Thursday, December 26, 2013

MiM Mail: Deciding between residency programs

Dear Mothers in Medicine,

I've been an avid follower since the beginning of medical school, and am amazed by the amount of wisdom and advice that passes through. I'm currently a 4th year who is struggling with deciding between residency programs, and was hoping for some much needed advice.

I'm applying for PM&R programs, but applied to a limited area since my husband is a graduate student, and has a few more years of training left in the city where we live now. We met in high school, and had a long distance relationship in college, which was very difficult for both of us. We decided that we would never do that again, and made staying together a priority. We both compromised for medical and graduate school, and went to a city where we could stay together, even though the programs weren't otherwise our top choice. For residency programs, I decided to apply to the surrounding area, because I couldn't stand the idea of being separated.

I'm lucky in that there are a couple of PM&R programs in the city where we live, and a few in a city that's about 2 hours away by car, and an hour away by train. I'm currently struggling with my rank list - I love the programs that are further away, but it would require us moving in between the two cities, and each commuting an hour to 1.5 hours each way, or me taking public transportation, which can take up to 2.5 hours, taking into consideration waiting time for the train and delays. Fortunately I have a friend in the city that I can stay with on the rougher days. Since PM&R has pretty reasonable hours, and I would theoretically study on the train, I'm trying to convince myself that it wouldn't be so bad, but I'm having my doubts.

None of the programs that I've applied to are considered the very top residency programs for PM&R. However, the programs that are further away are better known, and I feel like I would get broader exposure and better teaching from the attendings. My main  question is - how much does the reputation/quality of the program matter in the long run for jobs and fellowships? Obviously there are requirements that have to be met for every residency program, and I've heard from many people that what you put into a program is what you get out. Could I get the same out of a higher quality program as I would out of a lesser known and weaker program, where I put in a lot more effort to self study and seek extra exposures?

Of course it would be easier to stay in the same city, where we have a house and are already settled. But I can't help thinking about the programs that are further away, since they seem like a better fit. I'm afraid that if I decide to commute for the programs that I like better now, the commute might take its toll on both of us, and I would end up regretting it in the end.

I've been agonizing over my rank list for a few weeks now, and still have no idea what to do. Any help would be much appreciated!

Thank you,

Stuck Between Two Cities


  1. I think so much of what we learn is dependent on the quality of the faculty members and our peers. I do believe that the better a program you train at, the better trained you will be as well. Training at a more reputable program does make a difference in a future job search, esp in academics, but also in terms of a more competitive job in a bigger city in a subspecialty. That being said, of course what you put into it matters. Of course family/personal considerations matter. Good luck in your difficult, difficult decision!

  2. I agree with above. I do believe the program where you train does make a difference. I was in the same dilemma as you when it came time for my match list. Ultimately, we moved and we both commute about an hour (sometimes 1.5 hours for me) in order for us to be together and for me to be at the best program (I'm in Ob/Gyn btw). We had a long discussion before we decided and ultimately this was the best decision for us. There was an understanding that with my hours and commute (much less than my husband who hold a regular 8-4 job) that I would be doing very little at home in terms of cooking/cleaning during the work week. You HAVE to have a very supporting partner to do this.
    My co-workers think I am insane to be doing this.. but it keeps my sanity to spend time with husband everyday. We do not do well with distance... we had a short stint during medical school and it was awful.
    I think you also have to take into consideration that it impacts your relationship with your peers as well. I've found it's more difficult to meet up with them after work as I know I have an hour drive after the event. Sometimes I wonder if that is why I haven't formed very strong outside work relationships with anyone.
    Also, take into consideration if you want to have kids during your residency. We know, without a doubt, that there will be no kiddies. I can't imagine both of us commuting both so much with a little one at home.
    Either way, whatever you choose it will be temporary. We keep reminding ourselves that when the days get tough.
    Best of luck with your decision!

  3. Why can't you sell your house and both move to the new city, and let your husband have the long commute? If he's nearing the end of grad school, perhaps he is entering dissertation phase, and can work remotely more easily than he could have previously? Just a thought. I do know distance can be really tough, but I just don't think now is the time to start sacrificing your career.

  4. As the lone physiatrist here, I suppose I should answer...
    A lot of PM&R programs are total crap, and you won't learn anything. But I think fellowship matter more than anything... a good fellowship can make up for a crappy residency. And a lot of physiatrists don't do a fellowship per se but find a practice where elder partners mentor them. That's actually very common. I have friends who felt they came out of residency totally clueless and learned everything while in practice.

    I'm not sure what I'm trying to say exactly. Maybe that most PM&R residencies are shitty, so take the shorter commute if you can.

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  6. Thanks for all the great feedback so far! It's definitely been helpful.

    Fizzy- I was wondering how important the residency is for getting fellowships. Beyond the top tier programs, does the reputation of the program really matter? I know that some fellowships, like interventional pain, are more competitive than others, but it's not necessarily something that I'm looking to go into.

  7. I don't think it matters. For fellowships, the level competition depends on the fellowship. If you want a PM&R-only fellowship, then it's pretty non-competitive. If you want Pain, you need to be at a top tier program. If you want to do spine injections, you can do a Spine fellowship... those are easy to get. Of course, they don't pay as much anymore as of 2014, so the competition may go down.

  8. Fizzy, I've been trying to decide which programs to audition/interview at and have a question. It seems like people generally agree on the top 5-10 PM&R programs but how do you know which are the worst programs so that you can avoid them? Not sure if that's a dumb question but we don't have a PM&R advisor at my school and I feel like I have no guidance whatsoever on this.

    1. I don't personally know but these people do:

  9. I'm currently an M4 struggling with the same dilemma, hopefully going into Anesthesiology. I've ultimately have decided that if I'm happy the next 4 years of my life so will my children. After many interviews, I've noticed all promise very similar things as all have to adhere to the guidelines. So I feel my education won't be too different. I honestly don't think it matters when it comes to choosing, go where you'll be happy. I actually may be ranking out of state programs above my in state programs as I've liked those better. Good luck

    ****I'm currently doing a survey as part of an independent project for school. Just 10 simple questions on your experience as a mom in med school everyone is welcome to submit. Thank you


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