Residency program deal-breakers

[bestjess80]

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So I have realized after completing about 5 interviews so far that there a few deal-breakers for me. In other words, aspects of a program that, no matter how awesome it is otherwise, I just couldn't spend 3-4 years of my life there.
One of these is 12-hour shifts. I took about 6 yrs between undergrad and med school, and now have two kids. I realized that working 7am-7pm (really 6am - 8pm with commute, wrapping up charts etc) or vice versa, 8 months out of the year, for 3 years would mean never seeing my spouse or kids most days out of the week. I just can't do that.
I am also having a hard time with programs that use only paper charts, but I think I'm spoiled in that regard since my home school has an awesome EHR system that I've gotten used to. Not sure this is a deal-breaker, but definitely a huge downside.

What are some other things that are deal-breakers for you?

 

[catmandoo]

I had an interview where I was relentlessly asked about every other place I had interviewed. I tried to redirect focus back to the positives of the specific program I was interviewing at and said I didn't want to go negative.. but the line of questioning continued. I was so uncomfortable. I had volunteered before med school at that hospital so I knew many of the attending and had been reasonably interested at the start of the interview.

 

[Anon212]

I had an interview where I was relentlessly asked about every other place I had interviewed. I tried to redirect focus back to the positives of the specific program I was interviewing at and said I didn't want to go negative.. but the line of questioning continued. I was so uncomfortable. I had volunteered before med school at that hospital so I knew many of the attending and had been reasonably interested at the start of the interview.

I had one of these. The PD spent 90% of the interview trying to figure out why I'd want to live there when my parents live in another city. I explained that I don't feel any particular need to live close to my family and I haven't lived there since high school- he said I'd definitely change my mind and that I'd really like having my family nearby. I couldn't convince him otherwise. Eventually I also ended up wondering why I applied there in the first place (even though I originally was actually pretty interested in the program).

I mistrust programs that have the PD/assistant PD in the room during the resident lunch. Isn't the point to hear unbiased opinions?

"we have a lot of boarders" is never a good thing (my home program has this problem and it's a huge, huge pain).

There are others, but they're more personal and probably wouldn't apply to most people.

 

[winkleweizen]

number 1 deal breaker-4 years

 

[migm]

ED services that don't have the final say on whether to admit, EDs where the only point is to move the meat and resuscitations are quickly dispatched to ICU

 

[FSU2013]

.

 

[woeiru]

Programs where the residents brag about how few shifts they have to work. That's completely personal though, I can see how it would be a major plus for some people.

 

[RustedFox]

number 1 deal breaker-4 years

Yeah, this.

Granted. I'm a first-year-out attending from a three-year program. There's still a ton of stuff that I learn on a daily basis out here in AttendingLand. I've had those gooey moments where I've thought that "I just killed a person" or "Why didn't I learn this whenever I...."


Whatever.


I could have spent eleventeen years in residency, and not known about half of the stuff that I now know, see, and "work" on a daily basis.

We're all just doing our best, as we go on.

Sure, some of the stuff is "canon".

A lot is "known".

Some is "regional".

It just all... comes and goes.

I remember the day where someone gave a lidocaine bolus to some patient requiring some critical intervention way back in residency, and thinking - "Maaan, I'll never forget this lidocaine dose."


....


No idea why we gave lidocaine, or at what dosage.


Point being: All you MS-4s out there that are splitting hairs about which program will give you the best pediatric south-american oncology away rotation experience.... knock it off.


When you go to work the next day as an attending:

"Chest pain, 55 y/old male."

All day long.

 

[deleted109597]

Starting IVs, drawing labs, pushing patients to radiology.

Paying for food and/or parking.

Places where everything is negative.

 

[dotcb]

Agree - 12 hour shifts - even as an attending I would never wanna work 12's.

Spending your shifts doing ED nurse and tech tasks.

Programs where medical simulation pinch hits for the absence of large volumes of sick patients.

Paying for parking.

Programs where years 2, 3, and 4 are repeats of each other.

 

[DeadCactus]

Not a complete deal breaker but I agree that a lack of free food and parking are huge negatives to me. Apart from the financial implications, I think it is a great surrogate for how the program views residents. A city with a high cost of living is a big negative for me to. People spending an extra $10k a year to live in a city they'll barely see are nuts to me.

I haven't run into one yet but a program without longitudinal peds shifts would be a negative...

 

[winkleweizen]

Not a complete deal breaker but I agree that a lack of free food and parking are huge negatives to me. Apart from the financial implications, I think it is a great surrogate for how the program views residents. A city with a high cost of living is a big negative for me to. People spending an extra $10k a year to live in a city they'll barely see are nuts to me.

I haven't run into one yet but a program without longitudinal peds shifts would be a negative...

Agreed with the longitudinal peds...

 

[DrYoda]

number 1 deal breaker-4 years

+1

This is the only absolute deal breaker for me.

 

[Foster23]

+1

This is the only absolute deal breaker for me.

This really narrow down your choices, especially if location is of great interest.

 

[winkleweizen]

This really narrow down your choices, especially if location is of great interest.

Not really...so you cant move to denver or san fran? Thats about it. big ****ing whoop.

 

[RustedFox]

There are a number of four year programs in the east, too. I planned on staying somewhere in the NE/midatlantic region, and my list was whittled down significantly because of the "$250,000 mistake" that is the fourth year.

"Location" is highly subjective. For me, it was: "This program in PA is okay, thanks to location. This other one? No freakin' waaaaay."

 

[winkleweizen]

There are a number of four year programs in the east, too. I planned on staying somewhere in the NE/midatlantic region, and my list was whittled down significantly because of the "$250,000 mistake" that is the fourth year.

"Location" is highly subjective. For me, it was: "This program in PA is okay, thanks to location. This other one? No freakin' waaaaay."

If you want to move to chicago, you have three year programs there...boston-3 year programs...NYC-3 year programs. I, personally, dont think cutting out 4 year programs has narrowed my geographic possibilities too much, if it all. Unless you are gungho on a few select areas, of course, in fact theres plenty of places i find desirable that only have 3 year programs.

 

[RustedFox]

If you want to move to chicago, you have three year programs there...boston-3 year programs...NYC-3 year programs. I, personally, dont think cutting out 4 year programs has narrowed my geographic possibilities too much, if it all. Unless you are gungho on a few select areas, of course, in fact theres plenty of places i find desirable that only have 3 year programs.

I agree, but "location" means different things within a state. Would I take a job in Virginia ? Sure. Close to DC ? Hell no.

 

[Cerberus]

Agree - 12 hour shifts - even as an attending I would never wanna work 12's.

Spending your shifts doing ED nurse and tech tasks.

Programs where medical simulation pinch hits for the absence of large volumes of sick patients.

Paying for parking.

Programs where years 2, 3, and 4 are repeats of each other.

Hmm, I'm actually hoping to work more 12s next year. I'd rather get work done and not have to come in an extra day to get my hours.

 

[SserPrun95]

Do?

 

[UnderwaterDoc]

This really narrow down your choices, especially if location is of great interest.

I was under the impression that most places now were 3 years, something like 80% of the programs out there. Is that not true?

To answer the thread, 4 years was really the biggest deal breaker for me, didn't apply to a single one.

 

[SeekerOfTheTree]

I was under the impression that most places now were 3 years, something like 80% of the programs out there. Is that not true?

To answer the thread, 4 years was really the biggest deal breaker for me, didn't apply to a single one.

I concur. I did the same. 4 years is pointless for me.

 

[RustedFox]

I was under the impression that most places now were 3 years, something like 80% of the programs out there. Is that not true?

To answer the thread, 4 years was really the biggest deal breaker for me, didn't apply to a single one.

California is full of 4 year programs. The vaaast majority are three, yes. There is the "odd" four-year program or two in Jersey, NY, Illinois, other metro areas.

The fact that Cali has pretty much exclusively four-year programs speaks to what kind of a socialist quagmire that *that* place is. They pretty much need indentured servitude to support the legions of entitled freeloaders that flock to the place.

Not that I'm bitter over the election or anything...

Wonk.

 

[winkleweizen]

California is full of 4 year programs. The vaaast majority are three, yes. There is the "odd" four-year program or two in Jersey, NY, Illinois, other metro areas.

The fact that Cali has pretty much exclusively four-year programs speaks to what kind of a socialist quagmire that *that* place is. They pretty much need indentured servitude to support the legions of entitled freeloaders that flock to the place.

Not that I'm bitter over the election or anything...

Wonk.

hahaha...just gotta go for sacramento, loma linda, or orange county and avoid LA, SF and oakland.

 

[RustedFox]

California = great place to visit. Terrible place to make a paycheck.

There's a reason why they call it "Commiefornia".

Best buddy of mine from residency is an Asian fella from LA. He works in Vegas. Called him yesterday. His whole attitude is: "Yeah, Cali is great... until you begin to make a paycheck. Then...everyone gets a piece of your work. I'll live next to it, but I won't work there."

 

[Anon212]

I prefer four-year programs...*shrug*. To each his own.

 

[Daiphon]

It's been a while since I went through this, but the biggest deal breaker for me was *not* having graduated responsibility... I didn't want to be locked into a role based on my PGY status.

Sent from my DROID BIONIC using Tapatalk

 

[Cerberus]

Not a complete deal breaker but I agree that a lack of free food and parking are huge negatives to me. Apart from the financial implications, I think it is a great surrogate for how the program views residents. A city with a high cost of living is a big negative for me to. People spending an extra $10k a year to live in a city they'll barely see are nuts to me.

I haven't run into one yet but a program without longitudinal peds shifts would be a negative...

Food and parking can be hard to come by in NYC. Some programs offer one or the other, some don't. The more competitive a programs location, the fewer perks you can expect.

If you want to move to chicago, you have three year programs there...boston-3 year programs...NYC-3 year programs. I, personally, dont think cutting out 4 year programs has narrowed my geographic possibilities too much, if it all. Unless you are gungho on a few select areas, of course, in fact theres plenty of places i find desirable that only have 3 year programs.

There are 3yr Programs in NYC, but excluding 4 yrs does limit you as it is far from guaranteed that you will get into a 3 (or 4year) program in the city as they all tend to be very competitive. For me, location was far more important than length of program so I applied to both.

California = great place to visit. Terrible place to make a paycheck.

There's a reason why they call it "Commiefornia".

Best buddy of mine from residency is an Asian fella from LA. He works in Vegas. Called him yesterday. His whole attitude is: "Yeah, Cali is great... until you begin to make a paycheck. Then...everyone gets a piece of your work. I'll live next to it, but I won't work there."

Meh, it all depends on what your priorities are. For me, and a lot of people who are in NYC or California, the cut in pay is worth the location. I'd rather make far less money and live in a location I want to be in than make a fortune and live in the middle of the country. It's all preference.

 

[Cerberus]

For me the deal breakers were:

Location - I don't care how great a program is, if it's in a rural area, I'd be miserable (and I'm sure others would feel the same about big cities)

Weak department - having a strong EM department is important. The ER should be in control of the ER and in total control of ER patients. At some places I rotated, trauma swooped in and took over anything good, or anesthesia did intubations on certain days of the week.

Vibe - it was really important to find a place where residents got along and hung out outside of work. You spend a lot of time in the hospital and if you don't get along with your coworkers, it's going to be a long 3/4 years.

 

[Pigg-O-Stat]

Regarding 12 hour shifts...

As a med student, this was by far my biggest concern about going to my program. Like the OP, I have a family, 2 kids, and was concerned about never seeing them. I'm an R2 now, and have a different perspective. Our residency discussed the 12 hour issue about 6 months ago, and our PD gave us the option of changing to 10 hour shifts. It would have meant working an extra 4 shifts per month. As a group, we voted to keep the 12's. Ironically, I was one of the residents who voted to keep 12's.

They are definitely long shifts, but I just couldn't cast a vote that would take away 4 days off each month. I prefer to work longer hours but have more personal days with my family.

As a side note, the program was originally 10 hour shifts, but about 5 years ago the residents voted to change to 12's.

- Adam

 

[deleted109597]

At the same time, shorter shifts have better productivity, because you're not "pacing yourself" for the long haul. At least, that's what the n=1 at Scott and White showed.

 

[NERDY]

How many 12s do you work? 12 hours shifts often end up becoming 13 or 14 hours. With 1/2 days, 1/2 nights - the "off" time is basically spent sleeping, so I prefer shorter shifts.

 

[Pigg-O-Stat]

Not arguing for or against 12's. Just offering a different perspective.

At my program we do 18, 17, 16. (# of shifts per ED block for year 1,2,3 respectively)

 

[NERDY]

Not arguing for or against 12's. Just offering a different perspective.

At my program we do 18, 17, 16. (# of shifts per ED block for year 1,2,3 respectively)

Is there additional time for weekly grand rounds/conference?

 

[Pigg-O-Stat]

Grand rounds are every Wednesday morning, usually 8-1.

 

[NERDY]

Grand rounds are every Wednesday morning, usually 8-1.

So roughly 2-3 days/month that you have to come in on an off day for lecture?

 

[EM_Rebuilder]

Just because I see misconceptions on here, I had to jump in.

I went to a four year program; I do not necessairly advocate 4 year programs, but I think people are VERY foolish to write off any program just because 'its 4 years'.

Someone once said it best on here... EM is a 3.5 year specialty. Four year programs are few and far between; its simply cheaper to sacrifce education when 3 years is adequate.

Many four year programs do offer something special. Sometimes its additional training in a particular sub specilaty, research interests, education interests, or adminstrative duties.

I ranked highly and matched and complete a four year program. When I was ranking programs, what actually appealed to me was the fact that a four year program allowed you to 'spread out the specialty' into 4 years plus offer that extra year of training. I felt like I worked less on a month to month basis and generally enjoyed residency. I started moonlighting my third year, and during my fourth year, I banked.. so it was not a '$250,000 mistake'... I felt like I became a bit more well rounded adminstratively, and that has certainly opened doors in my full time position that I believe may have not been opened had it not been for my training.

I just caution students on shuting out a four year program because of just that. If its at a place you and your family might be happy, go check it out. You might be surprised...

As far as 12 hour shifts... I certainly believe its best to have experience the 'worst case scenario' in residency. I am not sure what percentage of full time jobs out there are 12s, but I would bet it is a majority. There are 8s and 10s and some sort of combos, but they just are not as common. I assure you its better to do a residency with 12s and then go work 8s, than to work 8s in residency and find your dream job that works 12s.

Good Luck.

 

[EM4Reals]

Just because I see misconceptions on here, I had to jump in.

I went to a four year program; I do not necessairly advocate 4 year programs, but I think people are VERY foolish to write off any program just because 'its 4 years'.

Someone once said it best on here... EM is a 3.5 year specialty. Four year programs are few and far between; its simply cheaper to sacrifce education when 3 years is adequate.

Many four year programs do offer something special. Sometimes its additional training in a particular sub specilaty, research interests, education interests, or adminstrative duties.

I ranked highly and matched and complete a four year program. When I was ranking programs, what actually appealed to me was the fact that a four year program allowed you to 'spread out the specialty' into 4 years plus offer that extra year of training. I felt like I worked less on a month to month basis and generally enjoyed residency. I started moonlighting my third year, and during my fourth year, I banked.. so it was not a '$250,000 mistake'... I felt like I became a bit more well rounded adminstratively, and that has certainly opened doors in my full time position that I believe may have not been opened had it not been for my training.

I just caution students on shuting out a four year program because of just that. If its at a place you and your family might be happy, go check it out. You might be surprised...

As far as 12 hour shifts... I certainly believe its best to have experience the 'worst case scenario' in residency. I am not sure what percentage of full time jobs out there are 12s, but I would bet it is a majority. There are 8s and 10s and some sort of combos, but they just are not as common. I assure you its better to do a residency with 12s and then go work 8s, than to work 8s in residency and find your dream job that works 12s.

Good Luck.

👍

 

[Hercules]

My residency did 8s on the weekdays and 12s on the weekends. This was perfect. It got you more weekends off while teaching you just how bad 12s really suck. As far as what is available as attendings, I would say the vast majority of places I looked at were not 12s unless it was a smaller single coverage ED.

 

[Iride28]

Just because I see misconceptions on here, I had to jump in.

I went to a four year program; I do not necessairly advocate 4 year programs, but I think people are VERY foolish to write off any program just because 'its 4 years'.

Someone once said it best on here... EM is a 3.5 year specialty. Four year programs are few and far between; its simply cheaper to sacrifce education when 3 years is adequate.

Many four year programs do offer something special. Sometimes its additional training in a particular sub specilaty, research interests, education interests, or adminstrative duties.

I ranked highly and matched and complete a four year program. When I was ranking programs, what actually appealed to me was the fact that a four year program allowed you to 'spread out the specialty' into 4 years plus offer that extra year of training. I felt like I worked less on a month to month basis and generally enjoyed residency. I started moonlighting my third year, and during my fourth year, I banked.. so it was not a '$250,000 mistake'... I felt like I became a bit more well rounded adminstratively, and that has certainly opened doors in my full time position that I believe may have not been opened had it not been for my training.

I just caution students on shuting out a four year program because of just that. If its at a place you and your family might be happy, go check it out. You might be surprised...

As far as 12 hour shifts... I certainly believe its best to have experience the 'worst case scenario' in residency. I am not sure what percentage of full time jobs out there are 12s, but I would bet it is a majority. There are 8s and 10s and some sort of combos, but they just are not as common. I assure you its better to do a residency with 12s and then go work 8s, than to work 8s in residency and find your dream job that works 12s.

Good Luck.

Great post. Unfortunately the region I applied in doesn't really have many 4 year programs, but I think you make a great point for them. As for 12 hour shifts, I also think thats a great point.

 

[DeadCactus]

I don't know why medicine clings so tightly to this notion that you need to be educated on surviving suckiness. I'm pretty damn sure life will teach us all to deal with our fair share of suck. We're humans, we'll adapt. Twelve hour shifts are the residency version of "No, you can't go home yet. You need to sit around and watch me to be prepared for how terrible being an intern is."

I'm not writing off programs with twelve hour shifts but I sure don't consider them an educational benefit...

 

[SeekerOfTheTree]

Being told a resident was terminated recently at the interview and asked how I would fit into that intense of an environment.

 

[Cerberus]

Being told a resident was terminated recently at the interview and asked how I would fit into that intense of an environment.

Did they give a reason the resident was terminated? There are plenty of good reasons for firing a resident and it doesnt necesarrily mean that the program is malignant.

 

[jbar]

I like my programs set up. 12s the first year, second a third 9s on the weekdays, 12s on the weekends (so more people have a weekend off). Yeah the 12s are long, but there is a difference between doing it for a year and going somewhere that you are working sixteen 12s a month as a 4th year resident.

We also get a 45 minute lunch break in the middle of our 12s, which certainly helps productivity.

 

[my doc in a box]

I don't know why medicine clings so tightly to this notion that you need to be educated on surviving suckiness. I'm pretty damn sure life will teach us all to deal with our fair share of suck. We're humans, we'll adapt. Twelve hour shifts are the residency version of "No, you can't go home yet. You need to sit around and watch me to be prepared for how terrible being an intern is."

I'm not writing off programs with twelve hour shifts but I sure don't consider them an educational benefit...

I can see the pros and cons of 12's vs 8's and am not sure which I'd prefer, but I totally agree with the sentiment I bolded.

 

[EM2013woot]

My initial deal breaker was not having longitudinal peds...but of the places I've interviewed at so far my fav place doesn't have it. It seems like most of my friends also had various "deal breakers" initially...but "fit"/gut feeling is starting to win out.

Also, I'm surprised that 12hr shifts have garnered so much attention while the way nights are scheduled hasn't come up. A few places I've seen do a "progressive" schedule of 2 shifts of days, 2 shifts of evenings, and 2 shifts of nights and then a 1-2 days off...I'm a bit leery of this as I'd rather have all my nights for the month grouped together. I don't want to be a zombie always working on a different sleep schedule, but maybe I'm being dumb about this since I've never actually tried it. Can anybody comment on the pros/cons of various ways nights get scheduled?

 

[EM2BE]

My initial deal breaker was not having longitudinal peds...but of the places I've interviewed at so far my fav place doesn't have it. It seems like most of my friends also had various "deal breakers" initially...but "fit"/gut feeling is starting to win out.

Also, I'm surprised that 12hr shifts have garnered so much attention while the way nights are scheduled hasn't come up. A few places I've seen do a "progressive" schedule of 2 shifts of days, 2 shifts of evenings, and 2 shifts of nights and then a 1-2 days off...I'm a bit leery of this as I'd rather have all my nights for the month grouped together. I don't want to be a zombie always working on a different sleep schedule, but maybe I'm being dumb about this since I've never actually tried it. Can anybody comment on the pros/cons of various ways nights get scheduled?

I think very few places allow for residents to do nights for a month, then very few nights otherwise. We all adjust and expect to work nights, holidays, and weekends. It's a great thing if you aren't on when you expect to be on. We max out at 5 shifts in a row, and that usually happens only to accommodate requests, esp if you yourself want a chunk of time off. We have it made I think. We can take 5 days off without it causing a horrible schedule the rest of the month and not having to use vacation days.

Ideally, it's a rotating schedule as you mentioned. Reality is that it doesn't happen that often because there are always requests out there and the program may have its own requirements. For example, some may say interns can't work on the busiest day of the week. It happens.

I am in a 4 yr program. No regrets at all. I think I have gotten a chance to do more things that I wouldn't have been able to do in a 3 yr program.

 

[EvoDevo]

Hmm, I'm actually hoping to work more 12s next year. I'd rather get work done and not have to come in an extra day to get my hours.

12s would be brutal as an attending. I don't 10s now hand I'm just <crisped> at the end...

 

[UnderwaterDoc]

As far as 12 hour shifts... I certainly believe its best to have experience the 'worst case scenario' in residency. I am not sure what percentage of full time jobs out there are 12s, but I would bet it is a majority. There are 8s and 10s and some sort of combos, but they just are not as common. I assure you its better to do a residency with 12s and then go work 8s, than to work 8s in residency and find your dream job that works 12s.

Good Luck.

This may be very regional, none of the places where I'm looking work 12s. As an attending it must be terrible to work so many hours.

 

[Perrotfish]

I like my programs set up. 12s the first year, second a third 9s on the weekdays, 12s on the weekends (so more people have a weekend off). Yeah the 12s are long, but there is a difference between doing it for a year and going somewhere that you are working sixteen 12s a month as a 4th year resident.

We also get a 45 minute lunch break in the middle of our 12s, which certainly helps productivity.

This always blows my mind. 'sixteen 12s a month' as a worst case scenario. Every other residency in the hosptial works 24 12s a month for almost every rotation, the entire way through. The lunch break is especially stupifying.