3 yr vs 4yr residency

So what's the question?

I'm sure he's trying to find info on the great 3 yr vs. 4 yr debate. And to his credit he checked the FAQ (which is where the broken link is). So, what are the arguments for and against 3 and 4 yrs? Looks like we oughtta rehash it and then add it to the FAQ.

I'll start:
Most EM programs are 3 years long. Many (likely the majority of) EM educators feel 3 years is sufficient time to train competent EPs. One less year of residency can have a significant impact on an individual's financial situation. Those residents who want additional training can look to fellowships. Why would anyone want to do an additional year of residency unless it's absolutely necessary?

Programs that advocate 4 years point to the ability of senior residents to take on more responsibility for running the ED as a whole. There is often more time for moonlighting (although most programs won't mention that) and the graduates of 4 year programs are though by some to be more seasoned and ready to jump right into their jobs at the end of residency. Some programs point out that as 4th year residents their seniors can do more such as run trauma codes and that such experience is invaluable.

My personal opinion is that it depends on the person. You can be sufficiently trained in 3 years. The first year or 2 out is tough on anyone. I wished a few times in my first year out that I had done another year. But, I survived. I think people put too much emphesis on the money. The money you make in 1 year is not enough to give up an educational experience that could benefit you your entire career. I also suspect that the extra year gives you some more perspective on what type of job you'll like the most. If you're the type of person who likes to get done fast and move on and you'd rather be out than cautious do 3. If you want to make sure you have as much education as you possibly can do 4.

I'll leave the 2-3-4 programs and transitional year programs to someone else.

Great, you brought up the 100,000 (more like the 200,000) dollar mistake, the argument that the 4th year is sometimes valuable, and the fact that the vast majority of EM programs are 3 years in length.

I think you left out that the 1st time pass rate for the ABEM boards is not significantly different for the 3 vs 4 year programs, but this may have been enveloped in your "you can be sufficiently trained in 3 years" comment. Just thought it should be brought up specifically.

Hmm, what else?

3 years:
- you're out of training faster
- no "$100,000" mistake
- no having to match a pesky transitional or prelim year (2-4 programs)
- you're just as likely to pass your board certification (if you apply yourself)
- you're in the majority (always good to feel good about yourself by being with the 'in' crowd )
- you may be slightly less likely to land a job at a 4 year program right after you finish residency (controversial)
- you lose your eligibility to fund your ROTH IRA a year earlier (potential loss of TAX FREE retirement income)

4 year programs (and 2-4 programs):
- many of the most highly regarded programs are this format
- '100,000 dollar mistake'
- have to match both EM program and pesky prelim/transitional year (2-4 programs only)
- questionably easier to get a job in academics (probably better served doing a fellowship anyway)
- questionably have an easier time transitioning into the "real world" after residency is over
- may be slightly more 'cerebral' than 3 year programs (again, questionable, but I've heard it thrown out there)

jd

DeLaughterDO said:

Great, you brought up the 100,000 (more like the 200,000) dollar mistake, the argument that the 4th year is sometimes valuable, and the fact that the vast majority of EM programs are 3 years in length.

I think you left out that the 1st time pass rate for the ABEM boards is not significantly different for the 3 vs 4 year programs, but this may have been enveloped in your "you can be sufficiently trained in 3 years" comment. Just thought it should be brought up specifically.

Hmm, what else?

3 years:
- you're out of training faster
- no "$100,000" mistake
- no having to match a pesky transitional or prelim year (2-4 programs)
- you're just as likely to pass your board certification (if you apply yourself)
- you're in the majority (always good to feel good about yourself by being with the 'in' crowd )
- you may be slightly less likely to land a job at a 4 year program right after you finish residency (controversial)
- you lose your eligibility to fund your ROTH IRA a year earlier (potential loss of TAX FREE retirement income)
4 year programs (and 2-4 programs):
- many of the most highly regarded programs are this format
- '100,000 dollar mistake'
- have to match both EM program and pesky prelim/transitional year (2-4 programs only)
- questionably easier to get a job in academics (probably better served doing a fellowship anyway)
- questionably have an easier time transitioning into the "real world" after residency is over
- may be slightly more 'cerebral' than 3 year programs (again, questionable, but I've heard it thrown out there)

jd

Click to expand...

Hmmmm... Never heard of that before. Does anyone think this even slightly offsets the 200k mistake?

AmoryBlaine said:

Hmmmm... Never heard of that before. Does anyone think this even slightly offsets the 200k mistake?

Click to expand...

As I've said before, it's not a $200,000 mistake if you use the fourth year wisely. This is equivalent to saying that the fourth year of medical school is a $200,000 mistake. I don't see that argued very often. People who stay for a fifth year of medical school to conduct research aren't considered making a $200,000 mistake.

It's all about what you want out of residency. If you want a lot of electives to explore various areas of medicine that you may not see in the ED, or to gain experience that isn't normally offered during residency (e.g., international experience), then a four-year residency is probably more your style since three-year programs rarely offer more than two electives.

Is it a $200,000 mistake? Not for most of us who choose to do a residency at a four-year program. Does it mean it costs you $200,000? Yes, but it's not a mistake if you want to get the most out of a residency. Also, my base salary for my fourth year is $56,000. I consider it more a $120,000 loss by choice judging by the average incomes of physicians.

Finally, a 2-4 program is not a four-year residency program. It's a three-year emergency medicine residency after a preliminary year. This is not the same as a four-year residency since you are often limited by the number of electives you can do during the three years of residency after your preliminary year.

southerndoc said:

As I've said before, it's not a $200,000 mistake if you use the fourth year wisely. This is equivalent to saying that the fourth year of medical school is a $200,000 mistake. I don't see that argued very often. People who stay for a fifth year of medical school to conduct research aren't considered making a $200,000 mistake.

It's all about what you want out of residency. If you want a lot of electives to explore various areas of medicine that you may not see in the ED, or to gain experience that isn't normally offered during residency (e.g., international experience), then a four-year residency is probably more your style since three-year programs rarely offer more than two electives.

Is it a $200,000 mistake? Not for most of us who choose to do a residency at a four-year program. Does it mean it costs you $200,000? Yes, but it's not a mistake if you want to get the most out of a residency. Also, my base salary for my fourth year is $56,000. I consider it more a $120,000 loss by choice judging by the average incomes of physicians.

Finally, a 2-4 program is not a four-year residency program. It's a three-year emergency medicine residency after a preliminary year. This is not the same as a four-year residency since you are often limited by the number of electives you can do during the three years of residency after your preliminary year.

Click to expand...

Muchas gracias for the reply. I feel a bit silly, but I'd never even considered the implications of the bolded statement until I read it just then.

I've been trying to gather a bit of info about the 2-4s. Some of them are obviously awesome programs (Cook County comes readily to mind). I'm just having a hard time seeing how the average EM applicant (read: me) is going to want to do a transitional year or even worse, a year of IM.

AmoryBlaine said:

I'm just having a hard time seeing how the average EM applicant (read: me) is going to want to do a transitional year or even worse, a year of IM.

Click to expand...

So we have heard a lot of opinions on 3 and 4 yr programs by various residents and grads in threads, but is there a grad or near-grad from a 2-4 programs who would like to comment on what they now think of their prelim year now that they are done/almost done? Maybe I should have asked last year since I am a week into my prelim medicine year already

The lack of elective time in a 2-4 really does blow, but all of the 2-4s that I know of pretty much spend almost all there time in the ED or ED-related rotations (US, tox, etc) once they start PGY2/EM1 so there is more ED training than the typical 1-3 where you spend at least 1/2 your first year off-service (not to say 3 yr programs are deficient or anything, I ranked more 3s than 4s, it just so happened the couple I really liked were 2-4). Also, after starting my prelim medicine year I realized that I can learn a lot about being a general doctor before becoming an emergency physician and this might help me get more out of my future EM training. I'm not advocating everyone going into a 2-4 or anything, I just don't think its the worst thing in the world.