Big name fellowships coming from a smaller program

Hello all,

I am a 4th year medical student applying to orthopedics this year. I am currently in the process of ranking programs, and I am kind of stuck figuring out where I would like to go. I got both "big name" interview invites, as well as smaller academic program interviews and I am trying to decide between the two. I felt more "at home" at the smaller programs, but I definitely have some interest in eventually doing more academic orthopedics and am wondering if you can still secure bigger name fellowships and jobs (either in academics or in desirable locations) coming from a smaller residency program? Are there any sub-specialities in particular that this might be a more difficult transition to make?

I figured this forum would have people most in the know about this since you all are going through the fellowship process right now.

Please know that I am first and foremost interested in picking a training program that will give me the tools and opportunities to become the best orthopedic surgeon I can be after 5 years -- I just am trying to keep the bigger picture in mind and want to keep as many doors open as possible for the future.

Thanks for your advice!

My advice is to go to the biggest name, most academic program you can. At high volume, private hospital community programs the educational component can be very minimal while the "service" component (ie holding retractors then closing while the attending is operating his second room) can be very high.

Also, when it comes time to apply to fellowships, private practice surgeons aren't always as plugged in to academics as the resident might need. Our surgeons are pretty out of the loop for the most part.

good luck

If you want a truly "academic" practice, then yes seek out a truly academic residency or one that has a lot of research. In my limited experience research is what gets you connections, by publishing or presenting you meet people, get invited to sit on committees, teach lectures, etc... You can do all that at a community program but it will mean more work on your part.

There are opportunities to be academic at smaller community/private practice type residencies as well, but you will have to seek them out. At our community program we have had a few guys go into academic practice (at University of X places) and one of our graduates is one of the most published authors in the sports medicine literature. But that represents probably 10% of our graduates. Most of us just want to start working.

And I disagree with the poster above me, community style programs usually produce surgeons who are quite good at operating but without a lot of publications of extreme OITE scores. It can be a bit of a trade off between academics and community. An academic university hospital is not going to do 6-8 TKAs or 8-10 scopes in a day unless they are an outlier. Private practice groups also hire PAs and such and so "service work" is not as bad as you would think.

Go where you feel you fit in best, residency is about being able to work with someone for 36 hours straight and not want to punch them in the face. You will be trained well just about anywhere.

Either way just match, you can figure out that stuff once you have secured the position.

Thank you both for the replies.

The few smaller places that I am very interested still have a good infrastructure to do research, and after talking with faculty and residents at these places, I believe that with hard work I could easily get 10+ publications during my time there.

I don't have aspirations to become faculty at a giant academic institution. My interest in academics lays more in teaching (which I have a background in), and creating a sustainable international experience for myself and residents, and less so about being a research giant (although I realize that it's apart of the game).

I mostly wanted to ask those more in the know than I am, about how much the name of where you trained matters for fellowship and a job afterwards. Thus far throughout undergrad and med-school, it doesn't seem to have mattered a ton, but I wanted to know if that would change in the future. More to your point Sparty, the places I felt I fit best were these smaller programs, but before ranking them highly, I wanted to have a complete understanding of the positives and negatives of attending a smaller, less academic, training program.