I'm new to this forum and wish I knew about it early. I'm in the process of applying for a GS PGY-1 next year and have received quite a few invitations for interview from both Uni and Comm programs. What are the pros and cons of each? Thanks
University-based vs Community GS programs
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Blade28
This question belongs in the Surgery forum - moving.
Ahhh... The age old question. I think it comes down to what you really wanna do in surgery. I applied like 50/50 so I can get a feel for the difference and make my decision ranking. I think at "the right" program for you it could be either an academic or a community, it all depends what you need and so many other variables. I'd be careful on choosing academics based solely on reputation. Read Goober's comment in this post if you want to get scared away from reputation: http://forums.studentdoctor.net/showthread.php?t=443092
The thing that I worry about is that at an Community center you may miss out on all the complex train wreck pain in the neck cases, and the floor patients who have complication after complication and never go home. I know that sounds like such a good thing to avoid all that crap, but I wanna to be prepared for anything. I don't wanna be worried about getting in over my head for the rest of my career. I'm sure other people can answer this question. I'm sure if you put some work into the search function of the forum you can find little bits and pieces and maybe even some huge chunks of this discussion(i'm too lazy to look right now).
These definately aren't absolutes but generally if you wanna do academic medicine you have to do an academic residency and if you wanna operate a lot early on you gotta do a community program.
Justin
The thing that I worry about is that at an Community center you may miss out on all the complex train wreck pain in the neck cases, and the floor patients who have complication after complication and never go home. I know that sounds like such a good thing to avoid all that crap, but I wanna to be prepared for anything. I don't wanna be worried about getting in over my head for the rest of my career. I'm sure other people can answer this question. I'm sure if you put some work into the search function of the forum you can find little bits and pieces and maybe even some huge chunks of this discussion(i'm too lazy to look right now).
These definately aren't absolutes but generally if you wanna do academic medicine you have to do an academic residency and if you wanna operate a lot early on you gotta do a community program.
Justin
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I think the answer to the age-old question of academic vs. community, as others have said, comes down to what you want to do with your career after residency.
Wanna be a professor? Wanna be a red hot? Go to an academic program.
Wanna live life in private, community practice doing bread-and-butter General Surgery? Go to a community program.
I doubt any General Surgery residency program is going to train you for everything you'll eventually encounter in life as an attending surgeon somewhere on staff. The fact is you'll learn whatever is most common at your institution, some complex stuff here and there (mostly at the academic places, but some red hot community programs too on occasion), and then continue to hone your technical skills and continue learning well into attending-hood. The learning never stops.
Several of the attending staff at my community program graduated well-known, academic programs who came over and were still uncomfortable doing complex things like Whipples and stuff. They learned while on staff here under the tutelage of the Department Chairman, who himself really learned to do this stuff while he was an attending too (and not during his residency at a well-known academic institution).
My personal reasons for choosing a community program? Sometimes the match chooses you, especially when you tell the Magic 8-Ball that you want to remain within an hour's drive of your family. 🙂 It all works out in the end, though. I've been relatively happy during the last 4 1/2 years in residency training and am doing a fellowship at a great place. I can't say the same for friends who entered the super top-notch academic programs almost because of the reputation, got the beat-down every live long day, and then ended up quitting at the end of the R3 or R4 years. What a waste.
So choose the program that best fits you and your career goals. Meet the residents. Speak with other applicants. Speak with people from your med school who have heard anything about these places. Discuss here on SDN.
Good luck.
Wanna be a professor? Wanna be a red hot? Go to an academic program.
Wanna live life in private, community practice doing bread-and-butter General Surgery? Go to a community program.
I doubt any General Surgery residency program is going to train you for everything you'll eventually encounter in life as an attending surgeon somewhere on staff. The fact is you'll learn whatever is most common at your institution, some complex stuff here and there (mostly at the academic places, but some red hot community programs too on occasion), and then continue to hone your technical skills and continue learning well into attending-hood. The learning never stops.
Several of the attending staff at my community program graduated well-known, academic programs who came over and were still uncomfortable doing complex things like Whipples and stuff. They learned while on staff here under the tutelage of the Department Chairman, who himself really learned to do this stuff while he was an attending too (and not during his residency at a well-known academic institution).
My personal reasons for choosing a community program? Sometimes the match chooses you, especially when you tell the Magic 8-Ball that you want to remain within an hour's drive of your family. 🙂 It all works out in the end, though. I've been relatively happy during the last 4 1/2 years in residency training and am doing a fellowship at a great place. I can't say the same for friends who entered the super top-notch academic programs almost because of the reputation, got the beat-down every live long day, and then ended up quitting at the end of the R3 or R4 years. What a waste.
So choose the program that best fits you and your career goals. Meet the residents. Speak with other applicants. Speak with people from your med school who have heard anything about these places. Discuss here on SDN.
Good luck.
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Can you still get a fellowship after attending a community program?
How about research work?? Possible to do research at an academic program or anything of that nature???
(of course that means that you are hardworking, etc. etc. resident?
How about research work?? Possible to do research at an academic program or anything of that nature???
(of course that means that you are hardworking, etc. etc. resident?
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Sure. You may have to work a little harder, get to know some people, etc. but I know several people from community programs who successfully matched into fellowship programs and none of them (sorry guys) were najor league candidates.
Pediatric Surgery? PRS? Yeah, that's gonna be difficult from a community program, but not impossible.
I think you meant is it possible to do research at a community program (because research options is one of the hallmarks of an academic program)? Most people who go to community programs are not interested in doing research and neither are the faculty, so there aren't active research labs and programs. I suppose if the program was supportive you could always go away for a couple of lab years, although again, given the nature and career goals of most of those in community programs, its a bit unusual. But you never know until you ask...the trouble with leaving for research in a program not set up for it, is who is going to take your place while you are relaxing in the lab?
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Generally agree with Dr Cox. To add some more detail, about 2/3 of GS graduates nationwide pursue a fellowship. There are lots of fellowships out there and you can get them from community programs. It may be harder, particulary for competitive fields.
As for research, there are some community programs that have a defined research year for some or all of their residents (Carolinas, Virginia Mason and Wm. Beaumont among them.) Some have a fairly formalized research curriculum without any dedicated research time. That having been said, if you know you want guaranteed, dedicated research time - university programs are the place to look.
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You people are good.
Thanks a lot. 🙂
Thanks a lot. 🙂
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Think of it this way. The majority of programs in this country are community-based and the majority of General Surgery Chief Residents are entering fellowship. So, yes, being from a community program doesn't put you out of the running for most fellowships.
Now that doesn't mean you're on equal footing for all fellowships, of course, compared to your academic program colleagues.
Pediatrics and Surgical Oncology may be difficult if not impossible to get as a community program graduate. PRS, to a certain extent, can also be tough for a community program grad. So some people will pursue research fellowships, take a year or more off, and that sort of thing. But then again, so do a lot of academic grads.
Good luck.
Thank you all for your input. Since research work during residency was mentioned here, I want to ask that if research during residency must be on basic or clinical science. I want to have some time off during my residency, most likely during research year, to work on a project on health policy and management but am wondering whether asking such a question during an interview would hurt my chance of getting matched to the program of my choice. What advice do you have for me? Thanks
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Blade28
Absolutely not. You can do pretty much anything for your research - basic science, clinical research, MPH, MBA, etc. Of course, funding and ease of entering the lab are dependent on your residency program.
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I'm in the lab now, and at my program there are 7 residents currently in the lab, 3 of which are doing strictly clinical, outcomes-based research. One of them also got his MPH while in the lab. Of the 3 incoming lab residents, 2 will be doing clinical/outcomes research. It's really up to you what you want your research time to be. If you have a project and get funding, you can do whatever you want. There are very few, if any, programs that I know of that absolutely mandate basic science research.
I think that once I become a resident, I may have the leverage in choosing the research project because the department can't just fire me because I'm not doing basic science or clinincal reserach. However, if I tell them up front during the interview about my research plan, I may risk not being ranked because some programs don't want their residents to have a gap in their training as it may negatively affect their clinical and surgical skills and the success rate of taking Step 3. Is it true?
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don't forget that if you do research in your program (vs going to another institution, NIH for example), you will still be expected to take call or even fill in for residents on maternity leave, vacation, etc. it might not be the "year off" that you anticipate. i wouldn't get into detail on the interviews about what type of research you want to do. #1, it may change, and #2, you don't want them to feel that you're locked into something, and inflexible.
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and i forgot- you do not have any leverage in residency, ever! they are still paying your salary. if they need a body in a certain lab, you will be it. don't like it? then get your own funding...easier said than done.
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Oh yes they can! You'll get a contract that is renewed every year and can be non-renewed without cause.
Even if they "can't" fire you, they will be making recommendations and filling out evaluation forms/credentialling forms for the REST OF YOUR LIFE. You have no power to force the department to do anything.
Not to mention that research during residency is actually a misnomer. You cease being an ACGME accredited, CMS funded resident while you're in the lab. Someone has to pay your salary and unless you secure independent funding that funding comes at the pleasure of your chairman.
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Basically, you've got to find the program that fits with your career goal. You can't go to a program where residents NEVER take time off to pursue research and tell them, "Hey, I'm not gonna be here next year because I'm taking time off, so find someone to fill my spot while I'm away and when I come back you can get rid of him." That kind of thing will just result in them saying, "Sure, sure. Go ahead with the research year." When you get back, guess what? The temp they just hired to fill your spot and they've changed the locks and referred your picture ID to security to tackle you on the way into the hospital.
The programs have an incredible array of ways they can play with your career if you don't play nice and by their rules. And being a "categorical" is no guarantee of a yearly contract either. It just means that you'll be more likely to get a contract the following year than the other residents in your program, but by no measure is being a "categorical" an absolute ticket to your graduation.
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Yep...agree with the others: you are NOT in control here regarding your lab time.
I've seen residents told they could be in lab x, only to be pushed aside for someone else. I've seen residents told they could do research time only to be told they need someone on the floors. I've seen categorical residents fired without (presumably) cause. I've seen residents pulled from the lab to cover call and vacation schedules. And I've seen residents be required to take Step 3 before they go into the lab (in reference to your comment about time in lab decreasing Step 3 scores...there are about 3 surgery questions on Step 3, so it really doesn't matter if you are away from clinical duties).
If you are well liked and keep your nose clean, you are more likely to get what you want, but never presume that people in medicine play fair. Having worked in academics long before I ever went to medical school, I can tell you that there are a lot of nefarious people out there who do things that would never fly in business or other fields.
I've seen residents told they could be in lab x, only to be pushed aside for someone else. I've seen residents told they could do research time only to be told they need someone on the floors. I've seen categorical residents fired without (presumably) cause. I've seen residents pulled from the lab to cover call and vacation schedules. And I've seen residents be required to take Step 3 before they go into the lab (in reference to your comment about time in lab decreasing Step 3 scores...there are about 3 surgery questions on Step 3, so it really doesn't matter if you are away from clinical duties).
If you are well liked and keep your nose clean, you are more likely to get what you want, but never presume that people in medicine play fair. Having worked in academics long before I ever went to medical school, I can tell you that there are a lot of nefarious people out there who do things that would never fly in business or other fields.
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Blade28
Yeah, never assume that your lab years are protected/guaranteed. Never assume you'll come out of the lab at the time agreed upon with your program director.
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Sometimes they make you stay a couple of extra years doing rat lung transplants because they see you've spent too much time on SDN when you were supposed to be working!
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Having said that... All you university guys holed up in a lab, like, how do you function with the idea that you may never be able to come back?
Isn't it made worse now that the ABS limits you to three surgical programs for training?
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Blade28
Sometimes they make you stay a couple of extra years doing rat lung transplants because they see you've spent too much time on SDN when you were supposed to be working!
Hey! Real-time PCR and immunofluorescence as well! Not just rat lung transplants!
🙂
The reponses from you Doc's are scary but helpful. I thought the residency contract would be similar to that in other fields. By that I mean the employer can't fire employees for no reasons.
The situation I'm in is that I am half way through the MBA and I have to finish the program in 3-4 years. If I wait until after residency, which of course will take at least 5 years, all my work toward the MBA will go down the drain. On top of finishing the MPH, as I mentioned above, I plan to work on a project on health policy and management so I don't need funding from the GS program.
So, how do I find out during the interview about whether a program would be flexible to let me take some time off to pursue a research project of my choice without raising the flag that I'm locked in and inflexible like gasnewby said? What indicators should I look for? Which program, University or Community, would be more flexible?
The situation I'm in is that I am half way through the MBA and I have to finish the program in 3-4 years. If I wait until after residency, which of course will take at least 5 years, all my work toward the MBA will go down the drain. On top of finishing the MPH, as I mentioned above, I plan to work on a project on health policy and management so I don't need funding from the GS program.
So, how do I find out during the interview about whether a program would be flexible to let me take some time off to pursue a research project of my choice without raising the flag that I'm locked in and inflexible like gasnewby said? What indicators should I look for? Which program, University or Community, would be more flexible?
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Oh okay...well stiil, they'll probably make you spend more time in the lab given all the evidence that you're on SDN when you should be running your gels.
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Don't worry...they'll find some reasons, even if they have to make them up.
I don't think overall there is any difference in flexibility based on whether a program is university or community based.
That said, while there are community programs which do allow research, ones that never had or are not used to having residents leave for a year or more, are more likely to be inflexible. Most university programs commonly allow time in the lab so are more used to working around this.
I think your indicators are:
- what others have done before you (does everyone seem to go into the same lab, have others gone away - say to the NIH or other programs, etc?)
- the response of the faculty and PD when interviewing you when you ask; as well as that of the residents.
Frankly, people are known to lie during the residency interview process, on both sides, so I don't think you are going to get anything close to a guarantee. Its like a marriage - they put on their best face as you do, tell you all these wonderful things and then you find out, sometimes years later, that it was all a farce.
You will not get a program to guarantee you in writing that you can pursue your plan. At best you will get a "sure we can arrange that" and then hope they are true to their word. Once you accept this fact and know that you may not be allowed to take time off, or you may be fired if you do so against their wishes, then you are ahead of the game.
Finally, consider programs which will have access to universities where you can complete your research. I've also seen residents feel like they can't leave their home city because of a mortage, family, etc. - you may or may not have those now or in a few years but you don't want to be locked into a program in the middle of no-where and need to leave to do your work, yet cannot sustain two homes on one income.
