What factors might be affected by the "ranking" of one's residency program?

[ENTapplicant]

Hello,

I'll be applying into the great specialty of otolaryngology this September. I'm fortunate enough to look good on paper as an applicant, thus maybe I have a shot at getting into some "fancy" residency program. I have attended a highly ranked research medical school and thoroughly enjoyed the experience, but know that my friends at my state school have also had fantastic training and an enjoyable time. As I consider otolaryngology residency programs, none of the "top" programs are close to family. I have been fine being far from family through medical school, and wouldn't mind it for residency training, but it might be a perk that I would consider more or less heavily than I ought to when creating a rank order or programs I'd hope to match into.

My Question: Suppose I choose to do my best to convince a residency program near family that they will be happy with me in their program, rank them highly, and eventually am lucky enough to match there, even if it's not "the cream of the crop" training program according to any list. How would this affect my career if I choose to do a fellowship, if I choose to go into academia, or if I choose to go into private practice?

I believe that part of me inflates the importance of ranking because I'm at a highly ranked medical school and my ego likes to be stroked by such flattery. My hypothesis, however, is that ranking probably doesn't matter as much as my ego tells me. I would really enjoy hearing from those with more experience than me on how this has or has not affected their career.

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[qwertuiop123456789]

I am not an ENT resident or attending, but I'll be starting residency in another specialty next month and was in a similar situation to yours. I attended a well-regarded state school with more research funding than many "fancy" academic centers (we are in the top 25 nationally for NIH funding). I interviewed at several nationally respected programs in my specialty, and at two "top 10" institutions. I ended up ranking first and matching at a regionally respected, but nationally unknown program in the same city as my family and I couldn't be happier.

At the end of the day what it came down to for me was answering this question: is this program going to allow me to accomplish what I want from my medical career? The answer for me was yes. I am most likely going to end up in private practice though I have not ruled out "clinician-educator" type roles at an academic center. I have zero interest in a basic research career but am open to pursuing clinical research if I can get involved in projects that interest me. You have to take a look in the mirror and attempt to figure out what your long-term goals are (career, personal, family), which is very difficult at this time, and try to end up at a program that allows your to balance them in the way you desire. In medicine we are groomed to seek prestige at every turn, but sometimes the right choice is for other factors to take priority. It was for me. My wife and I are hoping to start a family soon, so proximity to relatives was very important for us. I am not worried in the least bit that my career will suffer for making this a priority.

The best residency for you may not be the "best" residency on the rankings list. This became apparent to me on the interview trail. I was very impressed with the many of the programs at which I interviewed but I realized that my goals did not line up with their mission, so it was pretty easy putting my rank list together. I will admit that I felt a pang of doubt not putting the "best" places at the top. When I thought about it and realized that going to one of those programs would do nothing of importance for my long-term goals except keep me away from my family even longer, that feeling rapidly disappeared.

I wish you luck in making this decision. Trust your gut on the interview trail, and trust the process. If you are married or in a relationship, I'd like to pass along a great anecdote I heard on the interview trail: you need to choose a program in a city that will allow your significant other to be happy while you're at work. They're the ones who will be getting to know the city. They will be the ones sleeping alone while you're on call at 0200. Your job is going to be much easier and much more enjoyable if you know that they're happy while you're at work. This really struck me and I've tried to pass it along as much as I can. Again, good luck!

 

[OtoHNS]

It actually matters surprisingly little where you train.

I graduated from a smaller, perfectly fine but certainly not “elite”, ENT program. Any graduate from my program who wanted to go the academic route had no problem doing so. One of my former chiefs and a resident who graduated a year ahead of me are now nationally-known academicians who are very well published and are reviewers/editors for prominent journals. Everyone else who wanted to do fellowship and/or academics had not had a problem pursuing their goals. And those of us who wanted to do private practice didn’t have any issue either- your personality is probably the most important part of getting hired by a practice, not where you trained.