$100,000 Mistake

[UHSDOMBA]

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Hey colleagues,
I just read again the articles posted on the SAEM website describing the pros and cons of 3 vs 4 year programs. Both articles are well written (by Rosen and Hamilton). Here's the link:
http://www.saem.org/inform/provscon.htm
Now the questions I have for you residents and future EM residents are: Are you pursuing training at a 3 or 4 year institution? What's your reason for one versus the other? I am leaning towards the 3 year ones and am planning to cancel the 4 year programs' invites (Einstein, Wash U, LIJ, etc.). Also, I am already in so much debt (dual degree program) and want to make some benjamins right away. Any input would be awesome.

👍

 

[roja]

There is a long controversy about 3 vs 4. However, when you look at the vast majority of programs, something like 85% are 1-3. Now, some say you get better training from 1-4 adn that 3 is not enough. However, I find it hard to believe that 85% of EM trained MD's are inadequately trained.

There are definately benifits to both. I interviewed at both types, adn in the end ranked all the 1-4's low and cancelled the 2-4's (didn't rank the one I interviewed at).

Fours offer more elective time and often more floor rotations. However, my personal philosophy is I want to be an EM doc. I want to train in the ED. I want my off service rotations to educate me on what I will be doing in the ED.

I also wanted to have the freedom to do a fellowship. I think its harder to muster the energy after a four year program. Where as, after 3, a fellowship isn't that hard to add in.

The residents I know from 3's all feel adequately trained. You really should just go to the interviews. While in theory the 3's may appeal to you, you might love a 4 program. A 3 year program does you no good if you hate it. Its good to consider both and interview at both.

 

[The White Coat Investor]

We have two brand new faculty members. One straight out of our program, one straight out of Denver. I don't see any difference in competency, procedural skill, academic knowledge, ability to run the ED etc etc etc. I'm all for three years.

 

[southerndoc]

Fours offer more elective time and often more floor rotations. However, my personal philosophy is I want to be an EM doc. I want to train in the ED. I want my off service rotations to educate me on what I will be doing in the ED.

4's definitely offer more electives, but I'm not so sure about the floor time. We spend one month each of peds and med wards. We get 6 months of critical care unit experience (1 mo. SICU, 2 mos. CCU and MICU, 1 mo. PICU), 6 months of elective time, and a total of 26 months in the adult and pedi ED's.

I don't buy the argument that 4-year programs are more academic. I know plenty of 3-year programs that are very academic.

It's a personal decision. If you're set on making money sooner rather than later, then a 3-year is probably best for you. If you want more opportunities to explore various areas (international health, critical care, etc.), then 4-year programs are probably better for you mainly because they offer more critical care time.

Residency is a one-time thing. Make it count by doing what is best for you.

 

[The White Coat Investor]

One month of peds WARDS and two months of CCU? Ouch. Not sure I'd count that as an advantage, sounds like slave labor.

Residency may be a one time thing, but so's my life. Another year in a residency is a year I'm working too many hours to pursue my other interests. If I don't NEED the training to be an excellent EP, I'm not sure its an advantage. But hey, to each his own.

 

[rh]

I agree with the above posters. You need to go where you find the best fit. I interviewed at 1-3, 1-4, and 2-4 and ended up matching 2-4. I love my program. There are times when I whish I had matched 1-3. Like when I talk to my friends who are in the job search now. The longer program do have some perks though. At ours it is schedule, and time to spend with my family. We work 13 shifts on good months and 16 on bad months, average of about 14. Needless to say this leaves a fair amount of time to moonlight and spend with family. Moonlighting pays extremely well here. In the 2 years I will moonlight here I will come close, but not quite make up for the lost year of salary. So in the end for me at least it is almost a wash. It only means one more year before I can settle down permanently

 

[southerndoc]

One month of peds WARDS and two months of CCU? Ouch. Not sure I'd count that as an advantage, sounds like slave labor.

The peds ward really isn't an advantage. I think it's useless, but nevertheless, it's one of the less demanding rotations.

The CCU rotation is awesome. It takes some very sick people to get admitted to our CCU. As an intern you must pre-round on patients, but as a resident it's nice. So you're second CCU month, you don't pre-round and you don't write daily progress notes. So it isn't that bad. Besides, the experience with getting procedures, treating CHF'ers, MI patients, endocarditis, etc. is why I wanted to come here.

 

[roja]

I think what your going to find here, is that there are advantages and disadvantages to both. The really important thing is to find a program that offers what YOU need. Some really want lots of ICU/CCU type time. Others dont (the RRC requires two months). Again, advantages and disadvantages to both.

I'm at a 1-3. I have a great lifestyle, see my kid, have fun with friends, etc. I'm at a very intense ED program, in that we do LOTS of ED time. Our off services are geared towards ED management. This is what I wanted. We have faculty that expose us to lots of 'elective' type stuff, international, ultrasound, tox, clinical research, etc.

So, find a program that fits what YOU want, is in a city YOU want to live in, and has people YOU want to hang out with. Then youll have the best program for YOU.


/off soapbox

 

[margaritaboy]

I am at a 1-3 program, so here is my bias:

I will be board certified after 3 years, and then I can practice and pay off loans or pursue a fellowship for a year and have additional training.

Even if you go to a 1-3 program like me, you aren't forgoing additional training, if you choose to pursue it. It just seems like you have some additional flexibility, which was important for me because my wife is going through a Peds residency and it made sense that our training would end at the same time.

It works for me, but it's just my opinion.

 

[joshua_msu]

Well, for me it will be the $200,000 dollar mistake. Kinda makes the three year programs look very good.

 

[WilcoWorld]

Well, for me it will be the $200,000 dollar mistake. Kinda makes the three year programs look very good.

You might want to check your math...or let the rest of us know where we can get $240 k to start.

 

[Sessamoid]

You might want to check your math...or let the rest of us know where we can get $240 k to start.

It's out there if you're willing to live where you're needed/wanted.

 

[RBorhani]

The general rule is that the 4 year programs are more geared toward an academic career. However, I can tell you that unless you absolutely love a program and want to sacrifice one year of not getting paid and accruing interest on your loans, go for a three year program.

 

[roja]

You might want to check your math...or let the rest of us know where we can get $240 k to start.

Texas... the land of milk and honey. 😀 starting at about 300K

 

[las olas]

I have heard of up to $400K starting in the rural south. Those loans will disappear pretty fast, but you do have to actually live there.

 

[edinOH]

Life completely sucks unless you are living on either one of the coasts or in a big city in the NE.

Trust me.

Don't even consider moving towards the midwest-midsouth regions when you graduate.

 

[roja]

Life completely sucks unless you are living on either one of the coasts or in a big city in the NE.

Trust me.

Don't even consider moving towards the midwest-midsouth regions when you graduate.

Yes. Please. The south is terrible. Especially texas. Dont' go there. bunch o' rednecks... and its hot.



waits for salary to increase due to lack of EP's in her beloved homestate.

 

[Apollyon]

I have heard of up to $400K starting in the rural south. Those loans will disappear pretty fast, but you do have to actually live there.

Any place that will pay you $400K/yr will get at least $400K - maybe $500K - of work out of you. If it looks too good to be true, it is.

 

[cooldreams]

Yes. Please. The south is terrible. Especially texas. Dont' go there. bunch o' rednecks... and its hot.



waits for salary to increase due to lack of EP's in her beloved homestate.

hahha you guys are soooo babied! i live here where it is 100+ in the summer, very humid, and then -20 in the winter and very windy.

 

[kungfufishing]

Life completely sucks unless you are living on either one of the coasts or in a big city in the NE.




the NE? Nebraska doesnt have any good cities. Way too far from the coast, too.

 

[roja]

hahha you guys are soooo babied! i live here where it is 100+ in the summer, very humid, and then -20 in the winter and very windy.

do you walk uphill in the snow to work, both ways????????? 😉 😀

 

[Jeff698]

Yes. Please. The south is terrible. Especially texas. Dont' go there. bunch o' rednecks... and its hot.

You forgot to mention how humid it is. Plus, all those Texans ever talk about is how great their state is. Come on, you wouldn't want to live with that, now would you? Best to just avoid the place.

Jeff

 

[roja]

You forgot to mention how humid it is. Plus, all those Texans ever talk about is how great their state is. Come on, you wouldn't want to live with that, now would you? Best to just avoid the place.

Jeff

true true... you don't want any of that either.

 

[Sessamoid]

hahha you guys are soooo babied! i live here where it is 100+ in the summer, very humid, and then -20 in the winter and very windy.

Pshaw! We're in the middle of a cold snap here in Southern California, and it's getting down to the LOW 50's (Fahrenheit) at night! I actually had to put on a sweater when I went riding my bike on the beach! 🙂

 

[DOJDEE]

Pshaw! We're in the middle of a cold snap here in Southern California, and it's getting down to the LOW 50's (Fahrenheit) at night! I actually had to put on a sweater when I went riding my bike on the beach! 🙂

we just got 5 inches of snow here in independence missouri....

 

[Jeff698]

Did I mention the mosquitos?

Take care,
Jeff

 

[Sessamoid]

Did I mention the mosquitos?

Take care,
Jeff

I'm trying hard to forget the mosquitoes. Galveston was the only place I've lived where the mosquitoes actually travel in swarms. Little clouds of mosquitoes waiting around sidewalks and the soccer fields waiting for unsuspecting medical students so they could completely exsanguinate them!

 

[Jeff698]

I'm trying hard to forget the mosquitoes. Galveston was the only place I've lived where the mosquitoes actually travel in swarms. Little clouds of mosquitoes waiting around sidewalks and the soccer fields waiting for unsuspecting medical students so they could completely exsanguinate them!

You're not joking! Those little bastards made me crack my car windshield the other day (made me, mind you; made me). They swarmed into my car in the 2 seconds it took to jump in and slam the door. I experienced a brief episode of homicidal rage and I slapped everything within slapping distance. Sadly, I wear a great big Aggie ring. The mix of mosquitos, ring, rage and windshield combined for an unfortunate outcome. Dammit.

Fortunately, we just had a front come through and its actually pleasant here right now.

Take care,
Jeff

 

[TripleDegree]

Wait a second guys - $300K starting salaries?? $400K starting salaries?

Surely you jest. Anyone have any concrete evidence of these outrageous numbers?

 

[DrMom]

I personally know of an EP starting at $300K with good benefits & decent hours. This particular doc had a contract this summer with 1 year left of training. I know of another that started at $275K, but did some crazy shifts the first few months. Both of these are in Arkansas.

 

[8744]

Yes. Please. The south is terrible. Especially texas. Dont' go there. bunch o' rednecks... and its hot.



waits for salary to increase due to lack of EP's in her beloved homestate.

And, to the tune of "Dueling Banjos" we'll make you squeal like a pig.

 

[DOJDEE]

And, to the tune of "Dueling Banjos" we'll make you squeal like a pig.

hot dog!

 

[southerndoc]

Wait a second guys - $300K starting salaries?? $400K starting salaries?

Surely you jest. Anyone have any concrete evidence of these outrageous numbers?

A friend of mine (who is FP trained) just got a contract working in a rural Georgia ED making $285,000 working 13 12's/month.

 

[TripleDegree]

A friend of mine (who is FP trained) just got a contract working in a rural Georgia ED making $285,000 working 13 12's/month.

Not even EM boarded? Wow

 

[southerndoc]

Not even EM boarded? Wow

Nope... isn't that a slap in the face of our specialty? Oh well, I guess in rural Georgia, you get what you can. (I'm still glad I did an EM residency instead of FP!)

 

[JKP]

Just curious,
On the subject of salaries... how much do EP's make in New York (starting, 5 yr, 10 yrs etc.) / NJ? And is it difficult to find a job in the NY/NJ/LI area nowadays?
Thanks!

 

[DOnut]

Just curious,
On the subject of salaries... how much do EP's make in New York (starting, 5 yr, 10 yrs etc.) / NJ? And is it difficult to find a job in the NY/NJ/LI area nowadays?
Thanks!

I'm not sure about 5 or 10 years, but a girl I know accepted a position straight out of residency for $185K at Good Samaritan Hospital in Long Island.

 

[roja]

LI and NJ aren't too bad. the city is not so great. And competition is stiff.