Hooked on a feeling

[kaizen]

You constantly hear: go with your gut.

So my current #1 is in a place far from anything or anyone I know. My gut likes it. My common sense says "Ummm...this is too big of a decision to rely on your tempermental tummy. What do you know about this place anyway?"

For those that have ventured outside of their comfort zone for residency, do you think you would have been happier closer to home?

For those that stayed close, do you wish you had taken the risk?

If I am thinking about a career in academic medicine, should I skip the 'gut' feeling and go for the place with more resources and a better reputation?

I'll probably add more questions as I think of them.

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[Disciple]

Hopefully you know yourself better than anyone by now.

When making your decision, just try to be as completely honest with yourself as possible regarding what's most important to you. Not just today, but for the next 3-4 years and even after that. Maybe this will be congruent with your "gut" feeling and maybe not. Things have a way of working themselves out for the best.

Keep in mind that many people tend to be somewhat idealistic when they're younger. If that applies to you (being "idealistic" and/or "younger"), take it into account when making your decision.

 

[rehab_sports_dr]

For what it is worth, I subscribe to the Nick Hornby Hi-Fidelity theory- people who go by their guy have to remember that there gut has **** for brains.

While programs try to give you suffecient exposure on interview day, it is very difficult to get a full sense of the program just on gut feel. For most people, you spend the most time with only 1 or 2 residents who show you around, so your impression will be weighed largely on the basis of those individual residents, who may not even be there when you arrive 2 years later.

As an example of a faulty gut, when I interviewed at RIC as a medical student, I did not like the program. I felt blown off by the residents, and I don't think I had RIC in the top 10 of my rank list. Now that I am here as a fellow, I realize that the impression I had on interview day was way off- this is a great place, and clearly would have been near the top of my list if I had a truer sense of the program.

At another program, I was charmed by a particular resident who I met on tour. Now, years later, I know that resident in another context, and realize they were charismatic but not particularly competent, and I am glad I didn't match at their institution.

For these reasons, I recommend that medical students figure out what they value. I would write down all the thigns that are important to you (strength in the various disciplines, quality of attendings, level of academic support, camraderie, location, cost of living, etc), and then try to objectively rank each department based on how they rate in each of those areas.

The gut is a decent tie-breaker, but I would think things over thoroughly before just relying on the gut

 

[Brooklyndo2.1]

so here is a theoretical rank list...anyone feel free to contribute thoughts/comments

1. U of M (gut choice)
2. Temple
3. Jefferson (hey i like philly)
4/5 - Houston Baylor
6. UVA
7. Indiannapolis
8. Rush
9.Kessler
10. Stoneybrook
11. JFK
what do ya'll think??

 

[kaizen]

Okay, so the list is random, but I think I get your point. I thought U. Mich was a very good program in an awful location for me. Great for families and those that like life at a slower pace.

I would probably put jeff before temple based on what I perceive to be a difference in program strength as well as a definite difference in location. Jeff folks obviously work harder, but I liked all the residents I met.

If you are interested in msk stuff, most people would point you towards UVA before Baylor/UT.

Indiannapolis? I just don't know.

Kessler, JFK, Stonybrook - You want to leave the NY/NJ area. I can tell. I don't particularly like central jersey but JFK has a rep for good teaching so I would put it over stony - unless you had some strange reason to be in long island.

Now here's a question:
How does one choose between the super six, especially if none of them are close to home? I would like to think that they are each very distinctive programs, but do they really offer significantly different opportunities?

 

[mehul_25]

I would switch Jeff and Temple. Historically, Temple has been a stronger program but in the past five-ten years Jeff has become stronger. The residents are very successful in the careers (private practice, academics, fellowships) that they choose. They have some great faculty including Dr. Herbeson (?spelling). They also own or control most of the rehab beds in the city. All the residents I have worked with this year as a fellow have been tremendous. Additionally they have the opportunity to pursue outside interests including moonlighting.

 

[Brooklyndo2.1]

the same question is how does one choose between ones top 5 when you want everything...a good background, and a good msk bend...etc.... I dunno I liked Michigan overall.... lots of grad schools for us single folks to do some umm...shopping. as for temple/jeff... i loved both , but i do want more msk i think.... and baylor did blow me away but so did UVA, in completely different ways ...im soo confused.

 

[kaizen]

"shopping"...lol
I guess the chances of marriage are pretty high in that area too. What else is there to do?

rehab_sports_doc has given the best advice so far...and a bit of warning. Maybe second looks may help in teasing out the top 5 from each other. I became one of those 'excel' spreadsheet people--assigning weight to different aspects of each place. Then I disagreed with the list and started looking for places where my initial assessment 'must have' been wrong. The point is: I'm of no help here. Maybe I'll be much wiser next year.

 

[Brooklyndo2.1]

I keep hoping to be wiser every next year.... aint happenin.

 

[Brooklyndo2.1]

I would switch Jeff and Temple. Historically, Temple has been a stronger program but in the past five-ten years Jeff has become stronger. The residents are very successful in the careers (private practice, academics, fellowships) that they choose. They have some great faculty including Dr. Herbeson (?spelling). They also own or control most of the rehab beds in the city. All the residents I have worked with this year as a fellow have been tremendous. Additionally they have the opportunity to pursue outside interests including moonlighting.

That is the impression that I got while at Jeff, yet at temple they seemed? not to have any problems with fellowships etc.... Do you know of any specific weaknesses in temple that one should be aware of... Like i said I loved both programs...but how many second looks can you do???

Mehul : Feel free to PM if you have something to say youd rather not post here.
thanks
Brooklyn

 

[rehab_sports_dr]

I would consider Temple and Jeff of similar quality. The residents I have met from Temple in recent years have been excellent, and have done well in matching fellowships.

Both are excellent programs, and it is not obvious to me that one program should be matched ahead of the other one for everybody. If you are deciding between the two, I would focus on individual strengths within the department.

 

[mehul_25]

I agree that that both Temple and Jefferson are not very far apart in quality. The changes that have come about have been fairly recent. I think currently the faculty at Jefferson might edge out the Temple faculty, although certainly not by much. Also, I agree that Temple residents have not had any difficulty securing fellowships, a significant factor in that is the fact that many of the fellowship directors are Temple alums (Falco, Furman, ?Cano, etc.). Certainly with the change in ACGME requirements and the loss of accreditation of some programs their lure will diminish somewhat. Typically, Jefferson has two fellowship positions available for their grads completely inhouse. We often take a Jefferson PM&R resident into the Anesthesia Pain fellowship and there is a MSK/Spine spot at Rothman (Jeff Ortho group with 6-7 interventional/MSK physiatrists on staff). Additionally the past several years of Jeff residents have been very successful obtain fellowships in many other areas including research, and pain.

Jefferson also benefits from the opportunity to rotate with several useful rotations in-house incuding MSK ultrasound for one month and Anesthesia pain for one month, both required rotations. They also rotate with Rothman for 3 months.

Location might also be something of interest for some folks.

Historically, Temple has been excellent with many big names (Grabois, Braddom, Furman, Falco, etc.) having been affiliated with them at some point.
Although I will admit I do not know as many details of the Temple program, and I definitely dont think you will go wrong with either, I still propose that Jeff is currently a better choice.

 

[Disciple]

I dunno I liked Michigan overall.... lots of grad schools for us single folks to do some umm...shopping.

If the singles scene is a major concern of yours, you need to end up in NY, Miami, Chicago, Phoenix or San Francisco (no PM&R, but whatever) or LA.

At this point in your career I would put training and opportunities as paramount, but, different strokes for different folks.

 

[Brooklyndo2.1]

If the single's scene is a major concern of yours, you need to end up in NY, Miami, Chicago, Phoenix or San Francisco (no PM&R, but whatever) or LA.

At this point in your career I would put training and opportunities as paramount, but, different strokes for different folks.

a side consideration, and , as side considerations go, its not unimportant.... besides anyone who thinks its easier to find someone in a big city is wrong imho...

besides the only big city im strongly looking at is philly

 

[fozzy40]

I just recently rotated at a program that WAS in my top 3 (on paper) prior to actually being there. I left the program VERY disappointed because of the experience I had with some of the residents I was working with. I am conflicted because if I write out the pros/cons of each program, this one definitely was one of my favorites. The only con I have was my interaction with the residents was not the greatest. I am trying to be objective but I left was such a distaste for the program because of the interaction. Any thoughts?

 

[mehul_25]

Personally, I believe that you should put a lot of weight into your interaction with the residents. Typically unhappy residents will hint around or act funny to give you the message without coming right out with it unless they are really really unhappy. Programs can spin themselves to seem ideal or to gloss over their problems, but the residents are the ones living in the program day in and out.

Of course, there could always be a bad group of residents at an institution....

How did the residents behave specifically?

 

[fozzy40]

Let me preface this with I am definitely the "complainer" type and am very easy going. So the fact that I am actually mentioning this is saying something.

In addition, everyone at this program knew that I was interested in PM&R and applying to their program.

1) scutting me out
2) pimping me in front of the program director
3) during my interview, the chief resident was shocked to find out that I was rotating there for the past month (despite the fact that we have met and talked in the call room)

I hate to sound like I'm whining but I think that these were things that would piss anyone off.

 

[Brooklyndo2.1]

Fozz,
I had a similar experience in another program....not the interview and stuff part, but bad taste in my mouth part in a program that I thought would be number one.
Listen, If you hated 1 month there, and programs do say they tend to attract people that mesh together well or whatever, what makes you think you'll enjoy your learning environment for the years during which youhave to become a specialty physician.
thats the way I look at it.
Sucks to have wasted a month, then again, woulda sucked more to have been unhappy for 3-4 years

 

[fozzy40]

Thanks for the support. I've definitely tried to look at this objectively and take out the emotion (mainly anger of my decision but it was such an experience that it is hard for me to ignore. Perhaps this is fate's way of telling me that this is not the program for me.

 

[Disciple]

Let me preface this with I am definitely the "complainer" type and am very easy going. So the fact that I am actually mentioning this is saying something.

In addition, everyone at this program knew that I was interested in PM&R and applying to their program.

1) scutting me out
2) pimping me in front of the program director
3) during my interview, the chief resident was shocked to find out that I was rotating there for the past month (despite the fact that we have met and talked in the call room)

I hate to sound like I'm whining but I think that these were things that would piss anyone off.

1) Not all that unusual. It will be much worse during your intern and PGY-2 years
2) Not good, but can happen. Maybe he or she gets off on being a hard ass, or wanted to assure the PD that he or she was living up to their authoritarian responsibilites.

3) This is a bad sign.

Programs tend to have certain personalities to them, and tend to attract residents who fit those personalities. If this was just an interview or if you had only been shadowing for a few days I would say maybe blow it off. But, you had been there for a whole month.

All else being equal, I would choose a program you can work in for 3 years without being pissed off or irritated every day.

 

[rehab_sports_dr]

Hey Fozzy,

In terms of being mistreated by residents at a program when interviewing, I have a few thoughts:

1. If the resident was a PGY-2, then it matters more, because the resident will still be there when you start residency. It matters somewhat less if the resident is a PGY-3 or 4, since they won't be there anymore.
2. It matters more in a small program. In a big program like NYU, Temple, Baylor, etc. it should be pretty easy to hide from a toxic resident
3. I think the big thing is not the individual resident, but how it reflects on the program overall. Was this resident anomalous, or do they reflect the general tenor of the attitudes amongst the residents.

As a personal example, the two programs I have personal familiarity with are RIC and Kessler. I love both programs, and I think overall the residents are happy, professional, and competent. That said, both programs have residents who at times make lack in some aspects that make them strong ambassadors to the residency. So the impressions that a medical student may have may reflect a small subset of the actual experience.

Also, the factors that make a medical student happy are different than what will generate your happiness during residency. For example, medical students are shielded from things like the nurses on call, amount of procedure exposure, research mentoring, the ease of paperwork for conference reimbursement, etc. So the quality of a personal interaction with a resident could make a huge negative impression during a month as a medical student, but be a complete non-factor when you are actually a resident (since at many programs you are essentially working with attendings and not your fellow residents).

This is all my long-winded way of saying to be careful of how you heavilly you weigh the influence of one jerk.

 

[Disciple]

This is all my long-winded way of saying to be careful of how you heavilly you weigh the influence of one jerk.

True, but he did say it was the chief, who is supposed to be the shining representation of the residency, and chosen because of their leadership and skills in administration and diplomacy.

 

[fozzy40]

Thanks for the advice. All the points that each of you made are things I have considered. And like everyone else, I'm still trying to weigh what is important to me in a program. Since I just rotated there, I think I'm going to need some time to cool off, step back, and re-evaluate. Fortunately, I there are other programs on my list that are in the running for "#1" so I'm not terribly distressed (yet!)

Happy Holidays everyone!

 

[drusso]

I moved far away from home for medical school and then moved again for residency. If I had it to do over again, I would concentrate on the "day to day" experience of each prospective program---access to things that matter to you at work and away from work, ease of travel, proximity to a support network. Things like reputation matter but less than you might think. It eventually comes down to the individual.

 

[drvlad2004]

a side consideration, and , as side considerations go, its not unimportant.... besides anyone who thinks its easier to find someone in a big city is wrong imho...

besides the only big city im strongly looking at is philly

You are right about that. The singles scene in places like NYC and Miami is probably harder because many individuals live in those big cities for a very short amount of time and then relocate. NYC is notorious for that since it is so expensive to live there as well as all of us being very career-oriented also. Plenty of totally single people in NYC always complain that they have a hard time finding someone who is more commital.

Personally, go by the quality of the program and a program that you feel that will best fit you.

 

[rehab_sports_dr]

I actually thought it was easier to be single in a small town (where I did my internship), than in an urban area (where I did my residency, even though this is where I met my soon-to-be wife). It depends on what you value in your singles scene. For people who are bar/club oriented, obviously a big city is better. I am more activity/outdoor oriented, so I found a small town to be more of my feel.

When I was looking at residencies as a single medical student, a friend advised me that you should go to place where you have access to those things you enjoy in your free time, because like minded people will be attracted to the same sorts of things. For the most part, what matters is not the sheer number of singles, but the proportion of singles who share similar interests.

 

[Brooklyndo2.1]

I actually thought it was easier to be single in a small town (where I did my internship), than in an urban area (where I did my residency, even though this is where I met my soon-to-be wife). It depends on what you value in your singles scene. For people who are bar/club oriented, obviously a big city is better. I am more activity/outdoor oriented, so I found a small town to be more of my feel.

When I was looking at residencies as a single medical student, a friend advised me that you should go to place where you have access to those things you enjoy in your free time, because like minded people will be attracted to the same sorts of things. For the most part, what matters is not the sheer number of singles, but the proportion of singles who share similar interests.

those are my thoughts exactly
merry xmas

 

[Hemisphere]

I actually thought it was easier to be single in a small town (where I did my internship), than in an urban area (where I did my residency, even though this is where I met my soon-to-be wife). It depends on what you value in your singles scene. For people who are bar/club oriented, obviously a big city is better. I am more activity/outdoor oriented, so I found a small town to be more of my feel.

When I was looking at residencies as a single medical student, a friend advised me that you should go to place where you have access to those things you enjoy in your free time, because like minded people will be attracted to the same sorts of things. For the most part, what matters is not the sheer number of singles, but the proportion of singles who share similar interests.

I see your point... but you don't want to go somewhere so "outdoorsy" that there's nothing around but steers and queers LOL "" from a movie (no offense to anyone please, or take it up with movie directors). Can u guess which one? I was already in a relationship when went to medschool so it didn't bother me it was out in the country. But once broke up found it hard since there wasn't much of a dating scene since not much in town besides medschool and the chocolate factory, and a few stray steers residing on the actual campus which some of my single friends succumbed too but not me of course... even though the only people at bar were med students and all seemed to be taken... (can u guess which medschool, LOL) I matched in NYC, since I wanted to reverse the tables but then ended up getting romantically involved with a classmate at match day party, and still together during my pgy-1 year since i'm not nyc yet... could be single again once start PGY-2 it's up in the air i guess if she will re-apply to other programs for later...

Moral of the story? who knows, life changes... fast so don't spend toooooo long deciding!!! this profession is hard on relationships.

happy holidays all and go outside and get off this list...
My excuse I'm on call today on frickin' christmas.

at least it's --- dare i say the q word

 

[axm397]

I say go online - I know 4 ppl who met their fiance/spouse on match.com, 1 on catholic singles, and 2 on j-date. I went the old fashioned route and picked mine up at a bar

Funny story about match day hook ups - few of my classmates had their fun flings start on match day as well - most only lasted through graduation so hemisphere has done better than most.

 

[Hemisphere]

check it out...

pm&rsingles.com
bachelorsofbotox.org
painprincesses.com

just kidding...
maybe a new committee/agenda for the academy?


oh and ps. we didn't "hook-up" on match day...
it wasn't until the second date or so sheesh what do u take me for axm,
oh and we were friends before that too.

 

[The JockDoc]

Hemisphere, you've got mail.

 

[Disciple]

For the most part, what matters is not the sheer number of singles, but the proportion of singles who share similar interests.

Or, another way to look at it could be, density of singles in a particular area who are "young professionals" and in your age group.

 

[drvlad2004]

Online is definitely a good way to go I met my wonderful lady that way.