Here's question from a senior med student at a state school. She has excellent grades, USMLE Step 1 and 2 scores > 245, has co-authored 4 published papers, and was elected to AOA. She writes
I am looking to re-locate to a large city for residency as a number of my family members live there. I have interviewed at the large academic centers in the city as well as their community affiliates. I have also been involved in research and always assumed I would enjoy the biggest "named" institution possible. As I have interviewed, I truly feel that I would get better training (and be happier) and the academic-affiliated community programs in that city. However I have been told my several advisors at my home school that this would be "career suicide" and it would be "idiotic" not to take the best name that I have a chance at matching at. As far as fellowship, I have literally no idea what I want to do. Maybe surgical oncology, maybe transplant? Maybe vascular, maybe nothing?!
What is your insight into this? Should I seek what I perceive to be the best training/fit or should I rank the higher name academic programs for the sake of my career?
Here's my opinion. Be advised that it is strictly my opinion and may be neither popular or correct.
You should have no problem matching at any affiliated community hospital program and probably have a very good chance to match at every academic program in the city you want to be in.
I hope you have properly researched your top choices and are confident that the residents are happy and doing a lot of cases. Also you should be sure that the leadership of the program is stable. I suppose your mentors your school want you to take the academic track because that's what they did. It also enhances the reputation of the school when its students match in big name programs.
You remind me of me except I didn't have the publications you do. I took the "comfortable" choice for residency and never regretted it. I trained in the same city you are looking at. It's a great place to live.
I see it this way. Suppose after a couple of years in a community program, you decide you want to be an academic surgeon. After you residency, you can always take a fellowship in something at an academic medical center.
But if you go with a university program and are miserable, then what do you do? Five years (plus a year or two of research) is a long time to be miserable.
I went into more detail about this in a post three years ago.
Listen to your heart. Go for the place that you feel most comfortable with.
I strongly suggest ranking all of the programs you feel you can live with—just in case.
Good luck and let us know how it turns out.
Readers, feel free to disagree or agree as you see fit.