Cutting through the BS in choosing a residency

[gratefulgas]

Hi Guys,

Alright, so after years of lurking around these forums, Jet and others have inspired me, against my better judgement, to start contributing once in a while. But since I have nothing to contribute, I've decided to make this thread instead.

I'm interested, and I know a lot of other residency applicants are too, in hearing what some of the post-residency docs here think about choosing a program. My perspective, being a bit older than some of my peers, is that this entire process is mostly a joke. We go to these interviews, everybody smiles and plays nice, every negative is spun as a positive, the happy residents show up to the dinner and the bitter ones, if they exist, are never seen or heard. The name-brand programs pat themselves on the back, stick their chests out in the air and pretend that every doc wishes they could've gone there. The smaller programs put on a smug little smirk and tell themselves and us that they are the rare hidden gem that produces superior, private-practice-ready clinicians, and by the way those fellows are just going to do every heart and liver while you stand in the corner.

This is all hyperbole. Everyone has been mostly pretty cool, but you get my point. I want to go somewhere that I'll get good training and be happy and come out fearless. The concern is, if I go to a smaller program, by which I mean not a top 10 or 15 program, am I going to regret it? Do YOU regret it? I don't think I want to be a chair or a PD some day, but what if I do? I think I want to work in a large private-practice some day, assuming such a thing still exists in 5 years, but what if I don't? Does it even matter? Have you lost out on opportunities because you chose a smaller name over a bigger one? Did you lose out on time, extra money and a head full of hair with nothing to show for it by choosing a big name over a smaller one? Is a ruptured AAA in Vermont different than a ruptured AAA in Pittsburgh?

And yes, I know this has all been discussed before. If you have some thoughts, share them. Particularly if you're the guy who is reading this and doesn't want to chime in, because that's who I'm especially interested in hearing from.

---

Members don't see this ad.

 

[anbuitachi]

Hi Guys,

Alright, so after years of lurking around these forums, Jet and others have inspired me, against my better judgement, to start contributing once in a while. But since I have nothing to contribute, I've decided to make this thread instead.

I'm interested, and I know a lot of other residency applicants are too, in hearing what some of the post-residency docs here think about choosing a program. My perspective, being a bit older than some of my peers, is that this entire process is mostly a joke. We go to these interviews, everybody smiles and plays nice, every negative is spun as a positive, the happy residents show up to the dinner and the bitter ones, if they exist, are never seen or heard. The name-brand programs pat themselves on the back, stick their chests out in the air and pretend that every doc wishes they could've gone there. The smaller programs put on a smug little smirk and tell themselves and us that they are the rare hidden gem that produces superior, private-practice-ready clinicians, and by the way those fellows are just going to do every heart and liver while you stand in the corner.

This is all hyperbole. Everyone has been mostly pretty cool, but you get my point. I want to go somewhere that I'll get good training and be happy and come out fearless. The concern is, if I go to a smaller program, by which I mean not a top 10 or 15 program, am I going to regret it? Do YOU regret it? I don't think I want to be a chair or a PD some day, but what if I do? I think I want to work in a large private-practice some day, assuming such a thing still exists in 5 years, but what if I don't? Does it even matter? Have you lost out on opportunities because you chose a smaller name over a bigger one? Did you lose out on time, extra money and a head full of hair with nothing to show for it by choosing a big name over a smaller one? Is a ruptured AAA in Vermont different than a ruptured AAA in Pittsburgh?

And yes, I know this has all been discussed before. If you have some thoughts, share them. Particularly if you're the guy who is reading this and doesn't want to chime in, because that's who I'm especially interested in hearing from.

highly doubt ppl will say they regret not going to a top 10-15 school... most applicants can't make it to a top 10-15 school, im sure they end up being fine..

 

[seinfeld]

Went to a respectable national program, came out knowing there is very little I had not done and that which i was not exposed i was not scared of. When I take interview candidates, I do look at where someone is trained. If they have been out in practice I look to see cases they are doing/done.

Name recognition matters to the extent if makes a recruiter like me comfortable and helps get you into an interview. After that it comes back to who you are as a person, how your references phrase your evaluation. It will rarley hurt you have a top program on your CV but is may limit you if you go to a small regional program on the opposite side of the country from where you want to live.

 

[Morzh]

Thanks for posting OP. I'm a MS3 and you've described many of my own concerns about how to approach the application season next year.

I go to a Texas school am actually from the city my school is in. My wife is from here and all our family is here. The local residency is a good university program but doesn't have a nationally-known big name or anything. I probably want to eventually practice in (or within 100 miles) of this particular program. I'm not sure how much my life and career would benefit from uprooting to a big name program. But at the same time I have the drive to become a "rock-star" anesthesiologist (also want to be competitive for fellowships; thinking about CCM), and worry that I may be shortchange-ing myself if I were to give up a spot at a more nationally reputable program (should I even be offered one, of course).

 

[nimbus]

Thanks for posting OP. I'm a MS3 and you've described many of my own concerns about how to approach the application season next year.

I go to a Texas school am actually from the city my school is in. My wife is from here and all our family is here. The local residency is a good university program but doesn't have a nationally-known big name or anything. I probably want to eventually practice in (or within 100 miles) of this particular program. I'm not sure how much my life and career would benefit from uprooting to a big name program. But at the same time I have the drive to become a "rock-star" anesthesiologist (also want to be competitive for fellowships; thinking about CCM), and worry that I may be shortchange-ing myself if I were to give up a spot at a more nationally reputable program (should I even be offered one, of course).

There are many paths to becoming a rockstar. All of them involve working your ass off and maintaining a rockstar mentality. It can be done at any decent program but it may be easier if you're surrounded by like-minded peers.

 

[deleted171991]

Hi Guys,

Alright, so after years of lurking around these forums, Jet and others have inspired me, against my better judgement, to start contributing once in a while. But since I have nothing to contribute, I've decided to make this thread instead.

I'm interested, and I know a lot of other residency applicants are too, in hearing what some of the post-residency docs here think about choosing a program. My perspective, being a bit older than some of my peers, is that this entire process is mostly a joke. We go to these interviews, everybody smiles and plays nice, every negative is spun as a positive, the happy residents show up to the dinner and the bitter ones, if they exist, are never seen or heard. The name-brand programs pat themselves on the back, stick their chests out in the air and pretend that every doc wishes they could've gone there. The smaller programs put on a smug little smirk and tell themselves and us that they are the rare hidden gem that produces superior, private-practice-ready clinicians, and by the way those fellows are just going to do every heart and liver while you stand in the corner.

This is all hyperbole. Everyone has been mostly pretty cool, but you get my point. I want to go somewhere that I'll get good training and be happy and come out fearless. The concern is, if I go to a smaller program, by which I mean not a top 10 or 15 program, am I going to regret it? Do YOU regret it? I don't think I want to be a chair or a PD some day, but what if I do? I think I want to work in a large private-practice some day, assuming such a thing still exists in 5 years, but what if I don't? Does it even matter? Have you lost out on opportunities because you chose a smaller name over a bigger one? Did you lose out on time, extra money and a head full of hair with nothing to show for it by choosing a big name over a smaller one? Is a ruptured AAA in Vermont different than a ruptured AAA in Pittsburgh?

And yes, I know this has all been discussed before. If you have some thoughts, share them. Particularly if you're the guy who is reading this and doesn't want to chime in, because that's who I'm especially interested in hearing from.

It seems you already have a pretty good idea about the process, so you won't be easily fooled.

My advice is too look for a name/brand with national recognition, either in anesthesia or just in medicine. This will open all the right doors post-residency, for a job or a fellowship. A big program will expose you to more experience than a small one, so I would choose the former.

The one thing you have to pay attention to is whether the program is nicely-rounded. Some of the bigger names expose you to sick patients on a daily basis, while sucking royally at simple B&B stuff such as regional anesthesia. Every program has weak spots, but be careful that their weakness does not become your post-graduation weakness.

Another thing (which actually made me choose a lesser known fellowship program at the North Pole over a bigger name at my favorite South Pole) is gut feeling. In my particular case, I liked almost every single person I met in the program, I liked their approach to things, I liked the hospital, I even liked the funny crap they printed on their garbage cans.

 

[deleted171991]

Thanks for posting OP. I'm a MS3 and you've described many of my own concerns about how to approach the application season next year.

I go to a Texas school am actually from the city my school is in. My wife is from here and all our family is here. The local residency is a good university program but doesn't have a nationally-known big name or anything. I probably want to eventually practice in (or within 100 miles) of this particular program. I'm not sure how much my life and career would benefit from uprooting to a big name program. But at the same time I have the drive to become a "rock-star" anesthesiologist (also want to be competitive for fellowships; thinking about CCM), and worry that I may be shortchange-ing myself if I were to give up a spot at a more nationally reputable program (should I even be offered one, of course).

Go do a residency at a big name, then do a good fellowship close to home.

 

[Mman]

My only/best advice is to ask about where former residents work at each program. If the majority of recent grads are working in jobs (or getting fellowships) that you would enjoy, then that is a good program for you.

Most anesthesiologists (and residents and students applying) are nice people. There is something about the job that self selects for that personality. So at most (maybe all) programs you will have a majority of people having fun at their job. I don't think it's just hyperbole, it's true. But I did come across at least 1 program that had less than happy residents during interview day and dinner. Needless to say I didn't rank them and was glad in hindsight to have not done so. I think most residents will be honest with you if you ask for pros and cons of their program.

 

[jthedestroyr]

"Gut Feeling"

This is a a tough call I feel. My top choice I got a very mixed gut feeling. Prior to the trail they were my #1, and they are still my number 1, although I didn't get that "warm & fuzzy feelings" I got from a few other programs. I guess no program is exactly perfect and at the end of the day you hope you end up at the best program for you.

I'm pretty confident my top 5 are solid programs for me and I'd be excited to train at any of them.

 

[deleted171991]

"Gut Feeling"

This is a a tough call I feel. My top choice I got a very mixed gut feeling. Prior to the trail they were my #1, and they are still my number 1, although I didn't get that "warm & fuzzy feelings" I got from a few other programs. I guess no program is exactly perfect and at the end of the day you hope you end up at the best program for you.

I'm pretty confident my top 5 are solid programs for me and I'd be excited to train at any of them.

In my experience, when my gut says something is fishy, there is something fishy. It works 90+% with people (I rarely end up liking people I don't at first sight, even after getting to know them well), so I tend to listen.

You should ask yourself: What is your subconscious telling you by the very mixed gut feeling you got? What aren't you aware of?

 

[jthedestroyr]

I think the mixed feeling I got was due to the interview structure since it's one of the bigger programs. Most the programs I've interviewed at are mid sized (8-15 per class) and this program is pretty big (although not the biggest program, but close).

The residents were pretty friendly and I got along well with people I met, although there were a few other applicants that were pretty big dbags. I was pretty put off by this because I thought, man if I was in residency with this guy it would be a rough 4 years.

 

[deleted171991]

Don't worry about the applicants. They might have looked good on paper. Worry only about the current residents/attendings.

I actually chose a lesser known fellowship program over a bigger name because I did not like the latter's fellows (among others). It was the straw that broke the camel's back.

 

[jthedestroyr]

My top are solid programs hands down. I think I interview pretty well and I have been told I come across as genuine, passionate and pretty quick on my feet. Hopefully I was able to impress my top choices enough for them to rank me high.

At this point, I really don't think I've had any particular bad interviews. I've felt some interviewers went better than others, but all of them have been very fluid with great conversations. I had one interview that was "strange" but the residents actually warned us before hand that this particular faculty is just weird and that anything he said was not indicative of what the program may think of us, nor is he representative of the program.

 

[Mman]

I don't agree. I wouldn't use the word "nice". I would use "slick". No offense to the many nice people posting on this forum.

This is a 30 second-elevator pitch type of job. It self selects for smart thick-skinned salespeople, not nice people. Actually nice people could get very unhappy in the OR environment.

I'd call 90% of the people I worked with in residency (attendings, fellows, residents) nice.