Fellowship in the same place as residency

[ResidentMD]

Does anyone have any strong for/against opinions about doing a fellowship in the same place as doing your residency? Especially when the fellowships at the program are one of the best in the country anyway e.g. those at UCSF, Brighams/MGH, Hopkins, UPenn or then a step below like UCLA, Vanderbilt, Mayo, WUSTL.

This is especially concerning someone wanting to stay in academics and research. And from what I hear, for those interested in research, you often continue on for 2-3 years after your fellowship as a faculty in the same institution - so that you can slowly start growing independent from your research mentor. You can then move on as a faculty somewhere else. In other words, this is almost a 8-10 year commitment (3 + 2/3 + 2/3) that you are talking about, to one particular institution.

The 'for' opinions I have heard of are that you get to develop good connections right from residency itself, have your mentors in place for your fellowship, you know the system, you dont have to move yourself and your family to another city, etc.

The 'against' opinions I have heard are that you dont get a diverse exposure to working in different hospital/academic setups - so you dont develop a broad enough perspective, you are looked at as someone who was inbred (though this doesnt make sense to me).

Thoughts?

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[theunderdog]

Does anyone have any strong for/against opinions about doing a fellowship in the same place as doing your residency? Especially when the fellowships at the program are one of the best in the country anyway e.g. those at UCSF, Brighams/MGH, Hopkins, UPenn or then a step below like UCLA, Vanderbilt, Mayo, WUSTL.

This is especially concerning someone wanting to stay in academics and research. And from what I hear, for those interested in research, you often continue on for 2-3 years after your fellowship as a faculty in the same institution - so that you can slowly start growing independent from your research mentor. You can then move on as a faculty somewhere else. In other words, this is almost a 8-10 year commitment (3 + 2/3 + 2/3) that you are talking about, to one particular institution.

The 'for' opinions I have heard of are that you get to develop good connections right from residency itself, have your mentors in place for your fellowship, you know the system, you dont have to move yourself and your family to another city, etc.

The 'against' opinions I have heard are that you dont get a diverse exposure to working in different hospital/academic setups - so you dont develop a broad enough perspective, you are looked at as someone who was inbred (though this doesnt make sense to me).

Thoughts?

I am FOR staying at your residency for fellowship.

You pretty much hit it on the nail with your "for" reasons. All of the "against" reasons I have heard, from your post and others, are weak.

Let's start with some other "for" reasons. By the time you start residency, you begin your career. You start making a name for yourself and you start up your professional network. Your world only gets bigger if you stay on for fellowship and then as an attending. Even if you stay in the area as an attending, it is still the same benefits. This is, of course, if you go to a strong residency program and really have no need to go elsewhere for fellowship. People often try to move up or at least stay at the same level of reputation in their professional careers. It's like the physician who moves from clinical isntructor to assistant prof to associate pro, etc. Or the med student who goes to MGH for residency and then UCSF for fellowship. Seldom, you will see someone who went to Penn for residency and then go to a small unheard-of program for fellowship.

The "against" reasons are weak. Being inbred has nothing to do with anything. The not getting enough diversity may be a legit reason, but let's think about this. If you're going to MGH for residency and fellowship, all of the top wierd cases go to the top hospitals. When important people get sick or want the "best" treatment, common people automatically think that going to a name hospital is where they will get the best treatment. Look at Ted Kennedy with his brain tumor and all of the celebrities and where they got treated. So in my mind, you get better diverse experience at the top name hospitals. This is debatable, so don't call me out on it. Working at various academic setups is great, but honestly, how does that really benefit you? Yes, you get more adept at adapting to new environments, but how does that make you any better as a person and physician? Going from paper charts at one hospital to EPIC at another hospital makes you better in what way?

 

[jdh71]

I think if you want to stay academic, when it comes to fellowship, you need to attempt to match as high up the academic food chain as possible, and if that means somewhere else . . . so be it.