Staying at Home Program for Fellowship

[Dominus]

Hi all, having a bit of an internal debate. I really like my home program and home city for fellowship (PCCM). The program is a good program. However, a few faculty have given me the advice of leaving for fellowship to get a diversity of institutional exposure. I am interviewing broadly for fellowship but how big of an impact does staying vs leaving for fellowship have on career development?

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[gutonc]

Hi all, having a bit of an internal debate. I really like my home program and home city for fellowship (PCCM). The program is a good program. However, a few faculty have given me the advice of leaving for fellowship to get a diversity of institutional exposure. I am interviewing broadly for fellowship but how big of an impact does staying vs leaving for fellowship have on career development?

I think it more depends on what your career goals are and how your home program (vs others) can help you with those. If you want to do IP and your home program doesn't have that, then that's a poor choice for career development. If you want to be a translational CF researcher, a program without a CF program or research will be a poor choice for you. Etc, etc, etc.

Exposure to different institutions can definitely be a plus, but there's also something to be said about being comfortable and productive where you are. If you're already slotted in to a research project/program at your residency institution, you'll be likely to get much further in that if you stay put than if you move somewhere else and start over.

 

[AlbinoHawk DO]

Stay put. Between med school aways, residency, and fellowships, I've been to roughly 5 major institutions. In the end, medicine is medicine. Some places have a few more cases of X vs Y but it's essentially the same. The only time it makes sense to move is because you're going for a niche or you just want to be at your home program for whatever reason

 

[HemeOncHopeful19]

I think it’s way overrated unless your home program is particularly weak training for whatever reason - I would imagine for PCCM you want high volume high acuity with all the subspecialties around in a tertiary center for fellowship but I don’t actually know what I’m talking about.

 

[dozitgetchahi]

Stay put. Between med school aways, residency, and fellowships, I've been to roughly 5 major institutions. In the end, medicine is medicine. Some places have a few more cases of X vs Y but it's essentially the same. The only time it makes sense to move is because you're going for a niche or you just want to be at your home program for whatever reason

I’m gonna break with the pack here and say that I actually think branching out and going elsewhere is important. I have noticed some relatively big differences in management styles, “how we do things”, etc etc in the various institutions in which I trained. I think it gave me important perspective in the long run. Is it the most important thing to look for? No, but I have seen some “lifers” who did college/med school/residency/fellowship at the same place and frankly some of them seem fairly narrow minded and set in one way of thinking and doing things. I think it’s worth it to go elsewhere and see how it’s done.

 

[Ubba]

You asked about career development, which probably favors having a variety of names on your CV. But if you're happy where you are, I'll just point out that this culture in medicine of having to jump around the country for med school then residency then fellowship (the latter two based on the Matches) is utterly toxic. Many people become alienated from their friends and families by dint of this sacrifice.

 

[Gastrapathy]

do your fellowship in the geographic area where you want to get a job, home program or otherwise

 

[mszzeta]

Hi all, having a bit of an internal debate. I really like my home program and home city for fellowship (PCCM). The program is a good program. However, a few faculty have given me the advice of leaving for fellowship to get a diversity of institutional exposure. I am interviewing broadly for fellowship but how big of an impact does staying vs leaving for fellowship have on career development?

Agree above that the clinical training would be similar for your future practice. And you should choose based on your priority, not other faculty's advice. Major things to consider: 1. geographic location for future practice 2. any specific disease or subspeciality interest, if you have

I am not sure how diversity of institutional exposure can be important. Maybe different practice style? as long as there is a diversity of faculty with different training background (vs all faculty trained from a single institution), it should be fine

 

[Dominus]

Thanks for all the advice y'all. This has given me some things to think about. Part of my issue is that I don't have a geographic area I want to end up in currently. Arguably this means I should spread my wings and check out something new for fellowship but I have already done one cross-country move recently and I am dreading doing round 2.

 

[cards67]

Just apply broadly, interview and see how you feel. It's sound advice and one of the reasons I went elsewhere for fellowship, but I wouldn't go elsewhere for that reason alone. I certainly appreciate the new perspective gained, but many do perfectly fine staying put.

 

[Señor S]

If you like the place just stay. You can (and should) broaden your horizons just by making an effort to seek out other perspectives, by reading and by talking to people with different backgrounds. Intellectually lazy people who spend their whole careers in the "This is what I was taught as an intern" "This is the way it's done at the places I've worked" rut are that way by choice.

 

[hotsaws]

I think it really depends on your particular career goals. I certainly don't think institutional diversity for it's own sake is worth much. Geography matters for both PP and academics. Many large institutions hire internally (assuming you're someone that's desirable to work with) and it's easier to connect with local private groups if you live in that area. You mentioned you don't have a particular geographic tie, so you could take this opportunity to go live somewhere totally different and see if it piques your interest. There's also some practical benefits to staying put. If you've developed friendships and a network locally, then it might make fellowship easier if you're personal life is more stable. There's benefits to staying put and also with going to new places. It gets increasingly more difficult, IMO, to make big geographic moves once you've actually started your career. Just apply and interview broadly. Rank the programs that you feel are the best fit for you overall. If you like your home institution the best, stay there -- don't avoid it simply because someone suggested institutional diversity.

 

[FutureInternist]

Agree that fellowship should be at same location if no major difference in training.
You know the system, the attendings, who to call to get a stat echo etc.

Will say that once graduated do NOT stay in same system since you will always be thought of as a student by your now-colleagues who were your attendings a year ago.
Go out, come back if you must a few years later