Benefits of T10 vs T20/30 DR residency?

[Maybedoc1]

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Hello all,

I’m in the fortunate position that I’m having a very good application season and have received interviews at a lot of top programs however I have no idea how I’m going to make a rank list. I’ve got interviews at several of the top 10 big name programs like Mass Gen, Stanford, Mayo, Brigham, a couple top 20 like UWashington (in Seattle), and UCLA, some great western regional referral centers in the top 30ish like Colorado and Utah, and then some other smaller academic and community programs. I know these ratings are kind of nebulous though.

Ultimately I see myself ending up in New England, the Intermountain West, California, or the Pacific Northwest (leaning more towards the “west” versus the northeast though). But importantly I feel like I could go to any of these programs, be happy for four years, and make the most out of it. Sure some of the cities might be “better” than others, but they often come with high costs that are significant with resident pay being what it is. I really have no idea what I wanna do for my career, but I know that I want to be a rock solid doctor (the kind who knows their stuff and other clinicians trust) and I want great training in residency with exposure to a ton of pathology. I could see myself doing academics or private practice. Maybe research, maybe education, maybe some type of innovation, etc. I really don’t have any clear 10 year plan. Also I unfortunately don’t have a big happy family in X location that would pull me towards any of these spots versus another.

Part of me feels like if I have the opportunity to go to a place like MGH, Stanford, or Mayo I should do that as they’re obviously great programs, the name will follow me for the rest of my career, and may lead to great opportunities. However another part of me thinks that I would get just as good training, maybe even better training, at some of these western programs with multi state catchment areas and no academic medical centers for a thousand miles in any direction. I guess I just don’t know how different the training is and how much that big name matters at the end of the day and I’m looking for advice.

Tldr; have gotten interviews to several top programs, but have no idea how to rank or how much the name matters at the end of the day.

 

[HemeOncHopeful19]

Figure out where you want to live

If you’re single figure out whether you’d rather compete with finance bros in NE or Tech bros in Denver/LA

The training will be hard to differentiate imo

 

[Radology]

if you are dead set on climbing the ranks of academia, going to the top tier programs probably gives you a marginal leg up

If you expect to work for a private practice, it literally does not matter at all, especially in this market

 

[Maybedoc1]

if you are dead set on climbing the ranks of academia, going to the top tier programs probably gives you a marginal leg up

If you expect to work for a private practice, it literally does not matter at all, especially in this market

Thanks for your reply! Just to clarify. Does that marginal leg up in academics only apply to working at those big name programs like MGH? Like if you want to be a division head at MGH then you should try and go to MGH for residency, but if you want to be a division head at Colorado then you should go to Colorado for training? Or would an MGH grad have a big leg up on a Colorado grad even at Colorado? Hopefully that makes sense.

 

[MadRadLad]

Thanks for your reply! Just to clarify. Does that marginal leg up in academics only apply to working at those big name programs like MGH? Like if you want to be a division head at MGH then you should try and go to MGH for residency, but if you want to be a division head at Colorado then you should go to Colorado for training? Or would an MGH grad have a big leg up on a Colorado grad even at Colorado? Hopefully that makes sense.

You're getting too granular here. There is an immense amount of luck, timing, politics and many other things that have to fall in place for something that specific to happen. That said, your best bet to break into a place is by being there. Focus on being less outcome independent on specifics and more broad about what kind of a person you want to be.

Living 4-5 years in Colorado vs Boston is a better way to look at it.

 

[GadRads]

Globally speaking, it doesn’t matter at this level of training. First go to the location where you think you will be happy. Then follow with the programs that would fit your long-term goals. I went to a top 10 program, and even the top 60-70 programs produce radiologists that are just as competent. What matters is what you put into it. Most of these programs will get sufficient volume for clinical training.

Also, my observation is that fellow-heavy programs (usually the top 10 on the coasts), dominate procedures, disadvantaging residents. I only do procedures relevant to my subspecialty, however non-top 10 programs trainees did more procedures compared to my non-IR co-residents.

While interviewing, I have heard of Stanford graduates being not fast enough within their first few years out, but it doesn’t matter as they catch up eventually. They matched at Stanford for a reason. Apparently UCSF gets most of the volume. This is rumor at this point though.

 

[MadRadLad]

Agree on aiming for a resident-focused residency and a fellow-focused fellowship.

 

[Maybedoc1]

You're getting too granular here. There is an immense amount of luck, timing, politics and many other things that have to fall in place for something that specific to happen. That said, your best bet to break into a place is by being there. Focus on being less outcome independent on specifics and more broad about what kind of a person you want to be.

Living 4-5 years in Colorado vs Boston is a better way to look at it.

That makes total sense. I’ve been going back and forth endlessly trying to decide on how to rank things and I’ve been trying to consider all possible outcomes to try and help me decide. I’ve been worried that I’m turning down a “once in a lifetime opportunity” by ranking some of these programs lower, but from everything I’ve seen that’s not the case and it’s just better to think city vs city. I appreciate it

 

[Maybedoc1]

Globally speaking, it doesn’t matter at this level of training. First go to the location where you think you will be happy. Then follow with the programs that would fit your long-term goals. I went to a top 10 program, and even the top 60-70 programs produce radiologists that are just as competent. What matters is what you put into it. Most of these programs will get sufficient volume for clinical training.

Also, my observation is that fellow-heavy programs (usually the top 10 on the coasts), dominate procedures, disadvantaging residents. I only do procedures relevant to my subspecialty, however non-top 10 programs trainees did more procedures compared to my non-IR co-residents.

While interviewing, I have heard of Stanford graduates being not fast enough within their first few years out, but it doesn’t matter as they catch up eventually. They matched at Stanford for a reason. Apparently UCSF gets most of the volume. This is rumor at this point though.

Thanks for your reply! That all makes sense. I could see how at a certain point it doesn’t matter and most places will see similar enough cases and similar enough volumes.

During my Stanford interview one resident did mention that procedural experience was limited due to fellows, which is a negative for me as I’d like to be competent in them.

I’ve also heard that Stanford used to be lower volume, but during my interview they brought up exploding volumes and how that wasn’t true anymore. They mentioned they did ~850,000 wRVU a year specifically in their overview of the program. I’m not sure if that means ~850,000 imaging studies a year or something else? Do you know if this reputation of Stanford grads being slow impacts their job prospects at all?

 

[Cognovi]

Thanks for your reply! Just to clarify. Does that marginal leg up in academics only apply to working at those big name programs like MGH? Like if you want to be a division head at MGH then you should try and go to MGH for residency, but if you want to be a division head at Colorado then you should go to Colorado for training? Or would an MGH grad have a big leg up on a Colorado grad even at Colorado? Hopefully that makes sense.

Most of the division heads at Colorado trained at a mid tier residency elsewhere and then a big-name academic fellowship elsewhere (not including MGH)
Most of the division heads at MGH trained at MGH

 

[GadRads]

Do you know if this reputation of Stanford grads being slow impacts their job prospects at all?

I don’t think so. Never seen an unemployed Stanford rad graduate.

Being slow or fast is linked to your knowledge, familiarity with the type of study, confidence and level of anxiety. High levels of anxiety and obsessiveness can really slow down otherwise good radiologists.