geographic restrictions/places to apply

[emletters]

Hey guys, been a big help thus far and wanted to see if I could get a little more advice.

Trying to make a list of places I'd potentially apply to in the upcoming cycle, and really am having a hard time narrowing it down. I'm in a major city in the NE, and really don't have any desire to stay here anymore, but I feel like my school's name really only opens doors in this region. I'm fine staying in the NE, just tired of the city I'm in. Also, if possible, I'd really like to branch out and explore the midwest and north central portions of the country, in addition to randos here and there like denver or OHSU (no desire to be in cali or the southwest). But I'm not sure how receptive these places would be to an average applicant (or slightly below average) who has no ties to the area.

It's hard to ask my PD for advice because I feel like I'd be shooting myself in the foot by telling him I don't want to be in this area anymore or his program.

Finally (I know it's a lot of questions), I don't understand how to decide which places to apply to without knowing some kind of ranking of the programs in regards to competitiveness. EM isn't like other specialties where Ivy Leagues are always kind. Any thoughts are appreciated. Good luck to all who are working on their rotations right now!

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[mmmnmmm]

I had the same questions when I was applying last year. I think what really helped me figure out how to choose where to apply and rank places on my rank list was to think about what kind of environment you see yourself working in. High volume inner city trauma center? Medium volume academic powerhouse? Slower community hospital seeing more bread and butter? Some permutation of the above? It doesn't make much sense to train at a completely different practice environment than you think you will end up in.

Though it might be too late for this cycle, it might be good to do an away in a new spot you think you might be interested in. After living there for a month you'll have a better idea of whether you want to stay there for 3-4 years.

Competitiveness isn't too hard to suss out. Location is the number one determining factor of where people apply for residency. Desirable locations probably aren't going to surprise you: big cities are more competitive than suburbs or more rural areas, and people tend to prefer the northeast and west coast. Add in the big name EM programs -- an area of constant contention on this forum, but the doximity ranking for EM residencies sorted by reputation will give you a very rough idea of some of the bigger names-- and these two variables are what makes for a more competitive residency to get into. But competitiveness doesn't have that much bearing on the training you will receive. You can take solace in knowing that like 90% of EM programs will give you excellent training to practice as an EM doc.

Personally speaking, I was able to get interviews in parts of the country I had no connection to. I think at this point in the game, the best thing you can do is try to crush it on your EM rotations. A candidate with strong SLOEs will be sought after regardless of their geographical background.

 

[WildcatS11]

Hey guys, been a big help thus far and wanted to see if I could get a little more advice.

Trying to make a list of places I'd potentially apply to in the upcoming cycle, and really am having a hard time narrowing it down. I'm in a major city in the NE, and really don't have any desire to stay here anymore, but I feel like my school's name really only opens doors in this region. I'm fine staying in the NE, just tired of the city I'm in. Also, if possible, I'd really like to branch out and explore the midwest and north central portions of the country, in addition to randos here and there like denver or OHSU (no desire to be in cali or the southwest). But I'm not sure how receptive these places would be to an average applicant (or slightly below average) who has no ties to the area.

It's hard to ask my PD for advice because I feel like I'd be shooting myself in the foot by telling him I don't want to be in this area anymore or his program.

Finally (I know it's a lot of questions), I don't understand how to decide which places to apply to without knowing some kind of ranking of the programs in regards to competitiveness. EM isn't like other specialties where Ivy Leagues are always kind. Any thoughts are appreciated. Good luck to all who are working on their rotations right now!

I totally see why you think this, but this is the completely wrong attitude. Honesty (with a touch of gamesmanship) is the best policy. Whether it’s a PD or another faculty member - you need to ask this question of someone who knows you, knows your file, and can give straight up honest advice. Obviously don’t phrase this as “I want to go anywhere but here.” Try to give them your preferences. If you are a decent applicant, you will still be ranked for them, even if they know you’re not ranking them #1.

 

[TheComebacKid]

Add in the big name EM programs -- an area of constant contention on this forum, but the doximity ranking for EM residencies sorted by reputation will give you a very rough idea of some of the bigger names-- and these two variables are what makes for a more competitive residency to get into. But competitiveness doesn't have that much bearing on the training you will receive. You can take solace in knowing that like 90% of EM programs will give you excellent training to practice as an EM doc.

Overall, I find this to be a very poor tool in determining which programs are better than others. Doximity is arguable one of the worst tools to help you parse out the different programs as it's ranking progress is completely arbitrary without any objective methodology to the madness. Doximity is a social networking site for physicians. The "rankings" are to a huge extent based on how many reviews are given for a respective program. Older programs tend to be ranked higher just because there are more graduates. In fact, the process of ranking programs with Doximity is so bad that CORD has essentially taken the stance to do away with it all together.

Worthwhile reading:
Impact of Doximity Residency Rankings on Emergency Medicine Applicant Rank Lists - The Western Journal of Emergency Medicine

The arbitrary and senseless nature of prestige/ranking on this forum never ceases to amaze me.

 

[mmmnmmm]

Agree 100%. Want to clarify that I was not saying that Doximity ranking has any significant bearing on the quality of the program, merely its competitiveness. Likely in a self-fulfilling prophecy 'because it's highly ranked on doximity more people apply there' kind of way.

 

[enalli]

Aside from really well-known programs that everyone talks about, you won't really know what a program is like until you are a resident there. The next best thing is rotating there, and after that, interviewing. Pick the geographic areas that you like and apply to a mix of well-known and not-as-talked-about programs and you will come away with a few surprises after you interview. The first few programs in my rank list (and where I matched) were legitimately nowhere near my radar when I started applying. In fact, I specifically chose my first interview to be at a place that I was sure was going to be near the bottom of my rank list but I instead ended up being completely blown away by it.