Ranking help: Academic vs smaller program for PP job in Texas

[Radsapp2938]

Long time lurker here caught in a dilemma. Looking for some advice, preferably from those who are familiar with the market in Texas.

I'm considering a big name academic program vs a smaller name program with a solid reputation, both in Texas. My goal is to stay in Texas longterm, likely in PP.

I think I would be marginally happier at the smaller name program. I will say that the program also has a good reputation for solid clinical training, albeit on a regional level. It's not technically an academic program but has great volume and is a tertiary referral center. The city itself is also a better fit as it's low cost of living is great for raising a family (wife and kids).

My dilemma is giving up a large academic for a smaller program. I doubt I'll want any flashy jobs in cut throat cities, but I also don't want to shut doors on PP (or fellowship) opportunities when it's time to hunt. From those who are familiar, what's the current feelings on what program an applicant comes from assuming it's within the region?

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[Gadofosveset]

This is a bit of a dilemma.

Option 1: Texas community residency program you like, then Texas academic center for fellowship.

Option 2: Texas academic residency with Texas academic center for fellowship.

(I suppose there are others options, such as
#3: Academic or community program elsewhere and Texas fellowship, lower chance of meeting end goal
#4: Academic or community program in Texas and fellowship elsewhere, lower chance of meeting end goal
#5: No fellowship -- but I wouldn't bank on that)

The real answer is the degree of marginal happiness you're referring to and whether it outweighs exposure to / short term involvement in academic radiology.

My feeling is that you would have to have a very compelling reason (hometown, recently bought house nearby, something else) to override the more academic residency. A marginal preference is not enough for a training decision. It has less to do with getting a job in a coastal city than getting in the best teaching for four years and future job security.

From a training perspective, I see four arguments for an academic program:

- Less variability in teaching skills. More than likely the community program will teach you well in skills that have high reimbursement and which subsequently they see a lot of ("solid clinical training"). There may be some good practical teachers in those areas. The academic center will also teach these well (that's where many of the community teachers probably learned their skills). In the community, other skills will likely have much much weaker teaching... but you may still need those skills in the future, so it would be better to have a better teacher in those areas for a short while, even if you rarely use them in the future... especially if you rarely use them in the future.

- Wider exposure to different pathologies and types of studies. It's not necessarily about the level of acuity, it's about the breadth of exposure. You want to see everything for a while, not just the high volume stuff. By def., you'll see plenty of that later.

- (Good) peer pressure. At least when I interviewed, one of the benefits of community programs was that they had a "more chill" atmosphere. If this is the case, this is not really good for your training. If you were training for a sport would you train with people who just kind of ran at their own speed or with people who were pushing you to be better? In my experience, the academic center residents tend to keep each other moving forward, whereas some community programs have residents who just are allowed to fall off the radar. An alternative would be to have a community program that pushes you to be better, but I don't know many of these (I do know a few). Usually when a community program is bragging that you're going to go through rigorous training it means you're gonna get worked with poor teaching and the rather self-serving excuse of "OJT".

- The name recognition of the academic center may give you an advantage in the future if you need to switch jobs or leave the area.

You can make both options work for private practice, so only you can know if the marginal benefit of the community program outweighs the academic program experience.

 

[Radsapp2938]

This is a bit of a dilemma.

Option 1: Texas community residency program you like, then Texas academic center for fellowship.

Option 2: Texas academic residency with Texas academic center for fellowship.

(I suppose there are others options, such as
#3: Academic or community program elsewhere and Texas fellowship, lower chance of meeting end goal
#4: Academic or community program in Texas and fellowship elsewhere, lower chance of meeting end goal
#5: No fellowship -- but I wouldn't bank on that)

The real answer is the degree of marginal happiness you're referring to and whether it outweighs exposure to / short term involvement in academic radiology.

My feeling is that you would have to have a very compelling reason (hometown, recently bought house nearby, something else) to override the more academic residency. A marginal preference is not enough for a training decision. It has less to do with getting a job in a coastal city than getting in the best teaching for four years and future job security.

From a training perspective, I see four arguments for an academic program:

- Less variability in teaching skills. More than likely the community program will teach you well in skills that have high reimbursement and which subsequently they see a lot of ("solid clinical training"). There may be some good practical teachers in those areas. The academic center will also teach these well (that's where many of the community teachers probably learned their skills). In the community, other skills will likely have much much weaker teaching... but you may still need those skills in the future, so it would be better to have a better teacher in those areas for a short while, even if you rarely use them in the future... especially if you rarely use them in the future.

- Wider exposure to different pathologies and types of studies. It's not necessarily about the level of acuity, it's about the breadth of exposure. You want to see everything for a while, not just the high volume stuff. By def., you'll see plenty of that later.

- (Good) peer pressure. At least when I interviewed, one of the benefits of community programs was that they had a "more chill" atmosphere. If this is the case, this is not really good for your training. If you were training for a sport would you train with people who just kind of ran at their own speed or with people who were pushing you to be better? In my experience, the academic center residents tend to keep each other moving forward, whereas some community programs have residents who just are allowed to fall off the radar. An alternative would be to have a community program that pushes you to be better, but I don't know many of these (I do know a few). Usually when a community program is bragging that you're going to go through rigorous training it means you're gonna get worked with poor teaching and the rather self-serving excuse of "OJT".

- The name recognition of the academic center may give you an advantage in the future if you need to switch jobs or leave the area.

You can make both options work for private practice, so only you can know if the marginal benefit of the community program outweighs the academic program experience.

Thank you for your reply. It brings up several good points and reminds me of why academic programs are preferred. I'm definitely looking at option 1 vs option 2. I'll also go ahead and mention that the small program is Temple Scott and White. I will say that I believe the fit and happiness factor is more than "marginal" but I'm not really sure how much more. I mainly used the word marginal because I was looking for a more elaborate response than "go wherever you'll be happiest/has the best fit". For me, the city is ideal because I have family nearby in each direction. Also with a family, the cost of living can't be beat. With that said though, we can certainly afford to live in the larger city and will still be close to family.

Scott and White itself isn't really a community program or an academic program. It sort of falls into no man's land. It seems that the breadth of cases and pathology they see is on par with all the academic centers since they serve such a large area in Central Texas. The peer pressure thing is an interesting point and something that could be a legitimate concern between the two programs. I definitely have appreciated and benefitted from having strong classmates around me in medical school. Another thing that was mentioned by residents/recent grads was the extensive networking ties at S&W. I've heard that the faculty and leadership are very willing to make phone calls to program connections to help secure a job/fellowship. Though I am assuming this is present at every program, it appeared to be particularly advantageous at Scott and White since they are a well established program and largely dominate Central Texas.

My ultimate question then to you (and to others) is this: Without considering the other downsides you mentioned of training at a community program, how much does option 1 affect your chances at landing a reasonably attractive fellowship/PP job in region vs option 2?

 

[Gadofosveset]

Given the boundaries you've set up, I would think it would be no problem getting a PP job in the region. This is based on watching fellows get jobs in other regions, but if there's an attending out there with more TX-specific experience, it would be good to hear from you. It may be that the supply and demand pool in TX may be relatively tight with everyone in TX wanting to stay and others wanting in (like CA). That being said, the local networks you could set up at Scott and White would go a long way to getting you preference for a job as long as people know you're a decent person and a hard worker. Even if you go somewhere far-flung for a year of fellowship, I know several people in the midwest who set up a job with a private group at the end of residency, starting in one years' time (they usually choose a fellowship that would be advantageous to the group).

Looking at the S&W match list, it looks like they have some connections with local fellowships and have some internal fellowships of their own (IR? mammo?). So this really is not quite a "community" program. I would guess you would have no problem finding a reasonable fellowship and eventual job. If it's your definite plan to stay in the area, this is not a bad way to go about it.