Landing fellowship at 4 year program from a 3 year residency?

[GorillaPanic]

Hey y'all. The search function isn't really paying off for this question, was wondering if someone could lend some insight:

I ranked pretty much only 4 year programs, but then last minute decided to switch my number 1 to the one 3 year program I really liked. I eventually want to go into academics, but all the places near my hometown are 4 year programs. The advice on SDN has always been "do a 3 year residency + 1 year fellowship, you'll be more marketable!" but now I'm wondering if that's really true... I'm starting to kick myself for not ranking the more brand name residencies first.

Does anyone know of 4 year programs that will take 3 year grads for fellowship? Seems like 4 year programs only hire grads from other 4 year programs. How uphill of a battle will this be?

Thanks so much for your help, y'all.

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[miacomet]

Do a three year residency! Plenty of prospective academics end up in the community and unless you are independently wealthy a four-year program is costing you at least 300k. You can certainly do a fellowship from a three year program. I've seen several fellowships that claim they only take four year grads take three year grads.

What fellowship do you want to complete?

 

[EKGdoc]

One of our chiefs did EMS fellowship at Wash U (4yr program) last year. We're a 3-yr program (UICOMP). It limited his resident staffing during the fellowship but otherwise no restrictions/issues.

 

[GorillaPanic]

One of our chiefs did EMS fellowship at Wash U (4yr program) last year. We're a 3-yr program (UICOMP). It limited his resident staffing during the fellowship but otherwise no restrictions/issues.

Thanks so much for your response! I'm particularly interested in EMS as well (former paramedic with operations experience), though I wouldn't rule out ultrasound.

Would love to hear of other success stories if anyone else has some to offer (especially on the west coast). The rumored embargo on 3 year grads was really starting to worry me...

 

[miacomet]

Thanks so much for your response! I'm particularly interested in EMS as well (former paramedic with operations experience), though I wouldn't rule out ultrasound.

Would love to hear of other success stories if anyone else has some to offer (especially on the west coast). The rumored embargo on 3 year grads was really starting to worry me...

You can always work for a year and then do a fellowship. Voila- just like a four year residency, except you get paid an attending salary. Since you have been an attending, you will have more clinical experience than the four year grads. Or you can do a different fellowship at a place that accepts three years and then do another fellowship. You will have done two fellowships in 5 years instead of residency plus one fellowship.

I did a four year program. Our EMS fellow had done three years. Four year programs are the biggest scams ever. Maybe things have changed in the last decade, but I would do three years and two fellowships vs four years and one fellowship. Such a scam to get more free resident labor.

 

[The White Coat Investor]

Ahhh....the $400K mistake. I'm kind of surprised the 4 year residency programs haven't been phased out yet. I think the main reason is reputation- you'll notice that very few (none?) of the newer programs are 4 year programs. The better programs in better locations can get away with being 4 years long and still get quality applicants. Good luck with that in a new program in the midwest.

Don't be surprised if that desire to do a fellowship goes away during residency. People change. Life happens.

 

[enalli]

One of our recent grads went to do ultrasound at a place with a four-year residency. They had her working a mix of shifts at their community affiliate, then some non-teaching shifts at the main site. It was a non-issue.

 

[GonnaBeADoc2222]

Congrats making that last minute decision to go to a 3 year program. Kinda jeally. As someone who went to an ivory tower 4 year program, I can say this is the biggest (although in all honesty, not that big in the grand scheme of things - I had a good time and got good training) financial/lifestyle mistake an EM applicant can make. 4 year programs like to push this idea that in order to be a fully trained EM physician, you need 4 years. False - there's a reason the ACGME approves the existence of 3 year programs which are the vast majority of programs out there - it's because 3 years is enough training. If you're not ready after 3 years, you're not gonna be ready after 4. People who push this are merely rationalizing their presence in a 4 year program. These models exist to allow the hospitals to not hire more midlevels and allow the academic attendings to put in less clinical time - it is not for the benefit of the trainee. It was really awesome as a pgy4 seeing fresh midlevel grads make more money than me and work less hours. It was even more awesome having pgy4 level attendings (fellows that came over from 3 year programs) supervise me when I was a pgy4. That's right - same pgy level, supervising our pgy4s - kinda a slap in the face and flies in the face of that "need 4 years to be a competent ER physician" ideal huh?

By far and away the best way to establish an academic niche in EM is 3 year program + fellowship.

Anecdotally, if you're just interested in being a "clinician educator" and not a full fledged academician, I have friends who have gone to a 3 year program, and then gotten hired in this kind of role at a 4 year program straight out of residency.

 

[miacomet]

Ahhh....the $400K mistake. I'm kind of surprised the 4 year residency programs haven't been phased out yet. I think the main reason is reputation- you'll notice that very few (none?) of the newer programs are 4 year programs. The better programs in better locations can get away with being 4 years long and still get quality applicants. Good luck with that in a new program in the midwest.

Don't be surprised if that desire to do a fellowship goes away during residency. People change. Life happens.

Agreed 100%. I could see that at some point in the future if EM and EM fellowships get totally saturated then maybe four years will make the difference, but that time is not now and that time will not be three years from now or even five years from now. If you want some unique fellowship at a four year program that doesn't accept three year grads, you are better off doing a different fellowship for a year and then doing EMS. The top EMS fellowship is probably FDNY, and I believe they accept three year grads, although I don't know for sure.

I attended a four year program for a unique personal reason, but my impression of the four year programs is that are actually weaker in some ways in clinical training per time spent. Essentially, because they tack on a fourth year (which should be 90% electives, right?) they just assume you will learn enough with an extra year, whereas the three year programs know they have a tight timeframe and pack each rotation with learning.

 

[carbonizedeyesockets]

I'm a recent 3 year program grad and 2 of my co-residents matched fellowship at places with 4-year programs. Both in a highly desirable area at places considered highly competitive.

The 4 year program is a relic of the past, really. The reason they exist is because EM training used to be a general intern year then 2 year residency at most programs. When it was decided that EM residency should be 3 years (a highly contentious move), some programs absorbed the intern year, and others did not (kept the intern year, but added a year to residency). Over time, the places with an intern year and 3 years of residency just absorbed the intern year and became 4 year programs instead of just dropping the intern year.

 

[miacomet]

I'm a recent 3 year program grad and 2 of my co-residents matched fellowship at places with 4-year programs. Both in a highly desirable area at places considered highly competitive.

The 4 year program is a relic of the past, really. The reason they exist is because EM training used to be a general intern year then 2 year residency at most programs. When it was decided that EM residency should be 3 years (a highly contentious move), some programs absorbed the intern year, and others did not (kept the intern year, but added a year to residency). Over time, the places with an intern year and 3 years of residency just absorbed the intern year and became 4 year programs instead of just dropping the intern year.

Why are places in California (Harbor, maybe Stanford) switching from three to four years?

 

[carbonizedeyesockets]

Why are places in California (Harbor, maybe Stanford) switching from three to four years?

Sure, some programs have made the transition long after the original transition. The reasons a program chooses to do this is multifactorial. Stanford outlines their reasons and most of it is about professional development, scholarly pursuit, more supervision of interns, etc. Clearly, that stuff is viewed favorably by a lot of applicants, and it will allow a leg-up in some cases when graduating and looking to go into academics. But, be that as it may, it is NOT hard to do academics from a 3 year program, and despite what many 4-year programs say, many (sure, not all) will hire 3-year grads (I can personally attest to that). Also, it's California. Some programs could go to 5 years length and start every shift with a punch in the face from the Chair and people would still apply just because they want to be in California.

 

[deleted547339]

If a program doesn’t want you, you shouldn’t want them. 4 years is unnecessary to obtain competence. Pick your residency based on where you will be the best and happiest trainees, then pick your fellowship. The two choices should be independent.

I’m a graduating CCM fellow after a 3y EM program. After doing 5 years of total training, I’m over it. If I had done 4y of EM, there’s no chance I would have done a fellowship, much less a 2y fellowship. If you told me I had to be a trainee for another year....postal, id go postal. Not to mention the fact that I make 60ishk/y vs my peers who have made 3-400k for the past 2. If you added on another year.....(shudder)

 

[CTULosAngeles]

So to piggy back off of this question, what kind of things can an EM resident do during their training to make them competitive for fellowship applications? Is it just like medical school - do research in your area of interest and get a good LOR from the PD? Or is it more about being a generally good resident and just schmoozing at the right conferences?

I'm at a 3 year program without a Tox rotation and trying to finagle my way into a Tox fellowship, eventually

 

[alpinism]

So to piggy back off of this question, what kind of things can an EM resident do during their training to make them competitive for fellowship applications? Is it just like medical school - do research in your area of interest and get a good LOR from the PD? Or is it more about being a generally good resident and just schmoozing at the right conferences?

I'm at a 3 year program without a Tox rotation and trying to finagle my way into a Tox fellowship, eventually

Tox fellowships aren't competitive.

Just do an elective as a 2nd or 3rd year resident.

 

[miacomet]

It's just not hard to get most EM fellowships, and tox certainly is pretty easy to get. They don't increase pay or decrease hours or get you out of the ER.

 

[The White Coat Investor]

It's just not hard to get most EM fellowships, and tox certainly is pretty easy to get. They don't increase pay or decrease hours or get you out of the ER.

Exactly. I suppose a given fellowship position/location might be competitive, but getting a spot in that fellowship somewhere should be pretty easy even for an average resident. There is not high demand for these among most EM residents. Not a single one of the docs I graduated with did a fellowship and I think 4/9 of us (including me) spent at least a few years in some sort of an academic position. I think we've all left academia at this point.

Your career isn't all about money, but in general a fellowship is just as much a "$400K mistake" as an extra year of residency. It's not going to help you get a job that pays well. At best it'll help you get a job that pays less (i.e. an academic one.)

Be wise about these decisions. They do have consequences, both for the types of jobs you'll be able to get as well as your finances. In EM, a fellowship is generally for someone who wants to be on a tenured academic faculty for the rest of their career. Many of those jobs DO want to see a fellowship, and that fellowship will be your niche for the rest of your career. But to be a pit doc in a community ED like the other 90% of us....you'd better be really interested in doing it to "spend" $300K after-tax to get it.

 

[GorillaPanic]

Thanks for the insight, everyone!

The reason this question is so key to me is because I want to eventually move back to California where my family and friends are, but last minute ranked (and matched at) a midwest program ahead of 'em all (the 3 year one). I understand that I probably should have just matched in California if I wanted an easier entry into the academic job market there, but I just jived with the other program a little bit better. Fingers crossed that I can land a fellowship at one of those programs and get a foot in the door to an attending position.

I know it seems silly to think that someone just starting residency is so sure they want to do academics -- but I have a few graduate degrees and love the academic environment. Maybe it'll change, but I'm just trying not to keep the door wide open.

Thanks for the advice everyone! Seriously, thank you all for being so constructive, I really appreciate it.

P.S. Does anyone have any insight as to how marketable a fellowship in ultrasound is these days? Seems like the market might be saturated with fellowship trained docs... Should I stick with my EMS interest?

 

[CTULosAngeles]

Exactly. I suppose a given fellowship position/location might be competitive, but getting a spot in that fellowship somewhere should be pretty easy even for an average resident. There is not high demand for these among most EM residents. Not a single one of the docs I graduated with did a fellowship and I think 4/9 of us (including me) spent at least a few years in some sort of an academic position. I think we've all left academia at this point.

Your career isn't all about money, but in general a fellowship is just as much a "$400K mistake" as an extra year of residency. It's not going to help you get a job that pays well. At best it'll help you get a job that pays less (i.e. an academic one.)

Be wise about these decisions. They do have consequences, both for the types of jobs you'll be able to get as well as your finances. In EM, a fellowship is generally for someone who wants to be on a tenured academic faculty for the rest of their career. Many of those jobs DO want to see a fellowship, and that fellowship will be your niche for the rest of your career. But to be a pit doc in a community ED like the other 90% of us....you'd better be really interested in doing it to "spend" $300K after-tax to get it.

My thought is that Tox interests me, provides a way into a tight job market since my hometown is unfortunately desirable, and gives me an avenue to work outside the ED in my academic niche when later on I get tired of ED shifts. But it is an expensive couple of years, I'll give you that...

 

[miacomet]

My thought is that Tox interests me, provides a way into a tight job market since my hometown is unfortunately desirable, and gives me an avenue to work outside the ED in my academic niche when later on I get tired of ED shifts. But it is an expensive couple of years, I'll give you that...

I know a few docs who have protected academic time as toxicologists, but I don't know any who have managed to transition outside the ER with it completely. All are working at least 100 hours a month. I don't know about your hometown job market, but no one outside academics cares about tox ASFAIK. For academics, there's always a "hot" fellowship- a few years ago it was ultrasound (no one in the community uses US much), then critical care. Not sure what's hot now, but certainly not tox. Sure, Portland, Denver and NYU might be a bit more challenging to get, but even NYU didn't fill their fellowship a few years back.

 

[DeadCactus]

An EM fellowship is a luxury good. It's something you buy to make your work more enjoyable even if it makes no financial sense. It has less in common with something like a college degree than it does with a sports car.

 

[miacomet]

Thanks for the insight, everyone!

The reason this question is so key to me is because I want to eventually move back to California where my family and friends are, but last minute ranked (and matched at) a midwest program ahead of 'em all (the 3 year one). I understand that I probably should have just matched in California if I wanted an easier entry into the academic job market there, but I just jived with the other program a little bit better. Fingers crossed that I can land a fellowship at one of those programs and get a foot in the door to an attending position.

I know it seems silly to think that someone just starting residency is so sure they want to do academics -- but I have a few graduate degrees and love the academic environment. Maybe it'll change, but I'm just trying not to keep the door wide open.

Thanks for the advice everyone! Seriously, thank you all for being so constructive, I really appreciate it.

P.S. Does anyone have any insight as to how marketable a fellowship in ultrasound is these days? Seems like the market might be saturated with fellowship trained docs... Should I stick with my EMS interest?

Don't second guess yourself, and I don't think three years will matter much, but it's true that it's always easier to get a job near where you did residency. OTOH, if you delayed California for residency because you loved the program so much, I wouldn't be surprised if you decide to stay in the MW a bit longer when you see the higher salaries, lower COL, and generally better work environment (nurses that do their jobs, less boarding) outside CA. I don't think all academic jobs are competitive in California. With the insane COL these days, more and more docs seem to be kissing CA and NY goodbye.

It will work out...

 

[miacomet]

As WCI noted, in the community we do not care AT ALL about fellowships. Maybe peds would give someone a (slight) edge, but my unicorn job just passed up both ultrasound and tox trained people in favor of docs with no fellowship as ultrasound and tox don't really do anything for us in the community, but commitment, work ethic, and familiarity do a whole ton.

 

[miacomet]

So to piggy back off of this question, what kind of things can an EM resident do during their training to make them competitive for fellowship applications? Is it just like medical school - do research in your area of interest and get a good LOR from the PD? Or is it more about being a generally good resident and just schmoozing at the right conferences?

I'm at a 3 year program without a Tox rotation and trying to finagle my way into a Tox fellowship, eventually

What area of the country do you want to end up in? Are you set on academia? I only ask because different parts of the country need different types of docs/fellowships. Tox probably won't help you much in Denver, for example.

 

[GorillaPanic]

What area of the country do you want to end up in? Are you set on academia? I only ask because different parts of the country need different types of docs/fellowships. Tox probably won't help you much in Denver, for example.

I'd guess from his username that perhaps it's LA? I'm interested in going home to Northern CA myself... any advice on that front?

 

[miacomet]

There are lots of community jobs (especially Kaiser) in NoCal, depending on where exactly you want to be. It's an expensive part of the country. Academic jobs don't pay well. Will you be able to afford academia? That's the question... SF on 150k a year with a family just about qualifies you for subsidized housing.

 

[CTULosAngeles]

What area of the country do you want to end up in? Are you set on academia? I only ask because different parts of the country need different types of docs/fellowships. Tox probably won't help you much in Denver, for example.

Despite my username (inspired by an enthusiasm for all things Jack Bauer), I was born and raised in Portland OR. So I'm trying to get back there or Seattle for my long term career, since that's where all my family is. How would I figure out if Tox is needed in the PNW?

 

[miacomet]

Despite my username (inspired by an enthusiasm for all things Jack Bauer), I was born and raised in Portland OR. So I'm trying to get back there or Seattle for my long term career, since that's where all my family is. How would I figure out if Tox is needed in the PNW?

Portland has a big tox program. It's hard to get a job at OHSU, almost impossible to get a job at the private group in town (a very good private group, I might add) and possible to get a job with CEP or at Kaiser. Of these, OHSU cares about tox, but they have a big program already and I have no idea what they are trying to develop within their residency. EM is a tough gig to find in Portland. Not impossible, but one of the toughest markets in the country. Lots of EM docs in Portland commute elsewhere to work.

Seattle only really has UW. No idea if they are nurturing tox as a part of their program- I would ask them. As a younger program, they are definitely growing. There are community jobs in Seattle and environs, but tox will not help you in any way with the private groups, which are competitive, but not as bad as Portland.

Try and do residency in Portland or Seattle if that's where you want to live. Networking will help you more than a fellowship outside academia. As for the needs of their residencies...ask them.

 

[miacomet]

Grew up in a family with a household income of $70k in the south bay, so I'm sure I could make $150k work 😛. I feel like job satisfaction may be greater in an environment where I can teach. Any rec's on what types of fellowships are most useful out there?

70k fifteen years ago was way easier than 150k is nowadays. Even tech workers and docs are leaving! FWIW, they pay nurses more than 150k in the Bay Area and they can't afford to live in town. Stanford I think has a growing CC program. Don't know about UCSF or what their needs are. Bring your own grant funding and they will be OK with whatever your area of interest is.

 

[CTULosAngeles]

Portland has a big tox program. It's hard to get a job at OHSU, almost impossible to get a job at the private group in town (a very good private group, I might add) and possible to get a job with CEP or at Kaiser. Of these, OHSU cares about tox, but they have a big program already and I have no idea what they are trying to develop within their residency. EM is a tough gig to find in Portland. Not impossible, but one of the toughest markets in the country. Lots of EM docs in Portland commute elsewhere to work.

Seattle only really has UW. No idea if they are nurturing tox as a part of their program- I would ask them. As a younger program, they are definitely growing. There are community jobs in Seattle and environs, but tox will not help you in any way with the private groups, which are competitive, but not as bad as Portland.

Try and do residency in Portland or Seattle if that's where you want to live. Networking will help you more than a fellowship outside academia. As for the needs of their residencies...ask them.

Thanks a bunch for this detailed reply 🙂 You've given me a lot to cogitate about, I'll see what I can do for networking

 

[miacomet]

Thanks a bunch for this detailed reply 🙂 You've given me a lot to cogitate about, I'll see what I can do for networking

Hey, I'm glad my thoughts have been helpful. Feel free to PM me with more questions. Remember YMMV.

EM is a weird field (I'm sure all other fields are weird in their own way). It's hard- you crank for years and think tests, research, academic accolades and excellence. That may carry over into EM academia, but in the community where 90% of EM docs practice all that matters is personality and scheduling flexibility. That's it. Certainly people work in Seattle and Portland in academia, and you can if that is your absolute, ultimate goal. But there is only one residency (for now) in each locale, and they may or may not be your cup of tea, so if geography is that important you might want to consider whether working in the community is an option for you. In any case, those are tough markets (Portland particularly), so you might want to start strategizing and networking now.

 

[The White Coat Investor]

but in the community where 90% of EM docs practice all that matters is personality and scheduling flexibility. That's it.

You mean after clinical competence that is. The clinical competence is assumed. Without that you won't last in the community either.

 

[miacomet]

You mean after clinical competence that's it. The clinical competence is assumed. Without that you won't last in the community either.

I wish that were the case, but I've seen a fair number of clinically incompetent docs survive in the community, and yes, even in highly competitive markets as long as they met certain other criteria, such as P-G or billing. It's pretty easy to slip clinically in both community and academia, and I haven't seen many folks booted out except for personality issues. YMMV, of course.

 

[TheComebacKid]

I've duked out this argument with many people on SDN over the past several years and I am always in the minority. I preferentially chose to go to a 4 year program over a 3 year program, and I think it was the right decision for myself (as it has been for many people who have graduated from my residency). I have been told repeatedly by people on this board that I "drank the kool-aid" etc but I really think the discussion on this is extremely one-sided and I would like to offer a different view.

Before I dive into this topic (again), I have to make this disclaimer so I don't get chewed out: Going to a 4 year program DOES NOT (I REPEAT DOES NOT) make you more clinically competent than going to a 3 year program.

I attend a 4 year program that has 7 fellowships and that allows individuals to pursue academic careers and community as well. About 50% of our grads go into academics/fellowship and the other 50% will go into the community. The vast majority of individuals have felt that the extra year is worth it.

If you know you that you want to do tox or EMS straight of medical school, more power to you. For me, it's not that apparent. I know I want to do academics and fellowship because I love teaching/research and so forth. But I have already cycled through critical care, EMS, education, wilderness med and I am still not sure what I want to do (like them all). I have world class educators in all of these respective fields to grab beers with, to research with, and bounce ideas off of and figure out what's right for me. Does 4 years make sense financially? No. But it does make sense to figure out what it is what you want to do for the rest of your life and I would hardly consider that to be a 300K mistake.

4 year programs, in my opinion, without a doubt better prepare you for an academic career than 3 year programs. 3 year programs do not have the time to develop any academic niche, less elective time, and a more compressed clinical schedule that takes away from exploring academic interests. I can tell you that the vast majority of our fellowships prefer 4 year graduates. 3 year graduates are considered most definitely, but for a multitude of reasons are not ranked as highly (I have discussed this with fellowship directors at my program). If you are coming from a 3 year program you will not be allowed to supervise residents and your clinical time is delegated to essentially fast-track/triage shifts.

When you look at the faculty that our program hires, the VAST majority (>90%) of individuals are either 4 year graduates or 4 year + fellowship trained. There are very few 3 year + fellowship trained grads. There are NO 3 year non-fellowship grads. If you want to go into academics, from the standpoint of our chairman, you either did 4 year + fellowship, 4 year, or 3 year + fellowship. Sure I'm sure it's different elsewhere but that's just how it is at our shop. So I would caution people to think really hard about the value of a fellowship and a 4 year program if you are interested in academics.

I did a four year program. Our EMS fellow had done three years. Four year programs are the biggest scams ever. Maybe things have changed in the last decade, but I would do three years and two fellowships vs four years and one fellowship. Such a scam to get more free resident labor.

Prospective applicants have power in how they rank programs. I would hardly consider it "a scam" since most programs are transparent about what their curriculum entails and what their justification is for the 4th year. If you think that the 4th year is "a scam" then there are plenty of great 3 year programs you can go to. Many individuals (believe it or not) actually prefer going to a 4 year program and preferentially ranked 4 year programs ahead of 3 year programs.

Your career isn't all about money, but in general a fellowship is just as much a "$400K mistake" as an extra year of residency. It's not going to help you get a job that pays well. At best it'll help you get a job that pays less (i.e. an academic one.)

Be wise about these decisions. They do have consequences, both for the types of jobs you'll be able to get as well as your finances. In EM, a fellowship is generally for someone who wants to be on a tenured academic faculty for the rest of their career. Many of those jobs DO want to see a fellowship, and that fellowship will be your niche for the rest of your career. But to be a pit doc in a community ED like the other 90% of us....you'd better be really interested in doing it to "spend" $300K after-tax to get it.

Your "holier-than-thou" mentality towards people who want to pursue academics/fellowships/4 year programs is really off putting. Finances are important but some individuals are really passionate about academics/research and so forth and feel like they would thrive in academics. In my opinion, going to a 3 year program and working for a CMG right out of residency where you sell your soul to a corporation is as much akin to the "400K mistake" as doing a fellowship. There are TONS of people who leave residency and go into the community and are miserable, highly overworked, under compensated and have ridiculous metrics to put up with everyday. There are a TONS of people who go into academics and although they make less money, are happy at work and have very high job satisfaction. My academic attendings are not as financially well off as some of the community ED folks, but they have stable finances and are happy to come to work everyday and are working well into their 70s because they love what they do. Not saying this can't happen in the community as well (I know there are tons of great community jobs as well) but people can be happy in a variety of different work environments based on their interests and personality.

 

[deleted547339]

Hey, I'm glad my thoughts have been helpful. Feel free to PM me with more questions. Remember YMMV.

EM is a weird field (I'm sure all other fields are weird in their own way). It's hard- you crank for years and think tests, research, academic accolades and excellence. That may carry over into EM academia, but in the community where 90% of EM docs practice all that matters is personality and scheduling flexibility. That's it. Certainly people work in Seattle and Portland in academia, and you can if that is your absolute, ultimate goal. But there is only one residency (for now) in each locale, and they may or may not be your cup of tea, so if geography is that important you might want to consider whether working in the community is an option for you. In any case, those are tough markets (Portland particularly), so you might want to start strategizing and networking now.

Why does everyone want to live in Portland. I mean it’s nice, but it’s not this Holy Grail city like it’s treated. Seriously, what is the obsession????

 

[enalli]

I don't care for the 1-billion-dollar mistake argument--people should do what makes them happy, and sometimes that means leaving money on the table. I do strongly disagree with the view that academic-minded students should preferentially go to 4-year programs.

I attend a 4 year program that has 7 fellowships and that allows individuals to pursue academic careers and community as well.

There are many 3-year residencies that offer a similar breadth of fellowships.

If you know you that you want to do tox or EMS straight of medical school, more power to you. For me, it's not that apparent. I know I want to do academics and fellowship because I love teaching/research and so forth. But I have already cycled through critical care, EMS, education, wilderness med and I am still not sure what I want to do (like them all).

Let's say someone was undecided between wilderness medicine and EMS -- they could go to a 3-year residency and do fellowships in both in the same time that it would take a 4-year grad to do one.

4 year programs, in my opinion, without a doubt better prepare you for an academic career than 3 year programs. 3 year programs do not have the time to develop any academic niche, less elective time, and a more compressed clinical schedule that takes away from exploring academic interests.

Comparing a fresh 4-year grad with a fresh 3-year grad from an academic standpoint is silly. What you should be comparing is a fresh 4-year grad with a 3-year grad fresh out of a 1-year fellowship. It's obvious who developed the stronger academic niche.

 

[miacomet]

Northwell has a three year program with an optional, guaranteed fourth year fellowship in EMS, Peds, Ultrasound, or International. Best of both worlds, IMHO

 

[The White Coat Investor]

Your "holier-than-thou" mentality towards people who want to pursue academics/fellowships/4 year programs is really off putting. Finances are important but some individuals are really passionate about academics/research and so forth and feel like they would thrive in academics. In my opinion, going to a 3 year program and working for a CMG right out of residency where you sell your soul to a corporation is as much akin to the "400K mistake" as doing a fellowship. There are TONS of people who leave residency and go into the community and are miserable, highly overworked, under compensated and have ridiculous metrics to put up with everyday. There are a TONS of people who go into academics and although they make less money, are happy at work and have very high job satisfaction. My academic attendings are not as financially well off as some of the community ED folks, but they have stable finances and are happy to come to work everyday and are working well into their 70s because they love what they do. Not saying this can't happen in the community as well (I know there are tons of great community jobs as well) but people can be happy in a variety of different work environments based on their interests and personality.

Nothing holier than thou about it. Simply stating facts. A fellowship will help you get an academic job. An academic job pays less than a community job on average. If you want to do academics, you probably ought to do a fellowship. You also need to be okay with being paid less. The good news is that even academic emergency docs who do a four year residency AND a fellowship still make plenty of money to have a great life and even retire early very comfortable if they manage their money well. As mentioned earlier, money isn't everything in a career. It's not even the most important thing. It might not even be in the top three most important things. But very few of us would do this work for free, so you probably ought to pay some attention to it.

But students/residents should be told that few in the community care about their fellowship training and it isn't some magic way to get a competitive job in Portland.

 

[Birdstrike]

Four year EM programs are great...


...as a way to get your first year attendings to work for an 80% pay cut.