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MCAT guy

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I did a few searches on this to no avail. I am starting medical school soon and had a few questions about residency programs. I noticed US News ranks a lot of specialties but not EM (because it's such a new specialty?). I've read through a lot of the reviews posted on the FAQ and, in general, everyone has good things to say about most programs.

Are there rankings for Emergency programs? Does it not matter if you go to a top hospital or some smaller program? How do you guys chose a hospital over a dozen other ones?

From US News, their honor roll of hospitals (below). Would it be wrong to assume that these hospital would also have the best Emergency programs in the United States?
Does this stuff matter? Or will the right person become great at most residency programs in the US?
 
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From US News, their honor roll of hospitals (below). Would it be wrong to assume that these hospital would also have the best Emergency programs in the United States?
Does this stuff matter? Or will the right person become great at most residency programs in the US?

In my humble opinion as an applicant, yes I believe this is a faulty assumption. Don't assume because they're highly ranked hospitals their EM training will be the best.

Just an example, I think a lot of people would see Indiana as a very good EM program. But their hospitals (Wishard and Methodist) aren't on that short list. And there are more examples than just IU.

Carolinas, Cinci... etc.
 
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MCAT guy

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In my humble opinion as an applicant, yes I believe this is a faulty assumption. Don't assume because they're highly ranked hospitals their EM training will be the best.

Just an example, I think a lot of people would see Indiana as a very good EM program. But their hospitals (Wishard and Methodist) aren't on that short list. And there are more examples than just IU.

Carolinas, Cinci... etc.

This is what I'm getting at. Where are you learning which programs are good, like Cinci, Carolinas (what school is that?), and IU? Do you know of any old threads or websites that would have info like that?
 
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This is what I'm getting at. Where are you learning which programs are good, like Cinci, Carolinas (what school is that?), and IU? Do you know of any old threads or websites that would have info like that?

There have been numerous threads concerning the top EM program. With the exception of In-n-Out (sp?) Burger, no clear consensus has been achieved. Residency tends to be the terminus of EM training. This means there is far less importance put on going to a "top" program compared to IM, where such things factor highly in obtaining competitive fellowship spots. Going to a place where you fit into the culture and have a minimum of interpersonal conflict with attendings/fellow residents tends to be more important then the "name".
 

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I'm at one of the "top hospital" programs and while I think quite highly of my training, I was equally as impressed with the places that would never even crack the list.

Often times, the real gems for EM are, in fact, exactly the hospitals that would never ever make a US News ranking of the best hospitals . . .
 

MCAT guy

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I'm at one of the "top hospital" programs and while I think quite highly of my training, I was equally as impressed with the places that would never even crack the list.

Often times, the real gems for EM are, in fact, exactly the hospitals that would never ever make a US News ranking of the best hospitals . . .

I guess this is the whole point of my thread. I want to figure out what the gems are.

I've read through a ton of the reviews (massive EM residency review thread), lots of praise for most every program. It is hard to differentiate, most people enjoy where they go for the most part.
 

MCAT guy

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There have been numerous threads concerning the top EM program. With the exception of In-n-Out (sp?) Burger, no clear consensus has been achieved. Residency tends to be the terminus of EM training. This means there is far less importance put on going to a "top" program compared to IM, where such things factor highly in obtaining competitive fellowship spots. Going to a place where you fit into the culture and have a minimum of interpersonal conflict with attendings/fellow residents tends to be more important then the "name".

I understand that I won't be a leg up in employment or applying for positions, I just am trying to figure out where I can get the best training to become very good at my career.

So I guess your saying it doesn't really matter where you go, as long as it is high volume and a decent quality program.
 

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I understand that I won't be a leg up in employment or applying for positions, I just am trying to figure out where I can get the best training to become very good at my career.

So I guess your saying it doesn't really matter where you go, as long as it is high volume and a decent quality program.

Whoa. You aren't even in medical school yet, right? Take a deep breath. Seriously - worry about this the summer after your 3rd year (or maybe March of 3rd year when you're looking at aways).

But to answer your question, when I was making my list I asked my mentors at my home institution and then the attendings at my away gave some input on my list about the quality of the programs.
 

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Often times, the real gems for EM are, in fact, exactly the hospitals that would never ever make a US News ranking of the best hospitals . . .[

People are always posting and referencing these "hidden" gems of em residencies but no one ever wants to name them. Why is this? Drop names people!:)
 

MCAT guy

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Whoa. You aren't even in medical school yet, right? Take a deep breath. Seriously - worry about this the summer after your 3rd year (or maybe March of 3rd year when you're looking at aways).

But to answer your question, when I was making my list I asked my mentors at my home institution and then the attendings at my away gave some input on my list about the quality of the programs.

My med school app was poorly planned, so I'm attempting to atone for past sins and may be over zealous at the moment.

Often times, the real gems for EM are, in fact, exactly the hospitals that would never ever make a US News ranking of the best hospitals . . .[

People are always posting and referencing these "hidden" gems of em residencies but no one ever wants to name them. Why is this? Drop names people!:)

71275197.jpg
 

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With the exception of In-n-Out (sp?) Burger, no clear consensus has been achieved.

If they didn't have bible verses on their packaging I'd be a bigger In-n-Out fan.

Fatburger and Five Guys are also excellent Emergency Medicine training. Their pass rates are superb.

I also remember, back in college, when I used to burn like 10,000 calories a day with daily doubles, that an after-dinner Jack-in-the-Box triple cheeseburger provided an excellent Emergency Medicine education.
 

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If they didn't have bible verses on their packaging I'd be a bigger In-n-Out fan.

Fatburger and Five Guys are also excellent Emergency Medicine training. Their pass rates are superb.

I also remember, back in college, when I used to burn like 10,000 calories a day with daily doubles, that an after-dinner Jack-in-the-Box triple cheeseburger provided an excellent Emergency Medicine education.

The one and only time I've had In-n-Out was at ACEP this year. Burgers were quite good, although the fries were kinda meh. I keep waiting for Backyard Burger to open up an EM residency here, but that's probably ten years off.
 
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If they didn't have bible verses on their packaging I'd be a bigger In-n-Out fan.

Fatburger and Five Guys are also excellent Emergency Medicine training. Their pass rates are superb.

I also remember, back in college, when I used to burn like 10,000 calories a day with daily doubles, that an after-dinner Jack-in-the-Box triple cheeseburger provided an excellent Emergency Medicine education.


All fine residency choices, a bit too heavy on the CP and cardio for my taste. decent penetrating trauma, some of the best throughput though.
 

HoochIsCrazy

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The one and only time I've had In-n-Out was at ACEP this year. Burgers were quite good, although the fries were kinda meh. I keep waiting for Backyard Burger to open up an EM residency here, but that's probably ten years off.

Ask for the fries "well done". One of their secret code words. It will change your life.
 

MCAT guy

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This thread is dead.

For those EM residents/attendings, I really like EM but I feel like the constant swing shifts b/t AM and PM would be horrible for me. I don't really mind working 80 hrs a week but I think I would struggle doing 40-50 hrs of random day then night then day then night...

Does this mean I should look at another specialty?
 

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This thread is dead.

On the contrary...it's just getting started. The fact that you feel this way kind of answers your next question.

For those EM residents/attendings, I really like EM but I feel like the constant swing shifts b/t AM and PM would be horrible for me. I don't really mind working 80 hrs a week but I think I would struggle doing 40-50 hrs of random day then night then day then night...

Does this mean I should look at another specialty?

Maybe...assuming you can find something you like as much. As you move on in your career, you will be able to better tailor a "regular" schedule but that will take 5-10 years and if you're going to be miserable for those 5-10 years, it's probably not going to be worth it.
 

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I am interested to know what the residents/attendings' sleep habits were like in college.
 

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I guess this is the whole point of my thread. I want to figure out what the gems are.

I've read through a ton of the reviews (massive EM residency review thread), lots of praise for most every program. It is hard to differentiate, most people enjoy where they go for the most part.
What I've bolded is the whole point. EM is not like other specialties. There aren't USNWR rankings, because if you have an emergency, they're not going to take you to some hospital halfway across the country. They're going to take you down the street to your local ER, or maybe to your nearest trauma center. Also, EM is not like IM or other specialties where research funding determines a list of powerhouse programs. It's a clinically-oriented specialty. Not that you can't do research in EM, but it's not the focus at academic programs like it is in IM.

The reason people are jumping on you is because you're thinking like a pre-med, which is not at all a criticism of you, because you are a pre-med, so of course you think like one. :) But things are different at the residency level than they are at your level. Now that I've been going on interviews at all kinds of different programs, I realize that they really do all have good curriculums and would train me to be a good EP. In terms of what they offer for curriculum, the programs are all more alike than they are different. There are some programs that I like less than others, but that is for subjective reasons like a bad social fit, not wanting to live in that city, etc. In the end, people make choices based on things like location, three years versus four years, emphasis on certain subspecialties (EMS, tox, international, etc.), can their spouse find a job, and plain old gut feeling.

MCAT guy said:
For those EM residents/attendings, I really like EM but I feel like the constant swing shifts b/t AM and PM would be horrible for me. I don't really mind working 80 hrs a week but I think I would struggle doing 40-50 hrs of random day then night then day then night...

Does this mean I should look at another specialty?
Most programs don't switch shifts on you randomly. They either have block shifts (i.e., several nights in a row, day or two off, several days in a row, etc.) or they have circadian shifts where the shifts keep getting later and later. My experience in my med school rotations was that having a day or two off after your night shifts is key, because it gives you a chance to get back on track to wake up for day shifts in your next block. Anyway, it's not as bad as you might think if your program plans intelligently and you don't have people switching all their shifts so that they turn out to be random.

You should spend some time shadowing in the ER when you get to med school. It will give you some idea of what goes on in there. Don't just go during the day, do some evenings and weekends and nights too. It will give you a better idea. Personally, I love night shifts, especially on weekends. There tends to be more excitement, and plus, there are less people around, so you get to see and do more, even as a student.
 

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EM resident here... I think US News rankings are quite unrelated to our training in particular. While there are several respected programs on the list, most of the big-name EM programs aren't.

A big part of that is since we're such a new field, the "good" EM programs have evolved at places that are not traditionally recognized as The Best Hospitals. It makes it much harder to generate a good EM program when your admitting teams look down upon your department as inferior. As such, CMC, Denver, Cinci, etc. are not exactly household names.

And, as far as sleep habits go, I've always been a night owl :) Same goes for most of the other residents I know.
 

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The biggest concern for me was the three v. four year ED programs, with the latter being mainly at large academic programs. If you don't want to work in academics as a career, that fourth year of research and administration is a wasted year of your life and forfeiting attending pay.
 

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I agree that this is a flawed assumption. Emergency Medicine did not emerge out of the halls of the great houses of medicine. If you think about it, EM is a specialty that essentially has appropriate (and then expanded upon) the emergent parts of other fields' practices, and this hasn't happened with out a fight. In the places where the medicine and surgery programs are old and well entrenched I think it has been harder to wrestle away complete independence. If you look carefully at the list you posted above, you find that at least 4 of those 15 hospitals have programs that are less than 10 years old.
 
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The biggest concern for me was the three v. four year ED programs, with the latter being mainly at large academic programs. If you don't want to work in academics as a career, that fourth year of research and administration is a wasted year of your life and forfeiting attending pay.

Untrue. 4th year allows more time towards more EM rotations, outside rotations, elective rotations. It's not wasted.
 

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Remember that there are a lot of factors to consider when you are ranking EM training programs. You have the find the program that fits "you" best. Things that are important to those that create these rank lists, may not be important to you. For example, if you are not interested in doing any clinical research, it doesn't really matter if the program was ranked higher due to substantial NIH grant funding over the years. When you are ranking programs, ask these fundamental questions:

1) Are the residents happy?
2) Is there a good balance of autonomy and attending/senior resident supervision?
3) Is the patient volume appropriate? (Look at resident staffing. You don't want to go to a training program where the volume is too high...you won't have time to learn. Conversely, if the volume is too low, you won't see enough patients during your training.)
4) Where are the attendings from? You don't want to train at a program where everyone has been at the same shop for 10-20 years, and you definitely don't want to train at an inbred program. You won't learn about the different styles of practice because everyone does things the same way. Diversity is key.
5) Have there been recent changes or improvements made to the program? Change is good. Programs that are rooted in their "tradition" should cause an alarm to go off in your head. There is always room for improvement and change.
6) Are there mentors to help you find your niche? Make sure the residents and attendings are a heterogenous mix of people with a diverse array of interests and specialty training.
7) How does the program challenge and help residents reach their potential? You don't want to go to a program where everyone is "nice". Nice won't help you become a great doctor. This is your TRAINING. You want to go somewhere where there is constructive feedback given on a regular basis (both good and bad feedback). You don't want to be learning your lessons when you are out in practice on your own...
8) How involved are the faculty on a national level? Will they be able to help you find that dream job when you graduate. Or does everyone just stay in town without support to branch out...
9) How involved are the residents in the hospital? In GME? On a regional level? Nationally?
10) How well have the residents done on the inservice exams and national boards? Is there support when residents aren't good "test takers"?
11) How are the residents perceived in the hospital?
12) How is the relationship between the different services? Are there traditional turf wars or do all parties seemingly get along? You want to train at an institution where EM is respected and not trampled over...

The list can go on an on, but these are some helpful hints to get you started.
 

MCAT guy

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I heard these were top programs:

  • Indiana
  • Carolinas
  • Emory
  • Cook County
  • Cincinnati
  • UCLA-Harbor
  • Stanford
  • Vandy
 
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Ask for the fries "well done". One of their secret code words. It will change your life.

Hmm. Sounds interesting. I've always contended that eating the fries while they're fresh is best. They can become blah within 15 minutes, and never ever reheat

The one and only time I've had In-n-Out was at ACEP this year. Burgers were quite good, although the fries were kinda meh. I keep waiting for Backyard Burger to open up an EM residency here, but that's probably ten years off.

Fatburger is legit, but I still don't think Five guys is on that level yet. I can drive by In-n-Out and not even be hungry and want one because of the sweet aroma being churned out. And with fatburger I am always a little sad when I get to the last few bites, because the experience will be ending soon.

For the OP

There are few list of what the top EM programs are, because most will contend that most EM programs are good. Word is that they are tightly regulated so that residents receive comparable training.

However, there are places that are more competitive to match into. This may be because of location, affiliated university prestige, off-service rotation strength, research opportunities or whatever, but that probably has little to do with quality of training.

If I am missing something others will correct this.
 

SepulvedaMD

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I heard these were top programs:

  • Indiana
  • Carolinas
  • Emory
  • Cook County
  • Cincinnati
  • UCLA-Harbor
  • Stanford
  • Vandy

Sure most would agree that these are great programs, but the list can be expanded by a great deal. Also, by what criteria are these the "top" programs?

What about Hennepin, Northwestern, USC, Highland, Denver just to name a few? I have not seen, and question the real value, of an exhaustive list.
 
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Throw in the U of A where I graduated. In the end I find EM is a pretty regional specialty. I work for a well paid and well respected private EM group. I can tell you that being out on the west coast no one from our group would be falling over ourselves for someone from the list above. It really comes down to the individual. I would rather have a top resident (whatever that means, though I think i could better define it than I could best residency) from a average program than an average resident from a top program.

Also, what a community job is looking for is way different than an academic job. Discuss...
 

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Does level 1 vs level 2 matter very much? There are some level 2's with high volume and larger trauma services than some L1's, yet remain L2 bc of a smaller tertiary center... Basically, my question is: does it matter & how much? (in terms of quality of training & post residency job seeking)
 

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Does level 1 vs level 2 matter very much? There are some level 2's with high volume and larger trauma services than some L1's, yet remain L2 bc of a smaller tertiary center... Basically, my question is: does it matter & how much? (in terms of quality of training & post residency job seeking)

In terms of training, you're going to see less definitive neurosurgerical care with a Level 2. If you have a Level 1 siphoning off major trauma nearby, then you're not going to be as prepared for dealing with it as an attending. I don't know of any residencies that have this situation that do not also have you rotate through a Level 1 center. The RRC is pretty strict about how much trauma residents see (the reason my city currently doesn't have an EM residency, because the surgeons won't let non-surgeons rotate through our Level 1).

In terms of jobs, I honestly don't see it being a factor.
 

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I would have to agree that the "best" programs are based on the individual and what he or she is looking for. Different programs offer unique things that may or may not interest certain applicants making them desirable or not to that individual applicant. I would also add Pitt and Maricopa to that list of top programs. You may find that you love a program that does not have a "big name", but offers what you are looking for. Just my 2 cents.
 
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Untrue. 4th year allows more time towards more EM rotations, outside rotations, elective rotations. It's not wasted.
From the standpoint of getting paid to work, yeah, it is wasted.


Although having done 4 years myself, I think that I'm better prepared for the real world.
 

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Untrue. 4th year allows more time towards more EM rotations, outside rotations, elective rotations. It's not wasted.

I think the four year program was the best decision I made. I can also tell you that most all of our fourth year residents made as much as many of the full time EM physician (from lower paid areas) out there just from moonlighting.

The downside, by the middle towards end of the 4th year.. you just get tired of 'the system'. You get a bit too known and seasoned in your residency shop... you learn too much about nurses, attendings, etc etc... I think that is less likely to happen in a three year program.

All in all.. I am VERY happy I went to a 4 year program. To me, the key is a four year program with avid moonlighting opportunities. A four year program with no moonlighting would be VERY hard to go for IMHO....

I was told by two different medical directors that they often have a period of needing to babysit a 3rd year program resident with no moonlighting experience versus a 4 year resident with moonlighting is very much good to go.

Also, so many people say "I absolutely do not want to go into academics"... I can tell you, much can change in 3-4 years. Its not that you cannot get an academic appointment with 3 years, but the 4 year program certainly helps..
 

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I think the four year program was the best decision I made. I can also tell you that most all of our fourth year residents made as much as many of the full time EM physician (from lower paid areas) out there just from moonlighting.

The downside, by the middle towards end of the 4th year.. you just get tired of 'the system'. You get a bit too known and seasoned in your residency shop... you learn too much about nurses, attendings, etc etc... I think that is less likely to happen in a three year program.

All in all.. I am VERY happy I went to a 4 year program. To me, the key is a four year program with avid moonlighting opportunities. A four year program with no moonlighting would be VERY hard to go for IMHO....

I was told by two different medical directors that they often have a period of needing to babysit a 3rd year program resident with no moonlighting experience versus a 4 year resident with moonlighting is very much good to go.

Also, so many people say "I absolutely do not want to go into academics"... I can tell you, much can change in 3-4 years. Its not that you cannot get an academic appointment with 3 years, but the 4 year program certainly helps..

In these regards, I was told as a DO if I do an osteopathic 4yr EM residency that there was absolutely no chance that I would ever work at an allopathic EM program as an attending. Currently that doesn't matter to me at all but I wonder how an academic program would view a DO grad from a DO residency who had done a MD fellowship? I am told that nearly all of the EM fellowships are not competitive and would be attainable for a DO. These kinds of things could be important to an applicant.
 

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Often times, the real gems for EM are, in fact, exactly the hospitals that would never ever make a US News ranking of the best hospitals . . .[

People are always posting and referencing these "hidden" gems of em residencies but no one ever wants to name them. Why is this? Drop names people!:)
I can tell ya 2 programs that are definitely stellar programs, and what I would consider "hidden" gems because they're not huge names, but provide you with an AWESOME experience.

1) Wright State - Dayton, OH. I read & heard about it, and interviewed there as well, and was thoroughly impressed. http://www.med.wright.edu/em/res/

2) York Hospital - York, PA. I'm about to start my 3rd (and final) year there. I rep the hell outta the program every chance I get, because I genuinely believe it's an *amazing* program. http://www.yorkhospital.edu/default.aspx?program=2

To address some of the points/questions that Amaranthine mentioned, with respect to my program:

1) NUMEROUS times I've had rotating and interviewing med students tell us our residents were the happiest they've ever met of any program.

2) There's a ton of autonomy, especially in your 2nd year, and definitely during your 3rd year - while ensuring you have appropriate Attending supervision as needed/requested/appropriate. And upper levels (2nd & 3rd year residents) often walk 1st year residents through sicker/critical patients, without stealing experiences from them.

3) The volume is HUGE (around 80,000/yr), with only 33 residents in the program. The result is you get your butt whipped into shape, learning how to manage a very high volume of patients, and master the skill of multitasking and prioritizing. But volume is nothing without acuity. We have a VERY high acuity of patients. York County nationally has one of the greatest percentage of obese residents, which translates to the vast majority of our patients having a ton of co-morbidities (DM, CAD, PVD, CHF, OSA, COPD, etc). Our admission rate is about 30%, well above the national average. Sick for us is SICK.

This doesn't interfere with teaching time, either. Attendings STILL make the time & effort to teach, instruct, and provide feedback, even in the crazy busy environment we have. And that's unique, because we have a major urban experience/environment in the setting of a community hospital. So we have the funding (more on that later) without the overbearing fellows coming down to steal procedures from us - in fact, we do pretty much all of our own procedures with our EM faculty, and only consult if/when appropriate/needed.

4) Our attendings are from all over. We have a bunch of local Yorkians and former residents of our own program, as well as others from all over. We have some 30+ year faculty as well as some "fresh blood" from top programs like Christiana. We have some traditional EM docs, a few former Internal Medicine, a few former Surgeons, a few Paramedics, etc. ALL are EM Board Certified. But quite a varied background, for a variety of approaches & strengths. And we have young and old, including Ultrasound-trained fellows + U/S Fellowship. So diversity isn't a problem here.

And for me, who wants to go down south, our attendings and former residents have placed throughout the US. So I often hear from attendings about job opportunities in areas I'd like to practice, the ppl they know there, and how they can talk to people to get me interviews etc. Def. a positive to know that no matter where you wanna practice, we have Alumni there and/or current faculty with connections to there.

5) Our Program Director (who's been the same program director for over 20 years) is VERY receptive to change based on faculty & RESIDENT feedback. As such, we've ditched low-yield rotations (so we no longer have any floor months of anything), and custom tailored several off-service rotations so we get the experience we want & need, without having to do all the crappy scuttwork to achieve it. He makes sure our residents are the best taken care of in the hospital. The PD is also one of the Oral Board Examiners as well as on the Board of Examiners (so he writes questions for the board exam). In fact pretty much our entire Program Leadership are nationally recognized "big-wigs." So their letters of rec carry sig. weight.

6) Despite what you're interested in, we have people that do it, and will help you do it as well. AND, we'll front you the money to help you do it to boot. We get over $1,500 spending cash on pretty much anything medically related/yr, from textbooks & iPhone apps (including PEPID, etc) to whatever course/conference/experience you'd like to attend. Ultrasound, Wilderness Medicine, Tactical & Prehospital (like me), International, you name it, we do it.

On that note, Wellspan (the healthcare group that owns the hospital and several surrounding it) is the 4th largest employer in the state, so it has TONS of money. So in turn, we as residents get one of the highest salaries of any residents in the country - save places like NY, where all your salary's gonna get spent on your apartment rent anyway. This also means the HOSPITAL has tons of money. So with our crazy volume, we have the MONEY for techs, aids, support staff, and equipment! So you don't waste your time doing non-doc stuff (like pushing patients to imaging, drawing your own blood, getting your EKGs etc), albeit there are merits to learning how to do so. But by in large it is NOT your responsibility, and you can rest assured it WILL be done by the appropriate staff.

In addition, since Wellspan is so huge, the vast majority of our patients (I'd argue above 90%) have electronic medical records readily available. So I can look up PMH, meds, allergies, surgeries, previous EKGs, studies, labs, etc from their PCP and specialists, before I ever set foot in the room. And that is NICE.

7) The program (attendings) challenge you to do things diff ways, to get out of your comfort zone & learn how to approach problems in different ways. And they themselves have very different prespectives. Some guys are very hands-on, others are more laxed. Some are super thorough and detail-oriented, and others are minimalists. So you really see the different ways to skin a cat, and develop an arsenal of how to solve a particular problem, while developing your own preference of how you'd like to do things as an attending in the future.

9) Our residency is certainly the strongest in the hospital, without a doubt - despite it being a Level I Trauma, Peds, Stroke, Cath Lab, etc, so we have the full range of services & residencies (Medicine, FP, Surgery, etc). And on a regional & national level, our residents have won several awards for their research & presentation. No surprise there.

10 ) Lastly there are a ton of perks, like unlimited free food for residents, free for resident families while on-call (off-service) or on the weekends, program coverage for all sorts of medical-related expenses, free Rx as long as it's written by a doc within the Wellspan network, etc etc.

Alright, I think that's long enough haha. You get the idea.
 
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Dwindlin

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Edit: FDNewbie made my post irrelevant. So sad.
 
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Pinner Doc

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I was told by two different medical directors that they often have a period of needing to babysit a 3rd year program resident with no moonlighting experience versus a 4 year resident with moonlighting is very much good to go.

I think this is absolutely going to be the case for ANY newbie on their first few shifts within a new system, hospital, etc. An extra year of training within your own system won't help with this.
 

FDNewbie

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I think this is absolutely going to be the case for ANY newbie on their first few shifts within a new system, hospital, etc. An extra year of training within your own system won't help with this.
Couldn't agree more. 4 year programs don't give you additional EM experience; they give you additional OFF-SERVICE experience (unless you're taking EM as all of your electives). And even if one would like to argue the contrary, you're still operating as a resident the entire time, so you still lack that "OMG I'm actually on my OWN on this one" experience that you don't get until you're solo.

At my program, you can moonlight during your 2nd year internally (ie at our hospital), under the (loose) supervision of an Attending. Ditto your 3rd year, but you can also moonlight at outside institutions during your 3rd year as well.
 

Arcan57

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Couldn't agree more. 4 year programs don't give you additional EM experience; they give you additional OFF-SERVICE experience (unless you're taking EM as all of your electives).

The make-up of 4 year programs varies, and your statement is overly broad. For comparison, my med school's 3yr residency has 21 months of EM and where I went to residency had 26.5 months of EM. The "OMG I'm solo" feeling probably varies as much intra-residency as it does inter-residency. But that feeling is going to be only loosely correlated with actual performance.
 

tkim

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I was told by two different medical directors that they often have a period of needing to babysit a 3rd year program resident with no moonlighting experience versus a 4 year resident with moonlighting is very much good to go.

Extra year + moonlighting, versus one less and no moonlighting? Duh?

Three year graduate + moonlighting. Worked double coverage for the first six months not because I needed babysitting, but in order to learn a new hospital and system. It's not the medicine, it's the local 'culture' that needs to be caught up on.

A better comparison would be three years + moonlighting versus four years no moonlighting. I bet the moonlighting is the key - I know that when I started moonlighting, I worried a lot more about my dispos, since it was all mine.
 

FDNewbie

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How much can one earn while moonlighting?
I'd argue that what you do in residency is merely practice/kids play. Moonlighting is where you REALLY learn - where you realize YOU and ONLY you have to take the final decision, and have to live with the consequences. No one's gonna remind if you ruled this out or considered that. And you'll quickly realize that there's a ton more out there that you don't know and still need to experience.
 

Venko

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I'd argue that what you do in residency is merely practice/kids play. Moonlighting is where you REALLY learn - where you realize YOU and ONLY you have to take the final decision, and have to live with the consequences. No one's gonna remind if you ruled this out or considered that. And you'll quickly realize that there's a ton more out there that you don't know and still need to experience.

If you are moonlighting for gaining the experience of being an attending and taking all the responsibility of an attending, shouldnt you just wait and learn it as a first year attending? If you are doing it for financial support this is a different thing altogether, but for the chance to "REALLY" learn to make a decision...just wait, you'll have to make a decision when youre done with residency. Otherwise, by your same logic, just skip college and medical school and just get out there and moonlight...and all those psych, ophtho, IM etc residents who moonlight in EDs must have "REALLY" learned EM better than you.
 

FDNewbie

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If you are moonlighting for gaining the experience of being an attending and taking all the responsibility of an attending, shouldnt you just wait and learn it as a first year attending? If you are doing it for financial support this is a different thing altogether, but for the chance to "REALLY" learn to make a decision...just wait, you'll have to make a decision when youre done with residency. Otherwise, by your same logic, just skip college and medical school and just get out there and moonlight...and all those psych, ophtho, IM etc residents who moonlight in EDs must have "REALLY" learned EM better than you.
You certainly can wait until you're done, but as you mentioned, I think it gives you 2 things in one: earlier experience while you're still a resident, and extra $$ as/if needed.
 

WilcoWorld

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If you are moonlighting for gaining the experience of being an attending and taking all the responsibility of an attending, shouldnt you just wait and learn it as a first year attending? If you are doing it for financial support this is a different thing altogether, but for the chance to "REALLY" learn to make a decision...just wait, you'll have to make a decision when youre done with residency. Otherwise, by your same logic, just skip college and medical school and just get out there and moonlight...and all those psych, ophtho, IM etc residents who moonlight in EDs must have "REALLY" learned EM better than you.

Agreed. Use residency to get trained. If you want to earn extra $$$ then pick a program that offers money to pick up extra shifts (where I trained we got $600/shift, and that was a few years ago).
 

FDNewbie

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Agreed. Use residency to get trained. If you want to earn extra $$$ then pick a program that offers money to pick up extra shifts (where I trained we got $600/shift, and that was a few years ago).
That's what we have; it's called internal moonlighting. But you can moonlight externally as well if you want. Same concept.
 

KYTNOH

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I'm a PGY III that is moonlighting (I started at the very end of my PGY II year). Since I began moonlighting I was forced to make these patients "mine." And that has carried over into my residency shifts as well. I work in a low volume ED which gave me plenty of time to get used to practicing on my own. I can't imagine what it would have been like to go from residency to a job seeing 2.5pph overnight. Of course the money is also very nice. I don't make a ton, but I can supplement my income from residency nicely and has allowed me to build up a few thousand dollars for an emergency fund. Lastly, I think we provide higher quality of care to the patients in the hospital since we are all EM trained (or at least in the process of being EM trained).
 
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