What is the benefit of going to the "best residency program" you can get into? I am potentially thinking about taking a research year to achieve this

[CuriousMDStudent]

Title sums it up. First question is straight forward: What is the benefit of getting into the "best residency program" you can get into? The second question is: Should I take a research year to optimize my chances at getting into the "best residency program" I can get into?

Background on me: I am a second-year medical student at a T15 medical school. I will be applying to medical school during STEP 1 P/F. Due to this, there is a higher emphasis on my clerkship grades, STEP 2 score, research, and LORs. I am interested in orthopedics surgery.

During my first year, I got involved in 7 research projects.
- 2 of which have been written up and are being submitted.
- 3 of which have data collection completed and are being submitted.
- 1 which has data still being collected.
- 1 which is a long-term project which will be done by around 3rd year.

I feel that my first year wasn't the best academically. I was around average but slightly below average. This was due to adjusting to medical school, moving to a new city, feeling lost in life and covid mostly. I passed everything (thankfully it's true p/f) and feel like I have adjusted to medical school and feel more certain of what target is which is to become an orthopedic surgeon.

Now I'm thinking about what kind of program do I want to get into and if they'll fit my goals. Naturally, I thought to myself: "I'm going to aim for the best orthopedic surgery residency that I can get into". However, after taking some time to think, I wanted to first ask: What's the benefit of going to the "best residency program" I can get into. What's the difference between going to the #1 residency vs going to some regular residency. I asked some people. Some say it's if you want to do academia then you should aim for the best residency. Personally, I'm on the edge. I think research is cool and I like teaching. Academia might be what I want to do. But I also went into medical school for patients and I don't know if I'd just want to do clinical practice and if that's the case then wouldn't a regular residency be good enough.

This also leads to my next question: Should I do a research year to help optimize my chances to get into the best residency program I can get into? My school has a program that allows me to get a MS in research (practically a research year). It would be fully paid and I get a stipend. However, given my career goals, would this be something I should even do. It's a year of my life dedicated to research pretty much. I think I might do it because I like keeping my options open. Who knows, maybe when I finish my residency, I want to do academia. But if I end up just wanting to do private practice and focus on the clinical side, will this all have been a waste?

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[redsox93]

Best residency in terms of what? If you’re going off of doximity rankings it’s probably pretty useless to gauge. “Best residency” can mean a lot of different things to different people. For me (I’m doing rads) I wanted to prioritize clinical exposure during residency to make sure I came out as well prepared once I went into practice as possible. Like you already mentioned, higher ranked programs will be very beneficial if you want to do academics, but those programs aren’t always the greatest when it comes to clinical exposure. These are things you can figure out during interviews by finding out about specific procedural volume at places, if there’s competition with fellows, and you can also find out how many residents do private practice vs academics etc etc.. Ultimatey it comes down to what you value but I don’t see any reason to take a gap year if the only difference is going to a t5 residency vs a top 40 program unless you’re dead set on academics.

 

[CuriousMDStudent]

@redsox93 when I mentioned "best residency" I mean in terms of like ranking. Like what's the benefit of going to a higher ranked program.

 

[aldol16]

Whenever someone says "best" or "highest ranked", the natural next question should always be: on what basis? The best program by Doximity ranking? Well then you need to look at what Doximity considers and how it ranks programs. If those things matter to you, then you have your answer. For example, Doximity considers alumni research output as part of its algorithm. So going to a top Doximity program is probably going to better situate you for producing research in the future, i.e., academic practice.

The top programs are in general going to prepare you for the top fellowships and to go into the top academic posts. That's why they're the top - they do a good job of sending their graduates to the top places after graduation.

 

[OrthoTraumaMD]

@redsox93 when I mentioned "best residency" I mean in terms of like ranking. Like what's the benefit of going to a higher ranked program.

I can tell you that for ortho those rankings don’t mean jack. The so called very top academic places have resident constantly competing for cases with fellows. At this point pretty much any ortho residency will train you to be a competent surgeon. You should just focus on where you think will be the best fit for you personally.

 

[Tenk]

Rankings are only useful if you want to practice at some ivory tower academic program for the rest of your career. Almost any specialty that involves ANY procedures is always better the further you can get away from extra learners/fellows.

Example: I did EM residency at a program that rotated at three hospitals, one of which was a very big academic ortho center. I got ZERO hands on experience on ortho things here because literally everything that came to the ED ortho-wise was immediately handled by the ortho residents. Thank god I rotated at two other hospitals or I wouldn’t even know how to reduce a wrist.

 

[operaman]

Yeah there is a huge benefit to training at a great residency. You get better training and become a better surgeon. You may have more doors open to you and if you want an academic career then the connections are especially important. I wouldn’t have the job I have now if it weren’t for my program.

Now, how one defines “great” is another story. It’s hard. In the end you really have to do your homework and talk to a lot of people to get the answers. If you can do some aways it may help too. Rankings are just a starting point and may be woefully inaccurate. Often the top research places have lackluster surgical training; sometimes they have amazing training. There are programs in every field though with a reputation for training too notch surgeons.

 

[ChordaEpiphany]

Agree with the above posters that this is a multifaceted question, but I think you all are being a bit intentionally blunt about answering it.

OP is clearly asking if there's a reason to gun for HSS vs. decent academic vs. some community program. What does an HSS residency do for your resume that a community program can't?

In terms of physically doing orthopedic surgery, I'd argue very little. Every orthopedic surgeon will graduate from residency and find gainful employment somewhere making good money hammering people's bones in place. As for the specifics of the training, ask an orthopod, but I haven't heard too many argue that prestige rankings do anything for training quality.

The advantage of a top tier residency is that likely you can get hired (almost) anywhere geographically. You will be more attractive for academic positions. You will be more attractive for top-tier administrative positions or chief positions. If the profession goes completely belly up for some reason (basically impossible in any surgical subspecialty), you will likely be the first poached off by big business interests for the few high salary positions necessary to keep things running smoothly. I don't see the latter being a thing in surgery. Maybe in something like rads, where an AI revolution could (but probably won't) displace large numbers of physicians in our lifetimes, a top tier med school/residency would be attractive to your new Google overlords.

Weird possibilities aside, try to figure out what your life looks like in a few years and what your priorities are. A year of opportunity cost might not be worthwhile. Remember, you aren't just losing a year of attending salary. You are losing a year of attending salary + capital gains on everything you would have saved. As an orthopedic surgeon making $500K/year (~$320K post-taxes), if you save even $100K of that for retirement you'd be paying something like $700K and a year of your life in training. If you're on the border of a specialty, that's obviously worth it. If you're talking about HSS vs. Iowa, personally I'd save myself the trouble.

 

[DarkHorizon]

There’s little to no benefit unless you have no research and want to become a stronger candidate for Ortho in general. Even for academics, it’s silly. I’m a lowly DO, trained at a lowly community program, and my partner is Hopkins and HSS trained, the other partner trained at Michigan and Rush. In the community, no one cares. I’m busier than both of them and they both refer complex cases to me on nearly daily basis. I definitely make more than them as I am busier than them.

 

[GoSpursGo]

The so called very top academic places have resident constantly competing for cases with fellows.

And herein lies the rub, I think--if you want to stay in academia, there's probably some benefit to one of these brand-name programs. Otherwise there is likely marginal benefit.

 

[CuriousMDStudent]

Agree with the above posters that this is a multifaceted question, but I think you all are being a bit intentionally blunt about answering it.

OP is clearly asking if there's a reason to gun for HSS vs. decent academic vs. some community program. What does an HSS residency do for your resume that a community program can't?

In terms of physically doing orthopedic surgery, I'd argue very little. Every orthopedic surgeon will graduate from residency and find gainful employment somewhere making good money hammering people's bones in place. As for the specifics of the training, ask an orthopod, but I haven't heard too many argue that prestige rankings do anything for training quality.

The advantage of a top tier residency is that likely you can get hired (almost) anywhere geographically. You will be more attractive for academic positions. You will be more attractive for top-tier administrative positions or chief positions. If the profession goes completely belly up for some reason (basically impossible in any surgical subspecialty), you will likely be the first poached off by big business interests for the few high salary positions necessary to keep things running smoothly. I don't see the latter being a thing in surgery. Maybe in something like rads, where an AI revolution could (but probably won't) displace large numbers of physicians in our lifetimes, a top tier med school/residency would be attractive to your new Google overlords.

Weird possibilities aside, try to figure out what your life looks like in a few years and what your priorities are. A year of opportunity cost might not be worthwhile. Remember, you aren't just losing a year of attending salary. You are losing a year of attending salary + capital gains on everything you would have saved. As an orthopedic surgeon making $500K/year (~$320K post-taxes), if you save even $100K of that for retirement you'd be paying something like $700K and a year of your life in training. If you're on the border of a specialty, that's obviously worth it. If you're talking about HSS vs. Iowa, personally I'd save myself the trouble.

You understood exactly what I was asking and I really appreciate this thorough answer. Thank you to everyone else who answered as well.

 

[Phloston]

Title sums it up. First question is straight forward: What is the benefit of getting into the "best residency program" you can get into? The second question is: Should I take a research year to optimize my chances at getting into the "best residency program" I can get into?

Background on me: I am a second-year medical student at a T15 medical school. I will be applying to medical school during STEP 1 P/F. Due to this, there is a higher emphasis on my clerkship grades, STEP 2 score, research, and LORs. I am interested in orthopedics surgery.

During my first year, I got involved in 7 research projects.
- 2 of which have been written up and are being submitted.
- 3 of which have data collection completed and are being submitted.
- 1 which has data still being collected.
- 1 which is a long-term project which will be done by around 3rd year.

I feel that my first year wasn't the best academically. I was around average but slightly below average. This was due to adjusting to medical school, moving to a new city, feeling lost in life and covid mostly. I passed everything (thankfully it's true p/f) and feel like I have adjusted to medical school and feel more certain of what target is which is to become an orthopedic surgeon.

Now I'm thinking about what kind of program do I want to get into and if they'll fit my goals. Naturally, I thought to myself: "I'm going to aim for the best orthopedic surgery residency that I can get into". However, after taking some time to think, I wanted to first ask: What's the benefit of going to the "best residency program" I can get into. What's the difference between going to the #1 residency vs going to some regular residency. I asked some people. Some say it's if you want to do academia then you should aim for the best residency. Personally, I'm on the edge. I think research is cool and I like teaching. Academia might be what I want to do. But I also went into medical school for patients and I don't know if I'd just want to do clinical practice and if that's the case then wouldn't a regular residency be good enough.

This also leads to my next question: Should I do a research year to help optimize my chances to get into the best residency program I can get into? My school has a program that allows me to get a MS in research (practically a research year). It would be fully paid and I get a stipend. However, given my career goals, would this be something I should even do. It's a year of my life dedicated to research pretty much. I think I might do it because I like keeping my options open. Who knows, maybe when I finish my residency, I want to do academia. But if I end up just wanting to do private practice and focus on the clinical side, will this all have been a waste?

TLDR. Read first two lines. General notion of taking an entire year to do arbitrary research you don't particularly care about simply to get into "best residency possible" is mostly catered to living life based on others' opinions. You could go to a "mediocre" residency program and be a fantastic doctor.

 

[ChordaEpiphany]

TLDR. Read first two lines. General notion of taking an entire year to do arbitrary research you don't particularly care about simply to get into "best residency possible" is mostly catered to living life based on others' opinions. You could go to a "mediocre" residency program and be a fantastic doctor.

The deeper I go into this absolute pit of a pathway, the more I realize that the most surefire way to be miserable is to compare yourself to others and try to overextend.

In high school people cared about going to college and not winding up stuck in the same town they grew up in, but if you were one of the few on the honor's track, going to a brand name college mattered. Then you get to brand name college and everyone cares about getting into med school or T14 law or Wharton or whatever. Then you get to med school and everyone cares about being a NeuroRocketTesla Surgeon from Harvard with 77 BS publications. Even at Harvard, all the attendings are scrambling around, and many of them are doing research with their own bare hands, literally pipetting, to get that elusive tenure. Then they scramble for chief. Then they try their hand at being a Senator or something. It will never be enough.

I am nearly 30. I started my PhD thinking I'd keep up with Anki, get great clinical experience, publish tons of basic science, translational, and clinical papers, and match to a top tier residency so I could carve out more time for myself in a top tier fellowship for research. Then I imagined I'd be a tenure track faculty at a respected institution, guiding a well-funded lab.

Well after a year and a half of lab shutdowns and project delays and a project from hell, you know what I want now? A porch. That's it. Life is an absolute mess. Get yourself a porch and call it a day. That's all that's out there for anyone anyway.

 

[khush8]

So is it easier to get into mediocre residency programs than the Top tier ones?
For example, I am a DO. Anesthesia and Gen Surgery are competitive for DOs. But is it easy to get into mediocre Anesthesia or GS residency as a DO?

 

[efle]

Gonna add into the mix here that some people, personality wise, are incapable of being happy unless they feel like they're performing at the tip top level and surrounding themselves with the cream of the crop. This isn't just true in medicine, but definitely prevalent. Introspect a bit, think about whether you feel like being at a big name med school made any difference in your mind compared to U of State. That's basically the only reason to gun for the brand names if you intend to go into private practice.

 

[ChiDO]

I'm gonna agree with a lot of the ortho posters above. It's all about what you want to do in life and the experience you want. Being chief of ortho at wash u probably easier with an ivy pedigree. Being a Rockstar top producer in your pp group in the community...probably a great residency with early and often autonomy.

2 of our top 5 producers in my group DOs. We have mayo, has, ortho Carolina, rush, Jefferson, Andrews, etc in my group. And guess what, no patient cares because it doesn't matter in the community. We hire people who are likeable, well trained, and are a good fit to hit the ground running and produce.