Rank Help- Program Culture vs Clinical Exposure

[CA-101]

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Hi! I need some help sorting out two programs that are high on my rank list. For reference, I have a family... so I am also thinking about childcare, spouse's job market, moonlighting etc. I'm interested in academics and in CCM or CT fellowships. Part of me feels like I am weighing great culture/good exposure with good culture/great exposure if that makes sense.

UNC

Pros- Real family culture (lots of residents have kids). My partner and I love the research triangle area, and we have a small amount of extended family nearby. The program has no fellows so perhaps more autonomy (can't decide if pro or con). UNC is getting a shiny new surgical tour in '24, and there is a new late-pay starting in CA-1, but not sure if this is permanent.

Cons- No in-house fellowships for CCM/Cardiac (still match well), the stipend is relatively low for COL, I'm told there have been some recent staffing/high work hour issues (not unique as I understand). The program is well-regarded but not as highly ranked, there is not as much trauma/tx, and the SICU is run by surgery.

Emory

Pros- We also happen to like Atlanta, it's a "name brand" program. It gets 3pm relief (followed by preops) on Gen OR rotations. There are higher volumes of ECMO, MCS, transplant, and possibly a more complex case mix in CT and CCM with more anesthesia CCM involvement and in-house fellowships. There are dedicated didactic days 1/mo, and multiple hospitals to grow skills (can't decide if it's a good or bad thing).

Cons- Traffic, no family in the area, no moonlighting until CA-2 (but great rate thereafter), and hardly any residents have kids (like 3 in the whole program I am told)

 

[2buckchuck]

I’d go UNC 100%. I’d consider no fellows to be a pro.

 

[dabears505]

Jordan played for UNC. I think that should make it an easy decision.

 

[Angus Avagadro]

Well, these are complicated decisions. Which program gets you where you want to go? That's why you spent all those years working to be in your position. Academics? PP? What kind of doc do you envision yourself becoming? Researcher? Publisher? PP?Teaching? I get the lifelong search for balance and the support provided by nearby family. Pick the program that meets the goals you and your spouse strive to achieve. I think that will get you some piece of mind. Since we had no family in the area,we didn't have children until my wife was midway through residency and I a new uni attending.. I picked my residency based on the surgical volume and wanted the experience to become an excellent clinician. I wasn't interested in being a small community hospital doc. It will all work out. In my case, with my goals, I would rank Emory. Having said that, the decision you and your spouse make will be the best one. Good luck.

 

[jqueb29]

Multiple hospitals is a bad thing

 

[kidthor]

Just go where you think you and your family will be happy. Both programs are "name brand" places and are both top notch. You'll succeed at either!

 

[HemeOncHopeful19]

I just skimmed your post but you should choose based on where you’d prefer to live 30 years if you ended up deciding to IMO

Emory or UNC won’t change your career options, but having local connections MIGHT open doors to the one good practice in town if that’s where you end up staying.

If I had to put money on it I would bet on Atlanta over the UNC/Duke area because I have never heard of any UNC/Duke area job that wasn’t a ripoff but I vaguely recall something different/weird about Anesthesia at UNC/Duke in relation to other fields that might change the calculus.

 

[Drwine]

Multiple hospitals is a bad thing

Not for everybody. Some residents have difficulty with change and should avoid for training and practice. For others it will give them exposure to different practice settings and give residents a better idea what they want in practice. Obviously marginal residents more likely to fall through the cracks but well motivated residents who are willing to take ownership of their clinical experience will be stronger at the end of the training.

 

[Silo004]

UNC -- single hospital, family in the area and sounds like you might want to be there long term.

 

[GassYous]

multiple hospitals is a great thing as when you get tired of the culture and people at one place, you can get a break from them

 

[2Fast2Des]

multiple hospitals is a great thing as when you get tired of the culture and people at one place, you can get a break from them

Agreed, although as a trainee I have to say consistency does make it an easier work environment rather than figuring the stressful stuff like where to park, where the cleanest bathroom is, when is the cafeteria open until, learning the different culture/routine etc. Especially when it is a 1 year fellowship, time is of essence. As an attending I find it great going to 3 or 4 different places in my group because I would be bored out of my mind if I worked in the same location with the same staff day in and out and nice to be able to catch up with people after x amount of time if it's been a while I was at the certain site, keeps it fresh for me. Family vibe is important, and maybe more helpful if you need some flexibility or help on that front if the program has that culture, but depends what kind of clinician you see yourself becoming

 

[nimbus]

multiple hospitals is a great thing as when you get tired of the culture and people at one place, you can get a break from them

We make our new hires “rotate” at least through a majority of our hospitals. The feedback we get is that they mostly hate it ( new surgeons, staff, EMR, blood banks, lab, consultants, etc every month gets tiresome.) The upside is that they get to see the different cases, culture and vibe at each place and have a higher chance of ending up at a place that is a good fit.

 

[Ravenclaw90]

I would think that training opportunities are the same at both places; in the end, you get out of residency what you put into it. Therefore I would choose whichever location you’d be happiest living in. Atlanta has traffic, RTP doesn’t. Atlanta is a big city with more diversity, restaurant and entertainment options. Chapel Hill is a well-to-do college town but Durham and Raleigh are nearby too. Could you see yourself living in either location for the next 5-10 years? Like half of residents end up taking jobs near their program even if they don’t have ties to the region, so the advice to consider training where you might want to work is smart.

 

[woopedazz]

Multiple hospitals is a bad thing

I rotated through 8 hospitals during residency. Was fine. The outlier hospital also happened to be 1,900 miles away from the base hospitals...

 

[Silo004]

I rotated through 8 hospitals during residency. Was fine. The outlier hospital also happened to be 1,900 miles away from the base hospitals...

 

[NVO]

Multiple hospitals is not a pro when you have to drive between them within a day, especially if there is terrible traffic.

We rotate at the VA (same campus), and though I see the benefits of experiencing this different hospital system/patient population, you cannot imagine how much I hate the on-boarding process. Especially since we rotate perfectly infrequently such that we lose all EMR access by the time we come back, every time. (something like you must physically come back and log into a computer every 60 days otherwise you lose it all).

 

[pgg]

I rotated through 8 hospitals during residency. Was fine. The outlier hospital also happened to be 1,900 miles away from the base hospitals...

When I was a resident, I did rotations at 3 places that required living in a hotel - academically they were terrific experiences and I'm glad I did them. But residency is hard enough without extra travel, hotels, and nights away from family.

Out rotations can make up for home program shortcomings, or provide exceptional opportunities above and beyond "good" or "adequate" experiences at home.

One of my rotations was for cardiac anesthesia, since my home program had a very low volume, low acuity heart program. It would've been better if my home program did complex hearts, VADs, transplant, etc. But the out rotation made up for it.

Another rotation was for high risk OB. My home program did lots of deliveries, including moderately high risk stuff. Certainly no shortcomings there. But it was worth my time to go to to a high risk referral center for a month.

Ideally a program can provide a high level of everything. That's not reality though. A program with a lot of out rotations is maybe a bit of a flag, but a mid- or community- tier program that doesn't bother with any is probably a bigger flag.

 

[Mehd School]

Multiple hospitals is a bad thing

Disagree. I rotated in about 4 hospitals in residency and learned wildly different ways to approach the same problem and that has been invaluable. My current colleagues that trained in a place where everything was under one roof seemingly only saw one or two ways to do things. Because they often act as if their way won't work then there isn't another way.

 

[Angus Avagadro]

I targeted my program as it had the highest surgical case load in the city. If you are on the home team, Staff know you and give you more leeway. If you are the person from St. Elsewhere, Staff will be more cautious with you until you prove you aren't a Ninja. I noticed this when I rotated out for Peds and CCM.