Why does prestige matter for residency?

[OzFan321]

So why does it matter if a person matches at a top hospital? I understand the fact that places like MGH, Columbia, Cornell, etc have great doctors and great training, but for most doctors who aren't planning an academic career- why does it truly matter? From the doctors I know, many have trained at "community" hospitals and have made out quite well. Several are specialists in their fields and deliever quality care. And how would people compare doing a primary care residency at a top place versus a surgical subspecialty (as an example) at a lesser-known hospital? I'm just curious as to people's opinions on this issue.

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[analu]

one word: connections. easier to do whatever you want to do post-residency, i.e. fellowship, academics, even private practice in a competitive market, if you have BIG NAMES who will go to bat for you when you need them to. and the prestigious places usually have the big names....

 

[Plastikos]

Marketability is better too. Schools like Harvard and Yale enjoy great reputations no matter what the area of study. Harvard could have the worst cardiology fellowship in the nation and the pts wouldnt be the wiser, but would be very impressed by the H. While many smaller/community programs offer training that is at times better than a known academic institution, it will still be looked upon as less.

 

[njbmd]

So why does it matter if a person matches at a top hospital? I understand the fact that places like MGH, Columbia, Cornell, etc have great doctors and great training, but for most doctors who aren't planning an academic career- why does it truly matter? From the doctors I know, many have trained at "community" hospitals and have made out quite well. Several are specialists in their fields and deliever quality care. And how would people compare doing a primary care residency at a top place versus a surgical subspecialty (as an example) at a lesser-known hospital? I'm just curious as to people's opinions on this issue.

Hi there,
While there isn't that much difference between the top ranked medical school and the bottom ranked medical school in the United States, residencies are a totally different entity. If you are interested in academic medicine, you need to train in an academic residency program. If you are interested in private practice you can train academic or community but there is a huge difference in quality between the top academic/community residency programs and the bottom feeders. A poor residency with poor or non-existant teaching can torpedo your career very quickly.
njbmd

 

[DrNick2006]

Why are big names big names? Because the people there do great things, thats why. Do you want to learn greatness or mediocriety

 

[Pastrami King]

Marketability is better too. Schools like Harvard and Yale enjoy great reputations no matter what the area of study.

I wouldn't say that's entirely accurate. Yale's ophtho program is not particularly highly regarded, while University of Miami's and University of Iowa's are two of the best in the nation. And don't flame me. I'm a former Yale undergrad who has nothing but love for the bulldogs.

 

[ny skindoc]

So why does it matter if a person matches at a top hospital? I understand the fact that places like MGH, Columbia, Cornell, etc have great doctors and great training, but for most doctors who aren't planning an academic career- why does it truly matter? From the doctors I know, many have trained at "community" hospitals and have made out quite well. Several are specialists in their fields and deliever quality care. And how would people compare doing a primary care residency at a top place versus a surgical subspecialty (as an example) at a lesser-known hospital? I'm just curious as to people's opinions on this issue.

Its helpful to have a prestige name behind you.If you can get it then it opens doors.But its not at all neccessary for most of docs.If you train in GI or Cards,or Rads at a decent community program and youre a good doctor you are going to be very busy.If you want to be part of an elite "Beverly Hlills" type group practice then where you did your residency will matter.As far as academic medicine? Be aware that private practice docs tend to make much more $$ on average than those in academia.Its sometimes hard for med schools to fill academic as slots many of the best leave for private practice!

 

[Plastikos]

I wouldn't say that's entirely accurate. Yale's ophtho program is not particularly highly regarded, while University of Miami's and University of Iowa's are two of the best in the nation. And don't flame me. I'm a former Yale undergrad who has nothing but love for the bulldogs.

Not by us, but the general public or layperson, you know the general perception.

 

[OzFan321]

Thanks for all the replies. Would it be advantageous for a residency applicant who is solely interested in working as a private practitioner to do a community residency in their chosen locale versus going for a big-name academic residency that might not even be in the same area of the country? Feel free to reply.

 

[captaincrunch]

Hi,
I think that the pretige of the program does make a difference. After all, schools don't earn their reputations on luck; most of the top residency programs also lead the nation in NIH grants and patient care (at least as far as US News is concerned). Furthermore, being at these places helps ensure that you can get any fellowship that you want and perhaps even an academic appointment. That being said, I think a lot of people are attracted to these hospitals for the wrong reasons. Many will simply take the most competitive program available "because it's there." I've noticed that a number of FP applicants will shy away from the biggest-name programs in order to prepare for primary care. I would think that IM and Peds applicants considering primary care would choose similar programs, but we all seem conditioned into believing that these top programs are the best. While there may be a fair number of famous faculty members at MGH, UCSF, etc, it does not necessarily mean that they will spend large amounts of time on the floor teaching residents. Sometimes grand rounds at small hospitals are every bit as interesting as those at big name institutions. My advice: think about what kind of career you want and choose a program based on that. There are a handful of academic programs that also do an admirable job training primary care physicians along with subspecialists, so if you are unsure you can just go with one of these programs. Location does matter, especially if you have family or a significant other to consider. So I wouldn't pack up and move to Rochester just because you heard they are the best.

 

[CatsandCradles]

So why does it matter if a person matches at a top hospital? I understand the fact that places like MGH, Columbia, Cornell, etc have great doctors and great training, but for most doctors who aren't planning an academic career- why does it truly matter? From the doctors I know, many have trained at "community" hospitals and have made out quite well. Several are specialists in their fields and deliever quality care. And how would people compare doing a primary care residency at a top place versus a surgical subspecialty (as an example) at a lesser-known hospital? I'm just curious as to people's opinions on this issue.

I think a lot of the other posters have made excellent replies.

An example would be the Andrew Weil's books we see in our bookstores. They are a bestseller and the editors have stamped all over it that he is from Harvard etc. Being from Harvard is extremely marketable.

Now don't get me wrong, Weil's got some really good points, but I don't think he would be as successful if he was from let say West Virgina Osteopathic or something.

Let's flip the picture and take a look at missionaries. Take for example a book called "Mountains Beyond Mountains" by Tracy Kidder. The doctor in that book, Paul Farmer is a graduate from Duke and did his residency at one of Harvard's hospital.

If Dr. Paul Farmer was not from Duke and Harvard, he would not have been able to mobolize the huge resources needed to establish hospitals and clinics in third world nations. It's amazing what this guy did. He even stole microscopes from one of Harvard's labs and one of the professors covered up the whole incident for him. The microscopes were sent to a hospital that badly needed them in Haiti. Wonderful book I must say.

 

[DrNick2006]

I would look at the Physicians that you see doing what you envsion and look at the road they took to get there. COmmunity hospital programs can be very good and university programs not so good. You really need to look at individual programs and if they are able to get you to your goal. Are you trained to deal with the problems you will see in practice? Can they provide you with oppertunities in the future congruent with your goals (a job, a location in the country, fellowship oppertunities, research career etc.) Would you like the program? Those are the things that I used to decide on a residency program. Good luck!

 

[southerndoc]

The general public doesn't know that University of Miami's ophtho program is the best and Yale's is mediocre. The general public hears the name Yale, and they think it's top notch, regardless of specialty. The same is true with MGH, Johns Hopkins (depending on what area of the country you're in -- many in the South do not recognize Hopkins, go figure), etc.

Within the profession, most realize which programs are the best. No emergency medicine physician would argue with Cincinnati's reputation, but the general public wouldn't know that Cincinnati has the oldest and one of the strongest EM programs in the country.

Sometimes mentioning a big name hospital or medical school can be a conversation stopper. Some people don't know how to respond to it other than "Oh" or "Wow."

Go where you think you will fit in the best. Don't look for a name to wow people. Look for an excellent program that will give you great program. If you are going into a specialty where the public will look into your training records (i.e., surgery, internal medicine) then you'll have to weigh the name v. true professional reputation factor. Even though you might do ophtho at Univ of Miami, some patients may flip the pages of their HMO books and choose to go to the Yale trained ophtho because they think he/she is trained better, regardless of whether that is true. This is not the case where patients cannot choose their doctors (radiologists, emergency physicians, etc.).

 

[miamidc]

I agree it is all specialty dependant. I'm doing Anesthesia, and the rep is completly overrated. If you are doing private practice GAS, IT DOES NOT MATTER where you do residency. You will find a job, and very likely a good one at that, paying you $300,000 + so long as you did an allopathic US residency. Same goes for EM, Rads, Path, etc, etc. Academics is completely different all together. I am going where I will be the happiest, Miami which is prob 2nd tier and still academic but not Harvard, and I will learn a hell of a lot, and come out just as good as the guy who went to Harvard, and the only difference will be that I had a lot more fun in 4 years, and I consistantly had a golden brown tan and a big fat smile on my face. Maybe wouldn't be able to teach in big names in northeast, but thats not what Im looking for.So choose wisely.

 

[Mman]

When it comes to medicine, does it really matter what your patients think about your academic background? What percentage of patients even know where their physician trained? The point about reputation for residency mattering (and it matters to varying degrees for different fields and different career goals) is that it matters to the people that offer you jobs. Patients don't offer you jobs, other physicians do. So if going to big name program XYZ gets you more job offers and connections compared to someplace else it might be worth thinking about.

And if after meeting you, your patients even care where you trained then it is probably more of a function of your people skills.

 

[fourthyearmed]

If all you want to do is go into private practice in your hometown or something like that, it really doesn't matter. Some people get too caught up in prestige.

 

[Sanman]

Based on information from individuals I have known it really doesn't matter that much if you are going into private practice and you know the region. Sometimes going to a community or lesser university program with a strong local or regional rep works better. The academics at ivy U don't necessarily have the best connections when it comes to community private practice. A friend of mine completed residency at a strong community program in which he had connections and made more during residency, and he has he cushiest job I know of for an IM doc. Its all about knowing the right people in th job market. Then again an ivy will always carry more weight in a national job search.

 

[PhillyGuy]

Reputation matters if you are considering a competitve fellowship program post residency, like REI for instance. You have almost no chance of getting it if you do your residency at a small community hospital. It also keeps the door open for people who are not quite sure what they want to do yet. In that case, you can do pretty much whatever you want (fellowship, teaching, research, etc) after finishing a residency at places like MGH or UCSF. The same luxury isn't there for people at a small community program.

However, if you have competitively elminated fellowship or academic medicine and are set on private practice, then I don't think there's any disvantage to a community program. In fact, it may help likes others have said to do it in a place where you will be practicing to establish connections.

 

[miamidc]

Reputation matters if you are considering a competitve fellowship program post residency, like REI for instance. You have almost no chance of getting it if you do your residency at a small community hospital. It also keeps the door open for people who are not quite sure what they want to do yet. In that case, you can do pretty much whatever you want (fellowship, teaching, research, etc) after finishing a residency at places like MGH or UCSF. The same luxury isn't there for people at a small community program.

However, if you have competitively elminated fellowship or academic medicine and are set on private practice, then I don't think there's any disvantage to a community program. In fact, it may help likes others have said to do it in a place where you will be practicing to establish connections.

Most of the times, you will be able to land a fellowship spot at your institution, and if you want to stay in the area anyways, its probably better to stay where you are at. That being said, there are exceptions, suchas REI, Plastics, Cards, GI, maybe a few others. This is for 2-3 teir schools academic schools. Community hospitals seldemly offer Fellowships, exceptions to this one as well. Connections are the key. Local connections are huge if you want to stay local. Big Wig connections are huge if you want to have options in various cities more so. But locals are better than bigwigs if you want a good job in said area. That is my perspective.

 

[ZJz4]

Does prestige of fellowship(i.e. big name place) matter more than prestige of residency?

 

[GoSpursGo]

Does prestige of fellowship(i.e. big name place) matter more than prestige of residency?

It depends on your career goals.

If you just want to be a good doctor who takes care of patients, it probably doesn't matter at all. If you want to stay within academia, where you went and who your mentor was is incredibly important. And yes, in general if you do a fellowship, where you did fellowship matters more than where you did residency.

 

[ZJz4]

It depends on your career goals.

If you just want to be a good doctor who takes care of patients, it probably doesn't matter at all. If you want to stay within academia, where you went and who your mentor was is incredibly important. And yes, in general if you do a fellowship, where you did fellowship matters more than where you did residency.

Thank you