Rank Question: Community vs. University Programs

[GiraffeAddict]

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So as interview season wears on I find myself thinking about rank list time. I've interviewed at some of the bigger name "University of X" programs, as well as a smattering of community programs, both big and small. All of the advice I've gotten so far has been along the lines of "Ahh you've got to go to the best/highest ranked university program so you can get into the best/highest ranked fellowship" or "Just go where you've got the best feeling". Obviously this is oversimplifying it, but I find myself having mixed feelings. Some of these community programs have rocked, and feel like would provide excellent training. My dilemma comes in trying to justify ranking such programs higher than these fancy, big name university programs. What you do guys think?!

 

[Dumpstarrian]

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[qwerty89]

hmm I've gotten the sense that at some university programs the residents, especially first years, just function like a med student + read maybe a handful of studies a day. This is in contrast to some good community programs, where you might read 10 in morning as a junior resident + more in the afternoon.

Maybe I havn't interviewed at many top programs wehre the heavy fellowships are but everyone seems to say train at a place which is resident run as a resident and then go to a big name with tons of fellows for fellowship.

 

[dude1344]

This is just my experience at a "top" university program. I'm a first year and I read 30+ CTs in a day regularly... It just really depends where you go. Best thing to do is ask the residents!

 

[rads321]

There are large variations between programs and it would be hard to say all university programs are blah and all community programs are blah. I am at a solid university program and there is more volume than I could read even if I wanted to... at my internship in a smaller university hospital the volume was relatively low with the residents have excess downtime IMO.

 

[choweee]

Remember volume is one part of it, complexity is another. Our academic center covers a local community hospital remotely overnight and the CT A/Ps there are super straightforward and quick to read (e.g., mostly normal with appendicitis or diverticulitis. Occasional renal cyst). The daytime inpatient studies on the other hand are much more complicated, contain more pathology, and have more post-op findings. IMO I would rather spend R1 year delving into 10 diverse and complex CTs a day than working on speed with 30 straightforward CTs. Speed will come later!

 

[shark2000]

Remember volume is one part of it, complexity is another. Our academic center covers a local community hospital remotely overnight and the CT A/Ps there are super straightforward and quick to read (e.g., mostly normal with appendicitis or diverticulitis. Occasional renal cyst). The daytime inpatient studies on the other hand are much more complicated, contain more pathology, and have more post-op findings. IMO I would rather spend R1 year delving into 10 diverse and complex CTs a day than working on speed with 30 straightforward CTs. Speed will come later!

Very good point.
Also once you've read the first 100 diverticulitis or appendicitis cases, you look for more complexity. By the end of your first year, you should become comfortable with most bread and butter pathologies.

One other reason that in community programs residents can read more studies is the straightforward nature of the scans. Reading 50 normal CT heads is way different that reading 20 complex CT abdomen-pelvis.

Once you get good at reading all sorts of complex cases, pp will be like a piece of cake for you. You've already seen enough bread and butter cases in your training (which exist everywhere). But also, you can give high quality reads on uncommon complex scans that happen in pp. This brings a lot of respect to you among your colleagues and also among referring clinicians.

 

[qxrt]

Very good point.
Also once you've read the first 100 diverticulitis or appendicitis cases, you look for more complexity. By the end of your first year, you should become comfortable with most bread and butter pathologies.

One other reason that in community programs residents can read more studies is the straightforward nature of the scans. Reading 50 normal CT heads is way different that reading 20 complex CT abdomen-pelvis.

Once you get good at reading all sorts of complex cases, pp will be like a piece of cake for you. You've already seen enough bread and butter cases in your training (which exist everywhere). But also, you can give high quality reads on uncommon complex scans that happen in pp. This brings a lot of respect to you among your colleagues and also among referring clinicians.

This is not a distinction with a clear line between academic and community programs. If you are at a tertiary/quaternary care hospital, regardless of whether it is academic or community, you will see all the pathologies that any other large hospital will see. I would only agree with you in so far as that you are at a disadvantage as a resident if you are at anything less than a trauma 1/tertiary care hospital, or a hospital that refers its most complex patients to other larger hospitals. Most residents, at both academic and community programs, see the huge majority of their rare cases in case conferences and lectures and textbooks, not in the daily images they read out with their attendings. Sure, you may see more cases of radiologic manifestations of specific rare diseases if your medical center specializes in it, but there is such a wide variety of pathologies that no medical center monopolizes specializations in all of them, and, believe it or not, some non-academic hospitals are actually at or near the top of the pack in esoteric fields.

 

[shark2000]

This is not a distinction with a clear line between academic and community programs. If you are at a tertiary/quaternary care hospital, regardless of whether it is academic or community, you will see all the pathologies that any other large hospital will see. I would only agree with you in so far as that you are at a disadvantage as a resident if you are at anything less than a trauma 1/tertiary care hospital, or a hospital that refers its most complex patients to other larger hospitals. Most residents, at both academic and community programs, see the huge majority of their rare cases in case conferences and lectures and textbooks, not in the daily images they read out with their attendings. Sure, you may see more cases of radiologic manifestations of specific rare diseases if your medical center specializes in it, but there is such a wide variety of pathologies that no medical center monopolizes specializations in all of them, and, believe it or not, some non-academic hospitals are actually at or near the top of the pack in esoteric fields.

Your statement is oversimplification. Many radiologist programs are not level 1/tertiary care hospital. Big academic centers are usually sub-specialized in many fields. If you go to a big academic center, you will see a variety of pathologies in different aspects of radiology. A community program may be tertiary care center, but it is usually in one or a few fields. The goal is to get a comprehensive radiology training.

Also don't underestimate the value of sub-specialized attendings.

Despite all the talk about sub-specialization, most pp radiologists read a variety of cases. Getting a comprehensive training in residency is the key.

 

[qxrt]

Your statement is oversimplification.

My statements are much more nuanced compared to your constant simplification of "academic = quaternary subspecialized; community = secondary generalists." I agree that there are many community programs that do not have the sufficient capacity to support a variety of pathologies, but there are also many that do. This is not a characteristic with a definite line that corresponds to academic vs community programs. Subspecialist radiologists do exist in community hospitals that can support the volume; this is not a distinction based on academic vs community, but rather practice volume. And considering that many academic programs have practices that are actually private groups with contracts with the medical center, I do not know why you are speaking as if private practice only exists in community hospitals. There are definitely some community programs out there that provide better training and have better reputation than some academic programs.

 

[shark2000]

My statements are much more nuanced compared to your constant simplification of "academic = quaternary subspecialized; community = secondary generalists." I agree that there are many community programs that do not have the sufficient capacity to support a variety of pathologies, but there are also many that do. This is not a characteristic with a definite line that corresponds to academic vs community programs. Subspecialist radiologists do exist in community hospitals that can support the volume; this is not a distinction based on academic vs community, but rather practice volume. And considering that many academic programs have practices that are actually private groups with contracts with the medical center, I do not know why you are speaking as if private practice only exists in community hospitals. There are definitely some community programs out there that provide better training and have better reputation than some academic programs.

So then when it comes to fellowships how come most of graduates of these "better more reputable"community programs leave for the worse academic programs?

Anyway, I am not going to argue more. I am convinced that the community program that you are doing your training at, has the best education and its reputation is better than MGH and UCSF.