Least competitive programs

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Here's my list of the easiest programs to match at:

Highland, Harbor-UCLA, Denver, Cincinnatti, Hennepin, Bellevue, Carolinas.

Feel confident in listing these as your back-up programs.
 
Sure...it's been well established that these are worst.

1.) Wake Forrest...Do you really want to practice rual medicine?

2.) Maricopa (AZ)...It's hotter than hell.

3.) Universtify of South Florida...The nurses are smokin hot, but they're all lesbians.

4.) Las Vegas....They don't have an EM program, but the attendings constantly lose their sporks.


Hope this helps.
 
I've heard that if you're injured in Las Vegas you would be better off driving out into the desert and dying than be seen in one of their ED's.

As for Wake Forest, being in such a rural area allows us to hone our other skills, like tractor trauma and ddx. of various unusual congenital deficiencies.
 
JHU is simply scared of the DO. We FEAR the DO - especially those that are quinn-esque. Try Harvard though, they're pretty realistic for a good shot. Oh, speaking of good shots, MLK is pretty much cake - especially if you are from the east coast (just bring your vest). On that note, Eastern Virginia University is known for their laid-back approach to board scores. Speaking of Scores, Einstein NY, which is located near the infamous SCORES nightclub, is notoriously forgiving on the application....
 
Seaglass said:
I've heard that if you're injured in Las Vegas you would be better off driving out into the desert and dying than be seen in one of their ED's.
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I've been trying to tell people this myself. I figure it would help our overcrowding. 😉
 
Thanks for your replies!! Does anybody else have any experience with less competitive progrmas.. There's gotta be more schools that are decent but not cut throat, keeping in mind that there are 120+ programs in the nation..??
 
We have a somewhat frequent flyer intox that is a doorman at scores. All the male residents are really nice to him. It hasn't proved lucrative yet, though.
 
The least competative EM residency is a FP residency or even IM. If you only want urgent care or work in the Styx, then do a FP or IM path.
 
Aivengo, I'm sure you could guess that the others replying to your message were just kidding around. Cincy, UCLA, Denver, and the others listed are among the most competitive programs around.

Some of the easier programs to get an interview from are, in no random order (and as soon as I send this message, I'll think of some obvious ones that I forgot to include):

MLK/Drew in LA
Lincoln in NYC
Saginaw in Michigan
Detroit Receiving
Sinai-Grace in Detroit
Metropolitan in NYC
Maimonides in NYC

Questionable:
Puerto Rico (+/-)


Keep in mind that three of these "Easy 7" rejected me without an interview. Keep in mind also that some of the "Glamour 20" programs, which are extremely competitive, chose to interview me.

So life is a bit like Forrest Gump's mama used to tell him; and, being like a box of chocolates, you never know what you're gonna get.

Therefore, apply to several longshots, a meaty helping of mid-range programs, and a more than a handful of sh*tty ones, like the Easy 7 listed above.


HORNET

p.s. another moniker for the "Easy 7" is the "Malignant 7". they'll work your fingernails to little nubbins at those places.
 
Unfortunately, I mostly agree with the easy 7, with the possible exception of Detroit Recieving. And yes, I too was rejected from two of the easy seven, whereas I got several interviews from the Glamour 20.

Saginaw is actually a very benign program from what I understand but it's in the middle of nowhere.

Avoid MLK like the plague. Going through a very rough spell now, and not likely to get better any time soon. I wouldn't recommend Lincoln either.

In general, location has a lot to do with competativeness. Some of the best EM programs are actually relatively easy to get in because they're in the middle of nowhere. So, if you're worried about your chances, apply widely, ESPECIALLY to South and Midwest. California is always competative simply by location.
 
Hornet871 said:
Keep in mind that three of these "Easy 7" rejected me without an interview. Keep in mind also that some of the "Glamour 20" programs, which are extremely competitive, chose to interview me.
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It is quite possible that those programs who didn't offer you an interview did so because they didn't think they had any reasonable chance of matching you or that you would not be a good fit for their program (for whatever reason). It's not all about "competitiveness" when it comes to getting residency interviews.
 
Interesting point Sessamoid. What are other factors that come into play when PD's are considering people for residency spots?
 
iliacus said:
Interesting point Sessamoid. What are other factors that come into play when PD's are considering people for residency spots?
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Never having been one, I can only speak from limited experience. One short anecdote, though, may illustrate the point. My program is a good one, though geographically challenged. The PD at the time (has changed since I left) would often pass on offering interviews to candidates who were likely going to match at one of the big name programs. It makes sense, as that's a low yield investment when they could be interviewing a candidate that might actually match there. On the other hand, they did interview a stellar applicant (Harvard MD/MPH) because of a professed (and demonstrated by prolonged time on 3rd world medical missions) interest in working in underserved areas and fluency in Spanish, who did end up matching at the program.

Put yourself in the PDs shoes and try to understand that they have a limited number of interview spots, and that they'd like to maximize the yield of those spots.

Another thing that may affect interview decisions include political leanings that you've let on in the application. Gun control freaks would not have been popular at my program, for instance. A strong social support system in the area may help tilt the balance in your favor. A resident without friends or family in the area is more likely to turn out to be a depressed and unhappy resident than one who has roots in the area.
 
I heard that Detroit Receiving and Sinai Grace are now more competitive because the PDs pick up alot of US-IMGs with step 1 scores greater than 240.

I do believe someone has been lying to me! 😡
 
Out of simply curiousity, what exactly are the "glamour 20"? Its been discussed a MILLION times on here but it seems that a name has finally been put to the top programs. OK, OK, I konw they aren't really the "top" programs, but I like the terms "glamourous". How about now identifying them. Hornet, I want a list! This is fun.
 
iliacus said:
Interesting point Sessamoid. What are other factors that come into play when PD's are considering people for residency spots?
Click to expand...

Sessamoid's point is great. I have another example. When we were revieiwng for interviews last year, one applicant had like a 260+, great LORs, and stated over and over that they wanted to "be at the forefront of EM research." Well, my program is definately not the research mecca... this plaec wouldn't quite fit for them. We didn't bother offering them an interview, even though they were a great applicant!
 
What is a "top program?" I know MLK is a nightmare just because they're constantly in the news with horror stories about neglected patients. Is there really a huge difference between Wake, Miracopa, and South Florida (other than picking funny sdn posters) I get the impression that "top" programs are ones that people want to get into because of the location i.e. harbor-ucla, ucsd etc. The only thing that makes them a "top" program is their geography.

Sessamoid thanks for the perspective. You make good points and I see what you were eluding to in your earlier post.
 
iliacus said:
What is a "top program?" I know MLK is a nightmare just because they're constantly in the news with horror stories about neglected patients. Is there really a huge difference between Wake, Miracopa, and South Florida (other than picking funny sdn posters) I get the impression that "top" programs are ones that people want to get into because of the location i.e. harbor-ucla, ucsd etc. The only thing that makes them a "top" program is their geography.

Sessamoid thanks for the perspective. You make good points and I see what you were eluding to in your earlier post.
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As noted, most of the "top" programs are so because of geography. This also means that those programs get their pick of the best faculty (in general) as well as residents. So those programs considered "tops" are generally staffed by very good faculty as well, so it's not merely a matter of reputation. They probably do provide somewhat better teaching in general, though individual variation may overwhelm that general trend.

For that reason, big name schools with new, unproven programs will probably end up being among those "top" programs based on the desirability of the staff positions.
 
iliacus said:
What is a "top program?" I know MLK is a nightmare just because they're constantly in the news with horror stories about neglected patients. Is there really a huge difference between Wake, Miracopa, and South Florida (other than picking funny sdn posters) I get the impression that "top" programs are ones that people want to get into because of the location i.e. harbor-ucla, ucsd etc. The only thing that makes them a "top" program is their geography.

Sessamoid thanks for the perspective. You make good points and I see what you were eluding to in your earlier post.
Click to expand...

You're several years out from picking a program... but basically all the programs will get you board certified in EM, and you probably won't have any trouble finding a job (unless the market tanks shortly). All the people who were "Grandfathered" into EM and those that "started" the specialty are 20+ years in the workforce, and will be retiring soon... with the youngin's like myself to take their place.

There's not going ot be muhc of a difference. But some programs will emphasize some aspect of EM more than others. Off the top of my head, Pitt = EMS. Univ of MD = Trauma. Denver = Hippies.
 
Apollyon said:
Pittsburgh proper - both Pitt and Allegheny = EMS. And, Denver General Paramedics are the model to follow for EMS (I know, southerndoc will disagree, but nothing succeeds like success!).
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Why would I disagree? Denver Paramedics have a great national reputation.
 
Actually Denver EMS has taken a bit of a hit recently.

http://www.denverpost.com/Stories/0,1413,36%7E23827%7E2301058,00.html

I think many of the Denver medics were clinically some of the best I've worked with. If you were on death's door they could give you your best chance of reaching a hospital alive. Unfortunately, the division did have an overly macho attitude while also being quite closed to much in the way of outside oversight. That led to some loose cannons being allowed to flourish unchecked for quite some years which in turn is now biting Denver Health in the ass.
 
although I have heard good things about denver, my understanding is that medic 1 seattle(king county) under dr coppas is at the cutting edge of ems with the highest out of hospital cardiac arrest save rate, 1st 12 lead ekg program and field tpa years ago in addition to central lines in the field. I applied there as a new medic years ago and they said they had a 5 yr wait list for slots. after acceptance even if you are already a nremt-p you still have to do their 3000 hr medic program which includes atls.
 
From the Denver article:

"That's not a reasonable standard today in terms of what would be expected," said Jay Fitch, president of Kansas City, Mo.-based Fitch & Associates, one of the nation's largest EMS consulting firms.


----

LOFL. Jay Fitch has made huge sums of money disrupting a number of EMS services all across the country. There are a lot of unhappy medics working in systems he has created.
 
I really don't see any utility in central lines and TPA in the field, especially in an urban area. Sounds like an ago trip to me.

blotto, pgy1
 
I agree urban TPA is not necessary. With longer transports, I think it becomes a reasonable concept, esp. when the receiving hosp doesn't have a cath lab.


I disagree on central lines however. Obviously, they are inappropriate and slightly more time consuming when peripheral access is present. However, in the face of desperate hemodynamic instability or cardiac arrest, a "life line" is de riguer. We placed IJs and subclavians where we worked- typically on codes, bad traumas, etc. With the increasing size of Americans, access is becoming increasingly difficult, esp. peripherally.
 
Hmm. I'll agree that TPA may be useful in a rural scenario with a long transport time. However I don't see any utility in field personnel placing central lines. Too much opportunity to "stay and play". And in a code drugs can go down the tube, though I admit that this route was usually pretty messy. My old medical director used to say that an IV never saved anyone's life, and I agree with him for the most part. Wasn't there a study a good while back that showed no difference in outcomes in hemodynamically unstable trauma patients - agressive fluids versus none at all?

blotto,
10 year medic, now pgy1
 
blotto geltaco said:
Hmm. I'll agree that TPA may be useful in a rural scenario with a long transport time. However I don't see any utility in field personnel placing central lines. Too much opportunity to "stay and play". And in a code drugs can go down the tube, though I admit that this route was usually pretty messy. My old medical director used to say that an IV never saved anyone's life, and I agree with him for the most part. Wasn't there a study a good while back that showed no difference in outcomes in hemodynamically unstable trauma patients - agressive fluids versus none at all?

blotto,
10 year medic, now pgy1
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Keep in mind, they started using tPA long before it was clear that early cath was superior to thrombolytics. Their primary use of central lines was (is?) in medical arrests where they couldn't get other access.

The other thing that is, unfortunately, unique to King County is their degree of physician oversight. They have incredible physician involvement during their initial training, including physician based field training, and in their ongoing QI.

Damn sad, from my perspective. Sad, that is, because I'd like the whole country to have the same physician involvment. But then, that's why I'm in medical school. 🙂

Take care,
Jeff

18 year medic and now seriously slacking MSIV
 
The previous posters are correct: the central lines are done in medical codes. All patients in cardiac arrest receive either an external jugular line, or preferably, a subclavian central line. The Medic One paramedics are quite proficient at doing these.

Medic One does not carry thrombolytics. They carried them only as part of a research trial. They subsequently removed the drug from the trucks once that research ended.

Someone mentioned the training at Medic One. The UW School of Medicine/Seattle Fire/Harborview Training Program is quite intense (3,200 hours now, it was 3,600 hours but was scaled down a bit). In order to get a spot in the infamous training program, one of the five Medic One agencies (Seattle Fire, King County, Bellevue Fire, Shoreline Fire, or Evergreen Hospital) must sponsor you. They basically pay you to go to school, and in return you must sign a 2-3 year contract. The school is 7 days per week for about 10 hours per day.

Despite all the training they have, the paramedics aren't given much autonomy. Routine things -- such as administering albuterol -- requires an order from online medical control. The only standing orders are for cardiac arrests, trauma, or mass casualty incidents or severe system overload. All others require consultation with online medical control.
 
Agree lines encourage stay and play. Something which is bad in trauma or time-sensitive medical. Where I worked though, codes were supposed to be stay and play. We ran the code where the pt dropped. If we had ROSC, we transported. If we got nothing back, we called the coroner and did not go to hospital.

Did not know that about autonomy issue at Medic 1. That's too bad. All that knowledge and respect and they are still 1/2 "mother may I."

Also about stay and play, you CAN start a central line on the way, it's just not the easiest or smartest idea! ...



Are all you former medics going EM or moving on?
 
I am trying to keep an open mind thru each rotation. I always compare to EM. It is hard to improve on your first love...
 
DrDre' said:
Are all you former medics going EM or moving on?
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Oh yeah. Each painful minute of medicine last year made that decision ever more clear. Not to mention that sheer torture that was the dreaded well-child check... "so what seems to be the problem with Jr.? Nothing? Great...have a nice day"

Take care,
Jeff
 
former medic here............definately EM. I'm finishing up my 8 weeks of internal (eternal) medicine. It is sooo very painful. I can't tell you how much I don't care if someone's sodium is 132 or chloride is a "little low"......let's work up that anemia the patient has had for 10 years. Let 's get some iron studies, B12, RBC folate...................AHHHHHHHHH.

at least at the VA there are quite a few codes.

medicine is killing me.

EM all the way.

later
 
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