A tale of two programs.

[Indryd]

Hey guys. So I can't believe I'm making one of THESE threads, but I am torturing myself over this and need some input.

CLIFF NOTES:

Choose better training, or likely better job-placement.

Place ONE:
- training will be perfectly adequate, nothing special but above average
- but
- jobs/fellowships lined up in October of third year because they started getting letters from various groups and EDs in July.
- all picking and choosing between multiple dream offers.
- Strong record of groups who recruited a resident one year then hiring over and over from the program because they are so pleased.

vs.

Program TWO:
- phenomenal training in a trial-by-fire ED
- tons of autonomy and procedures
-but
- job placements kind of blah
- many pro-actively sending out tons of CVs, cold-calling, getting 3rd and 4th choices.



DETAILS:

*I am NOT going into academics, fwiw.

I am torn between two programs, both incredible, but differing in one or two important areas.

I did an away rotation at both of these places.

Program ONE is a usn&wp "top 5 medical school"/"top 10 hospital" with a respectable but not phenomenal EM program (way overshadowed by Medicine, Surgery, and multiple sub-specialties). They send about 70% of docs to community, 30% to academic, despite being located at a research powerhouse. I really gelled with the residents there. PD is incredible. Location is a B+.

Program TWO is a community hospital in a lower-income community. It is well-known only in EM circles because the EM program is the most powerful in the hospital and the place is basically run like a county hospital. About 90% community and 10% academic. Loved the residents and PD. Location is a C- .

Having spent a month in each place, I am absolutely certain the better program as far as pure training is the program TWO. Unreal amount of procedures, insane autonomy, almost NO consultants available.

Problem with program TWO is--despite the reputation in the EM community--it has a sad-looking "where-our-residents-are-getting-hired" list, with many residents having to cold-call, sending out tons of unsolicited CVs, getting jobs they are disappointed with, etc.

Program ONE, on the other hand, offers a great ED culture with middle-tier but happy, friendly residents. But the "...-hired" list for this program is unreal. Residents all had jobs/fellowships lined up in October of third year because they started getting letters from various groups and EDs in July. Everyone picking and choosing between multiple dream offers. Strong record of groups who recruited a resident one year hiring over and over from the program because they are so pleased.

Obviously the training at Program ONE is good enough to have an unreal job placement profile, but I know my training at Program TWO will be more hardcore, more autonomous, more complete.

I kind of feel like choosing ONE over TWO would be selling out, which I know sounds childish.

But, if in the end what I care about is landing that dream job, what good are all the bells and whistles of the hardcore place?

I'd appreciate any thoughts or advice.

Thanks in advance.

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[Hamhock]

Tough situation.

I think it would be helpful if you can describe what you mean by a "dream job"...what it is that the second program is getting you.

With that description, it might be easier to provide input.

HH

 

[Apollyon]

Just off-hand, but I am guessing choice 1 is Duke.

 

[Indryd]

I think it would be helpful if you can describe what you mean by a "dream job"...what it is that the second program is getting you.

By dream job I mean every resident I talked to at the first place couldn't stop beaming and talking about their future job. Whether the guy who got the 6000 visit/year in a sleepy coastal town, gal who got a peds fellowship in her hometown, guy got an 60/40 clinic/academic job in the south for 300,000, etc.

At the second place, it was like "yeah, I think I'll stay on for a year here, job market is rough right now" and "I took a job just west of Columbus, but only until something opens up closer to my family". Conference one week was job-seeking skills and tips, advantages/disadvantages of recruiters, etc. Almost everyone was staying within 100 miles because they knew a guy who knew an ED director, etc. But almost none of them had any connections there besides doing their residency.

 

[Indryd]

Just off-hand, but I am guessing choice 1 is Duke.

Never heard of it.

 

[bartleby]

I would not overestimate the role of the program in your job search unless you are looking for some high powered academic job where you need to show up with a well-defined niche and research agenda when you hit the door. If you go to ACEP once as a resident or join any of the professional societies in EM you will be getting letters in the mail and have recruiters humping your leg over the phone -- there are plenty of EM jobs to be had overall.

The whole job search process (assuming you don't have a felony record or some other blot on your record which will complicate getting a medical license -- both rarities) is HIGHLY resident dependent. Some of my residents are out pounding the pavement 14 months before graduation. Others are starting to clue in that they're going to have to look for a job only when they start getting letters warning them that their exit interview is 3 months away.

 

[deleted109597]

At the second place, it was like "yeah, I think I'll stay on for a year here, job market is rough right now" and "I took a job just west of Columbus, but only until something opens up closer to my family". Conference one week was job-seeking skills and tips, advantages/disadvantages of recruiters, etc. Almost everyone was staying within 100 miles because they knew a guy who knew an ED director, etc. But almost none of them had any connections there besides doing their residency.

Sounds to me like the second place is full of idiots, and I would avoid it for that reason. You can get almost any job from any residency. You don't need your PD/recent grads to help. Certainly it wouldn't hurt, unless your recent grads are tools or something.

 

[Redrox]

You can get almost any job from any residency. You don't need your PD/recent grads to help. Certainly it wouldn't hurt, unless your recent grads are tools or something.

So a well-connected PD isnt important? You think new places won't be at a disadvantage with a lack of alumni network and groups contacting them looking for folk?

 

[Apollyon]

Never heard of it.

You've never heard of Duke University?

 

[Indryd]

You've never heard of Duke University?

I assume it's something like Clown College, but for John Wayne impersonators?

 

[RustedFox]

I assume it's something like Clown College, but for John Wayne impersonators?

Zzzing !

 

[RustedFox]

So a well-connected PD isnt important? You think new places won't be at a disadvantage with a lack of alumni network and groups contacting them looking for folk?

Graduating from a 'new' program (first class) this June. All of us are turbo-stoked to start our jobs; all in geographic areas that we want - from Vegas to Florida.

I just went thru the job search not long ago. Really seemed like I had my pick of where I wanted to go.

 

[Apollyon]

I assume it's something like Clown College, but for John Wayne impersonators?

You just sound stupid, and, moreover, that doesn't even make sense. I'm not even a supporter, but, if you are one of those UNC people, or any doofus that really has such an opinion of college sports, that is just sophomoric. (And there are other people right here on the EM forum that are exactly like that - which is somewhere between sad and scary.)

 

[Indryd]

You just sound stupid,

and, moreover, that doesn't even make sense.

Of course it doesn't. That's kind of the point! If you can't laugh at yourself (as in myself...a potential Duke guy), life gets real hard real fast.

Anyway, program ONE is indeed Duke. Loved Duke . Other than potentially feeling vaguely like a sellout by not choosing a "hardcore" enough program, it's perfect for me.

PS I don't watch a lick of college sports (artsy fartsy type).

 

[RustedFox]

You just sound stupid, and, moreover, that doesn't even make sense. I'm not even a supporter, but, if you are one of those UNC people, or any doofus that really has such an opinion of college sports, that is just sophomoric. (And there are other people right here on the EM forum that are exactly like that - which is somewhere between sad and scary.)

Easy, star. He keeeds... he keeeeds.

I thought the gag was pretty good.

 

[Apollyon]

I am still unemployed, which has gutted my sense of sarcasm. I guess I got suckered, big time. I admit it!

 

[RustedFox]

I am still unemployed, which has gutted my sense of sarcasm. I guess I got suckered, big time. I admit it!

S'allright bud. You'll find that gig that you want, soon. Good luck to yah.

 

[EctopicFetus]

To the OP.. ask yourself this question.. whats the point of residency? Just about every EM residency grad will have a basc skill set. The rest is up to you. Programs matter but isnt the point of residency to get a job.

In your case it should be your "dream job" whatever that means to you.

I would pick a residency that could help me secure my "dream job"

 

[qwerty1234]

guessing place #2 is about 2.5 hrs away...

if you liked the folks better at dook and their jobs then I dont see how its even a tough decision...

 

[winkleweizen]

guessing place #2 is about 2.5 hrs away...

if you liked the folks better at dook and their jobs then I dont see how its even a tough decision...

lol at dook

 

[Hamhock]

To the OP.. ask yourself this question.. whats the point of residency? Just about every EM residency grad will have a basc skill set. The rest is up to you. Programs matter but isnt the point of residency to get a job.

In your case it should be your "dream job" whatever that means to you.

I would pick a residency that could help me secure my "dream job"

Not to cloud the OP's mind, but I will offer a different perspective.

What is the point of residency? Well, many; but the OP has cut it down to (1) obtaining the dream job or (2) becoming the most clinically adept doc possible.

Although I respect Ectopic's point of view, I would argue that the point of residency is to get the best training possible. You want to be the best EM doc possible, right?

I know there is a lot of Ayn Rand fans on this board, but even the hard-core Ayns must give a bit: There's more to being a physician than just getting what's best for oneself...there's the patient.

I would rather have a great job and be clinically superior, confident, and the best doc for my patients than have the dream job and be missing a bit clinically.

...but that's just me.

HH

 

[Indryd]

Not to cloud the OP's mind, but I will offer a different perspective.

What is the point of residency? Well, many; but the OP has cut it down to (1) obtaining the dream job or (2) becoming the most clinically adept doc possible.

Although I respect Ectopic's point of view, I would argue that the point of residency is to get the best training possible. You want to be the best EM doc possible, right?

I know there is a lot of Ayn Rand fans on this board, but even the hard-core Ayns must give a bit: There's more to being a physician than just getting what's best for oneself...there's the patient.

I would rather have a great job and be clinically superior, confident, and the best doc for my patients than have the dream job and be missing a bit clinically.

...but that's just me.

HH

You totally summed up exactly what I mean when I say "selling out". Mind clouded.

 

[Indryd]

guessing place #2 is about 2.5 hrs away...

How are you guys doing this?

lol were my descriptions really that specific? I tried to stay super-vague.

Very interested in knowing the program you have in mind...

 

[Apollyon]

How are you guys doing this?

lol were my descriptions really that specific? I tried to stay super-vague.

Very interested in knowing the program you have in mind...

Because we're that damn smart, dude!

 

[Pinner Doc]

You just sound stupid, and, moreover, that doesn't even make sense. I'm not even a supporter, but, if you are one of those UNC people, or any doofus that really has such an opinion of college sports, that is just sophomoric. (And there are other people right here on the EM forum that are exactly like that - which is somewhere between sad and scary.)

It's sad and scary to like college sports....? I love college basketball! Rivalries are the best.

 

[Apollyon]

It's sad and scary to like college sports....? I love college basketball! Rivalries are the best.

No, it is sad and scary to live and die over college sports, and to honestly dislike someone just because of the school for which a person roots. It is sad and scary that one person would assault another over sports. Your attempt at minimalism misses the point.

 

[winkleweizen]

No, it is sad and scary to live and die over college sports, and to honestly dislike someone just because of the school for which a person roots. It is sad and scary that one person would assault another over sports. Your attempt at minimalism misses the point.

Yet, you called the OP sophomoric for just teasing about not knowing where duke was? Seriously?

 

[Apollyon]

Yet, you called the OP sophomoric for just teasing about not knowing where duke was? Seriously?

Seriously, re-read, if that is what you got. My point for both was the same. If the OP was doing the same thing (insulting because of the school), that is sophomoric. That he clarified later did, well, clarify, the point remains - that not liking someone because of the school for which a person roots, or stating they're brain-damaged, or whatever, is sad, scary, and sophomoric.

 

[Pinner Doc]

No, it is sad and scary to live and die over college sports, and to honestly dislike someone just because of the school for which a person roots. It is sad and scary that one person would assault another over sports. Your attempt at minimalism misses the point.

Why do you assume I was "attempting minimalism"? A guy made a joke, and you went a little overboard. Total non-sequitur. I really had no idea where you were coming from. I absolutely agree it's sad and scary to truly dislike a person or assault another person over college sports, but seeing how that never happened here, I would say I'm still confused as to where you're coming from.

Oh well.

SYRACUSE BASKETBALL RULES!

 

[Pinner Doc]

Seriously, re-read, if that is what you got. My point for both was the same. If the OP was doing the same thing (insulting because of the school), that is sophomoric. That he clarified later did, well, clarify, the point remains - that not liking someone because of the school for which a person roots, or stating they're brain-damaged, or whatever, is sad, scary, and sophomoric.

It was amusing. It was fun teasing. People are more offended by your overreacting than by the initial comment itself.

 

[Apollyon]

Why do you assume I was "attempting minimalism"?

I said "disliking someone only for the college for which they root" and you said "to like college sports". Beating someone up for wearing a Crimson Tide jersey when you're an Auburn fan is bad. You equating that with "liking college sports". That is minimizing or trivializing. I am assuming nothing.

This is enough derailing.

edit: this was post number 15000 for me!

 

[Indryd]

Because we're that damn smart, dude!

So what's your guess?

 

[Apollyon]

So what's your guess?

I only got one part of it; I don't have a suggestion for the other. It's a team effort! St. John's in Detroit? That is just a (N)SWAG (non-scientific wild-ass guess).