Now in "top" residency program, but want different environment for fellowship

[hikikomori]

I am currently training in one of the "top" 10 programs.
The training is solid. But I am sick with the environment... academic snobs, red tapes, hospital systems that are too big and too well-funded to change.In other words, it is not the right fit in terms of personality and culture. Yes, I am paying the price for ranking "name" over my true preference.
I do not want to end up in the same environment for fellowship if I can help it.
I don't care about getting an academic job in a top institution. I do care about getting a job in major cities like SF or NYC for family reasons.
Would my pedigree of training matter much in job search?

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[Mman]

I am currently training in one of the "top" 10 programs.
The training is solid. But I am sick with the environment... academic snobs, red tapes, hospital systems that are too big and too well-funded to change.In other words, it is not the right fit in terms of personality and culture. Yes, I am paying the price for ranking "name" over my true preference.
I do not want to end up in the same environment for fellowship if I can help it.
I don't care about getting an academic job in a top institution. I do care about getting a job in major cities like SF or NYC for family reasons.
Would my pedigree of training matter much in job search?

I'd guess that yes, your pedigree of training will matter if you have a job search that is geographically narrow. I'd suggest doing a fellowship in NYC if that's where you want to live afterwards.

 

[boggy]

If you are in a so called "top" residency but then end up some lesser fellowship program at an average program the conclusion from those likely to hire you will be that you were a poor performer in that "top" residency and were sent down to a lower level fellowship. Plus, anesthesiologists are a dime a dozen in New York and San Francisco so you will need every prestige element possible to find a job in those markets. And even with all that you are likely to be exploited financially once you start working. Best advice is to do a similarly prestigious fellowship and hope for the best in the job market in your narrow geographic areas

 

[nap$ter]

I am currently training in one of the "top" 10 programs.
The training is solid. But I am sick with the environment... academic snobs, red tapes, hospital systems that are too big and too well-funded to change.In other words, it is not the right fit in terms of personality and culture. Yes, I am paying the price for ranking "name" over my true preference.
I do not want to end up in the same environment for fellowship if I can help it.
I don't care about getting an academic job in a top institution. I do care about getting a job in major cities like SF or NYC for family reasons.
Would my pedigree of training matter much in job search?

don't listen to em.

i did this - was a top resident in a top powerhouse program and chose a small no-name fellowship. all i cared about was the case exposure. teaching was personalized and i had choices about my own curriculum. best choice i ever made.

you don't need to do your fellowship in an academic powerhouse if you don't want to work at one.

your residency letters of rec will mention your caliber. you can explain your choice of fellowship.

i had my choice of the jobs i wanted (although i didn't want to live in a major city).

you do need to bow your head and toe the line and work hard in your residency. make the most of it.

you should also start establishing contacts in the cities/groups you want to work with now - the earlier the better.

 

[deleted126335]

All of the above posters point of view have merit. The truth is there is no magic formula. Luck, timing, flexibility are all huge factors. Top name brand credentials never hurt. How much they help an individual is open to debate. In my case they were huge in getting my CV noticed in an area where I had no ties. My group just happen to be looking at the right time for me and none of the senior docs contacts at the training programs they attended had any all star candidates that were willing to relocate to our less than desirable metro area at that time. There is no magic formula.

 

[Mman]

i had my choice of the jobs i wanted (although i didn't want to live in a major city).

And that's the difference. If you don't care where you work, finding a job is infinitely easier. If you have only 1 or 2 cities where you want to work, it can be damn near impossible. Lots of stuff you have no control over has to line up just right. I still say if you want to work in a particular geographic area, you should do residency or fellowship there. The majority of jobs are given to people with personal contacts to the job. Going to a "lesser" fellowship 1500 miles from NYC won't exactly help open any doors there for a job. That's why I think if you are really restricted geographically you need to be very particular about where you train.

 

[nap$ter]

And that's the difference. If you don't care where you work, finding a job is infinitely easier. If you have only 1 or 2 cities where you want to work, it can be damn near impossible. Lots of stuff you have no control over has to line up just right. I still say if you want to work in a particular geographic area, you should do residency or fellowship there. The majority of jobs are given to people with personal contacts to the job. Going to a "lesser" fellowship 1500 miles from NYC won't exactly help open any doors there for a job. That's why I think if you are really restricted geographically you need to be very particular about where you train.

i do care where i work. i initially applied for jobs in large (very desireable) cities, and some smaller towns (still regional referral centers; very desireable cities). i chose the smaller city job (i had offers in the big cities). i had my choice of jobs. we're talking pacific northwest, not the southeast

a prestige residency and fellowship won't help you if you hate your position and it is reflected in your work and recommendations. if you are top of your class wherever you are and it is reflected in your letters and you have good contacts you will have choices.

you do need prestige academic residency and fellowship creds if you want to work in the ivory towers.

but, if you just want the better jobs in the best cities, contacts and letters of rec are powerful. and in this global world of the internet, you really don't need to do your training in the city you want to end up in. you probably don;t know enough yet to choose your city definitively - things change.

 

[Mman]

i do care where i work. i initially applied for jobs in large (very desireable) cities, and some smaller towns (still regional referral centers; very desireable cities). i chose the smaller city job (i had offers in the big cities). i had my choice of jobs. we're talking pacific northwest, not the southeast

a prestige residency and fellowship won't help you if you hate your position and it is reflected in your work and recommendations. if you are top of your class wherever you are and it is reflected in your letters and you have good contacts you will have choices.

you do need prestige academic residency and fellowship creds if you want to work in the ivory towers.

but, if you just want the better jobs in the best cities, contacts and letters of rec are powerful. and in this global world of the internet, you really don't need to do your training in the city you want to end up in. you probably don;t know enough yet to choose your city definitively - things change.

disagree. Good jobs are hard to get. If you want to live in a particular city, the best residency/fellowship is in that city. If not, the 2nd best option is a prestigious name that will at least get your application noticed.

I agree that you shouldn't choose a fellowship you hate. That's not what I've suggested. I'm just saying that the narrower your focus on a job hunt, the better your credentials need to be. You can just say oh I want to work in NYC and I'm going to some random fellowship in Indiana and get some awesome letters of rec and then work in NYC. Letters of rec are almost irrelevant to a job search in private practice. We don't even ask for any. But contacts do matter. That's why where your fellowship (or residency) is counts.

If I was providing career advice, I'd say the best advice is try to be open minded about location. Because the more open that is, the easier the overall search will be. If your choice is I want to work in NYC or San Fran, well good luck. Best bet is finding a low paying academic job.

 

[IlDestriero]

disagree. Good jobs are hard to get. If you want to live in a particular city, the best residency/fellowship is in that city. If not, the 2nd best option is a prestigious name that will at least get your application noticed.

I agree that you shouldn't choose a fellowship you hate. That's not what I've suggested. I'm just saying that the narrower your focus on a job hunt, the better your credentials need to be. You can just say oh I want to work in NYC and I'm going to some random fellowship in Indiana and get some awesome letters of rec and then work in NYC. Letters of rec are almost irrelevant to a job search in private practice. We don't even ask for any. But contacts do matter. That's why where your fellowship (or residency) is counts.

I agree with this 100%.
If you want a job in one or two specific very competitive areas, do a fellowship there. If you can't, the best program that you can get into is the next best choice.
BTW, don't assume all the fellowships are the same as residency all over again. My Children's Hospital is night and day opposite of the well known adult hospital next door, which is much more malignant and backwards than the highly regarded place where I trained.
Interview around, ask specific questions about your concerns, and keep an open mind.
Good luck!

 

[bonesmd]

I am currently training in one of the "top" 10 programs.
The training is solid. But I am sick with the environment... academic snobs, red tapes, hospital systems that are too big and too well-funded to change.In other words, it is not the right fit in terms of personality and culture. Yes, I am paying the price for ranking "name" over my true preference.
I do not want to end up in the same environment for fellowship if I can help it.
I don't care about getting an academic job in a top institution. I do care about getting a job in major cities like SF or NYC for family reasons.
Would my pedigree of training matter much in job search?

What kind of fellowship do you want to do? That will probably matter too

 

[Guillemot]

If you dont want bull**** then getting a job in a big city might not be the best idea.

 

[BuzzPhreed]

What kind of fellowship do you want to do? That will probably matter too

x2

Tell us what fellowship. This has a lot of ramifications about where you might work too. If it's peds or CC, you're probably going to end up in some academic center anyway.

 

[hikikomori]

Since I do not even like being in the OR, my only option is CCM. I don't like pain. I am thinking of doing another residency and be a hospitalist. But that is another discussion. I am stuck with my residency for now.

 

[nimbus]

Since I do not even like being in the OR, my only option is CCM. I don't like pain. I am thinking of doing another residency and be a hospitalist. But that is another discussion. I am stuck with my residency for now.

Residency and PP are worlds apart. I was not a fan of the politics and pompous attitudes encountered during residency but the OR's in my current and previous PP gigs have been incredibly pleasant.

I suggest stepping away from the ivory tower and give PP a try before giving up anesthesia altogether.