Program selection process. smaller community programs vs. larger centers

[average]

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My wife and I have started looking at where we would like to apply for pathology residencies. We have looked all over the country but have been excluding programs that do not have an array of fellowships available also. This has not only narrowed our choices but eliminated many of the smaller communities. That said, we would very much prefer to be in a smaller community, <100,000 people.

Is my method wise or should I really be considering these other programs also? I simply want to become a community pathologist but am afraid that these smaller programs will limit my "sellability" when I enter the market. How do you think I should approach this problem? Is the above "sellability" issue true or is this an irrational fear? Thankyou for any feedback.

 

[dermpathlover]

My wife and I have started looking at where we would like to apply for pathology residencies. We have looked all over the country but have been excluding programs that do not have an array of fellowships available also. This has not only narrowed our choices but eliminated many of the smaller communities. That said, we would very much prefer to be in a smaller community, <100,000 people.

Is my method wise or should I really be considering these other programs also? I simply want to become a community pathologist but am afraid that these smaller programs will limit my "sellability" when I enter the market. How do you think I should approach this problem? Is the above "sellability" issue true or is this an irrational fear? Thankyou for any feedback.

I would only apply to huge programs in huge cities that have a huge array of fellowships, especially derm path. It is only for 4-6 years, then after that you can move to the sticks and rake in a fortune doing path.

 

[yaah]

My wife and I have started looking at where we would like to apply for pathology residencies. We have looked all over the country but have been excluding programs that do not have an array of fellowships available also. This has not only narrowed our choices but eliminated many of the smaller communities. That said, we would very much prefer to be in a smaller community, <100,000 people.

Is my method wise or should I really be considering these other programs also? I simply want to become a community pathologist but am afraid that these smaller programs will limit my "sellability" when I enter the market. How do you think I should approach this problem? Is the above "sellability" issue true or is this an irrational fear? Thankyou for any feedback.

Where do you want to practice? Small programs can actually be beneficial if your goal is to practice in that area, as other facilities in the area will know the program well (and hopefully respect it!). It makes it easier to find out about jobs, network, and perhaps see for yourself what these practices are like. In general, if you are a good resident you shouldn't have trouble. But if you train at a small community program in the southeast and then try to get a private job in the northwest, that will raise more questions than if you trained at a large program.

Do you even want to do a fellowship? Or are you paying too much attention to a few people who say you HAVE TO? People get jobs without fellowships, or with just surg path.

And to be truthful, if you are a good resident and communicate well it shouldn't be trouble to get a fellowship at a larger place. It might be tough to get a really competitive one.

I would only apply to huge programs in huge cities that have a huge array of fellowships, especially derm path. It is only for 4-6 years, then after that you can move to the sticks and rake in a fortune doing path.

Do you even know what you are talking about or are you just regurgitating hearsay? Not everyone has the same career goals, and not every path to residency is equivalent for these goals. You have to pick the program where you are comfortable and will succeed.

 

[average]

Where do you want to practice?

1. I can see myself practicing in a smaller town (50-150k).

2. I currently live in the midwest and would like to move elsewhere (SE or SW) for residency with the possibility to moving back to the midwest but likely staying if I can find a nice area.

3. Unlike many of the people on this forum, I have a wife and children. Because of this fact, finding "the best" program is not my primary concern. Don't get me wrong, I would like to find a great program. However, if the choice comes down to living in an area where I don't think my family can thrive vs. going to a less desired program, then I will choose the latter. I'm hoping to find both.

4. Money is not my primary concern. A modest salary with a low stress, diversified environment is all I ask.

 

[yaah]

Unfortunately, being able to judge some of the smaller (community) programs for residency becomes difficult. There are a lot of programs out there that don't do a great job training residents, but it's hard to tell which these are unless you are actually there. I would say your best bet, if possible, is to train at a larger program, affiliated with a university. In general these are "safe" programs that will train you with sufficient volume to make you competent. In addition, there will be enough teaching. But there are probably some larger community programs that serve the same function.

 

[Patholog]

My wife and I have started looking at where we would like to apply for pathology residencies. We have looked all over the country but have been excluding programs that do not have an array of fellowships available also. This has not only narrowed our choices but eliminated many of the smaller communities. That said, we would very much prefer to be in a smaller community, <100,000 people.

Is my method wise or should I really be considering these other programs also? I simply want to become a community pathologist but am afraid that these smaller programs will limit my "sellability" when I enter the market. How do you think I should approach this problem? Is the above "sellability" issue true or is this an irrational fear? Thankyou for any feedback.

Don't forget...sometimes the programs that have a lot of fellows are organized differently than those that do not. For example, my program only has 3 surg path fellows, so every non-consult case is the sole property of the resident or extern (PSF). In other institutions, the fellows run the cases and the resident can be somewhat of a bystander. My advice is to pick a resident-heavy program where residents preview, dictate and follow their cases through to sign out. There are very nice programs in <100,000 population areas, and some of those are in the midwest (I know people on here from the coasts would disagree, but I think it's true). If you go to a good program, people will recognize it.

Take that for what it's worth

 

[Epstein]

I'm sure there are probably other similar programs (i.e., Mayo), but the University of Iowa might fit your bill. It is a smaller community with a giant medical center. The path department is well respected nationally and has excellent surgical pathology training. There are a number of good fellowships (4 surgpath, 2 cytopath, 1 hemepath) for which you would have the inside track. I think they may be considering adding a dermpath fellowship, but the derm residents would probably have the inside track there.

The fortunate thing for you is that a program like Iowa tends not to be as competitive because it is in a smaller city (the county has 111,000 people).

Iowa City is a great town with reasonably priced housing (most residents own their own house).

 

[DarksideAllstar]

that have a huge array of fellowships, especially derm path

awww shiiit

 

[average]

Thankyou for all the advice. My wife and I are going to sit down and finish a preliminary list this week. Once I get the list together, I'll post it and look for feedback. 🙂
Found a useful site http://www.city-data.com/forum/ that is set up just like this but discusses cities around the US. I've found this helpful.

Also, www.citydata.com has much info on economy and weather

I try to look at each programs website to get a general idea of the individual programs but find this to be generally uninformative.

Thankyou again for the advice, and feel free to post more comments

 

[yaah]

I try to look at each programs website to get a general idea of the individual programs but find this to be generally uninformative.

Yeah, program websites are not really consistent. Some are really good and detailed, others basically just list the attendings. Some programs are listed on scutwork.com, but not that many.

You can always call or write to the programs and ask them for info, or even ask them to put you in touch with a resident in the program. You may have to wait for interviews for the bulk of your info though.

 

[Prairie]

I'm sure there are probably other similar programs (i.e., Mayo), but the University of Iowa might fit your bill. The fortunate thing for you is that a program like Iowa tends not to be as competitive because it is in a smaller city (the county has 111,000 people).

I agree that Iowa has a great program. It is, however, more competitive than you might suspect because of their post-sophomore fellowship program. This year the majority of the people they matched were from Iowa. If you really like the look of the program, I'd suggest doing an elective rotation to increase your odds of matching there.

 

[CameronFrye]

Iowa is a good program in the midwest and you should definitely check out Michigan too.

As for number of fellowships, I probably wouldn't focus a huge amount on that at this moment, especially if you aren't dead set on a particular fellowship. Places with tons of fellows running around can also be problematic. And as yaah said, you can always go to a bigger place for fellowship if you so choose. My program doesn't offer a ton of fellowships (2 cyto, 1 gyn, 2 dermpath, 1 heme, 1 TM, 2 neuro), but graduating residents have scored fellowships at places like Stanford and UPenn. Lots of residents also get good jobs without any fellowships (in smaller areas).

 

[RyMcQ]

It is, however, more competitive than you might suspect because of their post-sophomore fellowship program. This year the majority of the people they matched were from Iowa.

This varies from year to year. It did happen this year because the current R1s were a great group of PSFs a couple of years back. But there are other years when the residency isn't as competitive as you'd think for the quality of the program.

I do agree that if you are interested in a particular place, doing an elective rotation there is a good idea. That is, unless you are a terrible student, in which case you might want to just apply and hope for the best.

 

[yaah]

Competitiveness varies a ton from year to year at each program. It's best not to worry too much about it or try to "trend" it - the only thing you can control is your own application. So apply if you like the program, and do the best at your interview.