Thoughts on choosing location/family over program strength

[boromirmycaptain]

I am 4th year applying to internal medicine and my wife and I are struggling with the rank process. I am fortunate that as an average med student, I've been granted interviews at some really great programs. To give you a sense of the reputation spread of my programs, my most "prestigious" is maybe Yale or Mayo and least "prestigious" is Rutgers. Within that range of programs I did occasionally feel I had a better fit at many programs that were on the lower end of the name-brand spectrum too. Didn't want to imply that I'm chasing after big names and nothing else.

The issue is, ultimately my wife is what makes me happy, and I am blessed to have a really smart one by my side. She's a chemist though, and her job market is somewhat geographically limited to in/around certain cities. Our dilemma is: should I choose less prestigious programs, or programs I felt less sucker-punch-to-the-gut excited about, in order to give my wife every opportunity to have a career as well?

Though I know this is ultimately a personal decision, we badly need some advice and I think my question is one that many applicants have. She has been encouraging me to choose mainly based on my desires, which is kind. But I've recently begun to think that this may be the wrong tactic. I'm going to be a doctor whether or not I go to Rutgers, or Mayo. I have interest in fellowship, but no desire to end up as an academic hotshot. In fact I'd be perfectly ok with ending up in primary care if I like that best. But my wife won't be a chemist at all if she doesn't end up in a certain area. If we did have to live further out from a city, she would be willing/maybe could teach high school IF she went back to school for a teaching certificate, but chemistry is her passion and she's darn good at it.

After thinking in this fashion, I begun to wonder if it might be better for me to prioritize location over prestige/fit - within reason. For instance, I wouldn't rank my 2 community programs higher just because they're in a good city. Because they are not so great in terms of training, and I don't like them all that much. But it would mean ranking a place like Rutgers, which I just thought was solid (not a bad fit, obviously more of a mid-tier) over a place like Mayo (loved Mayo, thought it was the bomb).

So to summarize: will ranking mid-tier programs over bigger name programs for the sake of my wife's career be a stupid move for us in the long-run? Does it jeopardize your job prospects as a PCP or community-based subspecialist if you graduate from a program like Rutgers over a program like Yale?

Whoops- I'm a dirty liar and my wife is a "chemist" aka just trust me she's a scientist in a small field.

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[rokshana]

I am 4th year applying to internal medicine and my wife and I are struggling with my rank list. I am fortunate that as an average med student, I've been granted interviews at number of really great programs. To give you a sense of the reputation spread of my programs, my most "prestigious" is maybe Yale or Mayo and least "prestigious" is Rutgers. Within that range of programs I did occasionally feel I had a better fit at many programs that were on the lower end of the name-brand spectrum too. Didn't want to imply that I'm chasing after big names and nothing else.

The issue is, ultimately my wife is what makes me happy, and I am blessed to have a really smart one by my side. She's a chemist though, and her job market is somewhat geographically limited to in/around certain cities. Our dilemma is: should I choose less prestigious programs, or programs I felt less sucker-punch-to-the-gut excited about, in order to give my wife every opportunity to have a career as well?

Though I know this is ultimately a personal decision, we badly need some advice. She has been encouraging me to choose mainly based on my desires, which is kind. But I've recently begun to think that this may be the wrong tactic. I'm going to be a doctor whether or not I go to Rutgers, or Mayo. I have interest in fellowship, but no desire to end up as an academic hotshot. In fact I'd be perfectly ok with ending up in primary care if I like that best. But my wife won't be a chemist at all if she doesn't end up in a certain area. If we did have to live further out from a city, she would be willing/maybe could teach high school IF she went back to school for a teaching certificate, but chemistry is her passion and she's darn good at it.

After thinking in this fashion, I begun to wonder if it might be better for me to prioritize location over prestige/fit - within reason. For instance, I wouldn't rank my 2 community programs higher just because they're in a good city. Because they are not so great in terms of training, and I really don't like them all that much. But it would mean ranking a place like Rutgers, which I just thought was solid (not a bad fit, obviously more of a mid-tier) over a place like Mayo (loved Mayo, thought it was the bomb).

So to summarize: will ranking mid-tier programs over bigger name programs for the sake of my wife's career be a stupid move for us in the long-run? Will it jeopardize my job prospects as a PCP or community-based subspecialist if I graduate from a program like Rutgers over a program like Yale?

is your wife some sort of uber specialized chemist? would she not be able to find a job at almost any university? or company? she can work in the private sector as well...

make your list based on what is going to make you the happiest...if making sure your wife has a shot at her career, then so be it...but i'll have admit...i'm scratching my head trying to figure out how rutgers is better for a chemist than yale...

 

[boromirmycaptain]

Yes... fairly uber-specialized. In all honesty, I had changed her field slightly to maintain anonymity. She does have a PhD in a science though. And you'll just have to trust me when I say that jobs in academia in her science field are HARD to find. Especially at a very competitive place like Yale. It's like someone telling a doctor "you're in Boston so you'll just get a fellowship at the Brigham." Obviously we know it's not that simple. Outside of academia, she could work in the private sector by falling back on her training in the basics of her hard science. But even those private jobs can be harder to find at places sort of in the middle of nowhere or in smaller cities like UVA.

There is not much else in her field in New Haven besides the university unfortunately. But that aside, perhaps a better example is Mayo. I would seriously rank that program #1, but there is very little for her there. Same with U Mich and Case Western.

Great areas for her would be NY/NJ, DC, Boston, and maybe Pittsburgh (some academia connections in Pitt). In those areas, I have interviewed at Rutgers Robert Wood and Stony Brook, U MD, Georgetown, GW, Tufts, UPMC. Most prestigious programs I've gotten are maybe U Mich, UVA, Yale, Mayo.

So if we're getting into my specifics, the question is, would it be madness to rank programs like Rutgers/Stony/GW over programs like UMich/UVA/Yale?

Or more generally, is it career suicide for IM applicants to rank middling-tiers (I think Rutgers and Stony are still mid-tier?) over big name programs, for the sake of spouses/families?

 

[FlowLimited]

I don't think it's madness and it's certainly not career suicide. Some of these programs are more prestigious, but none of them will automatically limit your subspecialty options. I think this is a very reasonable compromise to make since your wife's happiness and career goals are clearly important to you.

 

[rokshana]

Yes... fairly uber-specialized. In all honesty, I had changed her field slightly to maintain anonymity. She does have a PhD in a science though. And you'll just have to trust me when I say that jobs in academia in her science field are HARD to find. Especially at a very competitive place like Yale. It's like someone telling a doctor "you're in Boston so you'll just get a fellowship at the Brigham." Obviously we know it's not that simple. Outside of academia, she could work in the private sector by falling back on her training in the basics of her hard science. But even those private jobs can be harder to find at places sort of in the middle of nowhere or in smaller cities like UVA.

There is not much else in her field in New Haven besides the university unfortunately. But that aside, perhaps a better example is Mayo. I would seriously rank that program #1, but there is very little for her there. Same with U Mich and Case Western.

Great areas for her would be NY/NJ, DC, Boston, and maybe Pittsburgh (some academia connections in Pitt). In those areas, I have interviewed at Rutgers Robert Wood and Stony Brook, U MD, Georgetown, GW, Tufts, UPMC. Most prestigious programs I've gotten are maybe U Mich, UVA, Yale, Mayo.

So if we're getting into my specifics, the question is, would it be madness to rank programs like Rutgers/Stony/GW over programs like UMich/UVA/Yale?

Or more generally, is it career suicide for IM applicants to rank middling-tiers (I think Rutgers and Stony are still mid-tier?) over big name programs, for the sake of spouses/families?

fair enough...for the programs that you listed, UPMC is probably the best of them and GW and Georgetown are comparable...

though Minneapolis is about 90 mins from rochester...

 

[boromirmycaptain]

Yeah she is doing what she can to find some opportunities in Minneapolis. Did you mean that UPMC=GW=G-town? Just wanted to clarify.

But more generally would you agree that there's not too much danger of career impact down the line if I end up ranking a program like Stony over Yale? I didn't mean for this to turn into a "help me rank" thing. But more generally was wondering if your residency prestige matters a heck of a lot in your future career. Like when you apply for jobs in IM/IM subs.

 

[rokshana]

Yeah she is doing what she can to find some opportunities in Minneapolis. Did you mean that UPMC=GW=G-town? Just wanted to clarify.

But more generally would you agree that there's not too much danger of career impact down the line if I end up ranking a program like Stony over Yale? I didn't mean for this to turn into a "help me rank" thing. But more generally was wondering if your residency prestige matters a heck of a lot in your future career. Like when you apply for jobs in IM/IM subs.

no, UMPC> GW=Georgetown.

it depends...CAN you get a fellowship from places like Stonybrook, sure...friend of mine got Columbia Rheum...but will it be easier out of Yale? sure...but an unhappy person at a prestigious program may not do as well as a happy person at less prestigious place...

 

[Raryn]

I am 4th year applying to internal medicine and my wife and I are struggling with the rank process. I am fortunate that as an average med student, I've been granted interviews at some really great programs. To give you a sense of the reputation spread of my programs, my most "prestigious" is maybe Yale or Mayo and least "prestigious" is Rutgers. Within that range of programs I did occasionally feel I had a better fit at many programs that were on the lower end of the name-brand spectrum too. Didn't want to imply that I'm chasing after big names and nothing else.

The issue is, ultimately my wife is what makes me happy, and I am blessed to have a really smart one by my side. She's a chemist though, and her job market is somewhat geographically limited to in/around certain cities. Our dilemma is: should I choose less prestigious programs, or programs I felt less sucker-punch-to-the-gut excited about, in order to give my wife every opportunity to have a career as well?

Though I know this is ultimately a personal decision, we badly need some advice and I think my question is one that many applicants have. She has been encouraging me to choose mainly based on my desires, which is kind. But I've recently begun to think that this may be the wrong tactic. I'm going to be a doctor whether or not I go to Rutgers, or Mayo. I have interest in fellowship, but no desire to end up as an academic hotshot. In fact I'd be perfectly ok with ending up in primary care if I like that best. But my wife won't be a chemist at all if she doesn't end up in a certain area. If we did have to live further out from a city, she would be willing/maybe could teach high school IF she went back to school for a teaching certificate, but chemistry is her passion and she's darn good at it.

After thinking in this fashion, I begun to wonder if it might be better for me to prioritize location over prestige/fit - within reason. For instance, I wouldn't rank my 2 community programs higher just because they're in a good city. Because they are not so great in terms of training, and I don't like them all that much. But it would mean ranking a place like Rutgers, which I just thought was solid (not a bad fit, obviously more of a mid-tier) over a place like Mayo (loved Mayo, thought it was the bomb).

So to summarize: will ranking mid-tier programs over bigger name programs for the sake of my wife's career be a stupid move for us in the long-run? Does it jeopardize your job prospects as a PCP or community-based subspecialist if you graduate from a program like Rutgers over a program like Yale?

Whoops- I'm a dirty liar and my wife is a "chemist" aka just trust me she's a scientist in a small field.

So, speaking in general terms, it all depends on what you want to do. From an IM standpoint:

Want to be a PCP in the community? Doesn't matter at all. Period. Any residency program in the country will be roughly equivalent to your ability to get a job. The ones with better clinical training will make you a better doctor and may make you more comfortable in that job, but if you're willing to work hard, you'll be a decent doctor after any ACGME-accredited program. Oh, and the better clinical training doesn't necessarily correlate completely with prestige, as there's a lot of community programs that have a wide variety of pathology and exposure (and others that don't of course).

Want to be a subspecialist in the community? Matters somewhat, in that you want to go to a place that will set you up to match for a fellowship. You don't really want to go to one of the "best" fellowship programs because they're inevitably very research focused, but you want to go to a solid one with a variety of exposure. Here it matters a bit if your residency program has at least some infrastructure for research, and it helps if they have in-house fellowships. And it also makes a difference what you want to do: If your dream is to do GI, unfortunately prestige will be a big part of your application. If your dream is to do nephrology, you need a pulse and a residency program.

Want to be a PCP/subspecialist and teach residents in the community? No real difference from the above. Just want a reasonably solid program.

Want to be an academician? Prestige matters. Research matters. Your career will be determined by the last place you trained.

Finally: Happy wife, happy life. The difference between the programs you're listing is not THAT large relative to your spouse revamping her whole career.

 

[OldPsychDoc]

...
Finally: Happy wife, happy life. The difference between the programs you're listing is not THAT large relative to your spouse revamping her whole career.

This.

 

[AdmiralChz]

Finally: Happy wife, happy life. The difference between the programs you're listing is not THAT large relative to your spouse revamping her whole career.

A couple residents here for a time lived apart from their spouse - it is doable for about a year but it became extremely stressful on them by about the 12th month. Don't make this mistake. You worked hard for your family, and you have some great programs to choose from - you need to have an honest, real talk. But seriously, spending 3 (or more) years apart in a young family can lead you down a dark, possibly relationship-ending path.

 

[Raryn]

A couple residents here for a time lived apart from their spouse - it is doable for about a year but it became extremely stressful on them by about the 12th month. Don't make this mistake. You worked hard for your family, and you have some great programs to choose from - you need to have an honest, real talk. But seriously, spending 3 (or more) years apart in a young family can lead you down a dark, possibly relationship-ending path.

I did ~2000 miles long-distance for three years. It was unavoidable in my case due to the match not going as well as I would have liked, but we made it work. But I did everything I could to avoid it.

 

[deleted480308]

you will make enough sacrifices for your career, let your spouse have this one

 

[j4pac]

I loved Mayo and ranked it #1. My wife is also a professional and I had real concerns about her not being able to get a job. I matched at Mayo and she got a job.

The bottom line is that you have to be able to live with the downside. We knew there was a chance that she may not work. We also knew that the Twin Cities weren't a work option because we have children and it would just be too much. We risked it and it paid off big time. It's cold. Like real cold. But it's great here.