ER Residency Programs

[CVPA]

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Can anyone, who is familiar with ER Residency Programs, give me a list of programs that are considered among the better programs in the country?

Is there a method in which residency programs are ranked?

Thanks.

Chris

 

[tonem]

I think it's pretty much word of mouth. There is no official ranking. From what I understand some of the top programs are Univ. of Cinn. (I have no idea how to spell it but its supposed to be the best), Pittsburgh, Denver Health, Carolinas, UCLA-Harbor, and maybe UC Davis. Thats all I can think of off the top of my head.

 

[jjbiv]

For a strong aeromedical focus (not for all) I really like the St. Vincent Mercy Medical Center EM program. Toledo, Ohio isn't the best of places, but it has its positives. Any other comments on the program?

 

[Firebird]

EM is a four year residency, right?

How often are you on call during res.? If I understand correctly, once you get a job, you're never on call.

Also, why do you all think the burn out rate is so high for EM physicians? Is it because of the high number of drug-seeking pts mixed with seeing the same problems (i.e.-sore throats, stomach aches, etc.) every day, along with not being able to control your pt load/type?

 

[ewagner]

EM is a 3 year or 4 year residency, depending on the institution.

Many of your questions may be answered at www.saem.org
Regarding "burn out", you are gonna get alot of conjecture on this board...beter just check out the site.
By the way, www.saem.org is purely a ACGME site, but that is where the best residencies are.

 

[droliver]

Other than the flexibility & fairly good pay I cannot imagine why anyone can be happy doing ER work as a career. Once you've gotten thru the fun & games of trauma during your training it turns into the worlds most frustrating family practice clinic. Burnout is fairly common (but somewhat less I understand with the new generation of ER Residency-trained Md's). Talking to several friends in the field, your job security is only one contract away from nil with multiple location changes being common in areas with high penetrance of management organizations. Many people also get frustrated by becoming glorified triage nurses & the political quagmire that exists between medical specialties @ various hospitals. The lack of continuity of care may be attractive to some going into ER, but it is not why I went into medicine.

 

[ewagner]

Like I said, alot of the responses on this site are purely conjecture. (see above)

I don't really feel I have the authority to say why each specialty is a poor choice. I find surgery to be boring and mechanical...FP to be boring and redundant etc...each person chooses a specialty for their own reasons. Do what is best for you.

 

[Firebird]

Originally posted by droliver:
•your job security is only one contract away from nil with multiple location changes being common in areas with high penetrance of management organizations. •

What's that mean?

 

[Mango]

I would KILL to get into the EM residency here at Cincinnati! It was one of the reasons that I chose this school. It's so competeive though. They usually take 1-2 UC students each year, and hopefully I'll be one of them someday. On that note, I should be studying!! 😉

 

[NurseyK]

Originally posted by Firebird:
•What's that mean?•

Generally, in my area at least, EM Physicians are part of a "group" and have a contract with the "group". They are not hired directly by the hospitals and, hence, not hospital staff (except the ED Director). Most of the docs are shipped between a few of the many local hospitals that hire EM docs thru that particular "group".

They have a contract. They are subject to yearly contract negotiations. They are subject to the usual HMO bullsh#t re: payment for services.

I hope this came out making sense (I haven't slept much today!) 🙂

Kat

 

[tonem]

We had someone match at Cinnci...needless to say she was pretty excited.

 

[DrQuinn]

Not all EDs are run by large conglomerations as you speak. Just as FP offices are run by 1, 2, or multiple physicians, so can an ED. I've worked in several (and plan on going into EM) and it all depends on the contract with the hospital. For example, Coastal is a large ED business that hires and fires ED docs much like Kaiser or any HMO would, but there are also hospitals under contract with a small group of physicians...
so i dont' think that EM is much different from FP or IM or any other multi-person practices out there...

Pros and cons for every specialty, just like ewagner said, this isn't the place for that... there are good websites out there with more objective information, I cant' remember them off the top of my head...

I personally find EM the perfect specialty for what I've always wanted in medicine. If you REALLY want to know you can always email me. As for burn-out, I think that's for the older physicians in it. Those who were or are residency trained in EM probably have less burn-out (or the same as any other specialty). Remember that EM is a relatively NEW specialty, and that before EM residencies, the Emergency Room (they used to be rooms, not deparmtents) was *sometimes* (but generally) staffed by volunteer doctors, or less-than-par doctors who needed $. Things have changed, thankfully.

 

[CVPA]

Hey Quinn:

I'm curious about your comments regarding EM groups "hiring and firing ER docs". Has it been your experience that EM positions tend to be less stable than others? I'm wondering how common it is for an existing group to be ousted or underbid by another group.

Although it is true that small groups can sometimes be contracted with a hospital, it is my understanding that they are becoming a rare breed. Obviously it is a better scenario for ER docs to get in with a small group as it affords the opportunity to become partner. Large conglomerates like InPhynet (formally Coastal)obviously do not offer the same opportunity.

Comments.....??

Chris

 

[droliver]

CVPA,

One of my fellow residents' classmates from the Emory med school/ER residency program is an ER physician near Miami and has had to relocate 3 times in three years as result of the turnover in contracts at successive Emergency rooms. That market may not reflect everywhere in the country, but it sure has led a very unsatisfied physician who is now considering retraining in another field and seems to be a trend in some volatile areas. Several of my friends graduating from their ER training this spring seem to have had fairly good luck with finding some of the more favorable (& stable) group situations with long-standing relationships at the hospitals they cover

 

[DrQuinn]

I haven't been working in ED's for a couple years now, but several years ago it was 50/50 in re: to small privately owned ER practices vs. large conglomerates (Coastal, or InPhynet as you said). I'm sure it varies throughout the nation... and I know in S. Florida, as DrOliver mentioned, it can be pretty ugly... a lot of the ER docs aren't happy around here because its less of a privately owned scene, and more of an HMO scene.

*sigh*

I would venture to say that outside of the major cities, there are more privately owned EDs... I dont' know how long that will last.
Q

 

[NurseyK]

Originally posted by QuinnNSU:
•I personally find EM the perfect specialty for what I've always wanted in medicine. If you REALLY want to know you can always email me. As for burn-out, I think that's for the older physicians in it. Those who were or are residency trained in EM probably have less burn-out (or the same as any other specialty). Remember that EM is a relatively NEW specialty, and that before EM residencies, the Emergency Room (they used to be rooms, not deparmtents) was *sometimes* (but generally) staffed by volunteer doctors, or less-than-par doctors who needed $. Things have changed, thankfully.•

Opinions, opinions...let me throw my $0.02 in FSAG...

I think burn-out has more to do with an individual's psych makeup than how one was trained. (For ex: I know quite a few Board Certs that have moved on to something else.) In other words, can you mentally and physically take the challenges of EM over the long haul? I don't believe any of us can answer that question at this point because none of us have been an EM Physician for "x" years. Since EM is my nursing specialty, my example will come from that direction, but can still apply to DO/MD's: We have many new applicants each year that come from the floors/etc. Some of these folks make it, some don't. Some thrive in our environment, some don't - and it's OK either way. The ones that don't are not lacking in motivation or desire, but rather in some aspect of their mental and physical beings: they don't move/think/react fast enough, tire quickly of the "same" complaints coming in day after day, don't like the "treat and street" mentality, feel like they are "left hanging" after a pt. D/C or Admit (no pt follow-up), want to get to "know" their pt's, hate "organized chaos"...etc, etc. One doc said to us nurses the other nite, "You can't ship 10 people to the morgue in under a week and not have it affect you." (Well put, I thought.) A consequence: burn-out.

There are good days and bad days in EM, just like any other profession on the planet; you'll have to see for yourself if you can handle it once you get there...

Kat 🙂

 

[droliver]

NurseyK,

very thoughful observations. Your perspective is a valuable for med students & nursing students considering ER work. I'm not sure some students recognize this when they pick ER for their residency. You really have such a brief time during school to find your job for the next 30 years, and with rare exception it can be diffucult to jump between specialties once a certain investment has been made in your training. The same can be said for some that select surgery based on their positive (or negative) experiences during medical school without considering the lifelong sacrifice of a normal lifestyle with predictable hours,etc. I've had talks with a number of MD's in private practice who say in private that they would never do it again had they knwo what they know now. Managed care & the hassles a/w it have contributed in no small part, but I think the stress & workload are just not appreciated by a lot of people. I grew up in a household where my father was a surgeon (as was his father & grandfather) & I feel like I have a better feel for this than most. To me residency has been exactly what I expected & I love what I do