3-year vs 4-year

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How many 3-year and 4-year programs respectively?
Is 3-year program more competitive?

 

[pseudoknot]

In 2004 there were 122 programs, of which 14 were PGY1-4 and 23 were PGY2-4, and the rest (i.e., the majority) 1-3. I don't know a source for a very up-to-date list although I believe some of the 2-4 programs have gone to 1-4 format.

I've never heard anyone say there was a difference in competitiveness between the two.

EDIT: per EMRA:

As of January 2006, there are 102 PGY 1 - 3 programs, 16 PGY 2 - 4 programs, and 19 PGY 1 - 4 programs accredited by the ACGME.

 

[southerndoc]

4 year programs are probably less competitive as most people want to do 3 years. Just a hunch.

 

[pseudoknot]

4 year programs are probably less competitive as most people want to do 3 years. Just a hunch.

That might be balanced out by the fact that four year programs tend to be older and include Denver, Cinci, USC, Highland, and UCSF to name a few.

 

[Pinner Doc]

That might be balanced out by the fact that four year programs tend to be older and include Denver, Cinci, USC, Highland, and UCSF to name a few.

although ucsf = new program

 

[pseudoknot]

although ucsf = new program

Yes, but nearly their entire first class was either AOA or MD/PhD. Being new apparently didn't adversely affect their recruitment. Reading their website makes me feel unqualified even to be a patient there.

 

[The Buff]

4 year programs are probably less competitive as most people want to do 3 years. Just a hunch.

I think the opposite is probably true since many of the four year programs are either very well respected (as mentioned above) or at big name places (ie Harvard, Yale) which tend to draw people from those exact same places. I definitely felt like the four-yeas were more competitive this year when I was applying.

As for current numbers I feel like it is about 25% 1-4, 74% 1-3, and one or two 2-4's left.

 

[tscottturner]

In general, I thought the four year programs were geared more towards research, and therefore were more competitive amongst individuals who choose that career path.

 

[RxnMan]

...many of the four year programs are either very well respected (as mentioned above) or at big name places (ie Harvard, Yale) which tend to draw people from those exact same places...

BIDMC is a 3-year EM residency. I've never heard anything about the BWH/MGH program. I've been told by seniors that they were taking something of a risk in applying to Yale EM.

For historical reasons, the Big Name places was not where EM started.

 

[SoCuteMD]

BIDMC is a 3-year EM residency. I've never heard anything about the BWH/MGH program. I've been told by seniors that they were taking something of a risk in applying to Yale EM.

For historical reasons, the Big Name places was not where EM started.

To be fair, BIDMC is a 3+1 program. They offer their residents a 4th year is a junior attending and the support to do research or complete a graduate degree.

MGH/BWH is an excellent program that has some big names in the field - Ron Walls in the chair at BWH.

Why, exactly, would someone be taking a risk by applying to Yale EM? There's no risk in applying to any given program, except the possibility that you may not get an interview. In addition, I would probably hold off about saying anything negative about a program publicly (even if you are quoting others) until you have first hand knowledge of that program yourself.

 

[RxnMan]

Why, exactly, would someone be taking a risk by applying to Yale EM?...

On Yale - I misspoke (wrote?) - I was referring to the uncertainty associated with any new(er) program. That is all.

 

[SoCuteMD]

On Yale - I misspoke (wrote?) - I was referring to the uncertainty associated with any new(er) program. That is all.

Are you sure you meant Yale? It's not that new a program. Both BIDMC and Columbia have much newer programs (<10y).

 

[southerndoc]

On Yale - I misspoke (wrote?) - I was referring to the uncertainty associated with any new(er) program. That is all.

Yale's EM program has started in 96 and has graduated 8 classes now. A newer program, yes, but not that new.

 

[pdp2001]

i applied to programs i liked - i ended up with half my interviews at 1-4, and half at 1-3. i took the length out of the equation, and after ticking programs off my list for various reasons, my top two were 3 year and my third was a 4 year. it's all about what you want from a program. more elective time is really the only difference between the programs. most people use that for research, but you don't have to. my suggestion is take a program as a whole because it probably won't be the 3 vs 4 that convinces you of a place. you'll get a great education at 99% of the programs in this country - the question is what special thing do you want that makes a program right for you outside of the educational aspect?

 

[bravotwozero]

I heard a resident tell me that more and more 3 years are planning on switching to 4 year programs, and some places won't hire you if you do a 3 year program. Is there any truth to this?

 

[ccfccp]

The only place I have heard this is a possibility is in academics. 4 year academic institutions are unlikely to offer attending positions to physicians who have the same level of training as their own senior residents. Often, in order to secure a spot like this, it seems people from three year programs will do a fellowship in order to secure their own niche. (It seems like a lot of people interested in academics do this anyway... although it is not required.)

 

[tkim]

I heard a resident tell me that more and more 3 years are planning on switching to 4 year programs, and some places won't hire you if you do a 3 year program. Is there any truth to this?

It may be regional, but I think that resident is full of ****.

 

[Greenbbs]

I heard a resident tell me that more and more 3 years are planning on switching to 4 year programs, and some places won't hire you if you do a 3 year program. Is there any truth to this?

maybe in academia, but in community land, you'll find a job no problem from ANY residency.

 

[LadyGrey]

It may be regional, but I think that resident is full of ****.

More regional than BS. I definitely heard this from attendings/ PDs at some of the 4yrs where I interviewed. (And the docs at the 3yrs admit it's true, too, but point out that you can always do an fellowship and then the 4yrs won't have the same problem with you, as ccfcp said).

 

[tkim]

More regional than BS. I definitely heard this from attendings/ PDs at some of the 4yrs where I interviewed. (And the docs at the 3yrs admit it's true, too, but point out that you can always do an fellowship and then the 4yrs won't have the same problem with you, as ccfcp said).

It's not clear that what B20 meant - community jobs or academic. Nor have I heard rumblings about the 1-3's changing to 1-4's. Clarification needed.

 

[Arcan57]

There has been a shift in a number of 2-4 programs to become 1-4. 1-3's becoming 1-4's have to figure out how to fund the extra year, which may be a deal breaker for many institutions. Getting your dream job out of residency is difficult regardless of the length of the program. If your dream job is an academic position at a four-year program, you will not get it coming straight out of a 1-3 program. Fellowship and/or board-certification will open most of those doors.

 

[southerndoc]

There has been a shift in a number of 2-4 programs to become 1-4. 1-3's becoming 1-4's have to figure out how to fund the extra year, which may be a deal breaker for many institutions. Getting your dream job out of residency is difficult regardless of the length of the program. If your dream job is an academic position at a four-year program, you will not get it coming straight out of a 1-3 program. Fellowship and/or board-certification will open most of those doors.

There are rumors that GME funding from the federal level may include a fourth year, which could be the basis of the three-year programs changing to four-year. I haven't heard any rumors of three-year programs changing to four-year programs though.

Regarding a three-year plus fellowship, yes you can do this for academics. However, you're probably going to be less competitive than a four-year graduate who also did a fellowship.

The fourth year may not be totally necessary, but it does open doors that might be closed with only three years of training. Although I never experienced this with job hunting, I have heard some groups that only hire four-year graduates. Their administration is almost always composed of four-year graduates.

For someone who did a three-year program to say that an additional year is not necessary is like a ninth grader trying to say that the senior year of high school is not necessary. How can one comment on it without experiencing it? Yes, you probably can learn things during your first year of attendinghood, but trial and error as an attending can get you sued pretty quickly. Four year programs usually offer things that many three year programs do not (more critical care training, more elective time to explore and develop yourself, etc.).

It is no secret that I am a graduate and supporter of four-year training programs. Personally I would like to see five-year programs like our Canadians. For me, the fourth year was a valuable year that provided a great deal of learning, primarily in how to manage an emergency department, teach effectively, and do more administrative type things. I've heard from quite a few colleagues that they can tell I graduated from a four-year program because I'm more confident, have more knowledge, and hit the ground running seeing more patients than typical new grads. However, this could be gained with self-study during an attending year if you're up for trial and error and willing to bear the risks of litigation from doing so.

 

[JackBauERfan]

There are rumors that GME funding from the federal level may include a fourth year, which could be the basis of the three-year programs changing to four-year. I haven't heard any rumors of three-year programs changing to four-year programs though.

Regarding a three-year plus fellowship, yes you can do this for academics. However, you're probably going to be less competitive than a four-year graduate who also did a fellowship.

The fourth year may not be totally necessary, but it does open doors that might be closed with only three years of training. Although I never experienced this with job hunting, I have heard some groups that only hire four-year graduates. Their administration is almost always composed of four-year graduates.

For someone who did a three-year program to say that an additional year is not necessary is like a ninth grader trying to say that the senior year of high school is not necessary. How can one comment on it without experiencing it? Yes, you probably can learn things during your first year of attendinghood, but trial and error as an attending can get you sued pretty quickly. Four year programs usually offer things that many three year programs do not (more critical care training, more elective time to explore and develop yourself, etc.).

It is no secret that I am a graduate and supporter of four-year training programs. Personally I would like to see five-year programs like our Canadians. For me, the fourth year was a valuable year that provided a great deal of learning, primarily in how to manage an emergency department, teach effectively, and do more administrative type things. I've heard from quite a few colleagues that they can tell I graduated from a four-year program because I'm more confident, have more knowledge, and hit the ground running seeing more patients than typical new grads. However, this could be gained with self-study during an attending year if you're up for trial and error and willing to bear the risks of litigation from doing so.

I also am supporter about 4 year programs, but I'm biased because I am in one. Not all of the residents at my program probably feel the same way, but like every other part of medical training, it depends on how much you put into it.

I think my preliminary medicine year was invaluable, almost every patient I see "medical type patient" I have had experiences that I relate to the care with stuff I learned during that year, kind of an approach of how to deal with them. Also during my medicine year, I had the opportunity to do a good amount of procedures. I'm at the end of my 3rd year now and am looking forward to a 4th year with many electives and emergency medicine rotations so I can focus even more on my interests.

I think it also helps if you want to get into academics, but probably not as much if you are going into a regular EM community type job.

I think an important point is my upcoming 4th year. Like Southerdoc said, I think I'll be able to focus more on managing parts of the ED. It seems less stressful to me since I still have that attending backup if I feel like I'm getting overwhelmed, less risk of litigation since I'm still in residency, and I still get to learn about certain patient diseases in depth without the responsibility of 'moving the meat'.

Will I be ready to be an attending after next year? I dont think anyone is ready to be attending, until they are attending regardless of 3 vs 4 years...I just feel 4 years makes me more comfortable, as would 5th, 6th, 7th....but It has to stop somewhere and I think 4 years is nice....

 

[Pure Anergy]

4 year programs are probably less competitive as most people want to do 3 years. Just a hunch.

I would be one of those people who started out not wanting to do a four year program. I'm planning to do a fellowship, so I thought, why would I want to do a fourth year when I'll already be adding on a couple of years anyway? But the problem is that so far the program I like best is four years, and now I'm feeling a little torn. I get what some of you are saying about a fourth year maybe helping for academic positions, but at the same time, there's a lot to be said for the argument by other people about the lost year of attending salary. I know it's kind of early to worry about this, but I keep thinking about whether it's better to do four years of a "perfect" program versus three years of a not quite perfect but still really likable program. So far I haven't seen anyplace that I wouldn't be willing to go, although of course they're not all equal to me. These decisions are just so painful. 🙁

The idea that doing a fourth year might reduce your risk of being sued seems like common sense, but does anyone know of a study that supports this theory? I suspect that one more year of residency might not be all that relevant when you consider that a lot of people who sue EM physicians are doing it for reasons other than malpractice. But if someone published a study about it, I'd really appreciate getting the reference.

 

[nycqqe]

The question is not 3yr vs 4yr, the question is where can you get the best training in the shortest amount of time? If that happens to be a 4yr program, then go for it. However I believe you can easily find a 3yr program that offers similar if not better training than your favorite 4yr program. Whatever the 4yr program promises you with their extra year, more training, more research, more mini-tracks...etc, you could all do that in fellowship or as an attending, while being paid more. While a 4yr program could definitely offer you "more", very often it also comes with more scut work as an intern and more attending responsibility with less pay as a 4th year.

 

[Pure Anergy]

The question is not 3yr vs 4yr, the question is where can you get the best training in the shortest amount of time? If that happens to be a 4yr program, then go for it. However I believe you can easily find a 3yr program that offers similar if not better training than your favorite 4yr program. Whatever the 4yr program promises you with their extra year, more training, more research, more mini-tracks...etc, you could all do that in fellowship or as an attending, while being paid more. While a 4yr program could definitely offer you "more", very often it also comes with more scut work as an intern and more attending responsibility with less pay as a 4th year.

It does seem like most of the extra time is for research and electives, which, like you said, I'd be doing as a fellow anyway. Is there anyone here who did four years followed by a fellowship? Do you think there was an advantage to doing the fourth year in your case?

 

[EM_Rebuilder]

Go where you will be happy with the surround living area.

I ended up in MS. I like trees, hunting, fishing and it was not too terribly far from home.

We were a 2-4, but have now made the swap to a 1-4. Rather 1-3 or 1-4 is better than another...its hard to say. Much of whats said are rumors floating around.

My only personal take is that I would not have wanted to go to a 1-4 that DOES NOT allow moonlighting. I think the ONLY valid sacrifice of an extra year of training is an extra year less of financial security (i.e. attending pay). I think moonlighting allows a pretty darn good bridge to attending pay.

In the end, you CAN NOT ever buy an extra year of training...

 

[roja]

There are rumors that GME funding from the federal level may include a fourth year, which could be the basis of the three-year programs changing to four-year. I haven't heard any rumors of three-year programs changing to four-year programs though.

Me either

Regarding a three-year plus fellowship, yes you can do this for academics. However, you're probably going to be less competitive than a four-year graduate who also did a fellowship.

I disagree. What will make you more competitive is your CV (not where you did your residency or even fellowship, but what did you do while you were a resident).

The fourth year may not be totally necessary, but it does open doors that might be closed with only three years of training. Although I never experienced this with job hunting, I have heard some groups that only hire four-year graduates. Their administration is almost always composed of four-year graduates.

For someone who did a three-year program to say that an additional year is not necessary is like a ninth grader trying to say that the senior year of high school is not necessary. How can one comment on it without experiencing it? Yes, you probably can learn things during your first year of attendinghood, but trial and error as an attending can get you sued pretty quickly. Four year programs usually offer things that many three year programs do not (more critical care training, more elective time to explore and develop yourself, etc.).

It is no secret that I am a graduate and supporter of four-year training programs. Personally I would like to see five-year programs like our Canadians. For me, the fourth year was a valuable year that provided a great deal of learning, primarily in how to manage an emergency department, teach effectively, and do more administrative type things. I've heard from quite a few colleagues that they can tell I graduated from a four-year program because I'm more confident, have more knowledge, and hit the ground running seeing more patients than typical new grads. However, this could be gained with self-study during an attending year if you're up for trial and error and willing to bear the risks of litigation from doing so.

This is a pretty standard argument, which has some validity. There are pluses and minuses to each. However, I think stating that 75% of emergency medicine trained physicians are, in essence, inadequately trained is a pretty gutsy comment. *You* may have gained more knowledge, but an extra year doesn't guarantee that everyone will get more out of it. Nor does it guarantee efficiency or ability to see more patients. These are all individualistic traits. The basic job of residency is to maximize the chances that a resident will learn what they need to be a quality EMP. It is to create the opportunities. What each person needs to get to that point is different. Hence, different lengths, philosophies, exposures, around a core basic of requirements. All the rest is a matter of putting all the little pieces of 'silver' on the scales and figuring out what is most important to each individual. (location, more ICU, trauma, cards, self directed learning, one on one teaching, etc etc etc).

 

[loomis]

BIDMC is a 3-year EM residency. I've never heard anything about the BWH/MGH program. I've been told by seniors that they were taking something of a risk in applying to Yale EM.

For historical reasons, the Big Name places was not where EM started.

i totally agree with you that EM had its start in the cradle of less known hospitals that had the guts to allow a new specialty to evolve. however, now that EM has becoming more and more "mature" in the field, one is seeing the best programs in EM (faculty/residents), heading to traditional powerhouse academic institutions like MGH/BWH/UCSF/NYU where you have high volume/pathology/acuity but also outstanding offservice residents and strong medical schools associated with them.

it'll be interesting to see how the future of EM evolves over the next few years.....be interesting to see what happens to traditional strongholds like cinci and denver/carolinas, as the gorillas of medicine like ucsf and mgh/brigham further develop their programs.....

 

[enfuegoEP]

Me either



I disagree. What will make you more competitive is your CV (not where you did your residency or even fellowship, but what did you do while you were a resident).



This is a pretty standard argument, which has some validity. There are pluses and minuses to each. However, I think stating that 75% of emergency medicine trained physicians are, in essence, inadequately trained is a pretty gutsy comment. *You* may have gained more knowledge, but an extra year doesn't guarantee that everyone will get more out of it. Nor does it guarantee efficiency or ability to see more patients. These are all individualistic traits. The basic job of residency is to maximize the chances that a resident will learn what they need to be a quality EMP. It is to create the opportunities. What each person needs to get to that point is different. Hence, different lengths, philosophies, exposures, around a core basic of requirements. All the rest is a matter of putting all the little pieces of 'silver' on the scales and figuring out what is most important to each individual. (location, more ICU, trauma, cards, self directed learning, one on one teaching, etc etc etc).

👍

 

[megawhizz]

There are rumors that GME funding from the federal level may include a fourth year, which could be the basis of the three-year programs changing to four-year. I haven't heard any rumors of three-year programs changing to four-year programs though.

I believe Johns Hopkins went from 3 to 4 in 2008