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Sep 27, 2001
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Just a quick question about that one extra year?....Why do it? I know there must be reason those programs exist, but other than the year of training I don't get it!

Are the 1-4 more research based or is it truly just in existence for a year of 'extra' experience? Does it make you more attractive for hire when you finish residency?

Can someone please explain this to me? Thanks!
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My name is Neo
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Also look around on the SAEM website... there are a few "essays" on there that are very useful for medical students, and there is a 3 vs 4 year program essay there too.

Also I think maybe even EMRA has a page on that too.


beyond all hope

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4 years is extra time to be scutted out and work for cheap. There is some small advantage in that you often get more off-service rotations, more time for electives, and more time for research. However, many 4 year programs are really only 4 years only to get more cheap labor.

Make sure you're really getting something out of the extra year, if you want to do 4 years. If you, you're giving up a year of autonomy +1-300Gs for nothing.

Andy Kahn

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On one interview, the PD and assistant PD felt that all residencies may have to move to 4 yrs someday b/c of the new requirements placed on EM residency programs each year. None of the existing requirements are deleted so with the addition of new required rotations, they felt that soon it may not be possible to fit all those rotations into just 3 yrs. Just a feeling they had so nothing for sure yet.

I'm know it's been repeated over and over but I will just go ahead and give my thoughts in case you don't find it in your search.

1. I applied only to pgy1-3 programs b/c I feel that if the majority of programs are in that format, it should be okay.
2. I do not see the advantages in a pgy2-4. (please let me know if you have some thoughts on advantages this might have for anybody)
3. The pgy1-4 programs may provide more elective/research time or more time to be an acting attending, but then it could also be cheap labor that really doesnt provide you with anything (as mentioned previously).
4. I really think the few other possible advantages of going to a 4 yr program include being eligible right away for a faculty or fellowship position in a 4 yr institution (which are the minority). However, I have heard of a couple of anecdotes where residents from 3 yr programs that did come straight out and get a position at a 4yr program. There are some fellowships at 4yr programs that will take you after a 3yr program and your salary will be based on your years of training. Still, I think if you went to a 3yr program and worked 1 year afterwards, some 4yr programs will then consider you for fellowship or faculty. For a faculty position, I think many feel having a 4yrs of EM training vs 3yrs or EM + 1yr fellowship makes you a stronger candidate.

I thought that 4yr programs would eventually change to 3yrs like some did, but it seems that the really competitive, original, or big names happen to be 4yr programs so I guess they dont feel the need or want to change. I figured there would be several applicants like me who would prefer 3yr programs, and I think there were much fewer applicants to pgy2-4 programs. Also, given that all the newer EM programs (Nebraska, Iowa, Penn State, Shreveport, USF, Duke, and I am sure I have forgotten some others) decided to be 3 yr places, I thought that trend would continue to make the 4yr programs feel the "need" to change (along with the funding they receive for each resident), but I guess if they can't fit all of the required rotations in 3yrs, there will be no choice but to expand the time frame.

However, if you really want to live somewhere, then perhaps a 1-4 or 2-4 at that location would be great for you. Just go where you will be happy and learn enough to be a great EP.


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I interviewed at 3 and 4 year programs. I kept an open mind and I think in the end it left me with more options. There were 3 year prog's that were great and 4 year prog's as well. It came down to the intensity of the training I wanted and the setting (inner city) I was looking for. As it turned out, my top three programs are 4 year programs. If you have any questions about the places I interviewed at you can contact my personal mail.
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