Rank list help 2021

[bravotwozero]

Check the hours at the VA. Yes it is easy but it is a ton of hours and its not 300k. But yes, its not there yet, I dont think anyone claims that. How many of your seniors took jobs making under 250/hr. I’m guessing 100%. Most got jobs in the 200-220/hr range. With CMGs there is no upside and no perks.

The VA job you refer to is paying about 175/hr and is a career killer. Talk to me in 5 years. I have seen the future and for work in EM it blows.

Well some of the VA places contract out the night and weekend staffing to non VA CMGs, leaving the VA employed docs to only work weekdays.

If that setup is available, it might be worth the pay cut for a lot of people. That alone is enough to tolerably extend ones career by an extra decade…

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[EctopicFetus]

Well some of the VA places contract out the night and weekend staffing to non VA CMGs, leaving the VA employed docs to only work weekdays.

If that setup is available, it might be worth the pay cut for a lot of people. That alone is enough to tolerably extend ones career by an extra decade…

Often no nights either. To each their own but if you hate em why do you want to extend your career? why not make more save more and retire from medicine sooner. Now I realize I have aimed for FI from day 1 of being an attending. This ironically has allowed me to enjoy work much more.

 

[miacomet]

How fascinating is it to see medical students continue to flock to EM, despite the data and the subjective advice from multiple generations of ER physicians.

Is it hubris? Delusion? Narcissism?

Yes

 

[Rekt]

That's probably the root of the problem, to be honest.

No matter how much you may like emergency medicine (and I fxcking love EM on good days), the reality is that you are looking for passion whereas everyone else sees you, and intends to treat you like an employee.

Your passion won't matter when your boss calls you in because your metrics aren't where they want them to be.

Your passion won't matter when you have 20 patients in the waiting room while you're fighting with the hospitalist to accept a social admit and EMS pre-notifies you that some full-code 90 year old COPDer is obtunded on CPAP, ETA 4 minutes away.

Your passion won't matter when a belligerent, feces covered inebriate assaults you in your workplace and your employer tries to dissuade you from pressing charges because "the paperwork won't be worth it".


None of the aforementioned examples are hyperbole. Every single one is an event that has happened to me. In. the. last. 6. months.




Every medical student thinking of EM should listen to this debate from SMACC DUB where they discuss whether or not Emergency Medicine is a failed paradigm. The reality is the job we sell medical students emphatically IS NOT the job you're going to be doing once you graduate residency. If you get a job at all.


Every single resident and attending on this forum is somone who, like you, thought "they couldn't see themselves doing anything else". You, MS4, are unfortunately not special or unique in this regard - we have all said something along the lines of what you've said here. Several years on, most of us, if given the chance, would probably do something else had we known what we know now.

And I say this as someone who went to a very well regarded residency and secured what many would consider a "good" job upon graduating residency.

I couldn't see myself doing anything other than EM.

Now I wake up every morning dreaming of doing literally anything else.

 

[EctopicFetus]

I couldn't see myself doing anything other than EM.

Now I wake up every morning dreaming of doing literally anything else.

But the med students think they are different. If it wasn’t so sad it would be level 10 funny.

 

[Jabbed]

I remember my VA rotation being something like 4-5 docs on shift at once for <1 pt/hr each. The training was of course highly variable and ranged from semi-retired nephrologists to actual boarded EM docs (albeit one or two had multiple DUIs).

Back to the OP, I interviewed at and liked WashU a lot. For a "big name" shop they have fairly high acuity, county vibes, and good procedural division with trauma surgery (not sure about ortho). 4 year is a con (unless you want academics) and they are a division of surgery rather than their own department. They also have great in house CCM fellowship if that's your passion.

 

[bravotwozero]

I remember my VA rotation being something like 4-5 docs on shift at once for <1 pt/hr each. The training was of course highly variable and ranged from semi-retired nephrologists to actual boarded EM docs (albeit one or two had multiple DUIs).

....Which is great for an EP on the verge of burnout and looking to slow down. In the process, you also end up minimizing and eliminating a lot of things that do make EM painful - seeing a high patient volume in an understaffed ED, worrying about getting fired because of c suite politics or frivolous complaints, lawsuit risk, circadian disruption. Then there's the incentive of getting a pension check...

 

[WilcoWorld]

Often no nights either. To each their own but if you hate em why do you want to extend your career? why not make more save more and retire from medicine sooner. Now I realize I have aimed for FI from day 1 of being an attending. This ironically has allowed me to enjoy work much more.

Unless it's not EM that you hate but practicing EM in your current meat grinder environment that you hate.

Taking a pay cut to do a job that you enjoy rather than despise, and that you see yourself happily doing for 10+ years longer is a smart (and financially sound) move.

 

[12jas]

It's not that med students think they are different it's the sheer ignorance as to what the job of being in EM really is. As a newly minted EM intern, I have spent the past few months realizing I made a terrible mistake and should have listened to so much of the good advice thrown around on this forum. Getting to sew lacs and tube patients is way more fun than most medical student rotations. You don't actually do 99% of the EM job as a student. Try letting your med student get **** on by consultants all-day or admit a patient to that one hospitalist who is a jerk to you know matter the admission, or make them see the psych patient that is swearing at you, who just slammed your nurses head into the wall. Make them pick up more patients than they are comfortable with and watch them quickly realize this is not fun. We shield the students from the sh** far too much.

 

[GonnaBeADoc2222]

It's not that med students think they are different it's the sheer ignorance as to what the job of being in EM really is. As a newly minted EM intern, I have spent the past few months realizing I made a terrible mistake and should have listened to so much of the good advice thrown around on this forum. Getting to sew lacs and tube patients is way more fun than most medical student rotations. You don't actually do 99% of the EM job as a student. Try letting your med student get **** on by consultants all-day or admit a patient to that one hospitalist who is a jerk to you know matter the admission, or make them see the psych patient that is swearing at you, who just slammed your nurses head into the wall. Make them pick up more patients than they are comfortable with and watch them quickly realize this is not fun. We shield the students from the sh** far too much.

IT's seriously not too late to bail and switch to something like psych. Your PGY1 year in EM will likely translate over for your prelim year.

 

[alpinism]

Its funny but looking back EM shares many things in common with the military.

Most students go into the field with this hollywood fantasy of shifts being nonstop action and adventure. It's like this goal in your mind that you'll become this badass cowboy seeing patients on the verge of death, making split second decisions to nail the diagnosis, and performing life saving procedures so the patient can go home to be with their wife and kids. The big problem as most veterans know is that its not like that in real life and those days are few and far between in most emergency departments or military deployments. Its really not surprising then in that case that so many students are still willing to go into EM despite the reports of decreasing job opportunities and lower salaries. They're more than happy to sacrifice having a stable career for a chance to be working their dream job after graduation.

 

[zurc2014]

Its funny but looking back EM shares many things in common with the military.

Most students go into the field with this hollywood fantasy of shifts being nonstop action and adventure. It's like this goal in your mind that you'll become this badass cowboy seeing patients on the verge of death, making split second decisions to nail the diagnosis, and performing life saving procedures so the patient can go home to be with their wife and kids. The big problem as most veterans know is that its not like that in real life and those days are few and far between in most emergency departments or military deployments. Its really not surprising then in that case that so many students are still willing to go into EM despite the reports of decreasing job opportunities and lower salaries. They're more than happy to sacrifice having a stable career for a chance to be working their dream job after graduation.

LOL I don't know of any 4th year students that think EM is nonstop action and adventure. I'm sure some exist (sounds more like premeds) but I haven't met anyone that thinks they will become a badass cowboy like you're describing. Not even close actually.

 

[zurc2014]

It's not that med students think they are different it's the sheer ignorance as to what the job of being in EM really is. As a newly minted EM intern, I have spent the past few months realizing I made a terrible mistake and should have listened to so much of the good advice thrown around on this forum. Getting to sew lacs and tube patients is way more fun than most medical student rotations. You don't actually do 99% of the EM job as a student. Try letting your med student get **** on by consultants all-day or admit a patient to that one hospitalist who is a jerk to you know matter the admission, or make them see the psych patient that is swearing at you, who just slammed your nurses head into the wall. Make them pick up more patients than they are comfortable with and watch them quickly realize this is not fun. We shield the students from the sh** far too much.

So what do ya say? Are you switching specialties after PGY1 as suggested?

 

[Franzd'Epinay]

Unless it's not EM that you hate but practicing EM in your current meat grinder environment that you hate.

Taking a pay cut to do a job that you enjoy rather than despise, and that you see yourself happily doing for 10+ years longer is a smart (and financially sound) move.

It's surprising to me how often you see this sort of advice to burned out colleagues.

"Oh, you hate your job? Have you thought about amping it up to 11 for five short years so you can retire forever?"

This is decent advice for someone who is actually really close to retirement (and who wants to retire), but incredibly tone-deaf otherwise.

 

[pillowsnice]

There are only a handful of residencies in EM that are truly "prestigious". None of the ones you listed make that list.

Institutional prestige =/= prestige within a specialty. WashU and UTSW are large, well resourced academic institutions but that doesn't actually translate into being big name EM programs. Nobody is gonna be reading a CV from any of the aforementioned sites and think "wow".

The other posters in this thread are correct - your main concern should be "will I have a job at the end of this?". Just to put things into perspective, the PD at Mount Sinai - Miami was having exceeding difficulty finding jobs in FL for their grads this time last year despite their department chair being a former president of AAEM. If that doesn't speak volumes, I don't know what does.

People's concerns about the job market aren't hyperbole. Sorry to burst your bubble but none of the places in your top 5 are going to be an umbrella in the coming ****storm that is Emergency Medicine in the united states.

Hello,

I am applying to EM and wanted some help with my top choices. I loved all of these and could see myself living in any of these locations. The cons were similar so that cancelled out. I plan on using prestige to rank since I have determined these to be a tie for all other factors I care about. How would you rank these institution's overall prestige?

WashU (Saint Louis)
UT Southwestern
Mount Sinai-Florida
University of Rochester
U of Miami-Jackson

I am ranking 12 programs but want to order the top 5 by prestige.

To get back to the OPs question: Yes, none of these are extraordinary, and frankly they are all very different types of programs. I think this post above does a good job at describing both spectrums of programs you have on your list. Do you need to be in Miami? Why do you have Mount Sinai - FL in your top 5? What do you want to do when you graduate from residency? Versus WashU and other academic programs, Mount Sinai is a small community hospital with no academic affiliations. I have heard that residents do learn to become strong "real life" ER docs in the sense that they can move the meat well, but it will definitely be harder to obtain fellowship or a non-FL job after residency. Most of the residents I know stayed in Florida area, and work in small community places. However, they have had some pretty impressive fellowship matches in the past considering their "status" as an EM program. Last year, they had someone match into u/s at Jacobi, and have had matches in other years at very prestigious EM programs (highland EM included). Mount Sinai is actually the original Miami program, as Jackson/UMiami is a fairly new program.

 

[Franzd'Epinay]

However, they have had some pretty impressive fellowship matches in the past considering their "status" as an EM program. Last year, they had someone match into u/s at Jacobi, and have had matches in other years at very prestigious EM programs (highland EM included).

Is this supposed to be impressive?

I'm not knocking Jacobi or Highland, but I can't say I've ever been impressed by someone matching into an ultrasound fellowship. In fact, I'm having trouble thinking of any traditional EM fellowship that would make me go "Whoa". Maybe the landscape has changed dramatically in the few years since I graduated from residency.

 

[turkeyjerky]

Is this supposed to be impressive?

I'm not knocking Jacobi or Highland, but I can't say I've ever been impressed by someone matching into an ultrasound fellowship. In fact, I'm having trouble thinking of any traditional EM fellowship that would make me go "Whoa". Maybe the landscape has changed dramatically in the few years since I graduated from residency.

My thoughts too. Maybe in a few years posters on here will be saying, "Sure that hca-program doesn't have the best rep or provide adequete training, but did you see that 75% of their grads got jobs? That's pretty good for a program in 2024"

 

[pillowsnice]

Is this supposed to be impressive?

I'm not knocking Jacobi or Highland, but I can't say I've ever been impressed by someone matching into an ultrasound fellowship. In fact, I'm having trouble thinking of any traditional EM fellowship that would make me go "Whoa". Maybe the landscape has changed dramatically in the few years since I graduated from residency.

Yeah, you're right that EM fellowships aren't that impressive in general. I'm just saying that compared to the majority of other programs in the area, Mount Sinai has connections to match into established fellowships if the OP desired. And for a small, no name community place, for that matter.

 

[Jabbed]

My wife is a medical sub-specialist and I describe my job to her as being Liam Neeson from Taken. 90% of the time you're doing nothing interesting. But every now and again you encounter very specific situations and make use of your very specific set of skills to make a difference.

Its funny but looking back EM shares many things in common with the military.

Most students go into the field with this hollywood fantasy of shifts being nonstop action and adventure. It's like this goal in your mind that you'll become this badass cowboy seeing patients on the verge of death, making split second decisions to nail the diagnosis, and performing life saving procedures so the patient can go home to be with their wife and kids. The big problem as most veterans know is that its not like that in real life and those days are few and far between in most emergency departments or military deployments. Its really not surprising then in that case that so many students are still willing to go into EM despite the reports of decreasing job opportunities and lower salaries. They're more than happy to sacrifice having a stable career for a chance to be working their dream job after graduation.

 

[Prehealth1011]

How fascinating is it to see medical students continue to flock to EM, despite the data and the subjective advice from multiple generations of ER physicians.

Is it hubris? Delusion? Narcissism?

Short residency with high $/hr = more applicants

Now are the hours actually there? That’s for their future self to figure out, not today’s problem. I had this exact conversation word for word with one of our M4s last week

 

[EctopicFetus]

Real talk here. I’m going back to old school sdn. In n our residency sdn.

But prestigious programs? Sorry there are none. Sure there are whatever type programs like mount sinai in Miami and a bunch of others. Even a few terrible sounding programs like some new ones in Mississippi or random Hca residencies in South Carolina.

But I’ve never met an em doc and been like wow man. YOU DID residency there? Wow.

Nope. Half the programs are “good”. 25% are meh. And an ever growing number are pure crap.

There is no top 5.

In undergrad, business school, med and law school there are elite schools. No such thing for em residencies.

 

[sylvanthus]

Its like saying you went to a prestigious DO program.




Its ok I can diss my own.

 

[RustedFox]

Real talk here. I’m going back to old school sdn. In n our residency sdn.

But prestigious programs? Sorry there are none. Sure there are whatever type programs like mount sinai in Miami and a bunch of others. Even a few terrible sounding programs like some new ones in Mississippi or random Hca residencies in South Carolina.

But I’ve never met an em doc and been like wow man. YOU DID residency there? Wow.

Nope. Half the programs are “good”. 25% are meh. And an ever growing number are pure crap.

There is no top 5.

In undergrad, business school, med and law school there are elite schools. No such thing for em residencies.

So much this.

 

[namethatsmell]

....Which is great for an EP on the verge of burnout and looking to slow down. In the process, you also end up minimizing and eliminating a lot of things that do make EM painful - seeing a high patient volume in an understaffed ED, worrying about getting fired because of c suite politics or frivolous complaints, lawsuit risk, circadian disruption. Then there's the incentive of getting a pension check...

I'll put in a plug for the VA too. The VA is slowly but surely changing for the better. While it's true that "if you've seen one VA...you've only seen one VA,"I used to work prn at one and the ED ran surprisingly smoothly. The patients were generally great, pathology was decent, other docs and consultants were quality, and there were some unusually humane features like actually getting paid if I had to stay beyond my scheduled shift time.

Not a good place for a new grad trying to prove themselves by seeing tons of patients or somebody looking to maximize their $/hr, but for folks looking for some stability and a respite from the chaos of the current EM landscape...the VA definitely offers that.

In general their EDs tend to be very well staffed, there's no PG scores, and sovereign immunity is incredibly liberating. As a federal employee you actually have rights and way more protection than working for a CMG/hospital/SDG. Their benefits are solid. When you factor in their retirement contributions and PTO/sick leave (~50 days off/year) it usually adds another 20-25% to the salary. Combine it with the reasonable workload...their hourly rate can actually be really solid. And many shops give their pit docs weekly paid admin time to compensate for the higher number of annual hours required vs the community (see below).

Of course it's not perfect. The EMR is ancient, their admin processes can be super cumbersome, and the required # of hours for FT EM is the same as all other specialties at 40 hrs/wk (though I've heard they're trying to change this).

Several years ago I was approached about a FT gig at a VA in a popular city. Started at 300k and would increase most years (and very unlikely to ever go down) since it's a federal gig. I didn't pursue it due to geography and as I liked having multiple PT gigs. But in hindsight, it now looks pretty good. In the last few years I've known more and more folks trying to get into the VA in their area...and they couldn't as these places were already fully staffed.

VA isn't perfect, but it can be a great option.

 

[lucid_leprechaun]

I'll put in a plug for the VA too. The VA is slowly but surely changing for the better. While it's true that "if you've seen one VA...you've only seen one VA,"I used to work prn at one and the ED ran surprisingly smoothly. The patients were generally great, pathology was decent, other docs and consultants were quality, and there were some unusually humane features like actually getting paid if I had to stay beyond my scheduled shift time.

Not a good place for a new grad trying to prove themselves by seeing tons of patients or somebody looking to maximize their $/hr, but for folks looking for some stability and a respite from the chaos of the current EM landscape...the VA definitely offers that.

In general their EDs tend to be very well staffed, there's no PG scores, and sovereign immunity is incredibly liberating. As a federal employee you actually have rights and way more protection than working for a CMG/hospital/SDG. Their benefits are solid. When you factor in their retirement contributions and PTO/sick leave (~50 days off/year) it usually adds another 20-25% to the salary. Combine it with the reasonable workload...their hourly rate can actually be really solid. And many shops give their pit docs weekly paid admin time to compensate for the higher number of annual hours required vs the community (see below).

Of course it's not perfect. The EMR is ancient, their admin processes can be super cumbersome, and the required # of hours for FT EM is the same as all other specialties at 40 hrs/wk (though I've heard they're trying to change this).

Several years ago I was approached about a FT gig at a VA in a popular city. Started at 300k and would increase most years (and very unlikely to ever go down) since it's a federal gig. I didn't pursue it due to geography and as I liked having multiple PT gigs. But in hindsight, it now looks pretty good. In the last few years I've known more and more folks trying to get into the VA in their area...and they couldn't as these places were already fully staffed.

VA isn't perfect, but it can be a great option.

Good to know! Most I know didn’t really have an ED. But yeah the best program is a busy ER that sees everything and a resident who wants to learn.

 

[The Knife & Gun Club]

Here’s my thoughts, as a golden-brown, soon to extra crispy PGY2.

The reality is 90% of residencies out there will more or less accomplish the end goal of training you to be good at your job. Usually every region has one “big player” who serves as the major training center for that area. In Missouri it’s WashU. In east Texas it’s UTSW. In the southern half of Florida its UM (northern half belongs of UF 🤮). Same for most other regions. Their training isn’t better necessarily but it’s also not worse, and their connections in the region will help you find work there. So pick where you’d like to build your network and train there.

People can bitch and moan all day about the specialty being “dead” but at the end of the day if you really like the job you’ll have more good days than bad. And when you start to feel the burn you’ll spend a month off service and realize how absolutely miserable the lives of every other speciality is, and come running back to the ED with the drunks, malingerers, and consultants talking to you like your a toddler. that feeling validates that EM is the right field for you.

Obviously I’d say go to UM cuz it’s a crazy county hospital on the edge of the world with strong community training, but hey, I’m biased 😬