Importance of Regional Reputation

[CyberMaxx]

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So I've been going through match lists recently (I know its a waste of time 😉) and I've noticed that schools often send their graduates to the same institutions for residency. These institutions are generally in the same city and region as the medical school. For example, one school that I was looking at sends 30-40% of their students to the same 5 institutions each year!

While I assume that this trend is largely due to students wanting to stay in the same area, can it also be explained by the relationship which develops between programs in the same region? Will medical students generally get more traction at local residency programs (or programs which annually accept many students from their school) versus programs across the country? Further, if this is the case should medical school applicants consider this when choosing between medical schools?

 

[thefritz]

Yes, if you are sure you want to do your residency in a certain area, it makes sense to go to medical school in that region. Residency applicants tend to end up around their medical school or around another geographic area they have a connection to (their hometown, where they went to college, where their family lives, where their wife/kids live, etc). Residency programs are more likely to interview and rank you highly if they know they are located in a place you want to be and will be happy. They do not want to match a resident from the opposite coast who has never left her home state and whose whole family lives there and will be a risk for quitting halfway through to move back.

 

[BurberryDoc]

Yes, if you are sure you want to do your residency in a certain area, it makes sense to go to medical school in that region. Residency applicants tend to end up around their medical school or around another geographic area they have a connection to (their hometown, where they went to college, where their family lives, where their wife/kids live, etc). Residency programs are more likely to interview and rank you highly if they know they are located in a place you want to be and will be happy. They do not want to match a resident from the opposite coast who has never left her home state and whose whole family lives there and will be a risk for quitting halfway through to move back.

I seriously doubt this. In theory it makes sense, but you can look at match lists and see tremendous variation/geographic spread in the match - even for state schools that are likely to not have this same geographic representation in their medical school class.

 

[CarlosDanger]

Are you looking at a state school's match list? It seems to me like state schools tend to retain a lot more of their grads in the nearby area because those students are more likely to want to stay close by. Private school students are much more likely to come from all over, so they will either return to their home state for residency (which could be anywhere) or will be more willing to travel somewhere new.

I think having a desirable local residency would be a plus for any med student because you'll have an easier time getting rotations there and forming relationships with the program. I guess the only issue is its hard to say at this point where or in what field I want to do residency, so any decisions I make now could easily change.

Still, if you know for sure you want to do a residency at X place, it would make sense (to me) to go to the school in or near X town. Although, I read someone on here a few days ago say that sometimes your nearby program only wants to match a limited number of students from your school, so if the interest at that program outstrips the number of seats available from your school, then I guess it could be an issue.

 

[thefritz]

I seriously doubt this. In theory it makes sense, but you can look at match lists and see tremendous variation/geographic spread in the match - even for state schools that are likely to not have this same geographic representation in their medical school class.

I've posted about this multiple times as this topic has come up a lot recently for some unknown reason. It's a truth nobody wants to hear, but the way it is that residency programs prefer to rank candidates from schools they are familiar with or candidates who have a demonstrated interest in attending their program other than just wanting to match somewhere. I shotgun applied for residency all over the country and what I got back was very unsurprising with maybe one exception. I could have just selected far fewer programs that were closer to me and had almost the same number of interviews without wasting as much money on programs across the country.

Going to school in a certain location opens up residency programs in that location to you. If you do an away rotation in another location and get a LOR, it opens up that program and other nearby programs. You may also get a splattering of random invites from places you applied to on a whim, but these will be few comparatively. Unless you have a 270/270 and 20 pubs, you're not going to have your pick of invites from good schools all over the country. Nearly everybody has decent USMLE scores these days and it's pretty tough to get by just on numbers alone like you can for med school. You need a foot in the door.

 

[BurberryDoc]

I've posted about this multiple times as this topic has come up a lot recently for some unknown reason. It's a truth nobody wants to hear, but the way it is that residency programs prefer to rank candidates from schools they are familiar with or candidates who have a demonstrated interest in attending their program other than just wanting to match somewhere. I shotgun applied for residency all over the country and what I got back was very unsurprising with maybe one exception. I could have just selected far fewer programs that were closer to me and had almost the same number of interviews without wasting as much money on programs across the country.

Going to school in a certain location opens up residency programs in that location to you. If you do an away rotation in another location and get a LOR, it opens up that program and other nearby programs. You may also get a splattering of random invites from places you applied to on a whim, but these will be few comparatively. Unless you have a 270/270 and 20 pubs, you're not going to have your pick of invites from good schools all over the country. Nearly everybody has decent USMLE scores these days and it's pretty tough to get by just on numbers alone like you can for med school. You need a foot in the door.

Well, judging by the match list for my University over the past 3 years, that seems to not be the case. The same applies for a number of friends who are currently interviewing for resi - and hey have okay scores (window of 220-250.)

Can't believe everything you read on the internet ;-)

Edit:
I just reviewed the 2013 match list, line-by-line. 115 graduates out of a total 177 participating in the match placed into programs not in the same state as that which the school is located in (Florida.) In fact, the breakdown is as follows:

31 in Northeast
20 on West coast
42 in the Midwest
21 in "Dixie"
63 in Florida

So while the single region with the most matches is Florida, the majority of applicants still left the state/region for residency.

 

[aspirantmed]

I've posted about this multiple times as this topic has come up a lot recently for some unknown reason. It's a truth nobody wants to hear, but the way it is that residency programs prefer to rank candidates from schools they are familiar with or candidates who have a demonstrated interest in attending their program other than just wanting to match somewhere. I shotgun applied for residency all over the country and what I got back was very unsurprising with maybe one exception. I could have just selected far fewer programs that were closer to me and had almost the same number of interviews without wasting as much money on programs across the country.

Going to school in a certain location opens up residency programs in that location to you. If you do an away rotation in another location and get a LOR, it opens up that program and other nearby programs. You may also get a splattering of random invites from places you applied to on a whim, but these will be few comparatively. Unless you have a 270/270 and 20 pubs, you're not going to have your pick of invites from good schools all over the country. Nearly everybody has decent USMLE scores these days and it's pretty tough to get by just on numbers alone like you can for med school. You need a foot in the door.

What if you go to medical school in a different part of the country than where you are originally from? For example, I'm looking at a Southern medical school, but originally am from the Northeast/Midwest. In that case, do you think residency programs would recognize an interest in returning to that part of the country, or would I be overshadowed by graduates of medical schools in the North?

 

[alpinism]

So I've been going through match lists recently (I know its a waste of time 😉) and I've noticed that schools often send their graduates to the same institutions for residency. These institutions are generally in the same city and region as the medical school. For example, one school that I was looking at sends 30-40% of their students to the same 5 institutions each year!

While I assume that this trend is largely due to students wanting to stay in the same area, can it also be explained by the relationship which develops between programs in the same region? Will medical students generally get more traction at local residency programs (or programs which annually accept many students from their school) versus programs across the country? Further, if this is the case should medical school applicants consider this when choosing between medical schools?

Sure, but its only a small aspect of regional biases. A significant number of M4s are in serious relationships and/or are in the process of starting a family (depending on the class or school it can be as high as 50% of applicants). For these students, their 1st priority is to stay near their significant other as well as their friends and family.

 

[thefritz]

In fact, the breakdown is as follows:

31 in Northeast
20 on West coast
42 in the Midwest
21 in "Dixie"
63 in Florida

So while the single region with the most matches is Florida, the majority of applicants still left the state/region for residency.

For a school located in Florida, this is about what I would expect. Regionally, Florida graduates could reasonably extend to the south and midwest. Therefore 71% obtained a 'regional' match. For the other 29% that went to the west coast or northeast, how many of those had a connection to the area? That is what you're not seeing.

Even if you don't want to stretch it and include the midwest, that's still 50% matching in Florida or neighboring states. That's pretty huge. Assuming half of the other people had a connection to where they matched (I'm just guessing here, who knows what it really is, but I feel this is more than fair), that leaves only 1 out 4 getting a match without a regional connection or personal connection. That's pretty in favor it of what I'm seeing on the trail.

 

[BurberryDoc]

For a school located in Florida, this is about what I would expect. Regionally, Florida graduates could reasonably extend to the south and midwest. Therefore 71% obtained a 'regional' match. For the other 29% that went to the west coast or northeast, how many of those had a connection to the area? That is what you're not seeing.

Even if you don't want to stretch it and include the midwest, that's still 50% matching in Florida or neighboring states. That's pretty huge. Assuming half of the other people had a connection to where they matched (I'm just guessing here, who knows what it really is, but I feel this is more than fair), that leaves only 1 out 4 getting a match without a regional connection or personal connection. That's pretty in favor it of what I'm seeing on the trail.

My definition of midwest in this evaluation: Texas, Oklahoma, Colorado, New Mexico, Arizona, Missouri, Kansas, Nebraska, Iowa, Minnesota, Wisconsin, Illinois, Ohio, Indiana. I would not consider this the same "region" as Florida. I suppose this boils down to how we are delineating regions of the United States.

 

[solitarius]

^ That's a gigantic Midwest.

 

[vc7777]

^ That's a gigantic Midwest.

Big - and sporadic - Michigan must be considered "downtown Canada"?

 

[BurberryDoc]

@thefritz, here is a breakdown of matches/state for the 2013 year at the Florida school I mentioned in my previous post. Breakdown region as per your definitions, and let me know what you find for out-of-region matches. Obviously, the state with the single greatest # of matches is Florida, but for purposes of this evaluation, we are really driving at how limited you are in matching out of region vs. in region.
Arizona 1
California 14
Colorado 2
Delaware 1
Florida 63
Georgia 7
Illinois 7
Iowa 1
Kansas 2
Louisiana 4
Maryland 5
Massachussetts 9
Michigan 5
Minnesota 1
Missouri 2
New Jersey 1
New Mexico 1
New York 11
North Carolina 4
Ohio 6
Oregon 2
Pennsylvania 4
Rhode Island 1
South Carolina 2
Tennessee 3
Texas 16
Utah 1
Washington 1
Washington DC 1

 

[CyberMaxx]

@CarlosDanger no I was looking at a private school.

Yes, if you are sure you want to do your residency in a certain area, it makes sense to go to medical school in that region. Residency applicants tend to end up around their medical school or around another geographic area they have a connection to (their hometown, where they went to college, where their family lives, where their wife/kids live, etc). Residency programs are more likely to interview and rank you highly if they know they are located in a place you want to be and will be happy. They do not want to match a resident from the opposite coast who has never left her home state and whose whole family lives there and will be a risk for quitting halfway through to move back.

Thanks for the insight thefritz! So you would say that regional bias has nothing to do with residency programs developing a positive (or negative) opinion of students from medical schools in their region then? Rather, it is solely due to the program director's confidence in the student's desire to live in their region?

 

[touchpause13]

My definition of midwest in this evaluation: Texas, Oklahoma, Colorado, New Mexico, Arizona, Missouri, Kansas, Nebraska, Iowa, Minnesota, Wisconsin, Illinois, Ohio, Indiana. I would not consider this the same "region" as Florida. I suppose this boils down to how we are delineating regions of the United States.

This is incorrect. Midwest is: MN, IA, ND, SD, IL, MI, OH, IN, KS, MO, WI, and NE.

(As defined by the US census)

 

[BlueLabel]

My definition of midwest in this evaluation: Texas, Oklahoma, Colorado, New Mexico, Arizona, Missouri, Kansas, Nebraska, Iowa, Minnesota, Wisconsin, Illinois, Ohio, Indiana. I would not consider this the same "region" as Florida. I suppose this boils down to how we are delineating regions of the United States.

Texas in the Midwest and not in Dixie?? We seceded!

Silly definition.

 

[BlueLabel]

This is incorrect. Midwest is: MN, IA, ND, SD, IL, MI, OH, IN, KS, MO, WI, and NE.

(As defined by the US census)

Please note the conspicuous absence of TX, as it should be

 

[alpinism]

Its important to understand that residencies also consider connections to the region when extending interview invites (where you grew up, went to undergrad/grad school, or had a job). Private schools like U Miami have a higher number of students from the west coast and the northeast than state schools like UF or USF. Because of this, while there's still a significant regional bias for the southeast, you'll see a more geographically diverse match list.

 

[kittykattat]

This is incorrect. Midwest is: MN, IA, ND, SD, IL, MI, OH, IN, KS, MO, WI, and NE.

(As defined by the US census)

This is correct! (source: Ive been trapped in the midwest my whole life) The idea that Arizona is in the midwest demonstrates a large lack of knowledge of either American geography or the meaning of the word "west" and other relative directions.

On another note, I've never heard of residencies being concerned that residents will quit because they are unhappy with the location... I assume that since there are so many teaching hospitals (a lot more than med schools anyway)(and assuming you arent gunning for a super rare weird specialty), people would only apply to residency positions in locations they could see themselves living in for a while, especially since they dont even have a say over their final match, right? I mean thats what I would do, but if anyone has evidence that this is not the case I would be interested to hear it!

 

[alpinism]

Also I think a more accurate description of US geographical regions (as related to residency applications) would include: West Coast, Rocky Mts, Midwest, Southeast, Mid atlantic, and Northeast.

 

[thefritz]

On another note, I've never heard of residencies being concerned that residents will quit because they are unhappy with the location... I assume that since there are so many teaching hospitals (a lot more than med schools anyway)(and assuming you arent gunning for a super rare weird specialty), people would only apply to residency positions in locations they could see themselves living in for a while, especially since they dont even have a say over their final match, right? I mean thats what I would do, but if anyone has evidence that this is not the case I would be interested to hear it!

For uncompetitive specialties, yes you can usually pick where you want to go and only apply there. For highly competitive specialties with few spots, no. There are fewer and fewer "uncompetitive specialties" these days. It's not just the 'super rare weird specialties' anymore like rad-onc and integrated plastics. Even internal medicine is very competitive this year. It is common for people to do what I did and apply to >100 programs.
Don't think that you can just waltz into an undesirable location with better than average numbers and they'll bow down to you because somebody like you is willing to come there.

 

[thefritz]

@thefritz, here is a breakdown of matches/state for the 2013 year at the Florida school I mentioned in my previous post. Breakdown region as per your definitions, and let me know what you find for out-of-region matches. Obviously, the state with the single greatest # of matches is Florida, but for purposes of this evaluation, we are really driving at how limited you are in matching out of region vs. in region.

OK, sure. If we square the country up with the same 4 regions:

Arizona 1 WEST
California 14 WEST
Colorado 2 WEST
Delaware 1 NE
Florida 63 SOUTH
Georgia 7 SOUTH
Illinois 7 MIDWEST
Iowa 1 MIDWEST
Kansas 2 MIDWEST
Louisiana 4 SOUTH
Maryland 5 NE
Massachussetts 9 NE
Michigan 5 MIDWEST
Minnesota 1 MIDWEST
Missouri 2 MIDWEST
New Jersey 1 NE
New Mexico 1 WEST
New York 11 NE
North Carolina 4 SOUTH
Ohio 6 MIDWEST
Oregon 2 WEST
Pennsylvania 4 NE
Rhode Island 1 NE
South Carolina 2 SOUTH
Tennessee 3 SOUTH
Texas 16 SOUTH
Utah 1 WEST
Washington 1 WEST
Washington DC 1 NE

22 west
33 northeast
99 south
24 midwest

Still looks very regional.

 

[thefritz]

@CarlosDanger no I was looking at a private school.



Thanks for the insight thefritz! So you would say that regional bias has nothing to do with residency programs developing a positive (or negative) opinion of students from medical schools in their region then? Rather, it is solely due to the program director's confidence in the student's desire to live in their region?

No, quite the opposite. Programs perfer to bring in candidates from schools they are already familiar with and have a track record of providing successful residents.

 

[lobo.solo]

For uncompetitive specialties, yes you can usually pick where you want to go and only apply there. For highly competitive specialties with few spots, no. There are fewer and fewer "uncompetitive specialties" these days. It's not just the 'super rare weird specialties' anymore like rad-onc and integrated plastics. Even internal medicine is very competitive this year. It is common for people to do what I did and apply to >100 programs.
Don't think that you can just waltz into an undesirable location with better than average numbers and they'll bow down to you because somebody like you is willing to come there.

100+ programs? That sounds like a lot. What specialty?

 

[boboyahoo]

I'm a premed but our institute's med school has a wide network throughout the state that allows students to do several away rotations to some very popular cities besides our own. Most students match in our state usually because they have several options to choose from given the location of away rotations they had. Either way, even if they didn't do an away rotation, the name of the school gets them through the door. Those that want to leave usually are out of state students, have family extensions, or have research extensions. I don't think there is a problem with matching into OOS programs, it's just that you might have to set your expectations lower since you are less sure of matching in there. Compared to regional, you might have more surety. If your med school is an ivy or in top 20, going out of state would be easier since the scope of recognition might expand throughout the country and even up to Canada. These schools might be more known to admit OOS students and not have a quota system for IS. Either that or their own state is thoroughly competitive in residency matching. Also just to add to the authenticity of what has been said, when a person wants a very desired specialty the first thing they'll pray for is to get matched at their med school institute or any away program hospitals they went to. By then, it's not the location, it's really the fact that will you match or not. If you survived 4 years in med school, you'll survive the next years in residency since you really don't get out that much anyways during that phase. Family-wise it might be an issue but something could be figured out later. This is coming from 2 med students I know personally.

 

[BurberryDoc]

I think this sentiment is being conveyed in a way that purports location plays a much greater role than it actually does.

Deans Letter, Letters of Recommendation, USMLE Scores, Grades, Honors, AOA - all of this is weighted much more significantly then your origin, and with much greater priority.

I, as most reasonable individuals would, suspect that if you have proven your worth in knowledge through your scores and your abilities on wards through your LoR, and you have demonstrated that your goals align with what the residency program is looking for - be it clinical/translational research at an academic program or outreach and free clinic work in a more community-oriented program, you will more than likely be considered seriously for an interview, regardless of your origin/connections to an area (or lackthereof). Bottom line.

If you are graduating with your MD from a top 40 or so program, and you are in at least the upper half of your class ranking, it would be nothing short of a departure from reason to say "Well, this student is from Kansas, went to University of South Florida for college, University of California Davis for Medical Schoole, but I have no reason to believe they would be happy and want to remain in our pediatrics program at Childrens Hospital of Philadelphia, having never lived in the Northeastern United States. I mean, yeah, they have a 249 step I score and they have earned AOA and have a number of publications in the area of childhood obesity, but I don't see any merit in considering this person for our program"

Please let me know what planet this makes sense on.

 

[Doodledog]

One of the great things about SDN is that there are lots of different perspectives expressed, often reflecting the experiences of the individuals posting more than generalizable advice. In this case, I have no doubt that there are some programs in some parts of the country that are more comfortable with interviewing people from nearby states. However, I do not think this should predominate over other aspects of picking a medical school. I am certain that our program sees it quite differently - we want to interview people from throughout the country and have no concerns about whether they will stay just because they moved to another part of the country. In spending a few decades talking to folks at interviews and during residency, I've learned that lots of young folks are interested in spending residency trying out a new part of the country. They may or may not stay for fellowship, etc, often depending on their personal relationships. However, it would not occur to OUR program to bias against people from outside our region and I am unconvinced that this should play an important role in choosing a med school for the vast majority of applicants.