Community CA Programs

[fetorius]

Can anyone share their thoughts on ranking community CA programs (SCVMC, Cedars, SBCH, Kaiser LA, and Harbor-UCLA) taking into account best training, fellowship placement, and job opportunities (assuming no preference for Northern vs. Southern California). Also if one wants to stay in CA long-term, would you rank all of the community CA programs over top tier (10-30ish) out of state programs or just some? Thanks!

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[Derv]

Don't know about the program but I heard Santa Barbara is pretty dope

 

[Naijaba]

Can anyone share their thoughts on ranking community CA programs (SCVMC, Cedars, SBCH, Kaiser LA, and Harbor-UCLA) taking into account best training, fellowship placement, and job opportunities (assuming no preference for Northern vs. Southern California). Also if one wants to stay in CA long-term, would you rank all of the community CA programs over top tier (10-30ish) out of state programs or just some? Thanks!

I interviewed at SCVMC and the faculty and residents were top notch. I got the vibe that the residents could've matched elsewhere, but they wanted to be in northern California (there are only two other programs and they are crazy competitive). The hospital services a large Vietnamese population and it seems like speaking Vietnamese would help, although radiologists are limited in their patient interactions. The faculty were very social inside the reading rooms making for a fun learning environment. One was talking about Survivor (the TV show) while another was talking about his travels around the world. It's very resident-run (there are no fellows!) so there's a lot of work to be done. They showed us a copy of their match list...almost all went to UCSF/Stanford/UW. I think if you want to go here you'd have to rank it high because there's huge demand.

 

[OrangeJuice1111]

I interviewed at SCVMC and the faculty and residents were top notch. I got the vibe that the residents could've matched elsewhere, but they wanted to be in northern California (there are only two other programs and they are crazy competitive). The hospital services a large Vietnamese population and it seems like speaking Vietnamese would help, although radiologists are limited in their patient interactions. The faculty were very social inside the reading rooms making for a fun learning environment. One was talking about Survivor (the TV show) while another was talking about his travels around the world. It's very resident-run (there are no fellows!) so there's a lot of work to be done. They showed us a copy of their match list...almost all went to UCSF/Stanford/UW. I think if you want to go here you'd have to rank it high because there's huge demand.

That's not how the match algorithm works

 

[qwerty89]

I'm sure the residents at these programs are generally speaking well qualified due to the sheer competitiveness of CA.

However there is something to be said to going to a program that is the major academic referral center for the city/state. More advanced pathology, Level 1 Trauma, etc.

If you are competitive enough to go to SCVMC/Kaiser/SBCH you are competitive enough for very good academic programs outside the state in other major cities.:

That being said to rank them it would be:

SCVMC > Cedars > Kaiser LA/SBCH > Harbor-UCLA

Harbor did not impress me at all on my interview day a few years ago. The affiliation with UCLA is trivial at best. I believe Cedars has a chest rotation at UCLA Reagan which Harbor does not. Harbor also has a lackluster peds experience since its all at Harbor and not CHLA. Most programs will ship their residents to the local peds hospital in town for their pedi experience (like Cedars). Facilities were pretty crappy and generally speaking its considered a last resort for people who want to match in CA.

Kaiser has the advantage of being in the kaiser system and having connections for future kaiser jobs. Not to mention your residency counts towards your pension if you choose to work there (correct me if I'm wrong).

Also regarding SCVMC and these other community programs. While they all have subspecialized faculty in each subspecialty (MSK, Body, Neuro, etc) they dont have enough to ensure that you will always read out with the right specialist. For example, at SCVMC they told me that the attendings rotate in different departments in order to "maintain their skills". I.E. you might on MSK but checking out with a body attending. While this might not matter as a first year when you are learning the basics. But there is no way they will understand the operative management of a fracture or bone tumor the same way that the MSK guy who goes to all the Rheum/Ortho interdepartmental conferences will. This matters when you are taking electives as a 4th year in your mini fellowships. Will these programs have enough complex Body MR, MSK MR, or TACE/Y-90, etc cases for you?

@shark2000 is familiar with socal programs.

 

[fetorius]

If you are competitive enough to go to SCVMC/Kaiser/SBCH you are competitive enough for very good academic programs outside the state in other major cities.

Thanks for the response everyone! Qwerty89, this is what I'm struggling with at the moment. Some of the CA community programs have excellent fellowship placement in CA (which I imagine would not be the case year after year if they did not train good Radiologists). The out of state programs also have excellent fellowship placement but much less so in CA (probably due to geographical preference more than anything else). My end goal would likely be to return to CA to work after residency/fellowship.

 

[meister]

Then you should train in California.

 

[Naijaba]

That's not how the match algorithm works

Ah yes this is true. I was trying to say that a lot of people rank SCVMC high despite being a community program.

 

[qxrt]

Also regarding SCVMC and these other community programs. While they all have subspecialized faculty in each subspecialty (MSK, Body, Neuro, etc) they dont have enough to ensure that you will always read out with the right specialist.

Cedars is the biggest hospital in California, not to mention top ranked in a bunch of specialties at least by US News. You really think they're not gonna have the volume for subspecialists?

 

[JonnyTalsma]

The advice I received from chief of IR at a large California academic hospital (because I had the exact same question) was to rank the higher tiered academic programs out of state, and that I could organize away rotations in California if that's where I wanted to go for a fellowship and end up practicing.

 

[qwerty89]

Cedars is the biggest hospital in California, not to mention top ranked in a bunch of specialties at least by US News. You really think they're not gonna have the volume for subspecialists?

Cedars may be an exception as they have relatively few residents to faculty and have other excellent clinical services. Many of its residencies are underrated (such as its IM residency). Looking at the other programs shows a different picture. Kaiser LA's faculty list shows a whopping 2 faculty that are MSK trained. Harbor UCLA has 24 total faculty for 24 (6 a yr x 4 years) residents. SCVMC has 24 faculty for 20ish residents. SBCH has 16 faculty for 16ish residents. You get the idea.

What happens when the 1 out of 2 MSK faculty is on vacation while you're doing your "mini-fellowship" in MSK during your 4th year elective?

Also note the IR fellowship match lists for these programs. Its obvious that most people who match community programs in CA placed a high priority on living in CA. Yet few seem to match IR in CA. They match well, just not at the premier CA IR fellowships (Stanford, UCLA, etc). Given how many of their graduates going into less competitive fellowships such as Body stay in CA, I doubt most ranked those OOS fellowships ahead of the top CA ones.


That being said if you absolutely want to be in CA after your training then yes you should train there. Just look at the roster of various Private Practice groups to see that nearly all did at least part of their training locally.

http://www.fullertonradiology.org/
http://www.bicrad.com/
http://www.cairad.com/CAIMA/CAIMAs_Physicians.html

*Have no idea if these are good groups or not, just giving examples*

 

[fetorius]

Great points to think about. I'm also having a hard time comparing the differences in fellowship placement (if any) between SCVMC and Cedars. SCVMC sends more to UCSF/Stanford (recently IR to UW and UCSD) while Cedars is USC/UCLA mainly. They both seem to place very well in a variety of subspecialties.

 

[qwerty89]

Great points to think about. I'm also having a hard time comparing the differences in fellowship placement (if any) between SCVMC and Cedars. SCVMC sends more to UCSF/Stanford (recently IR to UW and UCSD) while Cedars is USC/UCLA mainly. They both seem to place very well in a variety of subspecialties.

Small programs have good local networks, but not much outside of that. Not to mention most people for a variety of reasons tend to want to stay where they did their training. Found a spouse during residency. Settled down. Kids in local schools.

 

[qxrt]

Also note the IR fellowship match lists for these programs. Its obvious that most people who match community programs in CA placed a high priority on living in CA. Yet few seem to match IR in CA. They match well, just not at the premier CA IR fellowships (Stanford, UCLA, etc). Given how many of their graduates going into less competitive fellowships such as Body stay in CA, I doubt most ranked those OOS fellowships ahead of the top CA ones.

Based on the websites for these programs that have them, the most recent graduates within the past several years to go to IR have gone to top places, many in competitive locations, like Miami Vascular and Dotter (Kaiser), Mount Sinai (SBC and Cedars), U Colorado (Cedars), and U Washington (SCVMC). And yet, because many of them didn't go to Stanford or UCLA, you assume that they must have wanted to stay in California but weren't competitive enough to do so? I can understand the reasoning behind how you came to your assumption, but IR is a considerably different beast from the other specialties in that applicants tend to be more competitive and inclined to go to the best training program nationwide due to the variable nature of IR training, whereas for most of the other subspecialties you can learn pretty much most of it at most fellowships, and location becomes a bigger factor. As much as people may like to think that California is the best in everything, the IR programs considered to be at the very top in the nation are not in California.

 

[qwerty89]

Based on the websites for these programs that have them, the most recent graduates within the past several years to go to IR have gone to top places, many in competitive locations, like Miami Vascular and Dotter (Kaiser), Mount Sinai (SBC and Cedars), U Colorado (Cedars), and U Washington (SCVMC). And yet, because many of them didn't go to Stanford or UCLA, you assume that they must have wanted to stay in California but weren't competitive enough to do so? I can understand the reasoning behind how you came to your assumption, but IR is a considerably different beast from the other specialties in that applicants tend to be more competitive and inclined to go to the best training program nationwide due to the variable nature of IR training, whereas for most of the other subspecialties you can learn pretty much most of it at most fellowships, and location becomes a bigger factor. As much as people may like to think that California is the best in everything, the IR programs considered to be at the very top in the nation are not in California.

As someone originally from CA I can say with confidence that most people that went to undergrad, med school and residency there and have never left think of the place as the greatest place on earth. America is basically NYC and Boston in the NE, Florida in the SE, Texas and a bunch of nothing in the middle in their eyes.

A look at the graduating class of UCSF (2017) shows that 5/5 going into IR are doing so at UCSF. Now either UCSF grads love the bay area more than the SCVMC grads, or there is a difference. Now i know nobody is choosing SCVMC over UCSF or other top CA programs. They are debating good/top OOS with community CA, but this makes it highly unlikely that those IR people went OOS from their community programs entirely by choice.

A look at the fellowship thread from a year or two ago on AuntMinnie showed that the Stanford/UCSF MSK fellowships both filled internally. So a SCVMC grad was SOL that year for staying in the bay if they wanted MSK. Unless they went with a PP fellowship like Stoller. And there is noway to predict that.

Generally speaking the local community grads and fill up the remainder of whatever is left after the desirable internal candidates have filled those positions.

On the flip side this means that "coming back to CA for fellowship" isn't necessarily easy depending on the exact location and subspecialty.

My advice is that if you are 100% dead set on CA then stay in CA and hope for the best. Life is more than residency and due to the competitiveness you will have good quality co-residents. But just understand that its not the same thing as going to an excellent OOS university program. It just isn't.

 

[qxrt]

They are debating good/top OOS with community CA, but this makes it highly unlikely that those IR people went OOS from their community programs entirely by choice.

I understand the reasoning behind your assumption. But I happen to know that several recent IR applicants at one of those programs ranked the OOS IR fellowships they matched at above all the California interviews they got, including Stanford and UCLA. It's anecdotal and an n=1 as far as programs go, but given that there aren't many California community programs in the first place and even fewer people within those programs applying into IR, it's still a significant sample, and it's not unreasonable to think that applicants at the other programs have a similar mindset. And I don't discount the possibility that they may not have matched at those California programs after the interviews even if they HAD ranked them higher than the OOS ones. But regardless, your assumption does not hold true in all and possibly even most cases.

Don't get me wrong; I don't claim to know the answer. There are definitely benefits to a brand-name OOS residency when it comes to fellowship applications. But connections also become very important when it comes to fellowship level and the playing field shrinks, and it's not always so clear-cut as to whether brand-name or connection wins out at this level, particularly when it comes to breaking into a relatively exclusive area like California.

 

[fetorius]

My advice is that if you are 100% dead set on CA then stay in CA and hope for the best. Life is more than residency and due to the competitiveness you will have good quality co-residents. But just understand that its not the same thing as going to an excellent OOS university program. It just isn't.

I appreciate the thoughtful response from you and qxrt - it definitely has given me a lot to think about. Cedars was mentioned briefly above as an exception since there are a large number of specialized Radiologists on staff and their sheer volume of studies. Any other thoughts on this program specifically?