Choosing residency based on location rather than prestige—is this a bad idea?

[Latteandaprayer]

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Almost time to apply and I’m sure I’ll be applying into Neurology. My entire family and all my friends live in my Midwest state. My fiance is also from this state and would prefer to stay near family (doesn’t mind moving for me but strongly prefers here). As such, I am thinking of only applying to Midwest programs, and applying to every program in my state even if not the most known. As such, there’s a chance I’ll match to a “meh” residency when maybe I could match to a stronger residency if I widened my geographic preferences a bit (not to be braggy, but top school in the Midwest with 7/8 honors in core rotations, 260 step 2, some leadership, multiple pubs).

But location does matter a lot to me. Is this a bad idea, will I likely regret it later, or is this a reasonable approach?

 

[Asklepian]

Many residents stay near where they trained. If you want to stay in that area, no reason to go elsewhere as long as you go to a decent program. In that case, it's more about making the connections there which can be critical to getting the job you want afterward.

 

[s5260205]

At the end of the day, residency trainings are standardized, and it comes down to individual residents in terms of clinical acumen (i.e., doing their own reading proactively instead of the expectation of being spoon-fed knowledge). This means that as long as the hospital offers the patient population and an environment that fosters learning, you will be able to learn and grow. A resident from a name-brand program may not necessarily be better clinically than a resident from a lesser known one. A program with representation in every subspecialty (meaning they will draw the specific pathology) + a collegial environment among faculty and residents are really the most important parts about residency training. I'm sure Midwest has many such programs available, and it's in no way a bad idea to restrict yourself geographically.

I recommend applying to a few "reach" programs outside of the area of your preference. You would then have the options of ranking accordingly if the programs outside of your geographic area of preference really appeal to you (and to prevent regrets and "what if's").

 

[neglect]

Almost time to apply and I’m sure I’ll be applying into Neurology. My entire family and all my friends live in my Midwest state. My fiance is also from this state and would prefer to stay near family (doesn’t mind moving for me but strongly prefers here). As such, I am thinking of only applying to Midwest programs, and applying to every program in my state even if not the most known. As such, there’s a chance I’ll match to a “meh” residency when maybe I could match to a stronger residency if I widened my geographic preferences a bit (not to be braggy, but top school in the Midwest with 7/8 honors in core rotations, 260 step 2, some leadership, multiple pubs).

But location does matter a lot to me. Is this a bad idea, will I likely regret it later, or is this a reasonable approach?

The answer is to look inward, know thyself. What do you value? It appears, based on your scores that you worked extremely hard to earn a very competitive CV. Why do you do that? If you did it to ensure space at an elite institution, that’s fine. If you did that to better yourself, or out of another competitive impulse, that’s also fine, but it may speak to someone striving for more.

You don’t know where life will take you. And life is longer than residency. Looking back on things now it is very likely that I’ve had opportunities in part because I went to a highly recognized residency and fellowship. I know other people for whom it didn’t seem to matter at all. After Ivy league educations, they are content doing NCVs and titrating Vimpat all day, all week.

Look inward. Know thyself.

 

[voxveritatisetlucis]

We’re only on the planet for an average of 80 years, so why spend 4 somewhere you don’t like unless you have to

 

[Spinothalamic]

I generally agree with all the posts above, but do remember that not all programs are created equal. Some have a lot more elective time and dedicated EMG/EEG exposure. I really believe that some are so inpatient heavy that graduating residents would not feel comfortable practicing full-spectrum general neurology (and I’m not even including doing EMGs), so the default is to do inpatient or do an outpatient fellowship purely out of necessity. Some draw transfers/second or third opinions from other academic medical centers so you and your attendings truly are the “end of the line”. However, you can always keep in mind securing fellowship at an excellent institution to round out training at more of a mediocre location for residency. Fellowships in general tend to be much less competitive and it doesn’t matter as much where you did residency. Being close to family can be very important depending on your spouse’s job and if you have kids/are planning to have kids during residency.

 

[DrSatan]

Residency is brutal. If your co-residents suck (hint: they probably will) and you are isolated from friends/family, you will be miserable.

 

[deathmerchant]

Almost time to apply and I’m sure I’ll be applying into Neurology. My entire family and all my friends live in my Midwest state. My fiance is also from this state and would prefer to stay near family (doesn’t mind moving for me but strongly prefers here). As such, I am thinking of only applying to Midwest programs, and applying to every program in my state even if not the most known. As such, there’s a chance I’ll match to a “meh” residency when maybe I could match to a stronger residency if I widened my geographic preferences a bit (not to be braggy, but top school in the Midwest with 7/8 honors in core rotations, 260 step 2, some leadership, multiple pubs).

But location does matter a lot to me. Is this a bad idea, will I likely regret it later, or is this a reasonable approach?

Clinically it won't matter much for a smart/hardworking person as long as you are in any decent, non-toxic, upper-middle of the line program. Especially as far as getting any non-academic jobs and most fellowships. In fact, sometimes top programs are not the strongest clinically.

The main difference will be if you want to do solid research or want to climb the academic ladder- names and connections matter there.

 

[Latteandaprayer]

Clinically it won't matter much for a smart/hardworking person as long as you are in any decent, non-toxic, upper-middle of the line program. Especially as far as getting any non-academic jobs and most fellowships. In fact, sometimes top programs are not the strongest clinically.

The main difference will be if you want to do solid research or want to climb the academic ladder- names and connections matter there.

no desire to really work in academics at all… or do research beyond maybe some limited QI projects and the like

 

[kazill]

I chose location over prestige and don't regret it for a single minute. Residency is hard as hell, and having a strong support system nearby during it has been a life saver for myself, my wife, and my kid.

 

[Hank Rearden]

If you aren't interested in academics or research then you should definitely go where you will be happiest geographically. Only upside to going to a more prestigious place would be better mix of patients (like zebra cases) and possibly better clinical training, but there are good neurologists that can train you just about anywhere. You may not be as up to date on the latest clinical trial data, but as another poster said, much of this depends on you and your own self-instruction along the way. If you decide you later need some fellowship training, keep in mind that neurology fellowships aren't nearly as competitive as residency slots because only about 50% of neurologists pursue fellowship training.

 

[Captain_Falcon]

Isn’t the # of neuro residents that do fellowship much higher, more like 80%?