Where to rank: location vs/ prestige

[H2SO4]

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First, I want to say that I like all four programs, and would be happy at both. And I know that the decision could totally be taken out of my hands with the Match. But still...

Programs A/B: Two of the best in the US (consistantly ranked in the Top 5). I loved the programs, loved the residents, loved the area, etc. I'm not really that concerned with the ranking, but I want to do a fairly prestigious fellowship, and others care about rank. Also, both offer a fast-track into fellowship that I'm interested in (same program, just longer training). I've always wanted to live in the area and I have family fairly close by (w/in 2hrs). Given the choice, I'd rank places #1 & #2 in a heartbeat. But... It is somewhat expensive to live there (not NYC/Boston/SanFran, but still up there).

Program C/D: Top 25, well regarded programs. I liked everything about it, but the programs are fairly small (smaller than I'd like). Less prestige that Programs A/B, but still well thought of. Didn't like as well as A/B, but wouldn't slit my wrists over going here and will rank for sure. But... my wife LOVES the area, real estate is cheap, daycare is subsidized, and her job opportunities are AMAZING (much much more so that Program A/B). Given a choice, she would move there in an instant (her #1 for sure). Cost of living is very low, and we'd be able to buy a house immediately, have kids, and she has a great chance of landing a dream job. But, there's no fast-tracking for me and the fellowship opportunities are lower (would probably have to move after 3yrs - something that is less desirable). Plus, it's 4+hrs from family.

So, what to rank higher: my dream job in an expensive area, or her (possible) dream job in a cheaper area?

Ugh...

 

[toft32]

First of all, let me say, you're not in that boat alone. My wife (MS-4) and I are going through the same thing right now. She wants to go far away on an "adventure" to a wonderful program that fits her wants, is highly regarded, and will provide excellent opportunities. I, on the other hand, am leaning more toward a good program that is in a great area, closer to home and people I know, has a great housing market in a great community, and has very advantageous job opportunities for me. I'm sure I could get a good job in the new area, but think I would miss all of the other features of the close area.

I feel selfish in my thinking. She's worked so hard to do extremely well in Med School and I feel she should have every opportunity to go to a great program. Like I've read in other posts - residency is temporary, the knowledge gained is permanent. For that reason, I will be considering moving. We don't have children, so we're a little more free than you sound.

Also, like you said, we can only do as much as ranking the programs, we're ultimately at the mercy of the match process.

I wish you and your family luck in your "negotiations" 🙂 Please reply with insights from your side, and I can do the same from mine.

 

[doc05]

First, I want to say that I like all four programs, and would be happy at both. And I know that the decision could totally be taken out of my hands with the Match. But still...

Programs A/B: Two of the best in the US (consistantly ranked in the Top 5). I loved the programs, loved the residents, loved the area, etc. I'm not really that concerned with the ranking, but I want to do a fairly prestigious fellowship, and others care about rank. Also, both offer a fast-track into fellowship that I'm interested in (same program, just longer training). I've always wanted to live in the area and I have family fairly close by (w/in 2hrs). Given the choice, I'd rank places #1 & #2 in a heartbeat. But... It is somewhat expensive to live there (not NYC/Boston/SanFran, but still up there).

Program C/D: Top 25, well regarded programs. I liked everything about it, but the programs are fairly small (smaller than I'd like). Less prestige that Programs A/B, but still well thought of. Didn't like as well as A/B, but wouldn't slit my wrists over going here and will rank for sure. But... my wife LOVES the area, real estate is cheap, daycare is subsidized, and her job opportunities are AMAZING (much much more so that Program A/B). Given a choice, she would move there in an instant (her #1 for sure). Cost of living is very low, and we'd be able to buy a house immediately, have kids, and she has a great chance of landing a dream job. But, there's no fast-tracking for me and the fellowship opportunities are lower (would probably have to move after 3yrs - something that is less desirable). Plus, it's 4+hrs from family.

So, what to rank higher: my dream job in an expensive area, or her (possible) dream job in a cheaper area?

Ugh...

you should rank programs A/B as #1 and 2. First off, if it's not NY or SF, it's not that expensive. (Chicago? -- just a guess) Despite what you may think, it is possible to buy a house on a resident's salary (and you'll have 2 incomes). with more "prestige," you'll be able to get a good fellowship - think long-term: do you want to end up in general IM? plus, it's in an area you've "always wanted to live in" and family is close by. all important considerations.

the other thing is -- she might be able to get a "dream job" in the other city, but if you have to move in 3 years for fellowship, guess what? she'll have to leave the "dream job."

 

[kem]

Just from reading your post, I think you really want to go to schools A/B.

I really hope that everything works out for you, these decisions can be so tough!

🙂 kem

 

[abcde]

Do you mind telling us what field?

 

[H2SO4]

Believe me, I *DO* want to go to A/B. But, my wife wants to go to C/D. But the "Dream Job" that she wants is rare in the cities that A/B are located. Basically, it's like a couple's match with only one person ranking... Still not sure what we'll do. And I'd rather not say what city/specialty, since I'm sure someone might figure out who I am (boards are never truly anonymous!). I know for sure I want to do a fellowship, and a fellowship IS available at C/D, but for jobs later, having done a residency/fellowship at A/B will open many more doors... But on the flip side, the opportunities for my wife are AMAZING at C/D and will open more doors for her than those available at A/B, plus, she may have a MUCH longer commute.

Decisions, decisions...

 

[b&ierstiefel]

And I'd rather not say what city/specialty, since I'm sure someone might figure out who I am (boards are never truly anonymous!).

and the biggest population of lurkers are residents at other institutions. don't badmouth a program or a specialty; you might bring some of these lurkers out into the light

 

[fourthyear]

Tough call. You and your wife really need to work this out so you're at some sort of agreement. Ultimately, the match may decide for you, but if you get #1, well, you have to decide what #1 is for you both.

Most of all you have to come out of this situation with neither of you resentful to the other for a missed opportunity. You have to somehow agree on a comprimise that you are both going to be okay with.

So if she has a less-optimal job a few years during your residency, maybe you comprimise by planning to move where she has better opportunities after your training. Or, if you're really going to be working all the time anyway, maybe you want to give in a little and go where she'd be happier b/c it is always kind of hard on the spouse of a resident if they are not happy in a new city and the resident is never home to spend any time with the spouse.

Remember, no matter how you make your rank list you might not get your #1 anyway...and I have some crazy beleif that things end up working out okay most of the time even when you don't get what you thought was your first choice. I ended up at a place about 1/2 way down my rank list and, knowing now what I didn't know 2 years ago about what it really is like here, it actually has turned out to probably be a better fit - for location, program, spouse's happiness and everything, than the places I had ranked above. Try not to stress too much, although I know that is easier said than done...

 

[bobbyseal]

First, I want to say that I like all four programs, and would be happy at both. And I know that the decision could totally be taken out of my hands with the Match. But still...

Programs A/B: Two of the best in the US (consistantly ranked in the Top 5). I loved the programs, loved the residents, loved the area, etc. I'm not really that concerned with the ranking, but I want to do a fairly prestigious fellowship, and others care about rank. Also, both offer a fast-track into fellowship that I'm interested in (same program, just longer training). I've always wanted to live in the area and I have family fairly close by (w/in 2hrs). Given the choice, I'd rank places #1 & #2 in a heartbeat. But... It is somewhat expensive to live there (not NYC/Boston/SanFran, but still up there).

Program C/D: Top 25, well regarded programs. I liked everything about it, but the programs are fairly small (smaller than I'd like). Less prestige that Programs A/B, but still well thought of. Didn't like as well as A/B, but wouldn't slit my wrists over going here and will rank for sure. But... my wife LOVES the area, real estate is cheap, daycare is subsidized, and her job opportunities are AMAZING (much much more so that Program A/B). Given a choice, she would move there in an instant (her #1 for sure). Cost of living is very low, and we'd be able to buy a house immediately, have kids, and she has a great chance of landing a dream job. But, there's no fast-tracking for me and the fellowship opportunities are lower (would probably have to move after 3yrs - something that is less desirable). Plus, it's 4+hrs from family.

So, what to rank higher: my dream job in an expensive area, or her (possible) dream job in a cheaper area?

Ugh...

All I got to say is:

When Momma's happy, everyone's happy.


On the other hand, you can always lie to her that you put C/D as #1 and 2 and if you match at A or B, you can just say something like, "Hmm, it's crazy how this match system works...."

 

[cytoborg]

Let me take a moment to express just how much it STINKS that we have to spend hours agonizing over every possible contingency. 😡 Some computer is going to make little whirring noises and spit out The Place we will end up and make all of this meaningless. I mean, if we end up #10 on our ROLs then what was the freaking point of agonizing and killing ourselves over the nuanced comparisons of #1-4? ARGH!

Anyway, as you can see, I feel your pain. I am struggling with the Family vs Me debate right now as well, and it ain't easy. To take my mind off my own suffering, I thought about your situation quite a bit and came up with the opinion (and I know this is not what you want to hear) that you should rank C/D higher. It sounds like overall, those programs would be best for your family. Financial, living, and childcare concerns, and your wife's happiness in her job are going to be integral to you guys getting through the next few years. The only catch is your fellowship- can you stay at C/D for fellowship if you guys put down roots there? (i.e. wife's dream job, house, kids).

 

[DrQuinn]

I personally would go for C/D. Its not just your life but also your "life partners" as well. Compromise is probably the best key, as a previous poster stated. But when I was interviewing, I really didnt want to drag my wife to a city I knew she wouldn't like very much... she was extremely liberal and didint' ahve much opinion about it, but I knew she would liek to be in a big city and not in some po dunk area... so I rakned accordingly. this is my 6th year in FL and our 4th in Tampa, we decided to stay here for my residency, and she's very very happyw hich makes my life so much easier.

Q

 

[kem]

I just think you really have to make sure that if you ranked C/D #1, went to C/D and worked really hard but for some weird reason didn't match into the competitive fellowship that you want or did match and matched somewhere you both didn't want to live, if you would still be ok with your decision, and wouldn't be thinking, "I wonder what would have happened if I had ranked A/B #1."

Of course there is the other side too, if you put A/B #1 and your wife doesn't feel fufilled in her career and then gets upset with you because she gave up her dream job and you're never home and she's in a city she hates, would it be worth it? Or maybe she would surprisingly end up in a job she does love, and learn to love the new city, and end up really happy anyways? (And be nearer your family, which could help occasionally with childcare?)

I hope for all the best with your difficult decision.

-kem

 

[patelakshar]

A/B provides for better stabillity as well as a better future.

 

[Gut Shot]

What an awful decision to have to make. Balancing present sacrifice with future reward is a tough process. But unless ending up at A or B will have you in divorce court, I would rank them higher. Here are my reasons:

1. As painful as it is, you can delay buying a house, having children, and I presume your wife can delay getting her dream job. But your residency training is your apprenticeship, and if you are ambitious and dream of competitive fellowships then it is a pedigree you will wear for the rest of your professional career. If ever there was a reason to be selfish about your training then now could be the time.

2. You allude to your wife having amazing career opportunities near C/D, but also to starting a family. If you are like the vast majority of couples I know, after the babies start arriving you are faced with a choice: 40 hour/week daycare, relying on relatives for daycare, or one person quits/drops to part-time. It makes little sense to move somewhere for your wife's career if she is going to end up professionally hamstrung. Just something to consider.

3. You are obviously enthralled with A and B, and very lukewarm about C and D. As someone mentioned earlier, are you sure that there will be no resentment if you rank C/D higher and go there? At least if you shoot for top 5 and end up at top 25 then you can feel like you gave it your best shot, focus on the positives and try to be a bigger fish in a smaller pond.

I can envision some factors which would change my advice. For instance, if your wife had been working two fast food jobs for the last 4 years to put you through med school then I would give C/D more thought. I just don't know that much about your situation.

Whatever happens, I just hope that you will plan for the long term, and that you and your wife are both rowing in the same direction. One of my brothers was forced into a lousy job market by his wife, who had supported him during his Masters Degree and was tired of it. He had an offer to go on and finish his PhD, but he took a 35K a year job so they could buy a house and start having kids. Years later, after three kids and a series of crappy white collar jobs, she mused to my dad (a professor) "I wish he had gone on and gotten his PhD. He could have gotten a stable faculty job and we'd be so much better off."

My poor Pop almost had a stroke.

 

[H2SO4]

Great suggestions, harvarti, but there are some things that influence these:

1. We're both in our early 30's, wife is also gratuating this year with her professional degree and can't really "delay" a job. She'll get a job at any place, but the sheer number of opportunites are amazing around the C/D area. We're both older than your standard graduates, and VERY ready to be homeowners. But A/B may delay home-buying, since RE prices are higher.

2. Programs C/D have excellent daycare (subsidized!!!). And wife wants to work as much I as do (which I completely support her on). We're a two career family, no question. We'd have to sacrifice more to have kids at A/B (due to expense), but we've talked in great detail about kids, daycare, and such.

3. I like all of them, but A/B are "dream" schools. Resentment is always a possibility, but it could be on both fronts. That's why we've been talking about everything and with lots of people (including SDN'ers).

Both locations have benefits and drawbacks, and it could end up that my wife will get a WONDERFUL job near A/B. We're still discussing it. Man, I wish I knew now whether I even had a SHOT at any of these four schools! Ugh.

 

[NinerNiner999]

Plan for A/B and make it your point to TRY to have everything. Buy a house, make some investments, and start your residency. Suck it up and do it. If you are in a relatively good real estate market, you will walk out of residency happy with a chunk of your debts paid down. Plan now for the next few years ahead and don't look back.

 

[Gut Shot]

We're both older than your standard graduates, and VERY ready to be homeowners. But A/B may delay home-buying, since RE prices are higher.

It could be worse. When my father got his first post-PhD job in Denver (when he was 30), he and my mother rode into town on fumes with two kids, a huge dog, and absolutely no place to stay. They survived, and 37 years later they are retired in a big house out west with plenty of toys.

I'm also in my early 30's, so I feel your pain. But in 30 years will you remember the extra money for daycare, paying rent for an extra year, or your wife's first sub-optimal job?

 

[bente]

C/D all the way. If you could somehow divide the responses into med students (merely theorizing on hearsay) and attendings (have been there and have many many colleagues who have been in your shoes)....I believe attendings would overwhelmingly say go for C/D. At least those that are not divorced. Or on the academic rat race ladder. Repeatedly, med students OVERestimate how vital one prgm is over another for residency or fellowship. The farther you get away from academic institutions and training, the less your colleagues care....and the less your future employers care. They want compatibility. And you will find the vast majority of physicians who have been in practice for awhile relate that lifestyle and family harmony is far more important than the other factors in their job. Don't put off that harmony for some more perceived delayed gratification. Go ahead and PM me if you want.
Another point:

 

[Gut Shot]

....I believe attendings would overwhelmingly say go for C/D.

Indeed, this is where the question of H2SO4's level of ambition comes into play. If he wants a highly competitive fellowship and a high-powered academic career than choosing A/B becomes a no-brainer. Most attendings simply want to practice and have a decent life, which would make choosing C/D much more advisable.

For instance, if I wanted to go into dermpath (which I don't), then it becomes imperative that I go to a department that has a dermpath fellowship and an excellent track record of placing its graduates into dermpath fellowships. If I want to become a community practice pathologist in rural Iowa then it is arguably a waste of time to go to Brigham, Wash U or UCSF. If I'm hell bent on academics and research then OHSU and UCD should probably head south on my rank list.

I feel like I can speak with perhaps a shred more authority than just a med student spouting hearsay, as I have a PhD and have been involved in post-graduate academics/professional school since 1995. I have a number of close friends who are attendings, so I can appreciate how your pedigree can *potentially* affect your professional life.

 

[abcde]

He has already mentioned that he wants to do a fellowship. That changes the whole deal.

Do you mind expanding on the fellowship advantage that a/b offer. That will help clear the picture I think.

 

[H2SO4]

A/B offer both separate fellowships and a combined program (combo of residency and fellowship). Basically, acceptance into a residency there would guaranteed me a fellowship at the same place (combined or sequential). C/D offer the fellowship as well, but not as a combined program and they only take one fellow/year. So the "prestige" is not just doing a residency at A/B, but also being in a prestigous combined program and not having to worry about re-applying for fellowships.

 

[achieman]

I'm in a similar situation with 4 programs I like a lot. I also have my A/B school being top 5 institutions but in locations less than desirable and C/D schools that are in better location and I feel more comfortable. My plan is to compare apples to apples and oranges to oranges. For example, compare A to B, then C to D. Then I compare the "winner" from the 2 groups. My rank may turn out to be ACBD or CADB, a more shuffled approach.

 

[surg4me]

You're not alone and you should really look at the big picture...you're life is more than your job...I would imagine that the top 25 programs will get you to great places in fellowships as well as those in the top 5. From my experience talking to many attending and residents (in Gen Surg), the most happy seem to be those who have been able to have a balanced life...those who have one thing that's great but have other deficits seem to be more unhappy. For example, you're lucky you have a significant other...many single residents I know whet to great programs (in places where they don't want to permanently live), and found themselves too busy or stressed to have time to find someone to settle down with...many in their mid-30s feeling left out because their friends now spend time with sig others/wife/kids...consider your life as a whole and choose the best balance of prestige, career, location, life, etc.

best of luck