Does What residency you get determine QUALITY OF PHYSICIAN??

[TOMFighter]

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Does your residency determine what quality of physician you become, or is every residency standard in what it teaches.

If not so, why do people battle to get these "competitive residencies?"

What makes them so great? Is it better instruction? Will the residencies allow you to understand more/gain greater experience?

 

[8744]

Does your residency determine what quality of physician you become, or is every residency standard in what it teaches.

If not so, why do people battle to get these "competitive residencies?"

What makes them so great? Is it better instruction? Will the residencies allow you to understand more/gain greater experience?

Unless you graduate from a "Top Ten" residency in your specialty, you have to practice in the Midwest or somewhere less popular. It's not an absolute rule but the exceptions are very rare. I tried to find a good job but finally had to settle for the medical equivalent of minimum wage (barely breaking six figures) in Louisiana.

You take what you can get. I tried to get a job in California (San Diego area) and they laughed at me.

 

[dragonfly99]

Good question.
I think the residencies that are thought of as "top" tend to have more sicker patients/diversity of cases. Some just become better known because they are in a hospital/medical center that is well known for research. You can't make any blanket statements, but I think in GENERAL someone at a well known/top 30 or so residency in his field will get a better education than someone at a random residency.

Disagree with grouchy old dragon...at least for internal medicine there are a lot of job openings, including hospitalist. Harder to get a job in "more desired" areas but not impossible, unless you strictly limit yourself to only a tiny number of metropolitan areas, etc.

How hard it will be to get a job depends on supply and demand partially. For instance, child psych is really in short supply in most areas, so somebody with that specialty might find it relatively easy to get a job, even if not from a "famous" residency.

I think people seek residencies at the so-called "top" programs for various reasons, including
-think they will get a better education
-impressed by the status/"big name"
-think they will get in to a better fellowship/advanced education
-think they will make more money and/or find a better job later

 

[pgg]

Does your residency determine what quality of physician you become, or is every residency standard in what it teaches.

I'm a resident, not an authority on this matter, so I don't really know the answer to your question.

I will say that some programs offer opportunities that don't exist at other programs. For example, if the hospital doesn't take major trauma or do transplant, an anesthesiology resident there might do few (or no) cases in those areas.

But all accredited residencies offer a minimum breadth, depth, and quality of training, and I don't think anyone really doubts that any accredited program can turn a motivated, talented resident into a competent attending.

I believe, but have no data to prove 🙂, that top programs produce desirable graduates mostly because they are able to recruit top medical students (who are likely to continue to excel) ... not because the actual programs do anything special.

 

[docB]

Does your residency determine what quality of physician you become?

Yes, but only about 5% as much as the quality of the resident determines the quality of the physician. 95% hinges on the fact that you get out of it what you put into it.

 

[roja]

Yes, but only about 5% as much as the quality of the resident determines the quality of the physician. 95% hinges on the fact that you get out of it what you put into it.

 

[michaelrack]

Unless you graduate from a "Top Ten" residency in your specialty, you have to practice in the Midwest or somewhere less popular. It's not an absolute rule but the exceptions are very rare. .

I rarely disagree with Panda Bear, but I have to disagree with this, especially for primary care specialties and psychiatry. For those specialties in which there is some truth to this (ER), the influence of where you did residency becomes less important the longer it's been since your residency.

 

[yaah]

I think Panda was being sarcastic.

People miscontrue data all the time. They see people coming out of "top 10" residency programs and getting great jobs and assume it's because of the residency program. Just like how "top 10" medical schools place people in better residencies. What people neglect to realize (or ignore) is that "top" residencies and med schools often have more competitive candidates to start with.

The advantage of training at a larger program was partially stated above: breadth of material and experience. But there are outliers - some big famous programs do a lousy job of teaching, and some smaller programs make up for their weaknesses with outstanding teaching and guidance. And ultimately it comes down to what kind of resident you are - a crappy resident in an outstanding program is still a crappy resident (although they may do better than a crappy resident in a crappy program when it comes to looking for jobs). An outstanding resident in a crappy program is still an outstanding resident, and most people with half a brain who are doing hiring recognize these facts.

 

[Decepticon]

After residency, how can anyone tell whether you are an outstanding doctor or not? Is it by the letters of recommendation, or are we talking about publications in prestigious journals? I would assume the chance for doing top-notch research is higher, the better access to equipment and help you have.

 

[Decepticon]

Unless you graduate from a "Top Ten" residency in your specialty, you have to practice in the Midwest or somewhere less popular. It's not an absolute rule but the exceptions are very rare.

What about all the residency programs that are not located in the midwest, but still ain't among the top 10? Aren't they hiring people after you are done with your residency?

 

[8744]

I rarely disagree with Panda Bear, but I have to disagree with this, especially for primary care specialties and psychiatry. For those specialties in which there is some truth to this (ER), the influence of where you did residency becomes less important the longer it's been since your residency.

Dude....

 

[DebDynamite]

No.

 

[michaelrack]

Dude....

I was sleep deprived when I was writing that.

 

[elwademd]

After residency, how can anyone tell whether you are an outstanding doctor or not? Is it by the letters of recommendation, or are we talking about publications in prestigious journals? I would assume the chance for doing top-notch research is higher, the better access to equipment and help you have.

you can tell a little about a person in an interview.

therefore some places do a lot more than one interview.

they may even throw in a few other things such as testing- both formal (personality, skills, cases) and informal (throw in some delays/people running late).

add it all up, and the people/place hope that they've found out a lot about you.

Dude....

sometimes the obvious flies right over some people's heads.

 

[DarthNeurology]

Unless you graduate from a "Top Ten" residency in your specialty, you have to practice in the Midwest or somewhere less popular. It's not an absolute rule but the exceptions are very rare. I tried to find a good job but finally had to settle for the medical equivalent of minimum wage (barely breaking six figures) in Louisiana.

You take what you can get. I tried to get a job in California (San Diego area) and they laughed at me.

It depends on specialty I would assume. If Panda Bear is an ER resident (this is true right?) then maybe ER docs are saturated, after all, there are only so many EDs around the country and some family practice doctors do practice in ERs primarily where possible (state) specific. I think everything goes in bussiness cycles too, for example, folks out of IM residency doing "hospitalist" work was touted by some I have met as the latest and greatest may become saturated.

There are doctors who can go anywhere they want however. For example a famous ER physician who say was a PD and is nationally or even internationally known for groundbreaking research could probably call up enough of his amigos/amigas who are big whigs in and basically practice Emergency Medicine where ever the heart desired. Why? Because this person has a proven track record of accomplishment and any institutions reputation would increase because of it. Although I know Panda Bear feels like he has been through hell, poor baby haven't we all, you have to pay your dues if you want to sing the blues.

Most big wig academic types aren't focused on their salary, instead the "over achievers" (a misnomer as if you achieved it you haven't over achieved) are focused on being excellent in their field, getting reading for the national meeting, writing their next paper. Sure, the superstar surgeon who is 60 year plus and on the verge a lifetime achievement award working at the same hospital at Panda Bear may earn a whole lot more, like maybe three times more. But that doesn't motivate them primarily anymore in life, . . . I saw an elderly phsician who earned millions come out of retire to *work* for as many more years as he could as he was becoming bored. He worked in a "community hospital" and was offered about 1.5 times his salary from an academic place because he was "unimpeachable" i.e. I trust a doc who comes back when he could have traveled the world the rest of life or spend more time on his yatch and was well known as excellent clinically.

Not to beat up on Panda Bear, but if a resident complains about not having a high starting salary they are focused on being rewarded for "their hard work" i.e. work already done and not on *earning* their reputation. Unless Panda Bear won a noble prize or something then I don't think it is proper to complain about compensation this early on. I just read an article about people in Appalachia who can't afford to have their teeth pulled, much less repaired, and basically swarmed to a free dental clinic. People who's mouths hurt so bad they couldn't get proper nutrition inside them.

http://www.newsweek.com/id/150847

No, I don't think Panda Bear is necessarily at all a money-grubbing physician. The current climate in the U.S. is saturated with people obsessed with their salaries from doctors to nurses even. So it is natural to start comparing yourself to others in your profession. But in 20 years I am sure Panda Bear could wiggle into the region of the country he wants and some of his colleagues who may be earning more today may in divorce court in 20 years or alcoholic.

But Panda Bear should realize that his/her? salary is a big problem (many wish they had this problem) and is making him resentful. I would say focus on your patients who many I am sure are drug abusing, losing jobs, been in jail, and had all manner of horrible things happen to them. This is what I do when I feel sorry for myself is I focus my energy on helping someone else. ALSO, I would highly recommend that Panda Bear get a hobby, i.e. something else he can win at as he can't win the salary game for now. Such as:

Golf i.e. many bussiness people play golf as they can win a game after losing a contract.
Became a fan of some bizarre television series like Star Trek or Lost or Heroes and bring it up half a dozen times a day to mess with people.

And don't worry about what some interviewer said as maybe in twenty years you will be a big whig ER doctor who is begged to come lecture and work as high powered places around the country.

Remember, most importantly,

Save the cheerleader, save the world.😎

 

[8744]

...Not to beat up on Panda Bear, but if a resident complains about not having a high starting salary they are focused on being rewarded for "their hard work" i.e. work already done and not on *earning* their reputation. Unless Panda Bear won a noble prize or something then I don't think it is proper to complain about compensation this early on. I just read an article about people in Appalachia who can't afford to have their teeth pulled, much less repaired, and basically swarmed to a free dental clinic. People who's mouths hurt so bad they couldn't get proper nutrition inside them.

http://www.newsweek.com/id/150847

No, I don't think Panda Bear is necessarily at all a money-grubbing physician. The current climate in the U.S. is saturated with people obsessed with their salaries from doctors to nurses even. So it is natural to start comparing yourself to others in your profession. But in 20 years I am sure Panda Bear could wiggle into the region of the country he wants and some of his colleagues who may be earning more today may in divorce court in 20 years or alcoholic.

But Panda Bear should realize that his/her? salary is a big problem (many wish they had this problem) and is making him resentful. I would say focus on your patients who many I am sure are drug abusing, losing jobs, been in jail, and had all manner of horrible things happen to them. This is what I do when I feel sorry for myself is I focus my energy on helping someone else. ALSO, I would highly recommend that Panda Bear get a hobby, i.e. something else he can win at as he can't win the salary game for now....

Dude....I was kidding. I will actually be making an extremely good salary, much more than my peers who are hell-bent on working in one of the big markets, and the cost of living is much, much lower where I will be working to boot.

And I assure you that I don't a rat's ass about earning my reputation.

 

[8744]

...Although I know Panda Bear feels like he has been through hell, poor baby haven't we all, you have to pay your dues if you want to sing the blues.

Most big wig academic types aren't focused on their salary, instead the "over achievers" (a misnomer as if you achieved it you haven't over achieved) are focused on being excellent in their field, getting reading for the national meeting, writing their next paper. Sure, the superstar surgeon who is 60 year plus and on the verge a lifetime achievement award working at the same hospital at Panda Bear may earn a whole lot more, like maybe three times more. But that doesn't motivate them primarily anymore in life...

I am through paying dues, have no desire to pay any more, and am completely focused on making as much money at this career as I can within the confines of good medical practice, ethical behavior, and self-respect. Academic medicine has nothing to offer me and I assure you that, when I am finally done with residency, if I never see another medical student, resident, or academic attending again I will be perfectly happy.

The idea that I would subject myself to any more of This Mother****er for the privilege of singing some more blues is laughable. To answer the OP's question without humor, there is very little if any correlation between your residency program and how good a doctor you become and for the most part, your salary, the only objective indicator of your worth, depends more on location than lineage.

 

[8744]

Does your residency determine what quality of physician you become, or is every residency standard in what it teaches.

If not so, why do people battle to get these "competitive residencies?"

What makes them so great? Is it better instruction? Will the residencies allow you to understand more/gain greater experience?

Not everybody "battles" to get into competitive residencies. For my part, I was such a long shot that I applied wide and went cheerfully where I matched. Other people apply and rank programs based on geography and quality of life.

 

[yaah]

Most big wig academic types aren't focused on their salary, instead the "over achievers" (a misnomer as if you achieved it you haven't over achieved) are focused on being excellent in their field, getting reading for the national meeting, writing their next paper.

As if people in private practice are not focused on being excellent in their field. 🙄

There are all different kinds of self gratification and reward. There are also different kinds of excellence. For many in academics, it is more important to have a national reputation, be published in journals, invited to speak at conferences, etc, or to do research. For many in private practice, money is more important or location they work in. But don't delude yourself into thinking that the only physicians who treat taking care of patients as secondary to the other goals are in private practice. I know many many academic physicians who seem to care not one bit about teaching (despite being in an academic center and having a title of "professor") and are relatively more dangerous when it comes to patient care.

It is also true that there are many people who go into private practice because the politics and condescension inherent in many areas of academic medicine are just not something they want to deal with. Of course, there are many in academics who don't want to go into private practice because of the peripheral things they have to deal with there.

Is there really a huge difference between a resident who is focused on high salary and one who is focused on getting more publications for their CV? Or a more prestigious grant? The ends are the same: Career advancement. You can delude yourself all you want into thinking there is some inherent moral difference. For many people, academics is more rewarding. But not everyones

 

[michaelrack]

Is there really a huge difference between a resident who is focused on high salary and one who is focused on getting more publications for their CV?

The difference is that you can't eat a CV during your retirement years (I guess you could, but it wouldn't be very nutritious).

 

[yaah]

The difference is that you can't eat a CV during your retirement years (I guess you could, but it wouldn't be very nutritious).

Yeah but you can get paid by industry, private labs, etc as a "consultant." You can also get a lot of free vacations by accepting speaking engagements. Plus, many academic centers have far better pension plans, etc.

 

[dragonfly99]

"It is also true that there are many people who go into private practice because the politics and condescension inherent in many areas of academic medicine are just not something they want to deal with."

amen brother

 

[8744]

...It depends on specialty I would assume. If Panda Bear is an ER resident (this is true right?) then maybe ER docs are saturated, after all, there are only so many EDs around the country and some family practice doctors do practice in ERs primarily where possible (state) specific. I think everything goes in bussiness cycles too, for example, folks out of IM residency doing "hospitalist" work was touted by some I have met as the latest and greatest may become saturated...

Emergency Medicine is in great demand, I have received many solicitations, phone calls, and offers to interview, and easily got an excellent job with an excellent hospital system in the exact city where we wanted to live.

The trend is away from allowing non-Emergency Medcine board certified to work in Emergency Departments, by the way.

 

[3dtp]

I am through paying dues, have no desire to pay any more, and am completely focused on making as much money at this career as I can within the confines of good medical practice, ethical behavior, and self-respect. Academic medicine has nothing to offer me and I assure you that, when I am finally done with residency, if I never see another medical student, resident, or academic attending again I will be perfectly happy.

The idea that I would subject myself to any more of This Mother****er for the privilege of singing some more blues is laughable. To answer the OP's question without humor, there is very little if any correlation between your residency program and how good a doctor you become and for the most part, your salary, the only objective indicator of your worth, depends more on location than lineage.

I recently went through this debate myself. Had two competing offers one from highly prestigious academic medical center in the east and one from highly lucrative group focused on quality medicine, developing high quality care environments and taking excellent care of patients. I was deeply torn between the two. My wife finally beat sense into me and told me if I took the academic position and btch'd one minute about it after having lived throw 4 years of the errr, shall we say intrigue, disingenuity, pomposity of the faculty at my somewhat mediocre program, she'd get me committed. A friend of mine who is faculty at a noted midwestern institution not far from PandaBear told me she was happy that I chose the non-academic center and thought I'd be much happier. Another friend who was chair of my specialty at the same center was disappointed that I chose the private group.

I think I agree with PandaBear and others who have forsaken the academic route, but I do enjoy teaching and will absolutely miss this aspect. I rationalize this by telling myself that I am teaching patients every day. Time will tell if I've made the right choice.

 

[DarthNeurology]

For many in private practice, money is more important or location they work in. Is there really a huge difference between a resident who is focused on high salary and one who is focused on getting more publications for their CV? Or a more prestigious grant? The ends are the same: Career advancement. You can delude yourself all you want into thinking there is some inherent moral difference. For many people, academics is more rewarding. But not everyones

I have seen excellent doctors in community settings doing excellent teaching of residents and clinical work, and likewise have seen academic types who don't teach. Not all doctors can be academic types as some must go out into the world and practice medicine as best they can. There are a lot of unsung heroes who practice medicine in rural settings too.

HOWEVER, there is a world of difference between a resident focused on high salary and one who is focused on "getting more publications." The resident who gets a high salary wins more money for him or herself and may not be better than the average doctor.

The resident who is focused on "getting more publications" I would assume is interested in research and producing something that will help all of mankind, not just a raise for themselves. More and more lives are saved each year via medical advances. I think it is a gross generalization to say that a resident who is focused on research is the same as a money-grubbing resident, many or maybe even all M.D. I have seen doing research are really interested in progressing medicine.

The big question you may have been asked for medical school interviews is "What can you do for the field of medicine?" I'm sure no one says try to earn as high a salary as possible and live where they want within the bounds of ethical contraints, . . . Medicine needs researchers working on the latest vaccine or chemotherapeutic agent.

Let's look at the end results: A resident intent on earning a high salary benefits themselves and their families, I think it is hard to serve two masters i.e. high salary and excellent patient care but these folks say no problemo. The resident who you say is just padding their C.V. with research articles may become a principal investigator on a trial which could impact the lives of millions of patients and maybe your own life. So I think it is silly to lump both these people motivated by different forms as "career advancement". Please. One wants to line their pockets and the other usually doesn't

 

[michaelrack]

Let's look at the end results: A resident intent on earning a high salary benefits themselves and their families, I think it is hard to serve two masters i.e. high salary and excellent patient care but these folks say no problemo.

It's a lot easier than serving the 3 masters of academic medicine (research, teaching, patient care). At many universities, the academics try just as hard to make $ as private docs. At the Univ of MS med center, the academics are starting satellite offices away from the Medicaid clinics at the med center to compete with private docs. The Univ of MS has reorganized their physician practice plans and made the univ docs sign non-compete clauses so that the univ docs basically have to leave the state to practice medicine if they leave the university.