3 or 4 year program?

[lawj]

Can anyone tell me the pros and cons of 3 year vs. 4 year EM residency programs? Thanks in advance.

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[roja]

Can anyone tell me the pros and cons of 3 year vs. 4 year EM residency programs? Thanks in advance.

Do a search. Its been discussed at lenght. Also, check out the EMRA site. there is stuff there as well. Good luck.

 

[Haemr Head]

As a newbie to the forum and someone who gets frustrated with searches, I hope the seniors here won’t mind if I fire out an answer. Since I may be one of the few people in the country to have run both types and agonized over this issue, I hope it will be helpful. I will also stress that some of the PROs I have listed are often impressions and program specific (for example there are 3 year programs with far more responsibility in the senior year than some 4 year programs). I am sure I am forgetting a few pros and other the sources Roja has cited can add to this. Finally the chapter in Rules of the Road that AAEM produced really goes into a lot of detail on this issue

No Difference
Success in taking the boards in emergency medicine
PRO Three years
One less yearà higher income sooner
If you do a fellowship it makes more sense as you will have more training than someone in a 4 year program and will qualify for a position anywhere
Easy to transfer between programs (your first year does not count in a 4 year program for advanced credit)
When compared with a 2-4 model, all the time is spent and overseen by EM attending (no first year in medicine or surgery)
PRO four years
More confidence when practicing (impression)
Possibly more skilled in the ED and thus easier time during the first years with better chances at promotion (seems true for some but there are naturals that seem ready to play an a pro level in
Qualified to work in EDs that have 4th year residents, at least right out of residency. (Some of these programs quietly won’t take anyone with only 3 years of training regardless of experience after residency)
More time for electives and research experience that will not be available once you start working
Better prepared for academics (impression)
Better experience and responsibility as a senior (not always true – and personally I think the level of the responsibility given to the senior is the most critical criteria for training)

I know there are searches but a FAQ that summarizes the answers to the repetitive questions would really be nice. I would not have a clue of whether this could be done or who would do it.

 

[deleted109597]

Heh. Except now for 3 of us, this is now a 4 year vs 5 year question.

 

[DocWagner]

I can tell you there is about a 200k difference between a 3 and 4 year residency.
There is no skill difference.

 

[AmoryBlaine]

I can tell you there is about a 200k difference between a 3 and 4 year residency.
There is no skill difference.

This seems to be the conventional wisdom, but that would also seem to suggest that essentially nothing worthwhile happens in the extra year of training wouldn't it?

To me the 3 year vs 4 year thing is a strange internal debate. Is there any other specialty with variable length of training?

 

[southerndoc]

I see this thread has resurfaced again.

For my opinion, you can do a search. Haemr Head brings out some excellent points. As DocWagner points out, there may not be a skill difference, and in fact, most second years are as competent as third years in skills. However, there is a professional development difference between a third and fourth year, and there are opportunities available with the added research and elective time that would be difficult to obtain as an attending.

 

[WaZoBia]

This seems to be the conventional wisdom, but that would also seem to suggest that essentially nothing worthwhile happens in the extra year of training wouldn't it?

To me the 3 year vs 4 year thing is a strange internal debate. Is there any other specialty with variable length of training?

surgery 5 to 7 years
neurosurgery 6 to 8 years

 

[AmoryBlaine]

surgery 5 to 7 years
neurosurgery 6 to 8 years

Which Gen Surg programs are 7 years?

 

[TxMed]

Which Gen Surg programs are 7 years?

ucla, uthscsa, and many more. they basically throw in 2 years of slave labor research.

 

[AmoryBlaine]

ucla, uthscsa, and many more. they basically throw in 2 years of slave labor research.

I wonder if the folks over in the Gen Surg forum call that the "$500,000 and first divorce mistake."

 

[jgrady]

Couple more:

Peds ER:
Peds (3) + ER (3) = 6*
ER (3) + Peds F (2) = 5

Plastics:
Integrated 3 + 3 = 6
Gen Surg (5) + Fellowship (2) = 7

*I have a couple friends looking at this option because, even though it's longer, they don't to work on adults - ever!

 

[Dr. Will]

Couple more:

Peds ER:
Peds (3) + ER (3) = 6*
ER (3) + Peds F (2) = 5

Both of these mentioned include fellowships, not just length of residency. You aren't required to do a fellowship. I think the OP was trying to find out what places have these "required" extra years, such as the surg programs that have 2 extra years for research or 3 vs. 4 years of EM. There are 3 combined EM/Peds programs in the country, but I think you would still have to do a fellowship to specifically do Peds EM (correct me if I'm wrong).

 

[OUMD]

urology can be 5 or 6 years. i believe the 6 year programs have a year of research built into them.

 

[deleted109597]

Which Gen Surg programs are 7 years?

Drumroll....

The University of Cincinnati. The part I don't understand is how they can afford all of this. Medicare money stops at the minimum, but a fair number of their residencies are longer than the minimum. Regardless of how good the training is, that is a fair chunk of change that they are spending to be, well, different, since no studies show any difference between residents at the end.

That being said, it is still a cool hospital (in a not so cool town).

 

[Hard24Get]

ucla, uthscsa, and many more. they basically throw in 2 years of slave labor research.

Penn, too. The researching surgeons take turns serving as night float, too, so it helps them with their 80 hr work week. I wonder if it is one of those things where they feel they can't get an academic position without it?

 

[jaymodo]

One thing to consider, the decision to allow 3 year programs was made before resident hours were cut down to 80 hours/week. As mentioned earlier, federal funding had already been scaled down to 3 years, forcing programs to continue operating with a shortened length.

The fact that the 4 year programs are actually funding the final year themselves makes a strong argument for their value.

 

[a_ditchdoc]

I had to wrestle with the thought of three year versus a four year programs this past year. I really loved the four year program I applied to, and the location was my favorite of any, but in the end, the benefits did not outweigh the disadvantages. In the end you have to decide what benefits YOU the most. I am interested in a fellowship after residency (are you listening Roja???). So the question for me was five years versus six years. That did not eliminate the four year program, but certainly placed them lower on my rank list. I simply prefer to be done a year sooner as the additional year in the four year program was composed of offservice rotations, and five months of electives (something that was very attractive). Certainly the offservice rotations are valuable in general educational terms, and probably make you a little more well rounded, but the benefit simply did not outweigh the cost for me.

I am afraid there will never be a clear cut answer for this. Unless the governing bodies reach a concensus, students and residents will simply have to decide what is best for them.

ditch

 

[roja]

I had to wrestle with the thought of three year versus a four year programs this past year. I really loved the four year program I applied to, and the location was my favorite of any, but in the end, the benefits did not outweigh the disadvantages. In the end you have to decide what benefits YOU the most. I am interested in a fellowship after residency (are you listening Roja???). So the question for me was five years versus six years. That did not eliminate the four year program, but certainly placed them lower on my rank list. I simply prefer to be done a year sooner as the additional year in the four year program was composed of offservice rotations, and five months of electives (something that was very attractive). Certainly the offservice rotations are valuable in general educational terms, and probably make you a little more well rounded, but the benefit simply did not outweigh the cost for me.

I am afraid there will never be a clear cut answer for this. Unless the governing bodies reach a concensus, students and residents will simply have to decide what is best for them.

ditch

I hear ya. and this ultimately weighed in heavily for me. Although I was fairly clueless when I applied to residency (came in late after finally realizing that EM was waaaaaay cooler than Pediatric Rheumatology) to the whole debate, and was somewhat limited to location (ahem... NY), I quickly delved into the thow whole 1-3, 2-4, 1-4 cha-cha-cha thing. It certainly weighed in some but if I had not liked some of my other higher ranked so much more, there was one or two four years that would have ranked higher on my list. In the end, my number one had everything I wanted.

There are pro's and con's (as Haemr so eloquently pointed out i have been working nights and really shouldn't try to post coherently) to each side. Ultimately, I think location and fit (yes that dead old horse again) are the most important.

If its an issue for you, some of the things I would look at (and this is true of any residency) is to look at the total months in the ED... 4 years is no way a gaurantee that you will spend more time in the ED. (Our 3 year has more total EM months than several 4 years) Also, consider the offservices that you will be doing with that extra year... are you really getting more elective time? (1 mo extra vs 5 mo's?) weigh them and decide if they are worth the extra year for you. If you want to do a fellowship, the extra year does play in....

The hours thing, I feel is a null issue. If the RRC felt that 3 year residencies weren't getting enough exposure, they would cite them. In essence this arguement is saying that 85% of all EM trained MD's are not getting enough clinical hours. Not to mention that, in general, EM was never a serious offender of the 80 hour work week- except on off services. So it really didn't affect EM that much (from what the old folks tell me).


Ultimately, a_ditchdoc said it well: each student will have to decide what is best for them. You are ultimately the best peson to figure out what you need in a residency.

 

[southerndoc]

I wonder if the folks over in the Gen Surg forum call that the "$500,000 and first divorce mistake."

Duke's general surgery residency has one of the highest divorce rates in the country, something I've heard the former PD used to boast about. Their training program usually lasts 9 years.

 

[a_ditchdoc]

Nt to derail the thread or anything, and at risk of being highly inappropriate, but Roja has one hot pic!!!

(PS: I'm still sorry about sewing up the glass in that guys hand...Forgive me???)

 

[aliraja]

Duke's general surgery residency has one of the highest divorce rates in the country, something I've heard the former PD used to boast about. Their training program usually lasts 9 years.

Interestingly enough, back when I was a first or second year med student, the divorce rate for the graduating chiefs was over 100% because a couple of them had gotten divorced twice while residents.

 

[Apollyon]

Duke's general surgery residency has one of the highest divorce rates in the country, something I've heard the former PD used to boast about. Their training program usually lasts 9 years.

7 years - 5 clinical, 2 research. The CT-surgery fellowship is 3 solid clinical years (versus 2 at most other programs), which, when Dr. Sabiston was chair, led to the "Decade with Dave" (as most surgeons could do the 5 + 2 and be practice ready, but not at Duke).

Now, with more people being MD/PhD, several (I knew of 3 by the time I left) were able to have the 2 year research requirement waived, and get through in 5 years directly. I don't know how it is at other research-heavy programs, but residents don't need to do their research at Duke; one guy I know did his research years in Miami.

The divorce rate is a vestige of the "old school"; there was only one in the time I was there.

 

[Hard24Get]

Nt to derail the thread or anything, and at risk of being highly inappropriate, but Roja has one hot pic!!!

(PS: I'm still sorry about sewing up the glass in that guys hand...Forgive me???)

Yeah, isn't that really you, Roja? It looks like the same girl in the previous pic. I hope I am that pretty when I am an attending...

 

[roja]

Nt to derail the thread or anything, and at risk of being highly inappropriate, but Roja has one hot pic!!!

(PS: I'm still sorry about sewing up the glass in that guys hand...Forgive me???)

Of course. and talk about derailing.