Best Clinical Training?

[drfunktacular]

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Hullo everyone,

So, here's the list of programs I've applied to. My long-term goal, as I see it, is most likely PP or primarily clinical academic practice in a subspecialty like Heme/Onc or Pulm/CC. I.e., I don't want to do research. Obviously research is good and necessary &c. &c., but my atttitude is that I would rather be the guy putting the results of research to use; somebody has to be out there using all these new drugs and whatnot.

Anyway, I'm wondering, which of these programs are stronger for preparing for a subspecialty, clinical career?

Colorado
Emory
MGH
B&W
Hopkins
Mayo-Rochester
Duke
UNC
Wake Forest
Oklahoma
OHSU
Vanderbilt
Baylor
Baylor-Dallas
Scott & White
Methodist (Houston)
UTSW
UT San Antonio
UTMB
UT Houston
UW

I know that the "bigs" like Hopkins, MGH, B&W are going to be really research-focused. But at the same time, exposure to some level of elite academic work would be of benefit even to someone going into PP. So how do you balance that?

Thanks!

 

[indiamacbean]

I would question that Hopkins and MGH would be too research focused. yes they do a lot of research at those places but you sure will be doing a lot of patient care at both these institutions as a resident. the fellows that I have seen who have come from Hopkins and MGH are awesome clinical doctors.

 

[BlackNDecker]

The amount of pathology (i.e. patients) coming through Parkland (UTSW), Grady (Emory), and Ben Taub (UT Houston) is well known and probably unparalleled. I would say it's possible to rival this patient population in certain hospitals in Chicago, NYC and LA though this would probably be available only in county hospitals...which have their own +/-. This last sentence is highly subjective of course and open to criticism...

Your question is a little confusing because preparing for a subspecialty career these days is, arguably, quite different from preparing for general IM. What I mean is that to secure a fellowship in most of the listed programs (i.e. "top 20") requires extensive research and publications (or an Ivy pedigree). These programs are not looking for the most astute clinician, rather they are looking for individuals who can continue to be academically productive while balancing their clinical duties. I did not feel confident that I would have the time or mentorship available at UTSW to be academically productive... just my 2 cents.

edit: I believe Ben Taub may be closed down now...however, the IM residents at UT Houston run the ED which was unique among the places I interviewed.

 

[drfunktacular]

Ben Taub (UT Houston)

edit: I believe Ben Taub may be closed down now...however, the IM residents at UT Houston run the ED which was unique among the places I interviewed

I believe Ben Taub is affiliated with Baylor; they lost their affiliation with Methodist, maybe that's what you're thinking of? UT-Houston is affiliated with Memorial Hermann, I think.

Your question is a little confusing because preparing for a subspecialty career these days is, arguably, quite different from preparing for general IM. What I mean is that to secure a fellowship in most of the listed programs (i.e. "top 20") requires extensive research and publications (or an Ivy pedigree). These programs are not looking for the most astute clinician, rather they are looking for individuals who can continue to be academically productive while balancing their clinical duties. I did not feel confident that I would have the time or mentorship available at UTSW to be academically productive... just my 2 cents.
.

This kind of gets to what I'm really wondering about though: doesn't the "real" world need people in Heme/Onc or Pulm/CC? I mean, there's no major academic center in my hometown of ~250k--does that mean there should be no Oncologists there? So assuming I wanted to do that, why should I spend my life slaving away on research and fluffing academic feathers, only to beat a hasty exit ASAP? Or is that the only way to get there: playing the game, so to speak?

 

[BlackNDecker]

This kind of gets to what I'm really wondering about though: doesn't the "real" world need people in Heme/Onc or Pulm/CC? I mean, there's no major academic center in my hometown of ~250k--does that mean there should be no Oncologists there? So assuming I wanted to do that, why should I spend my life slaving away on research and fluffing academic feathers, only to beat a hasty exit ASAP? Or is that the only way to get there: playing the game, so to speak?

I was referring specifically to competitive subspecialty training at the "top 20." To match for a fellowship at one of these institutions, you will likely have to play the game...however, the top academic centers aren't necessarily the best places to train for a career in private practice. You might be better served matching in the region where you want to train.

From my limited personal experience, Baylor Dallas has the most "private practice" oriented clincal training program available at a "big name" institution. The downside is that its a small program with relatively few spots availble for subspecialty training.

 

[Mental Gymnast]

I'm not quite sure why people so often tend to think places like hopkins and MGH may be research-focused at the expense of clinical care. Indiamacbean, I could not agree with you more. I can speak from experience regarding both hopkins and mgh and can tell you that your clinical training here is superb. OP, take Hopkins, for example, and humor me as I list the following facts: 1) Located in Baltimore aka the syphilis capital of the country and previously the murder capital of the country, 2) Patient population very largely underserved with possibly highest minority population in the country (70% African American alone) 3) Hopkins is the biggest employer in the entire state of Maryland... etc etc

Now, who do you think takes care of the thousands of these patients (almost all of which are rather complex) who come through the hospital doors every week. Surely you do not think the residents are leaving these patients to die in the waiting rooms while they go finish pipetting their test tubes in the lab? The extent of pathology that you see here is incredible, there is a reason why the residents who come out of these places are so solidly trained, and there is a reason why these hospitals have such outstanding reputations in clinical medicine.

I would not be concerned about a place being too research-oriented at the expense of clinical medicine. I would rather see it as additional wealth of opportunities should you want it.

 

[drfunktacular]

I'm not quite sure why people so often tend to think places like hopkins and MGH may be research-focused at the expense of clinical care. Indiamacbean, I could not agree with you more. I can speak from experience regarding both hopkins and mgh and can tell you that your clinical training here is superb.

I certainly didn't mean to imply that the clinical experience at those places is inferior! I guess I am curious to know whaat the dedication to research among the residents there is. Are there people at MGH/JHU who choose not to undertake any huge research projects during their residency?

 

[WorkaholicsAnon]

I certainly didn't mean to imply that the clinical experience at those places is inferior! I guess I am curious to know whaat the dedication to research among the residents there is. Are there people at MGH/JHU who choose not to undertake any huge research projects during their residency?

I think the question should be rephrased as "are there people who matched at MGH/JHU for fellowship from other residency programs, who chose not to undertake any huge research projects during their residency?"

I feel the clarification should be made, as someone who trained at hopkins or MGH for residency will likely be judged differently from residents who trained elsewhere,whether its the "ivy pedigree" that someone here had referred to already, or simply preference for "their own," which tends to be the culture generally in medicine. It's likely both.

 

[lemonade02]

hahahaha this topic is making me laugh..see i'm a new intern and i've just now realized in the midst of this hell that most top programs are really no different clinically than other top programs or even lesser programs. its all a big lie. i made the mistake of buying into the hype of 'outstanding clinical training' recruiting speech of my program and its not making me a smarter doctor, just a busier one! seriously don't buy into the hype. a doctor who comes out of community hospital residency can be as good CLINICALLY as an MGH-trained doctor. the doctors that come from hopkins and mgh are kick ass because they are generally more clever than the rest of us to begin with! i know i'm jaded and i really hope i'm wrong

 

[drfunktacular]

hahahaha this topic is making me laugh..see i'm a new intern and i've just now realized in the midst of this hell that most top programs are really no different clinically than other top programs or even lesser programs. its all a big lie. i made the mistake of buying into the hype of 'outstanding clinical training' recruiting speech of my program and its not making me a smarter doctor, just a busier one! seriously don't buy into the hype. a doctor who comes out of community hospital residency can be as good CLINICALLY as an MGH-trained doctor. the doctors that come from hopkins and mgh are kick ass because they are generally more clever than the rest of us to begin with! i know i'm jaded and i really hope i'm wrong

Although I lament your jadedness, I appreciate your honesty. I get the feeling that a lot of people out there feel the way you do.

 

[dragonfly99]

Dr. funktacular
you're actually asking a question that can't really be answered.
One of the reasons is the "best clinical training" for one person might not be the best for another. One person might thrive in a pressure-cooker atmosphere (i.e. Hopkins or Mass General) while another might now. One person would be miserable in a rural, cold area like the area surrounding May or U of Iowa, while another would be miserable in Manhattan.

I do think there is something to the contention that super research oriented places are not as clinically oriented in some ways (i.e. Hopkins and Washington U. more interested in the residents doing research than getting good at intubating people or doing LP's).

I think for your career goals of doing a subspecialty, you should stay away from some of the lesser known places on your list. I'm not sure, but I'd think Oklahoma and Scott and White would fall in that category...not saying anything about their training b/c I can't comment on that. It's not necessarily rational, but people from less well known places don't get the top pick of fellowship programs. Places like Emory and Vanderbilt have a fairly big name...but you STILL need good LOR's from wherever you end up. However, regardless of which U. program you go to, you should be able to get a pulm/crit care spot or hem/onc spot somewhere. You want to put yourself in a power position. And yes, you will likely have to "play the game" at least a little to help your chances (i.e. do a little research elective during your residency program, schmooze with the hem/onc full professors, etc.). The game is what it is, and you can't change it. Most people ultimately go to private practice no matter where they do residency and fellowship...but while you are a resident, I wouldn't advertise the fact that that's what you want.

Ben Taub is one of the main teaching hospitals of Baylor (the main one/Houston Baylor). They also use the VA hospital. Those are both going to be I would think resource-poor environments, which might make it a little tough on the interns (i.e. lots of scut) but I don't have personal knowledge. They have had a good academic reputation through the years.

The Baylor Dallas is definitely private practice oriented. You may want to give it a look, however, as it seemed cush when I interviewed there years ago. You need to look at where their residents match for fellowship...my impression was that some did quite well, but mostly matched within Texas.

You should consider trying to get somewhere fairly close geographically from where you want to end up practicing (i.e. not all the way across the country), particularly for fellowship, if not for residency too. I didn't follow this advice myself, but it can make your life a bit easier.

 

[drfunktacular]

Now THAT'S good advice-giving.

You should write a book or something!

 

[dragonfly99]

Nope I don't think so.
You all will know = or more than me after a few years of residency...
Thanks though.
Good luck w/your search. Picking a residency is kind of like picking a college - you have to look at all factors like lifestyle/geographic region/teaching/reputation and think about them together, plus factor in your general impression when you interview there.

 

[agk]

An attending at a top-10 institution I did an away-elective gave me the best advice. He said that most institutions will give you excellent clinical training & that there's absolutely no difference between an academic powerhouse and a community hospital from a clinical standpoint (& this guy trained at 2 extremely well-known hospitals!). However, he did say that if you are planning to stay in academics and/or interested in prestigious fellowship spots, 'branding' does become important at that point. So the goal should be to go to the best place possible (provided of course you are happy w/location, etc).

 

[souljah1]

there's absolutely no difference between an academic powerhouse and a community hospital from a clinical standpoint

This is not necessarily the case. Academic hospitals often have the resources to do things other smaller community hospitals can't. This is not so much of an issue when you are talking about general medicine floors, but it does become relevant with getting exposure to the sickest of the sick. An academic hospital is likely to get outside hospital transfers from smaller community hospitals that include fulminant hepatic failure to be evaluated for transplant, cardiogenic shock for LVAD placement as a bridge to transplant, burn units, etc. Critical care, whether surgical or medical, is often VERY different depending on where you train.

 

[dragonfly99]

Agree with souljah
some of the community hospitals don't have enough really sick patients in their medical ICU's etc. That could hurt you, particularly if you pursue pulm/critical care.

Don't go to some place that is too podunk. Do go to a university program if you want to do hem/onc or critical care/pulm fellowships. There are a lot of univ. programs that would serve your purposed.
Try to get in to one that has a good reputation in its region of the country, if not a big national reputation.

If someone wants to do private practice general IM, then some of the community programs (the good ones) might actually be better b/c more of the attendings are in private practice, they may focus more on outpatient medicine, and may teach you more about how to function in private practice.

 

[hospmed]

I am a practicing internist and trained at UW. I had friends that trained at other big programs as well as those who did their residency at smaller and community hospitals. In the end you can get a great education at most programs and your training hardly ends at three years.
I work with colleagues who have trained at many different types of programs including those from the big ones you listed as well as smaller programs. I can honestly say that the the "better doctors" do not correlate with the notariety or size of the program. I would say that if you want to go into teaching or academic medicine then go with the bigger names, otherwise go with the program that best fits your needs.

good luck!

 

[OofMed]

So where can i get a list of the "top 20" programs that I keep hearing references to? I feel I need some sort of objectivity or at least consensus on program reputation before I can submit a rank order list. . especially because I want to do cardiology

 

[gutonc]

So where can i get a list of the "top 20" programs that I keep hearing references to? I feel I need some sort of objectivity or at least consensus on program reputation before I can submit a rank order list. . especially because I want to do cardiology

Take off your pants, bend over, reach between your legs and pull real hard. That's where you'll find this list.

 

[CanIMakeIt]

Take off your pants, bend over, reach between your legs and pull real hard. That's where you'll find this list.

LMFAOROTF 😀 hilarious

I tried it and all I got was pain but no list ... you lied gutonc LOL

 

[dragonfly99]

Come on, there IS no list.
You can look at the US News World Report lists if you want...best hospitals...best hospitals for cardiology...blah blah blah.
One can make generalizations about which places have well known medicine departments and cardiology divisions...that would give you an idea of where to go to get a good fellowship. But you can get a cards fellowship coming out of most university medicine programs, provided you do well as a resident.

Some hospitals with well known cardiology divisions include Duke, Cleveland Clinic, Emory, Washington U, any of the Harvard hospitals I guess...and many more.