Academic or Community Programs / Location

[rockydoc]

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Hi all,

I would like to remain in a certain geographic area of the country if possible for residency (arizona, if not then somewhere out west).

My question is if I were open to the idea of doing a fellowship after neuro residency, then does that dictate if I shoot for academic vs community programs? What are the pros/cons of either type of program?

I ask also because places like Barrow's in Phoenix I think have a good rep yet they are still community programs.

I appreciate your thoughts

 

[rockydoc]

anyone have thoughts?

do you need to be in an academic program to get into fellowship?

 

[Mattchiavelli]

anyone have thoughts?

do you need to be in an academic program to get into fellowship?

Someone else correct me if I'm wrong, but I think Barrows is the only community residency. If that's the case, I thnk you'd be at a disadvantage seeing as everyone else is from an academic institution. It would be best if you were coming from an academic institution that has a strong program in what you're trying to do for fellowship, mainly for the exposure and references. My goal for a residency was to find somewhere that had pretty much all the subspecialties so I can do electives and see if I'd really even want to do the day-to-day of, say, an epileptologist.

 

[rockydoc]

thanks for the reply. I thought that places like Kaiser Permanente, Cleveland Clinic, Mayo Clinic, Barrow's, etc were all "community" programs. I guess I just wasn't sure why people looked down on community programs in regards to fellowship when one would think that each of these places has a large neurology department with several subspecialties represented. Why does a subspecialist from an academic program have all the hook-ups and a subspecialist from a community program not? Do community doctors never go to AAN meetings and such? I'm not being argumentative, but I just feel I've never been given a straight answer and don't want to make a wrong choice for residency.

 

[Mattchiavelli]

It's a good question- Celveland Clinic is definitely not community and Mayo isn't either (if you go to the one in MN, you will understand that the center is really really out of proportion to the dinky Rochester MN). I do know if you go to Mayo in FL or AZ they're affiliated but less bigwig academic, though you can do some aways between the three places (usually people from MN getting to FL and AZ to escape the weather 😀)Dunno about with Kaiser.

It will make a difference in, say, being at a level 4 versus a level 3 epilepsy center in as much as being exposed to more advanced diagnostic and interventions. Or, if you want to do something like neuro-onc it would be helpful to be at the tertiary center where all the complex patients end up rather than the place that recognizes a lot of them and sends them off to be worked up/treated elsewhere.

If you want to do a fairly common fellowship like stroke or neurophysiology then you will probably be fine with a community program because what you learn will be applicable to bread-and-butter community type issues. There's also the idea of what motivates you to do the fellowship- if it's for more procedures or just to specialize more because you really like something, community might fly, but if you want to do research an academic center will have a lot more research going on that you can join into.

 

[rockydoc]

Thank you! That was some helpful insight. At the moment I don't think I will be involved in much research during my career. If I did a fellowship it would be out of pure interest in the topic (of course this is all said before I am in residency and things change). But it makes more sense that if holding a good academic position in a subspecialty is the goal, then an academic residency should precede that.

 

[Head]

The pool of applicants for fellowship positions is much smaller than the pool of applicants for residency and there are often many fellowship positions that go unfilled. This makes it much less competitive. If you are shooting for a clinical fellowship to practice in an non-academic setting, I wouldn't sweat where you go to residency.

If you have your heart set on an academic career, particularly one involving research, you'd probably be better off going to the best residency you can get into. Having said that, it's very common for people to go from 2nd or 3rd tier residency program to 1st tier fellowship just because the applicant pool is much smaller. I recommend looking at the graduating class for the residency programs you're interested in. Most programs publish where their grads are going for fellowship, and this will give you a good idea of how competitive you would be.