Residency Hours: Compare 3 year and 4 year programs

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Aloha folks,

EM residency applicant this upcoming match cycle. Interested in a mix of some 4-year and 3-year programs. I'm wondering if the schedule tends to be more lax/flexible at 4-year programs given the required hours are completed over a longer period of time? Think elective time, vacation, sick-days, time-off, etc.

-PHD

 

[emergentmd]

Pick 3 yrs.

 

[RustedFox]

Aloha folks,

EM residency applicant this upcoming match cycle. Interested in a mix of some 4-year and 3-year programs. I'm wondering if the schedule tends to be more lax/flexible at 4-year programs given the required hours are completed over a longer period of time? Think elective time, vacation, sick-days, time-off, etc.

-PHD

No.

You're amazingly cheap labor at a 4 year program.
You think they'll not squeeze you like the little lemon that you are?!

 

[TheComebacKid]

I'm at a 4 year program.

Again, tons of misinformation out there since everyone here is only about the 3 year programs. Overall, I work less shifts per month than my friends at 3 year programs and get more elective time (maybe it's different at other 4 year programs I can speak only for mine). Yes, you obviously work more shifts total, but I think the work/life balance is there in residency. But I think overall, there is more time to do research, international electives, QI projects, and so forth.

This argument that 4 year programs exist solely for the purpose of cheap labor is somewhat absurd. Different programs have different focuses. Some programs want to carve out extra time for niche projects for people who are interested in them. Other programs want you to focus on the clinical medicine the majority of the time and then go out and conquer the world. There's no right way to do it, and making blanket statements like "pick 3 years" isn't very helpful. It's all about what you want to do, how you want to accomplish it, your financial situation and so forth. There are pros/cons to each.

 

[deleted109597]

There is no simple answer. The data from the only research survey shows that there are some cush 4 year and 3 year programs, and some that are hard. Some 3 year programs have more EM hours than some 4 year programs in fact.
Basically, you'll want to compare the programs you interview at and make your own decision.
Emergency medicine resident clinical hours: a national survey. - PubMed - NCBI

 

[Fox800]

I'd argue that a 3 year program + 1 year fellowship is a much better use of time than a 4 year residency. Makes you more marketable.

 

[emergentmd]

I guess ur are more marketable with a 4th yr for competitive fellowships/admin/health system job.

But 95% will go to the community. A 4th yr will not prepare you any better if you are working at a community hospital.
3yr + 1yr attending >>>>>>>>>>>>>4 yr resident.

 

[alpinism]

I'm at a 4 year program.

Again, tons of misinformation out there since everyone here is only about the 3 year programs. Overall, I work less shifts per month than my friends at 3 year programs and get more elective time (maybe it's different at other 4 year programs I can speak only for mine). Yes, you obviously work more shifts total, but I think the work/life balance is there in residency. But I think overall, there is more time to do research, international electives, QI projects, and so forth.

This argument that 4 year programs exist solely for the purpose of cheap labor is somewhat absurd. Different programs have different focuses. Some programs want to carve out extra time for niche projects for people who are interested in them. Other programs want you to focus on the clinical medicine the majority of the time and then go out and conquer the world. There's no right way to do it, and making blanket statements like "pick 3 years" isn't very helpful. It's all about what you want to do, how you want to accomplish it, your financial situation and so forth. There are pros/cons to each.

This highly depends on the specific program.

I've got friends who trained at 4 year places who never got to do an international rotation and had very few opportunities for research.

At the same time some 3 year places offer international rotations every year and have tons of research opportunities.

 

[DocRPP]

There is nothing wrong with a four year program as long as the fourth year is used wisely. Think Johns Hopkins. Their fourth year is equivalent to the first year of fellowship, if the resident chooses to do one of their own fellowships. And there is no reliable way to determine how the hours compare - it varies from program to program. If the decision to choose the residency comes down to the number of years, then, in my opinion, it should go down to how well the fourth year is used rather than the number of clinical hours.

 

[GonnaBeADoc2222]

I trained at a 4 year program.

Do yourself a favor and do a 3 year program.

4 year programs are a complete waste of time and money. Make no mistake, they exist to exploit residents.

The 4 year programs that market the 4th year as some kind of mini-fellowship are selling you a lemon. Why not just let you graduate and then do a fellowship there? Because it costs them money.

Want to do academics? Do a fellowship.
Want more admin time? Do an admin fellowship. Get an MBA, Get involved in committees when you are an attending.
Want international experience? Do MSF as an attending. Get an MPH.

You can make all sorts of rationalizations as to why a 4 year program might be "right" for "some people." It's a delusion.

 

[SpacemanSpifff]

Aloha folks,

EM residency applicant this upcoming match cycle. Interested in a mix of some 4-year and 3-year programs. I'm wondering if the schedule tends to be more lax/flexible at 4-year programs given the required hours are completed over a longer period of time? Think elective time, vacation, sick-days, time-off, etc.

-PHD

Ignoring the blossoming 4 vs 3 discussion above, and answering your question: totally program dependent. There are some four year programs that work more shifts during ED months than most three year spots (Denver and USC come to mind), but overall I don't think there is a consistent trend. Usually four year programs have more elective time. I don't recall hearing of any programs that have "sick days". Time-off is also program dependent, usually it's 3 weeks in 1 week blocks, or 4 weeks in 2 week blocks.

The 4 year programs that market the 4th year as some kind of mini-fellowship are selling you a lemon. Why not just let you graduate and then do a fellowship there? Because it costs them money.

Residency pay being based off PGY, why would a 4th year resident cost less than a fellow who is PGY4? Fewer hours in the department?

 

[Zebra Hunter]

There is nothing wrong with a four year program as long as the fourth year is used wisely. Think Johns Hopkins. Their fourth year is equivalent to the first year of fellowship, if the resident chooses to do one of their own fellowships. And there is no reliable way to determine how the hours compare - it varies from program to program. If the decision to choose the residency comes down to the number of years, then, in my opinion, it should go down to how well the fourth year is used rather than the number of clinical hours.

Johnny Hopkins’ 4th year is not “equivalent to a fellowship” because you didn’t actually complete a fellowship.

 

[fahimaz7]

No. Don't do a 4 year program unless you feel it's necessary for either academics or to make you more comfortable flying solo.

 

[wonderbread12]

Actually, there was an abstract at SAEM18 in Indy that looked at this... 4yr and 3 yr programs and compared how many weeks they spend on each rotation. They looked at all 206 (or so) programs and it was interesting that the amount of time spent in the ED was near identical. I'm sure the abstract/poster is on the SAEM website...think it was by folks out of Rush

 

[DocRPP]

Johnny Hopkins’ 4th year is not “equivalent to a fellowship” because you didn’t actually complete a fellowship.

This is from their website.

The Johns Hopkins 4-year program, termed Focused Advanced Specialty Training (FAST), is unique in the country in that the 4th year will follow the format of a traditional subspecialty fellowship. Since many fellowships are two years in duration, a further major advantage to the new program is that the FAST track chosen will be considered equivalent to the completion of an entire year of a fellowship (similar to advanced placement) at Johns Hopkins. Thus, further subspecialty fellowship training in the area chosen, should it be pursued, would be one year less than the standard program.

So as I said, their fourth year is equivalent to the first year of fellowship, if the resident chooses to do one of their own fellowships.

 

[GonnaBeADoc2222]

Residency pay being based off PGY, why would a 4th year resident cost less than a fellow who is PGY4? Fewer hours in the department?

If the fellowship is ACGME accredited, they can pay you on the PGY scale. Things like admin, ultrasound, research, etc. are not ACGME accredited fellowships. Depending on the arrangement, people usually get something like 0.5 attending pay.

No. Don't do a 4 year program unless you feel it's necessary for either academics or to make you more comfortable flying solo.

It's not necessary for academics...at all.

If you need a 4th year to "make you more comfortable flying solo" you shouldn't be an ER doc.

This is from their website.

So as I said, their fourth year is equivalent to the first year of fellowship, if the resident chooses to do one of their own fellowships.

I stand corrected. That's pretty interesting. There are some 1 year fellowships though. Also, I would still want the freedom to leave Hopkins for fellowship if I had to for personal reasons, or if I just didn't gel with the faculty that the fellowship is under.

 

[deleted547339]

This is from their website.

So as I said, their fourth year is equivalent to the first year of fellowship, if the resident chooses to do one of their own fellowships.

That’s bogus.

Fellowships come in two flavors - acgme and non-acgme accredited. The acgme isn’t going to let you double dip. Hopkins can’t be accredited for a 3 and 4 y EM program. If you want to do tox or critical care, there’s no way you can double dip. Sure, if you want to do 2 years of international med or something along those lines you can and have it “count,” but call it was it is - a fourth year of residency with a lot of elective time followed by an abbreviated non-acgme fellowship.

Plus, most non-acgme fellowships are one year.

 

[Zebra Hunter]

This is from their website.

So as I said, their fourth year is equivalent to the first year of fellowship, if the resident chooses to do one of their own fellowships.

There is essentially only one fellowship that I can think of where this is beneficial due to being non-ACGME accredited and greater than 1 year of training and that is international medicine. I'm sure there might be 1 or 2 more, but as stated above, ACGME would not allow such a thing to happen for Toxicology or CC.

 

[Psai]

If the fellowship is ACGME accredited, they can pay you on the PGY scale. Things like admin, ultrasound, research, etc. are not ACGME accredited fellowships. Depending on the arrangement, people usually get something like 0.5 attending pay.



It's not necessary for academics...at all.

If you need a 4th year to "make you more comfortable flying solo" you shouldn't be an ER doc.



I stand corrected. That's pretty interesting. There are some 1 year fellowships though. Also, I would still want the freedom to leave Hopkins for fellowship if I had to for personal reasons, or if I just didn't gel with the faculty that the fellowship is under.

Ultrasound fellowship? Research fellowship? hahahaha what a scam

 

[TrailRun]

When I was deciding 3 vs 4, I talked to a resident from each of my top 4yr programs 'off the record.' These are fantastic programs BTW (HAEMR, BMC, Brown). Each universally said "I wish I picked a 3..." Since I was switching specialties and had already done a year of residency, I knew the pain they were experiencing. Although I'm sure there are residents there who are happy with 4.

Once you're in residency, you realize ANYTHING to shorten it would be welcome. No control over your schedule, working so much that you start to lose sight of why you enjoyed medicine in the first place, etc. That said, if you went straight through undergrad to med school, one more year should not make or break things. But 3 yrs will get you where you want to go regardless. My factors when choosing were 1. location, 2. culture, 3. 3>4. If I didn't get my top 3 yr I would have been happy at a 4 though.

Also, I'd like to see people start 'fighting back' against the trend toward more and more training, across all specialties. Med students taking a year off to do research? Gen surg residents doing 2 years of research and then fellowships on top of that? WTF. From a financial standpoint, it's a great loss. From a life standpoint, that's also time that could be better spent living. And I get that people want to be "clinician-scientists" but let's save jobs for someone else, aka I'll be the clinician and someone else can be the scientist.

To come back to your original question, I don't think shifts/hours are more compressed in a 3 year. There's just less elective time, from my experience. To me, 5 months vs 1-2 months of elective time wasn't worth the extra year. And that would be true especially if you're thinking a fellowship (like critical care or tox or peds which will add 2 more years).

 

[The White Coat Investor]

Aloha folks,

EM residency applicant this upcoming match cycle. Interested in a mix of some 4-year and 3-year programs. I'm wondering if the schedule tends to be more lax/flexible at 4-year programs given the required hours are completed over a longer period of time? Think elective time, vacation, sick-days, time-off, etc.

-PHD

Yes, you get more elective time. No, it isn't 12 extra months of electives.

 

[deuist]

No. Don't do a 4 year program unless you feel it's necessary for either academics or to make you more comfortable flying solo.

Not at all true. In this survey of department chairs at academic hospitals, completing a four-year residency program was only considered important for obtaining a job as an attending at a four-year program. None of the three-year programs seemed to care.

 

[deleted109597]

Residency pay being based off PGY, why would a 4th year resident cost less than a fellow who is PGY4? Fewer hours in the department?

Fellows get to be attendings as well, but they are paid less than what they earn by a long shot.

 

[Fox800]

Change my opinion: there’s really no beneficial reason to pick a four year program over a three year program, except geography (CA, Denver, Washington, NYC). Four year programs continue to be four years long because it benefits their departmental staffing from a financial standpoint, and use applicants’ geographical preferences to take advantage of this, under the guise of “reputation/better training”.

 

[surely]

Actually, there was an abstract at SAEM18 in Indy that looked at this... 4yr and 3 yr programs and compared how many weeks they spend on each rotation. They looked at all 206 (or so) programs and it was interesting that the amount of time spent in the ED was near identical. I'm sure the abstract/poster is on the SAEM website...think it was by folks out of Rush

I found the abstract you're talking about, out of Rush and everything, but it doesn't seem to say what you thought it did:

"Results: 200/202 programs (99%) had data available and the percent agreement was 99.9%. Among 3-year programs, the mean length of EM home rotations was 76.0 weeks, EM away 8.7 weeks, critical care 16.4 weeks, anesthesia 2.7 weeks, orthopedics 2.5 weeks, trauma/burn 6.8 weeks, ultrasound 2.4 weeks, obstetrics 3.1 weeks, pediatric EM 8.1 weeks, toxicology 1.6 weeks, emergency medical services (EMS) 1.8 weeks, administration 1.3 weeks, elective 6.4 weeks, and research 0.8 weeks. Among 4-year programs, the mean length of EM home rotations was 92.8 weeks, EM away 13.0 weeks, critical care 18.1 weeks, anesthesia 3.0 weeks, orthopedics 3.0 weeks, trauma/burn 6.7 weeks, ultrasound 2.7 weeks, obstetrics 3.1 weeks, pediatric EM 10.7 weeks, toxicology 2.8 weeks, EMS 2.3 weeks, administration 1.9 weeks, elective 12.2 weeks, and research 1.4 weeks. "

On average, the 4-year programs have 16.8 more weeks of EM home rotations, and 4.3 more weeks of EM away rotations. That's just about five extra months. Not that that tells us the real story: Number of hours in the ED, or at least number of shifts would be needed to make that comparison.

Either way, put me in the camp of 3 > 4 years. If you want to be somewhere specific for a geographic reason, fine, but it's not like residency is your last chance to live somewhere. You could always move out there as an attending as soon as you graduate from your 3 year program. There does not seem to be a widespread decrease in shift burden (shifts per month) at 4 year programs as compared to 3 year programs, to answer your question, OP.

 

[alpinism]

Choosing a 4 year program is basically the same as choosing $150/per hour job when you graduate.

These programs exist because some people are willing to work an extra year to live in a certain location.

 

[GonnaBeADoc2222]

Change my opinion: there’s really no beneficial reason to pick a four year program over a three year program, except geography (CA, Denver, Washington, NYC). Four year programs continue to be four years long because it benefits their departmental staffing from a financial standpoint, and use applicants’ geographical preferences to take advantage of this, under the guise of “reputation/better training”.

There are only two reasons to go to a four year program (neither of which have anything to do with the program being 4 years):

1) Personal need to be in location X
2) Previously established strong research relationship with a faculty member at said program with future academic aspirations in that sub-field (I imagine that this is a very rare circumstance)

 

[Petypet]

do a 3 year program and moonlight extensively

 

[enalli]

To answer the original question: no, that is not a correct assumption. There are four-year programs that work you to the tune 20 12-hour shifts per month (not including conference time). Make sure to ask for this information at each interview.

 

[engineeredout]

How about just go where you think you'll be happy?


3 years, 4 years, 5 years, in the scheme of things it really doesn't matter.

 

[deleted109597]

How about just go where you think you'll be happy?


3 years, 4 years, 5 years, in the scheme of things it really doesn't matter.

Because studies have shown that we are, in fact, *****s. So fluidity is important. Bounce around until you're happy. Unless you're happy bouncing around. Whatevs. But picking ahead of time that "I will be happy here" doesn't always work. Always, always have options.

 

[fahimaz7]

Not at all true. In this survey of department chairs at academic hospitals, completing a four-year residency program was only considered important for obtaining a job as an attending at a four-year program. None of the three-year programs seemed to care.

No kidding. That's why I said if it is necessary. I'm an attending as well. Not some off the street kid that has no clue what's going on in our field.