Thoughts on Private Practice Vs Academic Residencies

[jcbunny]

Hey there SDN community,

Does anyone have any thoughts on residencies at private practices versus an academic institution? I know that generally speaking, it is harder to pass boards coming out of a program at a private practice. But how much of a difference does this truly make? Are there any scenarios that you know of where someone has completed a 3 year residency and have never been able to pass boards? How commonly does this happen?


Thank you all for your input.

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[JaynaAli]

It definitely happens. How often depends on the specialty. I haven’t really heard of much of a difference between academic vs private pass rates but my specialty doesn’t really have private practice residencies so that may be my poor exposure. Historically zoo med has a pretty abysmal pass rate if I remember correctly. Pathology used to have a higher fail rate but they’re making efforts to revamp it and change that. I am not as familiar with other specialties numbers. It’s very common to not pass boards on the first try. There’s just so much to learn. Most people will pass on subsequent attempts. I failed my general phase 1 boards exam but passed it on the second attempt. I passed my phase 2 exam on the first attempt. A few never pass…but many of those will still go on and practice in that field anyway without the extra letters (aka the person in a surgery residency works in a GP or emergency hospital doing mostly or all surgery, the residency trained internist still sees complex medicine cases and maybe even takes patients for ultrasounds, the zoo person still works in a zoo, etc.). One of my coworkers is not boarded. She tried several times, passed all but one section, and decided to quit retaking it because she was already working as a pathologist.

So so so much of residency training is self driven reading I can’t see where you did your residency makes a huge amount of difference in the end. Maybe surgery since that really needs to be hands on in a way that internal med and oncology maybe don’t and you can only cut what presents to you, but I think a motivated person can probably be successful about anywhere.

 

[SnowJ]

So so so much of residency training is self driven reading I can’t see where you did your residency makes a huge amount of difference in the end. Maybe surgery since that really needs to be hands on in a way that internal med and oncology maybe don’t and you can only cut what presents to you, but I think a motivated person can probably be successful about anywhere.

I heard from some (surgery) residents recently say that academic residencies tend to make time for you to do your studying, research, etc built in as part of their schedule, whereas in a private residency you are more likely to be essentially working all the time and have to do studying on your own time, without breaks for it. That may make a difference and it might be the reason that it's considered harder to pass boards from private practice.
As to how much of a difference it makes in reality, I have no idea. I'm sure there's numbers, I'm just not sure where you'd find them.

 

[SocialStigma]

I did a private practice internship and an academic residency. I only applied to academic residencies when the time came because I knew I wanted a more structured environment. Some of the bigger private practice programs (eg. AMC, Angell, etc) will likely have structured journal clubs, enough residents to go around where you can have decent study/research blocks, etc, but many of the smaller programs will not. If there are only 1-2 residents in a program, then someone has to be on clinics at all time. There were 6 residents in my program (not to mention surgery interns, rotating interns, etc), so there was always a lot of flexibility in terms of making sure residents had adequate time off to study, do research, and rotate through other specialties. While it is true that studying for boards is mostly self driven, the faculty support, weekly journal clubs, and dedicated time off to study (ie. where you don't have to step foot in the clinic at all, no on call duties) can be the difference between passing and failing. During my residency, my faculty would also give us mock board exams every few months, where they came up with tests that were timed/structured exactly like the real deal, and we would go through the answers after. Very unlikely in a private practice that the attendings would have the time to do something like this. Also, you're more likely to see the weird or rare diseases in an academic setting than a private practice, and on boards it really helps if you've encountered a clinical case similar to the one being presented in the question before when you only have 2 minutes to answer an entire page.

There are definitely people who don't pass boards coming out of both academic and private practice residencies, or people who had to retake it multiple times. Anecdotally I've heard the pass rate for surgery boards is usually around 50-60%.

 

[Fish pixie]

I went into a academic residency that I quite due to it basically falling apart and all the faculty leaving and me being utterly miserable. Before and after the residency, I did academic internships, so I've been at 3 universities and seen how 3 sets of residents are being taught and how successfully they prepared their residents. I do think it matters, especially if they offer board oriented didactic courses and journal clubs. I have not seen how private practice residencies prepare their residents, but wonder if a profit-driven private practice would be able to give the residents enough focus and teaching to prepare them for boards.

 

[jcbunny]

Thanks everyone for your input. It seems like academic would be preferred but maybe don't write off private practice residencies. Does anyone have any suggestions on some good questions to ask during the interview that may help to determine if a program would be sufficient in terms of teaching you enough to get you through boards? Also- if anyone has any specific information on cardio that would be super helpful.

Thank you again!