Help with ROL!!!

[BatmanMD]

I got an easy question for everyone. I did a rotation in a hospital and I really liked the program, people, and everything clicked. The location was great, the worse thing about the program was they do 18-20 12 hour shifts/month. This is in a busy ED. Not much time for studying when you get home b/c you are exhausted. I told them I really liked it there and would like to be there next year, i.e. #1 on ROL.

I went on interviews a found another program, very similar. Everything clicked, the people, program, but the location is a little farther from where I want. THis program is a little slower, so I would have more time for reading. (might just be wishful thinking...).

Now the problem is that I think the other program would fit better with me, but I cannot tell, just from 1 visit. I cannot do a repeat visit, due to distance and lack of time. I know what the first ED is like. This has to be a common problem. If I rank the other program #1, should I send an email to the PD's secretary saying that I "enjoyed my month and will continue to rank them HIGH" or what is the best way to do this? I don't want to burn any bridges.

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[Doczilla]

Hmmmmm... Better the devil you know, Batman?

It sounds like you've decided that the program that's a little farther away might fit you better. Another way of putting that is, if they were both in the same city where you wanted to live, which would you rank?

By "farther away" I assume you mean farther away from family. Certainly if a family member is chronically ill or you are the sole support system for an otherwise healthy but lonely family member, that is a big consideration, especially if it would cause you so much worry to be so far away and have to keep travelling. It's only 3 or 4 years, though, and you can probably stomach the extra distance for that long.

If it's just farther away from areas that you are familiar with, then I'd say go for the place that fits you best, which sounds like this program where you interviewed (not rotated). You say you don't know it very well. Were there any red flags at the interview? Residents looking uneasy when asked about life in the city or in the program? Hideous board pass rates? Big faculty turnover?

No time for reading is a concern if the residents are having a hard time passing the boards, but many programs stress bedside teaching with the intent of helping you pass without as much reading. If you think you'll be exhausted all the time, how will you enjoy the city you're living in?

You will likely find a way to be happy in whatever program you match with, and you sound like you might be happy with either of these two programs. Go with your gut on this. Whichever way it works out, you'll do well.


'zilla

 

[DrQuinn]

Doczilla has good advice. Heed it well. Ever dance with the devil in the pale moonlight?

Anywyas, regarding the one program with 18-20 12 hour shifts. That's maybe slightly above average for most EM residencies. I've even heard of programs that have 23-24 12s for PGY1s. At USF, we do about 21-22 12s with a few 8s and 10s as a PGY-1. Its not a tough month but definately a strong learning month.

When i was a 3rd year on very slack rotations, I would feel guilty, especially since I was paying for it out of my own pocket (and collecting interest). I told myself I would work as hard as I could in residency. Now that I'm halfway through, I'm glad I didn't pick a program that had only "nine three hour shifts" or some crazy low number. I do think there's a point where having a super easy rotation in the ED is counter productive for education.

I think our program's hours is just about right. Obviously I would love having 5 more days off a month but this is residency and I'm cool with whatever education my PD and the RRC has set up for me.

Q

 

[southerndoc]

How can you do 23-24 12-hour shifts when RRC requirements limit you to 60 hours in the ED? Most programs have 4-week months (28 days). Even at 30 day months, 23-24 12-hour shifts will exceed the 60-hour workweek limit.

We work 18 12-hour shifts. We stay busy, but I'm glad we do. I've learned to see patients and document efficiently.

 

[BatmanMD]

Yeah, zilla, location matters b/c of family. Got 2 kids, not married. The mom and I get along pretty well. She understands that I don't have the typical 9-5 week, and I get to see them whenever I want. One program is 1 hour away, the other is 4 hours away from them.

The pass rates are great for the program 4 hours away. The other program is still pretty good, but not as strong. I would be happy at either place, but I remember telling the first program, rank #1, now I'm just not so sure. I don't know whether to tell them "im ranking you very high" or just see what happens. I got to be friends with a couple residents and attendings there during my month, thus the burning my bridges thing-it may be a great place to work later on.

Batman really kicks a$$. Can't get enough of justice league, very cool show. Always liked him, except the last 2 movies.

 

[kungfufishing]

dont worry about whether or not you told them you would rank them highly. Theyve done this before and know that verbal commitments in the match, from either side, dont mean too much. Rank how your gut tells you to.

 

[Scrubbs]

dont worry about whether or not you told them you would rank them highly. Theyve done this before and know that verbal commitments in the match, from either side, dont mean too much. Rank how your gut tells you to.

Ditto what the fish said... You can still tell the first program you're ranking them very highly and put them second - or even third! My ROL had 11 programs on it... top 3 was VERY HIGH .

 

[Homunculus]

Rank how your gut tells you to.

wise words from an experienced ROL'er. i doubt anyone fretted over their ROL more than he. i know, i witnessed it first hand-- truly frightening

his kungfu is strong, but mine is stronger.

don't outsmart the match. rank your **** then let it go. just getting it over with and turned in will help you more than anything. in the end you'll be just as well trained as most other people and will likely have plenty of connections to get whatever you need (from what i've heard, the EM world is still fairly small and interconnected-- not yet inbred like some IM places, but small enough that everyone knows someone that knows someone)

--your friendly neighborhood getting snowed on in DC caveman

 

[BatmanMD]

Thanks everyone who responded. I pretty much knew what the answer would be before I posted the thread, but wanted others opinions, just in case.

Best of Luck to everyone this year. Hopefully everyone finds a home.

 

[bartleby]

First of all, you are under no obligation to make any kind of promises about where you are ranking a program. All you have to write in your thank you note is that you liked the place and appreciated their time. My PD says all the time that talk is cheap, and I tend to agree. As far as a PD is concerned, there's nothing to keep you from saying that to every program that interviews you...

If you really like a place and want to make an impression on them, go back for a second look. It shows that you're taking the initiative to try to make an impression and to get to know your future co-workers.

Hours are hours, but a more valuable measure of the intensity and quality of the experience in a shift in the ED is average number of patients seen per shift in each year. There are plenty of places with no ancillary staff where you see 5 patients in a shift and that only goes up to 7 as a PGY 3. That means that there are scut and systems issues which are constraining you. Having said that, there are programs which do 8's, 9's or 10's and the residents start out seeing 6 to 8 per shift and wind up seeing 12-20 as seniors. Why are the numbers higher? Less scut and better ancillary support. Which is going to be higher yield for you as a resident? I don't think there's much debate about that... And you are going to need to get used to that pace of work if you don't want to get chomped when you get your first job.

The trend by far even in jobs in the community is to do 8 to 10 hour shifts, with 12's being the minority of shifts. Doing lots of 12's is draining and is not the kind of scheduling you're going to want to sustain over a 30 year career.

So the bottom line is that you should play it close to the vest, get a little more information about your programs, and pick what you think will make you happy. 3-4 years is too long to be miserable, particularly if you have a family.

 

[ChrisEM]

When is a good time to do a second look? Is anytime before feb 23rd good, or do some programs get their list in sooner than that?

 

[Syd Barrett]

To ChrisEM,

Regarding your second look, if your goal is to make an impression, then yes, Feb. 23rd is too late. At my program, our selection committee meets on Feb. 8 (or close to that date), we finalize our list, and our program director submits the list shortly after this.

Personally, our program does not encourage second looks. In fact, we have a policy (much like Indiana and some other programs) where we don't communicate with the applicants after the interview, as a means of taking the pressure off. However, I am aware that some programs DO base their rank lists on applicant interest ("If you really like us, come back and do a second look..."). I think that this is complete BS (extra time and money which applicants do not have). Our program ALLOWS second looks (shadowing, conference, journal club), but we want the applicant to do it only because he or she will be better equipped to make a final decision on our program.

Batman - you've received great advice on this thread. As for verbal/written commitments.....I can only speak for my program, but we do not move people up on our list because they wrote us a love letter. And on the flipside...a good friend of mine was ranked in our top ten last year. He told me and my colleagues that he would be ranking us #1. He ended up elsewhere. While some of my colleagues were a little miffed (only for a day or so), I was not. He changed his mind (he told me AFTER match) and he had his reasons. It's his business, not mine, and I respect that. I think it's really sad when residents and program directors get hung up on what applicants tell them....this obviates the true purpose of THE MATCH.

Barteby - you make a phenomenal point. The question is, at which program will you see the most patients per shift? It's all about the ancillary staff. Our ancillary staff is great, but I still work unbelievably hard while I'm there as we are expected to see between 15-25 patients per 10 hour shift. At my program, speed and efficiency is a big part of how we are evaluated and it is quite possibly the #1 thing that you will be evaluated on as an estabilished EP in the community, so keep that in mind as you make your decision.

Best of luck everyone!

Syd Barrett
Emergency Medicine PGY-2
Advocate Christ Medical Center