Community vs Academic programs

[jmcappleby]

I had a couple of general questions that I wanted to run by you guys as we approach interview season and we all think about what programs to interview at and how to rank them for residency.

1) Does one have to be "research-oriented" to obtain a fellowship? I am interested in Pulm/CC as a fellowship option. I have never really considered myself research-oriented, I've always been more interested in the clinical aspects of medicine but specialization is obviously competitive (some more than others) and as I understand some level of research is "expected."

2) On that note, regarding the "expected" research for fellowship placement, does it matter a great deal if that happens at a community program vs. a major academic center? On some level, the answer, i am sure is "yes," but how about in relation to Step scores, evaluations, LoRs when considering a relatively mid-competitive specialty like Pulm/CC?

3) Little fish in a big pond (30-50+ resident programs) vs. a big fish in a little pond (10-20 resident programs) - the former seem to be major, urban academic centers whereas the latter, I've noticed, are either university centers in smaller cities or community programs. The former seem to be the kind of programs where residents are "free labor" or "get worked like a dog" whereas the latter tend to be "cush" (?).
This is a question that has plagued me since I was a teenager looking at colleges. I think I am the kind of person who tends to thrive in a smaller, more intimate atmosphere but I am less like this now than I used to be.

Ultimately, location is relatively low on my priority. Although I am not a fan, if I have to live in NYC or LA, I will. I want to be the best that I can be, I want to be well-trained, qualified and prepared for anything I might see - just like any future physician. And so I am wondering about the relative advantages of a big program vs. a more intimate smaller program.
Would the benefits of a major tertiary care center with heavy exposure to research outweigh the benefits of being at a more cush program with, perhaps, better interactions with faculty and a more lukewarm approach to research. Am I likely to be "better-trained" for picking the former over the latter? Are my chances at a mid-competitive fellowship affected significantly depending on the choice?

As always, your help is most appreciated! Just trying to clarify some things in my head.

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[docscience]

1) Does one have to be "research-oriented" to obtain a fellowship? I am interested in Pulm/CC as a fellowship option. I have never really considered myself research-oriented, I've always been more interested in the clinical aspects of medicine but specialization is obviously competitive (some more than others) and as I understand some level of research is "expected."

Fellowships look at this:
1) Interview
2) LOR from specialists
3) PD LOR
4) University based residency
5) No visa issues
6) Elective grade/evals
7) USMLE Scores
8) Publications
9) Research Experience

So you can kinda of garner to what level research is considered. But I think not wanting to do some kind of research (clinical/bench/epidemiology) etc. looks kinda bad and makes the applicant look like he/she is not interested in the specialty?

2) On that note, regarding the "expected" research for fellowship placement, does it matter a great deal if that happens at a community program vs. a major academic center? On some level, the answer, i am sure is "yes," but how about in relation to Step scores, evaluations, LoRs when considering a relatively mid-competitive specialty like Pulm/CC?

See above list. I think it is hard to be an intern at a community program...trek your butt all the way to the closest University Center to do big whig research. Easier if it is done at a University where research is more accessible.

Ill let the experts take it from here.
Good luck! PM me for other details

 

[VCMM414]

To answer each of your questions:
1. One does not have to be "research-oriented" to obtain a fellowship. However, your definition of "research-oriented" may be different than that of the fellowship programs. You need to show some academic initiative, ie. research projects. However, this does not have to be groundbreaking work. Even simple case reports can help a bit, and to me that is not at all "research-oriented."

2. Actually, I would think the quality of research project matters more than where it is being conducted. It may be easier to find a good suitable project for yourself at a major academic center, however. Also, the LOR that may come of your project may carry more weight if it is written by a well known attending.

3. Big pond, for the most part. Being a standout resident in a small program can be beneficial if the said hospital offers the fellowship of your choice, and you are happy to stay on for fellowship. Otherwise, being in a major academic center will better facilitate your landing a fellowship spot.

Incidentally, do you dislike being in a larger program, or living in a large city? If it is the latter, there are many exceptions to your "major, urban academic centers" description. Off the top of my head, I can think of UF (Gainesville), Wake Forest (Winston Salem), Duke (Durham), UNC (Chapel Hill), MCG (Augusta), UVA (Charlottesville), Stanford (Palo Alto), Mayo (Rochester), etc. These are all in much smaller cities than NYC, LA, SF, Chicago, etc and therefore may be worth a look.

 

[jmcappleby]

Thank you for your replies! This has been most helpful.

To follow up, VCMM, I think it's more the big city that I dislike rather than a big program. I can't say that I fully know what it'd be like to be a resident in a 50-resident program vs. a 10-resident program (per PG year) so it is difficult for me to make that call. I do think that (based on my experiences in college) I might feel more comfortable in a smaller, more intimate setting - but then again, doesn't everyone?

I myself am an American citizen IMG, albeit with good board scores which is why I mentioned the urban centers when speaking of academic programs as I think I probably have more of a shot at USC, WSU and Einstein than at Stanford, Duke or Mayo Rochester. I am, of course, still giving it a shot.

But I definitely see the wisdom in what you mean about the big pond relating to access to research, well-known attendings and a wider fellowship network beyond the ones that may be offered at one's home institution even if they do favor their own as that seems a little limiting. I guess I just don't want to feel like I'd get "lost" or be just another anonymous work horse at a big institution with hundreds of residents.