Help! Can't decide between my top 3!!

[quideam]

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I know there are a billion threads just like this one circulating around, but I would really appreciate any input; I think i'm losing my mind trying to decide 😀 ! this is for emergency medicine, and my interests are international EM and ultrasound, and I'm definitely looking for that 'hard-core, knife&gun club, county' experience.

Program #1: Very strong national reputation, great didactics, and amazing clinical experience. But I hate the city, and it's also all the way across the country from friends/family. They're strong in ultrasound, but limited opportunities for international electives (but there is still some room for it).

Program #2: Slightly less known nationally, but only by a thin margin; a little less competitive than #1, but probably just due to location. For me, however, the location is Great - near friends/family and I love the city. My only hesitation location-wise is that maybe it's good to move around more (i'm nearby for med school too)? But then, i've lived abroad quite a bit and feel i have that 'perspective' that living in different places gives you... Also strong in ultrasound, and with better international opportunities. Didactics are ok, clinical experience just as amazing as #1.

Program #3: About as well known as #1, but smaller - smaller hospital, fewer EM residents, smaller volume. Knife&gun club just like the other two but just on a smaller scale. Wonderful location! (I don't know anyone there, but would be willing to move because it's in a great place). Good didactics, good clinically.

Basically, I guess my problem is that while I feel that #1 is a little stronger as a program - more polished, a little better known, etc - I don't like the location (but other people love the location - I think that's whats giving me pause). It probably will make absolutely no difference in the long run where I go - all three programs have excellent reps for putting out 'hardcore' EM docs, and people go into academics and great fellowships all the time. On the other hand, I also don't want to box myself into a particular location... unless I love the location? Is this a bad thing??

What to do?? Thank you in advance!!

 

[dragonfly99]

Don't go somewhere that you don't want to live.

Also, if a place says they don't really have formal electives abroad set up but that you could still do it, sometimes it doesn't work out that way. If they have some formal program(s) set up, that more residents take advantage of, then it will probably be less of scheduling issue to get one set up. at least that's how it works in IM...perhaps it's less of a problem in ER to have someone gone for a couple of months...

 

[quideam]

Good point. With program #1, it's not that they don't have electives set up (i don't care about setting them up myself, at EM programs it's generally not an issue). The problem is that with funding issues, they can't allow residents to go outside their system for electives - no going to other states or countries. So I'd have to use my vacation time (ugh!). Programs #2 and #3 would both allow me to use elective time to go (and even encourage it).

 

[LadyGrey]

I heard a similar story from a program, quideam-- everything had to be in system, so while they might be able to let you go away for an elective, you'd have to forfeit your salary for that month. Dunno if that's better or worse than using your vacation time... but certainly not great either way.

Combined with hating the city, I'd rank that third. So your list should be 2,3,1. There, another person's rank list problems solved. 😀 This is sooo much easier than dealing with my own.

 

[diosa428]

I agree with 2, 3, 1. I chose to go to med school away from friends and family and didn't think it would matter much, and it turned out being a pain. I miss home and I miss my friends and I miss being in the northeast... I can't just go home for the weekend because a plane ticket is too expensive for a weekend trip and it takes 12 hours to drive. When I go home for holidays, again driving takes forever and a plane ticket is expensive (and I don't have a car, which makes it difficult to see friends). Now add to this the fact that you're going to be in residency, which means that a "holiday" for you *might* be a day if you're lucky. Do you really want to be far away from home, at a program that wasn't even your favorite, just for a slightly more well-known name? Also, I think that it's often beneficial to train somewhere you want to end up so that you make connections in the area, etc.

FWIW, I also don't like the city that I'm in... I have every intention of going home ASAP.

 

[Doctor Bob]

The consensus seems to put programs 2 and 3 at the top. To me it seems that some of the decision may come down to the type of learner that you are.

Program 2: with the larger volume and poorer didactics you'll be learning more by hands on patient interaction. But with higher volume tends to come less time for the attendings to explain things to you. So you'll have to do more self-study after hours.

Program 3: with smaller volume you see less patients during the course of your residency, but have more time to discuss the ones you do see in depth. Plus improved didactics means more structure to the learning process.

There's no right answer. It comes down to personal preference. At the end of the day (or at the end of residency, whichever you prefer) you'll reach the same point regardless of which program you choose.

 

[LadyGrey]

Didactics are something that I've found hard to compare across programs, though I guess if you did aways at these places you'd have a decent idea whether it's good or just okay.

You mentioned that 3 is smaller... this may or may not apply to you, so ignore if it doesn't, but if there's any chance you might want to have a kid during residency, I've been told that it's less of a problem for other people at a bigger program. (Again, not assuming anything either way, just something that a female resident offered to me as friendly advice that I'm passing along in the same spirit).

 

[quideam]

Thanks for all the advice guys! Just to add a little more to this - i guess it's not that I hate the city for program #1 so much, but just nervous about moving all the way across the country for a somewhat "better" program. I like where I live now, but I guess i'm also open to living somehwere else for a while.... i don't know, whenever I change my ROL, i keep wishing I could change it again! And then when I do, I just change it back... I just don't know how to make this decision.

 

[DarthNeurology]

I know there are a billion threads just like this one circulating around, but I would really appreciate any input; I think i'm losing my mind trying to decide 😀 ! this is for emergency medicine, and my interests are international EM and ultrasound, and I'm definitely looking for that 'hard-core, knife&gun club, county' experience.

Program #1: Very strong national reputation, great didactics, and amazing clinical experience. But I hate the city, and it's also all the way across the country from friends/family. They're strong in ultrasound, but limited opportunities for international electives (but there is still some room for it).

Program #2: Slightly less known nationally, but only by a thin margin; a little less competitive than #1, but probably just due to location. For me, however, the location is Great - near friends/family and I love the city. My only hesitation location-wise is that maybe it's good to move around more (i'm nearby for med school too)? But then, i've lived abroad quite a bit and feel i have that 'perspective' that living in different places gives you... Also strong in ultrasound, and with better international opportunities. Didactics are ok, clinical experience just as amazing as #1.

Program #3: About as well known as #1, but smaller - smaller hospital, fewer EM residents, smaller volume. Knife&gun club just like the other two but just on a smaller scale. Wonderful location! (I don't know anyone there, but would be willing to move because it's in a great place). Good didactics, good clinically.

Basically, I guess my problem is that while I feel that #1 is a little stronger as a program - more polished, a little better known, etc - I don't like the location (but other people love the location - I think that's whats giving me pause). It probably will make absolutely no difference in the long run where I go - all three programs have excellent reps for putting out 'hardcore' EM docs, and people go into academics and great fellowships all the time. On the other hand, I also don't want to box myself into a particular location... unless I love the location? Is this a bad thing??

What to do?? Thank you in advance!!

I would go with 2,3,1. Residency is tough, you will cherish your golden weekend as time to do normal people things like go to the mall or shop or to the beach or whatever. For you, to have your golden weekends in a city you hate! Would be awful. I would go with 2 first as it takes a while to get new friends *outside of medicine*, and having family close by for holidays (of which there are a lot in 3-4 years) takes logstical pain out of the equation. Location, location, location, especially if the training you get at number 1 is only marginally better . . .

 

[quideam]

Thanks everyone - wise advice all around. I'm ranking them 2, 3, 1! LadyGrey, perhaps i'll see you next year 😉

 

[John Deere Gree]

Just follow your heart. That's what I do.

 

[LadyGrey]

Awesome, quid.