Advice from Attendings or Residents from Community Programs?

[qwerty89]

With rank lists due soon I'm looking for feedback from people who have trained or are training at community programs. How do you feel about the quality of education? Any issues at offsite rotations (usually peds)? Any issues with graduates of your program having trouble in job market?

I have the typical dilemma many have when they get past their top couple of ranks where they have to start deciding between community programs in desired location vs strong academic program.

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[Want2DoRad]

It totally depends on where your desired location is and what community programs you are talking about. The Aunt Minnie threads are typically richer in this information.

Generally, ped's is just something that residents force themselves to memorize; and most community program people don't mind being sent away. You are probably going to get a better experience being sent to a large children hospital than learning from a small hospital that only deals with bronchiolitis.

 

[qwerty89]

I guess one of the things I really wanted to know if whether or not those community residents felt as if they were behind when starting a fellowship at a top university fellowship program.

 

[Want2DoRad]

The first barrier is getting a fellowship in the first place. With rare exception, don't go to a community program if you want to do IR. Go someplace that has fellowships.

I would say that a significant portion of fellows went to the same place for residency. Those individuals are going to be ahead because they already know the system and the attendings.

Community peeps are in general going to be less prepared academically but can often work faster (and hopefully learn quickly enough to make up the ground). There are a handful of super sharp community people who were pigeon-holed into a community program because they were DO's or because their family wouldn't let them leave. They will do well wherever they go because they are self-motivated.

This will blow up into weird discussion points eventually nullifying the point of having the argument.

The majority of places having problems with the Core exam are community programs. There is a reason for this.

 

[shark2000]

IR and mammo fellowships have become hard to get especially in the area that you want to go. MSK Fellowship is easy to get even in top places but is not easy to get if you look for a top program in a specific location.

Let's say you do residency in a community program. You work hard and you can find a top IR or mammo or MSK fellowship in your desirable location. You have to look for a job 3-4 months into your fellowship. The fellowship attendings still don't know you well. However, most of other fellows have done their residency in the same program so the attendings know them very well (4.5 years versus 0.5 year). Now if there is a job opening in the same center that you are doing your fellowship or if a local private practice group contacts the fellowship director looking for a good candidate for their group, naturally you will be the last person on the list to get the job.

 

[FranzLO]

Out of curiosity, with mammo jobs more plentiful, and I assume and it varies, but about what % of a fellowship-trained rad's reads are mammo? I know that after other fellowships you still do a wide variety of all sorts of reads but do they make them do a higher % of mammo, since they don't want to read them? Or is it a full time gig or something like that?

 

[shark2000]

Out of curiosity, with mammo jobs more plentiful, and I assume and it varies, but about what % of a fellowship-trained rad's reads are mammo? I know that after other fellowships you still do a wide variety of all sorts of reads but do they make them do a higher % of mammo, since they don't want to read them? Or is it a full time gig or something like that?

Since there is a mammo screening program in the US, mammo is high volume, though its RVUs are lower. Groups HAVE TO provide mammo service even if they don't want. It is a boring job and has high legal risk. Most radiologists don't want to do it. Even mammo trained radiologists are willing to give it up after a decade of doing it (similar to IR). In contrast, people are very happy to continue working as Neuro or MSK for the rest of their life. Thus, finding an IR or mammo job is easier.

There is a caveat about mammo. People who are good mammographers are the ones who do A LOT OF IT. Fellowship is not as important as doing a lot of mammo to get good at it and to keep being good at it. Mammo is different than most of radiology and you either have to do it at least 2-3 days a week or don't do it. However, in real world for business reasons, the situation is different and it is not uncommon for people to do one day of mammo.

It seems that more than half of mammo studies are read by generalists. However, if someone is mammo fellowship trained they have to expect to do mammo at least 50% of their time, unlike subspecialties of radiology. Many groups may hire a neuroradiologist, MSK or IR and have them do 30% of their subspecialty and 70% of general radiology. But if a group hires a mammographer, at least 50% or sometimes 70% of their job will be spent doing mammo. You can find a 100% mammo job (who wants to do that??), but most groups prefer someone who is willing to do some general radiology on the side esp participate in call. It seems that most mammo jobs are 50-60% mammo and 40% general.

I am happy that I don't have to do mammo in my job. Most radiologists will be happy to give up mammo (and IR). It is also not uncommon for groups to hire an MSK radiologist or neuroradiologist but make them do a lot of mammo or light IR. So doing an MSK, Neuro or even IR fellowship does not guarantee that you won't do mammo.