IM residency: what makes university programs better?

[shouldigomd]

Large university programs (i.e. big state schools) in general are better than community programs seems to be common knowledge. Obviously when you compare a small program with no patients, few in house staff doctors and no teaching the answer is self explanatory. My question is what about those lesser known / up and coming / or even established non university programs that do have a decent teaching structure / hospitalists / specialists.

There are a handful of newer / evolving / growing residency programs out there. Given it be a decent hospital... to me it makes much more sense to go to a smaller non university program. Fewer residents = more access to specialists and perhaps an easier time getting involved in research opportunities. Also if there are only 10 or so 3rd years your chance of being chief is much better.

To me it seems as though many of these larger state schools treat you more like a piece of the system and it seems like it would be difficulty to stand out from the pack which is what it takes to land a fellowship in GI / Cards.

So what do you guys think? For sake of analogy take Mt. Sinai St. Lukes Roosevelt in NYC and pretend it had 35 residents and was in its 5th year of operation vs your average state university school like UF / UVA / UT / etc. What would you choose?

Thanks in advance for any insight!

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[whoknows2012]

Large university programs (i.e. big state schools) in general are better than community programs seems to be common knowledge. Obviously when you compare a small program with no patients, few in house staff doctors and no teaching the answer is self explanatory. My question is what about those lesser known / up and coming / or even established non university programs that do have a decent teaching structure / hospitalists / specialists.

There are a handful of newer / evolving / growing residency programs out there. Given it be a decent hospital... to me it makes much more sense to go to a smaller non university program. Fewer residents = more access to specialists and perhaps an easier time getting involved in research opportunities. Also if there are only 10 or so 3rd years your chance of being chief is much better.

To me it seems as though many of these larger state schools treat you more like a piece of the system and it seems like it would be difficulty to stand out from the pack which is what it takes to land a fellowship in GI / Cards.

So what do you guys think? For sake of analogy take Mt. Sinai St. Lukes Roosevelt in NYC and pretend it had 35 residents and was in its 5th year of operation vs your average state university school like UF / UVA / UT / etc. What would you choose?

Thanks in advance for any insight!

Your assessment of smaller program=greater access to subspecialists, research, and chief is flawed. Additionally a smaller lesser known does not give you better access to competitive specialties like cards and GI due to less competition between co-residents; in fact it's quite the opposite. Also with regard to research academic centers will almost always have more research opportunities than a community program, let alone a community program that is new. The worst residents who apply for cards or GI at a mid tier academic center still match (mostly) and I can guarantee the program you come from will have a large impact on which fellowship programs interview you. Your goal should be to get into the best residency program possible that will a) train you to be a great clinician, b) set you up well for a future in whatever you decide you want to do ( whether it be private practice internist or academic cardiologist) and c) a program in which you will be happy. Fellowship programs much prefer a known commodity (i.e. Good resident from good academic program) than and unknown commodity (good resident from unknown/new community program). Reason how you will but that's just the way it is.

 

[Instatewaiter]

Large university programs (i.e. big state schools) in general are better than community programs seems to be common knowledge. Obviously when you compare a small program with no patients, few in house staff doctors and no teaching the answer is self explanatory. My question is what about those lesser known / up and coming / or even established non university programs that do have a decent teaching structure / hospitalists / specialists.

There are a handful of newer / evolving / growing residency programs out there. Given it be a decent hospital... to me it makes much more sense to go to a smaller non university program. Fewer residents = more access to specialists and perhaps an easier time getting involved in research opportunities. Also if there are only 10 or so 3rd years your chance of being chief is much better.

To me it seems as though many of these larger state schools treat you more like a piece of the system and it seems like it would be difficulty to stand out from the pack which is what it takes to land a fellowship in GI / Cards.

So what do you guys think? For sake of analogy take Mt. Sinai St. Lukes Roosevelt in NYC and pretend it had 35 residents and was in its 5th year of operation vs your average state university school like UF / UVA / UT / etc. What would you choose?

Thanks in advance for any insight!

It depends on your goal. Are you looking to get solid training? Are you looking to get a fellowship? Are you looking to get into research?

If you are looking for solid training, you probably could get good training at many places but there are a few issues with smaller programs.
1) Volume of patients
2) Fewer innovations happen at non-academic places
3) The clinical leaders tend to be at academic centers (although not always)
4) Complex stuff often gets sent to larger places

If you are looking to get a solid fellowship, you're probably going to have an easier time from a university program.

With regard to research, you are going to have a much easier time getting into research at a large university program, hands down. You will have much more to choose from.

 

[shouldigomd]

Thank you both for the responses. Yes, I know my assessment is flawed I don't have much experience to go off of as I haven't seen many other programs outside my own. I want to do interventional cardiology so I am definitely looking at places that will give me a good opportunity to match while getting solid training. From what I understand research is very important when it comes to matching fellowship.

I know when you look at the extremes you can run into problems (small programs vs huge programs). I guess what I am wondering is more in the middle ground... about those new up and coming programs that are not university based. In the future they may grow into larger programs but they are still evolving and developing fellowships. To me the situation seemed ideal as you had a solid patient flow (decent size hospital with new residency program) with more individual based access to specialists. In my current program there are 100 residents and when they rotate in different fields it isn't quite the most intimate experience.

From what you guys both say, university based programs are a pretty clear cut better choice generally speaking? So would you guys say going to a "weaker" university based program like florida atlantic university > a solid community program like St. Lukes Roosevelt Mt. sinai in NYC sister to the well respected Ichan?

 

[Instatewaiter]

I know when you look at the extremes you can run into problems (small programs vs huge programs). I guess what I am wondering is more in the middle ground... about those new up and coming programs that are not university based. In the future they may grow into larger programs but they are still evolving and developing fellowships. To me the situation seemed ideal as you had a solid patient flow (decent size hospital with new residency program) with more individual based access to specialists. In my current program there are 100 residents and when they rotate in different fields it isn't quite the most intimate experience.

From what you guys both say, university based programs are a pretty clear cut better choice generally speaking? So would you guys say going to a "weaker" university based program like florida atlantic university > a solid community program like St. Lukes Roosevelt Mt. sinai in NYC sister to the well respected Ichan?

So if your goal is getting into fellowship, it actually benefits you to go to a program that has a long track record of getting people into fellowships and to go to a program where the PD and your cardiology PD konws people (and can make calls). A lot of fellowship matching involves people who have worked with you to make calls for you. This familiarity with people tends to happen at larger, university programs.

You want the program to be developed, not an up and coming program. You don't have the time to wait for it to be a known entity. You need it to be a known entity when you are applying just after your 2nd year of residency.

My program had about 100 residents (35 per year) which is a medium to large sized program. Every resident was known by basically every attending by name. And we tend to match 15-20 residents to cardiology per year. Larger programs don't have to be impersonal. It is all about the feel of the program.

 

[dozitgetchahi]

Thank you both for the responses. Yes, I know my assessment is flawed I don't have much experience to go off of as I haven't seen many other programs outside my own. I want to do interventional cardiology so I am definitely looking at places that will give me a good opportunity to match while getting solid training. From what I understand research is very important when it comes to matching fellowship.

I know when you look at the extremes you can run into problems (small programs vs huge programs). I guess what I am wondering is more in the middle ground... about those new up and coming programs that are not university based. In the future they may grow into larger programs but they are still evolving and developing fellowships. To me the situation seemed ideal as you had a solid patient flow (decent size hospital with new residency program) with more individual based access to specialists. In my current program there are 100 residents and when they rotate in different fields it isn't quite the most intimate experience.

From what you guys both say, university based programs are a pretty clear cut better choice generally speaking? So would you guys say going to a "weaker" university based program like florida atlantic university > a solid community program like St. Lukes Roosevelt Mt. sinai in NYC sister to the well respected Ichan?

Do not go to a 'new and evolving' program. I have seen/dealt with many of these types of programs as a med student and most of them were disorganized ****shows despite the best efforts of the administration. You don't want to go to programs where there isn't an established culture for medical education - as a resident, you simply won't be taken as seriously as you would be at a real academic place by attendings or nurses etc, and your training will suffer. You need autonomy to become a good doctor.

I'm not fond of community programs either. As a med student, I worked inside 4 community IM programs in 3 different states and the theme was the same at each of them - be all about the $$$, not about the education. The level of teaching from attendings, didactic quality, research opportunities, patient complexity etc at a true academic center is often unbeatable. The overall quality of training I got at IU far exceeded any community program I dealt with as a medical student.

What is your motivation for not simply going to the best program? Location?

 

[shouldigomd]

Do not go to a 'new and evolving' program. I have seen/dealt with many of these types of programs as a med student and most of them were disorganized ****shows despite the best efforts of the administration. You don't want to go to programs where there isn't an established culture for medical education - as a resident, you simply won't be taken as seriously as you would be at a real academic place by attendings or nurses etc, and your training will suffer. You need autonomy to become a good doctor.

I'm not fond of community programs either. As a med student, I worked inside 4 community IM programs in 3 different states and the theme was the same at each of them - be all about the $$$, not about the education. The level of teaching from attendings, didactic quality, research opportunities, patient complexity etc at a true academic center is often unbeatable. The overall quality of training I got at IU far exceeded any community program I dealt with as a medical student.

What is your motivation for not simply going to the best program? Location?

Thank you very much for the response. It seems as though established university programs are the way to go. I definitely noticed the theme you mentioned about the "established culture" for the student / resident. From my experience doing a rotation at one of evolving programs I definitely noticed the residents were babied by the attendings and didn't have too much autonomy.

My motivation is to get the best education / best chance for cards. I don't really care where. I just was trying to figure out what that is. To me it seemed as though a more intimate program that was evolving fellowships really wanted their residents to grow with them. A trend I find at many large programs is that few fellows actually stay at the school.

My other dilemma was comparing lower tier university programs to well established community non university programs. For example St. Lukes Roosevelt Mt. Sinai in NYC (solid community non university program) vs something like florida atlantic university / SUNY downstate.

 

[dozitgetchahi]

Thank you very much for the response. It seems as though established university programs are the way to go. I definitely noticed the theme you mentioned about the "established culture" for the student / resident. From my experience doing a rotation at one of evolving programs I definitely noticed the residents were babied by the attendings and didn't have too much autonomy.

My motivation is to get the best education / best chance for cards. I don't really care where. I just was trying to figure out what that is. To me it seemed as though a more intimate program that was evolving fellowships really wanted their residents to grow with them. A trend I find at many large programs is that few fellows actually stay at the school.

My other dilemma was comparing lower tier university programs to well established community non university programs. For example St. Lukes Roosevelt Mt. Sinai in NYC (solid community non university program) vs something like florida atlantic university / SUNY downstate.

I'd say that staying with the program for fellowship is a low priority. Many times, the best training you can match into for fellowship isn't your home program. That certainly wasn't the case in my subspecialty. On the other hand, you're aiming at a competitive specialty (cards) and thus having in-house fellowships can be an edge at some of these smaller programs (provided they actually take residents from their own home program - some of them basically don't).

What are your stats like? Any reason to think you wouldn't match mid-tier university programs? It's not all that hard, even now.

 

[shouldigomd]

I'd say that staying with the program for fellowship is a low priority. Many times, the best training you can match into for fellowship isn't your home program. That certainly wasn't the case in my subspecialty. On the other hand, you're aiming at a competitive specialty (cards) and thus having in-house fellowships can be an edge at some of these smaller programs (provided they actually take residents from their own home program - some of them basically don't).

What are your stats like? Any reason to think you wouldn't match mid-tier university programs? It's not all that hard, even now.

I have decent stats but I am SGU IMG. 255/253 on steps, 90% avg basic sciences, 3/5 rotation honors, published research. Trying to figure out my best options given my situation. I hope I can get into one of the big state schools but if not I am wondering what my next best option would be.

 

[the argus]

I have decent stats but I am SGU IMG. 255/253 on steps, 90% avg basic sciences, 3/5 rotation honors, published research. Trying to figure out my best options given my situation. I hope I can get into one of the big state schools but if not I am wondering what my next best option would be.

Your best option is to apply extremely broadly (like >150 programs). Go through the match lists from SGU/Ross/AUC over the past 3 years and apply to every IM program on those lists. With those stats you will get plenty of interviews. After that if you're sure you want cards, rank the programs high, university or community, that have cards fellowships. Prioritize (established) university programs over community programs.

Don't let the nonsense you read on SDN freak you out. You will be fine assuming you have decent LORs and don't write a terrible personal statement.

 

[235009]

Thank you very much for the response. It seems as though established university programs are the way to go. I definitely noticed the theme you mentioned about the "established culture" for the student / resident. From my experience doing a rotation at one of evolving programs I definitely noticed the residents were babied by the attendings and didn't have too much autonomy.

My motivation is to get the best education / best chance for cards. I don't really care where. I just was trying to figure out what that is. To me it seemed as though a more intimate program that was evolving fellowships really wanted their residents to grow with them. A trend I find at many large programs is that few fellows actually stay at the school.

My other dilemma was comparing lower tier university programs to well established community non university programs. For example St. Lukes Roosevelt Mt. Sinai in NYC (solid community non university program) vs something like florida atlantic university / SUNY downstate.

SUNY downstate's IM program is a sick joke. I would recommend SLR over it without question.


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[smartparts]

whats funny is that larger community programs sometimes have powerhouse departments. as such, the local university programs send their residents there to rotate in some specialties. the community program residents struggle to match in said specialty but the university program residents match easily even though everything they learned about the specialty they learned at the community program. in practice it wont matter but for fellowship, reputation makes a big difference.

 

[IMreshopeful]

whats funny is that larger community programs sometimes have powerhouse departments. as such, the local university programs send their residents there to rotate in some specialties. the community program residents struggle to match in said specialty but the university program residents match easily even though everything they learned about the specialty they learned at the community program. in practice it wont matter but for fellowship, reputation makes a big difference.

The assumption made - rightly or wrongly - is that an applicant at the university program is higher performing at baseline because they matched at that program. Also frankly most fellowships are made to encourage growth of their own academia so they will often try to find people who are of that mind.

 

[Mikkus]

Matching to a small IM program in no way helps you land a better fellowship. The university programs have access to the grant money for research, and that reason alone should be enough to try for a university program. Having a small number of fellow residence would be a hindrance, less people to discuss cases with, meaning you wont get to learn from your peers.

Having just been through the IM match with similar SGU stats to you I would say to apply broadly and go on as many interviews as you can. Once you see the difference in a community program vs a university you will understand. My match list top 6 out of 16 was university programs, 7-16 were established "community" programs or decent university affiliated.
I interviewed at a few brand new places, and although they were very nice and had only a small % of IMG's, I put them last. They seemed disorganized, new, and kept changing their program. They didn't have a chief who knew what they were doing, didn't have a call schedule that worked, and didn't have the fellowship contacts that come from years and years of placing fellows.

 

[shouldigomd]

Thanks for the responses guys! definitely looking into university programs. I am doing a rotation in a decent community / small / evolving program now and I have discovered the research roadblocks mentioned here.