Rank list woes

[Mehd School]

I know this probably isn't the place for this. But I thought I had my #1 down pat for the last two months. However, as it draws closer I am truly unsure between my top 3. Just going to throw this out there to the people that have been there and see what they think.

#1- In the city I want to live in long term. Favorite PD. Great name known Nation wide. Small group of residents, but I know two of them from med school and they're happy. Loved the other residents. No real fellowships. Not level 1 trauma. Horrible intern year.

#2- Also in the city I want to call home. Known as the best program in the city, but not known well outside of the area. Medium sized program, has all the fellowships. Going through a PD change (for the better). All fellowships, level 1 trauma. Residents and attendings were arrogant and pretentious. Tolerable intern year.

#3 - Far away from where I want to live long term, but close to where I went to med school. One of the best programs in the country that isn't Duke, Stanford etc. although not a massive name outside the anesthesia world. Most fellowships, level 1 trauma etc. Liked the residents a lot and the PD. Liked the city. Fantastic intern year.

I can't. Make up. My mind.

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[lverbmb]

I know this probably isn't the place for this. But I thought I had my #1 down pat for the last two months. However, as it draws closer I am truly unsure between my top 3. Just going to throw this out there to the people that have been there and see what they think.

#1- In the city I want to live in long term. Favorite PD. Great name known Nation wide. Small group of residents, but I know two of them from med school and they're happy. Loved the other residents. No real fellowships. Not level 1 trauma. Horrible intern year.

#2- Also in the city I want to call home. Known as the best program in the city, but not known well outside of the area. Medium sized program, has all the fellowships. Going through a PD change (for the better). All fellowships, level 1 trauma. Residents and attendings were arrogant and pretentious. Tolerable intern year.

#3 - Far away from where I want to live long term, but close to where I went to med school. One of the best programs in the country that isn't Duke, Stanford etc. although not a massive name outside the anesthesia world. Most fellowships, level 1 trauma etc. Liked the residents a lot and the PD. Liked the city. Fantastic intern year.

I can't. Make up. My mind.

Hard to determine which program is right for you specifically given that everyone has different priorities. I would just give my personal opinion on a couple of things.

1. Your intern year should really matter the least when choosing between a program. I get it, it can be a painful year but like all things it will eventually pass and you might be surprised that it wasn't as bad as you imagined. You are going to a specific program for anesthesia training - so that should be the focus of your priorities when choosing a program.
2. I personally think trauma is over rated. Thinking back now as a CA3 some of my bloodiest/difficult airway cases weren't even traumas. Bloodiest and most difficult airway i had was on a floor medical Heme/onc disaster... acute luek in DIC with previous radiation to the head/neck with diffuse alveolar hemorrhage - most transfusions was split between an L&D PPH (Questionable AFE) and a liver transplant both 100+ products. I mention this just cause I also thought being a trauma center was important when choosing residencies, looking back I don't think its as important as I had made it out to be.
3. I think the general advice is to go to a program near where you want to eventually end up as that program may have connections there. I would say the exception to that is the big "brand name" programs who have large alumni networks and even if they don't have alumni in the area you want to end up the name alone of the program will help open doors for you... i won't name any specifics but im sure you know which types of programs in talking about. These programs can also really help with fellowship if you end up choosing to do a fellowship.
4. Lastly i do think that if you had your mind made up on a program for the last 2 months then that program is probably right for you. Its normal to have doubts as rank lists come to a close but i've only heard of people regretting last minute changes.

Good luck!!

 

[wickedskillz]

Other things to consider
- If you're married, see if one city works better for SO
- Agree that level 1 trauma is cool but doesn't matter much
- staying in the same city that you want to live long term has all sorts of benefits, like knowing how practices are set up, you can buy a house early, etc..
- at the end of the day, going to a big name program matters a lot more for academic careers or if you're going to be moving around the country. I've met brilliant people from small programs and Idiots from big ones.
- what matters more imo is a comfortable and supportive work environment and exposure to great cases
- I would look into case volume of the smaller program. Do they do sick hearts, or just straightforward CABs? Are any of the regional people fellowship trained? Do they struggle to make any of their numbers? If there case diversity is good, it mihht be better if no fellows since you get first Dibs on big cases!
- wouldn't move for a bigger name unless it was a city i wanted to live in anyway, unless once again you're planning to try to get into a big fellowship and/or go academic.

And lastly, if you're stuck between 3 hard choices, don't fret - it probably means all three are good choices!!

Good luck!

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[wickedskillz]

Also, how often do graduating residents get the job / fellowship they're looking for? Maybe better to ask some of the CA3s about how their class did, and the class ahead of them..

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[Mehd School]

I wanted to thank everyone for their input.

In regards to my future goals, I will almost certainly complete a fellowship for various reasons. And I do have a real passion for education, however I'm not sure that I see myself as an purely academic physician. Possibly later in my career. All three programs listed are academic institutions who's name would in no way hurt my chances in the world of academia. My short term plans are to be a competent anesthesiologist in private practice, get this mortgage called student loans paid off and enjoy time with my family.

I'm glad to hear that trauma isn't as necessary as I originally thought. And truth be told, my current #1 offers a trauma month at the nearby level 1 hospital, but I have been told that while it's a great idea most residents don't end up taking advantage of it due to the stress of learning a new hospital for one month's work and education.

Residents at my #1 split between private practice and fellowships, and do extremely well in both. I'm feeling much better about it today. I legitimately lost sleep over it last night.

 

[wickedskillz]

Take comfort in the fact that if you're a motivated individual, your training will likely be fantastic at either of the institutions!

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[deleted697127]

I wanted to thank everyone for their input.

In regards to my future goals, I will almost certainly complete a fellowship for various reasons. And I do have a real passion for education, however I'm not sure that I see myself as an purely academic physician. Possibly later in my career. All three programs listed are academic institutions who's name would in no way hurt my chances in the world of academia. My short term plans are to be a competent anesthesiologist in private practice, get this mortgage called student loans paid off and enjoy time with my family.

I'm glad to hear that trauma isn't as necessary as I originally thought. And truth be told, my current #1 offers a trauma month at the nearby level 1 hospital, but I have been told that while it's a great idea most residents don't end up taking advantage of it due to the stress of learning a new hospital for one month's work and education.

Residents at my #1 split between private practice and fellowships, and do extremely well in both. I'm feeling much better about it today. I legitimately lost sleep over it last night.

Being a level 1 trauma center doesn’t necessarily mean a hospital gets a lot of trauma.

 

[Mehd School]

Being a level 1 trauma center doesn’t necessarily mean a hospital gets a lot of trauma.

If you're the only level 1 trauma center in a mid sized city I have to assume you would.