Training differences between small city and large city programs??

[AHillock]

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I am beginning to think about what programs I want to apply to. While I have heard there are some differences between philosophies at west-coast vs. east-coast programs, I am more interested in the differences in training at a smaller vs. larger city program.

I would like to hear some thoughts about neurology training at a more "rural environment" as opposed to a "urban environment"? I think I would prefer to be in a smaller town, but wouldn't want to do that if I thought my training would be compromised as a result. I was thinking about some programs in smaller cities/towns: i.e. UIowa, Mayo Clinic, UMich, Penn State, Dartmouth, UNC, and to a lesser extent Duke and URochester. Do you have any opinions or feelings from your interviews? In the end is there really a difference in training?

 

[AlternateSome1]

There are many strong neuro programs in small cities. Your training won't be compromised if you go to a good program. I'd add UVA and Wisconsin to your list for good training and small town environment. You might want to at least consider Cincinnati and Pittsburgh since these are in smaller cities and offer good training with the opportunity to live in the suburbs away from the city.

 

[AHillock]

There are many strong neuro programs in small cities. Your training won't be compromised if you go to a good program. I'd add UVA and Wisconsin to your list for good training and small town environment. You might want to at least consider Cincinnati and Pittsburgh since these are in smaller cities and offer good training with the opportunity to live in the suburbs away from the city.

Thank you. UVA was one of the programs that I forgot to mention that I have on my list.

 

[AlternateSome1]

I went through some of the same thoughts when I was applying to programs. My wife and I had no interest in large city environments, but I was concerned about finding a good program in a smallish city. I made up a list of all the places I would even consider applying to and wound up with about 17. The (former) chair of my med school neuro program sat down with me and gave his two cents on all of the programs and I wound up getting rid of about 4 and adding one based upon his advice. There are a lot of programs out there that are great places to train that don't have big names (for laymen). The advice I got over and over was to find a place that will train you to be a strong clinician, then consider research/name recognition for a fellowship. If you do decide on a larger city program for a fellowship, at least you don't have to live there more than a year or two.

 

[Neurologee]

Ok, so the cons of more rural program are obvious -- No huge selection of shows, restaurants. It's not walking distance to everything. No constant buzz of noise and activity 24 hrs a day.
But I gotta be honest - I really don't care about that stuff. I can go to the city for a weekend if I'm craving it (and I usually want to get the heck out of the city by the end of the weekend).

What I view as the Pros of a more rural program:
1. Affordability - I am not racking up more debt or delaying payment on loans, because my paycheck goes further than it would in a city.
2. Commute - I have a two minute drive, one red light, and I don't pay to park. Oh - and if I wasn't lazy, I could ride my bike in less than ten minutes.
3. Lifestyle - Laid back. Outdoorsy. Enjoying the simple things ... That is more what I crave after I leave the hospital, not more chaos.

The bottom line is, it's all personal preference, but don't think for a minute that more urban = better training. It's just not true.

My top three choices were all "less-urban" 1st was Penn State, then UVa, and Dartmouth - would have been happy at any of them - all three have unique, large, interesting patient populations from extremely braod areas of their respective states, and really beautiful hospitals and patient facilities. They are all are surrounded by beautiful land. Lots of outdoor activites at all of them, too! (You gotta get some fresh air during residency, right?)

 

[tranzformer]

I am also interested in this as I am looking at some programs in smaller cities/college towns. Any opinions on the diversity of cases/patient population? Any reason to worry that these programs might be lacking in that area?

 

[BernieB]

Programs in smaller towns often have more diverse patient populations because they get patients from a large geographic area. You may see a lot more zebras than in a large city where different hospitals often have different strengths. For example in a big city one hospital may be known as the place to go for strokes, and another as the place for movement d/o. In a smaller town the medical center is THE place to go for all things neuro so there is a broad spectrum of diagnoses seen. This can be a negative, as I found as a med student at UVA on cardiology rotation where I didn't see a basic MI but I saw a lot of interesting cardiomyopathies, etc.

I applied to big city programs and small towns and found that patient population-wise they were similar (in terms of diagnoses): about 50% stroke, and the rest your basic bread and butter neurology with some less common diagnoses. I think it is most important to choose a place where you would like to live and a hospital in which you are comfortable spending a lot of time.

 

[typhoonegator]

Programs in smaller towns often have more diverse patient populations because they get patients from a large geographic area. You may see a lot more zebras than in a large city where different hospitals often have different strengths. QUOTE]

Careful there; this comment reaches a bit too far. It's not like Columbia and MGH don't see any rare diagnoses. While the catchment of a more rural program may be larger in terms of primary area, tertiary/quaternary academic medical centers often get referrals from smaller centers. My program gets at least 20 phone calls per week from MDs at other hospitals requesting inpatient transfers. That gets you plenty of zebras.

I'm not saying that training at a more rural location isn't great, or doesn't make a lot of sense for some people, but there are two sides to the coin.

 

[memento]

To each their own. Go where you think you fit best. Large programs and small progams both have spectrums of diverse populations. I know of some large programs with populations which are less diverse than expected and smaller programs with more diverse populations. It depends.