T20 (~70k) vs. UPR SOM (~15k)

[deleted1192556]

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Hi everyone!
I got accepted into a T20 medical school and into my "in-state" medical school.
I'm Puerto Rican. UPR-SOM, the school I got into, is LCME accredited and not on probation, but even in USMD interviews I've been asked whether or not I'm a US citizen. All Puerto Ricans are... ;-:

Based on this, will going to an unranked, LCME accredited school outside the mainland US hurt me in my future? For residency? For faculty positions?

I've always wanted to do internal medicine, subspecialty (unsure which) and then do academic medicine.
Will I be held back for academic medicine even if I match into a highly ranked program for residency?

I do like the T20 program but it is far from home. It would require me to take out horrendous loans and force me to get a car in the states...
However, it is graded P/F whereas UPR-SOM still uses letter grades. There are way more research opportunities, UPR-SOM students usually go do research at other institutions over summer.

I live next to UPR-SOM, I get to be closer to my aging parents, and it wouldn't hinder me financially at all.

So which would be the better path for academic medicine and how can I make sure I don't shoot myself in the foot?
I'm certain on academic medicine. My mentors are involved in it. I enjoy research, but I also want to be financially responsible.

Thank you!

 

[zeyaatin]

i’d probably lean towards the USMD, will open more doors for you esp with your interests in academics.

the debt burden isn’t necessarily trivial but i think for the most part if you are mindful about your spending post residency it shouldn’t be too difficult to pay off with attending salary / looking at PSLF

 

[SpicyHotSauce]

i’d probably lean towards the USMD, will open more doors for you esp with your interests in academics.

the debt burden isn’t necessarily trivial but i think for the most part if you are mindful about your spending post residency it shouldn’t be too difficult to pay off with attending salary / looking at PSLF

Are UPRSOM graduates not considered USMDs, even though you apply to them through AMCAS and Puerto Rico is considered as a territory of the US?

 

[Mr.Smile12]

I'm also under the impression UPR is considered an USMD program.

I am sure most PR islanders have the dilemma of moving to the mainland or staying. What would your family think if you were to go to the T20? There's merit in getting connected to US academia if you want to ultimately be part of that community. Again, LMSA and NHMA connections could help you go through these factors.

Congratulations!

 

[deleted1192556]

Just to clarify: UPR is a LCME accredited USMD program.
All the medical schools in PR although Ponce is a for-profit school and the other two SJB and UCC have had accreditation problems in recent years.
The main distinction I'm interested in is whether there is a difference between mainland USMD programs and one in PR.

 

[LizzyM]

One of the biggest differences will be your loan burden and the freedom you will have to take a lower paying job after residency/fellowship if you choose the less expensive route. Academic medicine does not pay as well as private practice (although private practice is seldom a "small business" as it was a generation ago and now you are more likely to be working for wages and bonuses as an employee of a group practice owned by an investment group or a hospital conglomerate -- or both).

I've been working with academics for 40+ years and many of them came from state schools, not the T20s. Part of what will matter is where you match for residency and much of that is on YOU. Take advantage of the opportunity to do research in the summer on the mainland (NYC has a vibrant Puerto Rican community) and then figure on matching either in PR or on the Mainland. Either way, your alma mater will signal quite clearly that you are bilingual and that is a huge plus in much of the country.

 

[deleted1192556]

Thank you all for the insight! : )

 

[Goro]

The you of 50 will thank you for going for the lower tuition

 

[Med Ed]

I've always wanted to do internal medicine, subspecialty (unsure which) and then do academic medicine.
Will I be held back for academic medicine even if I match into a highly ranked program for residency?

The problem with you question is that "academic medicine" isn't one thing. Do you want to primarily be a clinician who does some teaching and occasionally collaborates on research projects? Or do you want to be more heavily involved in research and publishing, building a reputation and eventually vying for a department chair role?

 

[Mr.Smile12]

Wow. This is coincidence.

Puerto Rican medical students face challenges when applying for residency

Students report being misidentified as international medical graduates despite U.S. citizenship and medical school accreditation.

www.aamc.org

 

[chilly_md]

Moved to X vs Y

 

[deleted1192556]

The problem with you question is that "academic medicine" isn't one thing. Do you want to primarily be a clinician who does some teaching and occasionally collaborates on research projects? Or do you want to be more heavily involved in research and publishing, building a reputation and eventually vying for a department chair role?

Realistically I've always envisioned the former, right?
The latter would require an MD-PhD or heavy postdoctoral research training?

 

[Med Ed]

Realistically I've always envisioned the former, right?

I don't know, you tell me.

The latter would require an MD-PhD or heavy postdoctoral research training?

Generally speaking, yes. Some research-oriented people to MD-PhD, some do a year in medical school and then match into a residency with a dedicated research element, occasionally one will do a straight postdoc.

 

[deleted1192556]

I don't know, you tell me.

Just thought only the former was possible MD-only.

Regardless, how does school ranking factor into both options?

 

[Med Ed]

Just thought only the former was possible MD-only.

Not at all. MD/PhDs are few and far between, and most of them end up abandoning serious research to focus on clinical work, which is more lucrative and straightforward.

I just randomly chose a med school (University of Nebraska) and just randomly chose a specialty (neurology), and here is the chair: Matthew Rizzo, MD, FAAN, FANA

MD-only, residency in neurology, two fellowships, rose through the academic ranks, now also the director of their NIH clinical and translational research network. I have no idea what type of formal research training Dr. Rizzo may or may not have had, but it's clear he is someone who came in with an academic pedigree and has taken advantage of the various academic opportunities that came his way.

Regardless, how does school ranking factor into both options?

I'm typically a big advocate of going to the cheaper option, and skeptical of the criteria used to define the T20 schools (or T5, T10, T25, T50 schools, etc.).

However, attending any school in anyone's T20 list is going to give you access to name recognition, resources, and opportunities that you simply won't find at UPR. This will open doors for you regardless of how you end up shaping your career. In spite of the cost differential, that could end up paying off in the long run.

I certainly wouldn't choose UPR without trying to wring some matching financial aid from the T20.

 

[jvquarterback]

UPR. No question. Unless you get a matching scholarship from the T20.

You can look at a clinical masters degree from NIH or one of the top schools but they’re mostly a waste. Look at away rotations during 4Y and clinical research options before you start 1Y and between 1Y and 2Y.

Then for residency you can go to an academic center. Get involved in clinical research then as well.

Getting a job in academic medicine is really easy. They pay you less and are happy to take you at a discount.

 

[chilly_md]

I'm assuming this is 70 k vs 15k a year as opposed to the difference across all 4 years. Is this correct? Hard to say no to the cheap tuition if its going to be 200k+ difference by the end of it

 

[deleted1203336]

Look, I'm gonna be straight with you - T20 will open doors that UPR just can't, period.

The research opportunities at these top schools are NIGHT AND DAY different. You'll be working with big names on projects that actually get published in major journals, not just doing summer research that goes nowhere. Your classmates will be future department chairs and research stars. Those connections? Worth their weight in gold when you're applying to competitive fellowships later.

I've seen too many friends from lesser-known schools STRUGGLE to match into top academic programs despite killer scores. PDs have their biases, and that "UPR???" moment in your application review is real, even if it's totally unfair. You'll be fighting uphill the entire way.

The bigger issue is that UPR constantly gets lumped in with Caribbean schools by people who don't know better, despite being LCME accredited. The school's had its share of accreditation warnings in the past, and that history follows the reputation. You'll constantly be explaining "No, it's not a Caribbean school" and "Yes, I'm a US citizen" throughout your career. That gets old FAST.

Yeah, the loans suck. I get it. But academic IM at a top program leads to fellowship, which leads to faculty positions that pay well, especially if you climb the ladder to division chief or similar. Plus loan forgiveness exists for academic docs.

Being blunt - if you're 100% set on academic medicine, especially at a prestigious program, the T20 is worth the investment. UPR is a solid school, but for the career you're describing, you're making your life 10x harder by not taking the T20 acceptance.

Just my 2 cents from someone who's seen how this plays out. Whatever you decide, congrats on both acceptances! That's huge.

 

[neymarpluto]

Look, I'm gonna be straight with you - T20 will open doors that UPR just can't, period.

The research opportunities at these top schools are NIGHT AND DAY different. You'll be working with big names on projects that actually get published in major journals, not just doing summer research that goes nowhere. Your classmates will be future department chairs and research stars. Those connections? Worth their weight in gold when you're applying to competitive fellowships later.

I've seen too many friends from lesser-known schools STRUGGLE to match into top academic programs despite killer scores. PDs have their biases, and that "UPR???" moment in your application review is real, even if it's totally unfair. You'll be fighting uphill the entire way.

The bigger issue is that UPR constantly gets lumped in with Caribbean schools by people who don't know better, despite being LCME accredited. The school's had its share of accreditation warnings in the past, and that history follows the reputation. You'll constantly be explaining "No, it's not a Caribbean school" and "Yes, I'm a US citizen" throughout your career. That gets old FAST.

Yeah, the loans suck. I get it. But academic IM at a top program leads to fellowship, which leads to faculty positions that pay well, especially if you climb the ladder to division chief or similar. Plus loan forgiveness exists for academic docs.

Being blunt - if you're 100% set on academic medicine, especially at a prestigious program, the T20 is worth the investment. UPR is a solid school, but for the career you're describing, you're making your life 10x harder by not taking the T20 acceptance.

Just my 2 cents from someone who's seen how this plays out. Whatever you decide, congrats on both acceptances! That's huge.

I agree with this! Very well said. People on SDN will give you answers based on your of pros and cons. I have family members who went to schools in PR and they had a very difficult time matching here (IM btw). The reputation is on par with DO schools maybe slightly higher here and people confuse it with Caribbean at times as well (you can check out the PD rankings here to see what I mean: ). If you want to pursue academic medicine it is much better to attend the T20 even in the US even if it costs much higher as it will give you more opportunities. That being said, if taking care of your family and living with them is a priority go with your gut. Nothing is impossible and you can still accomplish what you want in life.