FM residency at an Academic Center vs County Hospital

[The_Sunny_Doc]

I’m torn between an FM residency at a top research institution (Duke) and one at a large well-respected county hospital (Hennepin in Minneapolis). I really loved how all of the residents worked alongside eachother at HCMC and how their ancillary services are all under one roof at the FM outpatient clinic there. At Duke we’d be in a regional hospital (alongside one other residency) and VA hospital (many residents there) for most of our rotations, and would serve a different patient population vs urban underserved. Obviously HCMC is a county hospital with comes with its own limitations. The quality of precepting could differ from that of the family at Duke even though there are many preceptors on faculty at UMN. Duke has so much to offer in terms of referral services but it’s FM clinic doesn’t have them all under one roof and so many patients will not be able to access some of the specialty services. I am interested in learning about cost-effective multidisciplinary care models which is why I am concerned about where I train. Also I really enjoy big cities. My family wants me to rank Duke highly due to the prestige factor/potential to do research but I’m a little burned out on research and want to have some time to enjoy life outside of residency. Obviously I want to become a knowledgeable physician with the ability to handle anything that walks into my outpatient practice, though.

Any thoughts on how to rank two very different programs and how it could impact my future in FM?

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[VA Hopeful Dr]

Didn't Duke shut down their FM program awhile back and then just recently reopen it?

 

[The_Sunny_Doc]

You seem pretty focused on details of the organization of each residency program/hospital and less focused on the actual training. I'd consider this - how do you envision your career once you're done with residency? What population do you want to work with, do you like inpatient/OB, do you see yourself doing a fellowship, etc.? How does each program help you get there?

Thank you. I do not want to do inpatient or OB and both programs could help me become a competent inpatient physician. Duke has its problems around 2006 but regrouped and is now ranked in the top ten of FM residencies by US news and world report (not that rankings mean anything). I will think longer about career goals and follow up with questions for the residents.

 

[The_Sunny_Doc]

Didn't Duke shut down their FM program awhile back and then just recently reopen it?

Yes, they’be regrouped since 2006. I am concerned about the history of DUMC not prioritizing its FM training due to its proximity to the medical center. I’ve heard that can be an issue at academic institutions.

 

[deleted480308]

I’m torn between an FM residency at a top research institution (Duke) and one at a large well-respected county hospital (Hennepin in Minneapolis). I really loved how all of the residents worked alongside eachother at HCMC and how their ancillary services are all under one roof at the FM outpatient clinic there. At Duke we’d be in a regional hospital (alongside one other residency) and VA hospital (many residents there) for most of our rotations, and would serve a different patient population vs urban underserved. Obviously HCMC is a county hospital with comes with its own limitations. The quality of precepting could differ from that of the family at Duke even though there are many preceptors on faculty at UMN. Duke has so much to offer in terms of referral services but it’s FM clinic doesn’t have them all under one roof and so many patients will not be able to access some of the specialty services. I am interested in learning about cost-effective multidisciplinary care models which is why I am concerned about where I train. Also I really enjoy big cities. My family wants me to rank Duke highly due to the prestige factor/potential to do research but I’m a little burned out on research and want to have some time to enjoy life outside of residency. Obviously I want to become a knowledgeable physician with the ability to handle anything that walks into my outpatient practice, though.

Any thoughts on how to rank two very different programs and how it could impact my future in FM?

It depends on the future you want. If your goal is a big policy govt job or ivory research somewhere then go to duke. If you want to a practicing fm doc seeing patients, go to a community program with good clinical precepting.

 

[VA Hopeful Dr]

Thank you. I do not want to do inpatient or OB and both programs could help me become a competent inpatient physician. Duke has its problems around 2006 but regrouped and is now ranked in the top ten of FM residencies by US news and world report (not that rankings mean anything). I will think longer about career goals and follow up with questions for the residents.

I just looked at those rankings, utter nonsense. It's all big university programs. It doesn't mention any of the very well regarded full scope West Coast programs.

 

[The_Sunny_Doc]

I just looked at those rankings, utter nonsense. It's all big university programs. It doesn't mention any of the very well regarded full scope West Coast programs.

I thought that might be the case.

 

[Sardonix]

I’m torn between an FM residency at a top research institution (Duke) and one at a large well-respected county hospital (Hennepin in Minneapolis). I really loved how all of the residents worked alongside eachother at HCMC and how their ancillary services are all under one roof at the FM outpatient clinic there. At Duke we’d be in a regional hospital (alongside one other residency) and VA hospital (many residents there) for most of our rotations, and would serve a different patient population vs urban underserved. Obviously HCMC is a county hospital with comes with its own limitations. The quality of precepting could differ from that of the family at Duke even though there are many preceptors on faculty at UMN. Duke has so much to offer in terms of referral services but it’s FM clinic doesn’t have them all under one roof and so many patients will not be able to access some of the specialty services. I am interested in learning about cost-effective multidisciplinary care models which is why I am concerned about where I train. Also I really enjoy big cities. My family wants me to rank Duke highly due to the prestige factor/potential to do research but I’m a little burned out on research and want to have some time to enjoy life outside of residency. Obviously I want to become a knowledgeable physician with the ability to handle anything that walks into my outpatient practice, though.

Any thoughts on how to rank two very different programs and how it could impact my future in FM?

So.

Duke Pros:
-Prestige
-Research
-Family is going gaga because it's Duke
-Quality of preceptors
-Good referral services

HCMC Pros:
-Seems like you had good gut feeling day of
-Good resident vibes
-Whittier clinic's ancillary services are all in one place
-HCMC is one of the most renowned hospitals in the Midwest

Things you mentioned you value:
-learning about cost-effective multidisciplinary care models
-Big cities
-Family input
-Being able to handle anything that walks through the door
-Life outside residency

Some questions:
-I assume you had a good day of/gut feel at both programs. Was it equal do you think? Gun to your head, what program do you instinctively blurt out as your #1?
-Minneapolis and North Carolina are very different places, culture and weather wise. Where are you from? Which are you more familiar with?
-Your family's input does seem to be important to you. Related to the previous item, how close are they to Duke or HCMC? Will you end up 1000s of miles away from them? Does that matter to you?
-If you're burnt out on research why are you interested in a research university?
-You mentioned life outside of residency is important to you. Is work life balance valued equally at both programs?
-I'm harping on your family here, but to be frank you're the one going through residency not them. Say--entirely hypothetically here--you are unhappy at Duke and are feeling down/burnt out... how important will your family's preference be then?

Just my 0.02. Time to go back to my own rank order list, which is a mess and I have even less idea what I want than you.

 

[The_Sunny_Doc]

So.

Duke Pros:
-Prestige
-Research
-Family is going gaga because it's Duke
-Quality of preceptors
-Good referral services

HCMC Pros:
-Seems like you had good gut feeling day of
-Good resident vibes
-Whittier clinic's ancillary services are all in one place
-HCMC is one of the most renowned hospitals in the Midwest

Things you mentioned you value:
-learning about cost-effective multidisciplinary care models
-Big cities
-Family input
-Being able to handle anything that walks through the door
-Life outside residency

Some questions:
-I assume you had a good day of/gut feel at both programs. Was it equal do you think? Gun to your head, what program do you instinctively blurt out as your #1?
-Minneapolis and North Carolina are very different places, culture and weather wise. Where are you from? Which are you more familiar with?
-Your family's input does seem to be important to you. Related to the previous item, how close are they to Duke or HCMC? Will you end up 1000s of miles away from them? Does that matter to you?
-If you're burnt out on research why are you interested in a research university?
-You mentioned life outside of residency is important to you. Is work life balance valued equally at both programs?
-I'm harping on your family here, but to be frank you're the one going through residency not them. Say--entirely hypothetically here--you are unhappy at Duke and are feeling down/burnt out... how important will your family's preference be then?

Just my 0.02. Time to go back to my own rank order list, which is a mess and I have even less idea what I want than you.

This was incredibly helpful. I am going to think about everything you mentioned as I do my ROL. I appreciate that you seem to know a bit about each program too.

I do think my family is very prestige-oriented and have pushed me to chase prestige in the past, which has not made me happy. Will think on all of this...

 

[Sardonix]

It's a confusing time, friend. I was very certain until I actually entered my ROL, now I'm second guessing everything so may have to just enter it and let the cards fall as they may.

Also stole this from reddit (which some guy stole from Tulane's website I guess?):
"And again, choose the program that is best for you. Reputation is compelling, as is the vision of how much pride you will have on match day when you announce that you are going to the House of God. At the end of that day, however, and for the next three to seven years of your life, you will be alone with your decision. The people in the audience at match day will not be there with you. Make it a decision you can live with for the rest of your life."