Okay, this is going to be long, so hang on to your hats, fam.
Was gonna post on the spreadsheet, but feel now it may not get the wattage I'd hope for. Anyway, hope this is an appropriate forum for me to post to and seek feedback on, although I also expect most answers will center around the genuine and still appreciated: "Only you know the answer to this, you do you, homie." Perhaps
@gamerEMdoc has some insight from his time submitting his ROL or an alternatively valuable perspective from his position as an APD, or even, any residents here or attendings having gone through residency, can shed light on what they thought was important when choosing their #1 and making their ROL, then, once in residency, what they realized actually was more important and how their ROL
may have changed had they known then what they knew now. In any case, here's my dilemma:
I am perplexed and on the fence, day in day out, between my top 2. The rest of my list including my top 3 and 4 are pretty much set, with some minimal weekly variably in the middle of my list every couple days or so, but overall pretty set.
My top 2 are as below:
-One is a smaller program, in a small town, giant name in academia, super happy residents, incredible (almost unbeatable) extra-EM opportunities (meaning academics/research/education, just name it), plus also very legit and impressive EM training. Great, great, great people. Everyone super friendly, this would feel like a new home to me, completely new region of the country I've never lived in before, which is simultaneously scary/exciting. I say smaller program b/c in terms of # of residents and Faculty, feels like a tight-kit, family atmosphere. BIG focus on resident wellness, work-life balance, having a life outside of work, supporting your interests and initiatives, career support, name it. 8 hours shifts. Community/Academic hybrid. A big plus for me is it's 3 years.
-The other is a slightly larger program (by # of residents), in one of the nation's largest and most diverse cities, with literally so much to do outside of work you'll never run out of activities and culture. Have somewhat more of a support network here, if you can call it that, in that I have lots of friends from undergrad who live here, but it's not like I'd hang out with any of them on a daily or weekly basis, I guess it's more that it's just nice mentally (potentially, not sure it really will make all that much of a difference day in day out) and somewhat more of a mental buffer/cushion if that makes sense, if even that. Awesome super duper good positive vibes on interview day, but the residents definitely work hard, e.g., harder than at the other program by a mile. Though I did get a sense of family here too, it's a much larger program by # of residents/Faculty/size of hospital/ancillary staff/name it. Not sure if that's a good or bad thing, just pointing out the facts as I see them. Significant Spanish-speaking population, sounds like that would be more work, cuz' it would be, because I know myself and would absolutely be forced to learn (at least medical) Spanish by the end of intern year, and the geek/intellectual in me love that that's one more string I'd add to my bow. Like I said, will work harder here, but definitely got the so-called and oft-mentioned feel of, will come out a "bad-ass" from here, FWIW (again, not sure that's even worth anything 5-10 years down the line except self-pride, which it's not like it's something I feel I need to be happy). 12 hour shifts to start, then mix of 8-10-12 hour shifts in years 3/4. County/Academic hybrid. 4 years, which I'm not a fan of.
Don't have immediate family or a SO in either location, so that's not a tie-breaker. Other things that aren't tie-breakers (which makes this so hard) is both programs have excellent reputations, both have awesome PD's that I truly feel would go to bat for you, both have excellent APD/Leadership teams, both place their residents in academic jobs across the country (my ultimate path that I aspire to), both have great and geographically diverse alumni networks (slightly more regional for the first program, but I got a genuine sense that's sincerely because the residents want to stay around and more are from the surrounding states, whereas program #2 attracts applicants from all over the country and they end up practicing all over too, though no doors are closed graduating from either program for sure). Both are absolute powerhouses in medicine (not specifically in EM, just medicine in general), and I feel I'd pretty much get equivalent EM/clinical training from either program. Both have outstanding, some of the best bedside teaching, attract Faculty truly interested in and committed to teaching, and I did not get an ounce of malignant vibes at either place. Residents I met at either place seemed super happy, but definitely more tired at program #2 (that said, not even close to other programs I interviewed/rotated where the residents were really super mega tired and majorly burned out, I didn't get that feeling at all at program #2).
I got the feels or whatever you want to call it at program #1. I really like program #1, but am just more "scared" cuz it's a new region in the country and less peripheral support (but again, that's on the fringes, it's not like I got a family member or partner waiting for me in either place), but I also know myself, and feel that all those "fears" just might be awash 1 week in as I make friends very easily (and it's not like I have an insta-support network in place at either program). The second program is more "exciting" by mere fact of its location in a big city, which on paper/interview day sounds like a big plus, but realistically, again, on a day-to-day basis, I just might not care as much since obviously at either place, most of my time will be spent in the hospital.
I think my dilemma ultimately comes down to, when I think of program #1, I smile/become giddy when thinking of the hospital/program itself, but less so the location/town. When I think of program #2, I smile/become giddy when thinking of the city, imagining myself there, coming out of my apartment every day. Program #1 "scares" me because of the location, program #2 "scares" me because of how hard I feel the residents work (honestly that's probably an overblown perception, I'm just not used to/have never done 12 hour shifts before). When I think of the PROGRAM specifically, I want to rank #1, well, #1, and when I think of the city, I want to rank #2, #1.
Because of the merciful schedule at #1, I would have more time to develop/expand my niches, publish, etc.; I could do that at #2 and that was a BIG focus of my interviews as they
strongly stated they will do everything they can to support me in those endeavors and are excited about me using their vast network of resources/Faculty/name it to develop those interests, but that'll definitely be more of a challenge.
If all this has to come down to wellness/wellbeing, #1 has a big focus on that and better work/life balance, which counts for a lot, but program #2 has this amazing city that would also tremendously contribute to my happiness by mere fact of just living in it (BUT if I'm just tired all the time, that may become awash as I might not even be able to appreciate all that there is to do around me and develop my other EM+ interests which bring me joy, but the problem is, it's very difficult if not impossible for me to know for sure until I match, e.g. until I'm the midst and thick of it, experiencing it and residency, I feel).
(To be clear, I'm not fooling myself, residency is residency, it'll be hard and a lot of work at either place, clinical duties come first, but that's the context I'm working with.)
When I think of #1, I feel it would be a once-in-a-lifetime opportunity to match at this specific program, and when I think of #2, I know it would be a once-in-a-lifetime opportunity to live in that city. #2 is in a region I used to live in for years (just not the specific city), so more culturally similar and in sync, I'd say, with my values, #1 would be a completely new region to me. Either way, I almost certainly won't live/work/establish myself in either place long-term.
My med school advisors, who are all wonderful and provide (generally speaking, occasionally not) sound advice, basically said: "You can't go wrong with either program!" in terms of EM training. With a subtext of "Roll the dice, both sound great!" but, ya know, I still need to put one first, and I'm not a roll the dice kinda person lol.
I realize asking advice of strangers on the Internet may be fraught with risks, but I have felt very lucky to find a supportive community on SDN with excellent advice from gamerEMdoc and several others.
And sometimes, advice from the outside and/or a complete stranger can churn out an unexpected perspective that unleashes new avenues for making this quite important decision.
Okay. I know that was insanely long. Any thoughts/advice greatly appreciated and welcomed. Thanks fam.