Does prestige in residency position translate into higher income?

[kwb18200]

My question is, within any given specialty, (say, anesthesiology) would the prestige of residency position translate into future greater income as a practicing physician? Does this change from specialty to specialty?

If the prestige of a residency position does not generally translate into future greater income, what advantages does it confer? I have heard, for instance, the prestige of a residency position matters more when entering academia.

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[Sartre79]

Not in the real world, but remember that you only get to do training once. I trained at a prestigious institution and have noticed that my training was much better than other people who trained at XYZ program. This was my anecdotal experience, so make of it what you will.

In truth, people skills and soft skills matter more in the community, especially in the age of Press-Ganey and patient centered care...there is a lot of customer service. So, I'll often see a doc/APP practicing bad, non evidence based medicine but patient's love them b/c of their bedside manner.

 

[RetinaDude]

My question is, within any given specialty, (say, anesthesiology) would the prestige of residency position translate into future greater income as a practicing physician? Does this change from specialty to specialty?

If the prestige of a residency position does not generally translate into future greater income, what advantages does it confer? I have heard, for instance, the prestige of a residency position matters more when entering academia.

As far as private practice is concerned, no one gives a hoot where you did your residency. Same goes for med school. Whether you went to Harvard, or EBF Med School, who cares.

Only place it all matters is academics and people who actually like to brag about going to "X" med school or "X" program

 

[snooper]

Medicine is unique.
Getting an MBA from a top business school definitely translates to a higher salary.
Getting a law degree from a top law school is now practically mandatory to a high-paying career in law.

But in private practice medicine the prestige of the school and the residency doesn’t matter at all (except perhaps in Beverly Hills and a few coastal enclaves, as mentioned above).

Or in places where patients google the credentials of their physicians

 

[Wordead]

Why is SDN underestimating the effect of brand names in private practices, especially given the increasing corporatization of medicine? People are still clinging onto the outdated 1990s notion of independent physician practices where no one cares where the attendings went and physicians were all making well north of $400K/year with flexible work schedules

The environment in 2020s is much worse as private equities led by top business school grads start taking over independent practices. And for these guys, nothing makes them more excited than having a Harvard/Stanford/Penn MDs and MD/MBAs on board to help them out with corporate takeovers and raking in many hundreds of millions of dollars.

What about being promoted to partner of the equity group? That’s likely to happen coming from a top med school

I graduated from a semi "name brand" program and frankly the patients that care where you went to school are the exact annoying high maintenance patients you don't really want.

And I think it's pretty cute that you think after a PE group buys you out that you're a "partner" in the equity group. What, you're going to tell them how to run a business? When you and/or your partners already ran the group into the ground to the extent that you needed a corporate buyout? No, you may get an ownership stake or sit on their board or whatever but you have zero decision making ability.

 

[drdoug]

My question is, within any given specialty, (say, anesthesiology) would the prestige of residency position translate into future greater income as a practicing physician? Does this change from specialty to specialty?

If the prestige of a residency position does not generally translate into future greater income, what advantages does it confer? I have heard, for instance, the prestige of a residency position matters more when entering academia.

Good question! And you are right in one aspect. The prestige of a residency program does confer a better chance of obtaining a job in an academic institution. Also, not only the prestige of any residency program, but how you perform during your residency does give you advantages in obtaining future employment. Also, if you are the Chief Resident (and perform well) - you will get glowing recommendations for either route, be in academia or a highly desired job in a group setting.

 

[Lem0nz]

Why is SDN underestimating the effect of brand names in private practices, especially given the increasing corporatization of medicine? People are still clinging onto the outdated 1990s notion of independent physician practices where no one cares where the attendings went and physicians were all making well north of $400K/year with flexible work schedules

The environment in 2020s is much worse as private equities led by top business school grads start taking over independent practices. And for these guys, nothing makes them more excited than having a Harvard/Stanford/Penn MDs and MD/MBAs on board to help them out with corporate takeovers and raking in many hundreds of millions of dollars.

Because it doesn't matter. If you haven't figured that out you aren't reading what people with experience in the real world are saying. The vast majority of patients do not have exotic zebra problems that need multi-million dollar treatments, they have normal problems and need a normal physician. They don't need Mayo or Harvard doing their medicine. There are PLENTY of patients in nearly every single discipline. Income in private practice and even most employed non-academic community practices is almost entirely related to volume, and referring physicians rely on personal relationships between each other + a proven track record of reliable outcomes so that you know what you can expect if you send a patient somewhere for a treatment. Where your training was influences almost none of that. It is not that hard to follow evidence based medicine.

 

[Slack3r]

What about being promoted to partner of the equity group? That’s likely to happen coming from a top med school

Lol, which PE group is going to “promote” the peasants to the C-suite? You’re there to churn patients and generate revenue, nothing more. Unless you’re already a partner at an existing practice prior to a buyout, the chance of an employed physician getting any type of decision-making position in a PE backed group is laughable.

 

[Dr G Oogle]

What about being promoted to partner of the equity group? That’s likely to happen coming from a top med school

It doesn’t matter. One of my Partners went to Harvard, for everything. I went to public college, med school. Residency and fellowship. I objectively am busier, have published more and get more grants. The only time it matters is when I want to turf a patient and I say “well my partner went to Harvard…”.

 

[i-doctor]

In rural America (and in much of fly-over country) people are thrilled to find a doctor who is U.S.-born and who speaks without an accent. And going to a U.S. Med school is even a bigger bonus!

 

[cabinbuilder]

My question is, within any given specialty, (say, anesthesiology) would the prestige of residency position translate into future greater income as a practicing physician? Does this change from specialty to specialty?

If the prestige of a residency position does not generally translate into future greater income, what advantages does it confer? I have heard, for instance, the prestige of a residency position matters more when entering academia.

Generally no. In the work place employers care about 2 things: 1. Are you board certified? 2. Any malpractice claims or issues with any medical board?

 

[Banco]

Don't drink the prestige kool-aid to the level that SDN feeds you. Yes it can matter in certain cases (probably moreso at the undergrad/medical school level), but it's a bit overblown. I highly doubt it matters much for private practice.

Ideally you find a very prestigious place with excellent clinical training.

 

[putmeincoach]

Lol, people caring about prestige on dat dere copium.

 

[Spetzler-Martin]

If you want to get rich, go to the Midwest. They pay a lot and fewer people are interested in working there. Attending that I did research with years ago would get letters begging him to move his practice to one of those states. Even offered a down payment on his house and moving costs, etc.

 

[voxveritatisetlucis]

If you want to get rich, go to the Midwest. They pay a lot and fewer people are interested in working there. Attending that I did research with years ago would get letters begging him to move his practice to one of those states. Even offered a down payment on his house and moving costs, etc.

How does southeast and southwest (not California) compare to Midwest?

 

[Spetzler-Martin]

Here's a map for IM as a reference. Obviously outdated and applies to just IM. However, if I had to place my money on it, I'd assume things are similar today and that for surgical specialties and medicine subspecialties (cards, GI etc), you'd see an even more stark difference relative to those who work in a big city on the west/east coast.

 

[MDMechEngr]

View attachment 357173

Here's a map for IM as a reference. Obviously outdated and applies to just IM. However, if I had to place my money on it, I'd assume things are similar today and that for surgical specialties and medicine subspecialties (cards, GI etc), you'd see an even more stark difference relative to those who work in a big city on the west/east coast.

looks like a heat map for tornados and death by weather.

 

[snooper]

I graduated from a semi "name brand" program and frankly the patients that care where you went to school are the exact annoying high maintenance patients you don't really want.

Ouch - where people trained is ONE information point for me, just like answers to my questions about outcomes, recommendations of experts, etc. If that makes me "an annoying high maintenance patient", then this is obviously not the right physician for me.

 

[voxveritatisetlucis]

Ouch - where people trained is ONE information point for me, just like answers to my questions about outcomes, recommendations of experts, etc. If that makes me "an annoying high maintenance patient", then this is obviously not the right physician for me.

Obviously going to be different for med students/physicians compared to the general public.

Most of the general public probably think that Brown residencies and med schools are better than case western, emory, utsw etc.

 

[snooper]

Well, even "the general public" can inform themselves about what is a "top" residency program in the respective specialty.

 

[voxveritatisetlucis]

I guess that’s true and maybe in certain geographies (Boston, NYC, SF etc.) the general public can be selective . However, as somebody who is in the process of trying to transfer care from the northeast to a fairly large in the MW, I have had to wait so long to get an appointment with a specialist that it becomes impossible to be picky. I also have good health insurance so I imagine it’s even more difficult for people with plans that are not often accepted.

 

[DarkHorizon]

Lowly DO Checking in…. Busiest in my group. Top producer. Live in a fairly desirable area in a large metro. Partners trained at ivory leagues and busy as well, but that hasn’t hindered me. Something about being able, available, and affable. Short answer is no. At least in private practice.

 

[DarkHorizon]

Ouch - where people trained is ONE information point for me, just like answers to my questions about outcomes, recommendations of experts, etc. If that makes me "an annoying high maintenance patient", then this is obviously not the right physician for me.

That’s cool, do it on your phone by googling the doctor. Just don’t ask annoying questions about how many of femurs or Tibias a surgeon has nailed when you are in the trauma bay, in his/her residency and fellowship, and proceed to ask to be transferred to mayo (which is over a 1000 miles away)

 

[Spetzler-Martin]

Lowly DO Checking in…. Busiest in my group. Top producer. Live in a fairly desirable area in a large metro. Partners trained at ivory leagues and busy as well, but that hasn’t hindered me. Something about being able, available, and affable. Short answer is no. At least in private practice.

So your partners trained with elephants and now work with humans?

I guess that’s true and maybe in certain geographies (Boston, NYC, SF etc.) the general public can be selective . However, as somebody who is in the process of trying to transfer care from the northeast to a fairly large in the MW, I have had to wait so long to get an appointment with a specialist that it becomes impossible to be picky. I also have good health insurance so I imagine it’s even more difficult for people with plans that are not often accepted.

I have family who live in the Bay Area. Wait time for a cardiologist was 2 months. Top rated cardiologist was even longer, ranging to 4 months. That's not exactly the amount of time I would want to wait if I think I have a cardiovascular pathology...

 

[FarmerToDoctor]

A big name or academic affiliated residency program may help you meet more well-connected individuals and help you land a fellowship. On average, it is more challenging for someone from a community-based program with no linked fellowship programs to match into a fellowship program. At that level, PDs like to select residents that they have experience working with or residents recommended by individuals that they know. There are also more opportunities for research, networking, and working with industry at larger academic centers vs a community based program. What you do with these opportunities is up to you.

This does not necessarily translate to more money, just more opportunities to make more money. And even then, you have to be at the right place, at the right time, and know the right people.

 

[FarmerToDoctor]

View attachment 357173

Here's a map for IM as a reference. Obviously outdated and applies to just IM. However, if I had to place my money on it, I'd assume things are similar today and that for surgical specialties and medicine subspecialties (cards, GI etc), you'd see an even more stark difference relative to those who work in a big city on the west/east coast.

This is probably still true. I know it is 100% true when it comes to cardiology compensation (see attached). Cardiologists in the South do MUCH better vs other regions. The West is #2 and the NE is #4. Another thing to keep in mind is that regions where doctors make more money traditionally have very few doctors to begin with, hence why organizations are willing to pay more.

 

[Wordead]

Ouch - where people trained is ONE information point for me, just like answers to my questions about outcomes, recommendations of experts, etc. If that makes me "an annoying high maintenance patient", then this is obviously not the right physician for me.

Not everyone's a match. Someone people should go to the tertiary or quaternary center where they can pepper the sub-subspecialist with questions and then go home and do more "research".

Well, even "the general public" can inform themselves about what is a "top" residency program in the respective specialty.

The general public has no idea what a top residency is for each field. Hell even other doctors outside the field probably don't know. If you guessed you'd probably get 50-60%.

 

[Ho0v-man]

Well, even "the general public" can inform themselves about what is a "top" residency program in the respective specialty.

Probably not. Even most physicians are pretty bad at this outside of their individual specialty.

 

[operaman]

Probably not. Even most physicians are pretty bad at this outside of their individual specialty.

Even within our specialty! Like I know what the best programs are generally speaking but even within that, there are some “top” programs that have been known to turn out poorly trained surgeons.

We’re going to be looking for a couple more docs in my dept soon and it’s interesting being on this side of things. No jobs are posted - mine never was - but we are quietly sniffing around trying to find some good candidates who are excellent surgeons. Program is definitely part of it as we want people who can hit the ground running, but even then there are texts and phone calls to find out who at the good program is actually good and seems to have good judgement as well. Not always an easy find!

 

[snooper]

Not sure what we mean by general public here, but, of course, they "can inform themselves"! You can ask someone in the specialty where they would go or where they'd send family members. For certain procedures, they may not have attended top institutions, but they are certaily top in their respective area. And you bet that I ask questions from my treating physicians. Some actually appreciate it. If you can't handle it, obviously not the right fit. However, deviating from the OPs original question -

 

[voxveritatisetlucis]

You can ask someone in the specialty

Who, besides other doctors, has a cardiologist, gastroenterologist, ent etc. on speed dial or who they are friendly enough to ask?

I suppose maybe in some wealthy circles, but it doesn’t seem like a common thing for most to have

 

[snooper]

I probably should have clarified, e.g. you see a general cardiologist who refers you to, say an interventional cardiologist. You ask the first cardiologist, where would you go? Or you see a dermatologist who refers you to a MOHS surgeon, ditto... ortho to spine surgeon, general dentist to root canal specialist, etc.

 

[ChiDO]

Lowly DO Checking in…. Busiest in my group. Top producer. Live in a fairly desirable area in a large metro. Partners trained at ivory leagues and busy as well, but that hasn’t hindered me. Something about being able, available, and affable. Short answer is no. At least in private practice.

Similar situation. Top 5 busiest in my group out of 20, but that's because the top 5 are all crazy busy. Our #1 does 1k total joints per year. We have multiple DOs, community trained MDs and some big name trained ortho partners (washu, mayo, OrthoCarolina, stanford, ect).

If you work hard in PP, you will succeed. We want hard workers. We lost a new guy a few years ago who trained at a prestigious ivy league who unfortunately didn't mesh well with the group and couldn't survive PP. Ended up leaving the Area and going into academics at a major university.

SDN is a giant echo chamber for prestigious institutions unfortunately and match lists.

 

[VA Hopeful Dr]

I probably should have clarified, e.g. you see a general cardiologist who refers you to, say an interventional cardiologist. You ask the first cardiologist, where would you go? Or you see a dermatologist who refers you to a MOHS surgeon, ditto... ortho to spine surgeon, general dentist to root canal specialist, etc.

They should always be referring you to someone who they would go to barring extenuating circumstances. Why would you refer a patient to someone you don't trust?

 

[Banco]

Well, even "the general public" can inform themselves about what is a "top" residency program in the respective specialty.

Not at all. They generally just assume big name = good program (like most things in life). Often that can correlate, but often not.

In reality, this is hard for med students to gauge. Or attendings for that matter.

 

[srirachamayonnaise]

It’s funny we think that people would normally pick a less prestigious residency program over a more prestigious one. Given a choice in IM, EVERYONE would pick Big4 programs over a community program. Whether that translates to more pay or not is not why people pick a better program. They pick them because they CAN. So the question here is if I fail to go to a prestigious program, can I still make good money?

 

[Hzreio]

It’s funny we think that people would normally pick a less prestigious residency program over a more prestigious one. Given a choice in IM, EVERYONE would pick Big4 programs over a community program. Whether that translates to more pay or not is not why people pick a better program. They pick them because they CAN. So the question here is if I fail to go to a prestigious program, can I still make good money?

I will tell you that prestige will not be my top priority if given a choice

 

[wholeheartedly]

It’s funny we think that people would normally pick a less prestigious residency program over a more prestigious one. Given a choice in IM, EVERYONE would pick Big4 programs over a community program. Whether that translates to more pay or not is not why people pick a better program. They pick them because they CAN. So the question here is if I fail to go to a prestigious program, can I still make good money?

Not really, a lot of people pick residency programs based on geographic location preferences.

 

[jstwannagraduaaate!!!]

I know some cards fellows from my non prestigious program who are going to work locums as gen cards and they will do well above the average MGMA salary......... so no

 

[RangerBob]

It’s funny we think that people would normally pick a less prestigious residency program over a more prestigious one. Given a choice in IM, EVERYONE would pick Big4 programs over a community program. Whether that translates to more pay or not is not why people pick a better program. They pick them because they CAN. So the question here is if I fail to go to a prestigious program, can I still make good money?

That's not quite true. Plenty of med students chose a community program because they feel it gives them the training that they are looking for. You see so many zebras at these top programs and certainly get a wonderful education/training, but if your goal is to be a country-bumpkin general IM doc, you're much better off going to a community program.

You see this particularly with FM, IM, EM, gen surg, among others.

But yes, as many people have reiterated over and over, if you don't match into a prestigious program, you can make good money. On average you'd actually make more by going to a less prestigious program because so many graduates of prestigious programs stay in Academics. In private practice, whoever works the hardest, bills the smartest, etc, etc will make more, regardless of where they did their residency.

 

[putmeincoach]

It’s funny we think that people would normally pick a less prestigious residency program over a more prestigious one. Given a choice in IM, EVERYONE would pick Big4 programs over a community program. Whether that translates to more pay or not is not why people pick a better program. They pick them because they CAN. So the question here is if I fail to go to a prestigious program, can I still make good money?

Bruh prestige bucks ain’t paying for the rari. In all seriousness, I’d wager it’s probably a negative correlation.

 

[Smurfette]

It’s funny we think that people would normally pick a less prestigious residency program over a more prestigious one. Given a choice in IM, EVERYONE would pick Big4 programs over a community program. Whether that translates to more pay or not is not why people pick a better program. They pick them because they CAN. So the question here is if I fail to go to a prestigious program, can I still make good money?

--EVERYONE wouldn't. There are plenty of reasons why some people don't want to go to a prestigious program.
--You are likely to make good money. Pay is higher outside of academics. High prestige programs tend to put their grads into academics. The pay difference between academics and community is substantial.

 

[Hzreio]

Bruh prestige bucks ain’t paying for the rari. In all seriousness, I’d wager it’s probably a negative correlation.

How do you feel about your 180k starting salary at Harvard?

 

[putmeincoach]

How do you feel about your 180k starting salary at Harvard?

Some start even lower lol

 

[snooper]

They should always be referring you to someone who they would go to barring extenuating circumstances. Why would you refer a patient to someone you don't trust?

Because they're in your practice or institution.

But --- I will leave this thread now.

To all of you who think that patients don't/shouldn't evaluate their providers, you may reconsider your attitude towards an "educated consumer": Last AARP newsletter had a very detailed list of information and data to ask for when deciding on a healthcare provider, incl. training, treatment outcomes, referrals, second opinions etc.

 

[operaman]

Because they're in your practice or institution.

But --- I will leave this thread now.

To all of you who think that patients don't/shouldn't evaluate their providers, you may reconsider your attitude towards an "educated consumer": Last AARP newsletter had a very detailed list of information and data to ask for when deciding on a healthcare provider, incl. training, treatment outcomes, referrals, second opinions etc.

I’m still fairly new in my area so I sometimes make referrals within my institution simply to a given department. This is done more out of ignorance and as I’ve gotten to know certain docs I really like who do good work and send me good notes, I’ve started referring to them specifically. Probably within a couple years I’ll have a good sense of my go-to people in each field both within and outside my institution.

 

[RetinaDude]

Because they're in your practice or institution.

But --- I will leave this thread now.

To all of you who think that patients don't/shouldn't evaluate their providers, you may reconsider your attitude towards an "educated consumer": Last AARP newsletter had a very detailed list of information and data to ask for when deciding on a healthcare provider, incl. training, treatment outcomes, referrals, second opinions etc.

I’ve had pts call the office and want to “interview” me with their list of questions before they “accept” me as their doctor. I’ve always told my office manager to tell them to “go find another doctor because I’m not putting up with those people”. I don’t have time for that crap. I don’t mind if people have questions about their specific care/disease but I am not going to sit for an interview about me and my qualifications. I’m way way too busy and people are just going to have to trust me or find another specialist (and good luck with that).

 

[voxveritatisetlucis]

Won’t hospital systems get extremely mad if you refer out of network? I’ve heard that but not sure how true it is

 

[guytakingboards]

Won’t hospital systems get extremely mad if you refer out of network? I’ve heard that but not sure how true it is

The C-suite is never going to be happy with that, but depending on their model they may be indifferent.

Big integrated care model like Kaiser where you're a hospital employee? You probably have to have a damn good reason to refer externally.

More traditional situation where you're an independent doc just hanging your shingle at their shop? Much less of a big deal.

 

[VA Hopeful Dr]

Won’t hospital systems get extremely mad if you refer out of network? I’ve heard that but not sure how true it is

Sometimes. If you have good reasons it's not usually an issue. They can't push too hard or you run the risk of violating Stark.

 

[VA Hopeful Dr]

Because they're in your practice or institution.

But --- I will leave this thread now.

To all of you who think that patients don't/shouldn't evaluate their providers, you may reconsider your attitude towards an "educated consumer": Last AARP newsletter had a very detailed list of information and data to ask for when deciding on a healthcare provider, incl. training, treatment outcomes, referrals, second opinions etc.

If a doctor is referring to someone who they know is subpar just because they're in the same practice or hospital system, that person is a bad doctor.

Patients can evaluate me all they want once they are established patients. Like the previous poster, I'm not going to do a pre-establishment interview, questionnaire, or anything along those lines. But if you're paying for a visit, ask away.