Are all hospitals in the US linked to universities?
2) If not, does that mean the private hospitals can offer residency positions too? As seperate entities?
3) Why are there then preference given to "university based" USCE's and LOR's as compared to private or out-clinic etc? Could someone outline the differences to me (I know the basics of it. Just mean to ask the real world implications of both)
4) Finally, how many residency programs exist in the US? Where can I find the compiled list of all of them?

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[Siggy]

1. No.
2. Yes, non-univesity hospitals can have residency programs. These are either county run hospitals or community run, private hospitals. There are pros and cons to each type of residency (university vs county vs community).
3. Preference is generally given to experience and letters from residency attendings (regardless of university vs county vs community) because residency program directors are interviewing potential residents... not potential attendings.
4. ACGME - Accreditation Data System (ADS)

 

[Caretaker22]

Thanks so much for the comprehensive reply, one final thing though: Can these hospitals then themselves offer seperate elective programs? Is their process going to be the same? Basically, as an IMG while im looking for an elective, should I be looking for a hospital backed by a university, a hospital highly ranked in the specialty I eventually want to pursue, or what exactly?

Also, could you please explain point number 3? I was always lead to believe LoR's from Dept heads or senior doctors of the department you are doing the elective are more valuable? Is that not the case? What do you mean by "attendings"?

Sorry for all the questions and thanks again!

 

[PTPoeny]

Can which hospitals offer electives separate from what?

Attending are fully licensed doctors that supervise residents in a residency program.

Yes, the better known a person is the more weight their letter will carry with the people reading it. But it can be hard to work enough with program directors or department chairs to get a letter from them. I think what the previous poster was trying to say is that a letter from a doctor who regularly supervises residents is going to carry more weight than a letter from a community doctor who almost never interacts with students and residents.

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[Caretaker22]

Ah ok I see. Very sorry if my question was confusing. I just always thought the hospital had to be linked to a university to offer electives, as the LoR's (in my head) were supposed to carry university letter-heads. I take it that is not the case, and the letter-head the LoR is written on may as well be the letter-head of that specific hospital even if its private, and it does not necessarily lose alot of weightage or benefit because of it. Is that correct?

 

[Siggy]

Thanks so much for the comprehensive reply, one final thing though: Can these hospitals then themselves offer seperate elective programs? Is their process going to be the same? Basically, as an IMG while im looking for an elective, should I be looking for a hospital backed by a university, a hospital highly ranked in the specialty I eventually want to pursue, or what exactly?

Sure, hospitals with residency programs can offer separate electives. For example, there might be an ICU rotation and a general medicine rotation run by the residency program. This is in addition to sub specialty rotations that may be offered (i.e. for internal medicine, pulmonology, cardiology, endocrinology, etc). However, when it comes to subspecialty rotations, two things come to mine. First, you aren't applying to a subspecialty yet. Second, just because a hospital has a residency program (like internal medicine) doesn't mean they offer a subspecialty fellowship as well.

At this point, you should be focusing on either a county hospital or a university hospital that has a residency in the base field you want to go into. Using the example above, if you want to do cardiology, find a place with an internal medicine residency. You have to do IM before you do cards.

Also, could you please explain point number 3? I was always lead to believe LoR's from Dept heads or senior doctors of the department you are doing the elective are more valuable? Is that not the case? What do you mean by "attendings"?

Sorry for all the questions and thanks again!

Attending physicians ("attendings") in the US are licensed and board certified physicians. In the UK, for example, they would be called consultant physicians. Essentially all physicians in the US are specialty trained with general practitioners being specialists in either internal medicine or family medicine.

Anyone can write a letter of rec. Yes, the department heads would be a better choice, provided you have time with them (for example, at the county hospital I did rotations at, the DO IM program director personally ran the ICU team and the MD IM program director personally ran one of the medicine teams). However an attending at a residency program is better than, say, getting a letter from a physician not involved with teaching at a residency program.