Why go to a program with 800 cases when you can go to one with 1200 -1400 cases? Don't assume that more volume equals less quality and the opposite certainly isn't true either. If you read literature on Whipples, for instance, from big-name institutions (the same ones with 800-1000 cases) they are very clear that the most experienced surgeon in the room should do the pancreaticojejunostomy. Well, I'm approaching 1400 cases, and have thrown every stitch on all 13 Whipples I have done. So, for you applicants out there, high volume doesn't mean "poor quality" or completing the easiest 51% of the case just to be able to count it.
My interpretation of big name programs with under 1000 cases is there is no pressure on them to produce a surgeon. Nearly all of their graduates will pursue a fellowship and get the real training they need to practice post-residency. Also, applicants are WAY TOO CONCERNED about what the wall of their office is going to look like (which most patients don't see and don't care about...) The writing on your training certificate never helped anyone in the middle of the night.
You should do whatever you need to do to get the training you need to take care of your patients the way you want to take of patients. If you want to be a chairman, sure try for a big academic program. If you want to be a high volume community surgeon (ie most everyone else) go to high volume program. If you don't know, go to a high volume program that places graduates in competitive fellowships and community GS jobs where your fate is not sealed the moment you open your match envelope.
Regardless of your goals, you should try to be as busy as possible during your 5 years as a resident because why not?
Thanks for a great post JayDoc. There are a lot of good points here: more volume doesn't equal poor quality and the opposite isn't true either. Regardless of how many cases residents do, they should be doing more than "the easiest 51% of the case".
I would, however, not say that graduates who pursue a fellowship are getting "the real training they need to practice post-residency", insinuating that if they went to a more high volume program they would be able to do those cases without fellowship training. For some/many types of cases it may be true, but most (if not all) gen surg residents can't graduate and expect to do, for example, a valve, lung transplant, carinal resection, CDH repair, put a kid on ECMO, repair imperforate anus, small bowel transplant, fenestrated aortic endograft repairs, and the list goes on. Every fellowship has bread and butter cases that every gen surg resident should be able to do, but that's not why most people go into fellowship training: it's either the cases most don't get exposed to during residency, maybe they always wanted to be 'X' category of surgeon, or academics. I know exactly what I want and will get out of my fellowship and it has nothing to do with the fact that I
can do a whipple, gastrectomy, hepatectomy, lobectomy, nissen, j-pouch, lap adrenal, thyroid, parathyroid, gastric bypass, AAA, carotid, etc. There are just some things you will never/rarely get exposed to during gen surg residency, at least enough to feel comfortable doing it after residency.
I will agree that there are residents who can't decide on a career path or don't feel comfortable after 5 years doing certain cases, and end up doing fellowships in things like minimally invasive just doing more nissens, bypasses, colons, etc, or trauma/critical care spending most of their time in the ICU, or even doing 1 year non-accredited fellowships in this or that.
I agree that applicants are too concerned about the reputation of a program, and we can all agree that there are plenty of great training programs across the country.
I would definately agree that if you absolutely know that you want to be a community surgeon, go someplace that trains exactly that. If you know you want to be part of the academic rat race, go someplace where everyone goes into academics. If you are not sure, go someplace where you have both options (either academic program that consistently produces community surgeons, or community programs that produces academic surgeons)
