community vs. university

[deucerp]

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seems my advisors say stay away from community programs, it's many people's "second choices" per them. obviously they're going to be biased since we're at a university. i've heard great things from people rotating at certain community programs and plan on doing an away rotation at one...anyone else have any input? P.S. this is definitely not meant to start a flame war I guess I was just wondering if people thought there were certain things better at one vs. the other.

 

[BayAreaOB]

This question comes up every year. The reality is that most OB/Gyn residents will NOT do a fellowship and that most people don't really need "the big name" to have the career they want. I think there is a spectrum of Community-based programs. The Kaiser programs in California and Beaumont in Michigan are examples of strong non-univeristy residency programs that have good surgical and OB numbers and diverse patient pathology. You may also find strong community programs in areas not near major universities. So, think about what you want out of residency and beyond. (someone had an great post on another thread).

 

[MeowMix]

Lots of factors to consider. For example, where I am, the community program has many more gyn surgery opportunities for the residents, and many fewer residents competing for that training. Much of this has to do with insurance issues; indigent women (the population at the U program) are very rarely going to get gyn surgery in this town (and it's a big city). The insured pts at the community program will get way more gyn surgery. If you want laparoscopic training, the community program again will give you more opportunities. This obviously will vary enormously between locations, so figure out what you want to learn and find out what opportunities you will have.

The APGO directory should be a great source for comparing programs, but I think the numbers in there are actually often out of date and precede the 80-hr rule.

 

[pillowhead]

Much of this has to do with insurance issues; indigent women (the population at the U program) are very rarely going to get gyn surgery in this town (and it's a big city). The insured pts at the community program will get way more gyn surgery.

Just out of curiousity, why is this the case? Are the insured patients getting unnecessary surgery and/or the indigent patients not getting surgery when indicated? Or is there something else going on like different pathologies affecting the two populations? Just struck me as strange.

 

[MeowMix]

The indigent patients who need surgery are not getting it, or they get it very late in the course of their illness. The insured patients get aggressive treatment early. Particularly in gyn onc.

 

[pruritis_ani]

Community vs University is the age old "town vs. gown" debate. As most such debates, there truly is no "right" answer.

For me, what was important was a solid training with numbers that will have me well prepared for general practice. In addition to numbers, I want to have an in depth exposure to all the sub specialties of ob/gyn in order to be as well versed as possible in all the procedures, as well as be able to handle what walks in my door, especially if a referral is not immediately available.

In that context, a community program makes sense. Typically there are higher numbers in both Ob/Gyn, and no fellows to fight with for cases. Lots of responsibility and independance from day one.

On the other hand, if I wanted to practice in a more academic setting (ie in a big city, within a teaching hospital), or go onto a fellowship, then a University setting would make more sense. More teaching, lighter case load, research emphasised, etc....

Anybody who makes a blanket statement such as "community programs are usually second choice" or "stay away from community programs" is quite frankly an idiot. clearly they have no interest in deciphering what the needs of the applicant are, nor do they have any interest in directing the student to the best program to fit needs. they are providing advice based soley on the bias they hold, and advising based on what they think you needs should be. pay little mind to people such as those....

bottom line...go where you will fit in, and where your needs will be met. Not sure what you want to do? Well, then go where training will be broad and deep, and give you the opportunity to do whatever you want....but, best to have an idea (ie fellowship or no fellowship) to give you some direction.

good luck

 

[drbhooks]

As a medical student, I observed residents who were in an university-based program; however, I am currently in a community based program so I can give the pros and cons for both.

I agree with the previous post that said that university-based programs have a decreased patient load, more emphasis on teaching and research. In addition, there is more exposure to the sub-specialities and if you have an interest in academic medicine, it is the choice for you.

Community-based programs offer the benefit of dealing with the private patient population which is more diverse and more realistic to your private practice experience. If you want to be a generalist (not specialize), I think it is a good option. Teaching can sometimes not be emphasized as much as university based programs, and often you have teach yourself a lot by reading and repetition.

Having seen and experienced both, I would recommend an university-based program if I had a preference. I am not satisfied with the community-based program I am at and I am transferring to an university based program. An university-based program can offer you more learning opportunities and more career opportunities. Whatever program you decide is best for you, weigh the pros and cons with your career goals and try to pick a program that has strong gyn training because obstetric numbers are easy to meet a most programs.