Lets play the rank game

[skramer3786]

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[HmanPath]

Well, this seems like the thread to ask my question on. I am having trouble deciding between Wash U and University of Washington. I liked both programs, and they both seem high in quality. However, any advice between the two? I might infer from the discussion that Wash U with a bigger name might be a smarter bet, but any advice would be much appreciated. Thanks.

 

[Apoplexy__]

Kirbymiester, you CAN go wrong if you don't use your brain, and won't talk to pathologists regarding issues that are considered valuable in education. For starters, you can download the article "Informed evaluation of pathology residency programs" of the pubmed. It is somewhat old, but many points are still relevant.

Thanks for the article, that definitely helps.

I'm assuming I'm going to use my brain, and make the most out of my residency experience. I'm assuming your point was that, like they always say about rotations, you get out what you put in. However, I'm talking strictly about the on-paper appearance for a hiring committee at some post-residency institution. If hiring committee's theoretically "scored" you on your application, would a name-brand residency program score you "maximum points", or are there possibly other residencies that hiring committee's would prefer over name brands?

 

[Lala79]

Kirbymiester, what gets you a job is
a) references from people the "hiring commettee" knows and respects b) your skills +passing boards c) your personality

If that is in place, THEN a reputable program is a reassuring factor. Someone posted on this thread earlier that bigger programs give you a better networking system and connections, but won't land you a job just by itself. This might change in the future, but for now connections and networking play a huge role in the "hiring" process. If you are striking to be in academia, than a "brand" name makes your life a lot easier to be accepted for a position.

 

[Apoplexy__]

I understand, I wasn't thinking that getting a job post-residency would be any different than getting a job in the rest of the workforce (regarding multi-factorial determination). All I was concerned about is that choosing name-brand would be NOT the smartest idea for a given specialty, because there could be better residency programs than those name-brands. It sounds like I have nothing to worry about.

a) references from people the "hiring commettee" knows and respects

And there is no "Harward" program).

Also...what? I never made these typos.

 

[Lala79]

haha, that typo is mine. Sorry about that) But there is still no "Harvard" program)

Well, you get to realize when you are making choices that there are many, many, many factors that are important. For me, personally, the team I will work with is essentual. I do not think that people for the most part would agree there is anything "better" academically than Hopkins/MGH/BWH, UCSF, ect but are they better for you? Let's say, you have a family, can you really afford being at work till 11 pm and coming to work at 5 am? Do you have though skin to deal with less than pleasant people that might be there?. Also, geography plays a role for many people, e.g are you willing to live in a city you hate for 4 years for a "name"? Oh, and professional interests. Derm is a pretty competetive fellowship, so if you know you want to do derm, it would be "better" to choose a program with derm fellowship at home. And the list goes on). So it is far more complicated than just choosing a name.

 

[gbwillner]

Lala is clearly talking about the Clinic.

The positive impressions I had from CC were from an attending prospective, not resident, BTW.

 

[gbwillner]

Well, this seems like the thread to ask my question on. I am having trouble deciding between Wash U and University of Washington. I liked both programs, and they both seem high in quality. However, any advice between the two? I might infer from the discussion that Wash U with a bigger name might be a smarter bet, but any advice would be much appreciated. Thanks.

There are obviously a lot of things to consider and both are top-tier programs. I looked at both when applying and went back for a second look at one. I think your thinking so far on this is good. PM me if you want more details.

 

[gbwillner]

Thanks for the article, that definitely helps.

I'm assuming I'm going to use my brain, and make the most out of my residency experience. I'm assuming your point was that, like they always say about rotations, you get out what you put in. However, I'm talking strictly about the on-paper appearance for a hiring committee at some post-residency institution. If hiring committee's theoretically "scored" you on your application, would a name-brand residency program score you "maximum points", or are there possibly other residencies that hiring committee's would prefer over name brands?

Bottom line: Are big name programs going to help you land a job? ABSOLUTELY. We keep reading about how there are 100x applications for each position... which applications do you think get picked up first? Who gets the interview? Of course there are situations where you are already local and already brown-nosing the staff at the local place so they know you well... but if they don't, who's word are they going to take on your performance, some schlub or world expert guy? Seriously, I can't believe some of the advice here sometimes. Path is a small market- are you going to wager on finding a local job in path? If so, you are setting yourself up to fail.

Most applicants are going to come off fairly similar on paper. One easy way to distinguish them is their training programs. Yes, for any local place the regional programs will have some clout and regional powerhouses will have even more clout. Hell, even where you grew up will have "clout". But some places have clout all over the country. And BTW, we are assuming private jobs here- if you are considering academia the influence of your program just shot up 100x. Yes, I get not everyone is super gunner and wants to be all that- that they are happy with a "job" "somewhere". And the decision on your program should weigh a lot of factors. But if the question is "will it help me get a job?" the answer is YES, otherwise some of these programs (especially Hopkins) wouldn't even exist.

Yes, at the end of the day if you are a douchebag no one will hire you. Yes, if you suck at pathology and have horrible recommendations no one will hire you (unless they don't realize you suck until it's too late- then they will STILL hire you). That happens regardless of where you train. But guess what- top programs are the most selective, meaning their trainees tend to be smarter and better anyway, and also less douch-baggy since that is a selection criteria for every step of the way in life. They have the best training opportunities and give you the best instruction. If someone has an inferiority complex because they didn't train at a top place and won't hire you because you trained at MGH... I can't really finish this thought because I don't believe it happens.

From my experience there are no downsides to training at a top place. If you can't "stand" to live in a city for 4 years you probably should reconsider your priorities. I get that you can't "afford" to live someplace... but just because you don't like it? You are there to learn and work. And there should be a lot of both.

/sorry about the rant

 

[Substance]

Bottom line: Are big name programs going to help you land a job? ABSOLUTELY. We keep reading about how there are 100x applications for each position... which applications do you think get picked up first? Who gets the interview? Of course there are situations where you are already local and already brown-nosing the staff at the local place so they know you well... but if they don't, who's word are they going to take on your performance, some schlub or world expert guy? Seriously, I can't believe some of the advice here sometimes. Path is a small market- are you going to wager on finding a local job in path? If so, you are setting yourself up to fail.

Most applicants are going to come off fairly similar on paper. One easy way to distinguish them is their training programs. Yes, for any local place the regional programs will have some clout and regional powerhouses will have even more clout. Hell, even where you grew up will have "clout". But some places have clout all over the country. And BTW, we are assuming private jobs here- if you are considering academia the influence of your program just shot up 100x. Yes, I get not everyone is super gunner and wants to be all that- that they are happy with a "job" "somewhere". And the decision on your program should weigh a lot of factors. But if the question is "will it help me get a job?" the answer is YES, otherwise some of these programs (especially Hopkins) wouldn't even exist.

Yes, at the end of the day if you are a douchebag no one will hire you. Yes, if you suck at pathology and have horrible recommendations no one will hire you (unless they don't realize you suck until it's too late- then they will STILL hire you). That happens regardless of where you train. But guess what- top programs are the most selective, meaning their trainees tend to be smarter and better anyway, and also less douch-baggy since that is a selection criteria for every step of the way in life. They have the best training opportunities and give you the best instruction. If someone has an inferiority complex because they didn't train at a top place and won't hire you because you trained at MGH... I can't really finish this thought because I don't believe it happens.

From my experience there are no downsides to training at a top place. If you can't "stand" to live in a city for 4 years you probably should reconsider your priorities. I get that you can't "afford" to live someplace... but just because you don't like it? You are there to learn and work. And there should be a lot of both.

/sorry about the rant

Everything you are saying is correct. This is a very interesting discussion that offshoots from the usual polemics about the poor job market. I foresee pathology applicants will be split into two categories - those that apply to only the big names as if they are the only programs that exist (which is sort of true with the glut), and everyone else. The former probably won't have any of these job-finding difficulties, while the latter will.

 

[Lala79]

Gbwillner, I did not mean to sound like geographic location should take a priority for program choices. What I mean, is when people choose between Wash U and U Wash, as someone from the post above, the location of the program can be considered in the decision making process. Why not? We are only human, and our overall confort and happiness affect our productivity. Also, geography is particularly important for people who also deal with small children, or a relocating spouse.

Right now my friend is ranking UF higher than Hopkins (for a different speciality though). Obviously, I questioned his choices, and he told me that he has a family to raise and he his kids will always come first. Assuming that only "top notch" programs will be popular is maximalistic in my vision, and people will continue going to all sorts of programs for various reasons. As for the job market...well. I think that people who deliberately choose to be in a small program do not want a "big job", and thus the job that MGH gradute is looking for would be quite different than someone from U of Florida. To put everyone in one pot is so generalistic so that I do not know even where to begin.

 

[2121115]

As a rule, yes, coming from a name brand program helps in the job search process. However, there are exceptions to the rule.

Also, look around at quality state schools - their residents get jobs. Do Hopkins' residents get better jobs? I suppose it depends on what you mean by better.

Overall, I can tell you this unequivocally - if you are planning to live in an urban metro area (i.e. northeastern megaopolis DC through Boston, Los Angeles, Chicagoland, etc), the competition is SO tough for new grads that you had better have a name brand training program in addition to other qualifications. However, (and to my point earlier) not everyone wants to live there, so it may not matter to them - to each her/his own. But if you grew up northeastern liberal elite private school and living long term in Alabama or Iowa seems unacceptable to you, better rank that name brand program and don't look back. Just saying.

 

[gbwillner]

Gbwillner, I did not mean to sound like geographic location should take a priority for program choices. What I mean, is when people choose between Wash U and U Wash, as someone from the post above, the location of the program can be considered in the decision making process. Why not? We are only human, and our overall confort and happiness affect our productivity. Also, geography is particularly important for people who also deal with small children, or a relocating spouse.

Right now my friend is ranking UF higher than Hopkins (for a different speciality though). Obviously, I questioned his choices, and he told me that he has a family to raise and he his kids will always come first. Assuming that only "top notch" programs will be popular is maximalistic in my vision, and people will continue going to all sorts of programs for various reasons. As for the job market...well. I think that people who deliberately choose to be in a small program do not want a "big job", and thus the job that MGH gradute is looking for would be quite different than someone from U of Florida. To put everyone in one pot is so generalistic so that I do not know even where to begin.

I don't disagree with your point- as I mention deciding on a program depends on a lot of factors, not just which program is better at training you or better for your career. I have kids and would have a hard time moving to NYC or anywhere near Hopkins. Those are valid concerns. My issue was with being in a temporary position and picking a place that will not be as good for your career for the personal taste of the city. This has been stated several times by several posters. Re: your point about different types of applicants... yes, I agree. But the guy from MGH has his chance at most jobs most places. The "lesser" applicant will have limited opportunities to begin with, and more likelyhood of difficulties in this market and being exploited.

 

[Euchromatin]

Completely agree. After having rotated at both big name places as well as smaller programs, I have to say that although residents may be busier at the big programs, the quality of teaching is also much better. You learn so much more sitting with an expert in the field who can explain not only the basic histology but clinical relevance and most up-to-date research on the entity. It's pretty cool to see how efficient they are while not compromising the quality of teaching, just because they're that good. It's actually more often the case at smaller programs where I saw attendings not expect much input from residents and not offer much of an indepth explanation or wasting a lot of time mulling over clinically irrelevant details about cases. I think a lot of it is personal preference, but that's why I'm wary of going to a more "laidback" program at the expense of better teaching quality and a more exciting learning environment.

I have also rotated at both "big name" and "smaller" programs (I mean smaller to refer to places with fewer residents and less academic prestige, not necessarily less specimen volume) and I disagree. I suspect this depends a lot on which specific programs you happen to have visited - I'm sure there are places with great training (and not-so-great training) in each category. I also agree with several other posters who have emphasized that the structure of surgical pathology rotations (i.e. how many specimens you, personally, get to see; preview time; responsibility given to you as a resident; amount of scut vs. educational grossing, etc.) is more important than the overall volume of specimens. However, I will say that places with higher overall volumes (and variety of cases) are more likely to have multiple examples rare entities in their files, which, even if they don't specifically come across your desk, you can pull for research projects, presentations, studying, etc.

In my experience, attending staff at programs with general surgical pathology signout are great teachers and provide excellent training. In fact, I have heard from several fellowship directors (at the huge, very sub-specialized "big name" academic centers) that they prefer to take residents from smaller programs with general sign out instead of their own residents because they are more efficient/competent and have better overall surg path training. I think some of the benefits of smaller, less academic programs include
1) attendings are not under as much "publish or perish" and/or internal political/promotion pressure, and tend to be more approachable/easy going; you aren't going to learn as much from someone if you are afraid to ask them questions or if they are so busy that they don't have time to spend with you
2) general sign out system has many benefits (although I understand people have different learning styles/preferences)
- get to see how a variety of different attendings (with and without fellowship/special experience in a particular area) approach cases from different organ systems, so you can really appreciate what findings/diagnoses are more/less objective, see lots of different styles of dictation/report writing, etc. [note that you would only be previewing/dictating for/signing out ONE attending's case load on any particular day - any program that wastes your time making you track down multiple attendings in one day to sign out different types of cases would be a huge red flag for me]
- get to see multiple organ systems every day, so you get more regular repetition/reinforcement, as opposed to a few weeks/months of one organ system which you may never see again in training
- get very efficient at handling large numbers of cases from multiple organ systems, which is how most non-academic practices are run

 

[Pollux]

Just wanted to offer my personal experience/perspective, coming from a medium-sized residency program.

I interviewed at quite a few of the so called "brand name" programs, and in the end matched at my current program because of my visa requirement (H1B, for those of you who know/care about it). I'm now in my final year of AP/CP combined program.

I am very happy about the training at my program, and would choose it again without a doubt. I think many people have said that residency is what you make of it, and I think that is definitely the case for me. I'm a self-professed bookaholic/slideholic, and I need sufficient time to read up on cases and look at slides/study sets at my own leisure. I feel that the workload here is optimal for me. We don't sign out past 6pm, and we definitely don't have to gross until the wee hours of the night. Scutwork is minimized, as we have two PAs for 30,000+ specimens/yr, so the residents would only need to gross the big cases once every 3-4 days when on surgical pathology rotations, and we're usually done grossing by 5pm.

One of the best things that I love about my program is that we have a daily department-wide consensus conference, where attendings bring diagnostically challenging or educational cases that come across their desk that day. Therefore, residents get exposed to cases outside of the subspecialty rotation that they are on. Our department chair holds the conference, and he is an amazingly well-rounded surgical pathologist. He uses the conference as an opportunity to teach residents at the scope using the cases shown, or he would show us some of the interesting consult cases that he received. It is also a venue where we go over one of the many national or international slide seminars in which he participates: CTTR, AMR slide seminar, Kansas slide club, APSEP, etc. It's simply an amazing experience that residents get to interact with him on a daily basis, learning from his expertise.

I have to admit that I did not take full advantage of the resources here until this year, when I finally have the knowledge and motivation to tackle some of the challenging slide seminars/personal slide collections that belong to my dept chair. This is what I felt that really propelled my diagnostic competence and confidence in surgical pathology. I try to go over 30-50 of these slides a day, and I try to read up on the entities that I have not previously encountered. Most of these cases are relatively uncommon entities, with the occasional rare entities that would normally show up once in a blue moon. For example, this week alone, some of the more memorable cases that I came across included phakomatous choristoma, biphasic pulmonary blastoma, dysplastic cerebellar gangliocytoma, neuroblastoma-associated renal cell carcinoma, and fetal lung interstitial tumor. I feel that this experience is more valuable than seeing 100+ run of the mill cases every day.

I also feel very prepared for the AP/CP board exam, as I have had sufficient time to hit the books from first year on rather than being inundated with excessive service work. For lack of a more objective measurement, I'm going to use the controversial *gasp* RISE score as an example. I scored above the 99th percentile for my PGY year for the last three years in a row, and my performance in first year (overall score 550) and second year (overall score 624) was better than 75% and 99% of PGY4s, respectively. Our RISE exams are proctored.

I'm not saying that big names don't matter, because let's face it, people in medicine like pedigrees and prestige. The name recognition is going to help someone find a job, assuming everything else being equal. I am also going to a big name institution for fellowship training this coming July in order to get more exposure at a high-volume place and make connections for my future career. I'm just putting my experience out there to support the notion that residency is what you make of it. You can have excellent training coming from a small/medium-sized residency program. It's definitely doable.

 

[Ruination]

Lala79 - I have just some rambling, general thoughts on program selection.

Some background, I did my residency and fellowship training at (2) separate large "high-powered" academic institutions in the same geographic region. I interviewed at both community and academic jobs last year, and ended up taking a position at a medium-sized academic program that is >500 miles from where I did my fellowship/residency training.

Geography/connections:
The private groups that I was fortunate enough to get my foot in the door and interview at had strong connections to my residency/fellowship programs either because 1) they were graduates of the program or 2) because they routinely sent consults to the faculty at the program. In both cases, faculty were told about job openings that were never nationally or locally advertised, etc., and faculty then let the soon-to-be graduating folks know about the opportunities. Its really interesting that although my residency and fellowship training programs were relatively close to each other, some groups were comprised of folks who almost entirely trained at one program or another. I also saw residents from other parts of the country from "big name" places doing fellowships at my program because they were trying to make local connections for private practice jobs. Usually their impetus for doing this was spouse/family-driven and in some cases they wanted to practice/live in a geographic area for other personal reasons. With respect to the academic jobs, the faculty that I did my fellowship training with were well-known and well-respected in their field and helped me make connections to get interviews for jobs that I thought looked desirable. Even despite this, some academic places wanted to make sure that I was willing to relocate to their geographic area regardless of how well respected (or not!) my recommendations and training were.

Big, medium or small programs:
For better or for worse, I admit that when I was choosing programs to interview and rank I think had a bias by going to a "big name" program, partly because I wanted the "name" on my CV and partly because I didn't know if I wanted to have an academic career or go into community practice. Now that I have been practicing in a medium sized academic program I can make some direct comparisons to what it was like training at a larger "high" powered place. In general, I think you can succeed in both instances. If you desire an academic career, probably going to a larger program is without a doubt helpful. If you are interested in a specific geographic region that you want to live/practice then maybe its less important than trianing at a nearby place. If you train a medium sized place that 1) has an active surgery department (transplant, oncologic, general), 2) has medical oncology and radiation oncology, and 3) pediatrics you will probably see enough cases (including rare tumors) to be well-trained. One thing that I have noticed being at a smaller program is that personal subspeciality consultations from community pathologists are fewer in number. I think that this is a vital component for subspecialty fellowship training; as a resident it didn't impact my training much, if it all. Teaching is comparable, although at some larger places, you might see more junior faculty signing out on a daily basis, with the world-renowned subspecialists having more time dedicated to research efforts, administrative endeavors, or their own personal consult services. My current institution and residency/fellowship institutions had equivalent resident didactic lectures and microscope sessions. Bigger programs in general will have more research opportunities and material to draw from; obviously this is more important for someone looking at an academic career. Preview time is important and I would not rank a program that doesn't give you designated time to look at cases on your own (usually the day before your signout on a 3-day cyle or the morning before your signout if you are grossing/previewing/signing out every day).

Where do the trainees go?
I think this is critical when thinking about what a successful program is, the end point being training competent pathologists and putting them into jobs that they want. It also gives you an idea of potential networking possibilities. Although I was at a "research"-oriented residency program, more than 50% of the graduating residents went into community practice, which you would never know about given my program's reputation. This can be important when you start looking for a job.


Overall
Pick a medium to large size program that will give you good case variety/exposure (usually reflective of the expertise of other departments in the hospital), in a place where you want to live, and that has a track record of placing residents/fellows into jobs/subspecialty fellowships that you think you might like to have yourself.

Feel free to PM me with any specific questions. Good luck in the match!

 

[yaah]

In Internal Medicine, you can pretty much skate by in residency and still have a relatively good paying job as a generalist (i.e. hospitalist) or specialist. In Pathology, this is not the case. If you're "skating by" in Pathology residency, then there's a high chance you may not have a job or may not get a fellowship.

And yet still be compensated less than the pathologists on staff at the same hospital you're at. I would disagree with that last point. There is not a "high chance" you won't get a job or fellowship. There is a chance I suppose, although I still don't really know many people who do truly fail in the end. I would say there is more of a chance you won't be able to get a job you really want, however, and you might have to settle or move around a lot.

More people are likely to bail on residency before they get to that point because they realize it isn't for them.

Thrombus is right though that there are definitely programs that are not that good and will not give you any real advantages coming out.

 

[DermViser]

And yet still be compensated less than the pathologists on staff at the same hospital you're at. I would disagree with that last point. There is not a "high chance" you won't get a job or fellowship. There is a chance I suppose, although I still don't really know many people who do truly fail in the end. I would say there is more of a chance you won't be able to get a job you really want, however, and you might have to settle or move around a lot.

More people are likely to bail on residency before they get to that point because they realize it isn't for them.

Thrombus is right though that there are definitely programs that are not that good and will not give you any real advantages coming out.

Isn't that like that at most hospitals? (i.e. more senior faculty have higher salaries, than junior faculty)

 

[Lala79]

Euchromatin, Pollux - thank you very much for sharing your experiences of training in medium size programs. I recall there was a post recently, where the author emphasized that if you are motivated and self-driven person, then you will be very successful in a medium size program since you will be taking more actions towards your own education and independent study. I remembered this post when I read the Pollux post, who obviously has been more proactive than your "average" resident.

Ruination, I am particularly grateful for your time to write a detailed and thoughful post.

Yaah and everyone else: at this point I am convinced of what programs are going to be on top of my ROL and this thread has been a tremendous help for me in the decision making process. However, I still struggle with the middle part and the bottom. I hear you and Thrombus that some programs would give me no advantage of coming out of. Can we name the names from the given list, which ones would be "smarter" to place in the middle or at the end? Of course, I do my own "research" on programs and do not rely on "internet" ranks fully, yet I want to hear general ideas. By the way, from most candidates I talked to, they have a very similar dilemma.

 

[yaah]

Isn't that like that at most hospitals? (i.e. more senior faculty have higher salaries, than junior faculty)

I was talking about new pathologists vs new hospitalists/IM.

As an aside to the points made above, do programs help you get a job. Well, sort of. I mean, it is extremely unlikely that where you trained is going to end up being the deciding factor into why someone picks you over someone else. I suppose it could theoretically happen, but it's unlikely. Where it has most impact probably is in giving people comfort if they are taking a relative risk that at least they know you have a good training pedigree and other people are also likely to find you to be a good candidate.