Biggest Name or Best Fit?

[path12345]

Applying for the match this year for path residency. There are some places that are close to home, more friendly and seemed like a program I may be happier with on the surface. They are typically in smaller cities but what I think are good programs and would receive quality training.

There were other programs in big cities, big names and better faculty (i.e. University of Chicago, Northwestern). I have never been much a big city person but the programs they present are impressive. They have faculty who are authorities and claim "limitless" research funding. I suppose most people in the medical field are hard wired to try and go to the best programs and biggest budgets so it may play to that. I was also rejected from a lot of other big name places so for me to get an opportunity to go to places like these so it feels like a good opportunity because they may like other things in my application the other programs didn't appreciate.

I talked with a faculty member the other day and she told me to just to go the biggest name possible. The job market is bad and it will give you the most connections, help you make the most money and that residency is only 4 years. Perhaps this sort of arguments works better in path where the opportunities are a little more limited. A lot of other people have told me differently. Many people say location is #1 or comfort level is #1.

What is everyone's experience/advice in this situation?

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[deleted314957]

Applying for the match this year with about 12 interviews for path residency. There are some places that are close to home, more friendly and seemed like a program I may be happier with on the surface. They are typically in smaller cities but what I think are good programs and would receive quality training.

There were other programs in big cities, big names and better faculty (i.e. University of Chicago, Northwestern). I have never been much a big city person but the programs they present are impressive. They have faculty who are authorities and claim "limitless" research funding. I suppose most people in the medical field are hard wired to try and go to the best programs and biggest budgets so it may play to that. I was also rejected from a lot of other big name places so for me to get an opportunity to go to places like these so it feels like a good opportunity because they may like other things in my application the other programs didn't appreciate.

I talked with a faculty member the other day and she told me to just to go the biggest name possible. The job market is bad and it will give you the most connections, help you make the most money and that residency is only 4 years. Perhaps this sort of arguments works better in path where the opportunities are a little more limited. A lot of other people have told me differently. Many people say location is #1 or comfort level is #1.

What is everyone's experience/advice in this situation?

Best fit/comfort level for sure. My experience/ back-ground goes back to 1977 and I have seen or been in most all practice environments. I am retired now.

 

[Alteran]

Best fit, hands down. You certainly don't want to spend four years training in a place you absolutely despise. In addition, namebrand is not all that it's cracked up to be.

 

[icpshootyz]

Keep in mind to choose a program that has a variety of fellowships available. Most fellowships go to internal candidates first, and if you have an inkling of wanting a hard-to-get fellowship (like dermpath), you should choose a program that offers that fellowship and has a track record of giving it to internal candidates over external candidates. You will get good basic AP/CP training just about anywhere, but these days fellowships are a must to get a job, so keep that in mind. Personally I chose a big name program that was also a good fit. I do believe the name carries weight when you're looking for fellowships and jobs.

 

[mlw03]

I agree with the advice given so far. A big name and good fit is ideal, but if you have to pick one, I'd go good fit. If you're unhappy every day, learning suffers.

I also strongly agree with the fellowship advice. Internal candidates have a huge edge, to say nothing that it sucks to move for one year (which I did). If you know what you want already, favour programs with that fellowship in house.

 

[pathstudent]

My general advice is to rank the programs highest which are the biggest programs in the cities you would most like to live for a few years followed by lesser programs in cities you would like to live followed by big programs in places you aren't as crazy to live.

 

[LADoc00]

A majority of residents settle down within 6-8 hours drive of their training program. So if you are looking at a program in IL but want to eventually reside in CA, you might need to rethink that.

In that respect location>all.

 

[gbwillner]

A majority of residents settle down within 6-8 hours drive of their training program. So if you are looking at a program in IL but want to eventually reside in CA, you might need to rethink that.

In that respect location>all.

I think this is sound advice for most typical applicants. There are a lot of reasons for the lack of mobility other than regional status of programs, like the fact you are also likely to gain a family with kids during training and moving long distances does disrupt your newly-settled life. In the end, the decision depends heavily on your goals and ambitions. If you want a job in private practice in CA, there is little reason to do your residency at the NIH or a good NE program, when you are more likely to get such a job with a residency at USC. If your goal is to be in a top academic department, the NIH makes more sense.

While regional reputation of programs do influence strongly your ability to move around, going to a "top" program alleviates this problem. Programs with national networks and reputation certainly open doors for you in all markets.

I would say "top" program (to me) trumps all, but if that is not an option, go ahead and go to the best regional program with the best fit, in light of your goals.

 

[Over9000]

I would have to give you the advice to go to the biggest name you can, given the job market problems. We, at present, do not have the luxury of choosing for "fit". Remember, the only thing you bring with you after residency is the name. The program can't come with you.

If you have an ivy-league name under your belt, your options are wider and because of that people are less likely to jerk you around. Even if it is in a city you may not like, remember residency is only four years. The rest of your life is the rest of your life. For instance, matching to an IMG-mill in New York because you like Manhattan is very short sighted. Matching to Harvard, even if you dislike Boston, is not.

 

[oldfatman]

I would have to give you the advice to go to the biggest name you can, given the job market problems. We, at present, do not have the luxury of choosing for "fit". Remember, the only thing you bring with you after residency is the name. The program can't come with you.

If you have an ivy-league name under your belt, your options are wider and because of that people are less likely to jerk you around. Even if it is in a city you may not like, remember residency is only four years. The rest of your life is the rest of your life. For instance, matching to an IMG-mill in New York because you like Manhattan is very short sighted. Matching to Harvard, even if you dislike Boston, is not.

I agree with this. No one will know how much work and studying you did at a good-fit program when you are done. All that stays with you is the name.

 

[levim1]

just because you are talking names...
if you had to compare CCF, mount sinai, Indiana, Wisconsin college of medicine (milwaukee), NIH (just names)
how would your ranking be? and how much of a difference between them?

 

[gbwillner]

just because you are talking names...
if you had to compare CCF, mount sinai, Indiana, Wisconsin college of medicine (milwaukee), NIH (just names)
how would your ranking be? and how much of a difference between them?

Depends on your intentions, again. Unless you are for sure only doing academia, stay away from NIH- unless things have changed in the last decade, they only train in AP and volume is relatively light.

Indiana has a solid reputation as a good regional place. I think Wisconsin too. Mt. Sinai is meh given the other superior training programs around it, don't know anyone from there; I wouldn't take that to mean their training is bad. I don't know what a CCF is.

 

[Sulfinator]

CCF = Cleveland Clinic

 

[Inez2000]

I wouldn't advise any new medical student to go into pathology because of the job market. If you insist, go to the best possible program and suck it up for four years. I feel pretty strongly about this. I went with the best-fit program.

 

[Sulfinator]

Did you end up landing a job, Inez2000? I believe you finished your fellowship in 2014.

 

[Inez2000]

Did you end up landing a job, Inez2000? I believe you finished your fellowship in 2014.

Yes, applied nationwide to every advertised job I was even slightly qualified for over the course of my fellowship year, and got one offer. Thank god, I felt lucky to get this job, even though it was 1500 miles away.

 

[Sulfinator]

Yes, applied nationwide to every advertised job I was even slightly qualified for over the course of my fellowship year, and got one offer. Thank god, I felt lucky to get this job, even though it was 1500 miles away.

And, I take it that your feeling is that you would have had an easier job search had you selected your training program based on "name" rather than on "fit?"

 

[Over9000]

Our overreliance on FMGs to fill residency spots implicitly suggests that ours is a field that does not demand the highest standard.

 

[shakyjakey1]

just because you are talking names...
if you had to compare CCF, mount sinai, Indiana, Wisconsin college of medicine (milwaukee), NIH (just names)
how would your ranking be? and how much of a difference between them?

i interviewed at both cleveland clinic and mt. sinai this past year, based on their perceived reputation in the field of medicine, and thought that would've have translated into their path departments. i wasn't impressed with either one for training. benefit of cleveland clinic is you get to work with goldblum, downside of cleveland is cleveland. benefit of mt sinai is the view, downside of sinai is you're used for grossing.

 

[MetroPath]

I would have to give you the advice to go to the biggest name you can, given the job market problems. We, at present, do not have the luxury of choosing for "fit". Remember, the only thing you bring with you after residency is the name. The program can't come with you.

If you have an ivy-league name under your belt, your options are wider and because of that people are less likely to jerk you around. Even if it is in a city you may not like, remember residency is only four years. The rest of your life is the rest of your life. For instance, matching to an IMG-mill in New York because you like Manhattan is very short sighted. Matching to Harvard, even if you dislike Boston, is not.

You may be right but I know ppl who graduated from non-Ivy league residency training programs (that matched DOs and FMGs and Carribe grads on a yearly basis) that did get jobs after one to two fellowships with no problems. Not going to a Ivy league residency does not necessarily mean you will have a hard time finding a job. I think sometimes you have to be in the right place at the right time with a board certification under your belt. Not everyone can match or be happy at Harvard.

Four years is a long time. If you cant see yourself at a certain program I would not recommend it. There are many good training programs out there that can land you a job.

 

[gbwillner]

CCF = Cleveland Clinic

What's the "F" for? Florida? Is this a satellite campus? If so, it doesn't count.

 

[Tissue issue]

Foundation. Sounds fancier, I guess.

 

[gbwillner]

ah. Would probably put that one up there then. Cleveland Clinic has a good reputation and high volumes.

 

[jp123ok]

Our overreliance on FMGs to fill residency spots implicitly suggests that ours is a field that does not demand the highest standard.

Juan Rosai was an FMG. Being an FMG does not equate to being poorly trained. Using ethnicity as a means of denigrating a person (or a training program) implicity suggests that you are a bigot.

 

[Sulfinator]

Juan Rosai was an FMG. Being an FMG does not equate to being poorly trained. Using ethnicity as a means of denigrating a person (or a training program) implicity suggests that you are a bigot.

I think that Over9000 may have simply been commenting on how competitive (or not) the field of pathology is for would-be trainees, not that FMGs who enter into pathology training come out poorly trained.

 

[Over9000]

Juan Rosai was an FMG. Being an FMG does not equate to being poorly trained. Using ethnicity as a means of denigrating a person (or a training program) implicity suggests that you are a bigot.

You shot from the hip without aiming.

I did not bring up race. I brought up foreign training. The race of the foreign-trained physician is irrelevant. In fact, lots of FMGs are white Americans. How does that make me a bigot?

My gripe is with the fact that pathology, as a field, has done such a poor job of becoming an attractive career choice for smart, capably-trained medical students. Rather than try to remedy that, we opt to accept people with questionable, and often substandard, training into our ranks just to keep numbers up. This can only serve to dilute the quality of care we provide, and the opportunities for making a difference that we can enjoy.

Believe what you will, but I have a hard time gauging the quality of medical training one receives at universities in countries like Iraq, Iran, Egypt, China and India, as well as the Caribbean islands. I wager that separating the wheat from the chaff is largely a matter of luck. Most of the "high performers" probably match to radiology or surgery. We're stuck with the rest of them and are "lucky" if one falls through the cracks. Again, our specialty has poor optics so we can only really hope to have the stragglers interested.

 

[deleted642280]

As far as the rank list goes, I decided on which city I want to live in where I have some family around- NYC. Then I listed the programs in order of competitiveness and fit. Then the next city, and so on... I really liked all the NY programs that I visited, but a lot of that comes down to personality. I was lucky though in that my top program for fit and personality was also a competitive program, so I didn't face the same dilemma as you with deciding between the two. I like a fast pace. It keeps me focused. When I'm bored I cause mischief

 

[Inez2000]

And, I take it that your feeling is that you would have had an easier job search had you selected your training program based on "name" rather than on "fit?"

Yes

 

[Sulfinator]

I will say that back when I was applying for residency (5-ish years ago), I asked multiple practicing pathologists (all happened to be private practice folks) for advice on choosing a residency program. All or most of them suggested something along the lines of "go to the best program you can get into." While going to the 'best' program one can get into is a somewhat hazy recommendation, I took the point enough that it made me change my rank order list significantly. Looking back at it all now, I am very glad that I did that.

 

[deleted314957]

Juan Rosai was an FMG. Being an FMG does not equate to being poorly trained. Using ethnicity as a means of denigrating a person (or a training program) implicity suggests that you are a bigot.

Lighten up. The statement was just a generalization. I don't know how many times Dr Rosai has been brought up to specifically address this generalization. Lets all be real folks.

 

[MetroPath]

Agree ppl here putting down FMGs have not looked at the faculty on staff at most residency programs. I think most attendings from assistant to the full professor level are at least 50% FMG, even in some big name programs.

From my experience meeting other FMGs, pathology seems to attract FMGs (based on my assumption) because of the English barrier or their field which they practiced in their home countries (urology, surgery) were too difficult to get into as a FMG (urology) or based on their age, they didnt want to go through a grueling surgery residency. They are attendings at an academic center now. A fair number of FMGs were in a PhD program before residency (mostly Chinese).

The surgpath director from my residency was a FMG. The vice chair and program director (residency program) where I did my fellowship were both FMGs. All the attendings from my fellowship were all FMGs (6 attendings). They all have 10-30+ years of experience as well.

So just simply saying and generalizing FMGs as being bad is just plain ignorant and IS bigoted.

 

[Over9000]

Agree ppl here putting down FMGs have not looked at the faculty on staff at most residency programs. I think most attendings from assistant to the full professor level are at least 50% FMG, even in some big name programs.

From my experience meeting other FMGs, pathology seems to attract FMGs (based on my assumption) because of the English barrier or their field which they practiced in their home countries (urology, surgery) were too difficult to get into as a FMG (urology) or based on their age, they didnt want to go through a grueling surgery residency. They are attendings at an academic center now. A fair number of FMGs were in a PhD program before residency (mostly Chinese).

The surgpath director from my residency was a FMG. The vice chair and program director (residency program) where I did my fellowship were both FMGs. All the attendings from my fellowship were all FMGs (6 attendings). They all have 10-30+ years of experience as well.

So just simply saying and generalizing FMGs as being bad is just plain ignorant and IS bigoted.

Most residency programs probably shouldn't be open. I don't see how one should be impressed by someone being an academic pathologist, because I assume most would rather do private practice but cannot because of factors out of their control, some justifiable, some not.

Also from my experience, certain cultures look down on pathology, along with psychiatry and family practice, precisely because those are the entry points for most FMGs into our medical system. Many FMG pathologists were other prestigious specialists in their home countries but were excluded from practicing those fields here, so rather than drive cabs or start from scratch, they settled into pathology - the Salvation Army of medicine - and are probably quite resentful of that. Its hard to have much respect for a specialty when your career alternative is driving a cab. I know that in Chinese culture, to match to such a low-competition field as pathology is to lose face.

If someone's English isn't up to par, they shouldn't be practicing in the USA, in any specialty. There is no excuse for poor communicators in any field. Being in a non-patient-contact specialty is not an excuse.

Someone obtaining a PhD before doing pathology is, again, not very impressive. PhDs are a dime a dozen, and anyone can get into one and finish it provided they will work for peanuts and write grant applications for their petulant supervisors.

There is nothing bigoted about desiring verifiably high standards in field, nor is it bigoted to scrutinize the training quality of FMGs. At least with domestic schools, there is a verifiable standard set so that everyone "should" meet a minimum level of competence. We don't have that kind of information or oversight for foreign schools. This doesn't mean all FMGs are bad, but that all FMGs (including white Americans who go to the islands - no playing the race card here!) need to be scrutinized heavily. I think that in pathology we don't scrutinize strongly enough, which results in the myriad challenges we face nowadays.

 

[Pathman1000]

Most residency programs probably shouldn't be open. I don't see how one should be impressed by someone being an academic pathologist, because I assume most would rather do private practice but cannot because of factors out of their control, some justifiable, some not.

Also from my experience, certain cultures look down on pathology, along with psychiatry and family practice, precisely because those are the entry points for most FMGs into our medical system. Many FMG pathologists were other prestigious specialists in their home countries but were excluded from practicing those fields here, so rather than drive cabs or start from scratch, they settled into pathology - the Salvation Army of medicine - and are probably quite resentful of that. Its hard to have much respect for a specialty when your career alternative is driving a cab. I know that in Chinese culture, to match to such a low-competition field as pathology is to lose face.

If someone's English isn't up to par, they shouldn't be practicing in the USA, in any specialty. There is no excuse for poor communicators in any field. Being in a non-patient-contact specialty is not an excuse.

Someone obtaining a PhD before doing pathology is, again, not very impressive. PhDs are a dime a dozen, and anyone can get into one and finish it provided they will work for peanuts and write grant applications for their petulant supervisors.

There is nothing bigoted about desiring verifiably high standards in field, nor is it bigoted to scrutinize the training quality of FMGs. At least with domestic schools, there is a verifiable standard set so that everyone "should" meet a minimum level of competence. We don't have that kind of information or oversight for foreign schools. This doesn't mean all FMGs are bad, but that all FMGs (including white Americans who go to the islands - no playing the race card here!) need to be scrutinized heavily. I think that in pathology we don't scrutinize strongly enough, which results in the myriad challenges we face nowadays.

So I've encountered exactly the opposite reaction when it comes to the image of pathology in other countries. From what I've seen, pathology is highly regarded as are surgical specialties, internal medicine and radiology. Pathology remains an extremely lucrative specialty in many parts of the world. Primary care, psychiatry and ironically dermatology are not as well-regarded, are considered easy specialties to match into and thus are usually reserved for medical students with low scores or red flags. The majority of FMGs I spoke with about this were Middle-Eastern, so maybe it's different in China. Regardless, going into a specialty (or medicine in general) for the prestige factor is a recipe for lifelong misery.

 

[icpshootyz]

Most residency programs probably shouldn't be open. I don't see how one should be impressed by someone being an academic pathologist, because I assume most would rather do private practice but cannot because of factors out of their control, some justifiable, some not.

Also from my experience, certain cultures look down on pathology, along with psychiatry and family practice, precisely because those are the entry points for most FMGs into our medical system. Many FMG pathologists were other prestigious specialists in their home countries but were excluded from practicing those fields here, so rather than drive cabs or start from scratch, they settled into pathology - the Salvation Army of medicine - and are probably quite resentful of that. Its hard to have much respect for a specialty when your career alternative is driving a cab. I know that in Chinese culture, to match to such a low-competition field as pathology is to lose face.

If someone's English isn't up to par, they shouldn't be practicing in the USA, in any specialty. There is no excuse for poor communicators in any field. Being in a non-patient-contact specialty is not an excuse.

Someone obtaining a PhD before doing pathology is, again, not very impressive. PhDs are a dime a dozen, and anyone can get into one and finish it provided they will work for peanuts and write grant applications for their petulant supervisors.

There is nothing bigoted about desiring verifiably high standards in field, nor is it bigoted to scrutinize the training quality of FMGs. At least with domestic schools, there is a verifiable standard set so that everyone "should" meet a minimum level of competence. We don't have that kind of information or oversight for foreign schools. This doesn't mean all FMGs are bad, but that all FMGs (including white Americans who go to the islands - no playing the race card here!) need to be scrutinized heavily. I think that in pathology we don't scrutinize strongly enough, which results in the myriad challenges we face nowadays.

It's not about scrutinizing enough or not enough. There are simply too many residency spots each year. Programs want to fill them, so they take whatever is available. Cut the spots and you can start to separate the chaff. Unfortunately there seems to be no impetus to do so.

 

[Over9000]

It's not about scrutinizing enough or not enough. There are simply too many residency spots each year. Programs want to fill them, so they take whatever is available. Cut the spots and you can start to separate the chaff. Unfortunately there seems to be no impetus to do so.

If we were to scrutinize and maintain a high standard, many programs simply would not fill. Unfortunately the current system rewards quantity over quality.

 

[MetroPath]

If we were to scrutinize and maintain a high standard, many programs simply would not fill. Unfortunately the current system rewards quantity over quality.

Why are you so angry? Did a FMG take your job or something? Did you have a hard time finding a job? Are you losing business in private practice?

 

[icpshootyz]

If we were to scrutinize and maintain a high standard, many programs simply would not fill. Unfortunately the current system rewards quantity over quality.

That doesn't make sense when we have a match system as well as a post-match scramble. EVERY spot fills. How would you keep spots from filling when the scramble exists? I don't know of any list of criteria there is to be a path resident (or a resident of any specialty really) other than being a med student in your graduating year or later. How would we "maintain a high standard"? What does that even mean?

 

[Over9000]

That doesn't make sense when we have a match system as well as a post-match scramble. EVERY spot fills. How would you keep spots from filling when the scramble exists? I don't know of any list of criteria there is to be a path resident (or a resident of any specialty really) other than being a med student in your graduating year or later. How would we "maintain a high standard"? What does that even mean?

What I mean is that even with a match system, if programs had higher standards they would be alright with not accepting anyone in the match or SOAP. Just because there is a match does not mean that programs must rank everyone that applies. Some of the surgical subspecialty programs do this. If they can't find anyone they like, they lapse the spot for a year. I've never seen that happen with a path spot.

By high standards I mean good board scores, preferably domestic students, good clinical grades and AOA, same as for any other specialty that has high standards. I know our field is not competitive, but there are too many of us around anyway so having a superbly high standard would certainly be good investment for the future of the field.

The assumption that anyone can get a spot in this field if they just apply reduces the perception of our work - professionally, politically and publicly - from consultant specialist diagnostician to unskilled, largely interchangeable, technical laborer.

 

[icpshootyz]

What I mean is that even with a match system, if programs had higher standards they would be alright with not accepting anyone in the match or SOAP. Just because there is a match does not mean that programs must rank everyone that applies. Some of the surgical subspecialty programs do this. If they can't find anyone they like, they lapse the spot for a year. I've never seen that happen with a path spot.

By high standards I mean good board scores, preferably domestic students, good clinical grades and AOA, same as for any other specialty that has high standards. I know our field is not competitive, but there are too many of us around anyway so having a superbly high standard would certainly be good investment for the future of the field.

The assumption that anyone can get a spot in this field if they just apply reduces the perception of our work - professionally, politically and publicly - from consultant specialist diagnostician to unskilled, largely interchangeable, technical laborer.

I still argue the only way that can happen is to cut back the number of spots. Highly competitive residencies remain that way because there are limited spots. We don't have that problem, we have an overabundance of spots. As long as we have too much supply, we allow for bottom tier students to be accepted and become practicing pathologists. As long as we allow mediocre to terrible residency programs to exist, we allow for bottom tier students to be accepted and become practicing pathologists. As far as I know NO field in medicine has any actual criteria to get in. It's not like Dermatology or Orthopedic Surgery have some strict Boards scores and GPA and research amount that their applicants must have. It's just that demand is so high compared to supply of spots that Derm/Ortho has the ability to pick the cream of the crop. We have the opposite problem. Cut the supply and you can select out the better applicants. Have bad programs shut down. Use some sort of algorithm based on surgical volume to allot residency spots.

 

[Tissue issue]

I still argue the only way that can happen is to cut back the number of spots. Highly competitive residencies remain that way because there are limited spots. We don't have that problem, we have an overabundance of spots. As long as we have too much supply, we allow for bottom tier students to be accepted and become practicing pathologists. As long as we allow mediocre to terrible residency programs to exist, we allow for bottom tier students to be accepted and become practicing pathologists. As far as I know NO field in medicine has any actual criteria to get in. It's not like Dermatology or Orthopedic Surgery have some strict Boards scores and GPA and research amount that their applicants must have. It's just that demand is so high compared to supply of spots that Derm/Ortho has the ability to pick the cream of the crop. We have the opposite problem. Cut the supply and you can select out the better applicants. Have bad programs shut down. Use some sort of algorithm based on surgical volume to allot residency spots.

Agree. However, we aren't hearing any volunteers. Instead, we're hearing about a pathologist shortage.

 

[blondie85]

I feel the same regarding how we could improve our specialty. Limiting the number of spots would increase competition and improve not just the quality of our specialty but the respect others have for it. And as someone whose dad is an fmg (so I am no bigot and come from an immigrant family), I still agree that the huge number of imgs and fmgs in the field is alarming. And I'm pretty certain that derm, if not ortho, purposely limits their spots so that when you get out of residency there is a big demand for you and you can command what you want. Path should do the same and solve two birds with one stone--increasing quality and respect and also making the job market better than the horror show it is right now, which would in turn attract more competitive applicants.

 

[Over9000]

Why are you so angry? Did a FMG take your job or something? Did you have a hard time finding a job? Are you losing business in private practice?

It is not the fault of the FMGs who take advantage of the opportunities that were given to them. If they were good enough to do something else they would have. Path is better than cab driving. If it were me I'd do the same.

I take issue with the fact that the system is set up such that programs and hospitals are rewarded for allowing so many underqualified people who I would not want even waiting my tables into this field.