Better to do residency at community hospital or major academic center?

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qqw

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How accurate is this:

At major academic centers = many residencies in many fields= FM is not first assist? Only see what no one else claims?

Hospitals with no other residencies = FM is unopposed? FM is first assist for everything?

If that is true, would it be accurate to say that being trained in a smaller hospital would allow you to see and do more, thus be more well rounded?

Thanks.

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Small hospitals are much better
for FM. The smallest the better, you might work harder.. In Bigger hospitals you will most likely be treated worst than a medical student..
that concept applies to the vast majority of the hospitals ( FM in small vs big hospitals )
 
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Really depends. My hospital is 550 beds with a 5-floor critical care tower and open ICU --rare for a hospital our size. Unopposed FM residency, one of the best kept secrets of the southeast.

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Depends. At Santa Monica-UCLA hospital - we are the Code Blue/Rapid Response team for the hospital. Also first assist on any C-sections if OB attending needs, handle precipitous vaginal deliveries, and OB triage. All that while handling a busy adult inpatient service, where we work with our own FM attending and an hospitalist IM attending depending on who comes into the ED (we don't discriminate when it comes to divvying up patients amongst the resident services). I appreciate having other specialties and residents around, you can learn a lot from them informally and through Grand Rounds.
 
In terms of first assist, we first assist on all Gen Surgery cases. We are the primary surgeons for all C sections (I don't even know how to first assist on a section because I've never really done it.) We're an unopposed community hospital (loosely affiliated with UCLA).
 
I've ranted elsewhere regarding how much doing a residency at a major academic center sucked and how bad the training was -- Let's just say that my residency couldn't teach a bunch of Boy Scouts what to do inside a candy store -- and yes, we were treated worse than med students --- I still have to restrain myself whenever anyone tells me how good the training was and really have to work on not going into screaming fits -- I am still very PO'd at that place and the only thing that has kept me from suing the pants off of them is that they're backed by a large state institutional system and have deep pockets -- I do periodically think about calling in the local investigative reporter and telling them where all the bodies are hidden though ---

So, yes, do yourself a favor and stay away from major academic centers if you truly want to learn family medicine --- at least, that's been my experience.
 
I've ranted elsewhere regarding how much doing a residency at a major academic center sucked and how bad the training was -- Let's just say that my residency couldn't teach a bunch of Boy Scouts what to do inside a candy store -- and yes, we were treated worse than med students --- I still have to restrain myself whenever anyone tells me how good the training was and really have to work on not going into screaming fits -- I am still very PO'd at that place and the only thing that has kept me from suing the pants off of them is that they're backed by a large state institutional system and have deep pockets -- I do periodically think about calling in the local investigative reporter and telling them where all the bodies are hidden though ---

So, yes, do yourself a favor and stay away from major academic centers if you truly want to learn family medicine --- at least, that's been my experience.

What sort of work are you doing now and do you feel comfortable/confident doing what you're doing?

I would like to be as well rounded as possible...But personally, I don't like anything surgical and don't want to be 1st assist during residency for gen surgery, Ob/GYN procedures. So that's actually a plus for me at big academic centers. However, I don't want to only see ear infections and colds either.
 
From what I ve seen of various programs:

Un-opposed = guaranteed to do tons of OB!!! with way less of medicine experience, more random procedures overall, better ED experience overall.

University/opposed program= less OB, but better gyn/women's health experience, better Medicine experience, probably less procedures, slightly less ED experience.
 
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How accurate is this:

At major academic centers = many residencies in many fields= FM is not first assist? Only see what no one else claims?

Hospitals with no other residencies = FM is unopposed? FM is first assist for everything?

If that is true, would it be accurate to say that being trained in a smaller hospital would allow you to see and do more, thus be more well rounded?

Thanks.

This is just my 2 cents but more important than just "community vs. academic" is "do you fit in the program?"

When I was on interview trail, I interviewed at a small community program where all residents I met had families/married, had deep connection to the town, all residents were looking to live/work there after residency. Sure you will get good training but I personally would never fit in the program culture.

so more important than just generalizing community vs academic.... see if you actually fit the program culture, would work well with faculty/staff/residents, fit in the culture of the city, etc. I think "fit" is more important
 
Small hospitals are much better
for FM. The smallest the better, you might work harder.. In Bigger hospitals you will most likely be treated worst than a medical student..
that concept applies to the vast majority of the hospitals ( FM in small vs big hospitals )

Smaller hospital you get to do everything.

I seem to be in disagreement with most here.

I chose to do my residency in a large, tertiary care center w/ extensive specialist services while my outpatient clinic was in the poor inner city area. The hospital had 3 internal medicine teams + FM teams. We alternated patients who were "unassigned" + would take patients from ours or the other 3 FM outpatient clinics.

I was involved in cases most would never get to see considering the size and tertiary care status of the hospital. I have managed extensive HIV patients, endless hospice/end of life patients, rare/tropical diseases. Thru consults/sub-specialists I think my knowledge advanced greatly. I am very procedure based and did not have a problem getting the procedures I wanted- I had done >30 paracentesis, countless (>100) joint injections, a couple thoracentesis, >10 IJ lines, >20 ABGs before residency was over.

We did our OB/womens health at the Womens/childrens hospital. I had >80 vaginal deliveries - including VBACs and augmented labor/delivery, lots from a FM group who did refugee medicine. I have done multiple 1/2/3 degree perineal repairs, lots of amniotomy, FHT monitor placements, >10 vacuum assisted deliveries.

For outpt, a large amount of our innercity patients were uninsured and medicaid. Often they could not get access to specialists due to financial or transportation reasons (lots of our pt's walked to the clinic), and we were the first and last line for these patients.

If I was to do it again I would do it the exact same way. I loved being in the inner city, talking with gangstas/homeless/mentally ill. I had families were I would see the kids, parents, grand parents, and cousins. There was a rawness/realness that I do not think you will get in a suburban community.
 
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