FM residency - does it matter where we do residency?

[lovedaisy]

Hello!

My question is: Does it matter where I go for FM residency? I applied to rural programs and urban programs, academic and community programs. all over IL (thats where i am from) and surrounding states also.

I am interviewing to a good mix of places and the more confused I am getting as to how I would rank them. It would have been easier if I was alone. but my husband is a graduate student and we were really hoping to find a place where I can pursue my residency and he can do post-doc. We did long distance during med school and we both hated it. So, my questions are:

1. Does it matter where I do residency in terms of location? If I pick a rural residency, does that mean I cannot get a job in a bigger city in the future?
2. I wanna be a faculty in the future as well. but, how difficult is that if I do residency in a community program instead of an academic affiliated program?
3. also...how important is it to look at benefits?

I know I cannot have the best of everything. Just looking for insights and wanna see what other people would do. Ultimately, I will prioritize where I Fit the best over evreything, but above mentioned thoughts are something I have been thinking about lately and would like some insights.

THANKS!!!

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[Sardonix]

Hello!

My question is: Does it matter where I go for FM residency? I applied to rural programs and urban programs, academic and community programs. all over IL (thats where i am from) and surrounding states also.

I am interviewing to a good mix of places and the more confused I am getting as to how I would rank them. It would have been easier if I was alone. but my husband is a graduate student and we were really hoping to find a place where I can pursue my residency and he can do post-doc. We did long distance during med school and we both hated it. So, my questions are:

1. Does it matter where I do residency in terms of location? If I pick a rural residency, does that mean I cannot get a job in a bigger city in the future?
2. I wanna be a faculty in the future as well. but, how difficult is that if I do residency in a community program instead of an academic affiliated program?
3. also...how important is it to look at benefits?

I know I cannot have the best of everything. Just looking for insights and wanna see what other people would do. Ultimately, I will prioritize where I Fit the best over evreything, but above mentioned thoughts are something I have been thinking about lately and would like some insights.

THANKS!!!

1a. Generally speaking, location matters regarding things like how close the residency is to your school (school reputation, connections) and/or if you lived in the area before (again, connections and ease of predicting if you may actually stay local). Residencies like applicants from schools they get along well with beforehand and they like applicants who may stay in their area, especially their state.
1b. This is FM we are talking. Cover your face, throw a dart at a map--bam, you have a job. So long as you didn't land in an extremely expensive and competitive city like NY, SF, downtown Chicago etc... you can basically move anywhere and have a job. Rural programs tend to focus on broader training and problems you see in rural areas. Vice versa with urban programs. There may be a bit of adjustment switching between a rural job and an urban job, but the biggest issue is what you want. It's much easier to adapt to a rural practice when you wanna be there, same goes for city life.

2. Mostly a non-issue. You just have to be pretty good at what you do, have great recommendations, and likely will need several years experience before being hired as a faculty. It's not very common for a PGY3 to be hired on as faculty right out of residency.

3. Benefits are VERY important. There's the obvious stuff like salary--getting paid below average to work in a HIGH cost city in California will be harder than getting paid MORE to do residency in a small midwestern town. But that leads into other obvious stuff I mentioned above. If you can't stand small town life and will be unhappy, don't go for that. Work is work, residency is residency--it will be hard but that's expected. It will be much harder if you loath where you live.
But let's talk other stuff that's not obvious.
- Don't underestimate the power of programs that offer free food. If it's quality food then even better. It's a HUGE stress off your back to not have to pay for meals while working 12-24hrs straight.
- Is clinic connected or close to the hospital? Much easier to work without having to travel between the two during crappy weather.
- Is the EHR tolerable or is it a curse like Allscripts or worse?
- If you use the gym, is there a gym nearby or in facility?

You get the idea. These things, while individually little, build up and instill a sense of being valued for the work you do. That can be helpful if you are in the middle of an overwhelming rotation or dealing with difficult people... which is obviously another story.

 

[lovedaisy]

Hey, Sardonix. I realllly appreciate your response. you mentioned some really good points.
Thanks so much!!!

 

[FrkyBgStok]

It matters for how you want to practice. For example, I am from a small city with 3 family medicine residencies. One has significantly more inpatient and OB experience, one is almost entirely outpatient, and one is a crappy mixture of both. The rural residency isn't going to affect much of your city job prospects and vice versa in the sense of filling requirements, however if you go to a residency which is entirely outpatient and you apply for a rural job that has significant inpatient and OB responsibilities, it is going to matter.

 

[DO.ctor]

I agree with the above. I would further emphasize the importance of receiving well rounded training if your goal is to do FM faculty work. I have similar aspirations - I'm just further down the path. What I have noticed is that many faculty positions want you to do outpatient/inpatient/OB, which is great. You should feel fairly confident that you can receive good outpatient and inpatient training during residency. OB training is another matter. Not all FM programs will set you up for practicing as an attending on L&D so be sure to find a program that has a strong track record in OB training. To give you an idea of this, most of my class (from an opposed urban program in IL) finished with <20 deliveries. This is not the only way to a faculty job but having good OB training will likely open you to more opportunities.

Some questions to ask:
- What are typical delivery numbers? How do I get more if I want more (elective, concentration, tracks)?
- Is there a graduation requirement for deliveries (ACGME got rid of this requirement but some programs still want a certain number of deliveries for you to graduate)?
- Is the program opposed (matters for L&D and other rotations where you may need to compete for learning/procedures)?

 

[lovedaisy]

Thank you everyone for responding. This is really helpful. A new dillema of mine: should i prioritize a program because it is affiliated with a nationally ranked hospital vs a community hospital that is affiliated with a so-so hospital? I am basially asking does the brand/prestige matter? what are ya'll thoughts?

 

[Sardonix]

Thank you everyone for responding. This is really helpful. A new dillema of mine: should i prioritize a program because it is affiliated with a nationally ranked hospital vs a community hospital that is affiliated with a so-so hospital? I am basially asking does the brand/prestige matter? what are ya'll thoughts?

If you want to go into academia or need access to something these big name institutions offer? Maybe. Otherwise, generally no.

One of my faculty last week said it best: FM specializes in community medicine. Whereas surgical subspecialties need big tertiary centers to see enough variety and have access to the right tools and training, FM is not the same. Sometimes the small community program in FM has even better training by comparison.

But this is all simplified into generic answers. The main question is what do you want and what do the programs offer you? Is the small community program checking all the boxes? Then that's it. But if the big name academic institution in the big city checks all the boxes AND trains you to be a full spectrum, unrivaled FM doc? Then go for it.

 

[DameJulie]

If one wants max flexibility and employment options after residency, is it preferred be trained in academic hospitals?

 

[SLC]

If one wants max flexibility and employment options after residency, is it preferred be trained in academic hospitals?

only if you want to be working in a larger hospital after graduation.

several of my classmates are hospitalists full time in academic centers. A few more went directly into FM OB faculty jobs right out of residency.

if your goal is to be a community physician in a community clinic, it won’t matter.

 

[lovedaisy]

thank you to alll of you so much!!! I really appreciate you guys's answers bcos i feel like these are things I cannot openly talk about with anyone for fear of judgement. But im so happy you all responded and gave me perspective.
Happy holidays!

 

[hallowmann]

If one wants max flexibility and employment options after residency, is it preferred be trained in academic hospitals?

It's not essential. What you want is good training, a good fit, and broad training. You want to go somewhere where people are graduating and practicing anything, e.g. some into FM with OB, some being hospitalists, some doing fellowships and some doing outpatient care. You can get that from community or academic centers, but not everywhere.