Pros and Cons of a small program

[Cholinergic]

What are the pros and cons of a smaller program (3-4/yr) vs a medium (5-6/yr)? I think I would do better in a smaller class and really get to know everyone. But, a resident I worked with said not to go to a program with less than 6-8 because of the possibility of someone getting sick, having a baby, taking a leave for whatever reason, etc). Is this a factor in anyone else's decision?

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[pruritis_ani]

I am at a smaller program, and would pick it again. The reality about coverage is that in any program, if somebody on your block is out, your work will likely go up. In a 10-12 person program, they just have more blocks to cover. Frankly, if somebody doesn't show up for whatever reason, then the attendings are the ones that get screwed.

I don't think it is a big enough concern to make it a real factor in the decision. The things about a program that make it small (ie community vs academic, lack of fellowship competition, geographic location) and the benefits (lots more direct interaction with faculty, functioning as a fellow on the subspeciality rotations, more direct clinical experience and better case numbers) are likely the reasons you are interested in it. So, to give up what you want in a program for some remote possibility of taking 2 extra calls in a month over your residency seems foolish.

 

[shamrock13]

I definitely think that program size should play some part in your decision. As a resident at a mid-sized busy program I can tell you that there were times that we were stretched when a member of our class had a baby just after the start of our second year. The good thing was that the other classes pitched in to help us, because there was no way all of the work was getting done without help. And in our program having a person not show up and an attending get "screwed" simply isn't an option.

That being said, there are a lot of benefits to a mid-sized program. I definitely know my attendings well and they know me well. Even with more people and fellows around we still function WITH the fellows. For example, as the oncology chief it is not the fellow's service, it is your service. Fellows are at a program to learn to do things that it simply isn't your job to learn during residency (ex: IVF).

No matter how many people are in your class you will get to know each other REALLY well. You spend more time with these people than your family, it is a given that you will start to learn a lot about each other. That being said, some of my best friends aren't even in my class.

Choose a residency based on what you want to get out of it. Do you want a fellowship track or general practice track? Academic or community? And choose based on the people that you clicked with best on the interview trail. Something about my program just felt like home to me when I was there, and I was absolutely right.

Good luck!

 

[Cholinergic]

Appreciate both your feedback!

 

[Diane L. Evans]

Most smaller program have an advantages of letting interns and lower level residents be able to learn more and get more one one one attention especially in gyn cases. A smaller residency program tend to have higher vag hyst numbers with residents partaking in surgeries even in year one simply because there are too many cases and not enough residents to cover them all. This is especially true at a resident program without a fellowship program residents get to do more. But as mentioned with the drop out rate of 5-10% losing a second yr resident to career change or any resident to 6 week maternity is a struggle--the result can be a lot of work and unhappy residents.

I feel that 4-5 residents a year is a perfect number but a larger program that rotates at many institutions has its advantages too take JHU for instance.


Good luck
D

PS also look into programs with night floats and not q 3 or q 4 day schedules you'll be able to plan your off time and not feel as sleep deprived (except the 6 week night float block)

PS just my opinion
D