Quality of FP residency programs

[HarveyCushing]

I know that it is hard to measure programs since there are so many different variables to take into consideration. I was wondering what those of you who are about to match to a program or are currently in residency looked for? Besides location and the intangibles, what aspects of your training were the most important to you? Opposed vs. un-opposed? Number of faculty? Population of surrounding area? Average number of patients seen per year? How well respected the graduates are (probably harder to determine?)? What would you recommend as some of the most important aspects to consider?

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[hippiedoc13]

All of the questions you've thought of are good ones. A couple more:

If the program is opposed, how is the relationship between the FM residents and the other services in the hospital? Are the FM residents well-respected by the other specialties?

What do most graduates of the program end up doing after they finish residency? (eg, private practice, academics, fellowship, HMO, underserved, hospitalist, stay in the local area vs go elsewhere, etc) Do they get jobs easily?

 

[Leukocyte]

I looked for University programs that are:

-Unopposed (No competition with other residents/fellows).
-Strong on procedures
-Strong OB/GYN component (including c-sections)
-Strong Pediatrics component

My current program fits all of the above criteria, except that we do not perform Stress Tests, Vasectomies, and Colonoscopies at the Outpatient clinic (we do everything else). It is a major university program, however our FM residency main clinical site is not at the University Hospital. It is a few blocks across town at a major medical center (larger than the University Hospital itself). It is setup this way to keep our FM program unopposed. We do however rotate at University Hospital and attend lectures there. Our noon lectures are provided by our FM faculty and faculty from other departments at the medical school. Naturally all our faculty are professors at the Medical School, and we have free access to all the medical school facilities on campus. If we are elected as Chief Residents, then we are automaticaly given a faculty position at the medical school. Plus we have access to all the basic science and clinical research opportunities at the medical school if we wish to engage in research. Second and Third year medical students at the medical school do their required "Advanced Introduction to Clinical Medicine" and "FM Core rotation" here with us at our site. In addition, fourth year medical students do their FM electives and Sub-Is here too. We are REQUIRED to teach the medical students, which can be a bit annoying if you are a busy PGY-1 like me. However, most of the medical students teaching is done by the PGY-3s.

 

[AwesomO]

As you'll hear everyone say it depends on what your looking for.

For me I looked for

1) A community program
2) Patient volume, diversity, and complexity.
3) ICU Exposure.
4) Flexibility of program, ie lots of elective time
5) Real world medicine, it was important to me that my attendings practice real world medicine and the politics and economics that entails. The last thing I want is to be in an isolated med school like environment then be shell shocked my first year as an attending.
6) Call during 2nd and 3rd year. I leave off intern year because it's a given I'll be spending a lot of time in the hospital. But during 2nd and 3rd year will I have time too moonlight or pursue other interests of mine.
7) Probably the most important to me was the confidence the program had in their residents. ie If you have a complex patient headed to the ICU do the attendings have specialists lined up to take care of the patients and have you there just for show or do they let you come up with a game plan then check with consulting specialists if it's appropriate.

 

[sophiejane]

I've said this before, but I think it's important enough to say it again:

FM is such a broad specialty, and there are so many ways to build your practice, that you really HAVE to think about that practice before you ever choose a program. What do you want to be trained to do? What do you not really care about? Are you looking for great outpatient volume, a well-organized clinic, moderate hospital and minimal OB exposure? How about a zillion procedures but not much clinic? How about 2 months of colonoscopy training that counts for your 2 months of required surgery (being done by yours truly as we speak)? Lots of electives so you can get in more EM months? Built in moonlighting? Urban? Rural? Suburban? Do you want to do lots of derm, or lots of peds?

It's all up to you, and there are programs that will prepare you well for any and all of this. But you have GOT to do your homework!! Don't expect one program to have it all. Do ask lots of very specific questions, then sit down with your chart and figure it out.

I will say that when we are reviewing applicants, if they don't have any idea of what kind of practice they want, it doesn't look very good to the committee. You need to come in with some kind of idea of what you want. Of course you can change that and people do, but at least give it some thought before you interview.

Surgeons, OB GYN, EM, etc. can pretty much pick a program and end up being trained to do what they need to do (with varying degrees of quality, of course). We have the blessing and the curse of tailor-making our future practice, and it starts when you start interviewing.

Best of luck.

 

[HarveyCushing]

Thanks for the advice guys. All that I know is that I want to go to an unopposed program that will give me the broadest training and the free time for electives. I am interested in practicing in a rural/small town and will probably want a program that has a fair amount of exposure to EM (or at least make it available). Not very specific but over time I hope to find what my nitch is and what I could see myself doing.

 

[AwesomO]

Thanks for the advice guys. All that I know is that I want to go to an unopposed program that will give me the broadest training and the free time for electives. I am interested in practicing in a rural/small town and will probably want a program that has a fair amount of exposure to EM (or at least make it available). Not very specific but over time I hope to find what my nitch is and what I could see myself doing.

Are you looking for a lot of OB? That alone helps narrow down the list of programs.

 

[HarveyCushing]

Are you looking for a lot of OB? That alone helps narrow down the list of programs.

I don't see myself doing a lot of OB when I practice, but I will do some. However I would like more than just a brief exposure to it since I will be working in a rural/small town and this might end up being part of my job description. But I don't want/plan to open an OB heavy practice

 

[HarveyCushing]

I would also like to know how much ultrasound training FP residents get? I am guessing unopposed programs will be stronger in this area?

 

[AwesomO]

I would also like to know how much ultrasound training FP residents get? I am guessing unopposed programs will be stronger in this area?

Do you mean OB ultrasounds? You get a fair amount of that depending on how many OB continuity patients you decide to carry or that your program dictates you have.
As for Abd ultrasounds you don't do that many, from my experience the techs do pretty much all of them. Aside from galstones most radiologists think it's a waste of time and money. With the availability of CTs they probably have a point.
If you wanted to learn how to do US though all you would have to do is set up a time with the radiology techs to teach you. I don't know if unopposed makes a difference in this area since I've never seen a resident physically do an US himself. So you would have no competition either way.

 

[sophiejane]

I would also like to know how much ultrasound training FP residents get? I am guessing unopposed programs will be stronger in this area?

It's very program dependent and difficult to make generalizations about how much exposure you will get. As with many things, it depends on your level of interest. My personal goal is to do enough of them to measure AFI and get a general survey of anatomy and growth. The rest I will happily leave to the radiologists.

 

[HarveyCushing]

Do you mean OB ultrasounds? You get a fair amount of that depending on how many OB continuity patients you decide to carry or that your program dictates you have.

Yeah sorry I didn't specify that I was referring to OB us. That makes sense that it will depend upon how much OB experience once has in a program.

 

[xdknjx]

I'm a 3rd year student and i'm starting to look into family programs. I've been using FREIDA and the info from aafp.org, but I can't really find info about which programs are heavy with procedures or OB, 1st time board pass rate, etc. Do I have to check each individual program website or is there another database for this info? Thanks.

 

[sophiejane]

I'm a 3rd year student and i'm starting to look into family programs. I've been using FREIDA and the info from aafp.org, but I can't really find info about which programs are heavy with procedures or OB, 1st time board pass rate, etc. Do I have to check each individual program website or is there another database for this info? Thanks.

Unfortunately, I think you really do. Or maybe that's a good thing.

I learned a huge amount from scouring websites. I also learned a lot from SDN, but everyone here has opinions, as we well know.

The best approach I think is to first narrow down to a region. If you are totally open about region, I strongly suggest going to some residency fairs. AAFP in August (usually in Kansas City) is a great one from what I hear. Collect as much info as you possibly can. Talk to lots of people. Ask on SDN.

The most important thing is to be really well informed. I know that is a long answer to a short question, but I really think you can't ask enough or know enough about the programs you choose to rank.

Best of luck.

 

[MeowMix]

The best thing is the AAFP conference, in my opinion. You will gather more info there in 2 days than in days of online/phone research. It is totally worth it. I managed to get a couple of days off a very demanding rotation to go, one that i was very nervous about asking for time off.

I liked the paper AAFP directory of all residency programs, since everything is in there. I got a copy in KC and went through it on the plane on the way back. Talk to recent alumni from your school and find out how they like their site. Find out where else they interviewed and what they liked. This is a great way to make connections and get inside scoops.

The big things I saw as differences were:
- ob
- inpt peds
- PACS or equivalent for imaging (I just could not stomach the idea of 3 yrs looking at X-ray, CT and MRI hard copies)
- pt population and language needs
- work hours - there's "80 hrs" and there's 80 hrs
- flexibility in electives - can you leave the state?
- onsite support for FM - there's "opposed" and there's opposed
- faculty time on wards - if they only do 2 wks/yr inpt, this may not be the teaching you want
- teaching type and time - I personally do not learn well from lectures and would have preferred a program with minimal lecturing. When people say the teaching is great or bad, find out what they like and what they are getting. It can be as simple as someone who loves lectures and wishes they had more.
- I loathe the multiple rounding schedule that requires pre-rounding at 5:30 and then successive rounds for the next 6 hours, finishing by noon if you are lucky. I chose a program that does not do that.

The questions you ask now will turn out not to be the most important for you, but really you can only learn by going through the process. By the end, you will know exactly what you should have been asking all along.

 

[Doc Oc]

Our FP program in Quincy, IL with SIU has alot of ER experience because you work in the ER on your call night from 5-11. You function as an ER doc and see patients with attending supervision, and when clinic pts come in and need admission you do that too. You do an ER rotation too and have alot of elective months 2 and 3rd years.

 

[Runtita]

Think about what you want to do when you finish residency and where you'd like to live. Then look for programs that will allow you to achieve those goals. The end justifies the means, so to speak.

For example, I want to end up in the Desert Southwest and work in an area with many outdoor extreme activities/sports, so I looked for a program with some exposure to wilderness medicine. Also, I wanted an unopposed program (I feel it will make me a better physician) so I could get maximum exposure to trauma and critical care. I'm a DO student, and I wanted a DO or combined program because I plan to use at least some OMT in my practice. I hate big cities, so I avoided applying there. I have a family and absolutely will not compromise my kids' education and safety, so I looked for communities with good schools and relatively low crime. We also love the natural world and I looked for a place with lots of opportunities to be outdoors. As a bonus, I looked at programs in states with no income taxes and I did pay attention to programs' retirement plan contributions!

My classmate, on the other hand, wants to do lots of OB in a rural setting. He looked for places with a big emphasis on that, specifically with surgical and lots of high-risk OB/peds rotations. He also wanted a good salary, a place safe for his kids, etc.

Another classmate wanted to be near family, so that was a primary goal for him in looking at programs.

All in all, my advice would be to get a game plan for what kind of FM doc you want to be (and where you want to live) and look for programs that will help you to be that doc in that place.

Fortunately for us, FM is a field that is begging for applicants, so most of us get one of our top choices.

 

[secretwave101]

Agree with the where to live advice. Pick an area of the country and there will probably be a program that suits you. Broadly speaking, more procedures in Western half of the country, but you can find procedure-heavy programs in the E. as well.

Also, be critical of the claims made by programs. I like my program, but I have to say that they tout their procedural training and they really shouldn't. I don't think they're being dishonest, but I think they just don't know. We DO get a lot of OB, and that's what we're known for. So, identify some programs you like and then check their websites...but from there, if you have the time and energy, you should try to contact some of the residents too and get their perspective.

In the end, you'll find you probably did a lot of work...but it's fun work! At least, it was for me.

 

[sophiejane]

Also, be critical of the claims made by programs. I like my program, but I have to say that they tout their procedural training and they really shouldn't.

So true.

There is no perfect program. I know I go on about mine, but there's a lot of stuff that goes on behind the scenes that ain't pretty.

In the end, if you go to an accredited program, you will graduate with the basic skills you need to START your career. The doc you become depends on you.

However, I cannot stress how important it is to get as much knowledge about the programs you plan to rank as humanly possible.

I spent two whole elective months and one required month checking out programs in depth. I had done a lot of homework on them and decided they would be in my top 3, so I felt the time was worth it. I wouldn't trade that decision for anything, and I credit it for helping me make a choice that I remain happy with.

 

[HarveyCushing]

So true.

There is no perfect program. I know I go on about mine, but there's a lot of stuff that goes on behind the scenes that ain't pretty.

In the end, if you go to an accredited program, you will graduate with the basic skills you need to START your career. The doc you become depends on you.

However, I cannot stress how important it is to get as much knowledge about the programs you plan to rank as humanly possible.

I spent two whole elective months and one required month checking out programs in depth. I had done a lot of homework on them and decided they would be in my top 3, so I felt the time was worth it. I wouldn't trade that decision for anything, and I credit it for helping me make a choice that I remain happy with.

I plan on doing that as well. I think elective rotations are key. I also plan on attending the AAFP convetion in KC this summer. I have heard a lot of good things about it and since I live down the street from the convention it will be easy for me to attend.

 

[secretwave101]

A second, unanticipated, reason I'm glad I did all that background work is that it reassures me now that the grass really isn't much greener anywhere else. Like Sophie, I really beat the pavement. I KNOW what else is out there. These days, I have confidence that my program's solid...even when I get burned out or p.o.'d about something.