when to "chase the name"

[epsilonprodigy]

As the interview season progresses, I'm starting to take a long and hard look at my goals to try to figure out what makes sense for me. I'm a "strong applicant" to general surgery, and I'm absolutely sure I want to do trauma/critical care. I know most people change during the trajectory of their training, but think I am very unlikely to do so based on my prior healthcare experience, and the fact that I'm generally not one to waver on these things once I decide. I'm also a wife and mom of a school-age child. Thus, we have significant ties to our current area: we own a home that we got a once-in-a-lifetime deal on, my son is in a strong public school system, we have family here, and my husband's job, while portable, has a substantial client base here (i.e. moving would mean rebuilding from the ground up for him.)

My mentors have all been advising me that I'm a great applicant and should shoot for the stars- the big names. Sure enough, I have some interviews at some really phenomenal and highly-ranked programs. I've always seen myself in an academic career, mainly because a) I love to teach b) I like the environment and staying abreast of things and c) the business side of practice sounds like a PITA to me (not sure if this is applicable to trauma surgery anyway.) But the truth is, I don't really like research. It's always been a means to an end- getting into the good schools, the good residencies, etc. When I think of what I want to do after training, I want the vast majority of my time to be spent on patient care (with teaching alongside it.) Specifically, what really motivates me is working with the underserved. I was a nurse in several inner city, wild-west-like ER's and ICU's before med school and am truly passionate about helping this population.

So, ranking-wise: there's my home program, which I love, there's a community-based-university-affiliated program nearby which isn't a big name by any means, but is exactly the kind of environment I thrive in (inner-city hospital with a high volume, huge percent of penetrating trauma and REALLY sick patients), and there are the big names, which have it all, EXCEPT for the location that makes sense for my family. I just had a great conversation with the P.D. of the aforementioned community program, and thought, "wow, this guy really gets what I'm about." Although everyone seems to agree that the training is solid and the volume/acuity is amazing, my advisors all think I'm nuts for even considering going to such a program when I have the option of going for the big names. Based on my goals, would choosing one of the "lesser" programs in terms of rank come back to haunt me?

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[IMPD]

Here is what your advisors know that you don't:

-- People change their minds, get divorced, get bored with sub-optimal careers and/or feel a vague sense of "that's all?" in their mid-life. They believe, with some justification, that going to the Big Name will help prevent these things from happening and/or give you more "options" if you end up in the need-to or want-to-change your life situation.

Here is what you know that your advisors don't:

-- What is meaningful to you and what makes you happy aside from medicine.

Either choice makes sense, and I think of it as "playing defense" (Big Names) or "playing offense" (choose your own adventure). It's also possible to argue that since your work will be a major part of your life it makes sense to "maximize" it. That is generally what the people giving you advice have done, and so they have an interest in perpetuating this advice. So, it's also possible to argue that non-work choices should be maximized, which is what your children and spouse would likely ask for after they give you the obligatory "whatever makes you happy, mom" talk.

I come from a long line of people that have chosen to stay put where I grew up and make the best of it and the best contribution I can. I've traveled and did train out of town (just 60 minutes drive), but after kids entered the equation, I was happy to be back to where I came from. It's normal to feel ambivalent about these decisions whichever way you go. My wife had an offer at Man's Greatest Hospital and reminds me of that fact whenever she gets irritated at the job she took in our Middling City. And yet, she too is mostly happy to be around people and family that know us and love us for things apart from medicine.

Good luck.

 

[epsilonprodigy]

Thanks for the replies, all. Unfortunately, instead of being told "whatever makes you happy," my husband is blatantly threatening not to move with me if I don't rank with geography as the sole priority:-( obviously, this would either leave me a functionally single mom as an intern in a new city, or separate my son from me for extended periods. Part of me is so irked by his willingness to give ultimatums and failure to understand the weight of this, that I want to just go wherever I want- but like I said, it's mostly about the kiddo. I think being separated from him and/or feeling like I screwed up his life would be more detrimental to my training than a middling program.

 

[medimedimedi]

Thanks for the replies, all. Unfortunately, instead of being told "whatever makes you happy," my husband is blatantly threatening not to move with me if I don't rank with geography as the sole priority:-( obviously, this would either leave me a functionally single mom as an intern in a new city, or separate my son from me for extended periods. Part of me is so irked by his willingness to give ultimatums and failure to understand the weight of this, that I want to just go wherever I want- but like I said, it's mostly about the kiddo. I think being separated from him and/or feeling like I screwed up his life would be more detrimental to my training than a middling program.

Sorry, but it sounds like you want to sacrifice your family for pride. The community program has everything you want, so it's not like you're sacrificing your career or training. Instead, you are willing to sacrifice the well being of your child and it's saying a lot when your husband is giving ultimatums if it's unlike him to do so. It's totally a question of how selfish can you tolerate being. I had somewhat of a similar situation where I have the opportunity to go to a top 5 program but I'm not even considering it because it's selfish. Instead, I'll be going to an unranked, no name program for family reasons. It hurts my pride a lot, but I just can't be that selfish. If you can be that selfish, you can bask in your prestige and pride for the rest of your life, alone.

 

[22031 Alum]

Make sure your husband is aware that ranking with geography in mind doesn't mean matching close by. Sometimes even strong applicants can be surprised by where the Match sends them.

 

[epsilonprodigy]

Sorry, but it sounds like you want to sacrifice your family for pride. The community program has everything you want, so it's not like you're sacrificing your career or training. Instead, you are willing to sacrifice the well being of your child and it's saying a lot when your husband is giving ultimatums if it's unlike him to do so. It's totally a question of how selfish can you tolerate being. I had somewhat of a similar situation where I have the opportunity to go to a top 5 program but I'm not even considering it because it's selfish. Instead, I'll be going to an unranked, no name program for family reasons. It hurts my pride a lot, but I just can't be that selfish. If you can be that selfish, you can bask in your prestige and pride for the rest of your life, alone.

You've misunderstood me. I am saying that it's looking more and more like I will have to sacrifice prestige for my family and build my rank list accordingly. The reason being, I can't live with the idea of making my son's life any harder than it needs to be. As for your assumption about it being "unlike my husband to give ultimatums," don't be so sure. I didn't/won't get into the details of our marriage, but suffice to say that this whole situation has brought up some pretty heavy questions that need to be addressed regardless of where we live.

It's funny that you mention "basking in prestige and pride alone". I know a good handful of highly accomplished, but bitter, angry, lonely female physicians. I can't help but think that living life as the "me" show on an ongoing basis may have contributed to some of their situations. I wouldn't exactly call such people "role models," but sometimes it's helpful to have examples of what NOT to do!


Also for the record: I AM ranking a local place #1- that's never been a question, and it's not a particular reach. Am I taking a "hit" by doing this? Well, maybe, but it's one I know I can live with and remain free of significant restrictions in the future. #2 on down is where it gets tricky- that's when I start having to choose between local community programs and far stronger academic programs.

 

[ThoracicGuy]

You've misunderstood me. I am saying that it's looking more and more like I will have to sacrifice prestige for my family and build my rank list accordingly. The reason being, I can't live with the idea of making my son's life any harder than it needs to be. As for your assumption about it being "unlike my husband to give ultimatums," don't be so sure. I didn't/won't get into the details of our marriage, but suffice to say that this whole situation has brought up some pretty heavy questions that need to be addressed regardless of where we live.

It's funny that you mention "basking in prestige and pride alone". I know a good handful of highly accomplished, but bitter, angry, lonely female physicians. I can't help but think that living life as the "me" show on an ongoing basis may have contributed to some of their situations. I wouldn't exactly call such people "role models," but sometimes it's helpful to have examples of what NOT to do!


Also for the record: I AM ranking a local place #1- that's never been a question, and it's not a particular reach. Am I taking a "hit" by doing this? Well, maybe, but it's one I know I can live with and remain free of significant restrictions in the future. #2 on down is where it gets tricky- that's when I start having to choose between local community programs and far stronger academic programs.

With surgery programs, you also have to consider if you want a fellowship. The stronger your program is, the better chance you have to get one that you want. Community programs can limit you significantly in this area.

You also need to consider that training is just five to seven years... Even if you go into general surgery private practice, there is no guarantee that you wouldn't have to move for a job. What will he say then when you can't find a job and have to move?

 

[doc05]

you need to go to the best program possible. if you "settle" when it comes to your training, you regret it. which programs are you considering?? there are many community programs (and academic ones too) that do not adequately train residents how to operate.

 

[J ROD]

I am in a less competitive arena, but the big name places I interviewed at did not impress me as much as some of lesser known names. I think most places will give you the basics since they have to be accredited. Not much is different in the program structure.

It was more the personality of the program. The lesser names were more laid back and seemed to be have better interactions and I want to be there. The bigger names have an attitude like I am lucky to be there and were not nearly as friendly and in most cases to me did not have more impressive extras. In fact, to me, they were less impressive extras or missing parts.

Name means less to me than the program and location. I think I can reach my goals from any program except 1.

 

[OldPsychDoc]

"Chase the name" when you're committed to an NIH-funded academic career above all else, including your family.
But unless I grossly misread your post, you'll get everything you want in life (perhaps except "name") with your local program--and you'll still be well-positioned for a career.
Picture this: you're post call coming home on Christmas morning. What do you want to see when you open the door of your home?
It's not easy to replace familial happiness. Don't trade it in on what someone else thinks is "prestige".
But what do I know? I'm just an old psychiatrist...

 

[j4pac]

I'm going to make an assumption here that your husband isn't a dirt bag and just wants to do what's best for your family. If that is the case...and you are given the opportunity to get residency trained locally...I believe he would have just-cause to be irked that you are being so selfish with your decision. If my wife was even considering not making that compromise for her children and myself, I would really questioning the person I married.

Of course you want to go to a big named program...who doesn't? But you're married and you have a child, and therefore, you have to make sacrifices to do what's best for your family. I don't think that there is any question that allowing your husband to keep his job, not uprooting your child, and still going into your speciality of choice is a FANTASTIC compromise.

 

[j4pac]

With surgery programs, you also have to consider if you want a fellowship. The stronger your program is, the better chance you have to get one that you want. Community programs can limit you significantly in this area.

You also need to consider that training is just five to seven years... Even if you go into general surgery private practice, there is no guarantee that you wouldn't have to move for a job. What will he say then when you can't find a job and have to move?

It's an excellent conversation that the OP should have with her husband. The truth is that she should have had this conversation with her husband a very long time ago. My guess is that the OP had every intention of doing residency and practicing locally until she found out she was competitive for a big named program. Now she considering the big named, non-local programs, to the shock of her husband. Her husband feels like she is putting work over family (which she is)...and since this is the first time the possibility of moving has been discussed the OP is shocked that her husband isn't more understanding of her career goals (knowing that by moving, she would be crushing her husband's career goals).

 

[j4pac]

Gonna need some kind of a source on this one...

I blindly made the number up. Well...actually I didn't...but it will probably take me some time to find the link to the study, I read it about a year ago.

EDIT: I spent the last 5 minutes hardcore searching the article and couldn't find it. That's a much time as I can spend...so I'll recant my statement.

 

[Morzh]

I blindly made the number up. Well...actually I didn't...but it will probably take me some time to find the link to the study, I read it about a year ago.

EDIT: I spent the last 5 minutes hardcore searching the article and couldn't find it. That's a much time as I can spend...so I'll recant my statement.

You need to work on your google kung-fu.

Press release
Article (PDF) - pages 800-803

Excerpt from press release:

Over 30 years of follow-up, the divorce rate was 51 percent for psychiatrists, 33 percent for surgeons, 24 percent for internists, 22 percent for pediatricians and pathologists, and 31 percent for other specialties. The overall divorce rate was 29 percent after three decades of follow-up and 32 percent after nearly four decades of follow-up.

Physicians who married before medical school graduation had a higher divorce rate than those who waited until after graduation (33 percent versus 23 percent). The year of first marriage was linked with divorce rates: 11 percent for marriages before 1953, 17 percent for those from 1953 to 1957, 24 percent for those from 1958 to 1962 and 21 percent for those after 1962. Those who had a parent die before medical school graduation had a lower divorce rate.

Female physicians had a higher divorce rate (37 percent) than their male colleagues (28 percent). Physicians who were members of an academic honor society in medical school had a lower divorce rate, although there was no difference in divorce rates according to class rank. Religious affiliation, being an only child, having a parent who was a physician and having a divorced parent were not associated with divorce rates.

Physicians who reported themselves to be less emotionally close to their parents and who expressed more anger under stress also had a significantly higher divorce rate, but anxiety and depression levels were not associated with divorce rate.

90% is clearly hyperbole, but there was a nugget of truth in it (that female physicians have higher divorce rates than male physicians).

 

[j4pac]

You need to work on your google kung-fu.

Press release
Article (PDF) - pages 800-803

Excerpt from press release:



90% is clearly hyperbole, but there was a nugget of truth in it (that female physicians have higher divorce rates than male physicians).

Thanks...don't know how the 90% number popped in my head.

 

[chronicidal]

I blindly made the number up. Well...actually I didn't...but it will probably take me some time to find the link to the study, I read it about a year ago.

I spent the last 5 minutes hardcore searching the article and couldn't find it.

This is so classic SDN.