Help with rank list!

[Spaceneedle2017]

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My rank list right now:

1. Michigan
2. MIR
3. Stanford
4. Seattle
5. UCSF

Am I crazy? Am I making a poor career decision? I just have family in michigan and my wife and I can't afford West Coast rent and cost of living anymore with a kid on the way.

Please make me feel better or knock some sense into me

 

[Gadofosveset]

No, you are not crazy if you're not trying to end up in Seattle. If staying in Seattle is your long term goal (e.g your username), then stay in Seattle and eat the cost. End of decision.

I imagine California is similar.

 

[futureradres12345]

My rank list right now:

1. Michigan
2. MIR
3. Stanford
4. Seattle
5. UCSF

Am I crazy? Am I making a poor career decision? I just have family in michigan and my wife and I can't afford West Coast rent and cost of living anymore with a kid on the way.

Please make me feel better or knock some sense into me

Career goals? Academics: go wherever you want in your top 5 and go to the best fellowship in your chosen subspecialty. Private Practice: Should probably go to the region you want to end up in long term, although you would still have a good chance of getting a good pp job on west coast if you did residency at UM or MIR and then did fellowship on west coast.

 

[Spaceneedle2017]

Thing is, I don't know. I dislike doing research but love teaching. Kinda hoping I figure it out during residency

 

[Derv]

Thing is, I don't know. I dislike doing research but love teaching. Kinda hoping I figure it out during residency

I am very much the same as you!

 

[Shifty B]

I personally would not choose Stanford over UCSF.

Otherwise, those are all excellent programs and you should probably decide on geography. That's the biggest difference in your list.

 

[Spaceneedle2017]

I personally would not choose Stanford over UCSF.

Otherwise, those are all excellent programs and you should probably decide on geography. That's the biggest difference in your list.

I appreciate your advice! I personally put Stanford above UCSF because the more competitive salary made rent more affordable

 

[Shifty B]

I appreciate your advice! I personally put Stanford above UCSF because the more competitive salary made rent more affordable

Yeah, I'm not sure that pans out in reality. Once you factor in the UCSF housing supplement, I imagine the difference in salary is negligible. Palo Alto may even be more expensive than SF lately. Overall, I think cost is a push.

UCSF is one of the top programs nationally that will prepare you for a private practice or academic environment. For years, despite a stellar reputation for the medical school, Stanford radiology has had a reputation for having odd personalities (both faculty and resident) and slow residents. Good research opportunities and ties to industry though. I don't think either is bad, but one is in the stratosphere.

 

[IR4thewin]

Yeah, I'm not sure that pans out in reality. Once you factor in the UCSF housing supplement, I imagine the difference in salary is negligible. Palo Alto may even be more expensive than SF lately. Overall, I think cost is a push.

UCSF is one of the top programs nationally that will prepare you for a private practice or academic environment. For years, despite a stellar reputation for the medical school, Stanford radiology has had a reputation for having odd personalities (both faculty and resident) and slow residents. Good research opportunities and ties to industry though. I don't think either is bad, but one is in the stratosphere.

Shifty B (and any other attendings perusing this forum), I would love to hear your honest opinion on reputations of residents and fellows coming out of programs. Particularly, are there any more "Top 30" programs that are known for producing slow residents? This is something that is hard to judge for us M4's traveling the interview trail.

 

[Gadofosveset]

Shifty B (and any other attendings perusing this forum), I would love to hear your honest opinion on reputations of residents and fellows coming out of programs. Particularly, are there any more "Top 30" programs that are known for producing slow residents? This is something that is hard to judge for us M4's traveling the interview trail.

This is a tough question to answer. For academic attendings, there are definitely faster and slower fellows, but it's not usually fair to compare them. For instance, I could say that the fellows from smaller programs are slower... but they're coming to a bigger center and seeing cases and situations that they've never seen before. It's good that they're slower; if they handled tertiary referral cases as fast as a rule out stone study, then there's something wrong (i.e. they have no idea what they could be missing on the more complex case and give it too little time). Some residents are fast because they're just sloppy (i.e. constant typos, template errors, poor descriptions). This is artificial speed because once you become an attending, you will have to slow down to fix those things or get endless calls / lose referrals, so might as well dictate appropriately from the get go.

A lot of speed is based on confidence. Confidence should be earned through a lot of experience.

Speed variability is dependent on (in no particular order):
- an individual's risk tolerance (often this is artificial speed. Many residents have a high risk tolerance. I would/did too, if all my liability fell on someone else)
- relative departmental teaching strength. If a place is known for good teaching in a certain area, then residents justifiably have higher confidence in that area --> faster in that area. This doesn't translate to all areas.
- individual aggressiveness (aggressive in taking cases and pushing yourself)
- breadth of cases seen in training / experience
- the amount of independent reading time probably helps

Speed differences between residents often sort themselves out at the end of fellowship, but not always. Differences after that point depend mostly on individual personality factors.

 

[Shifty B]

I'm not really trying to blow up the spot of a bunch of programs by saying their residents are all slow, because as Gad said there is a lot of individual difference. Plus I just happen to know the west coast reputations because I was a fellow out there. Speed is individual, but you will never become fast unless pushed. It can be during your residency, your fellowship, or your first day in private practice.

There are some general features to look for in a residency that will help you become faster:
- independent, or at least pseudo-independent, call. Residents should be on the hook for their reports for at least a short period of time. This may mean no in house attending, but there should at minimum be some separation between residents and overnight fellows/attendings. Sending to someone's queue at another location is ok, as long as you aren't reading out overnight.
- at least one work site in which residents outnumber fellows. At smaller hospitals, this may be your regular hospital. At bigger programs, this is often the county hospital or VA, where fellows may spend less time. If a hospital is one site with 2 fellows for every resident in each reading room, watch out. Also related:
- a county hospital. They tend to have higher study/person ratios, and residents have an opportunity to work more
- dictating full reports while on call. It's painful, I know, but you're gonna have to do it eventually. Work on your efficiency.
- a lot of call. If your call experience is 2 weeks of night float, I'm sorry, that's not enough. You need probably 2-6 months of night float or equivalent 24 hr call.

Other ways to find clues:
- ask the fellows there how they feel about residents. (Residents always think they are at programs that make them fast!) If a fellow thinks residents are useful and are happy to have them, that's a good sign.
- find the biggest private practices in the city, look at the roster, and see what residency the people came from. If it's stacked with the in-town residency, that's a good sign too

You can build efficiency at any program, but these features may make it easier.