Programs for those pursuing academics

[Amos]

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Now that the match is finally over I thought I would share my thoughts regarding programs geared for those pursuing careers in academics. I will repost part of this information in the impressions thread as well, but I wanted a dedicated academics thread to highlight some additional ideas.

Preface:
As you hopefully will hear repeatedly, make sure that you rank programs according to where you will be happy both personally and professionally. You will not do your best work unless you are comfortable where you are training. You need to feel at ease with your fellow residents, the city, ancillary support, research opportunities, program size, etc. etc. etc. In addition, no amount of prestige, or "opportunities", or other factors will allow you to function well if you are miserable.

With that being said…..

There are many great places to train in neurology. Your success will always come from within and the talents that you and your mentors help you develop. You could easily start a fantastic career in academics in 30+ training programs. There are however 5 programs that most chairpersons and program directors will point to as traditionally being viewed as "the best" neurology programs, with another 10-20 after that who like to think of themselves as being "in the next five." Thus I will start out saying a bit about those places and perhaps others can add feedback beyond that.

Whether the "big five" are currently the best and will continue to be is open to debate and is also contingent on your specialty of interest, family obligations, personal opinions, etc. However with all those caveats, historically the "classic pentad" are (in no particular order):

-UCSF,
-Partners,
-Hopkins,
-Penn,
-Columbia.

I will list a very brief blurb about each below. I STRONGLY encourage you to visit each for yourself, since opinions vary wildly and you will be surprised how much your preconceived notions about a program change during a visit. You may hear lots of comments from other applicants about "such and such place is malignant." Ignore such talk. Go see for yourself. Nine times out of ten the label "Malignant" means that the said program is highly competitive in terms of the match because it attracts some of the best students throughout the nation. It also usually means that the program is a rigorous training environment that believes that you learn the most by seeing a lot of different types of patients. In other words, "malignant"=talented residents + hard work + high expectations.

 

[Amos]

All of the programs below will have renowned faculty, lots of patients with diverse conditions, and highly motivated residents that are extremely intelligent. In addition, most have breadth and depth in many neuro subspecialties. As I mentioned above there are other great places, but I thought I would start with these.

UCSF:
Summary: A rigorous training program with multiple training environments that emphasizes clinical and research excellence.
Pros: Academic, general hospital, and VA training environments. Powerful chairman that is a clinician, administrator and scientist. Great program director that has served in that role for many years. Gorgeous city. Good administrative support. A diverse group of residents that have had previous success in research, patient care, and an array of other fields.
Cons: Very rigorous with heavy patient load and significant personal responsibility. The same or more call than peer programs. This may or may not be disadvantageous depending on your learning style.

PARTNERS:
Summary: A very large program (17 residents per year and growing) that combines the unparalleled clinical and research opportunities of MGH and the Brigham along with Boston Childrens.
Pros: More faculty than any other program and perhaps the most comprehensive coverage of all neurology subspecialties. Multiple chairpersons that are each influential in different arenas. Wonderful administrative support. Great City. Rich history.
Cons: Large program may not be for everyone. Harvard system makes for a unique research and clinical environment that may or may not mesh with your learning style.


HOPKINS:
Summary: A frontloaded, research oriented program that allows for tremendous flexibility throughout the final year to pursue research, electives, or other experiences.
Pros: Up to 12 months of time during the residency for research. Strong track record of helping residents secure K awards.
Cons: New chair + new hospital being constructed=a time of transition. This could be a good thing depending how seamlessly the changes occur. The main medical center is in a dangerous part of East Baltimore with armed guards everywhere. The residents seemed to have a lot on their plates.

U PENN:
Summary: The first department of neurology in the nation offers a balance of clinical and research experiences with perhaps less inpatient responsibilities than peer programs.
Pros: Outstanding program director that has served in that role for many years. Several residents have children and mentioned that there was plenty of time in the curriculum for family and friends. CHOP is right next door and has a huge peds-neuro faculty. Adjacent Ivy League undergrad campus adds a college feel and evokes memories of undergrad.
Cons: Main hospital is one of the first in the nation and at times shows its age. Smaller adult neuro faculty relative to peer programs. Philly is a nice city, but lacks the flair of San Francisco, Boston, or NY.

COLUMBIA:
Summary: Rigorous program with a rich history located in the heart of Manhattan.
Pros: On the cutting edge of advances in neuro critical care. Nice facilities. New York City is a big plus for some. They place a heavy emphasis on managing as many medical problems as possible in neurology patients without placing consults. I really liked their medicine program as well.
Cons: New York is a minus for some. Par for the course New York ancillary support which means you'll be doing blood draws, transporting patients, placing IVs etc. Up to 60% of clinic patients are Spanish speaking, which may be a plus or minus depending on your language skills.

Other places to think about:

By no means an exhaustive list, but other academically oriented programs that I would recommend:
-BIDMC.
-UCLA (a blizzard got in my way of visiting this one).
-Wash U.
-Mayo, Rochester.
-Michigan.

Places I didn't visit but I heard some good buzz about:
-Miami.
-Stanford.
-Northwestern.
-Case Western.
-UVA.

Places that I knew were good, but I left feeling great about:
-UCSF.
-Wash U.
-BIDMC.
-Partners.
-Penn.

 

[Vader]

Thanks Amos for posting this! I think these comments will be very helpful for those inclined toward academic neurology.

I think the list given above is a pretty good list to start out with. As Amos mentioned, choice of residency for most people comes down to more than academic reputation. Feeling comfortable in the environment and being happy with your choice is one of the most important factors in determining whether you will succeed.

Conversely, all of the above places mentioned train not only academic neurologists, but also those who will become community neurologists as well. Any of these programs, as well as many not mentioned on this list, will give you great training in clinical neurology.

 

[Amos]

Thanks Amos for posting this! I think these comments will be very helpful for those inclined toward academic neurology.

I think the list given above is a pretty good list to start out with. As Amos mentioned, choice of residency for most people comes down to more than academic reputation. Feeling comfortable in the environment and being happy with your choice is one of the most important factors in determining whether you will succeed.

Conversely, all of the above places mentioned train not only academic neurologists, but also those who will become community neurologists as well. Any of these programs, as well as many not mentioned on this list, will give you great training in clinical neurology.

I think Vader is right on in highlighting how many good places there are to train. A couple things to keep in mind when sorting through which programs you might apply to, especially if you are focusing on academics:

1) Quality of clinical training: The most important factor in my opinion. This is a clinical training program. How well do they train you in clinical neurology? This is even more important if you might dedicate a lot of time to research down the road. Now is your time to pick up the tool set you will need for the rest of your career.

2) Size: Are they big enough so that one resident is not covering an entire hospital q4. Are they big enough so that if a resident leaves the program that the remaining trainees aren't overwhelmed with additional responsibilities.

3) Faculty/Specialties: Do they have enough experts in enough subspecialties that you will have many fellowship opportunities.

4) Stability: This is correlated with size. Do they have enough faculty/resources to weather the current economic storm. Don't fall into the trap of thinking well I want to do "X" and "Professor Y" is at this school so I am set. You might change your mind, he/she might get recruited away, etc. People move all the time, especially if they get recruited away with "an offer they can't refuse" by one of the big time academic centers. Go somewhere that has so many awesome faculty that you will always find someone smarter and wiser than you to help you learn.

5) Flexibility: Is there time to do research and electives rather than "man the floor" for all 3 years?

6) Reputation: This will take care of itself if the above factors are met, but ask yourself "does the program have a history of training folks with goals similar to my own?" I was shocked by how many people all over the nation trained at basically one of a handful of places. Even at less well known centers, the majority of neurology faculty trained at the same schools, and then moved on to somewhere else.

7) City: Do I think I could live here for the next 3-6+ years? Would my significant other be able to get a job here? Would I feel safe here?

I also agree with Vader that you can also get crazy good training at academically oriented places and then choose to go primarily into private practice. However be aware that many of these programs are geared toward recruiting students that want to do academics. Many will tell you point blank that, that's their goal and if you aren't interested in that then they're not too interested either. Just something to keep in mind during the interview process. Be honest about your goals but also be aware of what each program is hoping to accomplish down the road.

And once again don't rank according to only reputation. I imagine that it won't be enough to get you fired up every morning as you walk to work, especially at 5 AM. In fact, unless you are the most diverse and tolerant person on the planet I would be shocked if all of the "big five" programs I discussed in my OP were in your top 5. They weren't all in my top 5. Other programs have to be in the mix, if for no other reason that there are a ton of good places.

 

[HarveyCushing]

Amos, this is great! 👍 Thanks for posting this. Hopefully the mods will sticky this under the FAQ.

 

[Amos]

I've gotten a couple private messages asking about other programs I mentioned, so I thought I would add a few more.

Send me a private message if you have other questions and I'll give you whatever limited input I have.

I'm not trying to spam these boards, but I do feel the need to help out next year's applicants. As always these are one applicants opinions. I try to focus on the positive, since I really liked most programs I visited. Remember that "cons" are all relative and subject to personal interpretation.

MAYO (ROCHESTER)
General: One of the best known clinical neurology departments in the world and the world’s largest group practice, Mayo prides itself on outpatient and fellowship training in an environment that gives residents time to read and pursue scholarly work.

Pros: Amazing facilities. Tons of money. Growing program, they are working really hard to build/maintain a top notch program and recruit great residents. Uber cush-residents have their own secretaries and light hours relative to some other programs. Good didactics. Residents have the chance to get involved in many case studies or retrospective trials. Most residents publish clinical work during residency.

Cons: Rochester MN is a strange town, though it's only 60 min from the Twin Cities which are great. Tough place to meet people if you're single, though always ranked highly in national magezines for places to raise kids. Basic science is not a high priority relative to other premiere departments. Requires residents to be self-motivated since the inpatient demands and call responsibilities are less than some other programs. Somewhat insular-There's the Mayo way of doing things and the Mayo way of doing things.

MICHIGAN: A Midwest program in a classic college town that has a long reputation of training good residents.

Pros: Residents tend to get great fellowships, either at Michigan or somewhere better. Basic neuroscience is really growing there, with new facilities and faculty joining the department all the time. Great, great college town.

Cons: Small program, 5-6 residentts each year. Not sure on their catchment area given Ann Arbor's proximity to Detroit programs and other major cities. Heavy outpatient emphasis with tons of clinic (maybe a plus depending on your interests).

 

[KillingMeSmalls]

You're right on about the basic sciences at Mayo. The chairman said this was something on which they've been working hard to improve.