r/InternalMedicine • u/Minimum_Jump_8595 • 8d ago
Community vs Academic IM Programs
Sorry in advance as I know this has been posted before, just hoping to get some insight into my personal situation as a 4th year student looking to match internal medicine in March.
I am a current 4th year who did most third year clinical rotations at a community hospital near my hometown. Really enjoyed it here and got along well with everyone. They do have a smaller IM residency program here which I was interested in partly because I had a good experience durning third year, and also because it is close to home, family, and friends. Most others I talk to or see posting online that pursue IM seem to be more interested in larger, academic programs with in house fellowship programs. Would I be doing myself a disservice by pursuing residency here or at another smaller community program near my hometown? At the moment I am not looking to pursue a fellowship post-residency but definitely not closed off to the idea. Will my clinical training at a smaller community program be on par with that of academic programs? Will my future job opportunities be more limited as opposed to someone who went to a larger program? Not interested in research so that doesn’t play a role in this decision. Though I loved the vibe of my community program, just want to make sure I am doing what’s best for my career in residency training as you only do it once.
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u/Double_Dodge 8d ago
If you want to do a competitive fellowship, go academic
If you want to be a hospitalist, community programs can be fine— even preferred— but I think trying for a large center is the move.
You want a place that doesn’t have to ship out complex cases because they don’t have XYZ service. And one that can attract cool referrals from the surrounding area
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u/vWfDestructor 8d ago
As someone who was set on fellowship and matched to an academic program i think the sweet spot is a community program near a big city where u can still be seeing complex ish patients. Coming from an academic program doesnt mean u will get into fellowship infact most of them just like mine was souless and hella toxic/competitive. I truly would have changed my rank list to a community ish program if I went back in time. I would say seeing u are happy at ur current one is a good sign, maybe do an AI or rotation at a nearby academic program and feel ur feels. But as a devils advocate academic is not > community and u can absolutely match fellowship from a community program just likely to another community ish program as well…
To end it, all my friends who are now in fellowship (and matched cards, heme/onc, pccm, rheum) were ALL in bum fuck nowhere programs and then I did mine at a mid tier NE program and had all the things but didnt match a highly competitive specialty :( (still lowkey stings lol) so moral of the story is that you can do anything, choose where you would be happiest.
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u/kuru_snacc 7d ago
Second this. I chose community prog in my personal paradise over academic offers in places I did not want to be. My soul would have been crushed knowing I'd be stuck several years in a place I had no desire to settle, but I am also pretty nontrad, have a kid in school etc.
I love my community program. It's a clusterf*ck at times but in a good way. I get a lot of autonomy and stay busy. I prefer that over 4-5 hour rounds and theory.
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u/epicpenisbacon 8d ago
If you want to do any kind of fellowship, yes you should 100% shoot for an academic program. You can still be a PCP or hospitalist coming from either a community or academic program, but I would argue you'd get much stronger training at a large academic program than a smaller community one. Being able to rotate through lots of advanced subspecialty consult blocks and seeing much more medically complex patients will only help you when you move on to independent practice
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u/WhyDoYouPostGarbage 7d ago
It’s the opposite - much better training at the community places. Much better opportunities and connections at the larger places. Seeing a medically complex patient as the fifth person in line behind the subsubsubspecialists isn’t great training.
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u/Lost-Volume1254 8d ago
If your goal is a competitive fellowship id shoot for an academic program. If you want just Hospitalist or PCP, community program is fine.