What's the real benefit of a powerhouse residency?

[ChordaEpiphany]

I am incredibly fortunate to have some very competitive IIs to gen surg programs. However, I have a spouse and family to consider, and I'm trying to gauge how I should prioritize academic prestige/connections vs. training quality vs. location. Goal is academic surgery with an active research group, but of course my first priority is being an excellent surgeon.

Given my goals, how much should I be willing to sacrifice to attend an "elite" program (e.g., Hopkins, MGH, BWH, UCSF, Michigan, Penn) vs. a "top tier" program (e.g., NYU, UCLA, Pitt, Yale, BIDMC, UCSD)?

Let's imagine I live in SD and have parents in SD. Spouse has a job in SD, could get a good job elsewhere, is willing to move, but would like to stay. Would making the jump to UCSF vs. UCSD be worthwhile? Similarly, would going to Hopkins over BIDMC be tangibly worthwhile? Michigan vs. Northwestern? Etc...

I'm aware it's an impossible question to answer and depends on program/life specifics, but I think hearing someone further along think through this will help me appreciate what I need to consider. Thank you in advance!

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[DOVinciRobot]

Let's imagine I live in SD and have parents in SD. Spouse has a job in SD, could get a good job elsewhere, is willing to move, but would like to stay. Would making the jump to UCSF vs. UCSD be worthwhile?

Personally I would say no.

The only caveat would be if you are looking to do research and focus on one little niche and UCSF has the world expert on that niche and SD doesn’t. Then maybe. But otherwise, I would personally go with the program where you think you’d be happier.

 

[ChordaEpiphany]

Personally I would say no.

The only caveat would be if you are looking to do research and focus on one little niche and UCSF has the world expert on that niche and SD doesn’t. Then maybe. But otherwise, I would personally go with the program where you think you’d be happier.

Nice. This was exactly my thought process. I had some doubts after meeting with our department chief, who went to one of these programs. They essentially told me to go to the most prestigious place I could match. They said the doors it will open will be unmatched, and that everywhere you go (within academia) you are considered "a cut above until you prove yourself otherwise". However, it seems like a lot of these advantages are limited to truly elite places and truly elite positions (i.e., MGH probably won't hire someone who trained at BI to be their chief of surgery). I dream as much as anyone else, but it seems ill-advised to make sacrifices upfront for a sliver of a chance at obtaining one of these ultra elite positions, which are extremely rare even among those who train at the powerhouse places. 20 years from now I don't even know if I would want a position like that.

It's already challenging to balance perceived quality of training with location and culture. Adding in worries like T5 vs. T20 as a criteria seems impossible.

 

[Lost in Translation]

Seconded what @DOVinciRobot said. Unless you're aiming to the "the guy" in a small niche within GS, where you train matters less than if you'll be happy there. You'll get excellent surgical training just about anywhere you go, so if your career aspirations are PP or community-based and not at a major academic referral center then rank based on your perceived happiness.

I recently matched into a fairly competitive subspecialty, however, did fall further down my list than I was anticipating (most of my top programs were ordered on prestige) but I don't really have aspirations to be "the guy" that's chair of a department or section chief or heading my own research lab. I just want to be sufficiently trained and ready to handle 99% of what I'll see in the community as my goals are likely community hospital-based PP, and the program I matched to is more than capable to meeting that goal so I'm not really disappointed.