Best EM Residencies?

[The Fuzz]

I'm a first year med student in Detroit. I'm very interested in emergency medicine, so I'm trying to figure out what some top EM residencies are.

From the research I've done, people basically say that for the most part, any EM residency will train you to be an excellent physician. Since my training will be strong pretty much anywhere, I want to know which one will provide the most opportunity/ freedom post-residency. For instance, if I wanted to be a surgeon and did a surgical residency at Mayo or Mass Gen, then settled down in Boston, if I wanted to move to Seattle a few years later, it would probably be easier for me to get a job out there with such a competitive residency on my CV. Basically, I want my resume to jump off the page as much as possible, so that I'll never be restricted by my qualifications in the future.

If there are other big things I can do to work toward this goal, what are they?

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[cbrons]

EM is not surgery.

My recommendation is to focus on doing well in your M1 classes for now.

 

[bashwell]

I'm a first year med student in Detroit. I'm very interested in emergency medicine, so I'm trying to figure out what some top EM residencies are.

From the research I've done, people basically say that for the most part, any EM residency will train you to be an excellent physician. Since my training will be strong pretty much anywhere, I want to know which one will provide the most opportunity/ freedom post-residency. For instance, if I did a surgical residency at Mayo or Mass Gen, then settle down in Boston, if I want to move to Seattle a few years later, it'll probably be easier for me to get a job out there with such a competitive residency on my CV. Basically, I want my resume to jump off the page as much as possible, so that I'll never be restricted by my qualifications in the future.

If there are other big things I can do to work toward this goal, what are they?

1) I entirely agree with @cbrons.

2) EM is more like FM than it is like GS. It's not exact by any means but I tend to think of FM and EM as opposite extremes ranging along a spectrum, with FM dealing with the chronic stuff and EM dealing with the acute stuff.

3) It's true you'll get great EM training at many if not most places, not just the big academic names (e.g. Mass Gen). In fact, you'll arguably get better training at community or county hospitals located in areas where you see a lot of emergencies (e.g. traumas like gun shot wounds). If it were me, I'd love to train at a place like USC for EM. But to each their own. There are tons of great EM residencies.

4) If you want to pursue academic EM, then check out Michelle Lin's blog ALiEM. If you want to end up working at a Mass Gen, then they tend to like to see EM residencies from similarly academic hospitals as well. But not always.

5) I suppose you could always do research. Research never really hurts (unless it affects your academic performance). In EM research seems to be mostly clinical. There's very little (if any?) lab or basic science type research. At least from what I've seen.

6) Do fun stuff like an elective in retrieval medicine flying in helicopters or planes. I'm in Australia now and they have doctors (lots of emergency physicians) doing retrieval medicine.

7) You can do an EM elective at the University of Washington in Seattle if you think you can impress. Getting face time with the relevant people will make your resume "jump off the page" since the PD and other attendings on faculty will know who you are.

 

[cyanide12345678]

Well first of all, I have no idea what you mean by "if I did a surgical residency in Mayo". If you want to do EM, you're not doing ANY surgical residency. You're training in Emergency MEDICINE (as the name implies, it's medical diseases requiring emergency treatment). They do some procedures like putting in chest tubes, cric people, needle thoracostomy. But most cases are going to be medical management of things like COPD exacerbation, CHF exacerbation, DKA etc. You're trained to diagnose the big bad and the ugly things. Like your differential for chest pain in EM includes MI, Tension pneumo, Dissection, boerhaave, PE. They're supposed to rule out these big bad ugly things. And they are the experts in the initial management of these ugly diseases. They eventually transition the patient to where they need to go after initial stabilization. Now that we have that out of the way. Since I literally just sent out my application to EM programs yesterday, I think this is a fair list of some really great EM programs in no particular order.

Cincinnati (the place where the first EM residency program started). Pretty cool places, solid program, amazing training, great flight program as well.
Denver
Carolinas
Pittsburgh
Indiana
Cook hospital
Most california programs (LA county, alameda, most of the UCs except UC davis which isn't that great a program)
Vandy
Emory
Hennepin
MGH/Brigham (doesn't get all that trauma come in there. Boston University gets most of the Trauma)
Hennepin (if you are okay with 6-9 months of freezing cold).

 

[cyanide12345678]

Given that you think EM is a surgical field. I would highly suggest exploring during medical school first before deciding what you want to do.

Also, if you want EM, you will actually be REQUIRED to do 1 home and 1 away rotation in EM at the bare minimum. So you will have to impress your own program, and then also impress another program as well and get atleast two SLOEs.

 

[mimelim]

EM is not surgery.

My recommendation is to focus on doing well in your M1 classes for now.

Given that you think EM is a surgical field. I would highly suggest exploring during medical school first before deciding what you want to do.

Also, if you want EM, you will actually be REQUIRED to do 1 home and 1 away rotation in EM at the bare minimum. So you will have to impress your own program, and then also impress another program as well and get atleast two SLOEs.

While I understand where you guys are coming from and that the OP likely doesn't know a ton about this stuff and should be focusing on more important things at this point...

EM can be a division within the department of surgery and/or fall under the purview of surgeons. It simply depends on how the hospital is setup.

 

[Bojack Horseman]

Well first of all, I have no idea what you mean by "if I did a surgical residency in Mayo". If you want to do EM, you're not doing ANY surgical residency. You're training in Emergency MEDICINE (as the name implies, it's medical diseases requiring emergency treatment). They do some procedures like putting in chest tubes, cric people, needle thoracostomy. But most cases are going to be medical management of things like COPD exacerbation, CHF exacerbation, DKA etc. You're trained to diagnose the big bad and the ugly things. Like your differential for chest pain in EM includes MI, Tension pneumo, Dissection, boerhaave, PE. They're supposed to rule out these big bad ugly things. And they are the experts in the initial management of these ugly diseases. They eventually transition the patient to where they need to go after initial stabilization. Now that we have that out of the way. Since I literally just sent out my application to EM programs yesterday, I think this is a fair list of some really great EM programs in no particular order.

Cincinnati (the place where the first EM residency program started). Pretty cool places, solid program, amazing training, great flight program as well.
Denver
Carolinas
Pittsburgh
Indiana
Cook hospital
Most california programs (LA county, alameda, most of the UCs except UC davis which isn't that great a program)
Vandy
Emory
Hennepin
MGH/Brigham (doesn't get all that trauma come in there. Boston University gets most of the Trauma)
Hennepin (if you are okay with 6-9 months of freezing cold).

What's wrong with UC Davis?

 

[kenjixshadow]

x

 

[jdh71]

The "best" EM programs are probably those that are at a county hospital, have high number and acuity, plenty of sick sick sick airway experience given to residents, trauma is handled by EM not the surgeons, and anesthesia isn't on your nuts about sedation.

 

[alpinism]

1) I entirely agree with @cbrons.

2) EM is more like FM than it is like GS. It's not exact by any means but I tend to think of FM and EM as opposite extremes ranging along a spectrum, with FM dealing with the chronic stuff and EM dealing with the acute stuff.

3) It's true you'll get great EM training at many if not most places, not just the big academic names (e.g. Mass Gen). In fact, you'll arguably get better training at community or county hospitals located in areas where you see a lot of emergencies (e.g. traumas like gun shot wounds). If it were me, I'd love to train at a place like USC for EM. But to each their own. There are tons of great EM residencies.

4) If you want to pursue academic EM, then check out Michelle Lin's blog ALiEM. If you want to end up working at a Mass Gen, then they tend to like to see EM residencies from similarly academic hospitals as well. But not always.

5) I suppose you could always do research. Research never really hurts (unless it affects your academic performance). In EM research seems to be mostly clinical. There's very little (if any?) lab or basic science type research. At least from what I've seen.

6) Do fun stuff like an elective in retrieval medicine flying in helicopters or planes. I'm in Australia now and they have doctors (lots of emergency physicians) doing retrieval medicine.

7) You can do an EM elective at the University of Washington in Seattle if you think you can impress. Getting face time with the relevant people will make your resume "jump off the page" since the PD and other attendings on faculty will know who you are.

Unfortunately as of this year U Washington doesn't offer a visiting EM rotation for students.

They're also one of the least respected programs out there (for good reason).

http://forums.studentdoctor.net/threads/interesting-news-from-seattle.578614/#post-7360951

The truth is that some of the best programs for IM/Surgery are often the worst for EM (not always, but its a common theme).

 

[lmn]

It depends on what kind of EM you want to practice. If you want to be the ED doc who can (more so has to) deal with whatever comes through the door without being able to consult every specialist in the world, then a rural program will probably be better. If you want to deal with lots of trauma, a heavy trauma center where trauma surgeons don't run traumas will probably be better.

In any case, just focus on doing well in classes. You don't even have a clue if you will still be interested in EM within the next year (much less 3 years down the line - once you've seen other specialties), so I wouldn't get so locked in on a certain EM program at this point.

 

[Obnoxious Dad]

I'm a first year med student in Detroit. I'm very interested in emergency medicine, so I'm trying to figure out what some top EM residencies are.

From the research I've done, people basically say that for the most part, any EM residency will train you to be an excellent physician. Since my training will be strong pretty much anywhere, I want to know which one will provide the most opportunity/ freedom post-residency. For instance, if I did a surgical residency at Mayo or Mass Gen, then settle down in Boston, if I want to move to Seattle a few years later, it'll probably be easier for me to get a job out there with such a competitive residency on my CV. Basically, I want my resume to jump off the page as much as possible, so that I'll never be restricted by my qualifications in the future.

If there are other big things I can do to work toward this goal, what are they?

Leaving Detroit for an EM residency in another city would be liking leaving Scotland in the summer to play golf. One of my daughter's undergrad classmates is an EM resident in Detroit and she is getting world class experience. If you can match at one of Wayne's 3 residency programs you will see everything and before you finish the Tigers will be decent again. Stay where you are.

 

[cyanide12345678]

People want to live in Detroit? At the end of the day, people choose a residency based on location

 

[joker2400]

People want to live in Detroit? At the end of the day, people choose a residency based on location

It's not a bad town, people just don't give it a chance

 

[The Buff OP]

I would say large metropolitan cities (Los Angeles, Houston, Baltimore, etc) that have EM residencies will give you the best exposure.

 

[Jabbed]

OP, you've received absolutely terrible advice so far.

Everyone knows that the #1 program in the country and the only one that will set you up to be the best EM doc that you can be is:

In-N-Out Burger

Don't even bother applying anywhere else.

Surprised that it took this long.

Edit: Granted, this wasn't posted in the EM forums.

 

[jdh71]

It's not a bad town, people just don't give it a chance

This was the same categorical type of argument I once used to argue in favor of anal sex back in college this one time.

 

[sylvanthus]

Did it work?

 

[waterpolo480586]

Sylvanthus. Are you doing your residency at Vidant or Maryland?

 

[baskintheglow]

Hey guys! I am a first year med student and I am hoping to get into anesthesiology so I can specialize in family medicine? How much monies can I make without owning my own scalpel?

(this is how I read OP)

 

[DoctorLacrosse]

lol I guess I can see the confusion, but I read the OP to mean he's looking for the best EM residency that will make his resume "jump off the page", just like doing a surgical residency at Mass General would make one's resume jump off the page.

OP is essentially looking for the EM equivalent of Mass General for surgery...

 

[el_duderino]

lol I guess I can see the confusion, but I read the OP to mean he's looking for the best EM residency that will make his resume "jump off the page", just like doing a surgical residency at Mass General would make one's resume jump off the page.

OP is essentially looking for the EM equivalent of Mass General for surgery...

That's what I got too, but it took a few reads to realize that.

 

[alpinism]

Right. But there really is no such program.

The problem is that there are essentially 3 types of EM residencies (academic/county/community) each with their own strengths and weaknesses.
One person's top program is often the bottom of another's rank list.

If OP is just after prestige and name recognition, then places like Cincinnati, Denver, and USC would probably fit the bill.
(some of the first programs that started in the 1970s with the largest alumni networks)

 

[cyanide12345678]

I just had a conversation with the Vice chair of the ED at cincinnati who said that a residency at Mass general will pop out more on a resume compared to one at Cincinnati in ED. Ofcourse he followed that up by saying that the training here is superior.

 

[cyanide12345678]

Cincinnati though definitely has the largest alumni network. It surprises me how many program directors are associated with cinci.

 

[Lmbrown456]

Well first of all, I have no idea what you mean by "if I did a surgical residency in Mayo". If you want to do EM, you're not doing ANY surgical residency. You're training in Emergency MEDICINE (as the name implies, it's medical diseases requiring emergency treatment). They do some procedures like putting in chest tubes, cric people, needle thoracostomy. But most cases are going to be medical management of things like COPD exacerbation, CHF exacerbation, DKA etc. You're trained to diagnose the big bad and the ugly things. Like your differential for chest pain in EM includes MI, Tension pneumo, Dissection, boerhaave, PE. They're supposed to rule out these big bad ugly things. And they are the experts in the initial management of these ugly diseases. They eventually transition the patient to where they need to go after initial stabilization. Now that we have that out of the way. Since I literally just sent out my application to EM programs yesterday, I think this is a fair list of some really great EM programs in no particular order.

Cincinnati (the place where the first EM residency program started). Pretty cool places, solid program, amazing training, great flight program as well.
Denver
Carolinas
Pittsburgh
Indiana
Cook hospital
Most california programs (LA county, alameda, most of the UCs except UC davis which isn't that great a program)
Vandy
Emory
Hennepin
MGH/Brigham (doesn't get all that trauma come in there. Boston University gets most of the Trauma)
Hennepin (if you are okay with 6-9 months of freezing cold).

Why do you say UC Davis isn't a great program?

 

[Tenk]

The best EM residency is the one that gives you the most autonomy and the most chances to moonlight.

 

[cyanide12345678]

Why do you say UC Davis isn't a great program?

It's a solid training program, I just wouldn't put it in the category of elite programs. There is nothing wrong with the place, it's just not Cincinnati, carolinas, Vanderbilt, UPMC etc

 

[alpinism]

The best EM residency is the one that gives you the most autonomy and the most chances to moonlight.

Sounds like the residents at LSU-NO.

When I interviewed there that was one of the biggest selling points of their program. Moonlighting is allowed starting PGY-2 and many second years are making over 100K as a result.

 

[MedBreak]

why is there so many people interested in EM lately

 

[NotyourNurse]

Detroit...lots of experience there. I am an EM attending. I went to Detroit for my training. You will have no problem finding a place afterwards if EM trained in the "D." You should look in your own backyard.....
You train inner city and see it all with often much less resources. Everyone will be looking to hire you. I never regretted training there but was glad to leave. I DID not see the better side of Detroit though. Did see lots of great people doing their part to make it a better place. WSU university much safer then it used to be....where I trained I was used to hearing gunshots. I wish I had the Detroit security team at my hospital now!!!! You have a wealth of support at WSU, EM was born in the Midwest. Detroit played a leading role in the development of EM.
Many of the "top" programs have a lot in their name. If you want academia in your future go there though. I know people from some of the top programs-some had disappointing training despite the big names. I would say UW is not EM friendly! Otherwise, you will learn what you need wherever you land: it's what you put into it too. Jobs afterward depend on networking as well. I can say though if you survive inner city training in "war zone" type places people are interested in hiring you! EM is not easy...make sure you know what you are getting into. You see more people die in front of you-kids included-and will be involved in "social problem nightmares." You are the safety net of everyone/everything and you are presented with problems that have NO answers with plenty of people ready to judge the outcome. It sounds glamorous but it will demand much of you. Definitely do away rotations in different areas if the country-this will prove very beneficial when applying for residency!!

 

[bashwell]

why is there so many people interested in EM lately

Probably for lots of different reasons. I'd guess a few of these reasons are because for a single person in their mid-20s (which is probably many if not most M3s/M4s):

-EM looks fun and exciting (e.g. ABCs, resus, trauma management)
-Variety, you get a bit of everything, general medicine, adults, OB, peds, psych
-You get to do procedures
-You get to do history, physical exam, investigations, call consults, etc., all of which make sense straight from med school and aren't so foreign or different from med school, such as for example doing a radiology residency would be a lot more different than med school and you'd have to learn tons more in depth pathology, anatomy, etc.
-It's a very social specialty, lots of teamwork, etc.
-Lifestyle seems reasonable. Nights and weekends don't seem so bad for singles in their mid-20s. Shifts, you're on when you're on, off when you're off. Pick up as many or few shifts as you want.
-Pay is good and great for a short residency
-Currently there are still lots of good jobs available in most parts of the nation (unlike many other specialties where good jobs and pay seem to be decreasing)
-It's a relatively short residency (most 3 yrs, some 4 yrs)
-The power and influence of Hollywood and the general media where emergency physicians are featured in many tv shows, documentaries, movies, etc.
-The power and influence of public perception among friends and family and even strangers

 

[The Anhedonia]

MGH/Brigham (doesn't get all that trauma come in there. Boston University gets most of the Trauma)
QUOTE]

This is not actually correct. Though there are 3 level 1 trauma centers in Boston w/in a 5 mile radius, the peri-Boston trauma is split evenly AND the pan-New England trauma mainly goes to MGH.

But I tots agree with your post otherwise. At MGH, the surgical procedures like chest tubes, central lines, thoracotomies, abcess drainages, fracture reduction, are done by either the ED surgical team or a consulting surgical service. ED residents/physicians here do way more medical

 

[FantasticDoctorFox]

srs question: do people actually consider factors like this for residency choice?

I don't think it is always a conscious part of the decision-making process, but rather a value-system that is unconsciously formed (based on depiction of a given specialty in the media, public perception, etc...) and then naturally "factored in", so to say.

 

[FriedKEEN]

why is there so many people interested in EM lately

Im starting to see a lot of interest in my school too

 

[bashwell]

srs question: do people actually consider factors like this for residency choice?

I don't think it is always a conscious part of the decision-making process, but rather a value-system that is unconsciously formed (based on depiction of a given specialty in the media, public perception, etc...) and then naturally "factored in", so to say.

Yup, I agree with what @FantasticDoctorFox said!

Also I was just listing a bunch of reasons that came to my mind, but not saying all or even most of the reasons I listed necessarily apply to every single EM applicant.

Plus I'm sure there are lots of other reasons I didn't list or don't know about too.

 

[HooliganSnail]

People want to live in Detroit? At the end of the day, people choose a residency based on location

Metro Detroit is a community of 5.5 million people. Most outsiders think that the city proper is the whole are, they are wrong. Until recently Oakland County (the county just north of detroit) was the second wealthiest in the nation behind Orange County.

It really is a nice place to live.

Don't talk about what you don't understand

 

[HooliganSnail]

I'm a first year med student in Detroit. I'm very interested in emergency medicine, so I'm trying to figure out what some top EM residencies are.

From the research I've done, people basically say that for the most part, any EM residency will train you to be an excellent physician. Since my training will be strong pretty much anywhere, I want to know which one will provide the most opportunity/ freedom post-residency. For instance, if I did a surgical residency at Mayo or Mass Gen, then settle down in Boston, if I want to move to Seattle a few years later, it'll probably be easier for me to get a job out there with such a competitive residency on my CV. Basically, I want my resume to jump off the page as much as possible, so that I'll never be restricted by my qualifications in the future.

If there are other big things I can do to work toward this goal, what are they?

You are not asking the right question.

What is the best EM residency FOR YOU?

That factors in the most important things. Area, drive to work, what your personal situation is (single, married, children?) What is the culture at each residency. There were places when I was a student that were "the best", but when I went there everyone was super serious all the time, and generally laughter was frowned upon. Screw that. All of that is so important in making your rank order list.

Heed this, so many people early in their training want EVERYTHING. I admit I was the same way. They want the prestige of an academic center, with the research. But they want the pure clinical experience of the community hospital where the ED does most procedures. They want to be able to go practice in another country, and to live an interesting life with great vacations, but also have all the knowledge and experience that comes from spending your entire 20s in a hospital.

You can't have all of it, and that is OK because in a few years from now, you won't want to have all of that.

Now is the time to do a little soul searching, and be completely honest with yourself.

What is it that YOU want the most out of your life and your career.

 

[TooMuchResearch]

Who moved this from the med student forums to here? Put it back in the med student forums.

 

[gro2001]

srs question: do people actually consider factors like this for residency choice?

Of course they do. Whether consciously or not, the image of the specialty plays a role in a lot of people's choice. What the public thinks of the specialty is essentially what your mom is going to think you do. I think a lot of people who end up becoming neurosurgeons do so partly because the public is convinced it's a very cerebral specialty. The indoctrination with phrases like 'it's not brain surgery...' plays a role. How else do you end up having people 'wanting to be neurosurgeons since they were 9'?

What's interesting to me is how different the perception of the public is from the perception from within the medical community. For example, while I love them and have a great deal of respect for what they do, I don't think of my neurosurgery, CTsurgery or cardiology colleagues as particularly cerebral. Certainly not compared to the neurologists, rheumatologists, nephrologists, etc. EM also has a very different lay/professional perceptions. I think the public thinks we are like Dr Green on ER and the medical community at large thinks we are the teenage stoner kid of the medical family who is still not sure what he wants to be when he grows up.

 

[el_duderino]

Of course they do. Whether consciously or not, the image of the specialty plays a role in a lot of people's choice. What the public thinks of the specialty is essentially what your mom is going to think you do. I think a lot of people who end up becoming neurosurgeons do so partly because the public is convinced it's a very cerebral specialty. The indoctrination with phrases like 'it's not brain surgery...' plays a role. How else do you end up having people 'wanting to be neurosurgeons since they were 9'?

What's interesting to me is how different the perception of the public is from the perception from within the medical community. For example, while I love them and have a great deal of respect for what they do, I don't think of my neurosurgery, CTsurgery or cardiology colleagues as particularly cerebral. Certainly not compared to the neurologists, rheumatologists, nephrologists, etc. EM also has a very different lay/professional perceptions. I think the public thinks we are like Dr Green on ER and the medical community at large thinks we are the teenage stoner kid of the medical family who is still not sure what he wants to be when he grows up.

And derm. It's prestigious in the medical community, but much of the public doesn't even realize you're a physician.

 

[deleted547339]

Given that you think EM is a surgical field. I would highly suggest exploring during medical school first before deciding what you want to do.

Also, if you want EM, you will actually be REQUIRED to do 1 home and 1 away rotation in EM at the bare minimum. So you will have to impress your own program, and then also impress another program as well and get atleast two SLOEs.

That's just not true.

 

[winkleweizen]

Why do you say UC Davis isn't a great program?

Because he has no idea what he's talking about

 

[deleted547339]

Oh, look. This again. Fun.

 

[emergentmd]

The best program

1. Allows moonlighting
2. Do not work you to death so you are allowed to moonlight
3. County hospital

Everything else likely will not matter in the long run.
Even in a non county program, once you moonlight enough you will be much better prepared when you are an attending than someone in a county program with alot of freedom.

Nothin beats making your own decision and having the final say.

I went to a county, busy any anything, great pathology, procedures left and right. Great experience but man when i moonlighted, I learned ALOT and independently.

 

[namethatsmell]

Meh, moonlighting is a over-rated. You have 3-4 years to train. Then you have the rest of your life to work on your own. It's true the extra cash is nice, but as a resident moonlighter you'll maximize your risk of: med mal, working at a terrible shop, and being taken advantage of by the man.

Prioritize a program that has sick patients, happy residents, a good peds experience, diverse training sites, and where there the ED does most things on their own. After that look for a shop with moonlighting if you like.

 

[deleted547339]

Meh, moonlighting is a over-rated. You have 3-4 years to train. Then you have the rest of your life to work on your own. It's true the extra cash is nice, but as a resident moonlighter you'll maximize your risk of: med mal, working at a terrible shop, and being taken advantage of by the man.

Prioritize a program that has sick patients, happy residents, a good peds experience, diverse training sites, and where there the ED does most things on their own. After that look for a shop with moonlighting if you like.

I dunno. I'm a senior who moonlights a moderate amount. I have killed my in-service thus far and do well clinically at my "real job." I think it would be easy to coast. Since I started moonlighting, I treat work very differently. I ask attendings questions I wouldn't have otherwise. I ask attendings about how they would have handled my cases.

I think my learning curve would have somewhat leveled off in my final year of training, but instead has become much steeper.

 

[Janders]

This is not actually correct. Though there are 3 level 1 trauma centers in Boston w/in a 5 mile radius, the peri-Boston trauma is split evenly AND the pan-New England trauma mainly goes to MGH.

Point of fact, there are FIVE level one trauma centers well within a 5mi radius of Boston-centre. All within 3 miles of where the bombings happened. MGH, BWH, BIDMC, Tufts-NEMC, and BMC.

 

[deleted547339]

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[gutonc]

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Gimme an F!