Thoughts on community/ state programs

[Demiurge]

I'd like to hear you thoughts on community programs in the northeast like lahey, auburn, baystate, st vincent. How do they compare to one another?

Also what about academic programs like the SUNYs, albany, and rochester.

Are some of these programs more highly regarded than others?

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[Demiurge]

I asked because how should prioritize these places if I have more interviews than I am able to attend?
Thoughts are welcome.

 

[shark2000]

In a good job market, nobody cares where you do your residency or fellowship. There were a short period of time that graduates could land a good job even without fellowship.

When the job market gets tight, name matters. Now people may argue forever on this topic. But at the end of the day, going to a top program for residency and fellowship matters within its own limits. Going to a top program like MGH, UCSF or Duke opens lots of doors. After that, it will be big state university programs. Each state has a big university that matter a lot esp in that state. For example, if you look for a job in Indiana, doing your training at the Univ of Indiana can help a lot.

None of the programs that you named above are going to impress anybody. In fact, other than local people, probably most radiologist don't know anything about these programs. My goal is not to bash any program here. But you have to know that if it comes to job placement, being a graduate of for example Lahey clinic puts you behind MGH, BWH, BIDMC, Tufts, Brown in rhode island, BU and even some non-local big program graduates when it comes to job placement. Not saying that you won't find a job, but it will be more difficult for you compared to the IR fellow at brown or breast fellow at MGH. Also consider that doing only one year of fellowship even at a big name, though may help you in job hunting, won't do a charm. You have to starting looking for a job early in your fellowship when people barely know you.

Bottom line: Rank these programs at the end of your rank list. If you end up in any of these programs, still you can find a decent job but will have more difficulty compared to people who go to bigger name programs.

 

[greg1184]

Do you absolutely want to be in the Northeast? Region plays a big role on wherever you want to get a job.

 

[STXINnoVation]

do people normally land a job near their residency region or fellowship region?

 

[txguy]

do people normally land a job near their residency region or fellowship region?

I can only speak from personal experience, but especially in the current dismal job market the best jobs are obtained through contacts/connections. This includes former residents, fellows, and attendings now working out in the community. This is the best way to get your CV pulled out of the pile amidst so many other qualified and identical looking CVs. This also underscores the importance of working hard in residency and fellowship because you never know who's help you will need in the future!

 

[meister]

Community programs typically are more focused on volume and may train better private practice physicians but there is tremendous variability amongst the dozens of programs.

 

[shark2000]

Community programs typically are more focused on volume and may train better private practice physicians but there is tremendous variability amongst the dozens of programs.

I am going to call it BS.

More volume yes. But usually much less diversity, much less pathology and much less sub specialization.

The graduates of community programs may have more speed right after graduation. But increasing your reading speed is not difficult. It can be achieved within the first 6 months of your private practice. But the quality of training, the diverse pathology that you have seen during residency, the experience of sitting with the subspecialty attending and .... can not be achieved after you are out of training.

Reading 40 abdominal CTs in a row is not the same as reading 20 abdominal CTs which are a mixture of normal, simple pathology (like appendicitis), more complex pathology and extreme pathology. The first one is just volume and the second one is quality. Volume is not equal to quality.

 

[colbgw02]

You're calling BS on a bunch of points that the post you quoted didn't make.

 

[shark2000]

You're calling BS on a bunch of points that the post you quoted didn't make.

"Train better private practice physicians" is the part that I called BS. I had to mark it bold.

 

[qxrt]

I am going to call it BS.

More volume yes. But usually much less diversity, much less pathology and much less sub specialization.

The graduates of community programs may have more speed right after graduation. But increasing your reading speed is not difficult. It can be achieved within the first 6 months of your private practice. But the quality of training, the diverse pathology that you have seen during residency, the experience of sitting with the subspecialty attending and .... can not be achieved after you are out of training.

Reading 40 abdominal CTs in a row is not the same as reading 20 abdominal CTs which are a mixture of normal, simple pathology (like appendicitis), more complex pathology and extreme pathology. The first one is just volume and the second one is quality. Volume is not equal to quality.

Why do you say community programs have much less diversity and pathology? Patients do not choose to go to an academic tertiary care hospital when they first get sick; they show up at their closest hospital and get a CT scan/MRI, get their strange zebra diagnosis, then get shipped off to the academic center for management after the diagnosis is already made. People do not go to academic tertiary/quarternary hospitals to get diagnosed, they go there for management, which is really not that significant to the radiologist-in-training. Sure, community programs may miss out on the follow up interval CTs, but that is nothing compared to seeing the initial pathology. If anything, community hospitals supporting radiology residency programs tend to be even larger in patient volume and oftentimes also diversity of patients than their academic counterparts.

Conversely, academic hospitals do not only focus on treating complex rare pathologies. They also depend on the bread and butter patient who comes in with abdominal pain and turns out to have a negative abdominal CT scan.

The lack of subspecialization at many community hospitals I do agree with, though.

 

[colbgw02]

He said 'may' train. Seems like a pretty name uncontroversial thing to say, but okay.

 

[shark2000]

Why do you say community programs have much less diversity and pathology? Patients do not choose to go to an academic tertiary care hospital when they first get sick; they show up at their closest hospital and get a CT scan/MRI, get their strange zebra diagnosis, then get shipped off to the academic center for management after the diagnosis is already made. People do not go to academic tertiary/quarternary hospitals to get diagnosed, they go there for management, which is really not that significant to the radiologist-in-training. Sure, community programs may miss out on the follow up interval CTs, but that is nothing compared to seeing the initial pathology. If anything, community hospitals supporting radiology residency programs tend to be even larger in patient volume and oftentimes also diversity of patients than their academic counterparts.

Conversely, academic hospitals do not only focus on treating complex rare pathologies. They also depend on the bread and butter patient who comes in with abdominal pain and turns out to have a negative abdominal CT scan.

The lack of subspecialization at many community hospitals I do agree with, though.

As you mentioned above a lot of times you make your presumed diagnosis on a CT and lose the patient on followup. Thus, you will never find out that your call on CT was a correct call or not. You won't have the pathology results for correlation.

Many referrals get overread of their imaging studies or follow up in tertiary care centers. Let's talk about neuroendocrine tumor of the pancreas. You may see one of these on every 500 CTs in community. Hence, you may see one or two of these cases on your whole yen month body rotation. Most likely, you won't eventually even find out that the hyper-vascular tumor that you called on CT was a NET of pancreas. You read somehow in vacuum. No pathology results, no other modalities, nothing. This is the typical scenario in community (like my current practice). Now compare it to a tertiary care center. There is an oncologist who exclusively sees pancreas NET. You go to the body room and read 20 pancreas NET CTs in one day (the day of his clinic). All cases have CT, may be MRI, Nucs study, EUS, Biopsy results and post treatment scans. Also there is a weekly NET tumor board with pathology, surgical oncology, med oncology, radiology, .... paticipating. Your attending has seen 1000 of these case so far. He has also published a radiographics article about pancreas NETs. He gives lecture in AFIP or RSNA about pancreas NET tumors. The same for Carcinoid tumor, ... For something like HCC you read US, CT, MRI, you participate in TACE or Y-90 or ablation in your IR rotation , you follow the post treatment scans, .... Your IR attending happens to be one of the Gurus in TACE. Don't you think there is a difference?

The best radiologists have become the best because they constantly attended multi-disciplinary conferences and they receive constant feedback by following their cases. Reading in vacuum is like doing something wrong and not getting any feedback. Do you know how many liver tumors I call on MRI or CT and never ever find out about the final pathology results? I have been on both sides. As a resident and fellow in a tertiary care center and as a pp radiologist. Believe me. I feel that I am losing or at least not improving a lot of my imaging skills because I am not in a tertiary care center.

Subspecialty training is like a gem. Never take it for granted. The chest attending who has seen all sorts of ILD with pathology correlates or the Neck imager who pretty much lives in the soft tissue spaces of the neck are way different than your average community radiologist (like me) who reads a CT neck just before his kyphoplasty case and an HRCT lung after he sings the ankle MRI.

All of this doesn't mean that you can not get a good education at a community hospital. But if you can match in a tertiary care center, go for it. It is worth it. You will appreciate it once you finish training and start your job.

 

[qxrt]

As you mentioned above a lot of times you make your presumed diagnosis on a CT and lose the patient on followup. Thus, you will never find out that your call on CT was a correct call or not. You won't have the pathology results for correlation.

Many referrals get overread of their imaging studies or follow up in tertiary care centers. Let's talk about neuroendocrine tumor of the pancreas. You may see one of these on every 500 CTs in community. Hence, you may see one or two of these cases on your whole yen month body rotation. Most likely, you won't eventually even find out that the hyper-vascular tumor that you called on CT was a NET of pancreas. You read somehow in vacuum. No pathology results, no other modalities, nothing. This is the typical scenario in community (like my current practice). Now compare it to a tertiary care center. There is an oncologist who exclusively sees pancreas NET. You go to the body room and read 20 pancreas NET CTs in one day (the day of his clinic). All cases have CT, may be MRI, Nucs study, EUS, Biopsy results and post treatment scans. Also there is a weekly NET tumor board with pathology, surgical oncology, med oncology, radiology, .... paticipating. Your attending has seen 1000 of these case so far. He has also published a radiographics article about pancreas NETs. He gives lecture in AFIP or RSNA about pancreas NET tumors. The same for Carcinoid tumor, ... For something like HCC you read US, CT, MRI, you participate in TACE or Y-90 or ablation in your IR rotation , you follow the post treatment scans, .... Your IR attending happens to be one of the Gurus in TACE. Don't you think there is a difference?

The best radiologists have become the best because they constantly attended multi-disciplinary conferences and they receive constant feedback by following their cases. Reading in vacuum is like doing something wrong and not getting any feedback. Do you know how many liver tumors I call on MRI or CT and never ever find out about the final pathology results? I have been on both sides. As a resident and fellow in a tertiary care center and as a pp radiologist. Believe me. I feel that I am losing or at least not improving a lot of my imaging skills because I am not in a tertiary care center.

Subspecialty training is like a gem. Never take it for granted. The chest attending who has seen all sorts of ILD with pathology correlates or the Neck imager who pretty much lives in the soft tissue spaces of the neck are way different than your average community radiologist (like me) who reads a CT neck just before his kyphoplasty case and an HRCT lung after he sings the ankle MRI.

All of this doesn't mean that you can not get a good education at a community hospital. But if you can match in a tertiary care center, go for it. It is worth it. You will appreciate it once you finish training and start your job.

All good points. But your argument is regarding tertiary hospital vs non-tertiary hospital training, which is different from academic vs community hospital training. It is true that all non-tertiary hospital training is at community hospitals (I think...are there non-tertiary care academic centers?), but vice versa is not true.

 

[shark2000]

All good points. But your argument is regarding tertiary hospital vs non-tertiary hospital training, which is different from academic vs community hospital training. It is true that all non-tertiary hospital training is at community hospitals (I think...are there non-tertiary care academic centers?), but vice versa is not true.

It is a spectrum. A big academic center is usually the tertiary care center for almost everything. Then many smaller academic centers are tertiary care center in many but not all fields. Some community programs may be tertiary care center in one or a few fields. Still the level of specialization is more in most academic centers compared to most community programs.

 

[raddadof2]

There is a lot of difference between "community" programs and I think if you disregard them all then you will miss out on some great opportunities. As a former "community" program resident, I landed a spot at one of the most competitive fellowships in the country and excelled there as well. I think you should look closer at programs before dismissing them. I'm in practice now and have since hired graduates from both community residencies and academic residencies. Frankly the "community" trained residents (from selected "community" programs) who then completed high end fellowships seem to have been the best mix for our group. They seem to be the most flexible and comfortable on the job.
The diversity of patients, the subspecialty mix of attendings, the volume of cases, the interactions with other specialties, and the amount of teaching should be what you are looking for in a residency, not just an academic name. There are many "academic" programs that do not provide the best resident training as much as there are "community" programs that produce outstanding residents. Do your research, check out where their graduates go for fellowships, ask about their connections/job placements, and very importantly see if their residents are happy while they are there.
Finally a lot depends also on where you want to be later in life. If you anticipate wanting to spend your eventual career at a large academic center in a big city, sub-sub specializing on one subset of radiology, then you will likely want to start out at a large academic medical center. The percentage of those sub specialty jobs however is a small subgroup of actual radiology jobs. The majority of the actual radiology jobs though are based where the population is (i.e. the community). You can do the math. You do want to get great training. You do want to get a great fellowship. And then you want to get a great job after graduation. While names matter, they can also be deceiving at times (both good and bad). Good luck on the match.

 

[VeitVat]

IMO the best marker for a residency program is resident satisfaction and morale.

Whether it's a big "name" program or a small program time and again during residency the best hallmark imo is:

- residents who consistently pass their boards
- as a group are happy.

Fellowship, job placement, contact with graduates, program culture. It's F-O-U-R years. Make it in a place where there's chemistry.

Good rule of thumb is:

1) Ivies: Harvard, Stanford, Yale, Hopkins. . . the name will be in your CV with you forever.
2) Programs where >90% of the residents are happy/satisfied/ have a good match with your personality - regardless of size (university/community).
3) Large state university programs (U Texas, UCSF, etc)
4) Desired geography.
5) Programs, regardless of size or prestige where you can "feel" the tension - drama, don't speak about prior residents, etc.

 

[dude1344]

IMO the best marker for a residency program is resident satisfaction and morale.

Whether it's a big "name" program or a small program time and again during residency the best hallmark imo is:

- residents who consistently pass their boards
- as a group are happy.

Fellowship, job placement, contact with graduates, program culture. It's F-O-U-R years. Make it in a place where there's chemistry.

Good rule of thumb is:

1) Ivies: Harvard, Stanford, Yale, Hopkins. . . the name will be in your CV with you forever.
2) Programs where >90% of the residents are happy/satisfied/ have a good match with your personality - regardless of size (university/community).
3) Large state university programs (U Texas, UCSF, etc)
4) Desired geography.
5) Programs, regardless of size or prestige where you can "feel" the tension - drama, don't speak about prior residents, etc.

The fact that you list Yale in with those programs and then list UCSF down in the "large state U programs" in a tier with UTexas doesn't exactly lend credence to what you say.

 

[Morphea]

Any thoughts on how these community programs compare among themselves and how they compare to nyc community programs: Hartford, lahey, christiana, pennsy?