Surgery residency: new vs established program dilemma!

[dtj333]

TLDR; really high on this new program (~1000 bed hospital) because of location, potential high case numbers, and the opportunity to assist in building a program. Am I crazy for wanting to rank this new program higher than the more established programs for these reasons? Am I underestimating the struggles of a new program?

Hi everyone,

I have been fortunate enough to have interview invites from a mostly community with a few academic programs this cycle. The academic programs are pretty well known in the region, but the only issue is that they happen to be in more rural areas, with one having particularly low case numbers.

A few of my community programs are arguably stronger in terms of case numbers and are in more desirable locations. However, I am questioning the fit/culture for myself as I reflect on my interviews.

I recently had an interview with a new surgery program that is a large community hospital (~1000 beds) in a desirable location. On paper it seems to have everything I’m looking for in a program. The interview was arguably one of my favorites. It seemed that the faculty all had strong educational backgrounds and were all heavily invested in building the program. I left feeling excited and even already planned a second look.

The dilemma: I feel like the safe choice would be to rank the academic/strong community programs ahead of this new program. However, location is a pretty big factor for me, so that’s why I’m hesitant about the academic places. Culture/fit is also a factor for me so that’s why I’m second guessing the stronger community programs.

My reasoning for the new program is I think it will be a very cool opportunity to be involved in the establishment of a new program (i.e setting the culture, possibly interviewing candidates, giving feedback for curriculum changes), and more importantly I believe I would also get major experience because there are no seniors to fight for case numbers.

What do you all think? Am I crazy to be thinking of ranking this new program ahead of the established ones?

Anyone in this same position (even in other specialties) before and had to make a similar decision?

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[ThoracicGuy]

What do you want to do afterwards? If you want to do a fellowship, look at the established programs, hopefully having placed residents in those fellowships recently. If you want bread and butter general surgery, sure, give the new place a good look. There will be growing pains associated with it and won't have the name recognition out there, but you should still come out trained to do surgery.

 

[DOVinciRobot]

I wouldn’t choose a new program over multiple established programs. I don’t know anyone who made that choice and was happy with it.

 

[palmerspoint]

Established program.

 

[Lem0nz]

TLDR; really high on this new program (~1000 bed hospital) because of location, potential high case numbers, and the opportunity to assist in building a program. Am I crazy for wanting to rank this new program higher than the more established programs for these reasons? Am I underestimating the struggles of a new program?

Hi everyone,

I have been fortunate enough to have interview invites from a mostly community with a few academic programs this cycle. The academic programs are pretty well known in the region, but the only issue is that they happen to be in more rural areas, with one having particularly low case numbers.

A few of my community programs are arguably stronger in terms of case numbers and are in more desirable locations. However, I am questioning the fit/culture for myself as I reflect on my interviews.

I recently had an interview with a new surgery program that is a large community hospital (~1000 beds) in a desirable location. On paper it seems to have everything I’m looking for in a program. The interview was arguably one of my favorites. It seemed that the faculty all had strong educational backgrounds and were all heavily invested in building the program. I left feeling excited and even already planned a second look.

The dilemma: I feel like the safe choice would be to rank the academic/strong community programs ahead of this new program. However, location is a pretty big factor for me, so that’s why I’m hesitant about the academic places. Culture/fit is also a factor for me so that’s why I’m second guessing the stronger community programs.

My reasoning for the new program is I think it will be a very cool opportunity to be involved in the establishment of a new program (i.e setting the culture, possibly interviewing candidates, giving feedback for curriculum changes), and more importantly I believe I would also get major experience because there are no seniors to fight for case numbers.

What do you all think? Am I crazy to be thinking of ranking this new program ahead of the established ones?

Anyone in this same position (even in other specialties) before and had to make a similar decision?

I just left a program like this as faculty from my last job a year ago. On paper it was sunshine and rainbows and was a huge 1000 bed community hospital program. In reality the internal politics at the attending level was a nightmare and had serious negatives for the residents who were starting there. There were still positives and eventually I think it'll be a good residency program but tread carefully.

Edit: Afterthought; you aren't there to build a program as exciting as that may sound. You're there to learn surgery. When you go to apply for fellowships (and more importantly, jobs), program building out of a fresh residency is not as important as just having another publication on your CV for fellowship or knowing how to operate well for a job.

 

[Doc320]

I wouldn't consider location unless two programs are identical in your private rating, which is never the case. It's basically quality of training, ability to get fellowships, not being so malignant that someone will try to permanently end your medical career, and reputation.

 

[LucidSplash]

The reality is that it takes time for attendings to develop the skill of teaching via true graduated autonomy. I would be less interested in the age of the program than in the history of the attendings and PD being involved in other residency programs.

 

[Medstart108]

I think established programs are generally safer, like you suggested, the challenges of building a new program are significant, more than you can likely appreciate at this stage. Residency is barely manageable for any resident, adding the challenges of a new program could very well seriously impact your career, don't be the guinea pig here. Even if the program turns out to be a great one, it will take several years before it becomes a program that you would like to attend.

 

[Severus21]

Go somewhere established if you want to go into academics or competitive fellowship

 

[dienekes88]

Established.

The case numbers may be high, but are those faculty used to teaching and taking residents through cases?

 

[ACSurgeon]

I’ll add- even if the case volume is high, you might not see the complexity or variety. You might have to go elsewhere for trauma/peds/transplant for rotations and be treated like an outsider.