Help with Rank List: UNC vs Duke

[0_0]

Hi all. MS4 that applied to anesthesiology this year. As my scheduled interviews are nearly done, I have naturally started to think more about my rank list.

Currently, I’m having a really tough time with UNC vs Duke. My gut says UNC > Duke purely based on my virtual interactions, but I can't help but wonder if I'm making a mistake by not taking a shot at a “prestigious” program? Title and prestige aren’t really my main concerns, but of course it’s nice to have that on your CV and can only be of benefit.

My husband and I want to stay in NC after residency and I’m interested in a fellowship, likely staying in academics (I know this is subject to change as time goes on). We have one small child and will possibly have one more in residency.

I've read posts about following your gut and initial impressions and UNC is the clear winner; however, my main question is:
Is the training and post-residency opportunities that different if training at Duke vs UNC? They both seem like amazing places.

What else can I do to help decide, and is there anything else I should look more closely at to help make my decision? (Of course this post assumes it’s entirely my choice).

Thanks in advance!

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[deleted1147063]

My husband and I want to stay in NC after residency and I’m interested in a fellowship, likely staying in academics (I know this is subject to change as time goes on). We have one small child and will possibly have one more in residency.

You must be kidding me! You want academia and you're not sure if Duke would be better? Yes, for PP jobs, prestige doesn't really matter. For academic jobs, fellowships and resume padding, prestige is hard currency. On the other hand, never work at a place that you dislike.

I won't comment about the pregnancy during residency. Just that I think it's not a good idea (except maybe as a CA-3).

 

[Remxed]

Even for private practice -- a lot more heads will turn when you said you trained at Duke vs UNC.

 

[0_0]

You must be kidding me! You want academia and you're not sure if Duke would be better? Yes, for PP jobs, prestige doesn't really matter. For academic jobs, fellowships and resume padding, prestige is hard currency. On the other hand, never work at a place that you dislike.

I won't comment about the pregnancy during residency. Just that I think it's not a good idea (except maybe as a CA-3).

Haha thanks. I guess from my perspective, it wasn't as obvious as it is from yours. Appreciate the input.

 

[Ronin786]

Huge difference in caliber between those two programs. Duke is a very cush residency with a lot of focus given on extra-curricular pursuits. UNC is much more clinical and not nearly as academic. Probably no difference as far as finding private jobs in the area, but if your goal is to pursue fellowship in NC, doing residency at Duke will be your easiest path to get a fellowship in the area. Duke traditionally takes a few of their own for fellowships.

If you're looking at short term go with your gut for UNC. But there's no contest when it comes to your stated future pursuits of fellowship and academics.

 

[0_0]

Huge difference in caliber between those two programs. Duke is a very cush residency with a lot of focus given on extra-curricular pursuits. UNC is much more clinical and not nearly as academic. Probably no difference as far as finding jobs in the area, but if your goal is to pursue fellowship in NC, doing residency at Duke will be your easiest path to get a fellowship in the area. Duke traditionally takes a few of their own for fellowships.

If you're looking at short term go with your gut for UNC. But there's no contest when it comes to your stated future pursuits of fellowship and academics.

Hi, thanks for your reply. This definitely helps answer my question.

Of course, I'd love to hear other opinions/insights as well.

 

[JiPo]

Duke. Not sure why this is even a question...

 

[0_0]

Duke. Not sure why this is even a question...

I'm not from the region, but family moved there while in med school. I didn't really have a reference, so it was/is a genuine question. Of course I know Duke is great, but I was not sure of the difference between the two schools. Thanks for your help!

 

[deleted1147063]

I'm not from the region, but family moved there while in med school. I didn't really have a reference, so it was/is a genuine question. Of course I know Duke is great, but I was not sure of the difference between the two schools. Thanks for your help!

Fair enough.

In anesthesiology, Duke is one of the big academic centers with national recognition. You will not regret having their name on your diploma. I have no idea about UNC (I'm not from the area).

 

[0_0]

Fair enough.

In anesthesiology, Duke is one of the big academic centers with national recognition. You will never regret having their name on your diploma.

This post was more to gauge how much of a contrast there is between the two programs. If it was inconsequential or minor, I would go with "my gut", but I genuinely enjoyed my virtual Duke experience and the people I met. Just not quite as much as UNC. I think I would be very happy at either.

At the end of the day, I'm after the best training that will keep as many doors open as possible. So far, it sounds like Duke is the way to go. Again, I appreciate the insight.

 

[yerhuckleberry]

I loved my experience as a resident at UNC. Were I to do it over again and be able to pick any program in the country, it would be UNC. The people and the program were just a perfect fit for my personality and I thrived, as a result. I am a big fan, then, of prioritizing happiness/fit over prestige.

 

[GassYous]

I loved my experience as a resident at UNC. Were I to do it over again and be able to pick any program in the country, it would be UNC. The people and the program were just a perfect fit for my personality and I thrived, as a result. I am a big fan, then, of prioritizing happiness/fit over prestige.

I'm in this camp as well. It is four years of your life so make the most of it. There's people that have bad things happen to them before their training is over.

 

[aneftp]

I’ve never worked with a bad Duke trained anesthesiologist. And I’ve worked in a few different practices.

Saying that. It’s all about fit with the program.

But find what program is more family friendly.

 

[Twiggidy]

Yes, the prestige of Duke will probably take you further, but of course that depends on how "far" you want to go. Both are university programs in the "research triangle". If for some reason you like the look of that Tar Heel blue, you won't be starving after you graduate, much like, sure UCLA looks great on the CV but USC doesnt mean your CV is getting thrown out. Sometime it's about feel and if one place feels better than the next rank it higher. Just work hard no matter where you end up

 

[DG51]

Program recognition won't be the limiting factor for your fellowship application coming from either of these programs, your ITE scores will be. Choose the program where you will have plenty of time outside of the hospital to study and enjoy life. If you choose to go PP, I don't think any of the AMCs that have saturated NC will care where you trained.

 

[dannyboy1]

For the vast majority of us where you went to residency makes absolutely no difference. With the state of the current job market you can write your own ticket. Fellowships are not that competitive. I went to a no-name community hospital for residency and everyone in my class who wanted a fellowship, got one. Maybe if you have aspirations to be a department chair. Otherwise, either is fine…

 

[Southpaw]

There are like 3 private practices left in NC and they won’t care if you came from UNC or Duke. NAPA for sure doesn’t care. Fellowships I imagine will care more about your letters and ITE. Honestly I don’t think it matters.

 

[Remxed]

OP mentioned she wants to stay in NC and work in academics. Just considering these 2 factors, training at Duke will certainly keep more doors open for her.

 

[teacher2md]

OP— do you see yourself producing a lot of research? Or do you want to be more of a clinical instructor to residents?

If the former— Duke may have more support for that stuff, but UNC surely has support as well.

If the latter- It really doesn’t matter. Your references matter and as long as you’re not a sociopath you can get an academic clinical instructor job anywhere. Go wherever you fit more.

Just know that a lot of incoming residents say that they want to stay in academics because they don’t know any differently. Don’t rule out private practice— we see plenty of sick, complicated cases as well. Your scope of practice will be much wider as an anesthesiologist in private practice vs academics as well.

 

[nimbus]

OP mentioned she wants to stay in NC and work in academics. Just considering these 2 factors, training at Duke will certainly keep more doors open for her.

How many academic programs are there in NC?

Duke, UNC, and ??

If she likes the culture of UNC and would like to stay there, it doesn’t hurt to train there.

 

[Remxed]

And Wake Forest I think. Neither choice is wrong by any means. Duke simply has a bigger name recognition within the academic world for whatever it's worth.

 

[vector2]

If there's even a small possibility that you're going to move from NC (especially far from NC) then choosing Duke is definitely a no brainer.

 

[0_0]

OP— do you see yourself producing a lot of research? Or do you want to be more of a clinical instructor to residents?

If the former— Duke may have more support for that stuff, but UNC surely has support as well.

If the latter- It really doesn’t matter. Your references matter and as long as you’re not a sociopath you can get an academic clinical instructor job anywhere. Go wherever you fit more.

Just know that a lot of incoming residents say that they want to stay in academics because they don’t know any differently. Don’t rule out private practice— we see plenty of sick, complicated cases as well. Your scope of practice will be much wider as an anesthesiologist in private practice vs academics as well.

I don't see myself producing tons of research, but I do anticipate contributing. Research isn't my "passion" though. My current vision of staying in academic is more for the clinical instructor role.
I absolutely have not ruled out private practice. I know that my opinions and goals will likely change as I grow in my career and personal life, but I cannot predict those things.

Also, I don't think I'm a sociopath...but isn't that exactly what a sociopath would say? Kidding, I'm a normal, hardworking person. Thanks for your input.

 

[0_0]

I loved my experience as a resident at UNC. Were I to do it over again and be able to pick any program in the country, it would be UNC. The people and the program were just a perfect fit for my personality and I thrived, as a result. I am a big fan, then, of prioritizing happiness/fit over prestige.

Thanks for this. This is probably an annoying question, but why/how do you think UNC was a perfect fit personality wise?

 

[kidthor]

Personally I’d go with gut feel in this case. Both programs will set you up well. Sure Duke is a fancier name, but everyone knows UNC too. In my opinion the “prestige” factor in medicine is becoming less and less Important. Many (good) academic programs are much less superficially picky than they once were in hiring.

And in my opinion you shouldn’t hesitate to have more kids at any point in training.

 

[0_0]

Personally I’d go with gut feel in this case. Both programs will set you up well. Sure Duke is a fancier name, but everyone’s know UNC too. In my opinion the “prestige” factor in medicine is becoming less and less Important. Many (good) academic programs are much less superficially picky than they once were in hiring.

And in my opinion you shouldn’t hesitate to have more kids at any point in training.

Hey thanks for sharing your opinion. Prestige isn't really important to me, its more about strength of training. I hope I don't come across entitled when I ask about these two programs. I think they are both great, and I feel very fortunate to be in my situation.

Also, I'm not going to put my life on hold for my career. It'll work out, it has to, just may be a bit harder. Appreciate your thoughts.

 

[GC-DR]

Current UNC resident half our staff trained at duke, half of dukes staff and fellows came from UNC.
Non biased opinion is residency is about fit.
You will work hard at both of our places. Anyone that says otherwise is lying to you.

But hard work can feel like 100 hrs with people you hate or 20 hours with people you like.
You will like everyone at either place.

I had a kid in internship and I’m having another kid as a ca2. Multiple people in my cohort had kids in internship of ca1 year.
Anyone telling you a job is more important than having a family while you are young and healthy is wrong and I’m not going to get into a debate with them because each to their own.

Both of our places are great you will get great training at either place. Duke has some name value, UNC has plenty as well.

 

[deleted1147063]

I had a kid in internship and I’m having another kid as a ca2. Multiple people in my cohort had kids in internship of ca1 year.
Anyone telling you a job is more important than having a family while you are young and healthy is wrong and I’m not going to get into a debate with them because each to their own.

It's not the job that's important. It's the training. You're doing it for yourself. You can have that second/third kid later. If you can't understand this now, you WILL after you graduate. Especially if you harm a patient, and hence your family.

This specialty is not one where one can read up and go back and fix a mistake later, without causing harm.

So do take every opportunity to see and experience as much as you can, as a trainee, because it's a jungle out there. Not the nursery you are used to in academia. You're not training to become a CRNA, but an independent consulting physician.

Sorry, but somebody should wake up your diapered overprotected generation.

 

[anaesthetic]

It's not the job that's important. It's the training. You're doing it for yourself. You can have that second/third kid later. If you can't understand this now, you WILL after you graduate. Especially if you harm a patient, and hence your family.

This specialty is not one where one can read up and go back and fix a mistake later, without causing harm.

So do take every opportunity to see and experience as much as you can, as a trainee, because it's a jungle out there. Not the nursery you are used to in academia. You're not training to become a CRNA, but an independent consulting physician.

Sorry, but somebody should wake up your diapered overprotected generation.

This is probably one of the most sexist, misogynistic posts I’ve ever read on SDN, and I’ve been on here for well over a decade.

I know many physicians who have had kids throughout their residency/fellowship training whom I would trust with my life. On the other hand, I know many physicians who never had any kids or remained single throughout training who shouldn’t be allowed anywhere near a hospital.

Instead of framing it in the context of “millennials” or “Gen-Z,” you should probably take a step back and realize what you’re really doing: telling a woman when she can have a baby. If you don’t see a problem with that, then I really don’t know what else there is to say.

 

[Onefellswoop87]

It's not the job that's important. It's the training. You're doing it for yourself. You can have that second/third kid later. If you can't understand this now, you WILL after you graduate. Especially if you harm a patient, and hence your family.

This specialty is not one where one can read up and go back and fix a mistake later, without causing harm.

So do take every opportunity to see and experience as much as you can, as a trainee, because it's a jungle out there. Not the nursery you are used to in academia. You're not training to become a CRNA, but an independent consulting physician.

Sorry, but somebody should wake up your diapered overprotected generation.

Wow
Yes, residency is important, but so is being a human. I can’t agree with you to put everything else on the back burner, including a timeline of having children, to maximize training. That is very different set of priorities than I share. Please spare us the “I walked uphill both ways to work.” The modern residency workhorse model (well, pre workhour restriction but arguably still present) was enacted/modeled by a cocaine and subsequently morphine addict (William Stewart Halsted). There has to be a better way to be a competent physician and a human being.

We can’t be robots in medicine. There is no perfect timeline for a child, but having been there (one in med school and internship) and I think most days I’m a competent anesthesiologist, with planning and spousal support, it is doable. Hard? Yeah. Harder than if you had no commitments outside of medicine? Yeah, I’d assume so. But that’s life . . . live it and make the most of it.

Necessity is the mother of invention: William Stewart Halsted’s addiction and its influence on the development of residency training in North America

William Stewart Halsted developed a novel residency training program at Johns Hopkins Hospital that, with some modifications, became the model for surgical and medical residency training in North America. While performing anesthesia research early in ...

www.ncbi.nlm.nih.gov

But to the original question, I don’t have any direct knowledge of either residency program. But I did undergrad at UNC and it’s an amazing city/college/area. And then went to med school at Wake, so my gut says that going to either Duke or UNC will give you to the tools to succeed.

 

[CubsDynasty]

They didn't say they were replacing time in residency with paternity/maternity leave, there are ACGME guidelines in place to ensure the time requirements are met. Sure, how programs handle this varies, but you can't make the assumption that having that second/third kid in training means you’re a worse doctor.

 

[patriot6]

FFP's comment sucks. Granted, I'm a male, but I had 4 kids during medical training. My training did not suffer because of it. Many people thrive in the stability that home life can provide you. You will certainly not be a worse doctor for having children in residency; in fact, I think you'll be a better doctor. Best of luck to you. I'm a Wake Forest alum and loved living in that part of the country.

 

[Arch Guillotti]

It's not the job that's important. It's the training. You're doing it for yourself. You can have that second/third kid later. If you can't understand this now, you WILL after you graduate. Especially if you harm a patient, and hence your family.

This specialty is not one where one can read up and go back and fix a mistake later, without causing harm.

So do take every opportunity to see and experience as much as you can, as a trainee, because it's a jungle out there. Not the nursery you are used to in academia. You're not training to become a CRNA, but an independent consulting physician.

Sorry, but somebody should wake up your diapered overprotected generation.

Awful reply. Every word of it.

 

[GassYous]

Having a kid when you're older must suck. I'm used to the late nights and sleepless nights from residency but the first year was still awful. I think residency training is important but you also need to live your life. There's just no perfect time to have a kid.

 

[dannyboy1]

It's not the job that's important. It's the training. You're doing it for yourself. You can have that second/third kid later. If you can't understand this now, you WILL after you graduate. Especially if you harm a patient, and hence your family.

This specialty is not one where one can read up and go back and fix a mistake later, without causing harm.

So do take every opportunity to see and experience as much as you can, as a trainee, because it's a jungle out there. Not the nursery you are used to in academia. You're not training to become a CRNA, but an independent consulting physician.

Sorry, but somebody should wake up your diapered overprotected generation.

First of all, the time needs to be made up as per ACGME. some of the residents in my program who took maternity leave graduated a few weeks late in July ( really no big deal in the scheme of things).
Second, the learning and experience doesn’t stop the second you flip the switch into attendinghood. I learned a hell of a lot in my first 2 years out,I’m sure you did as well.

 

[nimbus]

It's not the job that's important. It's the training. You're doing it for yourself. You can have that second/third kid later. If you can't understand this now, you WILL after you graduate. Especially if you harm a patient, and hence your family.

This specialty is not one where one can read up and go back and fix a mistake later, without causing harm.

So do take every opportunity to see and experience as much as you can, as a trainee, because it's a jungle out there. Not the nursery you are used to in academia. You're not training to become a CRNA, but an independent consulting physician.

Sorry, but somebody should wake up your diapered overprotected generation.

We’re talking about anesthesia, not neurosurgery. Lots of anesthesiologists had kids during residency. Haven’t noticed any difference between people who had kids during residency and those who didn’t. Maybe there should be a study. The results could be surprising.

 

[deleted1147063]

Awful reply. Every word of it.

Thanks. I was going to quit this forum anyway. I just needed a really good reason. It's really a waste of time.

Just to be clear: the bias is not mine. The bias is in the eye of the beholder, it's the projection of your thought processes. Read the post I was responding to.

My post was not intended for any particular gender, and it was definitely not discriminatory. I love all the women in my life, and I can't stand societies or cultures where women are second-rate citizens. But, beyond the pregnancy, it's awfully hard to do a residency with a small kid at home, for both spouses, so I was advising against a second or third one, especially in those 3-4 critical years for one's training, especially where there are 2 working spouses (which is the norm nowadays).

Also think about why the US has the 6th highest divorce rate in the world, with 40-50% of marriages ending in a divorce, IF people even get married in the first place. Extra stress doesn't help. But, hey, who am I to give advice to young people, they know everything much better. We are in Gattaca, and they must have better genes due to all that technological progress after I was born.

I also think that many people who disagree with my rant don't get to work with residents and see the quality that's coming upstream. It's worsening every year, especially with all this political correctness since childhood, which has always shielded Gen Z from real life. It's almost like in the Matrix.

I'm the first guy to say that one doesn't live to work but works to live, and that the American culture is too workaholic and money-oriented, but the level of laziness, lack of interest, and frankly incompetence among residents has been skyrocketing for the last 5 years, way before Covid. I would allow less than 10-15% of graduating CA-3s to take care of me or my loved ones.

Good luck to you all and your echo chambers.

 

[Arch Guillotti]

Thanks. I was going to quit this forum anyway. I just needed a really good reason. It's really a waste of time.

 

[kidthor]

I'm the first guy to say that one doesn't live to work but works to live, and that the American culture is too workaholic and money-oriented, but the level of laziness, lack of interest, and frankly incompetence among residents has been skyrocketing for the last 5 years, way before Covid. I would allow less than 10-15% of graduating CA-3s to take care of me or my loved ones.

The residents I work with are all motivated, smart, eager to learn, and hard working. They a have a reasonable (but not easy) call schedule and are also able to have a life outside of work. They certainly have a more humane existence than I did when I was a resident - and that’s all for the better.

 

[dannyboy1]

Thanks. I was going to quit this forum anyway. I just needed a really good reason. It's really a waste of time.

Just to be clear: the bias is not mine. The bias is in the eye of the beholder, it's the projection of your thought processes. Read the post I was responding to.

My post was not intended for any particular gender, and it was definitely not discriminatory. I love all the women in my life, and I can't stand societies or cultures where women are second-rate citizens. But, beyond the pregnancy, it's awfully hard to do a residency with a small kid at home, for both spouses, so I was advising against a second or third one, especially in those 3-4 critical years for one's training, especially where there are 2 working spouses (which is the norm nowadays).

Also think about why the US has the 6th highest divorce rate in the world, with 40-50% of marriages ending in a divorce, IF people even get married in the first place. Extra stress doesn't help. But, hey, who am I to give advice to young people, they know everything much better. We are in Gattaca, and they must have better genes due to all that technological progress after I was born.

I also think that many people who disagree with my rant don't get to work with residents and see the quality that's coming upstream. It's worsening every year, especially with all this political correctness since childhood, which has always shielded Gen Z from real life. It's almost like in the Matrix.

I'm the first guy to say that one doesn't live to work but works to live, and that the American culture is too workaholic and money-oriented, but the level of laziness, lack of interest, and frankly incompetence among residents has been skyrocketing for the last 5 years, way before Covid. I would allow less than 10-15% of graduating CA-3s to take care of me or my loved ones.

Good luck to you all and your echo chambers.

This sounds like one of those “kids these days” rants. To be perfectly honest your attendings likely said the same things about you when you were graduating. They might be right. Every new attending can use a little seasoning. At some point we establish that you are “safe enough” to go out on your own. Hopefully one learns from their early career mishaps and becomes wiser, while doing no lasting harm. In every like of work there is always the new guy who needs some more experience. Same with anesthesia. I wouldn’t let my loved one get anesthesia from ANY new grad, because they are new. Would rather they gain their valuable experience somewhere else.

 

[abolt18]

This sounds like one of those “kids these days” rants. To be perfectly honest your attendings likely said the same things about you when you were graduating. They might be right. Every new attending can use a little seasoning. At some point we establish that you are “safe enough” to go out on your own. Hopefully one learns from their early career mishaps and becomes wiser, while doing no lasting harm. In every like of work there is always the new guy who needs some more experience. Same with anesthesia. I wouldn’t let my loved one get anesthesia from ANY new grad, because they are new. Would rather they gain their valuable experience somewhere else.

You guys are crazy. I would feel comfortable with all or nearly all of my classmates I graduated with caring for me or a family member. Same with the class behind or ahead of me. Same with the current CA3 class.

And (GASP!!!) several of those are men and women who have had children and grown their families during training!

@FFP having young kids while in training never held me back IMO. While my family has always been my #1 priority in life, I was fortunate that I did not have to make sacrifices in my training while trying to keep being a good husband and father. We had some residents extend their training a little because they needed to take time to grow/raise their families. Additionally, I would argue that my family motivated me to work harder and succeed.

I enjoy your perspectives and viewpoints here, but like others, I disagree with you on this one here. I would tell residents to put their family goals first, career goals second. If that means having kids in training, so be it!

 

[JiPo]

I don’t think it is about having a kid in residency. If you are a dedicated resident with commitment to be a great anesthesiologist, you will make it work regardless.

I’ve had co-resident who had a kid in residency, and she is a phenomenal anesthesiologist that I would trust my family with. Also had another co-resident who also had a kid, but she was a weak resident with low ITE scores to begin with. Needless to say, she would not be my first choice if I were getting anesthesia.

 

[nimbus]

This study out of Wake Forest compared med school performance of college athletes to non-athletes. (As an aside, 8 of the 62 rowed crew. It’s no surprise they perform well because those people, and athletes in general, are not averse to suffering).

It would be interesting to see a study comparing residency performance of parents to non-parents.

Performing Under Pressure: Varsity Athletes Excel in Medical School

The admission process for medical school relies on objective and subjective measures of personal achievement, and selecting successful medical students is a daunting task for admission committees. While there is a significant body of literature examining ...

www.ncbi.nlm.nih.gov

 

[0_0]

It's not the job that's important. It's the training. You're doing it for yourself. You can have that second/third kid later. If you can't understand this now, you WILL after you graduate. Especially if you harm a patient, and hence your family.

This specialty is not one where one can read up and go back and fix a mistake later, without causing harm.

So do take every opportunity to see and experience as much as you can, as a trainee, because it's a jungle out there. Not the nursery you are used to in academia. You're not training to become a CRNA, but an independent consulting physician.

Sorry, but somebody should wake up your diapered overprotected generation.

Wow. I came here for help about discerning which program would provide me with the best training. I never mentioned I was after anything other than that, and I'm not looking for the easy path. You’re just making assumptions. Where ever I end up, I just hope theres not many people like you.

How disappointing.

 

[WholeLottaGame7]

Wow. I came here for help about finding discerning which program would provide me with the best training. I never mentioned I was after anything other than that. I'm not looking for the easy path. You’re just making assumptions. Where ever I end up, I just hope theres not many people like you.

How disappointing.

I trained at both places and have been an attending at both places. Happy to DM if you want my opinion or have any specific questions.

 

[Twiggidy]

Thanks. I was going to quit this forum anyway. I just needed a really good reason. It's really a waste of time.

Seriously. How many times have you said this?

 

[Twiggidy]

I would allow less than 10-15% of graduating CA-3s to take care of me or my loved ones.

Also, this could be a reflection of teaching. What is your institution actually teaching them to where you don't think 90% of graduates can't take care of you.

 

[GassYous]

Seriously. How many times have you said this?

It is hard to quit this place