Are there particular advantages for choosing a community vs university hospital for GI fellowship?
- Yes. Community programs have the luxury to be more endoscopy-focused. They can also serve as "feeder" programs into local (statewide?) private practices. If you know you will not consider academics, it is a much more efficient use of your 3 years to be at a community program, particularly one that is geographically advantageous to you.
For the most part, university programs will have the edge in education, research, volume of endoscopies, and broader variety of pathology.
- Yes to education, research, and range of pathology. Not so with volume of endoscopies. Most academic GI programs will have research expectations or even requirements during fellowship, and in fact many will have some protected research time even for non-research tracks. Some academic programs have retained the traditional model of inpatient GI and liver services, and while on these inpatient services GI fellows may not have as many scope opportunities as GI consult services. Finally, many academic centers have 4th year advanced endoscopy "super" fellows, which dilutes/eliminates the ERCP exposure for the general GI fellows. Doing the math, all GI fellowships are 3 years long, so if you have additional responsibilities such as above then you will have fewer scopes.
Of course, the above is a gross generalization. There are very clinical university GI fellowships out there. It should also be said that doing more scopes is beneficial, but only to an extent as everyone reaches a plateau at some point. You are more likely to reach that plateau earlier at endoscopy-heavy programs, but possibly at an expense to other aspects of your training.
However, will less job opportunities / offers be available if I go into a community program?
- Not necessarily. As above, many community programs have alumni connections with local/state-wide private practices.
Are community programs generally less busy than university programs?
- Depends on your definition for "busy." You will likely have more purely clinical time. But, you may not have as many inpatient floor months as programs that have retained the traditional GI/liver inpatient services. You will also have less academic pressure to publish, teach, mentor, etc.
The bottomline is that GI fellowship is 3 years no matter how you slice it. A training program that boasts focus in any one area will have to sacrifice somewhere else. You have to be truthful to yourself. What do you see yourself doing after fellowship? If there is even a slight chance that you may consider pursuing academic GI (or even just want to work in an academic center) then you should rank university programs higher, since going to a community program more likely than not will be a detriment to you. On the other hand, community programs and certain highly clinical university programs will train you well for entering practice immediately after fellowship. You may never be an expert in biliary diseases, IBD, or hepatology, but you will be ready to handle most of what occurs out there.
