Does it really matter where you do rads residency?

[PENNYWISETHECLOWN]

So I would prefer someone like a PD or great experience to give some thoughts.

Why does it really matter where you do residency? Even low-tier programs have solid curriculums, great culture, superb training, residency friendly environment where 100% get board certified. I know that some programs have worse call systems than others, but at the end of the day the fact of getting into a radiology residency in itself is a great accomplishment. You get your american board and have the license to practice anywhere.

I've seen faculty at top tier academic institutions that hold high positions in rads departments who did their residency outside the US. Isn't it really all about how much work you put in yourself that will ultimately decide your career and where you go (for fellowship and beyond)? If you get very active in research, win awards, and genuinely passionate about radiology it will stand out in your work for fellowship and future job opportunities no matter where you come from, right?

Let's put aside location benefits, reputation on doximity, "name" prestige, being around fancy facilities and top-level rads equipment, easier access to research of high-tier programs. What are the benefits of doing residency in a high-tier university program (eg for example MGH, UCSF, WASH U) versus residency in (eg Richmond Univ, Rutger NJMS, Baystate) which would significantly alter someones career success?

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[qxrt]

Quality of the starting material. The average resident at MGH is going to be much more conscientious, motivated, and hardworking than the average resident at Podunk residency. And any individual's personal qualities will have much more bearing on their abilities as a radiologist than their training program. Swap MGH's residents with Podunk residents, and the former will still outshine the latter.

The motivations and abilities of your coresidents can influence your own motivation. And besides, if you were actively winning awards, publishing research, etc, you'd probably not end up at one of the Podunk programs in the first place. Why take a chance on someone on the off chance that they may suddenly become more successful and motivated than their history might suggest, when you can choose someone who has already had a consistent track record of strong motivation and talent? It's true in any other aspect of life; your resume is like your credit score for programs who want some method of risk-assessment.

 

[PENNYWISETHECLOWN]

Quality of the starting material. The average resident at MGH is going to be much more conscientious, motivated, and hardworking than the average resident at Podunk residency. And any individual's personal qualities will have much more bearing on their abilities as a radiologist than their training program. Swap MGH's residents with Podunk residents, and the former will still outshine the latter.

The motivations and abilities of your coresidents can influence your own motivation. And besides, if you were actively winning awards, publishing research, etc, you'd probably not end up at one of the Podunk programs in the first place. Why take a chance on someone on the off chance that they may suddenly become more successful and motivated than their history might suggest, when you can choose someone who has already had a consistent track record of strong motivation and talent? It's true in any other aspect of life; your resume is like your credit score for programs who want some method of risk-assessment.

I get what you are trying to say. It sure feels good to be in a toptier program, but not sure if thats more due to an ego aspect (Oh look how great I am, I must be important to be a resident in X program) in addition to the other benefits i mentioned in my previous post . In addition, matching at places like Johns hopkins, UCSF, MGH is based on so many variable factors. You could be an exceptional candidate, but one interviewer didnt like your for some reason (Boom you're out). In other reasons, it could just be plain old dumb luck. Lets face it, matching isn't really a conventional process and can bite you in the ass despite being a great applicant. Plus, top-tier places have biased workplace politics that go on in the background of who to rank higher and match. For example, shying away from IMGs so the program doesnt look weak to AMGs. Ultimately, I find it hard how to base someones success, abilities, or talents on where they spent 4 years of residency to determine the next 20-30 years of their career. I mentioned this example before, but I personally know faculty at top tier programs who hold powerful positions in the department and did their residency outside the united states. Ultimately, it seems like there is hype and sense of apprehension if applicants dont rank top programs first over other places that are more lower tier but they fit well in and were happy with. At the end of the day, if you work hard enough anything is achievable no matter where you come from.

 

[qxrt]

At the end of the day, if you work hard enough anything is achievable no matter where you come from.

Of course, individual motivation, attitude, and ability by far trumps mere pedigree. That is why connections matter so much when finding a job. You neglect, however, the fact that there are many even in radiology who are satisfied with mediocrity, giving average reads, never striving to go beyond what is just enough to do an adequate job, earn a paycheck, and enjoy life outside of work. In the end, it is only a matter of priorities, and there is nothing wrong with that -- after all, some people have to be average by definition. Many practices, though, want the best they can get, assuming that the 3 A's (affability, availability, ability) are present. Not all trainees are created alike and have similar levels of potential, motivation, and ability at the start, and no residency program is going to fix that. I think we can safely assume that trainees with higher levels of motivation, ability, and potential are more likely to be drawn to more prestigious programs than not. By no means do I mean to presume that these institutions have a monopoly on high quality trainees, but rather that they are more likely to have more of them rather than those who just barely managed to scrape into the specialty. There are plenty of excellent trainees in no-name institutions, and many do go on to become excellent faculty members. The question is, are more prestigious programs more likely to have a significantly higher percentage of these types of trainees?

And before you accuse me of bias, I myself am a resident at a community program with some interest in academic medicine who, out of some realization of the above, targeted big names for fellowships.

 

[Rads4lyfe]

I get what you are trying to say. It sure feels good to be in a toptier program, but not sure if thats more due to an ego aspect (Oh look how great I am, I must be important to be a resident in X program) in addition to the other benefits i mentioned in my previous post . In addition, matching at places like Johns hopkins, UCSF, MGH is based on so many variable factors. You could be an exceptional candidate, but one interviewer didnt like your for some reason (Boom you're out). In other reasons, it could just be plain old dumb luck. Lets face it, matching isn't really a conventional process and can bite you in the ass despite being a great applicant. Plus, top-tier places have biased workplace politics that go on in the background of who to rank higher and match. For example, shying away from IMGs so the program doesnt look weak to AMGs. Ultimately, I find it hard how to base someones success, abilities, or talents on where they spent 4 years of residency to determine the next 20-30 years of their career. I mentioned this example before, but I personally know faculty at top tier programs who hold powerful positions in the department and did their residency outside the united states. Ultimately, it seems like there is hype and sense of apprehension if applicants dont rank top programs first over other places that are more lower tier but they fit well in and were happy with. At the end of the day, if you work hard enough anything is achievable no matter where you come from.

Where you do residency matters, but probably not as much as people on SDN think. As far as training, most academic programs and many community programs will train you just fine. I think the important differences is that at big name hospitals, you will see much more complex cases and zebras more frequently. Also, having a level 1 trauma center is critical for learning. Last, at top programs, you'll have lectures from faculty at the top of their field. You can definitely become a great radiologist from a community program, but the resources just wont be as readily available.

For practical purposes, going to a more prestigious residency will open more doors for fellowships and job prospects. If your goal is private practice in NYC, going to NYU or Cornell over a small unknown community program will definitely give you an advantage. Not only are the alumni networks larger, but some private practice groups like to advertise where their guys trained.

If your goal is to be chair of a MGH, then where you do residency/fellowship matters even more.

 

[PENNYWISETHECLOWN]

Of course, individual motivation, attitude, and ability by far trumps mere pedigree. That is why connections matter so much when finding a job. You neglect, however, the fact that there are many even in radiology who are satisfied with mediocrity, giving average reads, never striving to go beyond what is just enough to do an adequate job, earn a paycheck, and enjoy life outside of work. In the end, it is only a matter of priorities, and there is nothing wrong with that -- after all, some people have to be average by definition. Many practices, though, want the best they can get, assuming that the 3 A's (affability, availability, ability) are present. Not all trainees are created alike and have similar levels of potential, motivation, and ability at the start, and no residency program is going to fix that. I think we can safely assume that trainees with higher levels of motivation, ability, and potential are more likely to be drawn to more prestigious programs than not. By no means do I mean to presume that these institutions have a monopoly on high quality trainees, but rather that they are more likely to have more of them rather than those who just barely managed to scrape into the specialty. There are plenty of excellent trainees in no-name institutions, and many do go on to become excellent faculty members. The question is, are more prestigious programs more likely to have a significantly higher percentage of these types of trainees?

And before you accuse me of bias, I myself am a resident at a community program with some interest in academic medicine who, out of some realization of the above, targeted big names for fellowships.

I wasn't trying to accuse you of bias. Sorry if it seemed that way. I was merely trying to say that these top tier programs seem almost cult-like where there is excessive admiration to be a part of it for residency. At the end of the day you still get the same american board certification. I wish you the best for fellowship.

 

[qxrt]

I wasn't trying to accuse you of bias. Sorry if it seemed that way. I was merely trying to say that these top tier programs seem almost cult-like where there is excessive admiration to be a part of it for residency. At the end of the day you still get the same american board certification. I wish you the best for fellowship.

Oh, I didn't mean it as if you had actually accused me of bias. It was more of a general and preemptive statement; sorry about the miscommunication.

I don't think there is all that much admiration for prestige when it comes to radiology. Connections are more valuable than prestige when it comes to finding a job, after all. As we both have noted, individual attitude, motivation, and ability are far more important than any specific training program. The only question I am addressing here is, in the absence of any connections, which of two programs are we more likely to find someone with the above qualities?

And I've already matched for fellowship, but I appreciate your wishes.

 

[PENNYWISETHECLOWN]

Oh, I didn't mean it as if you had actually accused me of bias. It was more of a general and preemptive statement; sorry about the miscommunication.

I don't think there is all that much admiration for prestige when it comes to radiology. Connections are more valuable than prestige when it comes to finding a job, after all. As we both have noted, individual attitude, motivation, and ability are far more important than any specific training program. The only question I am addressing here is, in the absence of any connections, which of two programs are we more likely to find someone with the above qualities?

And I've already matched for fellowship, but I appreciate your wishes.

Congratulations.

For your question, I really don't think its a significant difference. I've met hard working, motivated, smart residents from a variety of programs (high and low tier). You feel you would see more of these "Qualities" in top programs, but thats only because they had the easier opportunities to show themselves.

 

[TCOM12]

The advantage to the bigger name places is the bigger alumni base. Just tends to open up doors.

At the end of the day, you don’t see a bunch of radiologists on the street corner pan handling. Someone hired them. It’s sort of what you put into it.

Have the ego to make a call (giving a real diagnosis instead of a differential) but have the humility to know the limits of you’re knowledge compared to the expanse of what there is to know in radiology and medicine. If you can do both, you’ll be a good radiologist wherever you end up.

 

[Tiger100]

If you want to join private practice, it matters but not significantly.

If you want to join academics AND make a name for yourself, yes it definitely helps and it helps a lot.

Medicine is better than law or business in a sense that CONNECTIONS and NAME BRAND is not as important. But still it matters.

Bigger places is equal to MORE connections. Imagine you go to a program with 12 residents each year and 40+ fellows each year. You make friends. Most importantly, like it or not, people are biased towards the place that they have been trained in the past. So if 5 years down the road you want to change jobs and the person who wants to hire you went to a 6-month fellowship at MGH in 1980s, still he likes graduates of MGH more. Since there are more graduates of MGH, then it means that you will have higher probability of facing them in the future.

I personally don't think that being trained at a bigger place really matters quality-wise. But it matters when it comes to finding a job. For example, if you want to get a job in Boston and you are not a trainee of one of the big Boston program, it is harder but not impossible. You can get a job, but probably the best jobs go to graduates of big name programs both because of positive BIAS that people have towards them and because of connections. Whom do you think they will end up hiring? Local fellows or a fellow from a Podunk residency?

For academics, many chairman of department and many big name radiologists were graduates of some big name programs. Obviously, some of it is just statistics (big name programs have more number of graduates) but some of it also comes from connections.




Having said that, at the end of the day in medicine especially in private practice getting a high quality well paid job is mostly a random process and also depends on your personality and goals. The place that you were trained, is important but not as much as you may think (may have a 15-20% influence).

 

[PENNYWISETHECLOWN]

If you want to join private practice, it matters but not significantly.

If you want to join academics AND make a name for yourself, yes it definitely helps and it helps a lot.

Medicine is better than law or business in a sense that CONNECTIONS and NAME BRAND is not as important. But still it matters.

Bigger places is equal to MORE connections. Imagine you go to a program with 12 residents each year and 40+ fellows each year. You make friends. Most importantly, like it or not, people are biased towards the place that they have been trained in the past. So if 5 years down the road you want to change jobs and the person who wants to hire you went to a 6-month fellowship at MGH in 1980s, still he likes graduates of MGH more. Since there are more graduates of MGH, then it means that you will have higher probability of facing them in the future.

I personally don't think that being trained at a bigger place really matters quality-wise. But it matters when it comes to finding a job. For example, if you want to get a job in Boston and you are not a trainee of one of the big Boston program, it is harder but not impossible. You can get a job, but probably the best jobs go to graduates of big name programs both because of positive BIAS that people have towards them and because of connections. Whom do you think they will end up hiring? Local fellows or a fellow from a Podunk residency?

For academics, many chairman of department and many big name radiologists were graduates of some big name programs. Obviously, some of it is just statistics (big name programs have more number of graduates) but some of it also comes from connections.




Having said that, at the end of the day in medicine especially in private practice getting a high quality well paid job is mostly a random process and also depends on your personality and goals. The place that you were trained, is important but not as much as you may think (may have a 15-20% influence).

Thanks for your insight. What if someone worked at a top tier program doing research for two years or so prior to residency. Would that help build internal connections by working for that department to help later on for fellowship at said institution?

 

[JoshSt]

Thanks for your insight. What if someone worked at a top tier program doing research for two years or so prior to residency. Would that help build internal connections by working for that department to help later on for fellowship at said institution?

Do you want to go into academic rads but are worried you won’t get into a higher or midtier program? I wouldn’t delay your training just for the prospect of matching somewhere more prestigious. No matter where you match for residency, you’ll be able to get a fellowship at a top 5-10 residency program, which will get your foot in the door to work somewhere higher tier.

 

[PENNYWISETHECLOWN]

Do you want to go into academic rads but are worried you won’t get into a higher or midtier program? I wouldn’t delay your training just for the prospect of matching somewhere more prestigious. No matter where you match for residency, you’ll be able to get a fellowship at a top 5-10 residency program, which will get your foot in the door to work somewhere higher tier.

Yes, I'm into academics. Thanks for the input and will keep that in mind.

 

[tco]

Go to an academic center with high volume, lots of variety, and a large network. Everything else will work out.

 

[Radology]

If academics, utmost importance.

If you’re not into academics It doesn’t really matter. Location and your residency performance will determine your job placement. Any half decent program will give you enough a base. The rest is up to you.