Community Program vs University

[sara223344]

The program I liked most thus far is a large nationally known community program, and I'd say certainly well-respected regionally. I only applied to one community program, every where else I've interviewed has been a Uni prog.

I'm a bit nervous about the fact that it's not a University (nor university affiliate) program. When I interviewed I was impressed by the size, the hospital, the residents, and research opportunity. I quickly decided it was my top choice. Two days later I interviewed at a nearby university program and in closing comments they advised us not to sell ourselves short by going to a community program (probably in reference to the program i spoke of). I got all nervous about it again.

My other concern is that I plan on eventually practicing outside the U.S, and how good a program actually is vs. name recognition presents me with a dilemma.

Thoughts SDNers?

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[Instatewaiter]

The program I liked most thus far is a large nationally known community program, and I'd say certainly well-respected regionally. I only applied to one community program, every where else I've interviewed has been a Uni prog.

I'm a bit nervous about the fact that it's not a University (nor university affiliate) program. When I interviewed I was impressed by the size, the hospital, the residents, and research opportunity. I quickly decided it was my top choice. Two days later I interviewed at a nearby university program and in closing comments they advised us not to sell ourselves short by going to a community program (probably in reference to the program i spoke of). I got all nervous about it again.

My other concern is that I plan on eventually practicing outside the U.S, and how good a program actually is vs. name recognition presents me with a dilemma.

Thoughts SDNers?

I think your decision depends on a few things:

First and foremost, what do you want to do after residency? If you know you want to specialize especially Cards or GI then you should probably pick a university program with those fellowships. However, if you want to do primary care or hospitalist medicine then you would probably be fine at the community program.

Second, how did the next best choice feel in comparison? Was there a huge difference between #2 and #1? I am a firm believer on going by feel rather than making these huge spreadsheets.

Third what kind of case load and what diversity of cases do you see? I am at a university program and I know that I would not have seen half of what I have this year if I was at a community program. Just this last few weeks I have seen/diagnosed AIHA, ITP, cryoglobulinemia, a lupus flare that presented exactly like sepsis, ACTH independent adrenal insufficiency, disseminated TB, WPW, as well as a host of other things that community hospitals send us when they have no idea what to do next. At a university program you see the diagnostic dilemmas and take care of sicker patients than at a community hospital who punt them to you. For instance, I had a patient with end-stage cardiomyopathy with an EF of 5% dependent on inotropes. That kind of stuff gets sent to a tertiary care center. Now you would never need to know how to take care of this stuff as an outpatient primary care physician, so it won't matter if you don't see this kind of stuff but if you are at all thinking about specializing it may be better to go to the university. Not all community programs are the same. Some are very solid and see a diversity of patients but most uni programs see more diverse cases.

 

[sara223344]

I think your decision depends on a few things:

First and foremost, what do you want to do after residency? If you know you want to specialize especially Cards or GI then you should probably pick a university program with those fellowships. However, if you want to do primary care or hospitalist medicine then you would probably be fine at the community program.

Second, how did the next best choice feel in comparison? Was there a huge difference between #2 and #1? I am a firm believer on going by feel rather than making these huge spreadsheets.

Third what kind of case load and what diversity of cases do you see? I am at a university program and I know that I would not have seen half of what I have this year if I was at a community program. Just this last few weeks I have seen/diagnosed AIHA, ITP, cryoglobulinemia, a lupus flare that presented exactly like sepsis, ACTH independent adrenal insufficiency, disseminated TB, WPW, as well as a host of other things that community hospitals send us when they have no idea what to do next. At a university program you see the diagnostic dilemmas and take care of sicker patients than at a community hospital who punt them to you. For instance, I had a patient with end-stage cardiomyopathy with an EF of 5% dependent on inotropes. That kind of stuff gets sent to a tertiary care center. Now you would never need to know how to take care of this stuff as an outpatient primary care physician, so it won't matter if you don't see this kind of stuff but if you are at all thinking about specializing it may be better to go to the university. Not all community programs are the same. Some are very solid and see a diversity of patients but most uni programs see more diverse cases.

Yea that's my greatest fear. I have zero interest in primary care, just not my cup of tea. I either wanna do pulm/cc or cards. The program is supposedly strong and sees a good variety of patients, though the ICU was quiet on my tour day. The program has its own fellowship for pulm/cc,and a shares a cards fellowship with a uni program. So I wanted to stay for fellowship itd be cool-- my chances of going somewhere better I'm not sure about.
My #2 is known to be a tough program but with great cases. I dont mind working hard, its just that the community program happens to be in a nicer area, I can live closeby while #2 would require a commute (which I hate), and like you said-- by my own personal feel i liked the community program.. rationally, I should probably pick a university program to 'insure' the quality of experience you see now, you know?

 

[confuse]

I think it depends on the caliber of the community program. You should look at the fellowship match list and compare it with some of the other university programs that you are considering. Some of the well known community programs discussed in this forum are really strong, arguably even stronger than most of the university programs.

In terms of patient diversity, if it's a decent size program with good volume of patients in an urban area, I wouldn't worry so much. You may miss a few zebras but as long as you can take care of sick patients in the ICU and know how to manage "bread and butter" cases, I think that's adequate. The zebras if you don't encounter during your residency training, you will have plenty of opportunity to encounter them later in your professional career. I think the main issue that comes to my mind when considering community programs is the quality of teaching. Most academic physicians at university programs are interested in teaching. Some of their salary may be dependent by how well they teach. However, most of the private attendings at community program have no obligation to teach. This may be an issue that you want to investigate further. In addition, do you feel that you can fit in with the residents at the program? Most community programs fill many of their spots with IMGs, not that IMGs are any less competent or friendly, but there is some cultural and social nuances that may be different from what you are used to. Good luck with your rank list.

 

[lordjesus]

IMHO if you have an opportunity to train at a university program its best to take it for 2 reasons:

1. Far better fellowship placement than community programs in majority of cases.

2. If you want to find a job after residency you might have an edge in competitive markets like NYC, San Francisco Bay Area, SoCal, etc If I was an employer, I will prefer a UCSF, UCLA or Stanford residency grad over a Kaiser, St. Mary or Santa Clara Valley grad.

 

[lordjesus]

I think it depends on the caliber of the community program. You should look at the fellowship match list and compare it with some of the other university programs that you are considering. Some of the well known community programs discussed in this forum are really strong, arguably even stronger than most of the university programs.

In terms of patient diversity, if it's a decent size program with good volume of patients in an urban area, I wouldn't worry so much. You may miss a few zebras but as long as you can take care of sick patients in the ICU and know how to manage "bread and butter" cases, I think that's adequate. The zebras if you don't encounter during your residency training, you will have plenty of opportunity to encounter them later in your professional career. I think the main issue that comes to my mind when considering community programs is the quality of teaching. Most academic physicians at university programs are interested in teaching. Some of their salary may be dependent by how well they teach. However, most of the private attendings at community program have no obligation to teach. This may be an issue that you want to investigate further. In addition, do you feel that you can fit in with the residents at the program? Most community programs fill many of their spots with IMGs, not that IMGs are any less competent or friendly, but there is some cultural and social nuances that may be different from what you are used to. Good luck with your rank list.

Apart from the top community programs in the country most might not have good teaching. I think having IMG's in a community or university program is not a bad thing, I learned a lot from some amazing IMG's from India during my away rotation. Some cultural/social nuances will be different but if you will be working in a city with a very diverse patient population, its prolly not a bad thing to learn about different cultures either!

 

[sara223344]

.

 

[superhero16]

where do Mayo and Cleveland Clinic stand in this discussion?

 

[Instatewaiter]

Both are very solid programs that will give you good options for fellowship.

 

[Gibbles]

Your skills, level of intelligence, previous test scores, and who you know will determine your fellowship status in terms of interview quality and quantity.

Whether you go to a university program or a community-based program makes absolutely no difference unless you choose the wrong program. By the way, a recent quality of care survey picked a community based program over all other programs in the nation (including community and university-based) in terms of overall rankings in multiple different areas for patient care, satisfaction, and overall attention high-level of care while spending the least amount of money. That was something that programs like the University of Pennsylvania, Johns Hopkins and other major programs failed hard at during the whole study process.

The program that I'm at routinely matches any given resident into a fellowship program of their choice and there are only 7 of us in any categorical IM year. We've had people matching into Cards that were assisting with PCI ,pacemaker placement, and assisting with cardiothoracic surgeries as an IM resident, as well as, a now future Gastroenterologist that has been given ample procedure time under supervision in the GI lab and is pretty much capable of performing EGD/colonoscopy unassisted. When it comes to getting experience without having to worry about fellows while truly getting to know an attending for a reference, a community-based program will always win.

However, an important lesson that should be learned before ever applying to an IM program is that reputation will truly only get you so far if you suck at medicine and don't do the work wherever you end up.

If you're interested in the study:
http://www.carechex.com/media/univhospstudy.aspx

You'll notice two programs that were top ranked in 9 categories. Multiple other were ranked very highly in multiple categories. I suggest you look at those institutions for quality training.

I suggest staying away from the programs that could use some work.

 

[brujerizmo]

I am not sure you can you use "quality of care" of hospital as a measure of good your residency program is. There are many hospitals that are pretty much off that radar that you will definitely get better training than the ones on that list. For instance, off the top of my head, in LA, IMHO, you will receive the best training at Harbor-UCLA. I do have to say that hospital is probably not close in caliber to those ones on that list. But, its a better program.

But, its safe to say, that it is up to you to make into a decent fellowship, and do whatever you want after residency. Getting into any top tier university or community program will not do anything for you if you are lazy and unwilling to put in the work to get into a good fellowship.

 

[Gibbles]

I am not sure you can you use "quality of care" of hospital as a measure of good your residency program is. There are many hospitals that are pretty much off that radar that you will definitely get better training than the ones on that list. For instance, off the top of my head, in LA, IMHO, you will receive the best training at Harbor-UCLA. I do have to say that hospital is probably not close in caliber to those ones on that list. But, its a better program.

But, its safe to say, that it is up to you to make into a decent fellowship, and do whatever you want after residency. Getting into any top tier university or community program will not do anything for you if you are lazy and unwilling to put in the work to get into a good fellowship.

The quality of a hospital directly affects the quality of a residency with opposite being true, as well. If a hospital is known for poor quality of care across the board, then one could easily reason that those people taking care of the patients in the hospital have absolutely no idea what they're doing. Those that are supposed to know what they're doing are those directly involved in patient care at most major institutions (i.e. the residents and those teaching the residents).

 

[Instatewaiter]

By the way, a recent quality of care survey picked a community based program over all other programs in the nation (including community and university-based) in terms of overall rankings in multiple different areas for patient care, satisfaction, and overall attention high-level of care while spending the least amount of money. That was something that programs like the University of Pennsylvania, Johns Hopkins and other major programs failed hard at during the whole study process.

If you're interested in the study:
http://www.carechex.com/media/univhospstudy.aspx

You'll notice two programs that were top ranked in 9 categories. Multiple other were ranked very highly in multiple categories. I suggest you look at those institutions for quality training.

I suggest staying away from the programs that could use some work.

That "study" you posted is a complete joke. Here are a few highlights from Hospitals I know first hand. .

1) Bon Secours-Memorial Regional Medical in Virginia (where I am from) is ranked 10th overall, in the country. I wouldn't even put it within the top 5 in the city of Richmond. It's by no means a bad hospital but it's ranked top 10 in the country?

2) Martha Jefferson Hospital shouldn't even be considered in the same league as UVA (they are just down the street from each other). Of course, Martha Jefferson is ranked in the top 150 in the country, while UVA doesn't make the list. I don't know anyone who knows anything about medicine who would choose MJ over UVA.

3) 4 of the 5 best hospitals in Virginia rank at the very bottom in Virginia, however many small, unknown hospitals rank at the top in Va.

4) Johns Hopkins is ranked 31st in MARYLAND and doesn't even break the top 225 in the country. I doubt very many people wouldn't consider it to be in the top 10 in the country (if not #1). I regularly get to see what kind of care the outside hospitals of Maryland deliver when they transfer patients to Hopkins. The fact that Hopkins ranks 31st in Maryland is laughable.

Basically, hospitals that are small and punt sick patients to real, tertiary care hospitals get high rankings while the innovative hospitals who take the sick conundrums somehow deliver poor care. What a joke