everyone wants the best of both worlds: a program that's a great fit non-medically (location, co-workers, cost of living) and medically (prestige, research, fellowships). in choosing a program, then, you're weighing near future happiness (where you'll be living the next three years) vs less near future happiness (fellowship and beyond). if you're lucky, you'll get both, but most people have to compromise. or think they have to compromise.
career is important, but so is happiness in the present. after all, you could die on the last day of a brutal, prestigious residency before joining the Cards program at Stanford, and then what would your sacrifice have brought you? it's true that humans are adaptable to adverse conditions and can 'suck it up' for three years or more. I wonder if that's as necessary as people make it out to be.
what I always tell residents and med students is to find a program that won't shut any doors on the career you envision. once you've identified programs like that, then choose the program that's the best personal fit.
the trick is determining which programs won't close doors for you. yes the community program on your list may have matched 1-2 residents to GI every year, but what they don't tell you is that only 1-2 out of 5-6 matched and the others are all hospitalists now. it's extremely difficult to determine the relative strength of these programs in terms of obtaining the fellowship of your choice or whatever else it is you desire. and there are no guarantees. hence the anxiety.
if you're stressing between harvard and hopkins, that's stupid. both will get you where you want to go, so pick whichever one meshes best with you on a personal level. if you're stressing between harvard and UCLA that's still stupid, as UCLA won't prevent you from going where you want to go. After that it gets trickier. there is a point of diminishing returns; at some point the name of your residency will get you a fellowship interview that another name won't. where is that point? that's hard to determine, and the best way to find out is by obtaining information. where do the graduates of the program end up? so 3 residents matched in Cards; how many applied? Where did they match (ie internally, at 'crappy' cards programs, at awesome cards programs)? a one year snapshot isn't great; ideally you'd have a list of where everyone in the last 5 years ended up.
sometimes this information is provided by the programs. at other times you need to talk to current residents or recent grads for the real scoop. even medical students can be helpful since they often have the inside dirt (ie, 'my renal fellow was a former resident and got one interview - at our program'). you can also check out the backgrounds of fellows in the field you're interested in; UCLA's cards program has some interesting info. overall, it's still an imprecise process.
realize that deciding a prospective program is a perfect fit personally based on an eight hour interview day is also an imprecise process. programs withhold information, policies change on short notice and even your feelings about what you 'want' may change. sometimes I think we're spoiled by too many choices. this is counterbalanced by the immense human capability for adaptability - you can learn to like any place you might end up at.
I even think that going to a community program vs Harvard may not be that different, depending upon what you want to do. For example at Stanford there's an Assistant Professor who did her residency at Kaiser SF, not prestigious. take a look at the backgrounds of some of the faculty at 'prestigious' institutions and you'll be surprised by the number who did residency/med school at state of non top 20 programs.
some people will say that these are the exceptions, that most people at prestigious institutions or in academic positions have a big name on their resume. I don't think this is true; I think what these examples illustrate are that excellence is recognized in any venue and that while institution may help boost your career, your personal drive and talent are also important.
what's the upshot, then? I would advise choosing the most prestigious program professionally that would make you happy personally. but then, since it's difficult to determine which program would satisy you personally, just pick a name out of hat.
P Diddy
Loopo Henle said:
I have noticed that there seems to be 2 main theories when it comes to choosing the order of the rank order list, and I am not sure which is the wisest way to go.
1) The Predominant Theory- Choose the programs where you feel you will be the happiest, and where you jive best with the system/housestaff because you don't want to be miserable for three years. 😛
2) The Ambitious Theory- This was summed up best by a neurosurgeon I was talking too while sucking out a chronic subdural hematoma. He basically said "Screw the happy places, go to the best residency you can get into because where you go opens and closes doors for your entire career." I think there is some merit to this way of thinking especially if academics or competitive subspecialties are in the future. After all, it is only three years and most level headed people will find a way to get along and be happy anywhere. 😎
When I look at my ROL from both of these perspectives #1 stays the same but 2-7 are rearranged totally. I was just wondering if others were struggling with this problem as well. 😕
