Top tier community vs low tier academic

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zealously

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Hi all,

I'm in the process of finalizing my rank list and am having a hard time deciding between "top tier community" and "low tier academic" programs. My ultimate goal is to do Hematology/Oncology fellowship.

I am stuck between two programs currently, one community and one academic. The community program has a good reputation within my state and is almost 100% USMD. They only generally match one person to Heme/Onc a year, and it is to the in-house spot. The academic program does not have as good a reputation in my state and is only 50% USMD. However, they match four people to Heme/Onc a year to their in-house spots.

The community program stated on interview day that they did not have much research available, while the academic program stressed that I would be able to do any kind of research I wanted at their institution. I guess logically it makes sense to go to the academic program if I am set on fellowship, but I see many of my peers ranking top community programs over lower tier academic programs. My main question is - is there ever any reason to go to a community program over an academic program if fellowship is the ultimate goal?

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Research is important but just as important is having people who write letters (and make phone calls) for you when it comes to fellowship time. If the community program doesn't have those academic connections you will be at a disadvantage. I wouldn't obsess over the match list too much because it is highly influenced by individual variation and what the subspecialty flavor of the year is that year (though it is a good thermometer for the overall performance). It is just as key to see if the faculty are publishing and if they are publishing with people outside of the facility. These cross-facility connections can be very important.
 
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Since we are dealing in generalities as unable to provide more specific advice to whichever programs you are considering, it is fine to go to a community program if you are understanding that your potential ceiling for fellowship placement might be a smidge lower than the academic program if you are missing out on chance to publish and I would also agree with the connections that can come with an academic program. I work at a large hospital with a community based IM program and the majority of the housestaff typically remain in-house for fellowship which has been an issue when there are multiple applicants vying for limited spots
 
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You may get more helpful advice if you shared program names. Idk what “top tier” community program means. Are we talking Hopkins Bayview or Bronx Lebanon?
 
You may get more helpful advice if you shared program names. Idk what “top tier” community program means. Are we talking Hopkins Bayview or Bronx Lebanon?
Thanks everyone for the advice so far. The two programs I am between are Baylor University Medical Center (BUMC) in Dallas and the University of Arkansas for Medical Sciences (UAMS) in Little Rock. I think BUMC has a small connection to UTSW since many of the faculty have dual appointments at both BUMC and UTSW, so there is some potential for cross-facility connections. However the vibe I got on interview day was that they definitely favored clinical training over research.
 
Thanks everyone for the advice so far. The two programs I am between are Baylor University Medical Center (BUMC) in Dallas and the University of Arkansas for Medical Sciences (UAMS) in Little Rock. I think BUMC has a small connection to UTSW since many of the faculty have dual appointments at both BUMC and UTSW, so there is some potential for cross-facility connections. However the vibe I got on interview day was that they definitely favored clinical training over research.

I would rank UAMS higher.
 
BUMC is low tier academic? This is not my area of expertise. . . . But its a thousand bed hospital. I work at a tertiary center that is half the size, and I occasionally send pts there. I have a poor opinion of one of the CHF docs there, . . but that is a bit off topic.

SDN putting too much On % FMG. Some places are just more favorable to FMG’s than others. UAMS sounds like they don’t favor FMG’s. And no place will gift you a fellowship. You have to do your research on your time. Likely be more gunners at BUMC, though. You might have the year where half the people wanted to do Heme/Onc and there is only one in house spot.
 
BUMC is low tier academic? This is not my area of expertise. . . . But its a thousand bed hospital. I work at a tertiary center that is half the size, and I occasionally send pts there. I have a poor opinion of one of the CHF docs there, . . but that is a bit off topic.

SDN putting too much On % FMG. Some places are just more favorable to FMG’s than others. UAMS sounds like they don’t favor FMG’s. And no place will gift you a fellowship. You have to do your research on your time. Likely be more gunners at BUMC, though. You might have the year where half the people wanted to do Heme/Onc and there is only one in house spot.

You have got it all wrong…
 
BUMC is low tier academic? This is not my area of expertise. . . . But its a thousand bed hospital. I work at a tertiary center that is half the size, and I occasionally send pts there. I have a poor opinion of one of the CHF docs there, . . but that is a bit off topic.

SDN putting too much On % FMG. Some places are just more favorable to FMG’s than others. UAMS sounds like they don’t favor FMG’s. And no place will gift you a fellowship. You have to do your research on your time. Likely be more gunners at BUMC, though. You might have the year where half the people wanted to do Heme/Onc and there is only one in house spot.
My apologies for not clarifying - I'd classify BUMC as top tier community and UAMS as "low" tier academic. BUMC is indeed a huge hospital but their residency programs are still considered community programs.

I know that %FMG is a poor way to judge programs, but my thought process is that there must be a reason that certain programs can't attract more US grads.
 
I would choose the place that has most in-house fellowships of the specialty I want
 
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Hi all,

I'm in the process of finalizing my rank list and am having a hard time deciding between "top tier community" and "low tier academic" programs. My ultimate goal is to do Hematology/Oncology fellowship.

I am stuck between two programs currently, one community and one academic. The community program has a good reputation within my state and is almost 100% USMD. They only generally match one person to Heme/Onc a year, and it is to the in-house spot. The academic program does not have as good a reputation in my state and is only 50% USMD. However, they match four people to Heme/Onc a year to their in-house spots.

The community program stated on interview day that they did not have much research available, while the academic program stressed that I would be able to do any kind of research I wanted at their institution. I guess logically it makes sense to go to the academic program if I am set on fellowship, but I see many of my peers ranking top community programs over lower tier academic programs. My main question is - is there ever any reason to go to a community program over an academic program if fellowship is the ultimate goal?

Be careful when looking at fellowship matches. What those don't tell you is how much research those FMGs had. If places match well, there's usually a confound to explain that. AMGs traditionally graduate more hospitalists/PCPs whereas IMGs hardly ever choose that unless there's a plan to bridge to fellowship for visa issues.

That said, I'd still choose the academic program so long as there's no collapsing culture or lack of attending physicians to teach. The environment is usually much better. Just make sure if you're fellowship minded that you're going to have to do some research to earn your spot.
 
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I agree with most that the academic place with more spots is probably “better” statistically for fellowship matching.

BUT, I actually remember one of those Baylor Dallas fellows from the interview trail because we interviewed together at like 3-4 places and I enjoyed talking with them. I have no doubt they would have matched somewhere else if they hadn’t ranked BUMC first and tbh I also remember one of their graduates being at LSU so it’s not like they only match in-house.

Long story just to say, you’ll probably be fine either way as long as you work hard and aren’t a weirdo.

What you really want to know is how many people from those places wanted to do Heme/Onc and didn’t match, which you won’t ever find out before getting there.
 
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In my experience, if you are AMG, you will still be at higher chance of match fellowship than IMG, even from the same program and other background is similar. So if 50% IMG and 4 match to hem/onc each year, this is a relatively strong program. This is just my intuitive sense. I don't have any hard evidence to back this

The other layer would be research experience. Sounds like UAMS will be stronger than BUMC as well. But still, how much efforts you put and your relationship to your program leadership and in-house hem/onc program probably matter most
 
My apologies for not clarifying - I'd classify BUMC as top tier community and UAMS as "low" tier academic. BUMC is indeed a huge hospital but their residency programs are still considered community programs.

I know that %FMG is a poor way to judge programs, but my thought process is that there must be a reason that certain programs can't attract more US grads.
Cuz it’s Arkansas?
 
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Cuz it’s Arkansas?
This is true. I guess the vibe I am getting from this thread is that academic always wins out over community for fellowship opportunities, unless location is important to you.
 
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Cuz it’s Arkansas?
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Thanks everyone for the advice so far. The two programs I am between are Baylor University Medical Center (BUMC) in Dallas and the University of Arkansas for Medical Sciences (UAMS) in Little Rock. I think BUMC has a small connection to UTSW since many of the faculty have dual appointments at both BUMC and UTSW, so there is some potential for cross-facility connections. However the vibe I got on interview day was that they definitely favored clinical training over research.

For some reason I felt that you were referring to BUMC during your post and my intuition was right. I have been a hospitalist at BUMC for several years and work with the housestaff. BUMC does not have any connection with UTSW. I do not know where you heard that many faculty have dual appointments at BUMC/UTSW which is not the case at least in the medicine subspecialties including the nephrology/ID/hem-onc/cardiology groups that have privileges at BUMC. The research apparatus at BUMC is definitely not as robust compared to a traditional academic center but there are still some opportunities if you look for it. The structure of the general ward months was completely revamped this past year which is a dramatic improvement compared to the old system that everyone had to suffer through. That being said, overall I would recommend UAMS over BUMC. Feel free to PM me if you want
 
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