Caught in a bind....

[Amygdali-lama]

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hi. I am usually a lurker, but decided to ask a question and am hoping for some advice to help me come out of my sdn shell....

anyway, i went on an interview for internal medicine at a very prestigious place that i would have never gotten the interview had i not done an outside elective there. they REALLY work their residents and have broken the 80 hour work week on a few occasions. BUT, they are a top 15 program and have a unbelieveable track record of fellowship placement in GI, which is something i want to do.

so, here is the question: would you still rank this place highly even though you know you will not be happy there for the next 3 years KNOWING that it will SUBSTANTIALLY increase your chances of getting a GI fellowship?

i have been going back and forth on this for a long time now and is getting me even more nervous as ROL time is kind of coming up faster than i had realized.

and the reason why i ask this is because i keep on hearing that one should not rank a porgram that they will not be happy at, BUT what if that program can pretty much set you up for what you really wanted to do all along.

advice is GREATLY appreciated!!!

 

[NR117]

For me it would boil down to whether or not the faculty consisted of decent people. I don't mind working hard at all if the staff are nice but if I have to be around jerks, even a 40-hour week would feel like an eternity. Case in point: I remember two rotations during my PGY-1 year where the workload was unbelievable BUT I had a fantastic time, despite the exhaustion!
What do you know about how residents are treated at this program, other than that they work hard and eventually stand a great chance of matching to GI?
Bottom line: it may be different for you but I wouldn't automatically conclude that I would be unhappy at a program where residents work very hard. Tired, yes. But not necessarily miserable.

 

[NR117]

Also, remember that you will only be a resident for so many years and then you get to be an alumni of that prestigious program forever. Just something else to consider...

 

[Amygdali-lama]

For me it would boil down to whether or not the faculty consisted of decent people. I don't mind working hard at all if the staff are nice but if I have to be around jerks, even a 40-hour week would feel like an eternity. Case in point: I remember two rotations during my PGY-1 year where the workload was unbelievable BUT I had a fantastic time, despite the exhaustion!
What do you know about how residents are treated at this program, other than that they work hard and eventually stand a great chance of matching to GI?
Bottom line: it may be different for you but I wouldn't automatically conclude that I would be unhappy at a program where residents work very hard. Tired, yes. But not necessarily miserable.

hey nr117

thanks for your quick advice. the thing is is that the program is very prestigious, and the people there know it and show it off too. by that, i mean that the people are VERY arrogant and can be very brash. i agree with you in that if i like the colleagues, work is tolerable and dare i say, even fun. but if your colleagues are p***ks, then it makes even the most simple day a big pain the butt. being there for over a month, the residents are very worked, but they are not the happiest either. from what it seemed like, half the people were there because they know that the name can get them far, and the other half are self-inflated egomaniacs who are compelled to thik they they DESERVE to be there. so, the first half just takes it as a 3 year prison sentence and the other half sit there and bicker as to "who's got a bigger ego" complex, more publications, greater knowledge base, higher IQ, higher Board score, etc. the attendings are good too for the most part, but they are very conservative people /with very "old school" values and beliefs (lets just leave it at that). they believe that the 80 hour work week is for wimps since they had to work 120 (which BTW is the reason why this place breaks the rule a few times and tells their residenst to lie on the "time sheet" to cover things up)

Yes, the place does NOT fit what kind of person I am. Yes, the place can take me far in life, and to be honest, my goal is not IM, but GI. Yes, I will likely be not happy there (would not go so far as to say miserable, but definitely not heppy).

now, with that as a background, would you still rank the place high?

 

[BKN]

now, with that as a background, would you still rank the place high?

Only if your goal is high powered academics. I would think that you can get a GI fellowship easily enough from many programs. (I don't really know that stats for GI, but you should be able to find out.)

 

[robotsonic]

I've been thinking about this a lot lately as well - the issue of whether to sacrifice some short-term happiness for future opportunities. I'm not really sure what the answer is, but I can tell you something I noticed. At some of the smaller, not-so-prestigious programs at which I have interviewed, many of the residents get really good fellowship placement. I was actually surprised by this. Although coming from a great residency helps with fellowship placement, it can't be the only factor, as evidenced by the residents at a few of the places I saw.

The point is that going to a less prestigious program might not hurt your chances at GI as much as you think. Just be sure that the places you rank highly have matched people in GI recently.

 

[Amygdali-lama]

Only if your goal is high powered academics. I would think that you can get a GI fellowship easily enough from many programs. (I don't really know that stats for GI, but you should be able to find out.)

YES! I got a response from the infamous BKN!

My goal does not necessarily lie in high powered academics, but i would like to end up at a university setting because i like teaching. Maybe this is just a product of mass hysteria, but it seems like GI is getting VERY competitive and some are saying applying to GI fellowship is analogous to applying for an ortho residency in terms of statistical probabliity of getting in. Since GI is not in the match, there is no hard and fast way to find out, but I did contact one program's GI fellowship pretending to be a resident just to find out how hard it like (yes, I realize its not indicative of ALL programs, and yes, I realize I need a life). They are a pretty decent GI fellowship (I wouldn't call it high powered by any means, but its not a dump either- insert GI joke here ) and they recieved 500 applicants for 2 spots!

I hope this is all just a craze and social paranoia, but I guess I have secumbed to the craze....

advice?

 

[Poety]

Also, as BKN said (and this has been his advice to me, he's the man!) big academic careers will require a name, or it will be harder to connect with all the people you need to get acquainted with. However, for a fellowship- you can probably attain that at a smaller program, be happy, and get some super outstanding letters of rec if you do very well.

Also look into programs that funnel their own into the fellowships. Unless ofcourse, we resort back to "prestige = happiness" in which case, you may suffer for the 3 years of residency, but ultimately be more satisfied at a big name institute.

Either way good luck! 🙂

 

[BKN]

YES! I got a response from the infamous BKN!

they recieved 500 applicants for 2 spots!

I hope this is all just a craze and social paranoia, but I guess I have secumbed to the craze....

advice?

Infamous?

So, there were about 4700 medicine positions last year. apparently >10% want to do a GI fellowship and they all applied to this place. 😎 I think somebody's leg was pulled hard.

 

[NR117]

Yes, the place does NOT fit what kind of person I am. Yes, the place can take me far in life, and to be honest, my goal is not IM, but GI. Yes, I will likely be not happy there (would not go so far as to say miserable, but definitely not heppy).

now, with that as a background, would you still rank the place high?

Well, this last piece of information changes things...If you are not just tired but unhappy too, that is a lot more difficult to take and there's a chance you'll perform below your capacity ( I know I would).

Difficult decision...Best of luck to you.

 

[tiene dolor?]

so, here is the question: would you still rank this place highly even though you know you will not be happy there for the next 3 years KNOWING that it will SUBSTANTIALLY increase your chances of getting a GI fellowship?

No ****ing way.

 

[wtwei02]

Same dilemma, different specialty. Then I thought to myself, crap, I'm going to be close to 30 by the time I get out of residency, and there's no way I want to spend the rest of my 20's being less than absolutely happy. I can always work harder, and get the fellowship i want, but if I'm at a unhappy place for the next 4 years, there's nothing I can do to bring back my 20's. That's my point of view.

 

[radonc]

i think people mistake those who attend prestigious med schools and residencies of being jerks, show-offs, and arrogant. while this may be true of some of those people, it isnt good to make generalizations. usually, while those who go to prestigious programs are smart, they are also well rounded, out going, and nice people who have the same goal....to become the best doctor they can be.
\

 

[Poety]

Same dilemma, different specialty. Then I thought to myself, crap, I'm going to be close to 30 by the time I get out of residency, and there's no way I want to spend the rest of my 20's being less than absolutely happy. I can always work harder, and get the fellowship i want, but if I'm at a unhappy place for the next 4 years, there's nothing I can do to bring back my 20's. That's my point of view.

Could be worse - you could be 37 when you finally get out 😉 ugg, I'm old!

 

[jennyboo]

by that, i mean that the people are VERY arrogant and can be very brash. i agree with you in that if i like the colleagues, work is tolerable and dare i say, even fun. but if your colleagues are p***ks, then it makes even the most simple day a big pain the butt. being there for over a month, the residents are very worked, but they are not the happiest either. from what it seemed like, half the people were there because they know that the name can get them far, and the other half are self-inflated egomaniacs who are compelled to thik they they DESERVE to be there.

I think to benefit both yourself and the residents who would be happier at this program without the negative vibes from your unhappy self, you should not rank the program. Why, having done the rotation and seen that you would not be happy at the place, did you even waste money to apply? The place rubs you the wrong way and it is clearly not right for you.

My goal does not necessarily lie in high powered academics, but i would like to end up at a university setting because i like teaching.

You can and will make of your career what you want to make of it. If you want to teach, you will find a way to teach wherever you are.

Since GI is not in the match, there is no hard and fast way to find out, but I did contact one program's GI fellowship pretending to be a resident just to find out how hard it like (yes, I realize its not indicative of ALL programs, and yes, I realize I need a life). They are a pretty decent GI fellowship (I wouldn't call it high powered by any means, but its not a dump either- insert GI joke here ) and they recieved 500 applicants for 2 spots! advice?

Are you nuts? Why did you call a program pretending to be a resident? You didn't need to do that and it didn't help you, and not only that I think you were dishonest. Calm down. You're making way too big a deal out of this.

 

[Mumpu]

Here's a better question. You know in advance the program is playing with fire with work hours. Do you really want to risk ending up at a formerly highly-ranked program on probation by ACGME? I'm sure that will not do well for your fellowship applications.

Any program that thinks it can do whatever it wants to because its "reputable" or "top 10" is full of **** and is bound to get burned (cough*Hopkins*cough). As a competitive applicant, you should exercise your powers of a selective consumer and take your application elsewhere. I recently interviewed at Northwestern which is Q5 with no night call, cush as can be, and boasts nearly 100% placement rate for GI and cards.