Pediatrics/FM Rank List Help

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May 15, 2022
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More a general request for advice on making a rank list with some details on my specific situation.
I have 14 interviews at this point and have only done 2 so far but I kind of wanted to start making a preliminary rank list in my head because I have a family and it's important for us to start planning.

I like pediatrics a lot and do see myself as a pediatrician so that is what I mainly applied (applied to 20, interviewing at 12). On my rural family medicine 4th year clerkship the attending convinced me to do a couple FM apps and wrote me a nice letter. I do like FM, I just am pretty sure that my practice would need peds in it and I also like OB, so this would be more of a rural FM situation ideally and I'm not sure how feasible that is these days anymore. I applied to only 2 FM residencies based on location (one where my husband really wants to move back - his hometown where his brothers, bio dad, grandmother, and other family live and we have friends. the city only has an FM rotation and one in Alaska because we like Alaska :) and I am interviewing at both of those.

So here are my main factors:
WHAT I WANT TO DO: I want good pediatrics training which I feel can be found at most accredited programs. I don't want anything specific apart from that. I also feel I could be happy as an FM doc as long as I have peds in my practice, I do like the other stuff too, just don't want my whole practice to be older folks is all.

MY FAMILY AND CHILDCARE: My parents live in one of the places I'm interviewing and my mother would love to help me take care of my son who will be 1 year old when I graduate med school this May. I plan to have another child during residency probably at the beginning of the second year? Not having daycare costs and having my parents help with childcare would be huge. Either the place or a place which is 1.5 hrs away would facilitate this. My parents don't love the idea of moving to where I am doing residency if I do it somewhere else - even though they are retired, they are settled and happy in their location and don't want to "chase me around" which is understandable. So prioritizing this has me ranking those 2 programs first of course.

HUSBAND'S FAMILY: The FM program in my husband's hometown where 2 of his brothers, his best friends, some of my friends, his grandmother all live. We do like this town a lot - I'm not naming it bc it's small and I don't want to be identifiable from this lol. It's a program with rural focus, OB, etc. This is actually the town my husband and I have agreed we probably want to live after residency. I would I believe rather be a pediatrician here than an FM doc eventually but I can also see myself being an FM doc in a smaller town in the area so I can have more peds in my practice. I do worry if I rank this first I may always harbor a bit of resentment though? Like a "well I really wanted to be a pediatrician but I picked this because you wanted to be near your family". Also the childcare is not quite as cut and dried as being near my parents because his grandmother is over 90 and his mom and stepdad live 5 hrs away.

ADVENTURE/SOMETHING NEW: I have an FM interview in Alaska and Peds interviews in Seattle, a Seattle/Alaska hybrid program where you spend 4 months of every year in Alaska, Salt Lake City, Idaho, and Florida. These are exciting to me. It would be cool to live somewhere different for 3 years and I'm enthused about the quality of Seattle Children's and Utah as well. If I ranked these first I may not get them due to them being competitive but I am a good candidate and I feel like living in these places would be fun. Downside- no free childcare and not near family.

So how do I approach the rank list? The options near my parents first, followed by "Adventure"? Adventure first, followed by options near my parents? Husband's favorite that I would probably not hate first to be near his family?

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So let's get the easy part out of the way--if you want to be a pediatrician, then you should rank all of those first and FM last. You can definitely take care of kids as an FM doc, but it will almost certainly be the minority of your practice. If you and your husband really, really want to get back to his rural hometown, I assure you that you'll find a pediatrician gig waiting for you there after you finish residency. Don't make a decision that you will regret for 30 years just so you can get there 3 years faster.

As someone who had 3 kids during fellowship, I would then prioritize childcare all the way. Adventure sounds fun, but it really just sucks when you realize you have no idea what to do with your kid who can't go to daycare with their 3rd ear infection in 4 weeks or your nanny gets sick. This is my personal advice so I wouldn't fault you for feeling differently, but the mental weight of knowing that your childcare absolutely positively cannot fail is substantial.
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Disclaimer: I don't have kids.

That said, I agree with GoSpursGo. While the rural program at Seattle Children's sounds awesome, keep in mind that you'll also be away from home--and your child(ren)/husband--for 4 months out of the year. So your husband would be the sole caregiver during this time, particularly since your family don't seem to want to move to help out (which is fine). Seattle, while great, also has a very high cost of living (I was just there a few weeks ago and gas was >$5/gallon, compared to ~$3.50 at home in the midwest), which would make childcare even more difficult/expensive during this time. So I would also recommend prioritizing where you can get help with your childcare, particularly if your husband does not have a particularly flexible job (one of my co-fellows' husband traveled quite a bit prior to COVID, so figuring out who was going to take care of the children when she was on service was a fun challenge).

And not that you asked, but if you end up in a peds program, make sure you go into it with the mentality that you won't have specialists around 24/7 to help out. That can help guide how you approach rotations (really figuring out what you can and cannot treat at 'home' vs sending to the big tertiary care center a few hours away).
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