IM Residency: Large Academic Center vs. Smaller Community-Based Hospital.

[Gregory Gulick]

Greetings, everyone. I'm facing a rather large dilemma about where I should do my IM residency. Right now, I'm rotating at a 400 bed community hospital that has FP, IM, Surgery, Anesthesiology, and Dermatology residencies. I'm very happy with the hospital and with the training I'm getting there.

Certain that I want to do IM, I'm trying to weigh the pros and cons of doing IM at this community hospital vs. a large academic center. I get so many different opinions from people, and would love to get as many opinions as possible from you guys.

Here's what I consider to be the pros and cons:

COMMUNITY HOSPITAL: The call schedule is about q6 days. This is attractive -- more time for my family! I currently live about 0.25 miles from the hospital, and love the area. Extended family is about an hour away. The cons are that the didactics could be MUCH better and there are no fellowships available at this facility.

ACADEMIC CENTER: First and foremost, a bigger facility means more pathology. Also, here I would have a better chance of landing a fellowship, should I decide to do one. It is probably more impressive on a CV to do a residency at a large academic center, vs a smaller hospital. The didactics are probably much better at an academic center, than at a community hospital. The cons are that the call schedule is probably q3 which means my family life will be aweful.

So please share your insights on what other factors I should be considering. What would you do if you were in my position?

Thanks.

G.

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[doc2003]

Do you know which fellowships interest you? This plays a big part in your decision. For example, if you think you want cardiology or hem/onc you best go to an academic center with a program. However, if you think you might want rheumatology perhaps it is not necessary. There are some essential questions to ask regarding the community program:

(1) How many months outside electives are allowed?
These months can be used to rotate at the larger, academic centers.
(2) Does anyone do research at the community hospital in a field you are interested in?
(3) Do you know of any IM or IM subspecialty docs in the community program with friends who are program directors of fellowships?

How upset would you be if you ended up practicing general IM?

 

[Whisker Barrel Cortex]

Where did you get the info that the academic center is q3? From what I have seen, very few internal medicine residencies are q3 (except maybe ICU). Usually they are q4-5. I would check into that first before deciding.

Just a little story about cushy internal medicine residencies: I had a friend (in California) who did a really nice residency in medicine. She graduated and decided not to do a fellowship. While she was looking at job offers, she realized that almost every single offer she had received had worse schedules than her residency! More hours! More call! She took the only job that was better and that was a 8-5 clinic job with no call paying only 80,000 to start (with 140,000 in loans to pay off thats not much).

Think about it. Your training during residency is the only time where you will have other physicians teaching you the art and science of medicine. You are allowed to make mistakes during residency, because there is someone there to correct them. If you choose the easier route, you may regret it later in your career.