Rank list confusion

[rankconfusion]

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(btw I am a long time member but created a new username for anonymity's sake)

So who else is totally lost or at least really perplexed about their rank list? Just finished my last interview today (hooray for that!) but don't know how I will come up with a rank list. My main problem is one that I know has been hashed and rehashed here before: fit vs. location. I ideally would like to move back to my home town, which has some of the lowest cost of living in the state and all of my immediate family (whom I haven't seen more than 2-3x/yr for the last 10 yrs), but the residency program itself is just not for me. I don't hate it (and I have come across 1-2 programs that I strongly dislike), but it is small, not the most academically rigorous and (truly not trying to start a flame war here) is filled almost entirely with IMG's/FMG's/DO's. I go to a big name, hoity toity, research intense medical school and think that I might feel out of place. Well frankly I did feel out of place today, the way my interviewers kept saying "oh it is so wonderful that you are even considering our program" - yuck - though I am sure that would all fade fast once residency actually starts. And the funny thing is, I sometimes feel out of place at my own school because people are so intense and hard. So, I would like people to be in a place that is more relaxed, but not this relaxed.

My hometown is also somewhat geographically isolated, so the next closest place for residency is a good 3-4 hours away (driving).

Another thing- if I had to guess what I want to do when I grow up, I would say primary care (i.e. not fellowship/subspecialty) back in my home town - so does it really matter where I do residency? (i.e. maybe I just need to get over my holier than thou notions of what constitutes the "best" residency training).

 

[Gordon Sims]

(btw I am a long time member but created a new username for anonymity's sake)

So who else is totally lost or at least really perplexed about their rank list? Just finished my last interview today (hooray for that!) but don't know how I will come up with a rank list. My main problem is one that I know has been hashed and rehashed here before: fit vs. location. I ideally would like to move back to my home town, which has some of the lowest cost of living in the state and all of my immediate family (whom I haven't seen more than 2-3x/yr for the last 10 yrs), but the residency program itself is just not for me. I don't hate it (and I have come across 1-2 programs that I strongly dislike), but it is small, not the most academically rigorous and (truly not trying to start a flame war here) is filled almost entirely with IMG's/FMG's/DO's. I go to a big name, hoity toity, research intense medical school and think that I might feel out of place. Well frankly I did feel out of place today, the way my interviewers kept saying "oh it is so wonderful that you are even considering our program" - yuck - though I am sure that would all fade fast once residency actually starts. And the funny thing is, I sometimes feel out of place at my own school because people are so intense and hard. So, I would like people to be in a place that is more relaxed, but not this relaxed.

My hometown is also somewhat geographically isolated, so the next closest place for residency is a good 3-4 hours away (driving).

Another thing- if I had to guess what I want to do when I grow up, I would say primary care (i.e. not fellowship/subspecialty) back in my home town - so does it really matter where I do residency? (i.e. maybe I just need to get over my holier than thou notions of what constitutes the "best" residency training).

Interesting. I believe you should rank those programs where you feel most comfortable higher on your list. After all you're going to spend the next few years in this program and don't want to be miserable because you feel out of place or don't enjoy the atmosphere there. Hope this helps.

 

[mcl]

It just doesn't sound like you'd be satisfied with the program close to home, which could ultimately lead to frustration and resentment during your residency. A 3-4 hour drive to see family doesn't sound horrible--you still get proximity and support without the sense of time obligation you might feel if you were living in the same city.

Honestly, I think your happiness with and affinity for the program has to be the primary motivator in determining your rank list.

Mileage may vary, of course.

 

[alwaysaangel]

I'm sure it varies based on specialty. But I have heard a lot of residents tell me that the first step to deciding your residency is deciding whats more important: Your life while at work or your life while not at work.

First you decide that, then you look at those factors.

If your life in residency is more important then did you get a good gut feeling and like the people you would be working with?

If your life outside of residency is more important then is the location one you like? Is it somewhere your significant other would be happy? Are you close to family if that important to you?

Basically its hard to compare the two concepts, so you need to decide which is more important first - all the residents I spoke to seemed very convinced that if you got what was most important to you then everything else would fall into place.

 

[shopsteward]

(btw I am a long time member but created a new username for anonymity's sake)

if I had to guess what I want to do when I grow up, I would say primary care (i.e. not fellowship/subspecialty) back in my home town

I'm surprised you're at this stage and not able to express with a bit more certainty what you want to do with your training. Perhaps that lack of certainty is at the root of your problem with deciding where you want to train?

You will be leaving your medical school pretty soon. The attitudes of the people there have been important for the last four years, but will very quickly become an irrelevance in your life. Working out how much those attitudes are really yours, or will be yours in the future, might help you in finding an answer to what it is you want to do.

You are right that the attitude of your home town program would settle down very quickly. After the first week, would be my guess. Your reputation then will depend on how you perform in the job.

If you think you are going to spend your career as a doctor in your home town, you might think about how important it is to you to go there next July for your residency, rather than in a few year's time after your residency.