How competitive, EM at Harvard JHU UPenn etc...

Discussion in 'Emergency Medicine' started by cbc, Mar 21, 2004.

  1. cbc

    cbc Senior Member
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    Please do not scold me for putting this up. I am just *wondering.* Let's say one is interested in doing academia in the future and want to go to top academic programs like Harvard or JHU for residency. What kind of Step1 and grades must one have to interview and match? What are the important components they look for in an applicant?

    Are UCSF and Stanford and UCLA considered as these top EM academic programs? If so, what are the stats to go to those places.

    I searched but didnt find anything regarding this specific topic.
     
  2. EMIMG

    EMIMG Senior Member
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    You can go into academics from any program. Perhaps hitting one of the lesser known programs and trying to start research and other things and getting involved and maybe being the big fish at a program like this rather than a little fish at a larger program will serve you better.

    Also, you may have a better shot doing a standard 3 year program and then doing a fellowship in any given topic.

    Yes, some programs are entrenched with history and some do more research than others; however, you may look better by doing more research at a little program and elevating their status.
     
  3. aliraja

    aliraja Troublemaker
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    You're not going to get scolded - it's a good question. :)

    Academic EM is very different from academic medicine in other fields. Due to the youth of our specialty, the more "conventional" research-heavy medical centers aren't the hotbeds that you might think that they are. MGH/BWH, JHU, Duke (my home school), UCSF, Wash U, etc... were all forced to develop EM departments late in the game due to the strength of either Medicine, Surgery, or both. These "mainstream" Departments wanted to hold on (understandably, since it's a fertile training ground) to their control of the ED. That's why Duke's program is only three years old and UCSF still hasn't managed to start one up (although it's in the works). These newer programs (all mostly Divisions of Medicine or Surgery rather than independant Departments) are all going to do exceptionally well, but they haven't been able to focus as much on research since they've had to deal with more startup issues (funding, recruitment, reputation-building, etc...)

    More and more programs in EM are getting into research and you can, honestly, go into most any program and do top-quality work. If you're really interested, your best bet is to read the top EM journals and look at the SAEM and ACEP presentation schedules and see for yourself where the kind of research that you want to do is being done.

    IMHO, the top research programs are still the juggernauts that have always been there: Cinci, Denver, Pitt, OHSU, Highland (esp. for a community ED), etc... they just have the support networks in place to make it easy to do the work. Again though - ANY program is going to be able to help you do the work.

    As for Board scores, etc... read through some of the FAQs (Yay Quinn!!) and older threads. I think the general consensus you'll get is to apply everywhere you want to go, regardless of your scores. It's a crapshoot anyway so why not pay the extra seven bucks per application?
     
  4. SewerRat

    SewerRat Member
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    Agree with all of the above. Other things to think about... academic EM is a pretty competitive market. Older more competitive programs (i.e. Cinci, Denver, Pitt, Hennepin, OHSU, Harbor-UCLA) tend to have greater networks of alumni and "legendary" graduates who may help out.

    Also, those emergency programs listed above with strong medicine and surgery programs definately will get better in the future. But it may be a long time in coming, especially because the big-shot medicine and surgery programs at these institutions are going protect their turf at all costs. Not to spread rumors but one of my buddies who matched UCSF for medicine said that the RD there told him that emergency medicine will start there "over his dead body". Yikes.
     
  5. cbc

    cbc Senior Member
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    Thank you all for contributing and writing me PMs as well. That was quite helpful.

    EMIMG, thank you for your input, but I'd have to say, that is probably one of the least popular opinions regarding academic medicine. I understand your point of being the big fish in small pond analogy. However, one must remember, first the fish needs to grow big, and second if not enough resources are in the pond the big fish will die. What I am trying to say is, first doing residency at an top research academic institution allows the resident to learn from the best researchers and have available all the funding and data/labwares around. Second, doing research at ie Kern medical center will be difficult to collaborate with other strong research faculty/dept, plus difficult to convince private sectors to grant funding compared to ie johns hopkins due to availability of patient pop/research history. Also, expansion of labs at Kern county is just not possible, whereas at hopkins the sky's the limit (one can own 2 floors of labs).

    Anyway, I think doing residency where I can learn research from the best researchers would be ideal, since I need to become a big fish first. When/if I become a big fish, whether I choose the small pond or big pond, that would be a long while to decide.

    Thanks for your opinion though. Hope everybody else keep their support flowing.

     
  6. cbc

    cbc Senior Member
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    Okay, this is what I don't understand. I am certain that UCSF medical center has a ER. Who the heck works there? If one comes in with a trauma, IM or surgery docs take care of them?

    Also, why would having a ED undermine the internal med dept? Wouldnt adding more depts only make the entire medical center stronger?
     
  7. Seaglass

    Seaglass Quantum Member
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    #1. There's only so much $$ to go around.
    #2. There may be a concern that the EM residents will "steal" the good procedures like LP's, thoracentesis, etc.
    #3. There may be a concern that the EM residents will "steal" valuable learning experiences like the workup of "I'm so hungry" or "I can't get it up."
    #4. There may be a concern that the ED attendings will be teaching IM residents when they are in the ED and that those residents will come back talking about triple A's and antrax when they should only be thinking of SIADH like good boys and girls.

    Seriously though, there is a lot of overlap between some aspects of EM and IM (except that we also do peds, ob, gyn, etc.) that concern is warranted, if not reasonable.

    C
     
  8. aliraja

    aliraja Troublemaker
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    :laugh:

    As for the UCSF residents, currently both Highland (the only EM residency in the bay area) and Stanford EM residents rotate through the UCSF ED (also, SF General and a few other hospitals around there). UCSF offers a really unique perspective for both of them (Highland is way County and Stanford is way country club private).

    Also, it's important to remember that there's a TON of residents at UCSF - just no EM residents. The IM and surgery folks love the learning that their residents get at the expense of an EM program.
     
  9. cbc

    cbc Senior Member
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    So is it safe to assume that hemorrhaging patients coming in the ER dept of UCSF are taken care of by IM docs? What about other ER hospitals like...Kaiser ER or other generic ER medical centers etc, are they taken care of usually by specialized EM docs or IM docs?
     
  10. Pelivar

    Pelivar Brain donor
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    Your a little confused CBC. UCSF has EM attendings working in the ED who see all of the ED pts that come in. The other posters were only talking about residents. They don't have an EM residency so that their surgery and IM residents can work in the ED, but the work under EM attendings. At Kaiser ED or generic community ED, they are mostly staffed by board certified EM docs. Some rural or poor hospitals are staffed by docs trained in other specialties, but this is becoming rarer. Hope that clarifies things a bit.

    -P
     
  11. Koschei

    Koschei Junior Member
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    newbie here

    does anyone have relative scores and numbers needed to get into say Cinci or Denver vs. Stanford or Hopkins? I heard that some of the big name hospitals with new ER programs are a little easier to match at.
     
  12. The White Coat Investor

    The White Coat Investor Practicing Doc and Blogger
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    While you HAVE to have at least 238 on Step I to get into Denver, you only need a 233 to get into Stanford. I know that for a FACT!
     
  13. southerndoc

    southerndoc life is good
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    Hey! How come I didn't get an interview at Denver or Stanford with my 246?

    Oh wait, I didn't apply there.

    Carry on...
     
  14. Pelivar

    Pelivar Brain donor
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    EM doesn't use scores and numbers as much as other specialties like medicine. LOR's and EM grades are more important. Read the paper on the SAEM.org webpage about EM selection criteria. There are probably people at Denver with a range of Step 1 and 2 scores, so there is no answer to your question.

    But if you have a at least a 238 than they are required to offer you a position and with a 246 they are required to kisss your a$$.

    -P
     
  15. NinerNiner999

    NinerNiner999 Senior Member
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    I heard that a score of 250+ will allow you to command a HUGE signing bonus with Denver and they will even pay off your student loans. Cincinatti gives you your own parking spot and Limo service during each weekend if you are above 255. On the flipside, if you are below 220 they expect you to drive the limo (if they even interview you at all).

    Seriously - board scores are a VERY SMALL portion of the overall application. Have fun and be a well-rounded people person - remember the ED patient population. Medicine is full of people who know how to read and take tests but cannot talk their way out of a paper bag. Make yourself stand out and don't focus on the numbers ;)
     
  16. kungfufishing

    kungfufishing Senior Member
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    I only had the comlex, and ended up pulling the ric-sha for the other applicants during my interview days.
     
  17. Homunculus

    Homunculus SDN Caveman Administrator
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    all those days spent at the gym finally paid off.
     
  18. tonem

    tonem Senior Member
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    When did they move Palo Alto out of the Bay Area?
     
  19. cbc

    cbc Senior Member
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    Also, in EM subspecialties such as ultrasound and sports med, do subspecialist earn more? Or would subspecializing be strictly an intellectual/clinical purpose? If there is a salary increase, how much on average is observed? This is not my primary concern regarding EM, but internet discussion forums seem to be the only place I can find an answer to this question, and so I ask it here. Thank you.
     
  20. Pelivar

    Pelivar Brain donor
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    This has been discussed in recent threads, so you might want to do a search. Sports med docs often earn less than ER docs. Ultrasound can earn you a little more money, but that is very variable. Also, a couple experts in the feild told me that they think once U/S gets more popular and routine the advantages of being fellowship trained will be less. So moslty the fellowships are for intellectual reasons and to get academic positions. But the nice part is that most EM fellowships are only 1-2 years.

    -P
     
  21. peksi

    peksi Senior Member
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    Ok, here is my two sense. My general feeling is that the market for EM Ultrasound Fellowship trained physicians is not just in academia, but actually in community EDs. This is where the level of expertise to use this technology is truely needed.

    There have been several recent graduats of fellowships who have now landed very well paying positions in difficult to enter private groups because they bring this true high level of expertise to the group. Once again, in most small to mid size groups almost everyone has some administrative position. The role of the ED Ultrasound Director will not likely end with academia as it is already transitioning to private community ED practice.

    I can tell you as an ED US Fellowship Director I often get cold calls from groups interested in our graduates plans for post graduate postions (aka academia/private practice)


    Paul
     
  22. southerndoc

    southerndoc life is good
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    If a private group recruits someone fellowship trained in ultrasound, wouldn't he/she be able to teach/certify the other physicians to use the ultrasound machine?
     
  23. Apollyon

    Apollyon Screw the GST
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    Our Res Director and one of the faculty (who did an U/S fellowship) are "Level 3" ultrasonographers. After you've had the class, you're a "Level 1", and you move up by doing a certain number of scans of certain body areas after being trained on that area. The Level 3's supervise, and that's how you advance (or, that's what we were told).

    So, in a word, yes.
     
  24. southerndoc

    southerndoc life is good
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    That's what I thought. So it would definitely make you a very competitive candidate for a position.
     
  25. cbc

    cbc Senior Member
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    Hi. Thank you for those who contributed. The responses are great, but still dont answer, do ultrasound subspecialists actually get paid more, or do they just have less problems landing a job?
     
  26. peksi

    peksi Senior Member
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    For the Dollars Issue. We have a survey comming out in SAEM this May that discusses salary and job description for academic EM US Directors. Do to academic publishing requirments I really cannot say more than that, you will have your answer about the academic side in about 2 months. However realize that there are still only a handful of EM US fellowship trained physicians in the country 8 as of now, this will be about 20-25 as of this July.

    Paul
     

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