@doggydog note: I'm going to try to jump out in front of this one: people can have different opinions than you, it's okay, no need to lambast them for it.
Submitted anonymously, via
Google Form.
Applicant Summary:
Step 1: >260, Step 2: >260
EM rotations: H/H
Anything else that made you more competitive:
leadership experiences in some impressive projects. told personal statement was particularly interesting.
Main Considerations in Creating this ROL:
1. reputation within + outside of EM (fully understand my own vanity is a legit criticism of my RoL)
2. strength of clinical training.
3. partner job market.
4. prefer 3 vs 4 year.
5. location (NE closer to family and prefer larger city, outdoor stuff like mountains, beaches, etc)
1) Brown
Wasn't on my radar before interview season. Of all the "name will impress my grandmother" programs, stood out as having excellent clinical training (singularly fulfills #1 and #2 on things that mattered to me). Training: 110k+ visits at main training site with excellent throughput (no psych boarding, fast track mostly taken care of by mid-levels, strong social work and safety net in RI), "county with resources" environment, EM is own department. Trauma is a consult service. QPath with US fellows giving feedback on scans. Graduated responsibility (but not so strict that you won't touch an airway until 3rd year like some other programs). Speaking of 3rd year, residents spend most of it running 8? CC rooms. Upper level ICU rotations. Dedicated ED radiology that routinely goes over imaging whenever you have time. 4th year pretending role but also enough elective time to develop niche or start fellowship/masters degree. Emphasis on resident as educator with teaching opportunities. Highest % of academicians in graduating classes that I encountered (60%).
Location: Downtown and East Side with beautiful architecture, preservation and renovation movements lead by RISD. No traffic or commute to different sites (Miriam close by and for Newport month, program gives you a beach house). Close to Boston without the traffic of COL. RI beaches are nice.
Cons: Providence wouldn't be the greatest for single residents. Fairly limited to two neighborhoods with decent QOL (the rest is sort of depressed-post-industrial). Winter in NE sucks. 4 year program. Not the EM-reputation of Pitt/Hennepin. Somewhat limited moonlighting (critical patient transfers for ~80/hour).
2) Yale
Training: also large primary hospital (~100k visits), again "county with resources" feel (using "county" to mean where the indigent patients go), again with a diverse patient population, similarly "the only game in town". Most impressive research, especially in med-ed. Very strong US, again with fellows reviewing QPath. J&J scholars program would be incredible if Global EM was my jam. Great sim, similar 4th year setup to develop niche. Ivory tower concerns should be mitigated knowing PD is a no-nonsense army guy.
Location: New Haven is a killer. That's how much I liked the program that it still made #2. Not much job opportunity for spouse. Winter sucks. Could make it work if you did a condo with exercise room, pool, etc, and some nice culture owing to the University.
Cons: didn't feel the same ownership of the ED/independence that Brown (among other programs) had. Rotate running trauma with surgery (complicated schedule). Really a tiny factor... location was the big drawback here.
3) Hopkins
Was my #1 for quite a while but something didn't feel right and I overthought it.
Training: 50k visits, have to rotate at a bunch of other sites (+ for diversity of experience/clinical setting but - for commuting and having that home-base big county hospital feel). These guys smell like internal medicine. Rounding and white coats in the ED, impressive DDx during chairman's rounds - felt like they knew Harrison's and Rosen's inside and out. Can't blame them considering modern medicine was founded here. One of oldest EDs (1974), have been their own department forever which ensures a huge alumni network with PDs/chiefs/chairs across the US. 4th year you work 1/2 time (attending schedule in the ED), designed for niche development but really makes more sense if you stay on for a 5th year to complete a fellowship as the 4th year work can count as the first year of certain fellowships. Plenty of trauma (no concern w Shock Trauma being closeby as Baltimore gets divided by East/West and produces more than enough trauma to support two residencies).
Location: It's not Manhattan, but that goes hand-in-hand with low COL and having a population conducive to EM pathology. Actually has a really nice waterfront - the city is super "block by block" and divided into small neighborhoods. Temperate and very walkable. Major transport hub, well-plugged into eastern seaboard.
Cons: ED felt quiet, no QPath, surgery runs the traumas, PD seems a little rule-oriented (no airways until you do anesthesia month), decent amount of commuting, 4 year program, really loved the program across the street (but just too hard to turn down the Hopkins pedigree).
4) Stanford
California dreaming. Has the academic reputation and research, strong job market for partner, and plenty of outdoor stuff to do.
Training: mostly at San Jose - 2nd busiest ED in Cali (90k?). In broad strokes, has all research/academic support you could want. Country club reputation is unwarranted considering a majority of the patients you see are at the county hospital in San Jose. Consider Stanford and the other Kaiser site the finishing touches on a robust clinical experience that really allows you to see the full scope of EM. Unrealistically strong (but shouldn't we all shoot for the stars) safety net and outpatient coordination through the Kaiser system - would feel comfortable applying Hestia criteria to these patients. 4th year is NOT designed as a niche/academic development year - leadership really feels that it takes 4 years to learn EM.
Location: most resident live in Mountain View between Palo Alto and San Jose to cut down on commute time. Cali. Bay area. Beach. Mountains. Sun.
Cons: commute was 2nd worst I experienced. Leadership schedules shifts so that you're opposite of the heavy-heavy-heavy-traffic, but I have a hard time believing there's not still in heavy traffic. 4 year program with less bang for your buck since it's not really designed to build a niche.
5) Maryland
Should be my #1. Best fit. Too vain to walk away from the names at 1-4.
Training: 50k visits, similar population to Hopkins. Everybody has an opinion re: Shock Trauma (not part of ED so never see trauma on an ED shift, but the volume is incredible so when you rotate for several months there you become expert. PD made analogy of learning to ride a bike: would you rather practice every day for a month or once a month for 3 years? At the end of the day, I feel like it's the procedures that matter [running a trauma is pretty algorithmic] and procedures are a-plenty here). Mattu is a boss. Willis is a boss (moved into med school leadership - academic affairs or something - but still works in the ED). Heavy "resident as educator" emphasis. Education/program leadership mentoring is second-to-none. This programs highlights that they train leaders, not just clinicians. I bought it. 3 year program (you work hard but what do you expect in a condensed timeframe?) and still strong research component. Multiple sites including some in DC which is a hellish commute.
Location: See Hopkins, though Maryland is on such a huge campus (nursing, other health schools) that there a buffer to the rest of Baltimore.
Cons: my Macbeth of a partner isn't as impressed by the name. Significant commuting. Doesn't have that 90k+ visit huge primary training site. Didn't feel same strength of US as Brown/Yale.
6) Pittsburgh
EM people in the northeast LOVE this program.
Training: Truly split (Mercy and Presby each like 60k), plus a couple other sites. One of those classically strong EM programs among the likes of Hennepin, Carolinas, LAC, Denver, Cinci... Stayed a 3 year program, so expect to work hard, but again probably worth it to get through a year quicker. Most would argue Pitt has the strongest EMS in the country, but that's not an interest of mine. Reputation, especially in the northeast (which has fewer long-established programs than the midwest) is super high. Most PDs produced of any program in the country.
Location: the horrible-ness of northeastern weather without the niceties of being connected to the eastern seaboard. This is a midwest city. The people are nicer here, but don't expect to ever see NYC/Boston/DC/Philly. COL is great. Traffic isn't bad. Gray gray city, little sun. Rivers are nice, hills are okay, delusional people compare the topography to San Francisco.
Cons: thought the emphasis on EMS was weird - outside of major cities, EMS director are often filled by non-BCBE folk, and within academic centers, it seems like the most junior faculty member gets pushed into the job - felt like it was a case of too much inertia to move on (program having lots of original EMS research, hard to let go of a field you started). Again not the 'wow-factor' outside of EM (which shouldn't matter, but excuse my vanity). Location doesn't help.
7) Baylor
Best city in the best market for EM in the country. If I don't train here, I'm coming down to practice here.
Training: Ben Taub (90k+ visits) is an absolute zoo. If there's a fellowship in hallway medicine, it will originate here. Incredible for training, not so incredible for patients, but then again, Texas is much better to doctors than it is to poor people. At first glance, feels like this program has the most diverse population in the country until you stop using "diversity" as a buzzword for non-white people. Almost exclusively indigent, uninsured, underserved population. Pathology here is amazing. Newer program than UTSW and UTH but I have no doubts that this will be the premiere program in Texas soon. PD Pillow was the most charismatic and engaging of the trail. Huge commitment to med-ed. When you think of "badass county programs" (Cook, Emory, etc), Baylor needs to be on your list. Just got granted full departmental status (in an impressively short time).
Location: Houston is awesome. Baylor sits in the middle of the largest medical center in the world. COL is cheap and all the buildings (except ironically Ben Taub) are new. Tarffic, despite the reputation, isn't bad at all. Don't live in the suburbs and try to commute. If you're within the 610 loop you're fine. Knowing Spanish would be a huge plus but is not a requirement.
Cons: might have trouble with the insured, medically literate patient. Resource poor is a blessing and a curse - you won't be using the cutting edge anything, but you'll learn how to get by with what you've got.
8) Georgetown
Sort of want to live in DC, sort of don't.
Training: not at Georgetown. Based out of Washington Hospital Center. Triple-focus on critical care, peds, and I forgot the third one. Really impressive what they squeeze into a 3 year curriculum (like 6 months of peds and ICU). Lots of 1 on 1 time with attendings. Came away really impressed but didn't get the same reaction from my advisors - I get the impression that we're in a different tier here than 1-6.
Location: DC, heard good things, COL and traffic are concerns - worth it?
Cons: none really, just didn't seem to have the reputation as some of the others
9) Albany
The glorious capital city of New York.
Training: solid all around. Well respected within the hospital (don't have the same intensity of medicine/surgery program reluctant to give up turf as some of the other programs on this list). Still a big enough city to feel urban, but you get trained like you're the only doc around (lots of responsibility, not a reliance on consult services). Best moonlighting opportunities that I came across (external, $150+/hr).
Location: lots of outdoor stuff between ADK and Berkshire mountains. Albany itself kind of depressed with a long gray winter (think Pittsburgh) - the attendings all live in the suburbs.
Cons: northeast winter, not as big a city as I'd like, again probably not the top-est of tier but an incredibly solid program.
10) NY Presby
Hats off to you if you want to live in NYC.
Training: split between Cornell and Columbia campuses. Bonus to have resources of both institutions, negative to have to commute between the two. Working toward departmental status, seems functionally independent. PD Carter is a big name in EM - they have a great resident as educator curriculum.
Location: Manhattan. Hellish COL. Hellish traffic. Hellish people.
Cons: didn't click with residents (though I do commend their geographic diversity - they even had someone from Queens in the program!).
11) Duke
Didn't get the impression that EM has made its footprint within the temple of Duke. Division of surgery. Can't imagine that Durham has the population base to support EM pathology (your rare disease medicine patients can fly into the triangle for specialists, but emergency medicine is local medicine).
12) Hennepin
Deserves better, but partner veto'd Minneapolis. Felt like this had the strongest procedural training. Loved the EM-run hospital (there are few other residencies based out of HCMC). Bought that this could be the best overall clinical training of the list. Cool stuff like broncoscopy suite in the resus rooms - do stuff here that you wouldn't anywhere else... but not sure that those skills translate (for example, nowhere else will have bronchoscope capability)
13) UConn
Very wellness-oriented program. Lightest schedule (18 8s as an intern, guaranteed 3 day weekend 1x/month), large impressive sim center. Not the same reputation (within EM and out) as other programs on here.
14) Denver
Community program on steroids. Learn by doing. They see more patients than any other program. Could graduate without ever picking up an EM text. I wholeheartedly disagree with their training philosophy. Little time for discussion about patient management or feedback. Residents proudly proclaimed they never needed to read since they see so much. Multiple surgeons (faculty and residents) who switched careers into EM who bring that mindset to EM.
Convinced that these docs graduate churning out RVUs like nobody else and are thus highly valued in community practice. However, I'm not convinced that they get the best EBM foundation.
Denver is kinda grungy. If you don't like weed or skiing you have no reason to idolize this city. Biggest disappointment of the trail.
Other:
Rejections: BIDMC, MGH/BWH, BMC, Penn, LAC, Carolinas, UNC, NYU
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