Wisdom of being the first in a new program

[shaggybill]

Just wondering if anyone has any thoughts on whether or not it's a good idea to be in the "first batch" for a new family med program. What are some pros and cons that a resident might run into, both presently and in the future? Thanks!

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[Call2Call]

Well, same as you'd expect for any guinea pig, I suppose.
I can't say I'm the first, but I am in the 2nd class...
- You have to be comfortable being a trailblazer;
- staying flexible (really, really!);
- trust in your program, faculty, and community (aka leadership buy-in);
- Be comfortable being a steward of young physician reputation as a trainee (e.g. non-provider colleagues, and patients, may not know what a "resident" is; you may get a lot of, "So what are you studying to go into?" or "When do you graduate medical school?");
- Be patient (not all the bugs will be worked out during your time in the residency).
- You get to help shape the residency;
- Likely have more direct input with the program leadership;
- Likely more flexibility in your own schedule (e.g. there were only 4 months during my intern year when I was even permitted to request a vacation; here I just need to have the request in about 2mo in advance).

As long as your residency can get you to board-eligible, and you get yourself to board-certified (as long as it remains a requirement), I predict it won't have a huge impact on future career. I think coming from a fancy program can be helpful (though you'll notice for something like family medicine there are no appropriately value-based rankings; e.g. the US News & World Report scores and ranks residencies by how much work the med schools do around primary care, and how many students they produce who go into FM, IM, Peds, and either OB or Psych; doesn't include non-academic-based programs, and doesn't evaluate the residents or residencies at all); but I don't think coming from a less-well-known program (especially given there are almost 500 FM programs nation-wide) carries significant weight in the context of a primary care workforce shortage.

Happy to answer any more questions!

 

[shaggybill]

Thanks for that informative reply. Sounds like it could go either way. When you say there is more flexibility, could you elaborate a bit? Seems like there would be less flexibility since you don't have as many residents to take up the slack for when you are out, but it's likely there are factors I'm not considering. The program would be unopposed as well, if that makes any difference.

 

[futuredo32]

I have and will have more experience at this. I was in the initial class at a psych residency and am doing a second residency at a new fp program.
The psych program was great, at first. We were a small class and were taught by attendings not residents and got tons of individual attention. All was great for 18 months and I was happy as a clam. It was a unique program in that it was very therapy and outpatient based and call was 100% from home. Well, 18 months later, the DME not the PD made drastic changes and the main hospital we were supposed to train at was changed to a hospital not set up for a residency program, we took tons of call, one week I am totally serious, I worked 128 hours and complained to the DME DIO, interim PD and no one cared. So be prepared for A LOT of change. I ended up leaving for another program as it took 5 or 6 months to get a new pd and got in a car accident driving home the week I worked all those hours (other weeks it was well above 100 and this is psych not surgery). I think things now are better with respect to call hours, but it is nowhere near the primarily outpatient based curriculum. We also had a lot of input which was nice. The entire hospital had started taking residents the year prior and except for podiatry, all of the PDs left or got fired. But I wouldn't trade the good 18 months for anything and will actually be working with one of the attendings from that program.
I am starting a brand new program in FP ]'(when you are applying for a second residency and weren't a competitive applicant to start with and don't want to move far from home, you take what you can get). And ALREADY there are changes from what was discussed on my phone interview to what is being considered. Call was going to be from home, but as the year progresses, they are considering an impatient FP service with call. I am a DO who did a TRI and they were going to start me as a pgy2 and try to get me credit for some of my MD rotations. Now, they are only going to get me credit for my DO rotations (not MD as agreed and I have done my share of inpatent IM) and MIGHT start me as a PGY2 and I was going to be the only PGY2 now I will be one of three PGY2s depending on our performance initially, they may decide to make us all PGY1s. After my experience as a first in a new program I wouldn't suggest it if other options are viable. I am hoping it works and will sincerely try, but I have been an intern twice, so that would be a major deal breaker and depending on what kinda call they are considering, that could be another. Being a DO and having programs eligible for the merge wasn't in my favor for next year, so I felt like I really had little choice but to take this one. Hope it works out for me and for you too.
There are often changes in a program but MORE in a new one.