Community versus academic residency?

[Catsfordays]

Hello all,
I wanted to pick your brains on the difference between academic versus community for residency. I have received mixed opinions on this from attendings. I have been told academic will train me the best, but I do want to match back home in California. As a not competitive DO, I think my options will be limited to community programs. I do not think this is bad, but will it hurt my chances at a fellowship and training overall? I really enjoy inpatient and I believe I want to do a stroke fellowship to be a neurohospitalist. I appreciate any input! Thank you.

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[Postictal Raiden]

One of the two community hospital based residency programs in CA closed. The other one, Riverside, is a terrible program. Residents are overworked, attendings not invested in teaching and just want to come do their work and leave on time to beat traffic (most live in Irvine), lack of resources.

I’m sure the residents there get very good exposure to all kinds of neurological emergencies. However, that can be said about most neurology residency programs.

Don’t sell yourself short just to be in CA. Aside from the big name places (UCLA, UCSF, Stanford, etc) the other programs are subpar compared places you find elsewhere. Many of CA use the location as their main selling point.

As a side note, some consider Kaiser to be a community based program. It may have been but it’s slowly changing and now they have a medical school. IMO, it’s a good program with a good work/life balance.

 

[confused_doc]

One of the two community hospital based residency programs in CA closed. The other one, Riverside, is a terrible program. Residents are overworked, attendings not invested in teaching and just want to come do their work and leave on time to beat traffic (most live in Irvine), lack of resources.

I’m sure the residents there get very good exposure to all kinds of neurological emergencies. However, that can be said about most neurology residency programs.

Don’t sell yourself short just to be in CA. Aside from the big name places (UCLA, UCSF, Stanford, etc) the other programs are subpar compared places you find elsewhere. Many of CA use the location as their main selling point.

As a side note, some consider Kaiser to be a community based program. It may have been but it’s slowly changing and now they have a medical school. IMO, it’s a good program with a good work/life balance.

Do you know any good outpatient heavy residencies?

 

[Catsfordays]

One of the two community hospital based residency programs in CA closed. The other one, Riverside, is a terrible program. Residents are overworked, attendings not invested in teaching and just want to come do their work and leave on time to beat traffic (most live in Irvine), lack of resources.

I’m sure the residents there get very good exposure to all kinds of neurological emergencies. However, that can be said about most neurology residency programs.

Don’t sell yourself short just to be in CA. Aside from the big name places (UCLA, UCSF, Stanford, etc) the other programs are subpar compared places you find elsewhere. Many of CA use the location as their main selling point.

As a side note, some consider Kaiser to be a community based program. It may have been but it’s slowly changing and now they have a medical school. IMO, it’s a good program with a good work/life balance.

Thank you for your response. I would be content with staying in the west in general, which not only seems to lack programs, but especially academic ones for my caliber. Do you have any recommendations in finding or thoughts on quality community programs in this region? I do plan on applying to the Healthone program in CO, the community programs in Nevada, and UofA as well.

 

[Postictal Raiden]

Do you know any good outpatient heavy residencies?

Not really.
Outpatient heavy residency is an oxymoronic statement haha

 

[Postictal Raiden]

Thank you for your response. I would be content with staying in the west in general, which not only seems to lack programs, but especially academic ones for my caliber. Do you have any recommendations in finding or thoughts on quality community programs in this region? I do plan on applying to the Healthone program in CO, the community programs in Nevada, and UofA as well.

HealthOne is solid.
Valley in Nevada is trash. Very bad.
Both of UoA’s are solid (Phoenix is a much nicer city to live in for 4 years tho).

 

[xenotype]

Thank you for your response. I would be content with staying in the west in general, which not only seems to lack programs, but especially academic ones for my caliber. Do you have any recommendations in finding or thoughts on quality community programs in this region? I do plan on applying to the Healthone program in CO, the community programs in Nevada, and UofA as well.

If your stats are truly below average 'not competitive' then you very likely cannot afford to restrict yourself to a specific geographic area eg 'the west coast' and need to apply very widely. Then make your rank list off of semi-realistic places that you know offer reasonable quality training. Only applying to community programs in a specific region is a recipe to not match. If you love neurology, you can learn to love it in Arkansas if that's what it takes. Plus, a real academic program at a true referral center should be very possible to get in a 'flyover' state even as not the best applicant. Once you are an attending you can go back to wherever you please, especially in this job market. California will make everything harder, and there just aren't many west coast programs in general and all tend to be competitive even for great applicants based on location alone. In arranging your rank list think about climate, distance and cost of safe housing to the hospital (driving on ice during call really sucks), and whether the residents seem happy.

Do an away at somewhere that is semi-realistic for you, get them to fall in love with you and rank them high and you'll have a lot of insurance and more certainty. You can get academic with this strategy at a great mid tier academic program potentially even with a red flag if they like you.

Also- don't worry about outpatient. That is what fellowship is for...

 

[Catsfordays]

If your stats are truly below average 'not competitive' then you very likely cannot afford to restrict yourself to a specific geographic area eg 'the west coast' and need to apply very widely. Then make your rank list off of semi-realistic places that you know offer reasonable quality training. Only applying to community programs in a specific region is a recipe to not match. If you love neurology, you can learn to love it in Arkansas if that's what it takes. Plus, a real academic program at a true referral center should be very possible to get in a 'flyover' state even as not the best applicant. Once you are an attending you can go back to wherever you please, especially in this job market. California will make everything harder, and there just aren't many west coast programs in general and all tend to be competitive even for great applicants based on location alone. In arranging your rank list think about climate, distance and cost of safe housing to the hospital (driving on ice during call really sucks), and whether the residents seem happy.

Do an away at somewhere that is semi-realistic for you, get them to fall in love with you and rank them high and you'll have a lot of insurance and more certainty. You can get academic with this strategy at a great mid tier academic program potentially even with a red flag if they like you.

Also- don't worry about outpatient. That is what fellowship is for...

Thank you for the feedback. I definitely was going to apply to at least the average number of programs for a DO (I believe around 35), but I would obviously prefer to be closer to family. I was planning to do aways in this region as well, but did want a consensus to see if the programs were quality. I appreciate the recommendations about rank list, I have never really driven in snow so it will be something I consider.

 

[xenotype]

Thank you for the feedback. I definitely was going to apply to at least the average number of programs for a DO (I believe around 35), but I would obviously prefer to be closer to family. I was planning to do aways in this region as well, but did want a consensus to see if the programs were quality. I appreciate the recommendations about rank list, I have never really driven in snow so it will be something I consider.

You don't want your first time driving in the snow to be at 5am as an intern on MICU in December in a new city. If your stats are average, you can get away with applying to the average number of programs (eg, average for the average DO neurology applicant- which probably looks a lot like the average MD applicant in step scores, grades etc). If you are below average, double what you need to be safe. Red flag? Carpet bomb most programs, do two aways, and pray- it can really pay off. I wouldn't count places like Stanford or UCSF in that 35 if you have no hope of matching there. The best news is- you can be a better neurologist than the guy that went to Stanford at the end of the day, in a better paying job where you want to be but it requires hard work and sacrifices.

 

[BlueBleck]

the average number of programs for a DO (I believe around 35)

ERAS releases this data. It was 60 last year for DOs, 45 for IMGs and 30 for USMDs. We also have a general sense of scores from the 2020 charting outcomes dataset. USMD matches to neuro average 232 for step1 and DO applicants 227. Not wildly off, so it's not necessarily scores necessitating more applications.

But if you're a top tier applicant, you're a top tier applicant. I know an absolute chad rock star neurosurgery DO applicant who dual-applied to neurology, planning to do NIR as a backup. He got T10 neuro interviews.

 

[slavicman]

I have also been struggling to differentiate between academic and community programs as a current neurology applicant. Some of the seemingly-community programs I applied to like HCA claim an "affiliation" with a medical school (such as HCA-UCF). NYU - Brooklyn also seemed to be like a typical academic program but also heard that their main training hospital is essentially a purely-community hospital with an NYU stamp.

Is there anything specific to look for on these programs' websites or specific questions to ask during interviews to help make this distinction clearer (if it even matters)?

 

[xenotype]

I have also been struggling to differentiate between academic and community programs as a current neurology applicant. Some of the seemingly-community programs I applied to like HCA claim an "affiliation" with a medical school (such as HCA-UCF). NYU - Brooklyn also seemed to be like a typical academic program but also heard that their main training hospital is essentially a purely-community hospital with an NYU stamp.

Is there anything specific to look for on these programs' websites or specific questions to ask during interviews to help make this distinction clearer (if it even matters)?

This is quite complicated and the volume/happiness/demeanor of the residents matters a lot. Personally- you need to train at a hospital that does thrombectomies, and a lot of them to get comfortable with stroke. Many community places with residents are too small for this(and some academic). TPA a couple times a month is not nearly enough. Exposure to complex transplant and oncology patients also helped me a lot in residency. It's best to train in a tertiary, busy referral center with residents doing most of the gruntwork so when you go out into a small community hospital and a complicated, sick patient shows up the appropriate spidey senses tingle like they need to. Does an HCA hospital have all of that for neurology residents at X program? You need to ask, because the typical Y State University Hospital with nothing around for 100 miles does all of that automatically and uses residents for everything. The reverse can be true as well- like a Mayo/CCF location having patients routinely refuse residents doing procedures/attendings micromanaging- terrible for education.

Basic questions that helped me: How many EEGs/Botox done by each resident by end of training? (200/50 are ok numbers) How often is tPA given/Thrombectomy done? Do you feel like your program director has your back? What happens when nurses/other services complain about residents? How many patients in continuity clinic per day/patient consults per call day? Any subtle red flag from a resident needs to be taken seriously that the program may have problems.

 

[BlueBleck]

How many EEGs/Botox done by each resident by end of training? (200/50 are ok numbers) How often is tPA given/Thrombectomy done? How many patients in continuity clinic per day/patient consults per call day?

I'm super happy at my program and have no regrets given my eventual goals. But I wish I had consistently asked these questions as an applicant. In retrospect, I didn't truly know what mattered and the above are excellent indicators of clinical volume. I was asking much more indirect questions like, "do you feel comfortable practicing independently as a general/stroke neurologist?," which literally everyone said yes to. I also asked if people hit the 80 hour restriction which everyone also denied, including notoriously malignant programs. So I was asking pretty useless questions.

At my community 500 bed hospital, the consult-only stroke list averages 8 active patients. With that and residents as first responders to all code strokes, we're averaging 4-5 tPA pushes and also about 4-5 thrombectomies. I have no idea how this compares to other hospitals, which tells you how little I knew about other hospitals.

 

[NEApplicant]

I'm super happy at my program and have no regrets given my eventual goals. But I wish I had consistently asked these questions as an applicant. In retrospect, I didn't truly know what mattered and the above are excellent indicators of clinical volume. I was asking much more indirect questions like, "do you feel comfortable practicing independently as a general/stroke neurologist?," which literally everyone said yes to. I also asked if people hit the 80 hour restriction which everyone also denied, including notoriously malignant programs. So I was asking pretty useless questions.

At my community 500 bed hospital, the consult-only stroke list averages 8 active patients. With that and residents as first responders to all code strokes, we're averaging 4-5 tPA pushes and also about 4-5 thrombectomies. I have no idea how this compares to other hospitals, which tells you how little I knew about other hospitals.

4-5 per what? By the end of residency?

 

[BlueBleck]

4-5 tPA pushes and 4-5 MTs per month. This is per resident.

 

[Postictal Raiden]

4-5 tPA pushes and 4-5 MTs per month. This is per resident.

I am at a hospital double the size. Our numbers are comparable. However given we are the only CSC in town, we get tons of drip and ship so most of patients arrive post tPA. Our EVT volume is about one daily so if you’re on stroke rotation, you’ll see plenty.

Honestly, the learning from tPA and sending people to EVT plateaus very quick. The ongoing learning is from the atypical cases such as those recurrent ischemic stroke from athero despite maximal medical therapy, perfusion dependent ICA disease, stroke secondary to a free-floating clot, managing bleeds in someone who needs to be on AC (LVAD or mechanical valve patients), etc

These are the cases you won’t experience a whole lot of unless you train at a large center

 

[xenotype]

I'm super happy at my program and have no regrets given my eventual goals. But I wish I had consistently asked these questions as an applicant. In retrospect, I didn't truly know what mattered and the above are excellent indicators of clinical volume. I was asking much more indirect questions like, "do you feel comfortable practicing independently as a general/stroke neurologist?," which literally everyone said yes to. I also asked if people hit the 80 hour restriction which everyone also denied, including notoriously malignant programs. So I was asking pretty useless questions.

At my community 500 bed hospital, the consult-only stroke list averages 8 active patients. With that and residents as first responders to all code strokes, we're averaging 4-5 tPA pushes and also about 4-5 thrombectomies. I have no idea how this compares to other hospitals, which tells you how little I knew about other hospitals.

My volume in training was about 3 times that, sometimes higher at a referral center double your size.

I am at a hospital double the size. Our numbers are comparable. However given we are the only CSC in town, we get tons of drip and ship so most of patients arrive post tPA. Our EVT volume is about one daily so if you’re on stroke rotation, you’ll see plenty.

Honestly, the learning from tPA and sending people to EVT plateaus very quick. The ongoing learning is from the atypical cases such as those recurrent ischemic stroke from athero despite maximal medical therapy, perfusion dependent ICA disease, stroke secondary to a free-floating clot, managing bleeds in someone who needs to be on AC (LVAD or mechanical valve patients), etc

These are the cases you won’t experience a whole lot of unless you train at a large center

Agree-being at a referral center again is key so you get VAD patients coming in, transplant patients coming in, high complexity onc patients like CAR-T. However just so all the applicants understand prestige really has not a flip to do with whether a hospital gets VAD patients, etc. Size, catchment area, local competition.