Now that the job market is collapsing, can we have some real discussion on the best residency programs?

[DragonSalad]

As many of us MS4s are starting to make rank lists and also consider which interviews to drop vs keep, given the job market, it would be really helpful to hear some advice on what programs are the best for finding good employment in the future.

If you look at basically any time the idea of a "best EM program" is discussed, these common phrases are just repeated:
"go where you want to live"
"does not matter at all"
"In before In-N-Out"
"to get hired you just need a pulse"

Of course, with midlevel creep, residency expansions, CMG takeovers, the future (as is often discussed heavily on this forum) is not looking too bright for new EM grads, and will likely be worse when I graduate residency in ~2025. So when there is a glut of EM docs, or god forbid a new model like anesthesia's 1 doc to 4 midlevels, it almost certainly will matter where you trained, perhaps especially to SDGs.

So other than avoiding HCA and brand new programs, can we hear some advice on what programs really are the best? Assume no specific interest in working in any particular geographic market after graduation, so whatever program would set you up the best nationally.

---

Members don't see this ad.

 

[Zebra Hunter]

Go where you want to live, it does not matter at all. I went to In-N-Out and got a job just fine. To get hired, you just need a pulse.

But seriously, outside of avoiding HCA residencies, if you are planning to do community EM, it really doesn’t matter for job prospects.

 

[BoardingDoc]

As many of us MS4s are starting to make rank lists and also consider which interviews to drop vs keep, given the job market, it would be really helpful to hear some advice on what programs are the best for finding good employment in the future.

If you look at basically any time the idea of a "best EM program" is discussed, these common phrases are just repeated:
"go where you want to live"
"does not matter at all"
"In before In-N-Out"
"to get hired you just need a pulse"

Of course, with midlevel creep, residency expansions, CMG takeovers, the future (as is often discussed heavily on this forum) is not looking too bright for new EM grads, and will likely be worse when I graduate residency in ~2025. So when there is a glut of EM docs, or god forbid a new model like anesthesia's 1 doc to 4 midlevels, it almost certainly will matter where you trained, perhaps especially to SDGs.

So other than avoiding HCA and brand new programs, can we hear some advice on what programs really are the best? Assume no specific interest in working in any particular geographic market after graduation, so whatever program would set you up the best nationally.

To repeat the quotes you listed above....

Go where you want to live. Outside of academics, it really doesn't matter where you go. It matters if you know someone who works at the shop you want a job at. If you don't have that, it matters if you can manage not to come across as a total creep when/if you interview.

Community gigs don't care where you went. If you want an academic gig, go to a big name academic program and then do a fellowship.

 

[alpinism]

The problem with choosing the "best residency program" is that most jobs don't care where you did residency.

But as a general rule of thumb the older the residency the more post graduation employment opportunities.

 

[Mushdoc]

The reason community jobs (which are the majority of jobs) don’t care where you trained is that prestige residencies don’t train you better to be a community doc. There is not a correlation between training at a high trauma, academic, research heavy, inner city program that is heavy on consultants and sees LVADs and weird chemo and being a better community doc where you are expected to move the meat, document well, keep patients and consultants happy and not get sued too often. This is coming from someone who trained at an academic place

 

[JacobMcCandles]

it almost certainly will matter where you trained, perhaps especially to SDGs.

Not really. I've seen great docs come from 'weak' programs and bad docs come from 'strong' programs. The longstanding advice for finding a job still applies. Want a job with a good SDG? There will also be some luck and timing involved.

 

[DragonSalad]

The reason community jobs (which are the majority of jobs) don’t care where you trained is that prestige residencies don’t train you better to be a community doc. There is not a correlation between training at a high trauma, academic, research heavy, inner city program that is heavy on consultants and sees LVADs and weird chemo and being a better community doc where you are expected to move the meat, document well, keep patients and consultants happy and not get sued too often. This is coming from someone who trained at an academic place

So programs with heavier community exposure are better if I want to join a good SDG? E.g Carolinas

 

[JacobMcCandles]

So programs with heavier community exposure are better if I want to join a good SDG? E.g Carolinas

You will need to know how to manage a department. Regardless, if you order some tests, get results, order some more tests, get more results, then order some more tests, etc. you won't last long anywhere.

 

[Tenk]

Damn, if I would have done residency at an In N Out I’d weigh like 400 lbs right now.

 

[Fox800]

No HCA programs.

No four year programs unless you have your heart set on academics, which, at this point, is too early to tell. Or you're dead-set on the west coast, since it makes sense to train in the region you want to work in.

No programs that farm you out to other cities/states to get core rotations done - that's a red flag. An elective is one thing. Sending all of the residents out of town to get a required trauma surgery rotation is a problem.

Well-known 3 year programs are where it's at.

I'll get heat for this, but the top 25 or so programs on the Doximity residency navigator are solid. Lots of old, well-known programs. There are some flukes in there that are riding on location or name (UCLA-OV, Stanford) but for the most part that's a solid list.

Now the real question, the one you need to ask yourself, is which of these is the absolute p o w e r h o u s e program which rules them all?

 

[RustedFox]

The phrase "Powerhouse Residency" is the new "F-A-T-T-Y M-C-F-A-T-T-Y-P-A-N-T-S".

 

[DragonSalad]

No HCA programs.

No four year programs unless you have your heart set on academics, which, at this point, is too early to tell. Or you're dead-set on the west coast.

No programs that farm you out to other cities/states to get core rotations done - that's a red flag. An elective is one thing. Sending all of the residents out of town to get a required trauma surgery rotation is a problem.

Well-known 3 year programs are where it's at.

I'll get heat for this, but the top 25 or so programs on the Doximity residency navigator are solid. Lots of old, well-known programs. There are some flukes in there that are riding on location or name (UCLA-OV, Stanford) but for the most part that's a solid list.

Now the real question, the one you need to ask yourself, is which of these is the absolute p o w e r h o u s e program which rules them all?

I agree that Doximity is mostly crap, but in that case, just as an exercise, here are the top 20 3-year programs on Doximity.

Carolinas
Hennepin
Indiana
Regions
Pittsburgh
Vanderbilt
University of Maryland
Emory
Henry Ford /Wayne State
Christiana Care
Detroit Receiving Hospital
Temple
University of Chicago
Harvard/BIDMC
Ohio State
Advocate Christ
Mayo
U Illinois Chicago
Case/MetroHealth

Bolded where I've had IIs from, in case anyone would like to impart any additional wisdom on my rank list..

 

[GeneralVeers]

The phrase "Powerhouse Residency" is the new "F-A-T-T-Y M-C-F-A-T-T-Y-P-A-N-T-S".

I wish we hadn't banned that POWERHOUSE RESIDENT. His words shall become legendary for all future EM grads.

 

[Angry Birds]

I think it's fair game to want to train at a level-1 trauma center, i.e. major tertiary care center.

 

[BAM!]

what is an HCA residency?

 

[DragonSalad]

The reason community jobs (which are the majority of jobs) don’t care where you trained is that prestige residencies don’t train you better to be a community doc. There is not a correlation between training at a high trauma, academic, research heavy, inner city program that is heavy on consultants and sees LVADs and weird chemo and being a better community doc where you are expected to move the meat, document well, keep patients and consultants happy and not get sued too often. This is coming from someone who trained at an academic place

I think it's fair game to want to train at a level-1 trauma center, i.e. major tertiary care center.

Genuine question from a med student who only got to rotate at a large level 1 trauma center / Academic / County program this year because of COVID:
So if there is a disconnect between these large academic centers and 90% of jobs after residency (i.e in the ccommunity), what are things I should actually be looking for in a program? One that doesn't consult too much? Focus on documentation and billing? More of a "keep the patient happy" vs under-resourced county program? One that has MDs doing high RVUs and pph?

 

[cyanide12345678]

I agree that Doximity is mostly crap, but in that case, just as an exercise, here are the top 20 3-year programs on Doximity.

Carolinas
Hennepin
Indiana
Regions
Pittsburgh
Vanderbilt
University of Maryland
Emory
Henry Ford /Wayne State
Christiana Care
Detroit Receiving Hospital
Temple
University of Chicago
Harvard/BIDMC
Ohio State
Advocate Christ
Mayo
U Illinois Chicago
Case/MetroHealth

Bolded where I've had IIs from, in case anyone would like to impart any additional wisdom on my rank list..

You'll be fine at any of those programs. There's likely little to no difference between any of those from a training perspective.

 

[dadaddadaBATMAN]

Genuine question from a med student who only got to rotate at a large level 1 trauma center / Academic / County program this year because of COVID:
So if there is a disconnect between these large academic centers and 90% of jobs after residency (i.e in the ccommunity), what are things I should actually be looking for in a program? One that doesn't consult too much? Focus on documentation and billing? More of a "keep the patient happy" vs under-resourced county program? One that has MDs doing high RVUs and pph?

It’s fine to train at those residencies. In an ideal world you would probably spend time at one of those centers and a community site where you had less competition for chest tubes and reductions (there’s no competition for reductions but it’s easy to be lazy and hit an ortho resident button if it’s there and some Attendings will).

Really aside from ortho I don’t think I had many weaknesses coming out or one of those places. I will say it’s good to pay attention to what has been done before you received the patient when you get ed ed referrals or are on trauma etc, it’ll help you understand the community doc expectations better.

 

[Fox800]

what is an HCA residency?

A residency program that's based out of an HCA-owned facility. Typically started in the last five years. They tend to have a reputation as new, unproven, and based at a site that has inadequate clinical volume and acuity to provide proper training compared to a tertiary hospital/level 1 trauma center/better-established program.

 

[namethatsmell]

The doximity list is basically a popularity contest and shouldn't be taken too seriously.

Here are some helpful things to look at when evaluating an EM residency:

1) Is it in a major metro (ie >1 million people) or is it the only program in a less dense but very large catchment area?

2) Do residents see lots of peds and in multiple settings?
***Peds exposure is probably the most variable major area of training between EM programs. A super sick kid, while thankfully a low frequency event, is the scariest thing you'll encounter in your EM career. The squirrely kid who may be harboring badness that hasn't clearly declared itself could be the 2nd spookiest thing. You want to see as many kids in residency in as wide a variety of EDs as possible. And a big bonus if you do PICU at a unit where EM residents actually get to do procedures.

3) Are the residents happy with their ICU experiences in terms of diversity of pathology, patient acuity, and having an appropriate level of autonomy?

4) Does the program have its own level 1 (or busy level 2) trauma center where EM does more than just the airway?

5) Was the program founded by a for-profit hospital group or CMG?

If you can answer "yes" to the first 4 questions and "no" to the last question, you've identified a program that will give you the ingredients needed to become an excellent EM doc. After that, go with your gut feeling.

 

[doggydog]

But which programs look best on a twitter bio?

Truest sign of a powerhouse program.

 

[Rekt]

People are listing things that possibly will train you better. Most of the above has nothing to do with job placement. The most important thing is the connections of the attendings that work there. I'd argue the fancy top 20 on doximity would be great for getting you an academic job but you're a cog otherwise and unless you're getting your attending a chair promotion then they don't care about you.

So it's actually very difficult to know what connections they have beforehand. All the jobs of my class last year and the year before were from our attendings talking to people, never listed/recruiter use. Realistically the only thing that will matter is going to a programs near where you want to work or finding spot that has an SDG for faculty but there isn't many programs that do.

 

[JacobMcCandles]

I thought I read that four-year programs are even harder to get into than the three-year programs?

If there's any ounce of truth to that then that's a sad indictment on current and future residents. There is only a very short list of reasons to pick a 4 year program over a 3 year program.

 

[DragonSalad]

You will need to know how to manage a department. Regardless, if you order some tests, get results, order some more tests, get more results, then order some more tests, etc. you won't last long anywhere.

There are some programs that use the fact that their senior residents (PGY3 in some 3 year programs, but mostly PGY4s in 4 year programs) actually manage the department instead of functioning as an upper level resident. I.e. they have to manage the flow of the department.

Is this something that's actually useful, especially in the case of 3 year programs?

 

[JacobMcCandles]

There are some programs that use the fact that their senior residents (PGY3 in some 3 year programs, but mostly PGY4s in 4 year programs) actually manage the department instead of functioning as an upper level resident. I.e. they have to manage the flow of the department.

Is this something that's actually useful, especially in the case of 3 year programs?

Every 3rd year resident everywhere should be managing the flow of the ED. I don't understand the distinction between actually managing the department and being an upper level resident. Those two things are the same, in my opinion.

 

[AlmostAnMD]

We banned the POWERHOUSE RESIDENT too soon.

He never had an opportunity to tell us which was the omnipotent manufacturer of steel residents he was birthed from.

Could've contributed to this conversation quite a bit.

 

[deleted547339]

Every 3rd year resident everywhere should be managing the flow of the ED. I don't understand the distinction between actually managing the department and being an upper level resident. Those two things are the same, in my opinion.

Yea, that’s probably because you went to a good program.

 

[deleted547339]

No HCA programs.

No four year programs unless you have your heart set on academics, which, at this point, is too early to tell. Or you're dead-set on the west coast, since it makes sense to train in the region you want to work in.

No programs that farm you out to other cities/states to get core rotations done - that's a red flag. An elective is one thing. Sending all of the residents out of town to get a required trauma surgery rotation is a problem.

Well-known 3 year programs are where it's at.

I'll get heat for this, but the top 25 or so programs on the Doximity residency navigator are solid. Lots of old, well-known programs. There are some flukes in there that are riding on location or name (UCLA-OV, Stanford) but for the most part that's a solid list.

Now the real question, the one you need to ask yourself, is which of these is the absolute p o w e r h o u s e program which rules them all?

Based on the BS that Stanford just tried to pull with vaccines, I wouldn’t want to be housestaff there.

 

[DragonSalad]

Every 3rd year resident everywhere should be managing the flow of the ED. I don't understand the distinction between actually managing the department and being an upper level resident. Those two things are the same, in my opinion.

From what I understood, in some programs (including my home program) the PGY3 sees his own patients and staffs with the attending, and doesn't really concern himself with the overall management of the department.

As opposed to a program where the 3 junior residents all staff with the PGY3, who ends up overseeing care of 25+ patients at the same time, while also managing the entire department's flow.

 

[JacobMcCandles]

From what I understood, in some programs (including my home program) the PGY3 sees his own patients and staffs with the attending, and doesn't really concern himself with the overall management of the department.

As opposed to a program where the 3 junior residents all staff with the PGY3, who ends up overseeing care of 25+ patients at the same time, while also managing the entire department's flow.

And then the PGY3 staffs all 25 of those with the attending? That doesn't make a whole lot of sense plus the numbers wouldn't hardly ever work out where there is only one PGY3 in the department with 3 other junior residents. To me managing the department isn't necessarily about taking checkout from medical students and junior residents, it's about department throughput. If anything, having a PGY3 responsible for 25+ patients (taking checkout and then seeing the patients) is the exact opposite of managing the department. That will bring a department to a standstill.

 

[Rekt]

From what I understood, in some programs (including my home program) the PGY3 sees his own patients and staffs with the attending, and doesn't really concern himself with the overall management of the department.

As opposed to a program where the 3 junior residents all staff with the PGY3, who ends up overseeing care of 25+ patients at the same time, while also managing the entire department's flow.

Seems pointless. They still have to be seen by attending. The former can still learn to "run a department". Flow comes with volume and optimizing pph along with juggling CVAs, trauma, acute resus instead of having Junior residents do it for you. More things matter than that.

 

[alpinism]

Doximity can be very hit or miss and I personally would not use it to compare programs.

Not to single out specific programs but I have no idea how Mayo is on that list. I'm in academics and don't know of a single person who thinks they're a top tier program and certainly don't know anyone who would hire someone preferentially just because they went there for residency. Sure Its got a prestigious name but that's for sub specialty physicians not for emergency physicians. There's very little education involved with constantly seeing complex sub specialty patients who come to the hospital for admission. In fact they're usually by far the simplest patients and typically you just call a consult and ask what labs and imaging they want ordered. Not only that but in the rare situation that they require any procedures they usually don't want them done by emergency physicians and try to get them admitted to the hospital as fast as possible.

 

[deleted547339]

From what I understood, in some programs (including my home program) the PGY3 sees his own patients and staffs with the attending, and doesn't really concern himself with the overall management of the department.

As opposed to a program where the 3 junior residents all staff with the PGY3, who ends up overseeing care of 25+ patients at the same time, while also managing the entire department's flow.

Our PGY3s will handle their own patients, staff the med student and intern or off service patients in the pod, handle all medical resuscitation, handle all EMS calls, sign EMGs, aid in ambulance triage and try to see any low acuity patients in the hallway/wherever they can see them, etc. That’s what I think of when I think of flow - managing 2pph plus all the other stuff that comes with running a department.

 

[cyanide12345678]

There are some programs that use the fact that their senior residents (PGY3 in some 3 year programs, but mostly PGY4s in 4 year programs) actually manage the department instead of functioning as an upper level resident. I.e. they have to manage the flow of the department.

Is this something that's actually useful, especially in the case of 3 year programs?

No. Not worth 300k. At 3 year programs, 3rd year residents take similar responsibilities.

Half of 4th year is mostly elective months for most programs. Not worth $300,000.

 

[DragonSalad]

The problem with choosing the "best residency program" is that most jobs don't care where you did residency.

You'll be fine at any of those programs. There's likely little to no difference between any of those from a training perspective.

Not to single out specific programs but I have no idea how Mayo is on that list. I'm in academics and don't know of a single person who thinks they're a top tier program and certainly don't know anyone who would hire someone preferentially just because they went there for residency.

The contradiction in these statements is what confuses me, and I assume other applicants as well. On the one hand, repeatedly on this forum I've seen it repeated ad nauseam that jobs don't care about where you did residency apart from the powerhouse In-N-Out. Perhaps this was true 10 years ago, but I'm not sure it will be in 5 years.

Regardless, although alpinism echoed those same thoughts earlier, in a later post he clearly implies that there is a certain group of programs considered top tier (which apparently Mayo does not belong to) from where residents would be hired preferentially.

From what I understand, less than 20% of Mayo patients are the complex referrals, and they do have significant autonomy in the 80% bread and butter. For example, they still split procedures and trauma on top of all airways, whereas I'm surprised to learn that reputed programs like Parkland still have surgery run the show. And they actually do have longitudinal community (10%) and pediatric (25%) shifts all 3 years.

Ironically, Mayo is actually one my top choices - and if it wasn't for this thread, I legitimately would never have heard this criticism of Mayo before, which is held by an academic attending. So I guess this discussion on the best residencies for employment wasn't useless after all? 🤷‍♂️

 

[The Knife & Gun Club]

You’re missing the forest through the trees dude.

Its not that x program is good or bad. It’s that it’s “fine.” The vast majority of them are fine. Some maybe you’ll be a little better at trauma coming out. Or crit. Or “complex referrals” whatever that means.

But very little of that matters when trying to get a job. The MED pathway creates this artificial meritocracy where the best SAT scores go to the best colleges, which prepares you to get the best MCAT to go to the best Med school to get the best step score so you can go to the best residency...etc.

But the reality is no one cares if your training program had 20% Peds in a longitudinal model or is associated with a famous medical school or whatever. It’s “can you do the job well” and play nice in the sandbox with your fellow attendings, consultants, etc.

See the conditions outlined above for what places can probably train you to do the job well.

The only other consideration is old program = big alumni network = easier to get your foot in the door places that maybe wouldn’t be actively recruiting docs otherwise.

 

[Druggernaut]

From what I understood, in some programs (including my home program) the PGY3 sees his own patients and staffs with the attending, and doesn't really concern himself with the overall management of the department.

As opposed to a program where the 3 junior residents all staff with the PGY3, who ends up overseeing care of 25+ patients at the same time, while also managing the entire department's flow.

If you're a doctor in the community, you need to be able to see a lot of patients quickly and efficiently. This is a different skill set than having patients presented to you and confirming that's a reasonable plan and leaving your juniors to carry them out.

The #1 program on my rank list as a med student had the PGY-3 working like you described. I've been at two places since there that briefly had an attending from that program and they were underwhelmed. They were slow and clogged the department up. During the interview presentation there they mentioned they were reworking how they handled senior residents so that complaint would happen less for their future graduates.

I also don't see the appeal in being supervised by someone who's only a year or two ahead of you in training. I think every one of our PGY-3's are competent and safe doctors, but they still have things to learn too.

Namethatsmell and TimedNewRoman's posts are most of what I'd prioritize, with the addition that other specialties routinely doing things in the ED that are within our scope of practice is a red flag.

 

[UrbanEM2]

Hear me loud and clear because I will only say this once: If you want any sort of a career in EM, you MUST, and I repeat MUST train at the University of Cincinnati. Without training at this program there is absolutely no way you will ever find yourself employed as an emergency physician.

That or just about any HCA program. Those are great too.

 

[Fox800]

Hear me loud and clear because I will only say this once: If you want any sort of a career in EM, you MUST, and I repeat MUST train at the University of Cincinnati. Without training at this program there is absolutely no way you will ever find yourself employed as an emergency physician.

That or just about any HCA program. Those are great too.

Would you consider UC a p o w e r h o u s e program?

 

[UrbanEM2]

Would you consider UC a p o w e r h o u s e program?

My post was in gest, but if you insist.

Back when I trained, it was considered strong. It's been a while so that may have changed. I know a handful of doctors that trained in that program and they were fantastic diagnosticians and proceduralists. Just gave me respect for the place.

Ultimately, there are great doctors from every program and bad doctors from even the "best" programs. It really depends on the individual. As long as the program gives residents the breadth of experience to build on as a young attending, it's really up to the individual to become a great doctor.

Dare I say, there are very likely some amazing ER doctors that trained at an HCA program.

 

[EM_kindaguy]

I do believe which program you go to matters - if only for the alumni/ job network being HUGE. Having pretty recently graduated and have worked at a few spots, all of my jobs have not been posted publicly, but rather word of mouth from recent alumni when they need some shifts covered or a new full timer. Network matters a ton with jobs. It's not everything, but it helps. Also definitely helped me that I stayed in the area of residency

 

[Franzd'Epinay]

Med students just never get it.

Ok, that's not totally fair: some SDN-type med students will never get it.

Once a residency program meets a certain threshold as a learning environment (based on catchment area, patient acuity, resident independence, faculty support, etc.), any resident can become competent. How competent depends entirely on the resident's own efforts. Because of this, there is more variability in skills within a residency class than there is between different programs. It is almost certain that the best residents from no-name-but-still-decent programs are better than the worst residents from p o w e r h o u s e programs. The reason why everyone criticizes a lot of the newer programs is that they likely will not meet that minimum learning threshold.

After that, getting a job is like in any other field: who you know matters a lot.

 

[KGflyboy]

Regardless, although alpinism echoed those same thoughts earlier, in a later post he clearly implies that there is a certain group of programs considered top tier (which apparently Mayo does not belong to) from where residents would be hired preferentially.

You are not quite getting the point and are misinterpreting the consensus.

These points, which seem contradictory to you, are NOT mutually exclusive.

Both of the following are true:

1. Some programs are definitely better than others.

2. Going to a better program will NOT help you get a better job in most situations. Employers typically don't care where you trained unless you want to go into academics. Then, training at a big name place can help.

Other points worth focusing on:

1. "Who you know" matters way more than the prestige of your program. Networking is far more important.

2. If you already know the general area in which you want to work as an attending, the best thing you can do is complete your residency in that same geographic area. If you want to work in Dallas, you will be more likely to get your wish by training at a mediocre program near Dallas than by training at a "top tier" program across the country.

3. Residency program rankings mean so little in the non-academic world it makes many of us throw up a little each time a medical student posts questions about which of the traditionally top rated programs they should go to. At this point, I initially assume somebody is trolling when these questions are asked, but then I remind myself not everybody was around to see this topic hashed out over and over again in the past. I realize it is not trolling and is simply another batch of medical students trying to pick a residency for all the wrong reasons because the only advice they have received up to this point was given by academic physicians. That's not their fault. It's just the nature of the beast since most of the ED docs they are exposed to in medical school are inevitably associated with academics to varying degrees. I think many students would take a different approach to making their tank lists of they had more interactions with ED docs who worked in various non-academic settings.

 

[DragonSalad]

Residency program rankings mean so little in the non-academic world it makes many of us throw up a little each time a medical student posts questions about which of the traditionally top rated programs they should go to.

I do appreciate all the advice that is being given, so apologies to the grizzled SDN veterans that had to suffer through this vomit-inducing thread..

However, the reason I created this thread is not to gun for number one ranked program, because I know there is no such thing. The question I posed was if there are any programs considered the best for finding good employment, given the current job market. I wonder if any of the posters above brushing this off as "another one of those threads" are currently applying for jobs? Perhaps involved in the hiring decisions?

The reality is that none of the PGY3s from my home institution have been able to find a job in this city, and this is not a historically saturated area. Having been on many interviews now and having talked to many residents searching for jobs, this isn't that unique. Though I did get the feeling that some of the more well known residencies were having an easier time.

But that's why I asked above if I should be looking for anything in particular: programs that have an SDG as faculty (which are these??), community exposure, "RVUs per MD hour" (this was actually advertised to us in one interview day), PGY3 patients per hour averages, etc.

Despite this, if the consensus is it truly does not matter at all where you train (for the purposes of good employment) beyond meeting the minimum requirements, and it being who you know, then I accept that.

 

[KGflyboy]

The question I posed was if there are any programs considered the best for finding good employment, given the current job market.

That's a reasonable question for sure.

I'm reading between the lines a little based on other info in your response, but it seems like your home program may truly just be in a saturated city. The job market is tough. I started a new job within the last year, albeit I signed a year before the pandemic hit. I work for a SDG that did hire a few people since the pandemic started. All of them were hired based on reputation and knowing people already working for the group. Nobody was hired from a big name program, and I know had opportunities to. We hired people we knew instead. The only person from a big name program hired in recent years happens to be from this area originally and knew people working here.

I really think that despite the tough times your home program PGY 3s are having finding jobs within that city, it would be even tougher for somebody from a well known prestigious program 1000 miles away with no networking connections or ties to your city to get a job there.

I think you should train near where you ultimately want to live if you can find a program you like there.

Or just train anywhere and hope the job market will bounce back. We can always be optimistic right?

 

[Rekt]

I do appreciate all the advice that is being given, so apologies to the grizzled SDN veterans that had to suffer through this vomit-inducing thread..

However, the reason I created this thread is not to gun for number one ranked program, because I know there is no such thing. The question I posed was if there are any programs considered the best for finding good employment, given the current job market. I wonder if any of the posters above brushing this off as "another one of those threads" are currently applying for jobs? Perhaps involved in the hiring decisions?

The reality is that none of the PGY3s from my home institution have been able to find a job in this city, and this is not a historically saturated area. Having been on many interviews now and having talked to many residents searching for jobs, this isn't that unique. Though I did get the feeling that some of the more well known residencies were having an easier time.

But that's why I asked above if I should be looking for anything in particular: programs that have an SDG as faculty (which are these??), community exposure, "RVUs per MD hour" (this was actually advertised to us in one interview day), PGY3 patients per hour averages, etc.

Despite this, if the consensus is it truly does not matter at all where you train (for the purposes of good employment) beyond meeting the minimum requirements, and it being who you know, then I accept that.

You have people closest to the reality of the market answering your questions. A lot of attendings on here have been at cush jobs for years and are very removed from the the market.

I'm not sure why you're even persuing EM still. I love what I do, but we're the next rad onc and approaching fast. I'd go back and pick something else in a heart beat. Remember you're 3-4 years removed from finding a job and it's not like any programs are going to close. In fact there's only going to be more grads from more programs (and more pretend level providers and ivory tower *****s will keep pushing PLPs to further their career). ACEP and the RRC remain silent. They don't care about EM.

 

[Torsion]

I'm in the middle of my intern year and very happy with where I am. Here are what I think a MS4 should be looking for in an EM program:

1) Acuity - We are the only Level 1 in a fairly large metro area of a desirable city ~ 300 visits a day pre-pandemic in our adult ED alone with an additional Peds ED seing 60,000 annually. You want to be forced out of your comfort zone and seeing high acuity right away. I interviewed at some "Ivory Towers" with brand new EDs seeing a whopping 60,000 visits a year that were nearly empty when we took our interview tour. Be careful about these places.

2) Establishment - My program has been around for nearly 40 years with alumni practicing in nearly all 50 states and even some foreign countries. The substantial alumni network will assist in getting your foot in the door in difficult markets. Additionally, because the residency and the group that runs it is well established and has a strong relationship with the hospital system, many of our veteran docs have advanced into hospital executive positions. This means that the business end of the hospital is generally responsive to the needs of the ED.

3) Practice Arrangement - My residency is run by an SDG. These are not as difficult to find as some on this board would have you believe. The EM residency at my medical school was also run by an SDG, I rotated at a program with a strong SDG partnership, and I interviewed at a few others run by SDGs. All it takes is a little planning and knowledge of the business of EM prior to applying and interviewing. I believe that learning environment in a strong SDG run program vs. one in which the core faculty are employed (such as in a large academic quarternary care center) is probably about equal. Both are going to offer a better experience then CMG run or HCA run shops. I think an advantage of an SDG run residency is the potential for better networking for more financially lucrative jobs with better work environments after training.

4) Benefits - Don't underestimate this one. The quality of benefits offered by the hospital system under which you will be employed speaks volumes about how they view their employees and specifically their physicians and residents. I get health insurance with a low deductible and reasonable premiums, I get 100% free parking adjacent to the hospital, I get access to free hot meals in the doctors lounge daily and additionally get a daily food stipend for the main cafeteria which provides a decent array of options. We have a strong, competitive salary for cost of living in the area. We get yearly bonuses. We also get discounts and benefits for business all over town. Oh, and all residents and front-line staff got vaccinated for COVID immediately on the first day they were available.

Compare all of that to the cluster f**k that happened at Stanford last week, or the program at the "Ivory Tower" institution I interviewed at that made residents pay $600 annually for the "privilege" of parking in a deck 300 yards away from the hospital entrance. Bottom line - go where you will be well treated and well supported.

 

[turkeyjerky]

The disparate responses above are evidence that, unfortunately, no one really knows enough to answer the original question, so people always resort to glib responses. I would say that the following are certainly self-evident:

1. All programs are absolutely not equal, in terms of training and job placement, and the two may be somewhat correlated but are certainly not equivalent.

2. It absolutely matters where you train in terms of finding a good job. It probably doesn't matter where you train if you want a crappy job (for now at least, but in the future when true permanent oversupply occurs, it may matter). Unfortunately most people will end up in crappy jobs going forward.

3. In terms of finding a good job, the order of importance is personal > regional > reputational. Figure out where you want to spend your life and go to the best program you can in that area. Do all the residents at program A in city X seem to have an inferiority complex about program B in the same city? You should probably go to program B.

The job market is bad and only getting worse.

 

[partypantss]

How common is it that programs are affiliated/ run by an SDG? That seems to be a fairly important perk that generally isn't advertised much by programs. I've only had a couple places mention it. A running list would be nice.

 

[KGflyboy]

It absolutely matters where you train in terms of finding a good job.

This seems to be contradictory to the consensus on this board for the last several years when this question comes up. I've been following these posts ever since I was a medical student. I followed them again when applying to residencies. I followed them when applying for jobs as a resident. I followed them again when looking for other jobs after residency. I've never seen any attendings on here state you can't get a good job easily if you train at the wrong residency.

Are you basing your diverging opinion on what you predict will happen now that the market is more competitive? I have never encountered a community ED that used name of a residency program to determine whether they wanted to hire a doc or not. That sounds like an exception, not the rule.