Choosing location over strength of program

[interviewtrail]

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I know this has been commented before but I figure I'd readdress this topic since many may be going through the same situation. Before interview season started, I would've been more than happy to match at a program in a city I am currently residing. However, I've received interview invitations from a couple of really top notched programs that are about a 4 hour drive away. For family/personal reasons, it would be much easier to end up matching in my home city. However there is always this temptation to be at these world renownded programs I had no realistic expectation to hear from. The programs I was offered interviews here are considered average with generally unhappy residents (I did a rotation here). They claim long/unpredictable hours with very little intraoperative teaching, lack of complex cases - mostly SDA, no transplants, service/education balance shifted towards service, ie. being stuck in eyecases all day, etc. My question is, are all programs created equal if in the end you end up passing the boards and become an anesthesiologist? Or is there really a benefit from training at the best of the best program? What would you choose, an average program with a happy family or a great program with an unhappy but understanding family?

 

[deleted126335]

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[VentdependenT]

I know this has been commented before but I figure I'd readdress this topic since many may be going through the same situation. Before interview season started, I would've been more than happy to match at a program in a city I am currently residing. However, I've received interview invitations from a couple of really top notched programs that are about a 4 hour drive away. For family/personal reasons, it would be much easier to end up matching in my home city. However there is always this temptation to be at these world renownded programs I had no realistic expectation to hear from. The programs I was offered interviews here are considered average with generally unhappy residents (I did a rotation here). They claim long/unpredictable hours with very little intraoperative teaching, lack of complex cases - mostly SDA, no transplants, service/education balance shifted towards service, ie. being stuck in eyecases all day, etc. My question is, are all programs created equal if in the end you end up passing the boards and become an anesthesiologist? Or is there really a benefit from training at the best of the best program? What would you choose, an average program with a happy family or a great program with an unhappy but understanding family?

You gotta be happy where you are living. If your home situation is solid and stable and moving elsewhere would seriously make your life(lives) miserable then you should stay. However, if you think you'll be much happier at another program which is within driving distance, then you should start driving yourself a little bit nuts about your situation.

Look man, you're going to be spending a lot of time at work. If you are miserable at work you are going to be more miserable at home than you should be.

Get a good education and keep your sanity. If folks are passing their boards over at the "home program" and feel they can handle complex cases, then you know its going to be ok. However if you are crankin out eyeball cases as a CA-3 and only sluggin in propofol for LMA's then you are offering nothing in terms of marketability.

 

[amyl]

As far as the family issue, If you are talking about relocating during residency with a spouse to a community where he/she will have no job, no family, and a community that is not a good fit, you are asking for trouble in your marriage. If you are talking about disappointing possessive parents, that is something else.

absolutely.

i was just talking to a resident at an interview who did this exact thing and it ruined his relationship. his home program was weak and he went to one a few hours away. his fiancee moved and transfered medical schools with the best of intentions and super understanding.... long story short, its over.

if you are talking about uprooting your spouse to somewhere he/she will likely be unhappy regardless of how understanding he/she seems at this time (ie no friends, doesn't know anyone, place they aren't crazy about...) you are asking for trouble.
my husband more or less veto'ed one place i interviewed at and i am debating about not ranking it vs. putting it last. not matching vs. possible divorce -- tough call.

 

[toughlife]

I know this has been commented before but I figure I'd readdress this topic since many may be going through the same situation. Before interview season started, I would've been more than happy to match at a program in a city I am currently residing. However, I've received interview invitations from a couple of really top notched programs that are about a 4 hour drive away. For family/personal reasons, it would be much easier to end up matching in my home city. However there is always this temptation to be at these world renownded programs I had no realistic expectation to hear from. The programs I was offered interviews here are considered average with generally unhappy residents (I did a rotation here). They claim long/unpredictable hours with very little intraoperative teaching, lack of complex cases - mostly SDA, no transplants, service/education balance shifted towards service, ie. being stuck in eyecases all day, etc. My question is, are all programs created equal if in the end you end up passing the boards and become an anesthesiologist? Or is there really a benefit from training at the best of the best program? What would you choose, an average program with a happy family or a great program with an unhappy but understanding family?

i'll play the devil's advocate and suggest not to sell yourself short. Look at the long term implications of being a subpar-trained anesthesiologist in the face of increased competition coming from all angles.

The last thing you want is not to feel comfortable doing any case as an attending. If you will spend your days at the home program doing eyeball cases you are selling yourself short of an education.

I know family is key and your happiness depends on it but you can also make the argument that a divorce can still happen for other reasons besides where you train for residency or later down the line. What if you choose a crap program just because you didn't want to piss off your SO and then that person ends up leaving you anyway? You will be lonely and poorly trained.


Talk things up front and tell your SO what he/she can expect for the next four years of your life. Bottomline is don't sell yourself short.

 

[173291]

I for one am having an uber tough time choosing schools. I got that "feeling" at two locations. One, was also ideal geographically. Then, I read that thread reminding me to double check accredidation cycles. Guess what... they are on a two year review!!!😱 Does anyone know if we could find out specific reasons/probs. to correct list?

Anyway, my other good "feeling" school has a five year review cycle, but is in a terrible location for me.

Any suggestions on how to choose? I only have 3 interviews left and I am not expecting too much from those. HELP!!!

 

[173291]

Dude, where are all the fourth year med students? Still interviewing? No time to post? Or am I the only one having trouble figuring this residency rank thing out? I want to hear how other people are faring. How they are making decisions.

 

[amyl]

other people are pm'ing me but not posting publicly that they are struggling with should they rank a "name" program over someplace that might be good but easier. maybe some of the attendings, private practice docs, senior residents can chime in -- will these name programs make us better doctors, get better fellowships, get better jobs, etc. a few people are wondering to me privately if they should go for the hard work program with a name or go for the solid program with no name but a nicer four year experience....

 

[coprolalia]

What would you choose, an average program with a happy family or a great program with an unhappy but understanding family?

Can't say that if I had a chance to choose all over again I would've necessarily picked differently. But, I also can't say I wouldn't have.

I've worked with the same people for a year-and-a-half now in my academic program. I've worked with different people in a separate gig in a private-practice environment. I think that the PP group would offer me a job when I'm done, so that's a plus. I don't want to stay in the area, though.

What I've noticed throughout my entire existence in this medical world we live our lives in is that there are miserable people no matter where you go and what you do. They will try to drag you done. So, it really doesn't matter if you go to Community General Anesthesia program or Big Academic Center program. It's all about how you react to and handle stress. Some people, no matter where you are, will always want to play the "zero-sum game" with you, and they never outgrow this. It's the "I'm right, you're wrong" attitude (that I even sometimes see on this forum) that is killing the medical profession. Other people are hopeless slackers that just want to go through the motions and get out the door. These two groups are, in my opinion, the most miserable people to be around in the hospital for different reasons.

What's my point? No matter where you go, you will find these people. And, they will bring you down if you let them. So, it doesn't matter where you do your training. Be cognizant of that and don't bring it home with you. And, if your significant other is going to be happier and have a better life in an area where family is, that should weigh heavily in your decision. You don't want to be around miserable people (patients included) all day long only to come home to someone else who's also miserable.

In the end, if you are in a board-eligible, board-certifiable program that has high board-pass rates on the first try and a good reputation of placing grads in the jobs they want in the locales they want, then you'll do just fine. Your life outside the hospital is a factor during residency, and if you're bored, lonely, or miserable - or the person that's sharing your life is the same - it's going to make that 3-4 years much worse.

Just my $0.02.

-copro

 

[amyl]

thanks copro.
maybe i will make my husband decide my rank list....then it can be his fault if i end up unhappy ;-)

 

[coprolalia]

thanks copro.
maybe i will make my husband decide my rank list....then it can be his fault if i end up unhappy ;-)

For some reason, I actually rarely hear candidates ask about where grads get jobs when they're done.

😕

-copro la-la-lalia...

 

[173291]

For some reason, I actually rarely hear candidates ask about where grads get jobs when they're done.

😕

-copro la-la-lalia...

I think our version of that question is how many candidates end up in private practice vs fellowships vs academia. It is really hard to gauge good vs "bad" jobs. I don't know anything about private anesthesia groups or which ones are considered to be "top notch." I do know about the reputation of certain fellowship programs, etc. It's tough, man.

Alright SDN land, please share what types of jobs graduates from your programs get. It really would be helpful. We are running out of time before we have to make and certify our rank lists and this ain't getting any easier.

 

[coprolalia]

Well, I think it's more important to know what kind of interviews they are getting and where. It's pretty easy to get just any job nowadays. Depends on where you want to go. For example, last year's graduating class got jobs all over the place, and pretty much everywhere they wanted to be. No one got stuck in a crappy job, as near as I can tell. And, everyone had a job by this time last year.

This year's class is pretty much the same. About half are going on to fellowships (3 in house and 1 at Hopkins), and two others got local jobs and the others are going back to their respective hometowns with great local gigs. The starting salaries I've heard have ranged from $220,000 to $450,000 (for one of the graduating cardiac fellows). No one is staying at our institution and none are going straight into academia elsewhere.

-copro

 

[173291]

Well, I think it's more important to know what kind of interviews they are getting and where. It's pretty easy to get just any job nowadays. Depends on where you want to go. For example, last year's graduating class got jobs all over the place, and pretty much everywhere they wanted to be. No one got stuck in a crappy job, as near as I can tell. And, everyone had a job by this time last year.

This year's class is pretty much the same. About half are going on to fellowships (3 in house and 1 at Hopkins), and two others got local jobs and the others are going back to their respective hometowns with great local gigs. The starting salaries I've heard have ranged from $220,000 to $450,000 (for one of the graduating cardiac fellows). No one is staying at our institution and none are going straight into academia elsewhere.

-copro

May I please ask which institution that is?

 

[climbingdocs]

So every time I am talking to my SO about matching (for next year) we get in fights, because I tell him that he is too picky about where he wants to go. So I gave him a list of all the programs and told him that he needs to find me at least 30 places that he likes. He wants to be close to good climbing areas, and that is his only requirement. So I hope applying to 20 programs will be enough 😕

 

[coprolalia]

May I please ask which institution that is?

You may ask, but I'm not going to say. 😉

-copro

 

[coprolalia]

So every time I am talking to my SO about matching (for next year) we get in fights, because I tell him that he is too picky about where he wants to go. So I gave him a list of all the programs and told him that he needs to find me at least 30 places that he likes. He wants to be close to good climbing areas, and that is his only requirement. So I hope applying to 20 programs will be enough 😕

Isn't Noyac a climber? Ask him.

-copro

 

[IlDestriero]

Hi,
I just found this thread and wanted to reiterate something that I wrote elsewhere.
Just as the quality of your undergraduate University and MCAT scores affects the competitiveness of your Medical School application and the quality of your medical school and USMLE scores affects the competitiveness of your residency application, the quality/prestige of your residency training will affect your job search and marketability. Prospective employers want to know that you can handle the workload in their practice and that you will pass your boards on the first attempt, and not become a thorn in their sides down the road. For many reasons it is in your best interest to train at the best program that you can get into. By the best program I mean a program which does very complex cases on a regular basis, easily exceeds all of their numbers and has a reasonably happy and stable resident class. If everyone that you talk to at the interview is unhappy because they are worked to death every day, given infrequent or poor lectures, and/or feel unprepared to handle challenging cases, you too will be miserable and poorly trained and would likely do better at a different (though still strong) program. Even worse would be a program where everyone barely meets their numbers or requires "creative accounting", having to send you to other hospitals for several out rotations, etc. It is one thing to say that the ICU training or pain clinic is weak and send you to another hospital for this small component of your education, it is quite another if many of your cases at your home program are ASA 1 or 2 or outpatient (or ASA 3/4 eyeballs!) and you are going out for hearts and vascular or trauma and peds cases. (are you listening Dr. Interviewtrail)
However with regards to post residency competitiveness for jobs, if you are certain that you want to live in a particular area of the country you would probably increase your likelihood of finding a job there by attending the best residency program that you could in that region, unless you can match at an elite program with national name recognition. Why? Because your future employers/partners will be personally familiar with graduates of your residency program, if not graduates themselves.
One last caveat- if you are planning to relocate across the country to go to an elite program primarily for the name but intend to relocate again after residency is over, be sure that the program that you think is "elite" is actually NATIONALLY recognized as an elite program and not just regionally recognized as a superior program. It is difficult to come up with a good example but Vanderbilt or UNC may have extraordinary anesthesia programs, but coming from New England and now California, I don't know anything about them, as opposed to Mass General, Mayo, Hopkins, or Stanford who's names are known worldwide.
The fact is that pedigree, and being selected as a Chief Resident, will open doors for you. You will get an interview where others will not. You may not get the job and you almost certainly will not get a better offer, but you will get an interview just because you have Harvard Medical School or a Mass General residency on your CV. This bias will likely decrease as ones career goes on. I will not deny however that an elite degree is probably overrated. Trust that I know about that of which I speak as I was an attending for several years before returning to academia for a fellowship and I am currently on the job interview circuit again myself.
Good luck with your difficult ranking decisions and trust your judgement.
Regards.

 

[lord_jeebus]

I have a similar dilemma.

I am interested in pain, and most likely interested in eventually settling down where I am now. My local program is strong and competitive - 5 year accreditation cycle, graduates dominate the local area and also have nepotistic alumni networks in very lucrative areas that I wouldn't mind living in. I know the pain fellows and their training is excellent -- leaps and bounds beyond a bigger name program that I visited. I know the attendings and we get along very well. They fill completely from within so I would have to do the residency to do the fellowship.

So far, seems like a very straightforward decision. However

I am also very interested in device development and other industrial ventures, and also considering getting involved in public policy. I have a good friend who invents devices for spine surgery, but besides that I have no industry contacts. No one at my institution is involved in this sort of thing, to my knowledge. I am wondering if I would be better off trying to match at Stanford or MGH. My impression is that I would face no difficulty in returning to my local area at the end of my training. What I can't figure out is the extent to which these big national names could help me towards this goal. My thinking is that even without such a huge name, if I were to join or establish a large successful pain practice (which I would want to have regardless of business involvement), I could use that as a base for further career development. On the other hand, I did my undergrad at a very big name and have seen the power of those connections in the business arena.

I also have not decided against a career in academia, although I think I'm less likely to go for that route.

Opinions?

 

[VentdependenT]

I have a similar dilemma.

I am interested in pain, and most likely interested in eventually settling down where I am now. My local program is strong and competitive - 5 year accreditation cycle, graduates dominate the local area and also have nepotistic alumni networks in very lucrative areas that I wouldn't mind living in. I know the pain fellows and their training is excellent -- leaps and bounds beyond a bigger name program that I visited. I know the attendings and we get along very well. They fill completely from within so I would have to do the residency to do the fellowship.

So far, seems like a very straightforward decision. However

I am also very interested in device development and other industrial ventures, and also considering getting involved in public policy. I have a good friend who invents devices for spine surgery, but besides that I have no industry contacts. No one at my institution is involved in this sort of thing, to my knowledge. I am wondering if I would be better off trying to match at Stanford or MGH. My impression is that I would face no difficulty in returning to my local area at the end of my training. What I can't figure out is the extent to which these big national names could help me towards this goal. My thinking is that even without such a huge name, if I were to join or establish a large successful pain practice (which I would want to have regardless of business involvement), I could use that as a base for further career development. On the other hand, I did my undergrad at a very big name and have seen the power of those connections in the business arena.

I also have not decided against a career in academia, although I think I'm less likely to go for that route.

Opinions?

Go where you'll be happy damn it! If you want to design something then thats your deal. You'll have to seek out the dev team. No big name will do that for you. It doesn't matter where you go. If you have that goal in mind then seek it out!

 

[lord_jeebus]

Go where you'll be happy damn it! If you want to design something then thats your deal. You'll have to seek out the dev team. No big name will do that for you. It doesn't matter where you go. If you have that goal in mind then seek it out!

Awesome

Thanks Venty that's what I wanted to hear