Another MS3 with More Questions

Is University of Maryland considered a top tier program???

Mid tier*

mid tier***

i know this has been discussed ad nauseam but is there a list out there with the best programs? or mid tier? 

i myself am planning on applying to mid/low tier as well and have no idea what those programs are (although I doubt there is really a "low" tier since most urology programs are solid). 

or is it just a matter of opinion? which then will take me back to square one.

thanks

Top Midwest: mayo, cleveland clinic, pittsburgh, WUSTL, iowa, indiana, michigan, kansas, nebraska, kentucky, ohio state (some say this one is malignant)

Mid-tier midwest: not as familiar

Top West: ucla, ucsf, usc, u washington, stanford, ucsd, ohsu, colorado, utah

Mid-tier west: UC davis, UCI, arizona programs, NM, kaiser LA

Top East: hopkins, harvard programs, Penn, Lahey, Maryland

Mit tier East: Rochester (strong), yale, dartmouth, Georgetown and a variety of others

Top South: Emory, Baylor, Vandy, UVA, UTSW, UF, Alabama, EVMS, Duke, UNC, Oklahoma (some say this is malignant)

Mid tier south: not as familiar but maybe Mayo Jacksonville, MUSC, Tulane, Tennessee programs and a variety of smaller programs

This information is readily available if you go through US News with the caveat that major cancer centers that don't have residency programs are all affiliated with a hospital that does and you'll have to do some research to figure out which one that is (with a few exceptions).  Despite the rankings, I would not overlook smaller programs in areas that you would like to live...when it comes down to it, you can get a top fellowship pretty much from anywhere (because the training is very similar across the board). 

The way I figured this out was to ask one of the more senior faculty members where he would apply if he was applying today and he gave me a list of about 25 programs.  From there I weeded out a few where I coudn't live, picked a few that weren't on the list from places that seemed cool to live and picked a few more from hear-say on Uromatch.com.

Be prepared for some regional bias (the norm, but not the rule), especially at smaller programs (again a norm but not a rule).  Connect with a current resident (R3 or higher) if you're not from the region and try to get them to put in a good word (but don't be an ass) if you're really attached to a particular program.  You'll hear a lot of crap on the trail about chairs stepping down and blah blah blah but you'll be able to tell on interview day if the program has the depth to withstand a little uncertainty (most can and do).   

I am probably forgetting a bunch of good programs so feel free to add others.

And with regards to regional bias, you can save a lot of money by applying mostly to programs in your region. 

Major omission from the top mid-west list: Northwestern

in regards to regional bias --

i went to med school in the north east but am originally from the south and want to return there. i have two AI's set up in the south as well to "show my interest" and my permanent address is in the south. 

so, is it okay if i still apply to the south then and not be discriminated against?

I am from the midwest, went to med school on the east coast, and matched in the south without any aways. I don't think there's discrimination unless it's a smaller program. Program reputation is all the pull an applicant would need to go to a lot of these places, so it's expected that you will apply outside of your geographic base.

Top southern program omission: Wake Forest - Very high volume, solid attendings, great research

I think that this question can be answered pretty well by looking at the "Top 5" lists from the last few years. There's a bias towards top applicants posting, so you'll basically see the top ~15 or so programs in the country repeated over and over again.

Hope the sub-I's are going well for everyone.

Take this post with a huge rock of salt.  I don't understand how this guy can place programs into tiers.  Some of these are obvious, but a lot of the programs he placed into various tiers is completely random.

Don't forget the NY programs:

Top tier: Columbia, Cornell, NYU

Mid tier: probably all of the others

I'm going to end this debate by saying the top two programs in the country are the Mayo Clinic and Cleveland Clinic, the tie goes to the Mayo Clinic. Here is why....

1.) Both programs functions under the mentorship model (one-on-one with an attending) which provides a very high amount of operative experience early in residency, and a consistent amount throughout residency.  Uro-1 resdidents are doing big cases that at many other programs would be done by a chief or a fellow. At Mayo in MN Uro-2 are practically doing open prostatectomies by themselves , and in AZ the Uro-1 residents are doing almost half of a robotic prostatectomy.

2.) Both places have a large amount of ancillary support, there is ABSOLUTELY NO SCUT WORK. Like I said the URO-1's are in the OR and not covering the floor and jerking off all day as you would see in most programs.

3.) Both places have 5 residents a year and cover only one or two hospitals. Their call schedule is ridculous URO-1 - URO-3 you are on call like once maybe twcie a month, and the chiefs are on-call one-in-five.  I dare you to find a better schedule. You cannot beat that.  

4.) The teaching at both institutions are superb and both contain very well-known faculty members in all areas of urology. There is a solid mixture of open surgeons and laparoscopic/robotic surgeons.  Both places contain ample research opportunities and have some of the largest organ treatment databases (MAYO - Kidney, Cleveland - adrenal, kidney).  ANd most importantly the residents get a ton of autonomy in the operating room and with patient care, they finish residency knowing how to operate!! Regardless of their high-end patient population the attendings still let them participate in surgeries.  I've seen residents from these other big name institutions operate (John Hopkins, Cornell, Columbia, etc..) and have been very shocked by their limited abilities in the OR.  The biggest reason fallacy of some of these big name east coast programs is that you will get to operate!! Even the fellows don't get to do much at JHU.  do you think A. Tewari is letting his residents do his prostates skin-to-skin....., think again folks!!

Now the reason why the tie goes to Mayo Clinic is because of two main reasons in my opinion..., Mayo is a 5 year program as oppose to the 6 yr program at Cleveland Clinic.  I believed you do a year of research which can be an invaluable experience and is also sought out some applicants.  But if your like me that extra year, even though it may be very chill, is still an extra year.  If you are planning to do a fellowship, damn near all good fellowships require you to do 2 if not 3 years extra with 1 or 2 years of research, that could mean 8 - 9 years of training total compared to 7 yrs.  That extra year was a huge negative to me, it does allow you to be more productive in resarch and may even afford you some bench research skills, but you can still be very productive resarch wise in a 5 year program, it does take extra effort though.

Second reason why the tie goes to Mayo Clinic is that they have a less fellows.  Cleveland has fellowships in just about every field in urology, while Mayo has just one fellow in Oncology, and there are more than enough onc cases to go around there.

The biggest drawback of any these programs are there geographical locations, which probably hurts Mayo more, since Rochester, MN can be very tough for a single individual.

With all this being said, at the end of the day you must choose the program that fits your personality and falls into your geographical range.  Please, please, please go spend a day or two (with a second look) with your top programs.  It shows interest and you could further impressive places prior to them formulating their final rank list. most importantly you get to see how things really function at a place where you could be spending the next 5-6 years of your life. Trust me its worth it.

i hope this helps

uci is definitely top tier in the west. look at their faculty! come on now.

So what about my chances hah

Everyone will agree that both Mayo and Cleveland Clinic are both great residencies.  Saying it is the best is tooting your own horn and seeing things one dimensionally.  Couple of Comments:

1. Call at most Urology programs are not that bad.  Scut work has been minimized by most.  Putting in SP tubes and foleys and seeing trauma and seeing trauma in the middle of the night is useful

2. There are some programs that give you more autonomy than others both in the operating room or elsewhere.  Here is why autonomy elsewhere is more important:

-Evaluate the patient from beginning to end.  Decide who goes to OR, what supplies are needed, how to arrange a schedule, following the patient after the operation.  That experience can only be had at a county or VA hospital and I believe is invaluable

-Most residents coming out of residency will learn how to do a robotic prostate.  How many will do that many afterwards?  Doing big whacks are great but you won't get to do many or want to do many unless you are at an academic center

-Even the autonomy in the operating room may change at Mayo.  Healthcare is changing and a private hospital having two residents do open cases in prolonged period of time with more complications will only last so long

3. Location, location, location.  This is 5-6 years of your life and wouldn't you want to spend it somewhere you will be happy.  Your training won't be that significantly better at Mayo or CCF than most other programs

This is not saying that CCF and Mayo are bad programs but there are downsides to both.  You will not do wrong at many of the above programs.

UCI is not in the top tier.  The big name faculty are Clayman who is Dean of the Medical school and not the clinically active.  McDougall name is in education only.  Ahlering is a good name but nothing amazing.  The have one peds guy Khoury which is not an extensive experience and splits time as department chair and clinical.  There are no other big names in fact the faculty list is somewhat limited for a top tier institution. UCI should not be in the same tier as Hopkins, CCF, UCLA.

interesting comment, however misguided. khoury is not the chairman- he was interim chairman after clayman stepped down and apparently a big name in peds. the new chairman is jamie landman from columbia, who is one of the best lap/endo guys around. he is one of clayman's proteges.  also they now have dr. ghoniem doing female now.  ahlering is among the best prostatectomists around (only does prostates, but is a skinner fellow and very well known).  gelman on reconstrcutve attracts patients from all ver the world and supposedly is amazing in the or.  i would love to match at that place!!!!

Oh I forgot to mention that as chief at Mayo you are considered "junior Faculty/clinical Instructor" you see your own patients in the clinic (New consultations follow-ups from previous chiefs, etc), all new consults in the hospital go to the chief service.  You schedule and arrange your own surgical cases, they are booked under a staff attending.  you follow them after the surgery, etc, etc....  On days you don't have any cases scheduled you operate with one of the attendings that do not have a resident on their service.

Although the call schedule at most urology programs may be better than other surgical subspecialties, the call schedules at these two programs are insanely chill.  And your call frequency will be a huge factor in your overall happiness as a resident.  And placing catheters in the middle of the night after an incompetent nurse/medicine resident failed is not brain surgery, you do not need an entire 5-6 years of practice to be good at it.

AND MAJORITY OF PROGRAMS WILL NOT LET RESIDENTS PERFORM AN ENTIRE ROBOTIC PROSTATECTOMY (SKIN-TO-SKIN) BY THEMSELVES!!!

Like I said before the biggest downside to these two programs is the location.  Though I stand by my statement that for pure urological training these are the two best programs in the country (period)!!

I'm not going to comment on tiering, but I will clarify the faculty at UCI, because this person is a couple years behind in their information.  Hopefully this clarifies things, as the website does not have some of the latest updates:

Chairman is Dr. Jaime Landman, laparoscopy/endourology, expert in kidney cancer and stone disease
Dr. Clayman is the dean of the medical school, and has in fact scaled back his clinical practice, however continues to have office hours and operates every other week.  In addition, he continues to attend conferences.
Dr. McDougall is a well-known name in minimally invasive surgery, in addition to being on the forefront of resident education.  She is currently the AUA chair of education.  She is the program director, and a great resident advocate.
Dr. Ahlering - fellowship trained in uro onc; world renowned for robotic prostatectomy
Dr. Khoury - previously chief of peds urology at Sick Kids.  Excellent experience with him, you will work with him as his only resident for 6 months, getting the same experience as a pediatric fellow at any other top tier peds urology training program.  He is a gifted teacher, and one of the top pediatric urologists in the world.

Uro Onc - Ahlering, Dash, Simoneau
Lap Endo - Landman, Clayman, McDougall, Louie
Female/Neurourology - Ghoneim (recent addition to faculty, from Cleveland Clinic Florida)
Peds - Khoury
Infertility - Spitz
Reconstructive - Gelman
General - Ronningen

Hospitals include UCI, VA, Kaiser, CHOC

What matters as a resident applicant is what kind of training you will receive, regardless of "tier."  You will receive top-notch training, from skilled surgeons who are commited to your learning.  The training is well balanced, with emphasis on minimally invasive techniques on the lap endo service, however with extensive open experience with Drs. Dash and Simoneau on Onc service, and Khoury on peds.  Robotic training at UCI, VA and CHOC.

Ultimately, what seals the deal is the fit with the program.  As reiterated multiple times in the forum, you will receive good training at many places across the country.  I urge you to visit the program and get the scoop first hand.  If not on a rotation, then maybe a second look after the interview process.  Meet and interact with faculty and residents, you will work with them for years, and interact with them well after your residency training is complete.

In any case, look forward to meeting many of you this coming year.