Emergency Medicine Residency at "Ivy League" Hospitals

[Potts32]

Hey everybody. So I'm a third year med student that has finally 100% committed to doing EM (I always had a hunch). After talking with the program director at my school I was surprised to hear that the "most reputed" programs in EM were at Cincinatti, Pittsburgh, Denver, etc.... and not, as I naively assumed, at the traditional powerhouse hospitals like Harvard, Columbia, Johns Hopkins, etc.
On talking to some of the residents at my program, they said that if you train at one of the academic powerhouse hospitals as an EM resident you will loose out on the management of your patients and getting to do procedures. Plus if the medicine and surgery services are very strong, you will get little respect at an EM resident.
Now I'm very aware of that last statement because even at my school where the EM residents are the strongest residents in the hospital (save maybe some of the surgical subspecialties) on every service I suffer through the endless of litany of hearing EM docs as "glorified triage nurses," glorified paramedics," and well you get the gist.

So is this true? I understand how loaded of a question this is but would appreciate any input as I'm trying to come up with programs to apply to.

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[kbrown]

Hey everybody. So I'm a third year med student that has finally 100% committed to doing EM (I always had a hunch). After talking with the program director at my school I was surprised to hear that the "most reputed" programs in EM were at Cincinatti, Pittsburgh, Denver, etc.... and not, as I naively assumed, at the traditional powerhouse hospitals like Harvard, Columbia, Johns Hopkins, etc.
On talking to some of the residents at my program, they said that if you train at one of the academic powerhouse hospitals as an EM resident you will loose out on the management of your patients and getting to do procedures. Plus if the medicine and surgery services are very strong, you will get little respect at an EM resident.
Now I'm very aware of that last statement because even at my school where the EM residents are the strongest residents in the hospital (save maybe some of the surgical subspecialties) on every service I suffer through the endless of litany of hearing EM docs as "glorified triage nurses," glorified paramedics," and well you get the gist.

So is this true? I understand how loaded of a question this is but would appreciate any input as I'm trying to come up with programs to apply to.

Not touching this with a ten ft pole.

 

[SoCuteMD]

Check the FAQs. The RRC has such strict oversight of EM training programs because a) they are relatively new and b) there aren't that many that you will get great training at ANY program. The consensus on this board is that you should make your decisions based on more personal preferences: location, schedule, number of non-EM rotations, 3 yr vs 4 yr, what the research interests of a particular faculty are, you get the point.

I know there is at least one Ivy League teaching hospital resident on here and he seems very happy with his program. He mentioned a few weeks ago that friends of his at similar programs are also pleased with their experiences.

PS: you left Carolinas off your "surprise" list!!

 

[NinerNiner999]

No problems here. We here at Hopkins pride ourselves on our individual resourcefullness and our ability to manage our own patients, placing them wherever in the hospital we see fit with minimal resistance. We get our own airways, manage our own traumas, and never have to fight for procedures. We are well-respected both on and off-service. To make a generalized statement about "Ivy League" programs being sub-par is risky at best, and to be honest fairly uninformed. I encourage you to visit a program you may be interested in and discover what you like about it (and more importantly how it works with your style of learning).

Fatty McFattypants, M.D.

 

[EctopicFetus]

Hey everybody. So I'm a third year med student that has finally 100% committed to doing EM (I always had a hunch). After talking with the program director at my school I was surprised to hear that the "most reputed" programs in EM were at Cincinatti, Pittsburgh, Denver, etc.... and not, as I naively assumed, at the traditional powerhouse hospitals like Harvard, Columbia, Johns Hopkins, etc.
On talking to some of the residents at my program, they said that if you train at one of the academic powerhouse hospitals as an EM resident you will loose out on the management of your patients and getting to do procedures. Plus if the medicine and surgery services are very strong, you will get little respect at an EM resident.
Now I'm very aware of that last statement because even at my school where the EM residents are the strongest residents in the hospital (save maybe some of the surgical subspecialties) on every service I suffer through the endless of litany of hearing EM docs as "glorified triage nurses," glorified paramedics," and well you get the gist.

So is this true? I understand how loaded of a question this is but would appreciate any input as I'm trying to come up with programs to apply to.

One of the things that resonated with me when I interviewed was that one thing to consider about these "Ivy League" institutions is when you are off service who is training you. At many of these programs you mentioned they have some of the best and most famous ICU docs or best docs in other fields.

Now I am not silly enough to point out programs but it was something to consider. Overall, as many on here have said the RRC has pretty stringent requirements so no matter where you end up you will get good training.

 

[southerndoc]

There is one thing that will always happen: no matter where you do your residency, and even where you practice afterwards, you will always get criticism from admitting teams. The residents always criticize the ED physicians because the residents do not want to admit the patient.

The Denver, Cincinnati, Carolinas, Emory, and other programs are well respected and considered better programs only because they are some of the oldest programs in the country. Oldest doesn't always mean the best, but they are the most well respected programs. There are far many graduates of these programs that promote their respective programs than there are the newer programs.

Go where you think you will be happy. There has to be a good mix of ED management. Most ED's will manage their patients like any other -- you don't think Denver doesn't have its share of subspecialties? Any major teaching hospital will have numerous inpatient subspecialty services that you will be consulting. I do not mind consulting these services. In fact, I prefer it. There's nothing better for me to consult ENT for the peritonsillar abscess, and have that ENT resident train me how to properly perform drainage of the abscess. I would much prefer to learn from a senior resident in a subspecialty than from an ED physician that might do a particular procedure maybe once or twice per year.

Things to look for in residency: adequate patient volume (most people learn best by seeing and doing since it sticks in memory longer), great teaching (you need this not only during a shift, but also in lectures), simulation medicine (a growing way of learning rare and important case presentations), good comraderie (if you don't fit in, scratch a program off your list immediately), great ultrasound experience (it will improve your chances of getting a job after residency), critical care experience (many programs offer 3-7 months of ICU experience; 1-2 months usually isn't enough), and if you are thinking of academics, then ample research opportunities. Some people also look for international experience for their own interests, and many EM residencies now offer this.

Good luck in your search for residency. You will no less get adequate training just about anywhere you go if it is RRC approved/ACGME accredited.

 

[Apollyon]

great ultrasound experience (it will improve your chances of getting a job after residency)

Anyone who finishes an EM residency will get a job - somewhere. U/S may or may not be the thing that gets you the job you want when it's down to you and one other person. However, no ultrasound = no job isn't true.

 

[southerndoc]

Anyone who finishes an EM residency will get a job - somewhere. U/S may or may not be the thing that gets you the job you want when it's down to you and one other person. However, no ultrasound = no job isn't true.

Nope, never meant to imply that no ultrasound = no job. (Rereading my statement, I wonder how you came to that, but anyhow...)

Ultrasound definitely makes you more marketable!

 

[ERMudPhud]

There is one thing that will always happen: no matter where you do your residency, and even where you practice afterwards, you will always get criticism from admitting teams. The residents always criticize the ED physicians because the residents do not want to admit the patient..

My recollection from residency was that the admitting team always said, "Thank you for this interesting case and the opportunity to expand my knowledge base. Furthermore it appears you've done such an impeccable job of working up and treating the patient that there is really nothing left for me to do but read about this fascinating case"

I guess things really are different at the Ivy Leage programs.

In all seriousness though, the top medical schools had powerful medicine and surgery programs and were fairly stuck in their ways so they were very very late to embrace EM. Leaving other places like Denver, Cinci, Pitt, Carolinas, to blaze a trail and establish their reputations and their connections. The big name schools have come a long way in catching up though. Certainly places like Harvard, Yale, Penn and others have well respected programs now. Its still true that if you go to those places the EM department may have less power which could potentially be an issue. On the other hand as people have pointed out the educational opportunities and resources available at those schools is really unparalleled

 

[Apollyon]

it will improve your chances of getting a job after residency

(Rereading my statement, I wonder how you came to that, but anyhow...)

Seems pretty clear to me - the first statement was yes/no, not how good of a job. Do you see it now?

 

[southerndoc]

Seems pretty clear to me - the first statement was yes/no, not how good of a job. Do you see it now?

The first statement isn't yes/no. I said "it will improve your chances of getting a job after residency." I didn't say "it's required to get a job after residency."

At any rate, why are you bringing it up anyhow? You get ultrasound training at your program!

 

[bluejay68]

I am a HAEMR intern and just want to echo just about everything said so far. I don't feel like I am getting too little exposure to patient volume or procedures, and the off-service teaching is excellent. Compared to Med/Surg we are definitely the new kid on the block, so we are still setting policies (i.e., who gets the ED thoracotomy, fine tuning how the admitting procedure works, etc) and it is obvious which departments have more money (they get better food for lunches - a nice perk of the off-service rotations, especially Medicine), that I assume were worked out years ago at older programs, but I don't really see this at a big problem (especially if you are the type who likes being a part of something at an influential time, when the stage is being set for future clinical practice).

Anyway, I think the quality of available EM programs out there is an embarrassment of riches for all of us into the field - as mentioned so many times before, the RRC keeps us all on a tight leash and the standards for training are high everywhere. Pick a program where you enjoy the learning environment, the personalities already there, the location, etc.

 

[TysonCook]

The only other thing I can add is that I did an away month at MGH (HAEMR)w/Kimo and Dr. Thomas and LOVED it. But when it came to ranking programs I just could NOT justify the cost of living in Boston. So in the end it was an awesome program that got nixed by other factors.

Moral of the story; you may love every thing about the "best" programs, but my end up ranking them lower because you just...can't...make...yourself...live...in....(fill in the blank here).

I am a HAEMR intern and just want to echo just about everything said so far. I don't feel like I am getting too little exposure to patient volume or procedures, and the off-service teaching is excellent. Compared to Med/Surg we are definitely the new kid on the block, so we are still setting policies (i.e., who gets the ED thoracotomy, fine tuning how the admitting procedure works, etc) and it is obvious which departments have more money (they get better food for lunches - a nice perk of the off-service rotations, especially Medicine), that I assume were worked out years ago at older programs, but I don't really see this at a big problem (especially if you are the type who likes being a part of something at an influential time, when the stage is being set for future clinical practice).

Anyway, I think the quality of available EM programs out there is an embarrassment of riches for all of us into the field - as mentioned so many times before, the RRC keeps us all on a tight leash and the standards for training are high everywhere. Pick a program where you enjoy the learning environment, the personalities already there, the location, etc.

 

[JkGrocerz]

The only other thing I can add is that I did an away month at MGH (HAEMR)w/Kimo and Dr. Thomas and LOVED it. But when it came to ranking programs I just could NOT justify the cost of living in Boston. So in the end it was an awesome program that got nixed by other factors.

Moral of the story; you may love every thing about the "best" programs, but my end up ranking them lower because you just...can't...make...yourself...live...in....(fill in the blank here).

Thats exactly how i felt about Hennepin...

 

[bluejay68]

Thats exactly how i felt about Hennipen...

Not to get too far off the subject, but a nick perk of the HAEMR program is that the pay is substatially higher for residents than just about anywhere else I've seen - I'll be over $50k next year as a PGY-2.

I don't think it quite makes up for the higher cost of living in Boston, but it's a huge help (when I was interviewing last year, most starting salaries were mid-to-high 30's to low 40's). For example, the starting salary at UCLA Harbor (which I really liked as a program and ranked in my top 3) was about $35k and the rent (for a nice place, granted) would have been in the same ballpark as Boston. Also, if you are willing to commute 20-30 minutes and pay $80 per month for parking at the hospitals, you could live outside of Boston where there actually exists a logical housing and rental market.