Academic v.s. Community

[JP2740]

So I'm approaching application time, and it finally dawned on me. I have been somewhat productive during residency, and everyone tells me I have a very high chance of going to some of the top places. However... I don't think I want to do research. I just don't see myself spending my time trying to get grants or being 80-20 or any of that. I like clinical medicine, and I just see myself doing scopes, seeing patients, and living a relatively normal life that way. So all along in training, you kind of feel that you need to go to the top program considering geography and all those other important things. Does this apply to fellowship? Should I go to a community program that will give me better procedural experience (with possibly equivalent training? esp. if it has a liver transplant set-up) even if it lacks in the prestige and research? Will having the prestige/research open up doors for me later? If I just want to be hospital employed or private practice, what should I do to maximize my prospects after graduating from this endless road? Assume I can go anywhere, what do I choose?

@IM2GI

@Gastrapathy

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[IM2GI]

So I'm approaching application time, and it finally dawned on me. I have been somewhat productive during residency, and everyone tells me I have a very high chance of going to some of the top places. However... I don't think I want to do research. I just don't see myself spending my time trying to get grants or being 80-20 or any of that. I like clinical medicine, and I just see myself doing scopes, seeing patients, and living a relatively normal life that way. So all along in training, you kind of feel that you need to go to the top program considering geography and all those other important things. Does this apply to fellowship? Should I go to a community program that will give me better procedural experience (with possibly equivalent training? esp. if it has a liver transplant set-up) even if it lacks in the prestige and research? Will having the prestige/research open up doors for me later? If I just want to be hospital employed or private practice, what should I do to maximize my prospects after graduating from this endless road? Assume I can go anywhere, what do I choose?

@IM2GI

@Gastrapathy

You are never wrong to go to the "best" program you can. Academia is not for everyone, and lots of people still end up going into practice out of those programs, much to their chairman and PDs chagrin. You can spend a lot of your research time in the procedure unit or on electives if you want.

Even if you think you might want to end up in practice, I would still recommend aiming for strong academic programs. The stronger your CV the more employable/marketable you are to groups. The one person I know who went form a "top" IM program to a community GI program because he thought thats what he wanted regretted it.

The main caveat to that is there is some regional bias to training, and that if you know you want to end up living in a certain area, sometimes it is helpful to train nearby.

 

[JP2740]

You are never wrong to go to the "best" program you can. Academia is not for everyone, and lots of people still end up going into practice out of those programs, much to their chairman and PDs chagrin. You can spend a lot of your research time in the procedure unit or on electives if you want.

Even if you think you might want to end up in practice, I would still recommend aiming for strong academic programs. The stronger your CV the more employable/marketable you are to groups. The one person I know who went form a "top" IM program to a community GI program because he thought thats what he wanted regretted it.

The main caveat to that is there is some regional bias to training, and that if you know you want to end up living in a certain area, sometimes it is helpful to train nearby.

I always figured a PP would value procedural experience/efficiency over the academic pedigree. It makes a difference to them that they have someone from a top academic program?


Did your friend regret it because of the lost marketability or some other reason?

 

[IM2GI]

I always figured a PP would value procedural experience/efficiency over the academic pedigree. It makes a difference to them that they have someone from a top academic program?


Did your friend regret it because of the lost marketability or some other reason?

It's hard to generalize what a private group wants. There are so many of variable sizes, and there can be regional bias.

It will be easier to transplant yourself from a big program to any region of the country, whereas community program X might be great for that region, it may be harder to move.

In some community programs you lose the "process" that you are used to in academia. The formality, the rounding, the structure, the residents/teaching.

 

[nmfms]

@JP2740 from my (limited) experience interviewing this past cycle: I can't specifically speak to community programs because I did not apply to or interview at any, but as above posters mentioned, I would be leery of them.

In regards to University/Academic programs, they vary GREATLY. Several programs I went to dedicated 12-18 months to research, and procedure numbers were adequate but by no means large. Some particularly well known "big" academic names have fabulous/brilliant/hard-working fellows, but (according to some faculty I've spoken to) their technical skills are not that great (because they emphasized more research etc while in training).

Other (typically smaller ~2-3 fellows/year) Univ programs have something like 4-6 mos research, and are aggressive in getting fellows big procedure numbers, and even offer several months of therapeutic endoscopy to fellows interested or who may need to be serviceable with ERCP in a PP job etc.

"Assuming you could go anywhere" .. it seems a smaller/less academic focused but still quality Univ setting that has a good track record of giving fellows a very broad clinical experience and still lets you dabble and do the requisite research may be the right fit. GI depts are small and you are going to want to feel like you vibe well with the PD/chief/fellows. In general, University "names" are at least known everywhere and may open doors, whereas community programs may be well less known?

 

[JP2740]

It's hard to generalize what a private group wants. There are so many of variable sizes, and there can be regional bias.

It will be easier to transplant yourself from a big program to any region of the country, whereas community program X might be great for that region, it may be harder to move.

In some community programs you lose the "process" that you are used to in academia. The formality, the rounding, the structure, the residents/teaching.

And what if the community program you match at is the general region that you want to practice in?

 

[IM2GI]

And what if the community program you match at is the general region that you want to practice in?

That becomes much more complicated, political and case by case.

There are some private groups that are mainly fed by certain programs and have incredible bias. It would be really hard to know that kind of information as a trainee.

Do you have a very strong idea of where you want to live? You can research the local private groups websites and see where they all trained.

 

[JP2740]

That becomes much more complicated, political and case by case.

There are some private groups that are mainly fed by certain programs and have incredible bias. It would be really hard to know that kind of information as a trainee.

Do you have a very strong idea of where you want to live? You can research the local private groups websites and see where they all trained.

Good idea. I'll definitely do this.

I suppose also the high ranking academic place is somewhat close to the area that I want to live, so it would not hurt to just do my training there if they would take me. There's a great community program in the area that seems to be well regarded. The other places are kind of a drop off though.