Community Vs. Academic Residency

[BrooklynBulls]

Now that interviews are winding down, I'm trying to put together my rank order list. What I'm finding difficult is deciding between staying in prime metro locations like NYC, Philly or at least prime-metro-adjacent places, which are mostly lower-tier academic or decent community programs, or going for the more "prestigious" academic spots, some of which happen to be in places I don't have any particular desire to live or practice in afterward, at least right now. My question isn't how to rank these places, but how much of a difference it makes where I go. Are the decent community programs in NYC comparable to the mid-tier academic places in terms of job opportunity, prestige, fellowship placement, etc? It is very difficult to judge as a 4th year medical student. What career opportunities open to me going to a place like URochester or Stony Brook or Yale that a place like Maimonides or St. Luke's Roosevelt does not?

I'd really appreciate any input, because this is really my only dilemma in terms of ranking.

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[RadsonRads]

x2. I am experiencing this exact dilemma.

 

[colbgw02]

I think this gets really difficult when referencing specific programs and locations, as you are.

The easy part is if you want to practice academic radiology. In that case, you go to the most prestigious university program that you can get into.

Apart from that, it has a lot to do with where you want to practice and, as a corollary to that, what sort of fellowship the programs can get you. If you want to practice in location A, then most residencies in that location will serve you better than a residency elsewhere, particularly if that residency is a reasonable path to a nearby fellowship. On the other hand, if there is a better residency outside of location A that will get you a better fellowship, then that is probably the better play.

 

[shark2000]

It depends on what academic institutions and what local community hospitals you are talking about.
For example if you compare Mallinckrodt with the worst community program in NY (I don't know what does that mean), then the situation is very different than comparing University of Rochester or SUNY upstate to a decent community program in Manhattan. Many community programs in Manhattan provide you with better education and opportunities than for example SUNY upstate.

It is case dependent and can not be generalized.

 

[MadRadLad]

I think this gets really difficult when referencing specific programs and locations, as you are.

The easy part is if you want to practice academic radiology. In that case, you go to the most prestigious university program that you can get into.

Apart from that, it has a lot to do with where you want to practice and, as a corollary to that, what sort of fellowship the programs can get you. If you want to practice in location A, then most residencies in that location will serve you better than a residency elsewhere, particularly if that residency is a reasonable path to a nearby fellowship. On the other hand, if there is a better residency outside of location A that will get you a better fellowship, then that is probably the better play.

I guess my question is not specific to purely radiology, but here goes. If you end up going to a well known academic program, be it top notch or mid tier, but decide later that you don't want to do academia. Will it help your case when looking for private practice jobs because you trained at a well known institution? Or does it not matter since it's not an academic environment anyway?

 

[colbgw02]

I guess my question is not specific to purely radiology, but here goes. If you end up going to a well known academic program, be it top notch or mid tier, but decide later that you don't want to do academia. Will it help your case when looking for private practice jobs because you trained at a well known institution? Or does it not matter since it's not an academic environment anyway?

I can't speak to other specialties, but in radiology, it's not that training at a great university program has no impact. It's just that the impact is not nearly as important by the related factors of who you know and geography.

Let's say you're the bestest, most awesomest radiologist ever. You went to medical school at Duke, residency at MGH, and fellowship at Hopkins. But now you're looking for a job in California, and the practice is deciding between you and Billy Bob. Billy Bob doesn't have your credentials, but he's never left California and knows one of the partners from residency at KP in LA. The partner can vouch that Billy Bob is a good dude, and he's also a known quantity. You're an unknown, and - relatively speaking - nobody cares how great your CV is. By the way, I'm just pulling this example out of my butt, so I don't claim that it's accurate.

Conversely, let's say you end up at a breast fellowship at University of State. It's a good fellowship, and you got the position largely because previous residents from you program have gone there and performed well. A position has opened up a local private practice, so the mammo guy calls up his old fellowship at University of State and asks his old attendings who's there now that's worth anything. Your name comes up - boom - there's your job.

tl;dr version: Knowing the right people is by a large margin the most important factor in the job search. Going to academic university programs will help you get a job as a function of their ability to get you in touch with the right people.

 

[MadRadLad]

That was a great summary, thank you. How common is it to go back and do a fellowship after practicing for 5-10 years first?

 

[Shifty B]

That was a great summary, thank you. How common is it to go back and do a fellowship after practicing for 5-10 years first?

Not unheard of, but pretty rare. You would have to have pretty good reasons to take the financial hit (unless you had a terrible job that you didn't like). There are a variety of short courses and fellowships that can help get you started in a different area if that's what you want to do.

 

[shark2000]

For academics it really matter where you have trained.

For private practice I totally agree with colbgw02. Local connections is more important than name of the program however within its own limits. For example, if a local community program does not have a good reputation or is not considered a strong program locally, don't expect local groups to hire you over a graduate of MGH.

 

[gastrograffin63]

Just look at their fellowship match rates, those NYC community programs tend to be comparable to the university programs that you listed.
From my experience, the NYC programs also attract more competitive applicants due to their location.
If you want to be in the city, don't hesitate ranking those programs high.

 

[vm26]

tl;dr version: Knowing the right people is by a large margin the most important factor in the job search. Going to academic university programs will help you get a job as a function of their ability to get you in touch with the right people.

Agree...going to a top ranked academic radiology residency does not guarantee you the "best" training necessarily. I trained in NYC and the better academic programs had better conferences/board review (and of course professional connections). During my fellowship, some of the stronger fellows (eg. accurate but faster) came from private practice residency no name programs in BFNW...

 

[je355804]

Not unheard of, but pretty rare. You would have to have pretty good reasons to take the financial hit (unless you had a terrible job that you didn't like). There are a variety of short courses and fellowships that can help get you started in a different area if that's what you want to do.

If you don't match into a particular fellowship you were seeking after your first try, is there anything you can do to become more competitive? I am mostly asking because it looks like some 20% of people applying to IR last year didn't match... what can those people do to have a shot the second time around?

 

[Gadofosveset]

Keep it simple. Go to the academic center for training.

- More diverse cases.
- Subspecialized faculty can actually teach you how to read those cases (e.g. I'd rather have a specialized body radiologist teaching me about MR liver than a pp doc who trained 15 years ago, thinks in terms of nuclear medicine hepatobiliary scans, looks for big things, and then signs it off, hoping for the best)
- Although variable, volumes will probably be the same. If you can't develop speed at one, you can't develop speed at the other.
- Larger group of residents and faculty, better connections. Faculty references go further overall.
- Larger resident classes are important. If you're at a program with three people per year, and the other two suck, you're stuck, man. Larger class sizes play the odds that you'll find someone on your wavelength.
- Academic institutions tend to attract residents who are more academically inclined. This has a multiplier effect on driving you to be better since you don't want to look like a ***** compared with your classmates. No such pressure exists at some smaller programs where there can be a conspiracy of slacking. This is a terrible terrible thing for your training, which you will find out when you go to the academic center for fellowship and get demolished.
- More interaction with referring clinicians, tumor boards, etc. Important.

You can't know what you've never seen. It's not hard to tell which incoming fellows have trained at small programs. Some of them are very good, but they were undertrained and low expectations were put on them, so there's a lag time as they figure that out and start getting up to speed. Most of them get there, but the point is that they were not encouraged to run at full speed during training.

Think of it in terms of sports. Do you want to train all out or at half-speed? Who do you want teaching you how to hit, pitch, strategize? The person up on the literature or the person who stopped reading 15 years ago and wants a resident there basically just to take night call? If you train at full speed it's going to be harder, but you have the option of dropping back to half-speed and being an asset. It doesn't work the other way around.

 

[Gadofosveset]

If you don't match into a particular fellowship you were seeking after your first try, is there anything you can do to become more competitive? I am mostly asking because it looks like some 20% of people applying to IR last year didn't match... what can those people do to have a shot the second time around?

It depends on the fellowship. For IR: more/better references, research, publication in JVIR, presentation at SIR, making networking connections at the place you want to go.

 

[shark2000]

Just look at their fellowship match rates, those NYC community programs tend to be comparable to the university programs that you listed.
From my experience, the NYC programs also attract more competitive applicants due to their location.
If you want to be in the city, don't hesitate ranking those programs high.

Fellowship match means almost nothing in radiology. Every program has a resident who is going to Hopkins or MGH for fellowship. Don't let programs sell that to you.

Gadofosveset had a nice summary. I totally agree.

Speed is not something magic. One reason that you may be able to read more studies in community programs is that cases are simpler. Anyway, some people can not be fast enough no matter when they train. For other people, getting fast is not difficult. Even if you are not fast, you will gain the required speed in the first 6 months of you pp. But the skills that you learn by working in a big academic center, the sub specialized training and more importantly the connections that you can make can not be easily achieved after you enter pp.

 

[je355804]

It depends on the fellowship. For IR: more/better references, research, publication in JVIR, presentation at SIR, making networking connections at the place you want to go.

How does one do said research if they are out of residency? Are there research positions available for instance?

 

[Want2DoRad]

http://www.kevinmd.com/blog/2015/01/tragic-physician-story-match-doesnt-want-hear.html

 

[Want2DoRad]

If you don't match into a particular fellowship you were seeking after your first try, is there anything you can do to become more competitive? I am mostly asking because it looks like some 20% of people applying to IR last year didn't match... what can those people do to have a shot the second time around?

I know a girl who didn't match IR, so she went to do a different fellowship at a place that has IR positions in an effort to make some connections. Of course, since match happens over a year before training begins, there is still a gap, but you can hope for an unexpected opening.

 

[PL198]

Keep it simple. Go to the academic center for training.

- More diverse cases.
- Subspecialized faculty can actually teach you how to read those cases (e.g. I'd rather have a specialized body radiologist teaching me about MR liver than a pp doc who trained 15 years ago, thinks in terms of nuclear medicine hepatobiliary scans, looks for big things, and then signs it off, hoping for the best)
- Although variable, volumes will probably be the same. If you can't develop speed at one, you can't develop speed at the other.
- Larger group of residents and faculty, better connections. Faculty references go further overall.
- Larger resident classes are important. If you're at a program with three people per year, and the other two suck, you're stuck, man. Larger class sizes play the odds that you'll find someone on your wavelength.
- Academic institutions tend to attract residents who are more academically inclined. This has a multiplier effect on driving you to be better since you don't want to look like a ***** compared with your classmates. No such pressure exists at some smaller programs where there can be a conspiracy of slacking. This is a terrible terrible thing for your training, which you will find out when you go to the academic center for fellowship and get demolished.
- More interaction with referring clinicians, tumor boards, etc. Important.

You can't know what you've never seen. It's not hard to tell which incoming fellows have trained at small programs. Some of them are very good, but they were undertrained and low expectations were put on them, so there's a lag time as they figure that out and start getting up to speed. Most of them get there, but the point is that they were not encouraged to run at full speed during training.

Think of it in terms of sports. Do you want to train all out or at half-speed? Who do you want teaching you how to hit, pitch, strategize? The person up on the literature or the person who stopped reading 15 years ago and wants a resident there basically just to take night call? If you train at full speed it's going to be harder, but you have the option of dropping back to half-speed and being an asset. It doesn't work the other way around.

does the bold mean you're stuck doing more work, or just that you're stuck without any peers with similar ambitions to yourself making it less enjoyable?

 

[Gadofosveset]

does the bold mean you're stuck doing more work, or just that you're stuck without any peers with similar ambitions to yourself making it less enjoyable?

Both really, but I was thinking more the latter.

It's not always similar ambitions so much as it is personalities that work together. You're going to see these people almost every work day for four years.

 

[deleted705698]

well, as someone who just got stuck at a community program through the match, these responses make me quite sad...

 

[Radology]

Don’t feel sorry for yourself. Bust your ass, be one of the best residents your program has ever seen, and you will be able to go wherever you want.

I say this as a graduate of a community program that I ranked 15th. Fast forward, I ended up turning down interviews for jobs at the same ivory towers that rejected me, and have a nice job at a great PP in a city over saturated with radiology trainees that I was competing with

 

[Lifeman]

Don’t feel sorry for yourself. Bust your ass, be one of the best residents your program has ever seen, and you will be able to go wherever you want.

I say this as a graduate of a community program that I ranked 15th. Fast forward, I ended up turning down interviews for jobs at the same ivory towers that rejected me, and have a nice job at a great PP in a city over saturated with radiology trainees that I was competing with

You matched at the program you ranked 15th? The common advice these days is to interview at 12-13 places because that gives you a >95% chance to match. I'm getting worried since I have 9 interviews this season.

 

[TCOM12]

9 interviews = 9 opportunities to match. Most people match their top 3. Unless there are more applicants than spots, you'll probably match somewhere.

The caveat is if you interview poorly and have marginal scores. Even then, there are a lot of weird people in radiology (me included), so you're probably likely to match.

Also, now is the time to send out emails to programs you still may be interested in that haven't offered an interview. Sure, you didn't get an initial offer, but the second you get interviewed you're theoretically on a level playing field.