Residency Type

[SomeDoc]

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First year here- who might get FMcF'tied for asking this, I'm just not sure if its a silly question or not, and am trying to gauge what might be important later on. If someone does not go into a "competitive" EM residency, will there be any limitations to practice opportunities later on? Would a physician who did his/her residency in a small, little-known community program have any difficulty attaining spots at big, academic EM programs post-residency?

 

[WallowaWanderer]

First year here- who might get FMcF'tied for asking this, I'm just not sure if its a silly question or not, and am trying to gauge what might be important later on. If someone does not go into a "competitive" EM residency, will there be any limitations to practice opportunities later on? Would a physician who did his/her residency in a small, little-known community program have any difficulty attaining spots at big, academic EM programs post-residency?

I think that's a fair question - in fact, one that I asked several times in the last year. I love the mountains and living in small towns - and there are a lot of smaller programs in awesome places to live. When I asked this question, people gave me the "you'll get great training anywhere" response. That's not the full answer, however.

First of, let me clarify that many of the strongest programs in EM are community based and send lots of people in academics. - i.e. Carolinas, Christiana, etc. So, I'll just speak for the smaller, less well known community programs. The small community programs don't send as many people into academics, both because they are smaller (less total alumni, so 20% of a smaller number will always be a smaller number) and because proportionally less people at those programs are interested in academics. Thus, coming out of a smaller, less well known community program you will have, in general, a smaller network in the academic world.

There's also the issue of name recognition. Within academics, there are programs that other academicians hold in high regard - and thus coming out of one of those programs you will find it easier to get into academia.

But, I still think that if you go to a smaller, less well known, community program and you excel - like do research, education projects, presentations at conferences - then you'll end up being a more atractive candidate for academics than if you come out a big name place but didn't do any of this stuff. In that way, it's not unlike the residency selection process. I am at a little known, mediocre med school but since I did well I'm not at a disadvantage.

And then there's another issue . . . which is that if you want to go into academics and are coming out of all but a handful of 3 year programs, you will probably need to do a fellowship (unless you come on faculty with the place where you trained). There are a handful of very competitive fellowships, but most are not all that competitive because academics is a huge pay cut, most fellowships aren't acredited, etc.

So, in summary, it's just like every admission process you've been through so far. Coming out of a big name place will help you, but you'll you also need to be succesfull and have a good CV. If you come from a less well know place, then it might take more effort but as long as you have a good CV then you'll likely get where you want to go.

Disclaimer: just an MS IV

 

[SomeDoc]

Thank you very much for your time and for the detailed explanation. That helped clarify things a lot.

 

[southerndoc]

Going to a smaller, lesser known program won't ruin your chances of getting into academics if you play your cards right. Likewise, if you play your cards wrong, even a high profile residency won't get you an academic job. For example, if you attend a program where everyone does research and you fail to do research or take opportunities available to you, it could ruin your chances for a job in academics.

 

[roja]

Although there is some truth to the post above, I think that smaller community based programs tend to not put as many people into academics because they self-select for people who don't want to go into academics.

With regards to the misconception that you must do a four year or 3 plus fellowship to get into an academic setting, this is an incredibly common (and incredibly incorrect) misconception.

What determines if you will be a strong canidate for academics (regardless if you are from a 3 or 4 year program) will depend on the types of things you do DURING your residency. If you do 'academic' stuff, you can land in an academic position. If you do nothing but get your training (nothing wrong with this but you do nothing extracurricular), then you are less likely to get an academic position (again, regardless of 3 vs 4).

Keep in mind: your CV is what tells about you. What is in your CV is what matters. Not so much where you trained.

 

[WallowaWanderer]

With regards to the misconception that you must do a four year or 3 plus fellowship to get into an academic setting, this is an incredibly common (and incredibly incorrect) misconception.

Roja, you're at a really strong, highly academic, well known 3 year program. Are you sure that coming out of a less well known, small, community program you would be able to jump right into a faculty position at a different institution? With a great CV you can do anything and there are always exceptions, but what I'm hearing from PDs at both 3 and 4 year institutions is that the days of walking into a faculty position after residency are over. But, I'm sure you know a lot more than me regarding this.

 

[roja]

Well, thanks. Knowing people at a variety of programs, I do think that you can go to a smaller community program and still get a job in academics. j

It depends on what you *do* during your 3 years. If you bust your tail, not just working at being a resident, but get involved in CQI, administration, disaster or many other types of things, then you increase your potential MUCH MUCH more than someone who goes to another type of program who has little on thier CV other than graduating residency.

Networking is important (something that maybe is less at community based programs but probably not as EM is a small world).

Mentoring is also important. This also will be dependent on the program. Now, one might wonder (and rightfully so) that if one is interested in academics, why they didn't focus on a more academic residency. However, it is not a nail in the coffin.

My point is that your CV is YOU. It, more than your residency name, is going to determine if you are going to have an easier time getting an academic position.


(that is not to say that if you are trying to stack the deck, a more academic place won't have a tiny bit of influence. It doesn't hurt, but it doesn't gaurantee anything)

 

[anonymousEM]

Every department has something that they are "looking for" each time they hire for any job. For the vast majority, I agree with roja and don't think a 3 year program will hold you back (I am a 3 yr program grad and now almost done with a fellowship) but I did interview at a couple of places where they were looking to keep 3 year grads from supervising thier 4th yr residents as first year fellows. Now, if I'd been otherwise superior to the other great applicants, I don't think it would've mattered (they did go to the trouble and expense of interviewing me and paying for accomodations etc) but I think there is the chance that that a 4yr would be taken over a 3yr grad if everything else were equal. That being said, I am currently at a program which has 4 year residents. I don't think it's enough of an issue to be the thing that makes you do a 4 yr residency if you otherwise aren't interested.

Besides, the majority of programs are 3 year residencies. Thus, so are the majority of academic positions by sheer numbers. I guess you have to think about whether your dream job is to work at a particular 4year place...if so, then MAYBE, it's an issue.