University or Unopposed program?

[lsu1000]

Just curious if anyone who has had experience in this area looking back would have chosen a Univ program, or an unopposed community program. All other things being equal.

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[8744]

Just curious if anyone who has had experience in this area looking back would have chosen a Univ program, or an unopposed community program. All other things being equal.

Are you crazy? Unopposed.

Jeez.

 

[lsu1000]

why is that?
I've always thought a Univ program looks better, especially if trying for a fellowship.

 

[iatrosB]

Are you crazy? Unopposed.

Jeez.

no-brainer there

 

[iatrosB]

why is that?
I've always thought a Univ program looks better, especially if trying for a fellowship.

It is well known that MOST of the time, you get better training at an un-opposed program because you don't have to compete with other services for the "cool" patients (IM, OB, Peds...).

 

[Faebinder]

Unopposed.

 

[elizabeth5863]

I think a university program is fine, as long as there are lots of pts to go around for everyone. I'm doing an elective as an M4 right now and there are med students, IM residents, FM residents, and fellows seeing pts in the clinic. There are enough pts around for everyone and I am so glad that there are other people around to help out with the workload. I'm also learning from other people's pts as well and not just my own. An unopposed program is nice but even if you don't go to one, I think that is fine as long as there are lots of pts and you get opportunities for procedures. (Some procedures, i.e. central lines, are so invasive that I'm not even interested in learning it. I won't be doing it as an FP, so I don't mind if someone else does it).

 

[dr.smurf]

i was on the fence about this when i was applying and now that im about to finish an opposed univ affiliated community and i would say hands down go unopposed!! if i had it to do over i would go unopposed. good luck!

 

[deleted87716]

Are you crazy? Unopposed.

Jeez.

I'm going to have to agree with Panda Bear on this one.

Don't worry...it's 21 degrees outside, but hell hasn't frozen over.

 

[dr.smurf]

oh and did i mention you would not have to deal with ob residents?

 

[PKB]

I think a university program is fine, as long as there are lots of pts to go around for everyone. I'm doing an elective as an M4 right now and there are med students, IM residents, FM residents, and fellows seeing pts in the clinic. There are enough pts around for everyone and I am so glad that there are other people around to help out with the workload. I'm also learning from other people's pts as well and not just my own. An unopposed program is nice but even if you don't go to one, I think that is fine as long as there are lots of pts and you get opportunities for procedures.

That is exactly what i "thought" too!!!!!!!

 

[Tn Family MD]

To each his own, I guess. If you are the kind of resident that needs stuff served up to you on a silver platter, then maybe unopposed is the way to go. You won't have to battle for procedures and patients that way. But, if you don't mind standing your ground now and then when it's your turn to do a procedure, then you will do fine in MOST university affiliated programs. I am an intern at a Univeristy FM program that is opposed and I have yet to have a procedure taken from me that I wanted. I am already certified at my institution to do chest tubes, central lines, vasectomy, endometrial biopsy, circumcision, OB ultrasound and a number of other procedures without an attending present. So, I clearly am not lacking procedural experience. I have had some instances when I was on the surgery service where the surgery interns thought they should have procedures over me, but I just stood my ground and did the procedures when it was my turn. It didn't turn into a big issue really. To each his own, I guess

 

[lateness]

To each his own, I guess. If you are the kind of resident that needs stuff served up to you on a silver platter, then maybe unopposed is the way to go. You won't have to battle for procedures and patients that way. But, if you don't mind standing your ground now and then when it's your turn to do a procedure, then you will do fine in MOST university affiliated programs. I am an intern at a Univeristy FM program that is opposed and I have yet to have a procedure taken from me that I wanted. I am already certified at my institution to do chest tubes, central lines, vasectomy, endometrial biopsy, circumcision, OB ultrasound and a number of other procedures without an attending present. So, I clearly am not lacking procedural experience. I have had some instances when I was on the surgery service where the surgery interns thought they should have procedures over me, but I just stood my ground and did the procedures when it was my turn. It didn't turn into a big issue really. To each his own, I guess

well said...

 

[labruy69]

"(Some procedures, i.e. central lines, are so invasive that I'm not even interested in learning it. I won't be doing it as an FP, so I don't mind if someone else does it)"
as an FP resident I do these and I will be doing/supervising them as an attending. Since I'm in an unopposed program, there is no one else to do these procedures, so I have to learn how to do them and become proficient.
PS
The not having to deal with OB residents alone makes unapposed superior.

 

[Tn Family MD]

Don't feel like being in an unopposed program is what makes FP residents do central lines. I have done over twenty and I am barely halfway through my intern year in a university opposed program. I quit documenting them in my procedure log because I already have enough to be credentialed at my university hospital when I become an attending. That being said, the FM program where I went to med school was very weak and I never saw a resident do any type of procedure there, let alone a central line. When it comes to program selection, what's that latin saying, let the buyer beware. There is no reason to avoid university programs in sum total though. Some are great.

 

[deleted87716]

what's that latin saying, let the buyer beware

How about "caveat discipulus" (let the student beware)?

 

[Tn Family MD]

Yeah, but we all know FM residency is a buyer's market and the buyer's are the interviewee/med student/future resident. But I do like caveat discipulus

 

[Saluda]

I am in an interesting position in that I am switching from Peds to FM.

While I was a peds resident at a large university program, I worked on wards, newborn, outpt and Peds ED with the family medicine residents. On every single one of those rotations the FM residents were treated like second class citizens. They saw the less interesting cases, they had crappy call schedules (made by the peds chief) and the attendings spent less teaching time with them.

Several of my attendings mentioned that they thought FPs had no business seeing kids. This line of thinking showed in their treatment of the FP residents. It becomes a kind of self-fulfilling prophecy when your attendings don't teach you because they think you are not competent.

I know from two of my friends at university programs that this is how they have been treated. One is currently trying to find an unopposed program she can switch to. She recently asked to follow her failure-to-progress pt to c-section, but was told that she could only if she did not touch the pt during the procedure.

I would think very very seriously about going to an opposed program. I know for a FACT that the attendings and residents tell applicants during the interview season that they are "well respected" and "taught well" etc on the off-service rotations. I have been there on the other side, and I know this is a big fat lie.

good luck all!

 

[Saluda]

.

 

[elizabeth5863]

I am in an interesting position in that I am switching from Peds to FM.

While I was a peds resident at a large university program, I worked on wards, newborn, outpt and Peds ED with the family medicine residents. On every single one of those rotations the FM residents were treated like second class citizens. They saw the less interesting cases, they had crappy call schedules (made by the peds chief) and the attendings spent less teaching time with them.

Several of my attendings mentioned that they thought FPs had no business seeing kids. This line of thinking showed in their treatment of the FP residents. It becomes a kind of self-fulfilling prophecy when your attendings don't teach you because they think you are not competent.

I know from two of my friends at university programs that this is how they have been treated. One is currently trying to find an unopposed program she can switch to. She recently asked to follow her failure-to-progress pt to c-section, but was told that she could only if she did not touch the pt during the procedure.

I would think very very seriously about going to an opposed program. I know for a FACT that the attendings and residents tell applicants during the interview season that they are "well respected" and "taught well" etc on the off-service rotations. I have been there on the other side, and I know this is a big fat lie.

good luck all!

Hi Saluda,

Do you mind sharing which state you and your friend did your residencies? I haven't come across attendings with the attitude that fp's shouldn't be seeing kids and, at my university/institution and most programs I've heard of in the midwest and california, fp is well-respected.

As far as the "interesting" cases in peds, are you talking about the common cases or the cancer and subspeciality cases? I've rotated thru various peds subspecialities as a med student but as a future resident I'm not as interested in peds cancer cases and I'm more interested in the bread and butter cases.

Please PM me if you don't feel comfortable sharing which institution you're at or which one your friend is at. I hope it's not a program I have on my rank list. Thanks!

 

[lsu1000]

So what is the consensus as far as fellowships later down the road? Is a Univ program going to look better than an unopposed program?
I mean, central lines and chest tubes are fine but will not be practiced in a clinic setting, so choosing a unopposed program for more procedural experience seems second to fellowship resume status. That is if you are looking to go with a fellowship.

No?

 

[Shodddy18]

unopposed!

 

[drwatson]

I am in an interesting position in that I am switching from Peds to FM.

While I was a peds resident at a large university program, I worked on wards, newborn, outpt and Peds ED with the family medicine residents. On every single one of those rotations the FM residents were treated like second class citizens. They saw the less interesting cases, they had crappy call schedules (made by the peds chief) and the attendings spent less teaching time with them.

Several of my attendings mentioned that they thought FPs had no business seeing kids. This line of thinking showed in their treatment of the FP residents. It becomes a kind of self-fulfilling prophecy when your attendings don't teach you because they think you are not competent.

I know from two of my friends at university programs that this is how they have been treated. One is currently trying to find an unopposed program she can switch to. She recently asked to follow her failure-to-progress pt to c-section, but was told that she could only if she did not touch the pt during the procedure.

I would think very very seriously about going to an opposed program. I know for a FACT that the attendings and residents tell applicants during the interview season that they are "well respected" and "taught well" etc on the off-service rotations. I have been there on the other side, and I know this is a big fat lie.

good luck all!

To be honest, I thought that this type of mentality was the rule, rather than the exception at University Medical Centers. I'm rotating through one now and almost every attending scoffs at the idea/thought of family medicine. Additionally the Family rotators are just assumed to be incompetent. I figured this (sadly) was just the case at most academic centers.

 

[sophiejane]

I think there will come a time in the not so distant future that postgraduate training for FM will take place primarily in community based unopposed programs.

At least I hope so...

There is no comparison, really--they are different beasts entirely. There are some university programs that allow more autonomy for FM residents, and afford them more respect, but the general consensus among those who really choose FM because they want to do FM and not because it's a fallback or plan B seems to be that unopposed programs provide better, more comprehensive training.

 

[Faebinder]

I think there will come a time in the not so distant future that postgraduate training for FM will take place primarily in community based unopposed programs.

At least I hope so...

There is no comparison, really--they are different beasts entirely. There are some university programs that allow more autonomy for FM residents, and afford them more respect, but the general consensus among those who really choose FM because they want to do FM and not because it's a fallback or plan B seems to be that unopposed programs provide better, more comprehensive training.

I think you are very right... and that's why the number of FM programs is dropping rapidly... those who cant maintain their unopposition or turf in academy are not going to do well... and it's hard to do it when pediatric, OBGYN and IM are sitting there taking your inpatient services.

 

[sophiejane]

I think you are very right... and that's why the number of FM programs is dropping rapidly... those who cant maintain their unopposition or turf in academy are not going to do well... and it's hard to do it when pediatric, OBGYN and IM are sitting there taking your inpatient services.

OK, Faeb...that was posted at 4:53 a.m.....are you already awake or never went to sleep? Time to raid someone's drug closet for Lunesta samples...hang in there...

 

[oldbearprofessor]

I am in an interesting position in that I am switching from Peds to FM.

While I was a peds resident at a large university program, I worked on wards, newborn, outpt and Peds ED with the family medicine residents. On every single one of those rotations the FM residents were treated like second class citizens. They saw the less interesting cases, they had crappy call schedules (made by the peds chief) and the attendings spent less teaching time with them.

Several of my attendings mentioned that they thought FPs had no business seeing kids.

I'm sorry you had that experience. I am sure you'd agree that not all pedi residents and attendings treat family medicine residents badly. I've worked alongside and as an attending with family medicine residents for many years and have not seen this attitude, although I'm sure it exists among some pediatric attendings in some places.

Regardless, although I'm sure "unopposed" is better on the whole for family med training, it does make me feel a bit sad that being trained in pediatrics by pediatricians is perceived as less optimal for family medicine residents. I enjoy teaching family medicine residents as well as OB residents alongside the pedi folks. I've seen lots of good experiences from the pedi residents teaching newborn procedures and care to family medicine residents, etc. I'm pretty sure I have some insights that would be of use to family medicine trainees regarding the nutritional management of healthy and at-risk newborns and in an unopposed program, they wouldn't have the chance to hear me. In fact, I am lecturing to the family med program in the near future, so they must think I know "something."

 

[sophiejane]

Regardless, although I'm sure "unopposed" is better on the whole for family med training, it does make me feel a bit sad that being trained in pediatrics by pediatricians is perceived as less optimal for family medicine residents. I enjoy teaching family medicine residents as well as OB residents alongside the pedi folks. I've seen lots of good experiences from the pedi residents teaching newborn procedures and care to family medicine residents, etc. I'm pretty sure I have some insights that would be of use to family medicine trainees regarding the nutritional management of healthy and at-risk newborns and in an unopposed program, they wouldn't have the chance to hear me. In fact, I am lecturing to the family med program in the near future, so they must think I know "something."

On the contrary...most of the unopposed programs I looked at had at least one and often 2 pediatricians on faculty, along with 1-2 OB/Gyns. You don't have to go to an opposed program to get trained by specialists. In addition to peds and OB, surgery and all subspecialty rotations at most unopposed programs give you the opportunity to work one-on-one with the specialist, without the annoyance of residents who look down their nose at you and give you crappy cases and schedules.

 

[deleted87716]

On the contrary...most of the unopposed programs I looked at had at least one and often 2 pediatricians on faculty, along with 1-2 OB/Gyns. You don't have to go to an opposed program to get trained by specialists.

Ditto that. I trained at an unopposed program, and all of my specialty rotations were with specialists. Including neonatology.

 

[Tn Family MD]

I think we should all just agree that there are great opposed and great unopposed programs out there. Also there are truly horrible opposed programs and truly horrible unopposed programs as well. Just because one is opposed or unopposed, that is not the deciding factor for determining how good a program is. In the end, be careful about choosing a program and you will end up with great training, whether it is opposed or unopposed.

 

[iatrosB]

I think we should all just agree that there are great opposed and great unopposed programs out there. Also there are truly horrible opposed programs and truly horrible unopposed programs as well. Just because one is opposed or unopposed, that is not the deciding factor for determining how good a program is. In the end, be careful about choosing a program and you will end up with great training, whether it is opposed or unopposed.

Very good points. The only thing I would add is that an un-opposed program is probably a safer bet for an applicant. It is sad that there is such disparity from one program to the next (be it opposed or un-opposed). There are great opposed programs certainly, but on average, un-opposed is a safer bet in a field where residency standardization is sub par at best.

 

[Faebinder]

Unopposed... trust your instinct... Unopposed. Even if they dont have the fellowship.

 

[elizabeth5863]

So... if there is an opposed (university) and unopposed program in the same city about 20-30 minutes away from each other, which one would you rank higher? (I like the people at the opposed program so much more, but I'll get more procedures at the unopposed program). The opposed program has excellent teaching, a great program director and faculty, and the residents seem like "family" to me... but the procedure log of a 3rd year resident I saw was unimpressive. What should I do??? (Please help... I'm deciding which one to rank as #3 and #4 and most likely will end up at the opposed program if I rank it higher).

 

[Faebinder]

So... if there is an opposed (university) and unopposed program in the same city about 20-30 minutes away from each other, which one would you rank higher? (I like the people at the opposed program so much more, but I'll get more procedures at the unopposed program). The opposed program has excellent teaching, a great program director and faculty, and the residents seem like "family" to me... but the procedure log of a 3rd year resident I saw was unimpressive. What should I do??? (Please help... I'm deciding which one to rank as #3 and #4 and most likely will end up at the opposed program if I rank it higher).

Step 1:

Sacrifice a goat to Muzabel, the river god.

Step 2:

Meditate on all you have done to wrong everyone in the world.

Step 3:

Pick the upposed over the opposed (unless you would rather graduate with less procedural skills).

 

[lateness]

So... if there is an opposed (university) and unopposed program in the same city about 20-30 minutes away from each other, which one would you rank higher? (I like the people at the opposed program so much more, but I'll get more procedures at the unopposed program). The opposed program has excellent teaching, a great program director and faculty, and the residents seem like "family" to me... but the procedure log of a 3rd year resident I saw was unimpressive. What should I do??? (Please help... I'm deciding which one to rank as #3 and #4 and most likely will end up at the opposed program if I rank it higher).

depending on how you plan to practice afterwards, it also depends on how much you liked the other program, and the people there.. I agree with majority of the people that unopposed on the average is better, but there are some good opposed programs where you can do a lot of procedures bc there are more to be done, with protected time for the FMs , but I would rank where I would I think I would be more happy and comfortable if I had the choice..

 

[Faebinder]

OK, Faeb...that was posted at 4:53 a.m.....are you already awake or never went to sleep? Time to raid someone's drug closet for Lunesta samples...hang in there...

It scares me how you managed to deduce that.. Thanks Sophie.