Question for attendings- rank list help

[crazyhands]

Hello!

I'm really stuck on what to do with my rank list. My top two programs are very different. One is high volume, more pathology, much more inpatient requried rotations and the other is just the opposite with lower volumes, less pathology, and much less inpatient. Both groups of residents seem happy.

I really love the outpatient setting. I would love to have a career in a largely outpatient subspecality field like behavioral/developmental, endo, sports med, etc. or outpatient gen peds.

My question is this: How much sense does it make to work really hard doing a ton of inpatient work, seeing alot of pathology, and risk burning out and not wanting to do a fellowship if I'm fairly confident that I want to go into a field that is largely outpatient? I should add that the smaller program does send residents to pretty decent fellowships.

thanks! I really do appreciate your advice!

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[oldbearprofessor]

My question is this: How much sense does it make to work really hard doing a ton of inpatient work, seeing alot of pathology, and risk burning out and not wanting to do a fellowship if I'm fairly confident that I want to go into a field that is largely outpatient?

None.

Go where you'll be happiest - you've made it clear which that will be so enjoy and don't worry about it.

PS: Change your status - I'm guessing you're not "pre-health" anymore.

 

[twilightdoc]

Hello! I'm really stuck on what to do with my rank list. My top two programs are very different. One is high volume, more pathology, much more inpatient requried rotations and the other is just the opposite with lower volumes, less pathology, and much less inpatient. Both groups of residents seem happy.

At the risk of sounding un-academic, which geographic location did you like the best? Remember that you won't be working all the time, and there is a good chance that duty hours will be reduced again in the next couple of years. So the living environment (both the city itself and surrounding area, proximity to family or friends) should be a consideration for you.
And given the RRC rules for Pediatrics residencies, I find it hard to believe that two programs are structured as differently as you portray them. Certainly there are differences in volume and perhaps acuity, but the RRC has really put a lid on the number of months that are allowed in intensive care settings, inpatient settings, etc.
And you mentioned that "both groups of residents seem happy". Did you find yourself "identifying" more with one group than the other?
If you really liked both programs, then you are in a "no lose" situation, and I suspect that you will get good training in either one. Sometimes you just have to go with your gut instinct.

 

[crazyhands]

At the risk of sounding un-academic, which geographic location did you like the best? Remember that you won't be working all the time, and there is a good chance that duty hours will be reduced again in the next couple of years. So the living environment (both the city itself and surrounding area, proximity to family or friends) should be a consideration for you.
And given the RRC rules for Pediatrics residencies, I find it hard to believe that two programs are structured as differently as you portray them. Certainly there are differences in volume and perhaps acuity, but the RRC has really put a lid on the number of months that are allowed in intensive care settings, inpatient settings, etc.
And you mentioned that "both groups of residents seem happy". Did you find yourself "identifying" more with one group than the other?
If you really liked both programs, then you are in a "no lose" situation, and I suspect that you will get good training in either one. Sometimes you just have to go with your gut instinct.

I liked both locations! And I do think that the programs are fairly different. One is a community program university affiliated and the other is academic. The smaller program (11-12 residents per level) averages 3-6 patients/intern in the summer and more in the winter. At the pre-interview dinner, there were alot of interns that attended. They are very happy and don't seem overworked.

So let's say I match at the smaller program and then decide I would want to be a hospitalist. I really think that I would not be nearly as comfortable. However, I am very confident that I would like to do largely outpatient peds (leaning towards subspecality).

So, let's say I was in general outpatient private practice peds. How valuable is it to get the high inpatient volume and pathology, if the 90% + of outpatient peds seems routine?

 

[twilightdoc]

So, let's say I was in general outpatient private practice peds. How valuable is it to get the high inpatient volume and pathology, if the 90% + of outpatient peds seems routine?

Presuming that we are talking about accredited residency programs, the good news is that you will get good training at most of the Peds programs in the country. True, the volume and the pace might be different among different programs, but people learn in different ways. I don't think that you would necessarily be short-changing yourself if you matched at the community-based, University-affiliated program, again assuming that they have most Peds specialties represented. I think you are under-valuing outpatient Pediatrics. True, many of the patients may not be particularly ill, but you just never know what is going to show up in a clinic or an ER, and you have to be vigilant that you don't miss something important. And every family situation is a little different, so you need to hone your skills in communicating with a variety of individuals and personalities. The paradox is that, while inpatients are usually sicker than most clinic patients, inpatients may actually be less stressful to manage- you would probably have more readily-available resources, consultants, nurses, etc. On many services, inpatients are "pre-packaged" in terms of their diagnoses, treatment plans, etc. You may not have that luxury as often in the clinic. While I am not a "general" Pediatrician, I have great respect for my colleagues who are- outstanding diagnosticians, communicators, and patient advocates.

 

[crazyhands]

Presuming that we are talking about accredited residency programs, the good news is that you will get good training at most of the Peds programs in the country. True, the volume and the pace might be different among different programs, but people learn in different ways. I don't think that you would necessarily be short-changing yourself if you matched at the community-based, University-affiliated program, again assuming that they have most Peds specialties represented. I think you are under-valuing outpatient Pediatrics. True, many of the patients may not be particularly ill, but you just never know what is going to show up in a clinic or an ER, and you have to be vigilant that you don't miss something important. And every family situation is a little different, so you need to hone your skills in communicating with a variety of individuals and personalities. The paradox is that, while inpatients are usually sicker than most clinic patients, inpatients may actually be less stressful to manage- you would probably have more readily-available resources, consultants, nurses, etc. On many services, inpatients are "pre-packaged" in terms of their diagnoses, treatment plans, etc. You may not have that luxury as often in the clinic. While I am not a "general" Pediatrician, I have great respect for my colleagues who are- outstanding diagnosticians, communicators, and patient advocates.

Thanks for sharing your thoughts. I appreciate it!

 

[BigRedBeta]

Probably too late to affect your rank list I'm guessing, but I think what should really be the deciding factor is your personal learning style. Are you someone who does best by doing or would you rather have a chance to see your patients, do some reading and then develop your plan.

My residency program was in the high volume category and I can tell you that the interns and residents who wanted time to think, were perfectionist in their notes and needed to be absolutely certain of the details struggled immensely. The high volume, changing plans and degree of autonomy was great for me, but in a slower setting, it would have been me who struggled. There are certain skill sets (somewhat mutually exclusive in fact) that matter in each type of setting. Neither setting is superior to the other for patients or producing good pediatricians in a general sense but for individual residents may make a huge difference for their development and overall happiness (because who wants to struggle or see their best skills end up being fairly useless?)