I said that Baylor was different. And I'll give you that Cinci produces more general pediatricians than CHOP or Boston (I haven't ever looked at the numbers for the Combined program).
What becomes the issue is how do the programs focus on standard pediatric care. It's one thing to see bronchiolitis 50 times, it's another thing to have it be an understood focus of education with the approach being "what do you need to know if you're a general pediatrician in Pig's Knuckle, Missouri or Donkey Hoof, Ohio". Autonomy in taking care of bread and butter pediatric patients is crucial. And hospital based care of bronchiolitis isn't sufficient either, there needs to be exposure through the continuum of care from clinic, to the ED, to the floor, to the PICU.
In my experience in fellowship at a top 10 children's hospital, the residents didn't realize how little autonomy they had. They felt they had taken ownership but only because they hadn't seen what true autonomy looked like - and that's with the usual caveat that no pediatric trainee ever gets the same level of autonomy of their IM cohort. The residents at my hospital were all incredibly smart, but struggled to make decisions because no one ever let them...great place to be a fellow though.
Just to give a few simple examples - in my residency (large freestanding children's hospital that took 26 interns/yr, had some fellowships but not fully loaded - NICU/PICU/Cards/Pulm/PEM/Neuro), we did high flow on the floors and only transferred bronchiolitics when they needed NIPPV or an ETT (and in my intern year, it was the year of H1N1 so the PICU didn't want to hear about our any non-ETT needing kids even if they were on 16-20LPM). In fellowship, if a kid reached 4LPM of HFNC, it had to go to the PICU. So there were a whole subsection of patients that interns never got to see, even though they weren't that sick and only maxed out on 6 or 8 LPM. In the NICU at my residency program, interns were expected to attempt UAC/UVC's on all the babies that needed them. They were taught by the upper level resident who was there to help and only in extreme emergencies or if the line was particularly difficult did the fellow take over...and when one of my best friends interview for Neo fellowships at the big names she was shocked to hear time and time again that only fellows put in lines. Nevermind the fact that being able to put in lines is a hugely beneficial skill for anyone who routinely goes to deliveries and is well within in general pediatrics scope of practice.
That's the sort of difference I speak of when I say that bread and butter pediatrics is not a priority and why it's up for debate on whether not going to a big name program and not wanting to do fellowship is a good idea.
