How much difference does where you do residency make when job hunting?

[EMdupe2017]

Current MS4 trying to start making my rank list, made a new account for anonymity purposes. My question is this: If I want to get a community job in a difficult market like San Diego or maybe Hawaii after residency, how much difference does the perceived prestige of my residency make?

I understand that it's best to do residency in the region you think you want to end up in as there is a strong regional bias. This won't be a problem as I have plenty of southern california interviews. My question is, within regions if there is an advantage between going to a residency perceived as being more prestigious.

For my purposes more specifically, will I have an easier time getting a job in a difficult market like SD coming from one of the big 4-year programs in the area like Harbor/USC/UCLA vs a 3-year program like UC Irvine or Loma Linda?

Thanks in advance!

(Edited for clarity)

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[The White Coat Investor]

Yes. It matters. When we hire, we want the best.

So we prefer an MD residency over a DO one.
We prefer a harder to get into residency over an easy to get into one.

Why? Three reasons. First, you were a more competitive applicant pre-residency. Second, you were surrounded by more intelligent and accomplished peers for 3-4 years and that probably rubbed off. Third, you might have even gotten better training.

But there is also an element of residencies we know. We're more likely to take someone who went to a residency one of us went to or one that is close enough to us that we know their reputation. But something in New York City or Florida? We have no idea if it is any good even if it enjoys a great reputation on the East Coast.

 

[The White Coat Investor]

BTW- there are consequences to getting a job in a difficult market. Hawaii and San Diego jobs pay like crap and you pay taxes and cost of living out the wazoo.

 

[Angry Birds]

Current MS4 trying to start making my rank list, made a new account for anonymity purposes. My question is this: If I want to get a community job in a difficult market like San Diego or maybe Hawaii after residency, how much difference does the perceived prestige of my residency make? Like would I have an easier time finding a good job coming from like UCLA as compared to UC Irvine? Or will it really not matter?

Thanks in advance!

In general, it is a buyer's market. That is to say, you could do your EM residency at McDonald's and still get a job at 99% of places.

It is commonly argued that it might make a difference in a more desirable location, such as SF, LA, NYC, etc. However, I had no problem, even though I went to a non-elite residency program (although I did go to a solid university program)... I had no problem whatsoever finding jobs in two of the most highly competitive areas of the country. In fact, I had places begging me to join them.

So, I don't agree with WCI's post.

The only exception I would say is for academic positions in highly competitive cities. There it would absolutely make a difference.

Yes. It matters. When we hire, we want the best.

So we prefer an MD residency over a DO one.
We prefer a harder to get into residency over an easy to get into one.

Why? Three reasons. First, you were a more competitive applicant pre-residency. Second, you were surrounded by more intelligent and accomplished peers for 3-4 years and that probably rubbed off. Third, you might have even gotten better training.

But there is also an element of residencies we know. We're more likely to take someone who went to a residency one of us went to or one that is close enough to us that we know their reputation. But something in New York City or Florida? We have no idea if it is any good even if it enjoys a great reputation on the East Coast.

Sorry to say, but this is a horrible hiring strategy. The "smartest" medical student and resident isn't necessarily the best one to work with. This is elitism at its worst in fact.

 

[EMdupe2017]

BTW- there are consequences to getting a job in a difficult market. Hawaii and San Diego jobs pay like crap and you pay taxes and cost of living out the wazoo.

Thanks so much for the response! As a follow up, how bout within MD residencies in the same geographic region? I'm just wondering if I'm going to handicap myself by trying to go to a less prestigious 3-year program like UC Irvine or Loma Linda vs some of the 4-year more "powerhouse" type programs like Harbor/USC/UCLA?

And yes, I know those drawbacks are very real, but am somewhat tied to the areas due to family/personal reasons.

 

[Vandalia]

But there is also an element of residencies we know. We're more likely to take someone who went to a residency one of us went to or one that is close enough to us that we know their reputation. But something in New York City or Florida? We have no idea if it is any good even if it enjoys a great reputation on the East Coast.

I would second this point. As far as we are concerned, your "official" references are next to worthless. At this level, you should be able to find a few people who will say great things about you no matter your actual ability. What really matters are the people who are known to us who will give us an honest assessment of you. (This is one reason why it is an exceptionally bad idea to burn any bridges without a very good reason.) This also means that we give great weight to the programs in our region because we have those contacts. If it comes down to someone who our sources tell us will be a great hire versus someone with a great resume from an "elite" program on the coasts where we don't have that info .... we are going with the person who we know best. Part of that is on us too, since we apparently have a very good reputation as an employer, we have the ability to make those choices.

If you are absolutely certain you want to work in Arkansas for your entire career, find the best residency program within a couple of hundred miles. If you are absolutely certain you don't want to work in California, don't chose a California program. But go with the best residency program for you that you can get into. But keep in mind general categories of the "best" are meaningless. It depends on your situation, your career goals, and your personality. If your spouse is also a resident and you have a couple of kids the best choice might be close to family. If you want to do academic EM, a community program is a bad idea. If you know you want to do rural EM an academic program is probably not a good choice. If you are an introvert, a program that places a lot of emphasis on group socialization is not a good choice. And so on.

 

[Janders]

Personal opinion--
(1) "top tier" residencies do add a bit to your application. Good luck defining those. I go by the Potter Stewart Rule.
(2) Much more important, if you are known to someone I know, then I trust you are ACTUALLY good and not an axe-murderer. Such is life. So doing residency in the region/area you eventually want to work in does certainly have its advantages.

None of this is deal breaking.

 

[EMdupe2017]

Thanks for the replies everyone. I guess I should have been more specific with my question. I am a competitive applicant who has interviews at all of the southern california programs and am trying to decide how to rank them. Mainly was concerned about the difference in resume power for job hunting (as I said, ultimately would like to end up in SD, maybe orange county or Hawaii) in doing residency at one of the "top tier" 4-year programs such as Harbor/USC/UCLA vs one of the solid but less prestigious 3-year programs in the area such as UC Irvine or Loma Linda.

 

[s109442]

In general, it is a buyer's market. That is to say, you could do your EM residency at McDonald's and still get a job at 99% of places.

It is commonly argued that it might make a difference in a more desirable location, such as SF, LA, NYC, etc. However, I had no problem, even though I went to a non-elite residency program (although I did go to a solid university program)... I had no problem whatsoever finding jobs in two of the most highly competitive areas of the country. In fact, I had places begging me to join them.

So, I don't agree with WCI's post.

The only exception I would say is for academic positions in highly competitive cities. There it would absolutely make a difference.



Sorry to say, but this is a horrible hiring strategy. The "smartest" medical student and resident isn't necessarily the best one to work with. This is elitism at its worst in fact.

Agre would we would hire a kid trained in Detroit over a kid from/trained in Utah

 

[Apollyon]

Current MS4 trying to start making my rank list, made a new account for anonymity purposes. My question is this: If I want to get a community job in a difficult market like San Diego or maybe Hawaii after residency, how much difference does the perceived prestige of my residency make? Like would I have an easier time finding a good job coming from like UCLA as compared to UC Irvine? Or will it really not matter?

Thanks in advance!

Hawai'i is not a difficult market. You show up with a license, you will be working as soon as they can get you credentialed. Your pay will be in the 1st percentile, and you won't be able to buy a house, and, as stated, taxes will crush you, but you're in Hawai'i!

I tell people, after I tell them I worked in HI, that living there was great. Working there, not so much.

 

[TheComebacKid]

I think the hiring processes described in this thread are pretty toxic and counterproductive.

So if you are an LA or SF job, you are more likely to hire an applicant from a local EM program because someone you trust and know said "Hey take this guy, he's great." Meanwhile you are going to shut out someone who graduated from Carolinas because you don't know their references personally?

The downside to this mentality is that certain jobs in certain cities are completely inbred. There is no change in thought, no change in culture, no diversity. Everybody does things the "LA County" way or the "Highland" way. Not to say that's the wrong/bad way (these are phenomenal programs after all) but why not introduce someone from a somewhere new to mix things up a bit? I think the risk you take on is minimal because there are so many other great programs in the country that offer some high quality applicants.

I go to a "mid-tier" residency program in the midwest. We recently hired a bunch of new attendings from the coasts, and from other places in the midwest. I can tell you that these new attendings are some of my favorite to work with because of their different approach to things. This is compared to the attendings who were born and bred at our institution.

Disclaimer: training at midwest program want to go back to California for family reasons but probably never will get a job there because I'm going to be locked out for reasons already mentioned in this thread. Yes I'm butthurt about that.

 

[Hercules]

I think the hiring processes described in this thread are pretty toxic and counterproductive.

So if you are an LA or SF job, you are more likely to hire an applicant from a local EM program because someone you trust and know said "Hey take this guy, he's great." Meanwhile you are going to shut out someone who graduated from Carolinas because you don't know their references. .

Unfortunately yes. Let's say I am running a very high functioning high paying SDG. When I go to make a hire I need to know that the new hire will be able to play nice and not mess up the great thing we have going. Almost every graduating resident is going to be clinically competent so the big name residency does little for me. What I need is some known entity to vouch for the applicant. I want to hear that he turned in all his paperwork on time, had no disciplinary issues, was loved by nurses and attendings both in an out of the department , received tons of patient compliments, and never whined or complained.




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[TooMuchResearch]

Unfortunately yes. Let's say I am running a very high functioning high paying SDG. When I go to make a hire I need to know that the new hire will be able to play nice and not mess up the great thing we have going. Almost every graduating resident is going to be clinically competent so the big name residency does little for me. What I need is some known entity to vouch for the applicant. I want to hear that he turned in all his paperwork on time, had no disciplinary issues, was loved by nurses and attendings both in an out of the department , received tons of patient compliments, and never whined or complained.




Sent from my iPhone using SDN mobile

Exactly. I stayed near residency for my job. I gave potential employers the official references they requested, then they called/texted their friends (my attendings, not necessarily the official references) and asked if they should hire me.

People that moved away from the area after residency ALL used residency grads or contacts of our attendings to find good positions.

Sent from my Moto G (5) Plus using SDN mobile

 

[EMdupe2017]

Again, I appreciate all the responses, but I think this has gotten a little off track. Probably my fault for not being more specific with my original question.

I understand that it's best to do residency in the region you think you want to end up in as there is a strong regional bias. This won't be a problem as I have plenty of southern california interviews. My question is, within regions if there is an advantage between going to a residency perceived as being more prestigious.

For my purposes more specifically, will I have an easier time getting a job in a difficult market like SD coming from one of the big 4-year programs in the area like Harbor/USC/UCLA vs a 3-year program like UC Irvine or Loma Linda?

(Edited original post for clarity to better reflect the purpose of this thread)

 

[GeneralVeers]

My experience is that where you did med school/residency is irrelevant. As has been said previously it is a Buyer's Market for us. As long as you have a pulse, and no significant history of getting sued/fired you can pretty much get any job.

I went to one of the worst residencies every to exist (now closed) and have never had anyone NOT offer me a job. Granted I don't want to work in "popular" high-tax **** holes, but having worked at 10 different hospitals, and 4 different groups, I can say that no one has cared.

 

[The White Coat Investor]

Sorry to say, but this is a horrible hiring strategy. The "smartest" medical student and resident isn't necessarily the best one to work with. This is elitism at its worst in fact.

How would you screen 50 CVs to interview 5? Seriously. What piece of the CV would you use? Or would you interview all 50?

I would say the name of your residency is the single best piece of information on that CV.

Just because most jobs aren't competitive doesn't mean you can get a competitive job without a relatively strong CV.

 

[The White Coat Investor]

Thanks so much for the response! As a follow up, how bout within MD residencies in the same geographic region? I'm just wondering if I'm going to handicap myself by trying to go to a less prestigious 3-year program like UC Irvine or Loma Linda vs some of the 4-year more "powerhouse" type programs like Harbor/USC/UCLA?

And yes, I know those drawbacks are very real, but am somewhat tied to the areas due to family/personal reasons.

I know UCI, Loma Linda, and Harbor relatively well. Not so much USC and UCLA. My impression of USC is somebody who trained there would not do well, at least for a while, in our shop. There's a pretty big learning curve learning to be nice to people after training in a big nasty county traumerrific program. We really don't care that you can manage 12 traumas at once since we only see one at a time. Probably no different from Harbor that way though honestly. My point is your idea of "prestigious" may not correlate with my idea of prestigious. Like residency, it's about getting a match.

 

[The White Coat Investor]

Hawai'i is not a difficult market. You show up with a license, you will be working as soon as they can get you credentialed. Your pay will be in the 1st percentile, and you won't be able to buy a house, and, as stated, taxes will crush you, but you're in Hawai'i!

I tell people, after I tell them I worked in HI, that living there was great. Working there, not so much.

That was my understanding of Hawaii jobs too...not so competitive to get, but tough to pay back debt.

 

[The White Coat Investor]

Thanks for the replies everyone. I guess I should have been more specific with my question. I am a competitive applicant who has interviews at all of the southern california programs and am trying to decide how to rank them. Mainly was concerned about the difference in resume power for job hunting (as I said, ultimately would like to end up in SD, maybe orange county or Hawaii) in doing residency at one of the "top tier" 4-year programs such as Harbor/USC/UCLA vs one of the solid but less prestigious 3-year programs in the area such as UC Irvine or Loma Linda.

For heaven's sake don't rank them by "prestige." Rank them by how well you fit in with the people there. And only you can decide whether the $400K mistake is right for you or not.

All of those programs are going to be fine to get a job in OC or Hawaii. UCI would probably be the best in my opinion. Just stay on as faculty and boom! You're in OC with a job!

 

[The White Coat Investor]

I think the hiring processes described in this thread are pretty toxic and counterproductive.

So if you are an LA or SF job, you are more likely to hire an applicant from a local EM program because someone you trust and know said "Hey take this guy, he's great." Meanwhile you are going to shut out someone who graduated from Carolinas because you don't know their references personally?

The downside to this mentality is that certain jobs in certain cities are completely inbred. There is no change in thought, no change in culture, no diversity. Everybody does things the "LA County" way or the "Highland" way. Not to say that's the wrong/bad way (these are phenomenal programs after all) but why not introduce someone from a somewhere new to mix things up a bit? .

"Diversity" is great, but fit is better. We're not building a med school class here, nor a residency faculty. We're basically marrying a group of people for 30 years. Clinical competence is assumed (especially if you're coming from a known, solid residency). At that point, fit matters most. My job depends on these people not screwing up relationships with consultants, referral sources, administrators etc. I don't care what their race, gender, religion, sexual orientation, or favorite sport is, but they better be able to get along with the rest of the group, the nurses, the patients, the medical staff, and the administrators or they'll be back on the street in a few months.

 

[The White Coat Investor]

Agre would we would hire a kid trained in Detroit over a kid from/trained in Utah

And we would do just the opposite.

 

[The White Coat Investor]

Sorry to say, but this is a horrible hiring strategy. The "smartest" medical student and resident isn't necessarily the best one to work with. This is elitism at its worst in fact.

You've clearly never hired someone that had trouble passing their boards and kept doing stupid clinical stuff. When the next hire comes around you start freaking out and asking for USMLE scores and stuff. I don't need the smartest, but I certainly don't want the stupidest. I mean, I want to be able to sign people out to this doc and not have to worry about my patients dying.

 

[GeneralVeers]

I don't understand why people worry about "prestigious" when it comes to attending jobs. My experience from working all over the country is that EM is basically the same everywhere at its core, with a few differences around the edges. I personally don't care if it is county, community, or tertiary care center. The important things are:

1. Salary
2. Scheduling
3. Location

Your order may vary.

 

[EMdupe2017]

For heaven's sake don't rank them by "prestige." Rank them by how well you fit in with the people there. And only you can decide whether the $400K mistake is right for you or not.

All of those programs are going to be fine to get a job in OC or Hawaii. UCI would probably be the best in my opinion. Just stay on as faculty and boom! You're in OC with a job!

Thanks again for the reply. And no I'm definitely not going to rank them by prestige. Fit/people are by far the most important thing I'm ranking by, but I've had really good interactions at most of my interviews thus far. Honestly I've been leaning UCI #1 as it's a 3-year, but I was just concerned about handicapping myself for getting into some of the more competitive community groups in OC or SD by not trying for one of the others.

 

[bravotwozero]

depends on where you're going. I trained in Detroit, and had no problem finding work in Houston, and was able to land several contracts without any connections whatsoever.

 

[Angry Birds]

You've clearly never hired someone that had trouble passing their boards and kept doing stupid clinical stuff. When the next hire comes around you start freaking out and asking for USMLE scores and stuff. I don't need the smartest, but I certainly don't want the stupidest. I mean, I want to be able to sign people out to this doc and not have to worry about my patients dying.

I don't actually disagree with this post of yours. There is a difference between saying "I don't want someone who has failed multiple board exams, repeated a year, etc." and "I only want people from UCLA/UCSF/etc. with golden pedigrees." If you just believe what's in bold above, then I don't have a problem with that.

Also, you know I'm a fan of yours, even if I didn't agree with your post. Thanks for the work you do!

 

[The White Coat Investor]

I don't actually disagree with this post of yours. There is a difference between saying "I don't want someone who has failed multiple board exams, repeated a year, etc." and "I only want people from UCLA/UCSF/etc. with golden pedigrees." If you just believe what's in bold above, then I don't have a problem with that.

Also, you know I'm a fan of yours, even if I didn't agree with your post. Thanks for the work you do!

The smarter the better, all else being equal. But if you stick with "more prestigious" schools and residency programs your odds seem a lot better to avoid the really problematic docs. They just got weeded out at an earlier stage (probably along with some great docs).

 

[TheComebacKid]

The smarter the better, all else being equal. But if you stick with "more prestigious" schools and residency programs your odds seem a lot better to avoid the really problematic docs. They just got weeded out at an earlier stage (probably along with some great docs).

I don't really agree with this, but just for the sake of the discussion... If you say as an employer "I want someone from a prestigious residency program", and you are in a highly desirable city to live in, why not branch out and look at all the prestigious residencies out there as opposed to just those in your city? For instance, I can't fathom why an employer in a highly desirable city has a completely inbred crop of physicians. Sure, it's comfortable. You know what you're getting. But why don't you give someone the chance from a prestigious program in another part of the country to join you? You would probably overall get a way better group of people together. The risk for LA County hiring someone from Cincinnati (or vice versa) is minimal since Cincy is an unbelievably prestigious program. Yet a large percentage of the faculty at LA County trained there.

I sometimes browse the faculty pages for a residency program. Some of the top programs in the country have virtually every single person on their faculty train there. Being such a great program, you could probably attract the best talent from all over the country, it seems to me that you are limiting yourself to hiring all your faculty from your program when in fact there are other applicants out there from "prestigious" programs as well. I assume there are similar practices in community shops as well.

Regional bias is a matter of comfort and risk intolerance. But historically I think if you look at places that have really succeeded, sometimes it's because they took a chance on someone outside their comfort zone. And again, I think the risk is minimal when it comes to clinical competence when there are so many prestigious programs out there.

 

[BoardingDoc]

I don't really agree with this, but just for the sake of the discussion... If you say as an employer "I want someone from a prestigious residency program", and you are in a highly desirable city to live in, why not branch out and look at all the prestigious residencies out there as opposed to just those in your city? For instance, I can't fathom why an employer in a highly desirable city has a completely inbred crop of physicians. Sure, it's comfortable. You know what you're getting. But why don't you give someone the chance from a prestigious program in another part of the country to join you?

Because you don't have to. As several people here have alluded to, there are significant advantages to selecting from a pool you're familiar with. Is the resident from a program across the country going to bring new and interesting ideas and be a great fit? Maybe. But the short answer is: "who cares?" If you're a desirable practice, you will have your pick of the litter from the local high quality programs where you 1: know what you're getting and 2: can talk to someone who you know and trust about whether or not this person is a good doc vs a douchecanoe. If you're trying to create a board of docs to lead a residency, yes, I'd argue that there is a strong benefit to bringing in as many new and diverse ideas as possible. If you're trying to maintain a well running community shop where everyone plays nice in the sandbox, those intangibles aren't as much of a priority as getting a doc who will fit in, work well with everyone and has the added bonus of ties to the area which makes it more likely that this person will be around for the long haul as opposed to needing to replace them in a couple of years when they decide they don't really like this new geographic area so much.

 

[The White Coat Investor]

Bingo. Comparing my shop to LA County makes zero sense.

 

[The White Coat Investor]

I don't really agree with this, but just for the sake of the discussion...

And why wouldn't you agree with this? You think you're better off fishing at the brand new residency programs and the ones on probation than the ones with the great reputation? You prefer docs with low board scores to docs with high ones? You think we should interview every one willing to interview with us? It's not clear to me what you're advocating or disagreeing with.

 

[surely]

And why wouldn't you agree with this? You think you're better off fishing at the brand new residency programs and the ones on probation than the ones with the great reputation? You prefer docs with low board scores to docs with high ones? You think we should interview every one willing to interview with us? It's not clear to me what you're advocating or disagreeing with.

Isn't there a wide swath of programs that are somewhere between having a "great reputation" and ones that are brand new or on probation? Like the entire middle third of programs, many of which have super strong residents?

For instance, I have my eye on a residency where over a third of the current interns have Alpha Omega Alpha, but it isn't one of the go-to SDN "great reputation" shops. My guess is that applicants chose it for fit, just like I was going to until y'all stepped in and made me nervous about name recognition. In one post, WCI says rank by fit instead of prestige, but then he says "the name of your residency is the single best piece of information on that CV." So I guess the advice is... preliminarily rank by prestige, but use fit as a trump card to nix programs you wouldn't be happy at?

 

[The White Coat Investor]

Isn't there a wide swath of programs that are somewhere below having a "great reputation" and ones that are brand new or on probation? Like the entire middle third of programs, many of which have super strong residents?

For instance, I have my eye on a residency where over a third of the current interns have Alpha Omega Alpha, but it isn't one of the go-to SDN "great reputation" shops. My guess is that applicants chose it for fit, just like I was going to until y'all stepped in and made me nervous about name recognition. In one post, WCI says rank by fit instead of prestige, but then he says "the name of your residency is the single best piece of information on that CV." So I guess the advice is... preliminarily rank by prestige, but use fit as a trump card to nix programs you wouldn't be happy at?

Let me see if I can help you reconcile those two statements. Admittedly, I can see why it would be hard for a medical student to do so.

# 1 You're not going to have trouble finding a job. If you complete an EM residency, you're going to get a job. If you pay attention, you'll likely get a good job. That's whether you're at a fancy pants residency, a "middle of the road" residency, or a residency on probation. So don't panic.

# 2 Since residency is 3 years long, you don't want to be somewhere you don't fit well, no matter how prestigious. So pick a residency primarily based on fit. Fit, location, quality of education, prestige is perhaps the order you should look at it.

# 3 There are some jobs in this country that are very hard to get. Not a lot, but a few. They are located in places like Portland, Denver, and Salt Lake City. They combine a great outdoorsy place to live, a moderate cost of living and tax situation, and the opportunity to own your job in a small democratic group (which is becoming more and more rare all the time). They are places where the patients and consultants are nice, there are no toxic partners, the pace is reasonable, and the pay is good. SDNers refer to these as "unicorn jobs." My job happens to be a unicorn job. Thus, it is highly desirable. Because it is highly desirable, we have a plethora of applicants who want to come work here. We don't go to ACEP and buy a booth. We don't buy ads in the back of the throwaways. In fact, we don't advertise at all. We hire one person every year or two and have our pick of about 50 CVs that people just send to us because they're out beating the bushes looking for the really good jobs. Now, if you've ever looked at a CV of a graduating resident, you would know there isn't much on there that is useful. There's a name and a phone number and an email address. The name of their college and maybe their major. The name of their medical school. The name of their residency. Maybe a few publications, presentations, and research crap that you don't care about because you're a 100% community shop. And now, unless you want to dedicate every afternoon for the next month to interviewing 50 people for one job, you've got to figure out a way to narrow them down. What would you use? Their name? Their major? The name of their college? Whether they did research or not? Their hobbies? I would submit that the most useful thing on that CV is the name of their residency. Second most useful? Probably their hobbies. You know why? Because that tells us whether they're going to be happy in Utah and stay here for the long term or not. Mountain biking, hiking, and backcountry skiing = good. Clubbing, political protesting, surfing = bad.

Hope that helps.

 

[mcmcmcmcm]

Let me see if I can help you reconcile those two statements. Admittedly, I can see why it would be hard for a medical student to do so.

To be fair, you have to have a very high IQ to understand SDGs. The benefits are extremely subtle, and without a solid grasp of EMTALA regulations most of the information will go over a typical medical student’s head. There’s also SDGs' nihilistic outlook, which is deftly woven into their sweat equity- their group philosophy draws heavily from Osler's literature, for instance. The attendings understand this stuff; they have the intellectual capacity to truly appreciate the depths of these groups, to realise that they’re not just profitable- they say something deep about LIFE. As a consequence medical students who don't understand SDGs truly ARE idiots- of course they wouldn’t appreciate, for instance, the truth in SDGs' existential catchphrase “this is a unicorn job,” which itself is a cryptic reference to Tintinalli’s epic Emergency Medicine. I’m smirking right now just imagining one of those addlepated simpletons scratching their heads in confusion as SDGs' genius wit unfolds itself on their job search. What fools.. how I pity them.

And yes, by the way, i DO have an SDG tattoo. And no, you cannot see it. It’s for the ladies’ eyes only- and even then they have to demonstrate that they’re within 5 RVUs of my own (preferably lower) beforehand. Nothin personnel kid

(Big fan of your work, WCI, but I just couldn't help myself)

 

[surely]

Let me see if I can help you reconcile those two statements.

Solid advice, appreciate it! The tl;dr is that awesome jobs in competitive markets will care where you trained... Unlike the OP of this thread, I think I'll be happy in non-competitive markets, so I won't worry about it much.

 

[Tenk]

I was chief resident. That seemed to be a slight boost, but when I told people I had well over 1,000 hours moonlighting under my belt that seemed to do more than anything else. I had pretty much already proven I could fly solo and I also had press ganey data all in the green with doctors/directors outside my residency program who could vouch for me. I think that helps distinguish you when you are looking for your first job out of residency more than just a name. If I had to choose between a good program that allows moonlighting versus a great program that doesn’t, I’d pick the good program in a heartbeat and never look back. Just my experience though, I’m sure other people have other opinions on the matter.

 

[enalli]

I was chief resident. That seemed to be a slight boost, but when I told people I had well over 1,000 hours moonlighting under my belt that seemed to do more than anything else. I had pretty much already proven I could fly solo and I also had press ganey data all in the green with doctors/directors outside my residency program who could vouch for me. I think that helps distinguish you when you are looking for your first job out of residency more than just a name. If I had to choose between a good program that allows moonlighting versus a great program that doesn’t, I’d pick the good program in a heartbeat and never look back. Just my experience though, I’m sure other people have other opinions on the matter.

It seems a bit silly to compare your job prospects as a residency graduate with the equivalent of one year of attending experience with those of an actual fresh residency graduate. At that point you're looking for your second job while they're looking for their first; of course you're going to have a leg up.

Now, I don't disagree that moonlighting will give you a financial advantage, but comparing job prospects this way is a bit pointless.

 

[filhodeinferno]

Current MS4 trying to start making my rank list, made a new account for anonymity purposes. My question is this: If I want to get a community job in a difficult market like San Diego or maybe Hawaii after residency, how much difference does the perceived prestige of my residency make?

I understand that it's best to do residency in the region you think you want to end up in as there is a strong regional bias. This won't be a problem as I have plenty of southern california interviews. My question is, within regions if there is an advantage between going to a residency perceived as being more prestigious.

For my purposes more specifically, will I have an easier time getting a job in a difficult market like SD coming from one of the big 4-year programs in the area like Harbor/USC/UCLA vs a 3-year program like UC Irvine or Loma Linda?

Thanks in advance!

(Edited for clarity)

Where you do residency doesn't matter so much as who you know at the place you want to work. I went to a middle of the pack residency that was 2000 miles away from where I got a job in a very competitive market. I got the job because I knew a guy who knew a guy who vouched for me. It's all about that.

If you don't know somebody where you want to work, then doing a residency that is close by there so that you can make some connections would definitely be beneficial.

 

[TheComebacKid]

And why wouldn't you agree with this? You think you're better off fishing at the brand new residency programs and the ones on probation than the ones with the great reputation? You prefer docs with low board scores to docs with high ones? You think we should interview every one willing to interview with us? It's not clear to me what you're advocating or disagreeing with.

I think you are going to complete extremes which is not what I am advocating for.

There are some very high quality residents at "middle of the road" programs that may have chosen to go there for family reasons or other commitments. I think that to say that by recruiting from "prestigious" residencies, you are avoiding "problematic docs" is a gross generalization.

I also have no idea what correlation there is between how high your board score is and how well you will fit in with a particular group. I can venture a guess and say it's probably not a strong correlation.

 

[RustedFox]

It seems a bit silly to compare your job prospects as a residency graduate with the equivalent of one year of attending experience with those of an actual fresh residency graduate. At that point you're looking for your second job while they're looking for their first; of course you're going to have a leg up.

Now, I don't disagree that moonlighting will give you a financial advantage, but comparing job prospects this way is a bit pointless.

Uhh... no, amigo.

The job prospects are the same fresh outta' residency no matter how much or how little moonlighting you did during residency.

What Tenk did was make himself a Jedi Master by moonlighting as much as he could when he felt like he was ready during residency.

By contrast, I did absolutely ZERO moonlighting during residency. My time off was more important to me. My home/life situation was radically different than it was now.
Debt be damned. I had the rest of my life to pay that nonsense off.

We had the same jobs to look at, when they were hiring.

I know this, because I know Tenk in real-life. I helped to train him.

Tenk was a better candidate fresh-outta-rezzi than I was. Period.

As Vader said: "When I left you, I was but the learner. Now, I am the master."

 

[Angry Birds]

I was chief resident. That seemed to be a slight boost, but when I told people I had well over 1,000 hours moonlighting under my belt that seemed to do more than anything else. I had pretty much already proven I could fly solo and I also had press ganey data all in the green with doctors/directors outside my residency program who could vouch for me. I think that helps distinguish you when you are looking for your first job out of residency more than just a name. If I had to choose between a good program that allows moonlighting versus a great program that doesn’t, I’d pick the good program in a heartbeat and never look back. Just my experience though, I’m sure other people have other opinions on the matter.

Mann, I was toast just doing the regular schedule for EM... Can't imagine moonlighting on top of that. Kudos, but definitely wasn't for me! Kudos though I guess...

 

[fahimaz7]

Moonlighting certainly helped me grow as a resident and made the transition much smoother. We apwere able to moonlight as a PA as a pgy2 and externally as a pgy3. I did about 15 shifts as a PA and another 40 as a pgy3 at two outside hospitals (Single coverage). This is the equivalent of 3 months of attending shifts, which is certainly a leg up on someone who has never worked independently.

15x12 pa shifts
40x12 pgy3 shifts
= 624 clinical hours working independently at time of graduation.

 

[Tenk]

Mann, I was toast just doing the regular schedule for EM... Can't imagine moonlighting on top of that. Kudos, but definitely wasn't for me! Kudos though I guess...

I worked 240 hours a month for 12 months straight. Makes my current 144 hour months seem pretty damn easy.

 

[The White Coat Investor]

I think you are going to complete extremes which is not what I am advocating for.

There are some very high quality residents at "middle of the road" programs that may have chosen to go there for family reasons or other commitments. I think that to say that by recruiting from "prestigious" residencies, you are avoiding "problematic docs" is a gross generalization.

I also have no idea what correlation there is between how high your board score is and how well you will fit in with a particular group. I can venture a guess and say it's probably not a strong correlation.

We're talking past each other. I'm talking about how you can avoid the bottom of the barrel docs by sticking with prestigious residencies. You're saying there are good docs at middle of the road residencies. Those two facts can co-exist. One does not make the other untrue.

I will freely admit that my/our tactic throws the baby out with the bathwater in many ways. What is your suggested alternative because I assure you nobody wants to interview 50 docs for one position?

 

[The White Coat Investor]

What Tenk did was make himself a Jedi Master by moonlighting as much as he could when he felt like he was ready during residency.

By contrast, I did absolutely ZERO moonlighting during residency. My time off was more important to me. My home/life situation was radically different than it was now.

Tenk was a better candidate fresh-outta-rezzi than I was. Period.

That advantage lasts a very short time. It just doesn't take that long to get a typical solid residency grad up to speed.

 

[The White Coat Investor]

To be fair, you have to have a very high IQ to understand SDGs. The benefits are extremely subtle, and without a solid grasp of EMTALA regulations most of the information will go over a typical medical student’s head. There’s also SDGs' nihilistic outlook, which is deftly woven into their sweat equity- their group philosophy draws heavily from Osler's literature, for instance. The attendings understand this stuff; they have the intellectual capacity to truly appreciate the depths of these groups, to realise that they’re not just profitable- they say something deep about LIFE. As a consequence medical students who don't understand SDGs truly ARE idiots- of course they wouldn’t appreciate, for instance, the truth in SDGs' existential catchphrase “this is a unicorn job,” which itself is a cryptic reference to Tintinalli’s epic Emergency Medicine. I’m smirking right now just imagining one of those addlepated simpletons scratching their heads in confusion as SDGs' genius wit unfolds itself on their job search. What fools.. how I pity them.

And yes, by the way, i DO have an SDG tattoo. And no, you cannot see it. It’s for the ladies’ eyes only- and even then they have to demonstrate that they’re within 5 RVUs of my own (preferably lower) beforehand. Nothin personnel kid

(Big fan of your work, WCI, but I just couldn't help myself)

Very funny. But it's kind of true in a way. I mean, when residents come interview they're asking stupid questions. "Do you have an ultrasound machine? Do you have "good back-up? How much trauma do you see? How much peds? Which EMR do you use?" They care about all the wrong stuff. And when I say wrong, I mean different stuff than they will care about in just a few years. 5 years in they're going to care about how much they're paid (i.e. do they need to look for a different job in order to make what they're worth), whether there are toxic people in the group and medical staff, how shifts are divided up and compensated, how much control they have over who they work with and how they do their work etc. They're not going to care how ultrasounds are done in the hospital. They won't care whether you see 5% trauma or 10% trauma. In fact, they'll probably be sick of doing trauma at all by then. They'll be on their third EMR since they got there. They'll care much less about "back-up" because they'll just transfer crap that can't be taken care of at that place. The less your hospital can do, the more transfers you do, the easier transfers are to do etc. Whether I transfer you or admit you, one call does it all. It just doesn't affect your happiness at all.

It would be even worse talking to a medical student.

So yes, the subtleties of actually owning your job are lost on medical students, residents, and many new attendings. They just haven't realized yet that they should care about this stuff because it really will affect them for the rest of their careers.

 

[Brahnold Bloodaxe]

Very funny. But it's kind of true in a way. I mean, when residents come interview they're asking stupid questions. "Do you have an ultrasound machine? Do you have "good back-up? How much trauma do you see? How much peds? Which EMR do you use?" They care about all the wrong stuff. And when I say wrong, I mean different stuff than they will care about in just a few years. 5 years in they're going to care about how much they're paid (i.e. do they need to look for a different job in order to make what they're worth), whether there are toxic people in the group and medical staff, how shifts are divided up and compensated, how much control they have over who they work with and how they do their work etc.

Well, could it be that they know and care about those things you mention as being important, but also know better than to bring them up during the interview? Asking about money and toxic personalities in the group seems like the sort of thing that might strike the wrong chord, so why risk asking about it? And since you can't ask the important and potentially gauche questions, you're left grasping for filler stuff like "how 'bout them ultrasound machines."

 

[RustedFox]

Well, could it be that they know and care about those things you mention as being important, but also know better than to bring them up during the interview? Asking about money and toxic personalities in the group seems like the sort of thing that might strike the wrong chord, so why risk asking about it? And since you can't ask the important and potentially gauche questions, you're left grasping for filler stuff like "how 'bout them ultrasound machines."

When I was first job hunting 5 years ago, I interviewed at 7 shops in my area. I asked about US machines.

3 said "we don't use those".

Kthxbye.

 

[deleted109597]

4 year residency and then wants Orange County or Hawai'i?

Fairly Oddparents Burn GIF - Find & Share on GIPHY

 

[The White Coat Investor]

When I was first job hunting 5 years ago, I interviewed at 7 shops in my area. I asked about US machines.

3 said "we don't use those".

Kthxbye.

Maybe that's why they're asking. I didn't realize there were still EDs out there without an ultrasound in the department. I've been out of residency for 11 1/2 years and I have yet to work in a department where I didn't have a bedside US machine available to me. That includes four continents, academic medical centers, community EDs, glorified urgent cares, trauma centers, and tent hospitals. US is part of our core credentials. It's just assumed that you can do it because you're an emergency doc at our hospital.

If you are running an ED without an US, stop it. You're embarrassing the specialty.