Rank list for PP

[Radiologyreviews2015]

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I would really appreciate any advice on my rank list. My goal is to get back to the west coast, and probably PP>academics. I'm having a lot of trouble because I'm worried the "big name" places I interviewed at won't get me the training I need for PP (I want to become a beast at crushing lists and doing procedures). I'm also couples matching, fiancé doing peds, so ideally I'd like a program with lots of fellowships so we can just stay and not do this process again. Thoughts are appreciated, especially from any residents at these places.

UW- ideal location, tons of fellows, traveling to 6 sites in Seattle traffic sounds miserable, high cost of living
MGH- amazing residents, great perks, great fellowships, Boston could be cool but $$$ and cold
Mallinckrodt- great facilities, friendly residents, good cost of living, don't want to get stuck in midwest
UTSW- liked Dallas, tons of fellowships, nice PD, seems like Texas job market is good, amazing moonlighting
Emory- great gut feeling, friendly residents, my favorite interviews, unsure about Atlanta
USC- everyone was so happy, tons of hands on experience, great network, LA not my fav
Brown- everyone happy, really hands on, department best in hospital, Providence was cute, only 2 fellowships
Mayo Rochester- People were down-to-earth, great volume, low cost of living, unsure of Rochester
BID- loved the PD and chair, tons fellows
Michigan- nice residents, had some off interviews, unsure about AA
Northwestern- tons of fellows, unsure of Chicago job market, better cost of living than Boston
U Chicago- liked the PD and interviewers, less fellows than NW so more hands on
UT Houston- nice residents, loved MD Anderson, hate Houston weather
Baylor Houston- loved the PD, very hands on, hate Houston weather
OHSU- amazing location and facilities, good fellowships, maybe too laid back

Interviewed at a few more but not ranking bc of weird vibes on my interview day.

 

[Radiologyreviews2015]

The biggest name on your list is MGH and you don't think they have enough cases for you to crush? Partners is buying up hospitals left and right and a lot of the imaging is sent to the academic center for interpretation. The false rumor that people send out that academics doesn't have enough volume is just false. Large academic centers are expanding like crazy and buying up community practice. Places like MGH have never ending lists for you to crush. Their imaging is also advanced and complex. If you can chew through those lists, then you are set for PP. So in my opinion, the places that train the best academic radiologists also train the best private practice radiologists.

 

[Radiologyreviews2015]

I agree with you on MGH, their residents seemed very knowledgeable and on the ball, but they heavily stressed academics. I keep going back and forth on my top 5, and I need to decide soon so I can send the #1 email before programs make their decisions. I'm really curious if anyone can comment on the hands on experience at UW, MIR, Emory, UTWS. I'm hoping the job market will be wide open in 5 years and that location won't matter as much.

 

[Radiologyreviews2015]

You can crush as many cases as you want at MIR. I have friends at programs all over (including several you listed), and none match the volume I see daily. There isn't a slant for academics or private practice, and in my experience, people don't have trouble getting jobs outside of the Midwest. With the combination of volume and complexity, I don't see how I could be any better prepared for private practice.

I agree with the above that high volume academic places prepare residents the best for private practice.

 

[Radiologyreviews2015]

Just rank by where you/your fiancé want to end up working. There's really not a bad program in your list, and you'll have the best bet with pp in your area. Don't get caught up in the SDN critics and prestige, do whats best for your family.

 

[Radiologyreviews2015]

Texas is a really good market. As well as just a great place for a physician (of any specialty) to work.

 

[shark2000]

I would really appreciate any advice on my rank list. My goal is to get back to the west coast, and probably PP>academics. I'm having a lot of trouble because I'm worried the "big name" places I interviewed at won't get me the training I need for PP (I want to become a beast at crushing lists and doing procedures). I'm also couples matching, fiancé doing peds, so ideally I'd like a program with lots of fellowships so we can just stay and not do this process again. Thoughts are appreciated, especially from any residents at these places.

UW- ideal location, tons of fellows, traveling to 6 sites in Seattle traffic sounds miserable, high cost of living
MGH- amazing residents, great perks, great fellowships, Boston could be cool but $$$ and cold
Mallinckrodt- great facilities, friendly residents, good cost of living, don't want to get stuck in midwest
UTSW- liked Dallas, tons of fellowships, nice PD, seems like Texas job market is good, amazing moonlighting
Emory- great gut feeling, friendly residents, my favorite interviews, unsure about Atlanta
USC- everyone was so happy, tons of hands on experience, great network, LA not my fav
Brown- everyone happy, really hands on, department best in hospital, Providence was cute, only 2 fellowships
Mayo Rochester- People were down-to-earth, great volume, low cost of living, unsure of Rochester
BID- loved the PD and chair, tons fellows
Michigan- nice residents, had some off interviews, unsure about AA
Northwestern- tons of fellows, unsure of Chicago job market, better cost of living than Boston
U Chicago- liked the PD and interviewers, less fellows than NW so more hands on
UT Houston- nice residents, loved MD Anderson, hate Houston weather
Baylor Houston- loved the PD, very hands on, hate Houston weather
OHSU- amazing location and facilities, good fellowships, maybe too laid back

Interviewed at a few more but not ranking bc of weird vibes on my interview day.

I think you won't get a good training at MGH or Mallinckrodt. Choose a small community program and read 50 NORMAL head CTs. It prepares you better for your goal.

It is depressing that you don't care about the quality of teaching, getting exposed to high end pathology, staffing out with Gurus in the field and becoming a well trained radiologist. You just want to be able to crush the list.

Is this really your understating of practice of radiology? Crushing the list without any quality?

 

[Radiologyreviews2015]

OP's logic is flawed and might lead to some serious disappointment and regret down the line. Anyone can crush lists reading normals. Do that with an complicated list and you will be set. No one ever complains about "low volume." The lists at MGH, MIR, and Mayo never end. Read all you want.

 

[DeucesHigh3]

OP's logic is flawed and might lead to some serious disappointment and regret down the line. Anyone can crush lists reading normals. Do that with an complicated list and you will be set. No one ever complains about "low volume." The lists at MGH, MIR, and Mayo never end. Read all you want.

Yeah, where are these powerhouse academic programs that do *so* little imaging that the residents are just chilling in the reading room, waiting for scans to come in? It seems like a very false dichotomy to me.

 

[Radiologyreviews2015]

Thanks for your thoughts everyone, although I wish we could keep our comments more kind and respectable. I think its absolutely true that big academic medical centers will give you a broader fund of knowledge and allow you to see more zebras in real life, I was asking for opinions on how the resident experience differs within these places. On several tours I had residents tell me that fellows steal a lot of the good procedures/cases on this or that rotation. I don't think its wrong for me to want great didactics and lots of hand on work.

 

[Radiologyreviews2015]

Thanks for your thoughts everyone, although I wish we could keep our comments more kind and respectable. I think its absolutely true that big academic medical centers will give you a broader fund of knowledge and allow you to see more zebras in real life, I was asking for opinions on how the resident experience differs within these places. On several tours I had residents tell me that fellows steal a lot of the good procedures/cases on this or that rotation. I don't think its wrong for me to want great didactics and lots of hand on work.

No one is making you rank any one way or another. If you really value that over the resources of larger places, by all means go ahead and rank them.

 

[cowme]

There is a massive range of volume at the big names. I know fellows at some of the biggest names in radiology, and their experiences are night and day. One spends half of his day staring an empty work list and trying to look busy, the other has yet to leave the hospital before 630 pm. Unfortunately, it's not really something you can get a good gauge on beforehand, but some of the big names are actually horrid experiences for private practice.

 

[Radiologyreviews2015]

All respectable academic program will have a never ending list. Nobody sits around. Fellows get higher end imaging but there's plenty to go around that they expect residents to help out or they will never go home. At my program, first year residents can read brain and spine MR, CTAs, MRAs, abdominal and pelvic MR, pregnant appy MR, prostate MR, and any joint MR. Our hospital MR scanners run 24/7 and we have outpatient MRs that scan 12 hours a day including weekends. On the other hand, you could be at a smaller place with no fellows but also no high end imaging and be reading normal xrays and simple CTs all day. I'm going into PP and I feel well prepared.

 

[cowme]

Sorry to bust your bubble, but you are wrong. Sorry I'm not willing to name names and trash programs publicly, but I promise you one of everyone "top 5" programs has this problem bigtime in certain departments. Too many attendings, residents and fellows on service and not enough work to go around

 

[Radiologyreviews2015]

By that logic, people should go to community programs for residency and fellowship in preparing for private practice. Yet even residents from community programs flock to top academic names for fellowship.

You have to realize that the majority of residents from even the most academic programs end up in private practice (just because of the fact that there are way more pp jobs than academic jobs). In today's corporate medical environment, it is these large academic centers that are buying up community hospitals and increasing their volume. The notion that academics does not have enough volume for a future in private practice is at least 20 years out of date.

It is also much easier to dictate normal or near normal studies. The complex cases get referred from community practice to academics. Dictating tertiary abnormal cases is like running with weights. Once the weights come off, you can crush the normals.

 

[cowme]

Oh, ok. Thanks. I'll take your anonymous word for it. I'm sure you must know more than me with all your vast experience on your elective rotation in radiology.

 

[shark2000]

Some people can never become a fast reader. It is mostly due to their personality that is a mixture of OCD and "taking their time" to do a task. Somehow like note writing in internship. Some people are very fast at it and some never can become fast.

Otherwise, there is not MAGIC in becoming fast. It comes with time for 80% of people. It comes with practice. You can get there after 1-2 years of private practice. On there other hand, the quality of training, the great education and the network that you can make in a big place is not easily achievable by doing 1-2 years of private practice.

A lot of community program residents keep bragging about their SPEED. Reading 100 normal head CTs is different that reading 20 very complex CT abdomen and pelvis. Anyway, even if the graduates of community programs are faster upon their graduation, in 2 years they will be no different than a graduate of a big academic center. However, other advantages of being trained at a big academic center can not be replaced easily.

Long story short, it is a BS to say going to a small community program prepares you better for private practice. This has been going around for over a decade. I remember it from my med school. Also interestingly, the same community program residents who claim that their program is better than MGH, MENTION 10 times during their job interview or during a meeting that they did their body fellowship at HOPKINS or HARVARD or STANFORD.

 

[cowme]

Good lord, every time anything remotely negative is said about a top program it automatically devolves into a discussion about why mgh is better than Community hospital programs...as if that is what anyone is comparing

 

[Radiologyreviews2015]

Good lord, every time anything remotely negative is said about a top program it automatically devolves into a discussion about why mgh is better than Community hospital programs...as if that is what anyone is comparing

and all the snide remarks about "10 years into practice, no one will care that you were trained at XXX". Every time my fellow 4th year students tell 1st years that "preclinical grades don't matter at all" or "being a gunner during 3rd year is not worth it", I cringe so much. We all know what kind of people the medical profession attracts (please don't tell me the self-sacrificing type, or the type that doesn't care about grades/prestige)

 

[Radiologyreviews2015]

OP seems like he or she has a good work ethic and has great opportunities from the list provided. It doesn't cost you anything to rank a great program over a good program. Analogy I like to make is with cars. If I'm buying a car, then I'm buying the Toyota Camry or Honda Accord over my dream car Tesla Model S or X because the former costs $25,000 and the latter can cost $100,000. I cannot justify spending $100,000 on a car. The $25,000 Toyota or Honda is much better value to me because I'm paying for it.

However, what if someone is giving you that car and it doesn't cost you anything. Then I'm picking the Tesla in a heart beat. My point is to ignore the noise and just go to the best program you can. You have great opportunities, best of luck.

 

[Radiologyreviews2015]

and all the snide remarks about "10 years into practice, no one will care that you were trained at XXX". Every time my fellow 4th year students tell 1st years that "preclinical grades don't matter at all" or "being a gunner during 3rd year is not worth it", I cringe so much. We all know what kind of people the medical profession attracts (please don't tell me the self-sacrificing type, or the type that doesn't care about grades/prestige)

Ah yes, the true sign of a gunner: gunning those years behind you.

 

[futureradres12345]

One other argument in favor of the big academic programs is to be surrounded by the best and brightest and to draw inspiration/motivation to work hard from being around those people. If you are the type of person, like myself, who has a tendency to coast when the opportunity presents itself or to work up (or down) to the level of those around you, it might be valuable to go to one of the big name academic programs.

This is not to say that people at smaller community programs are not smart or hard-working, but generally speaking I think most people would agree that, on average, the community programs have a more relaxed culture and less oversight from attendings. Again, I realize I'm generalizing here and there are likely many exceptions.

 

[Radiologyreviews2015]

By and large, academic programs tend to have more opportunities, more dedicating teaching time, and stronger networking. If you graduate from a mid to top tier academic program, you will have the opportunity to pursue both academics or private practice. You will see more and be exposed to a bigger breadth of pathology (and taught by those who are experts at reading it). A few years into working you will likely be reading as fast as you would have if you had trained in exclusively in bread and butter.

If you go to a community program, you can get very good training for the PP world and perhaps have good connections locally. However, you are more than likely limited to PP unless you show some academic achievement (and opportunities may be less common for this in the community). You may be faster right out of training but your exposure to some of the rarer pathology may be significantly less just based on patient population. I feel like there's no real downside to academic programs due to better emphasis on training and more opportunities. You can still carve your path in any direction. It's harder to do when coming from a community program. I'm talking big picture here though, every program and situation is different.

 

[Radiologyreviews2015]

Most people would go to the top academic centers for residency over community programs if they had the opportunity to interview and match there. Community program residents go to the top academic programs for fellowship for a reason. We cannot have a reasonable discussion unless we are honest with ourselves. For example, I went to a mid-tier college only because I couldn't get into the top ones (trust me I applied). Same thing for medical school (I applied to all the top ones and was rejected). We often try to justify our positions and try to make ourselves feel better by bending the truth and I don't think that's healthy. It would be wrong of me to say that my school is better than Harvard or Stanford or Yale (for whatever reason I make up), because I wanted to go to Harvard or Stanford or Yale in the first place (I would do that in a heart beat if given the chance). Tides changed in medical school and I was fortunate enough to interview and rank majority of the top names you guys throw around. So do the best with the situation that you are in and be honest.

 

[Shipping News]

Yeah, where are these powerhouse academic programs that do *so* little imaging that the residents are just chilling in the reading room, waiting for scans to come in? It seems like a very false dichotomy to me.

Stanford perhaps?

 

[Radiologyreviews2015]

Nah, endless lists here too

 

[Radiologyreviews2015]

Nah, endless lists here too

MGH MSK does not have enough MR volume for their residents, because they take too many fellows + minifellows each year. At best, you can expect to read 4-5 MRs per morning. The rotation is set up where morning is MR and afternoon is radiographs.