Big decision: The best vs. the best fit

[lumbago61]

I have been a long-time "lurker" of this forum as a guest and it seems like there are so many genuine and knowledgeable people on here.

Now that I've gone on all of my interviews and rank list decisions loom, I could really use some advice from the senior members on this board who have gone through this process.

For the #1 program on my rank list I am deciding between a program from list A vs. list B (below)

List A: RIC, Spaulding, UWash

vs.

List B: Colorado, Temple, MCV

As for whats tying my stomach up in knots:

Based upon my interview experience - I feel that the programs on list A have more resources, stronger overall faculty, better national reputation in the field, more consistant fellowship matches, etc.

However...

I have a stronger gut feeling about the "personal fit" at a certain program on list B, it's closer to friends and family, in the region I ultimately want to settle down and work and has a strong alumni base in that area.

My goals: Likely private practice and I want an opportunity to have a legit shot at a landing a strong Sports and Spine (or maybe Pain) fellowship if I choose to go that route.


The question:
Am I crazy, stupid, naive, etc for wanting to rank a program from list B #1 above a program on list A?!!

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[Jin25]

seems like a no brainer to me. personal happiness at a great program vs. going to a program with a better name on paper. good residents become good fellows. thats the trend. goto a program where you fit, and you will excel there. it matters more to excel as a resident than it does to goto a top 3 program versus a top 10 program.

you want to go into private practice not academics, and it seems like you found the perfect program ("I have a stronger gut feeling about the "personal fit" at a certain program on list B, it's closer to friends and family, in the region I ultimately want to settle down and work and has a strong alumni base in that area").

rank your "b" list program number one, and hope that you arent on their "b-list"

 

[SportsMed09]

Going through this process with you, I have had some of the same questions, though my decisions are being swayed by locations of programs as well as the training they offer. I think that ranking the places you fit in will increase your satisfaction and happiness to be at your program of choice. In turn, you would be a more productive and more desirable resident coming out when you want to look for fellowships, rather than being less happy but throwing around a bigger name.

 

[drusso]

Go where the fit feels best.

 

[Ludicolo]

Best fit.

I have a stronger gut feeling about the "personal fit" at a certain program on list B, it's closer to friends and family, in the region I ultimately want to settle down and work and has a strong alumni base in that area.

Sounds like you’ve already made your decision. Don’t underestimate the value of a support system.

 

[DOctorJay]

agreed, go for fit, all of the programs you listed are excellent.

 

[lumbago61]

Thank you to everyone for your advice. I had basically made up my mind prior to posting this, but I guess I just wanted to get some other perspectives on the matter from those who have been in my position before.

I am almost certain that I will rank as you all suggest. Though this is ultimately my decision, it is comforting to here support for it.

 

[lumbago61]

In the private practice sector, how common is it for pedigree from a nationally renowned institution (and assumption of top-notch training) to trump local connections for a grad from a more regionally known training program?

In PM&R groups I would imagine it could go either way and maybe favor the latter type of program, but what about Ortho/NS groups?

How does this usually pan out in the "real world"?

 

[axm397]

I think most people associate specific people with institutions. So you if your institution has a physiatrist who is well respected and well known in the community, that will be helpful. I have found that although not a lot of ortho/NS/anesthesia know "Rehab Institute of Chicago", most know "joel press, president of NASS", or "norm harden, CRPS expert". It also helps if there is a large alum base. many of my job opportunities have come from RIC grads all over the country. There is a certain level of trust that comes with having training in common as most people who train at a specific institution tend to share skill levels and to some extent, philosophy.

 

[PMR 4 MSK]

In the private practice sector, how common is it for pedigree from a nationally renowned institution (and assumption of top-notch training) to trump local connections for a grad from a more regionally known training program?

In PM&R groups I would imagine it could go either way and maybe favor the latter type of program, but what about Ortho/NS groups?

How does this usually pan out in the "real world"?

Having interviewed with many ortho groups and now working at one, I can tell you that for the most part, private practice groups have absolutely no clue which programs are the best and have never heard of most of our "superdocs". I trained 90 minutes from here and they don't know a single one of my attendings. I think they just base it on the strength of the ortho program at the same institution.

 

[rehab_sports_dr]

> List A: RIC, Spaulding, UWash
> List B: Colorado, Temple, MCV

I agree with what other people are saying- if you think the best "fit" is in list B, then I would go with the program in List B

However, I would note one of the main reasons I say this is that the programs you list in List B are all very good programs- they are all clearly top 20 programs, and cases could be made for them being top 10 programs

To me, this would be the sports equivalent of a basketball team saying "I really need a power forward for my team. Should I take Chris Bosh or Chris Paul?" Chris Paul is a better player, but Chris Bosh is still an elite team and better fits your needs

If you had lower tier programs in List B, then I would say go to the better overall program. The difference between the top programs and the bottom programs is pretty substantial.