Established program w/gap year vs. new program w/no gap year (immediate position the following year)

[UnderDerm]

1) Which would you rank higher and
2) What are your reasons for your choice?

An established program but you would have a gap year, or a new program that you would start immediately (no gap year)?

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[asmallchild]

1) Which would you rank higher and
2) What are your reasons for your choice?

An established program but you would have a gap year, or a new program that you would start immediately (no gap year)?

Which one do you like better? Which one seems better?

I would pick the program that I thought was better (typically it's going to be the established program) since your residency program will prepare you for the rest of your career.

I wouldn't let the absence or presence of a gap year distract me from the more important decision: picking the best possible program for training

 

[naijacardriodoc]

Aren’t you losing a year’s worth of salary by choosing the gap year? Isn’t the new program still required to teach you everything you need to know?

 

[asmallchild]

Aren’t you losing a year’s worth of salary by choosing the gap year? Isn’t the new program still required to teach you everything you need to know?

Not all programs teach equally. Picking the correct program to set you up for the rest of your career will ultimately out weigh a year's salary.

 

[reno911]

Not all programs teach equally. Picking the correct program to set you up for the rest of your career will ultimately out weigh a year's salary.

While this advice is correct in this specific case, I don't think it's true in general.

For the most part dermatology education is what you make of it. If you are an intelligent and motivated resident (which most are) I'm certain that it is not going to matter whether you train at the best program in the country or the 30th best program in the country. You will turn out as an excellent dermatologist either way. There is just not that much of a difference. You probably only really run into a problem when you start scraping the bottom of the barrel.

However, when it comes to the specific question asked by OP, then this advice is reasonable. If the program is literally starting from scratch, there are some growing pains that are expected as things are getting set up and it's likely this could have a significant effect.

 

[Slack3r]

Not all programs teach equally. Picking the correct program to set you up for the rest of your career will ultimately out weigh a year's salary.

Do they teach you to freeze SKs that much better? Let’s not get it twisted: ANY program will set you up fine for general, private practice derm. As noted above, most of derm residency is self directed anyway. Want to do complex rheum/derm, or a Mohs fellowship? Maybe a different story.

 

[asmallchild]

Do they teach you to freeze SKs that much better? Let’s not get it twisted: ANY program will set you up fine for general, private practice derm. As noted above, most of derm residency is self directed anyway. Want to do complex rheum/derm, or a Mohs fellowship? Maybe a different story.

That has not been my experience. I'll just use the example of surgical dermatology as that is primarily what I practice now but I can generate any number of examples across all areas of dermatology residency training.

I did my residency at the "lower tier" program in town. That being said, our program had a strong focus on churning out private practice dermatologists and in particular, efficient private practice dermatologists. We had more than adequate volume within any area of dermatology and in particular surgery. (I tell students all the time that a VA rotation where you get to be the primary surgeon is always a huge plus) I graduated and had very few issues making the transition to private practice.

The other residency program in town is a very well-known perennial "top 10" program. Yes, I'm sure they meet the ACGME minimums for surgical volume. However, having done an away rotation at their program as a PGY4 amongst their PGY4s, I can unequivocally state their surgical skills / knowledge were severely lacking and would have put them at a significant disadvantage for an immediate and smooth transition into private practice. (I'm talking basic questions like "how do you place a vertical mattress suture" being asked by their PGY4s, including one who actually was in the midst of applying for a Mohs fellowship)

I went on to pursue fellowship training a few years later and was able to interact with 2 other residency programs in a different part of the country (1 DO program, another very well known perennial top 10 program, both of whom sent residents to shadow my fellowship program). I also found significant differences amongst them (this was at a time when DO programs did not fall under the ACGME umbrella so perhaps things are better standardized now)

tl ; dr = if you are desperate, then yes, pick any program you can get into and take it from there. If you have the luxury of selecting, pick the program that you think will provide the best training and don't let small items like "I'll miss out on 1 year's salary" cloud your judgement

 

[reno911]

That has not been my experience. I'll just use the example of surgical dermatology as that is primarily what I practice now but I can generate any number of examples across all areas of dermatology residency training.

I did my residency at the "lower tier" program in town. That being said, our program had a strong focus on churning out private practice dermatologists and in particular, efficient private practice dermatologists. We had more than adequate volume within any area of dermatology and in particular surgery. (I tell students all the time that a VA rotation where you get to be the primary surgeon is always a huge plus) I graduated and had very few issues making the transition to private practice.

The other residency program in town is a very well-known perennial "top 10" program. Yes, I'm sure they meet the ACGME minimums for surgical volume. However, having done an away rotation at their program as a PGY4 amongst their PGY4s, I can unequivocally state their surgical skills / knowledge were severely lacking and would have put them at a significant disadvantage for an immediate and smooth transition into private practice. (I'm talking basic questions like "how do you place a vertical mattress suture" being asked by their PGY4s, including one who actually was in the midst of applying for a Mohs fellowship)

I went on to pursue fellowship training a few years later and was able to interact with 2 other residency programs in a different part of the country (1 DO program, another very well known perennial top 10 program, both of whom sent residents to shadow my fellowship program). I also found significant differences amongst them (this was at a time when DO programs did not fall under the ACGME umbrella so perhaps things are better standardized now)

tl ; dr = if you are desperate, then yes, pick any program you can get into and take it from there. If you have the luxury of selecting, pick the program that you think will provide the best training and don't let small items like "I'll miss out on 1 year's salary" cloud your judgement

There is certainly some truth in this post, but it is extremely difficult (bordering on impossible) for a graduating 4th year medical student, based on what they experience in an interview (or even an away rotation), to accurately determine that a perennial "top 10" program provides worse training than a lower tier program. So, even in the cases where that difference exists, realistically no med student is going to suss it out, unless there are giant red flags everywhere, in which case it wouldn't be a perennial "top 10" program.

Of course, that is a different issue than whether one should forgo a year of salary for perceived better training.

 

[asmallchild]

There is certainly some truth in this post, but it is extremely difficult (bordering on impossible) for a graduating 4th year medical student, based on what they experience in an interview (or even an away rotation), to accurately determine that a perennial "top 10" program provides worse training than a lower tier program. So, even in the cases where that difference exists, realistically no med student is going to suss it out, unless there are giant red flags everywhere, in which case it wouldn't be a perennial "top 10" program.

Of course, that is a different issue than whether one should forgo a year of salary for perceived better training.

Oh I agree, I ranked the "top 10" program #1 during the match process.

It was only after completing residency, working for awhile, returning to do fellowship, and then seeing a few other programs during my fellowship year where I could appreciate my "lower tier" program more. And to see how it did a better job of preparing me for my personal goal: private practice dermatology.

I don't expect an MS4 to be able to figure it out. I also wouldn't expect anyone to pass up an opportunity to train at a top tier program because they perceive the lower tier program to offer better training.

That being said, my point was that there are differences in terms of the quality of training. If we go back to the OP's question, I would be much more comfortable selecting the established program over a brand new program.