3 vs 4 year EM Programs impact on Job Opportunities

[Walkitout14]

Hi, I am a 4th year medical student going into EM and I am looking to go to a program in or around NYC. I am leaning towards 3 year programs and was wondering what the impact of going to a 3 yr program without fellowship vs a 4 yr program without fellowship is on job opportunities for community EM in NY. I understand that for academic positions a 4 yr program or a 3 year program with fellowship is necessary but wasn't sure if there was a real difference between a straight 3yr vs 4yr program in terms of job opportunities for community EM in NY? I also understand that yes a 4th year is one more year of training so on that grounds I would assume they would be more marketable but I guess what I'm really asking is if that extra year really makes that much of a difference in terms of marketability for community EM in NY. Thanks for the replies in advance.

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[EM_Rebuilder]

I cannot talk specifically about the NY area, but community wise, 3rd vs 4th year probably has little impact on 'getting a job'. I think it can help boost you into other leadership/administrative positions in those community jobs if that is your thing.

I would rank the residency programs in order of how pleased you were with the program/location and put little strain on 3rd vs 4th year program. If they were equal in your mind, put the 3 first. I think too many students make a bad choice in 'discounting' all 4th year programs.

I went to a 4 year program and will argue it was one of the BEST choices I have made in my life. I paid off my student loans by moonlighting/living like a resident for that extra year, plus I believe it has helped open doors into some leadership positions earlier in my career. I very truly think I am in a better financial position and have reduced my actual clinical time more for administrative time because of that 'wasted extra year of training' people talk about...

Good Luck.

 

[Hamhock]

Many (really, most) of the "best" programs in NYC are 4 years...do not disregard them as a group just because they are four years in length...especially if you are more interested in getting the best training possible and opening the most doors after residency (community -- and certainly academic)

HH

 

[gman33]

Look at how the extra year is spent.
An extra year of EM training at a good program isn't a bad thing.
Some of the 4 year programs I looked at just had more off service rotations.
One had less total EM months than many 3 year programs.
This didn't seem like a good use of my time.

 

[Cerberus]

I went to a 3 year program in NYC, I'm doing a fellowship and have an administration level position lined up when I graduate. Many people from my program have stayed and none have had trouble staying in community or Academic centers. I feel that the 3year+Fellowship puts you at a huge advantage over residents from 4 year programs.

 

[Inertia123]

I went to a 3 year program in NYC, I'm doing a fellowship and have an administration level position lined up when I graduate. Many people from my program have stayed and none have had trouble staying in community or Academic centers. I feel that the 3year+Fellowship puts you at a huge advantage over residents from 4 year programs.

Said the person who went to a 3 year program. Seriously, you can rationalize the crap out of whether 3 yr or 4 yr program is better. Honestly, I hate this debate and I feel like we should have uniformity of education and every program should either be 3 or 4 yrs. Community employers want a EM boarded doc. They don't care about anything else. Rank programs based on your true preferences.

 

[Cerberus]

Said the person who went to a 3 year program. Seriously, you can rationalize the crap out of whether 3 yr or 4 yr program is better. Honestly, I hate this debate and I feel like we should have uniformity of education and every program should either be 3 or 4 yrs. Community employers want a EM boarded doc. They don't care about anything else. Rank programs based on your true preferences.

It is a never ending debate, which I only chimed into because others were saying how great 4 year programs are. I also asked the same question as a medstudent, and ended up ranking based on where I thought I'd have the best fit. I'm thankful it ended up being the 3year program I went to (it's far less likely I would have done fellowship after 4 years of residency). I'm not doubting that having 4 years of supervision is better than 3, I also don't doubt that 5 is better than 4, or 6 is better than 5. I have had zero issues going from my 3 year residency to being an Attending. I have had 0 adverse outcomes that could be blamed on lack of training. I haven't had more situations where i thought "wait, what do i do?" than I feel I would have with another year of supervised training.

 

[Groove]

Product of 4 yr program. In hindsight, it's really difficult to give any sort of subjective opinion, having a singular experience. For myself, I have no regrets as I received exceptional training, so the 4th year was worth it in that respect. Do you need a 4th year to practice good EM? No. Are you more polished? Sure. However, you're more polished in 5 years and 10 years, etc.. If you have the opportunity to moonlight a lot, as I did, it's not a wasted year in terms of salary. Moonlighting within the framework of residency can also be high yield in terms of having opportunities to discuss cases, etc..

Personally, I think training trumps everything. That being said, a formal fellowship is probably optimal for academics and a 3yr residency + 1yr fellowship seems much more efficient. I'm sure academic positions are just as available for 4yr or even 3yr + no fellowship graduates, but I don't have any tremendous insight into academics. I'll freely admit that there are a couple of fellowships that I was interested in during residency and chose not to pursue after residency due to the overall length of training.

Again though, I wouldn't have traded my 4 yrs for another 3 yr program as the training and experience was top notch IMO. I felt prepared for every scenario and environment which was infinitely more valuable to me than any perceived missed opportunities.

 

[ORL10]

I have said this before it matters more about the resident than the program and or years. I ranked a three year program first based on gut then 4, four year programs next. Pick your program because its where you want to be and where you think you will be happiest and not because of said reputation or years.

I will say i do catch a lot of friendly grief from my co fellows (4 year program or em/im guys) on a daily basis but then again I'm on average three to four years younger.

 

[nycqqe]

It's simple. Go to a residency that can give you the most/best training in the shortest amount of time.

Usually that is a 3 year program.

You don't need more "time" in a residency. Otherwise why not 5 years?

What's "more" is usually fluffed up by administrative time, off service rotations that are chill so residents can take a break or not chill but they need warm bodies more than you need their teaching, and a slower progress in EM training as an intern because senority invariably matters when there are 3 classes of residents more senior than you.

Some residencies are 4 years simply because they can be. They are not doing it for your welfare. Places where people are willing to go to and do that extra year , often because of the prestige or reputation, maybe location, or maybe because people truly believe(or make themselves believe) that those 4 years are more and better.

If a place tells you that you "need" 4 years. Believe them, that they do in fact need 4 years to train you. Just don't naively think that you will be a better you 4 years later in life.

A better bet at being a better you 4 years later, is to go to a really strong 3 year place, where you won't be unhappy so you can be focused and work hard, and then do a fellowship or even just work as an attending for a year.

 

[The White Coat Investor]

If you want to do four years of training do a fellowship. You'll be more attractive to both academic and community programs, and you'll make more money. 4 year programs remain 4 years because they can. They're generally good programs in good locations and could still fill if they offered 5 years of training. Should you go to a solid 4 year over a mediocre 3 year? Probably, but the people who can get into good 4 years can also generally get into good 3 years.

When we're evaluating applicants for our job, we do give more credit to someone with 4 years of training than 3. But not enough more that you should do an extra year based on that. 9 of our last 10 partners went to 3 year programs.

 

[TooMuchResearch]

If you want to do four years of training do a fellowship. You'll be more attractive to both academic and community programs, and you'll make more money. 4 year programs remain 4 years because they can. They're generally good programs in good locations and could still fill if they offered 5 years of training. Should you go to a solid 4 year over a mediocre 3 year? Probably, but the people who can get into good 4 years can also generally get into good 3 years.

When we're evaluating applicants for our job, we do give more credit to someone with 4 years of training than 3. But not enough more that you should do an extra year based on that. 9 of our last 10 partners went to 3 year programs.

But nobody will definitively tell us which programs are the good ones ; ) But lets not have this turn into another of those threads.

 

[Mad Jack]

I asked an EM resident at my employer how he felt about it. He said to really look into how the extra year is spent. He chose a 4 year program because he got to do international rotations, a toxicology rotation, a CMED rotation, and research with that extra year. He warned that many programs just expanded to a fourth year because they needed the cheap labor and do not actually provide extra or unique learning opportunities, so choose wisely.

 

[EMdoc10]

How common is 4yr prog + fellowship? Or is that unnecessary since one has tons of elective time to pursue fellowship interests/gain enough scans to be boarded, etc.

 

[Arcan57]

How common is 4yr prog + fellowship? Or is that unnecessary since one has tons of elective time to pursue fellowship interests/gain enough scans to be boarded, etc.

In my graduating class roughly a third did fellowship. Going to a 4 year program gives you opportunity to find out what interests you and in some cases that interest can be satisfied during the 4 yrs and in some cases it leads to a fellowship. In general, people that are fixated on earning potential screen out 4 yr programs so the economic hit of doing a fellowship may not be as repellant to 4 yr grads as to 3yr grads.

 

[SoCuteMD]

How common is 4yr prog + fellowship? Or is that unnecessary since one has tons of elective time to pursue fellowship interests/gain enough scans to be boarded, etc.

I've long since forgotten the numbers, but my understanding is that a higher percentage of 4 year grads do a fellowship (though in absolute numbers, more 3 year grads do as they outnumber 4 year grads 4:1).

I'm doing fellowship and I did a 4 year program. Does it have a material impact on my lifestyle and income for those two years? Yes. Did it get me a job that would not have been open to someone without a fellowship? Yes. I will say that I could have had the job from a 3 year program + fellowship, but I'm not sure I ever would have FOUND my fellowship in a 3 year program.

 

[deleted547339]

I've long since forgotten the numbers, but my understanding is that a higher percentage of 4 year grads do a fellowship (though in absolute numbers, more 3 year grads do as they outnumber 4 year grads 4:1).

I'm doing fellowship and I did a 4 year program. Does it have a material impact on my lifestyle and income for those two years? Yes. Did it get me a job that would not have been open to someone without a fellowship? Yes. I will say that I could have had the job from a 3 year program + fellowship, but I'm not sure I ever would have FOUND my fellowship in a 3 year program.

Mind sharing what fellowship you did?

 

[eefen]

If you want to do four years of training do a fellowship. You'll be more attractive to both academic and community programs, and you'll make more money.

Can you expound on this? It was my (perhaps mistaken) understanding that EM fellowships are most useful to someone who is genuinly interested in a particular subject (e.g. US) or who wants to fit into a certain (usually academic) niche - in terms of value added with respect to salary, it seemed that fellowships tend to not make much of a difference or even detract from one's earning potential, depending on the fellowship and the environment one practices in - again, the real value simply being the background knowledge added. I'd be in hearing everyone's thoughts.

 

[Arcan57]

Can you expound on this? It was my (perhaps mistaken) understanding that EM fellowships are most useful to someone who is genuinly interested in a particular subject (e.g. US) or who wants to fit into a certain (usually academic) niche - in terms of value added with respect to salary, it seemed that fellowships tend to not make much of a difference or even detract from one's earning potential, depending on the fellowship and the environment one practices in - again, the real value simply being the background knowledge added. I'd be in hearing everyone's thoughts.

He's saying that you make more during a fellowship than you do as a 4th year resident. This is predominantly due to moonlighting opportunities available for BE grads since fellows get paid as PGY-X so you're not making more during a fellowship intrinsic to the fellowship itself. Since no one pays 4yr grads more than 3 yr grads at a given shop, there's no added earning potential for the 4th year . The highest paying jobs tend to be in areas that are not competitive and thus a 4th year of training doesn't give one "a leg up" on a higher paying shops in general. A fellowship probably hurts your salary overall, but that's going to be due to a predilection for staying in academia where the salaries are laughable compared to private practice (in many cities). Theoretically a fellowship could get you some sort of administrative stipend being a group's (or more likely system's) "go-to-doc" for that subspecialty. Nothing reimburses better than shiftwork so you're either tacking on more hours to get that stipend or you're trading easier hours for less pay.

 

[eefen]

He's saying that you make more during a fellowship than you do as a 4th year resident. This is predominantly due to moonlighting opportunities available for BE grads since fellows get paid as PGY-X so you're not making more during a fellowship intrinsic to the fellowship itself. Since no one pays 4yr grads more than 3 yr grads at a given shop, there's no added earning potential for the 4th year . The highest paying jobs tend to be in areas that are not competitive and thus a 4th year of training doesn't give one "a leg up" on a higher paying shops in general. A fellowship probably hurts your salary overall, but that's going to be due to a predilection for staying in academia where the salaries are laughable compared to private practice (in many cities). Theoretically a fellowship could get you some sort of administrative stipend being a group's (or more likely system's) "go-to-doc" for that subspecialty. Nothing reimburses better than shiftwork so you're either tacking on more hours to get that stipend or you're trading easier hours for less pay.

Ah - that makes sense. Thanks for the explanation.

 

[SoCuteMD]

Mind sharing what fellowship you did?

I am currently a simulation fellow.

He's saying that you make more during a fellowship than you do as a 4th year resident. This is predominantly due to moonlighting opportunities available for BE grads since fellows get paid as PGY-X so you're not making more during a fellowship intrinsic to the fellowship itself. Since no one pays 4yr grads more than 3 yr grads at a given shop, there's no added earning potential for the 4th year . The highest paying jobs tend to be in areas that are not competitive and thus a 4th year of training doesn't give one "a leg up" on a higher paying shops in general. A fellowship probably hurts your salary overall, but that's going to be due to a predilection for staying in academia where the salaries are laughable compared to private practice (in many cities). Theoretically a fellowship could get you some sort of administrative stipend being a group's (or more likely system's) "go-to-doc" for that subspecialty. Nothing reimburses better than shiftwork so you're either tacking on more hours to get that stipend or you're trading easier hours for less pay.

A lot (but certainly not all) of the non-ACGME accredited fellowships are actually paid at a higher rate than PGY4/PGY5. My salary is about 40% higher than my salary as a PGY5 on my institutions pay scale would be (and I moonlight on top of that). This was the case for 2 of the 3 places I interviewed.

 

[Roy7]

Currently I do a lot of hiring for my group. I work in a community, non-academic (e.g. no-residents) suburban medical center (not in New York). I never look at 3 versus 4 year programs.