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Advantage of going to a top residency program

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The_Sunny_Doc

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Forgive me if this is a silly question, but what advantage is there to going to a top residency program? Does it make you a better doctor because of the more advanced training you'll receive? What if you'd just like to own your own practice and not conduct research? The last thread made about this appears to be 3 years old.

Thanks for any insights.
 

JimmyB123

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Ego. Research. Fellowship opportunities. Don't know about money though
 
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invisibleman023

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What if you'd just like to own your own practice

That doesn't happen anymore.

But yeah a "top" residency doesn't necessarily correlate with better training. Many ACGME residencies will make you a good doctor. I would suggest going for a university program over a community one though simply because you'll find more interesting/tougher cases and if you want to pursue a fellowship, it'll be a lot easier.
 
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SLC

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That doesn't happen anymore.

But yeah a "top" residency doesn't necessarily correlate with better training. Many ACGME residencies will make you a good doctor. I would suggest going for a university program over a community one though simply because you'll find more interesting/tougher cases and if you want to pursue a fellowship, it'll be a lot easier.

This is basically it, though I'd add the caveat that in Family Medicine, the community hospitals tend to offer far better training than the academic centers. This is because there aren't other residents around to compete with for cases. In FM you sorta need to learn everything, so the more "unnopposed" the residency program, the better.

In fact, some university systems are moving their FM programs out of the university hospital and into nearby community hospitals for just this reason.
 
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racerwad

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That doesn't happen anymore.

But yeah a "top" residency doesn't necessarily correlate with better training. Many ACGME residencies will make you a good doctor. I would suggest going for a university program over a community one though simply because you'll find more interesting/tougher cases and if you want to pursue a fellowship, it'll be a lot easier.

I disagree, but going to a top residency does correlate with better training - otherwise, what makes it the "top"? I agree that the top program in a given specialty may not have a lot of name recognition amongst distant friends and family, but it will be better than its peers for a reason. I agree with SLC that being university based isn't always the best and this can vary by specialty, but there is definitely variation across programs. The worst program will probably still allow you to obtain the minimum necessary training, but it will come at the cost of efficiency, opportunities, and networking opportunities for the future. Everyone should try to go to the best program they can, knowing that what makes a program the best can vary by specialty and professional goals.

I've just finished my interviews and it was eye-opening the differences between some programs.
 
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BrooklynBulls

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Telling different "tiers" of residency apart is easy. How much scut you have, the amount of patient/pathologic variety, research opportunities, perks (personal days, moonlighting, "educational" funds, etc), fellowships associated with the program, name brand of the hospital, history of fellowship placement among past residents, fame of faculty, and probably the most obvious, location, are all ways to tell how important a program is to MOST people, and therefore where it "ranks."

Better doctor? Hard to define what a "better doctor" even is. It should help you have more career opportunities. It should help you subspecialize. It should make sure you're very competent, but competence is derived just like it was in medical school-- only the lowest bar of "passing" is required. By how much you pass? That's entirely up to you, your motivations, and your aspirations.
 
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notbobtrustme

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what are your goals? If you want to treat patients, you can learn to do this at most any residencies.

If you want to write chapters for Harrison's Internal Medicine, you need to get that high powered connections that come with a top program.
 
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ChrisGriffen

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Residencies are considered good if they allow for research, good pathology, minimal scutwork, good pay, high fellowship placement history, strong didactics, etc.

"top" residencies in your respective location have all/most of these

Depending on what you are looking for, there may be no advantage to going to one of those programs.


There is a reason you get to submit a personal rank list.
Your "top" residency will be what you and only you choose. The advantages of going to your "top" choice are going to be what you decide.
 
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ChrisGriffen

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But if you interview at Mass General, you rank that number 1.
 

Instatewaiter

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But if you interview at Mass General, you rank that number 1.

Really when you interview there it's just a bunch of cardboard cut outs that make it look like a huge building. In reality MGH is just a community hospital behind an impressive looking facade
 

ChrisGriffen

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Really when you interview there it's just a bunch of cardboard cut outs that make it look like a huge building. In reality MGH is just a community hospital behind an impressive looking facade


Just like the fate of the ol' number 6 huh?
 

Instatewaiter

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No I've just never seen blazing saddles
 

Instatewaiter

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Does going to a better residency program allow you to have an easier time getting jobs as an attending?

Yes, espeically in job markets where it is tough to get a job
 
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DopaDO

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Pretty amazed by what I've seen in this thread. There are huge advantages to going to a top residency program and there are even more advantages for going into academic program vs community. First off, alumni base in huge. One of the reasons I chose my program is because they have produced physicians in every part of the country. Connections are very big, especially in smaller fields like mine. Community programs often see their residents settle down in the area they trained because potential emplolyers/partners outside of the community programs city/region won't have any clue about the quality or lack thereof of the residency.

Additionally while there may not be a huge difference between #10 and #20, the difference between #20 and #60 is going to make a difference in both fellowship and job opportunities.

You don't know what your goals will be in the future. Keep your options open - you only get to train once. While quality of training is not the most important thing to consider on your rank list imo, it's definitely up there and should absolutely be considered.

Edit: Med school prestige I'd considered important by many premeds. Residency is where you learn to be a physician, not med school. Why wouldn't residency be even more important? Here's the kicker, it is more important. Everything you do in med school is not to learn how to be a physician. All that matters in med school is becoming the best residency applicant you can be so you can go to a great program and become a great physician. There's a reason people fly to MD Anderson from all over the country instead of going to their backyard community hospital.
 
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SurgeDO

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bragging rights.

five years out of residency you'll be practicing the same way the colleagues around you practice. if you are still practicing what you learned in residency, you are outdated.
 
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costales

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Pretty amazed by what I've seen in this thread. There are huge advantages to going to a top residency program and there are even more advantages for going into academic program vs ACGME.

What?
 
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DopaDO

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Sorry for the typo, I meant community.

As for the post having a lot of misinformation... idk what to tell you. Those are my experiences from what ive seen and heard from faculty at academic programs. While it could be different for certain specialties (family does come to mind), in general you will have more opportunities coming from a stronger residency than a weaker one. Quality of residency is important. You only get to train once.
 
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racerwad

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Sorry for the typo, I meant community.

As for the post having a lot of misinformation... idk what to tell you. Those are my experiences from what ive seen and heard from faculty at academic programs. While it could be different for certain specialties (family does come to mind), in general you will have more opportunities coming from a stronger residency than a weaker one. Quality of residency is important. You only get to train once.

I agree with you, DopaDO - something seems to happen with pre-meds who are super concerned about "med school prestige" and then become so meh regarding where they do their training.

Has everyone just busted their ass to get into/survive medical school, just to settle on a training program that will affect the rest of their careers?

Life is all about networking and making the most of your opportunities. Hopefully, you try and pay it forward when you can to continue the cycle. Why wouldn't anyone want to be at their respective field's "top" program? There is a lot of variability among programs and applicants that make one place more attractive than another between two individuals, but let's be realistic and acknowledge that there are places that do a better job than others at training residents.

Back to the OP, yes, this is a silly question. There are myriad reasons why going to a top residency program is better. BrooklynBulls made a great list and other variables will become clear to you when you're out interviewing and comparing programs. Don't bother working so hard just to roll over when it comes to choosing a residency.
 
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dozitgetchahi

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If you want to get into a specialty like IM where the majority of people want fellowships aftwerwards, then yes the 'quality' of the residency program will be extremely important. It could be the difference between getting a fellowship in a competitive subspecialty vs getting nothing at all.

In specialties were relatively few pursue fellowships, then it is perhaps less important but still can be very meaningful.
 

hallowmann

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    To some degree I think that comes down to maturity.

    Premeds are chasing that USNews ranking. Prestige drives all, even at the cost of hundreds of thousands of dollars of extra loans in many students' cases.

    Four years, a lot of hard work, and a little growing up later - people's priorities change a bit. Some people just want to get off the rat race as quickly as possible and get a real job. Others have families and kids and don't particularly want to move to Boston just because that's where the "BEST" program is. Others have realized they don't actually like research or academics all that much and their definition of a "top" program may be very different.

    This is really important here. The bottomline is that it depends on your goals. Some people want the big academic job, competitive fellowship, etc. Other people want to finish their 4-5 years at the program where they'll be able to stay close to family and where they like the atmosphere. All of these factors shape the programs that are perfect for you.

    I know some people that left high ranking programs in the middle of PGY1 to transfer elsewhere, because they didn't like the environment. Obviously good academic programs are essential for certain fields and in order to pursue fellowships, but that's not always (nor does it have to be) the most important thing to everyone.
     
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    Dharma

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    Connections. Access. Variety. Opportunities. (Relatively speaking). The game doesn't change all that much.
     

    SLC

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    To some degree I think that comes down to maturity.

    Premeds are chasing that USNews ranking. Prestige drives all, even at the cost of hundreds of thousands of dollars of extra loans in many students' cases.

    Four years, a lot of hard work, and a little growing up later - people's priorities change a bit. Some people just want to get off the rat race as quickly as possible and get a real job. Others have families and kids and don't particularly want to move to Boston just because that's where the "BEST" program is. Others have realized they don't actually like research or academics all that much and their definition of a "top" program may be very different.

    This is really important here. The bottomline is that it depends on your goals. Some people want the big academic job, competitive fellowship, etc. Other people want to finish their 4-5 years at the program where they'll be able to stay close to family and where they like the atmosphere. All of these factors shape the programs that are perfect for you.

    I know some people that left high ranking programs in the middle of PGY1 to transfer elsewhere, because they didn't like the environment. Obviously good academic programs are essential for certain fields and in order to pursue fellowships, but that's not always (nor does it have to be) the most important thing to everyone.

    This is much of what I had originally typed up in response to DopaDO's post. But I was typing on my iPhone and for some reason the cut and paste thing is all screwed up and the formatting ended up ruined and I just bagged the response.

    My response that there was a lot of misinformation in Dopa's post was too harsh. I certainly respect DopaDO and I see his/her point. I just think it was stated in a way that seemed too overreaching to me.

    I guess I was just going to write that there are alumni bases from every program out there that's been around a while, community and academic alike. In Phoenix, there's a huge base of doctors from almost all the specialties that trained at Banner Good Samaritan, a community program (and a really good one at that). Mayo-Scottsdale is starting to make it's mark too. One thing I've noticed is that people tend to settle near where they train for residency. This is nowhere near universal but in Oregon a goodly chunk of the docs trained at OHSU, the Providence IM places, and UDub. In AZ, the vast majority had trained at Banner Good Samaritan, UofA, and Mayo-Scottsdale. I suspect this trend holds true across the country.

    What I guess I'm saying is that academic or not, you're most likely to find locally trained docs in any given location. And the non-local ones tend to be from all over. I really don't think that if you train at University of Iowa, that you're going to have an easier time finding a job in Portland, OR because there's going to be this large "alumni base" there that will help get you the job.

    Where residency ranking means something really important IMO is fellowship opportunities. As has been mentioned by racerwad earlier, name recognition matters there. But if your goal is to become a regular old Dermatologist, Urologist, Radiologist, Anesthesiologist, Hospitalist etc etc and just go to work at a hospital and make a living, you can do that anywhere. In other-words, if you want to go to residency, learn to practice your field to the best of your ability, and then go to work, you will be able to do that from anywhere. If you want to really subspecialize and be the dermatologist that focuses on esoteric dermatologic manifestations of psychiatric disorders or something strange like that, then going to a big academic center is going to be in your best interest.

    But most aren't interested in that, they just want to get off the ride they've been on for the past decade or so as soon as possible. They want to spend their residency training years in a nice program, in an area they're comfortable living in, or in a place that makes sense for a significant other and/or kids that may be in the picture. Then they want to find the best job possible, and start making some friggin money for once and get out of the pile of debt they spent the prime of their life accumulating.

    The other thing about high ranking academic programs (and it's related to the esoteric specialization thing I mentioned above) is that they are essential for folks vying to become an academic practice doc. This career path tends to pay far less, but has important perks for some. For example: there's a lot of prestige out there in being an authority on something, and some folks are looking for that more than they're looking for anything else. But most folks aren't hoping to become Chair of surgery at University of Ivory tower when they're applying for residency though, so this again is a fairly small and select group IMO.

    Academic residencies are good for fellowship matching (in most fields) and for putting residents on a track for academic medicine practice. But if one's goal does not include those things, I really think it's best to pick a place you want to be regardless of whether it's highly ranked or not.

    This post shouldn't be construed as me saying anything even in the realm of community programs being better for most than academic centers. Just that a good community program can teach you everything you need to learn and more, and shouldn't be dismissed as "not worthy of the effort expended through medical school" as some here seemed to imply. I don't think the differences are anywhere near as significant as some here have implied for the majority of students.
     
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    costales

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