Difference in University vs. Community Hospital Training

[bile duct]

I've interviewed at an equal number of community hospitals and university programs for GI fellowship. I want to do general GI and have the opportunity to do the bread and butter endoscopy. I'm not sure at this moment if I'll continue into academics.

Are there particular advantages for choosing a community vs university hospital for GI fellowship?

For the most part, university programs will have the edge in education, research, volume of endoscopies, and broader variety of pathology.

However, will less job opportunities / offers be available if I go into a community program?
Are community programs generally less busy than university programs?

Any insight would be greatly appreciated.
Thanks guys.

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[Biliary Tree]

I am also currently interviewing and have no first hand experience as a GI fellow to this point, but here are my thoughts.

Are there particular advantages for choosing a community vs university hospital for GI fellowship?
-I suppose this entirely depends on your career path. If you want to remain in a community setting then I guess having more bread and butter exposure may help. A lot of university programs now have VA settings and sometimes community settings where you will get this exposure as well. Endoscopy volumes would be higher at places with a VA most likely.

For the most part, university programs will have the edge in education, research, volume of endoscopies, and broader variety of pathology.
-Agree, don't think this point can be argued

However, will less job opportunities / offers be available if I go into a community program?
-Probably. Even if you are applying for a job in a community setting, if you are applying against someone who trained at a top tier University program, he/she will have the edge. Same principle as has instigated a lot of griping on this forum. "All the candidates from the top tier university programs are hogging all the fellowship interviews." That problem isn't going to go away when you start applying for jobs.

Are community programs generally less busy than university programs?
-Probably, but is that what you want? A busier fellow is one with more exposure to different disease entities, procedures etc. He/she will likely be a better trained gastroenterologist when entering the work force.

 

[bbbaluga]

I am also currently interviewing and have no first hand experience as a GI fellow to this point, but here are my thoughts.

Are there particular advantages for choosing a community vs university hospital for GI fellowship?
-I suppose this entirely depends on your career path. If you want to remain in a community setting then I guess having more bread and butter exposure may help. A lot of university programs now have VA settings and sometimes community settings where you will get this exposure as well. Endoscopy volumes would be higher at places with a VA most likely.

It also depends on programs which have advanced endoscopy traning or not. If they do, the exposure to advanced endoscopy will be less, so does the exposure to ERCP.

For the most part, university programs will have the edge in education, research, volume of endoscopies, and broader variety of pathology.
- Agree, don't think this point can be argued.
- Some community programs (WB, Geisinger... have the above...). Totally agree

However, will less job opportunities / offers be available if I go into a community program?
-Probably. Even if you are applying for a job in a community setting, if you are applying against someone who trained at a top tier University program, he/she will have the edge. Same principle as has instigated a lot of griping on this forum. "All the candidates from the top tier university programs are hogging all the fellowship interviews." That problem isn't going to go away when you start applying for jobs.
- I dont think so. Whenever you want to go for private practice, it doesnot matter. It matters on what you can do (ERCP, volume of procedures that you did...)

Are community programs generally less busy than university programs?
-Probably, but is that what you want? A busier fellow is one with more exposure to different disease entities, procedures etc. He/she will likely be a better trained gastroenterologist when entering the work force.
- They are also very busy. Some arenot. Univ Mississpi, UTMB.. for example

Anyway, I am just an applicant. Those are my impressions. Maybe some GI fellows can help us more.

 

[kpdoc]

Here are my thoughts from interviews talking to fellows at both settings

Are there particular advantages for choosing a community vs university hospital for GI fellowship?
-I suppose this entirely depends on your career path. If you want to remain in a community setting then I guess having more bread and butter exposure may help. A lot of university programs now have VA settings and sometimes community settings where you will get this exposure as well. Endoscopy volumes would be higher at places with a VA most likely.

It also depends on programs which have advanced endoscopy traning or not. If they do, the exposure to advanced endoscopy will be less, so does the exposure to ERCP.

I second this-all big universities have advanced fellows and you do not do any significant no. of ERCP where as some community programs give you the hands on time. It does vary from 20-150 (in 3 yrs) and the ones that give you the high volume say that the fellows need to focus on getting that number if they want in 3rd yr, plus it's more for putting it on their CV rather than being confident at doing them,....

For the most part, university programs will have the edge in education, research, volume of endoscopies, and broader variety of pathology.
- Agree, don't think this point can be argued.
- Some community programs (WB, Geisinger... have the above...). Totally agree
-volume of endoscopies some community programs do have that but probably not all the above esp research

However, will less job opportunities / offers be available if I go into a community program?
-Probably. Even if you are applying for a job in a community setting, if you are applying against someone who trained at a top tier University program, he/she will have the edge. Same principle as has instigated a lot of griping on this forum. "All the candidates from the top tier university programs are hogging all the fellowship interviews." That problem isn't going to go away when you start applying for jobs.

- I dont think so. Whenever you want to go for private practice, it doesnot matter. It matters on what you can do (ERCP, volume of procedures that you did...)

-Probably depends on your desired region of practise too- if they have a big university or many programs in the area like Chicago you might not be able to grab attention to your cv coming from a community program but will get the attention if you are coming from a big name institution
-ERCP does seem to matter when you do job searches

Are community programs generally less busy than university programs?
-Probably, but is that what you want? A busier fellow is one with more exposure to different disease entities, procedures etc. He/she will likely be a better trained gastroenterologist when entering the work force.

- They are also very busy. Some arenot. Univ Mississpi, UTMB.. for example
-No generalization here: some community programs are crazy busy covering 2-3 institutions and some university programs appear pretty light where during research time (>6 m) its up to you how much time you do endoscopy

I really hope some fellows post on this thread to give their personal feeling

 

[bile duct]

thanks kpdoc, biliary tree, and bbbaluga for your insight. that information helps out.

so basically, since i am unsure if i want to do academics, i should probably rank all my university programs ahead of the community programs? i'm feeling it now where those coming from the top university residencies are hogging those fellowship interviews and don't want to feel that way again when i apply for jobs.

if anyone has any more insight, i would be appreciative for your thoughts. insight from current GI fellows or attendings would be very valuable.

 

[NEXUS 5]

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.