Free standing EM programs vs. EM under various departments

[AP MD 05]

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I'm a fourth year med student in the process of applying for EM. I recently joined this forum and have found a ton of useful and encouraging info. I just recently started researching programs and looking into which ones to apply to and how many.
My question is how do free standing EM programs differ from when the dept of EM is under the dept of surgery or under the dept of IM?
Are free standing EM programs better? ...more competitive? ...Is this an important factor to consider when applying?
Is there a list of which programs are free standing depts and which ones are under the dept of surgery or dept of IM?

I'm looking at applying ~50. This seems like a lot but my
Step I is below avg. (in the 200-210),
My grades are decent, rank is in the top 1/3
Still awaiting grade and letters of rec. from fourth year EM rotation done in Aug.
I'm going to take Step 2 at the end of Sept. in hopes of improving.
Based on my numbers does 50 seem like an overkill or reasonable?

If anyone has any input/suggestions on these questions that would be awesome.
Thanks

 

[roja]

Its not just what 'dept' an em program is under but how well established it is. One indicator is how many 'non-RRC' rotations you have to do in a program.

My program is free standing. We only do rotations that directly related to ED management. No cardiology (we do ccu) and no medicine floors (MICU x 1 mo).

Our Ob, ortho, etc are all directly related to ed. we don't do thier floor scut.

so, take a look at how the programs are structured.

Being a free standing dept usually means the program is strong and has strong political clout. However, there are well established ED programs that have maintained thier department status for history, tradition.

good luck

 

[beyond all hope]

Good example is the University of Chicago. Very strong, old program, still a division of IM. Plenty of political clout.

My program is a full department, but as a new department has less clout than some more established ones. Right now I'm on a CT-ICU rotation: very little educational value, mostly done because surgery needs bodies due to the 80 hour rule.

Also the personal power of the PD/Chairman matters a lot. Goldfrank at Bellevue, etc.

 

[southerndoc]

As a general rule, departmental status is granted by medical schools when a division gets so many faculty members, publishes a certain amount of research annually, has a budget that justifies departmental status (e.g., it's getting equal to the previous department's budget), etc.

Keep in mind that many places have departmental status within the hospital, but not within the medical school. Being a department of the medical school affiliated with a particular hospital usually means more faculty, research, teaching etc.

So, as a general rule, departments are probably better because they've usually had to "earn" department status and usually have to produce so much research to maintain that. Having said that, the rules vary by institution. Being a department in one institution might be an easy thing to accomplish, but might take an extrodinary feat to accomplish at another institution.

We are trying to get department status, and I have to admit, the requirements are enormous.

 

[DrQuinn]

My program is new, so we are part of the Division of Internal Medicine. But anytime we've had a problem (with rotation schedules, requirements of a rotation) and we've brought it up to our PD, the problem is fixed almost immediately. In TGH, we are our own Department and the ED carries a lot of clout throughout our 900 bed hospital.

Even though our program is in our second year, we are greatly respected by all the off-service rotations, and a lot of them say we are probably the strongest residents in the hospital.
Q

 

[AP MD 05]

thanks for the input.
I was just concerned about departmental status because I had heard some programs have no autonomy. i don't know which programs but i heard there's a few programs where even the airway (ie intubation), anesthesia comes down to manage. i really don't know if that's true or not, just something i had heard from previous fourth year students.

 

[Seaglass]

I was just concerned about departmental status because I had heard some programs have no autonomy. i don't know which programs but i heard there's a few programs where even the airway (ie intubation), anesthesia comes down to manage.

IMHO this is more of an "older program vs. newer program" type of issue. Even so, most new programs realize that these battles have to be fought and won before residents ever show up. In my experience the older programs I interviewed at had well defined and appropriate roles for their residents with regard to the things that matter (airway, trauma, codes, etc) without friction from the other services. The newer programs were always like "Yeah, we're working on that" or "We're moving towards such-and-such." Of course I'm at one of the oldest programs in the country now so you can see how I felt about all that.

That is not to say that newer programs can't have a good handle on this type of thing, just my opinion. Apollyon and Quinn could probably give a good synopsis of how things are evolving with their new programs.

C

 

[FoughtFyr]

The newer programs were always like "Yeah, we're working on that" or "We're moving towards such-and-such." Of course I'm at one of the oldest programs in the country now so you can see how I felt about all that.

That is not to say that newer programs can't have a good handle on this type of thing, just my opinion. Apollyon and Quinn could probably give a good synopsis of how things are evolving with their new programs.

C

I'm at a relatively new program - Mayo; traditionally a surgery and IM "powerhouse" institution, and we have none of these problems. We are a separate department and I really don't know about our political clout within the institution. Our response to trauma (and we get lots) is shared with the trauma surgery folks with the specific responsibilities rotating on an odd/even day basis but we always have the airway. As far non-RRC rotations, we have only one, that is a combined month of reading EKGs institution wide 3 mornings a week and being on the psych service's call rotation covering the ED. We have that month at the continuing request of the EM residents. It is not scut - each of our reads is reread by an attending, but a way to really hone your EKG skills. As for the psych part, it is ED coverage only, so that is also fine. Codes here a run by the services on the floor/area where it occurs (we have 1150 beds and 53 ORs - it would be difficult to cover that from the ED), but if an EM resident is present on that team (e.g., SICU month), they can operate with autonomy.

I think the only difference between here and the other places I interviewed is that many places contended that their residents were widely regarded as the "best in the hospital". While I think that our department considers us to be the best, I think that every program here believes that of "their" residents. No one is widely regarded as the "best in the house". But that is o.k., everyone here is really driven to learn, teach, and perform. It really is fun!

- H

 

[Sessamoid]

I think the only difference between here and the other places I interviewed is that many places contended that their residents were widely regarded as the "best in the hospital". While I think that our department considers us to be the best, I think that every program here believes that of "their" residents. No one is widely regarded as the "best in the house". But that is o.k., everyone here is really driven to learn, teach, and perform. It really is fun!

- H

Sounds nice, but it's still too cold. If only they had a program in Scottsdale!

 

[FoughtFyr]

Sounds nice, but it's still too cold. If only they had a program in Scottsdale!

The ED is a nice 70 degrees and flourescently lit year round! Tunnels connect everything to the parking garages and I have a garage at home. If it is cold there, well, I'm a newlywed, use your imagination! (And if you come up with something new and novel pm me 😀 )

 

[Sessamoid]

The ED is a nice 70 degrees and flourescently lit year round! Tunnels connect everything to the parking garages and I have a garage at home. If it is cold there, well, I'm a newlywed, use your imagination! (And if you come up with something new and novel pm me 😀 )

My house is pretty much 70 and sunlit year round. You become a real weather wuss when you live in LA, especially the beach towns. People here complain when it gets below 60 or above 80. It's above 80 here the last few days in the beach towns and there's no end of complaining. 🙂

When we get to the middle of the winter the highs will probably dip down near 70. Pretty chilly, huh? 🙂

 

[roja]

My house is pretty much 70 and sunlit year round. You become a real weather wuss when you live in LA, especially the beach towns. People here complain when it gets below 60 or above 80. It's above 80 here the last few days in the beach towns and there's no end of complaining. 🙂

When we get to the middle of the winter the highs will probably dip down near 70. Pretty chilly, huh? 🙂

Yes, but you have to live in LA. 😀

 

[Sessamoid]

Yes, but you have to live in LA. 😀

Actually, I was afraid about that, as I had a bias from formerly being an SF resident. Turns out I quite like the place. My mood varies pretty directly with the weather, so I'm an amazingly happier person here in LA than I was in Florida. Especially this month.