The "Best" EM Residency

[docB]

Some of the newbies and lurkers probably just can't understand why all the posts about the "best" EM residency get either curt brush offs (the best residency is the one with the best fit) or outright hostility and all eventually get derailed into a discussion of fast food. Here's why. In reality there is no universally recognized "best" EM residency. The dogma is that they will all give you good training. But more than that the idea of people searching for a residency based only on its perceived prestige is offensive to most EM people. We tend to dislike the name dropping and arrogance that attitude implies. At least, we like to think we do. So that's why no one will ever get a straight answer out of this forum about what the "best" EM residency is.

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[bulgethetwine]

Some of the newbies and lurkers probably just can't understand why all the posts about the "best" EM residency get either curt brush offs (the best residency is the one with the best fit) or outright hostility and all eventually get derailed into a discussion of fast food. Here's why. In reality there is no universally recognized "best" EM residency. The dogma is that they will all give you good training. But more than that the idea of people searching for a residency based only on its perceived prestige is offensive to most EM people. We tend to dislike the name dropping and arrogance that attitude implies. At least, we like to think we do. So that's why no one will ever get a straight answer out of this forum about what the "best" EM residency is.

All good points. docB's candor illustrates why docB should be PD at In-n-Out Burger, the best residency program in the continental 48.

 

[USCDiver]

What I always wonder is, do they have these discussions on the other specialties' fora? Are there consensus 'best' programs for other specialties? Certainly there are crappy IM, FM, Surg, etc programs, but are there 1 or 2 programs that are head and shoulders above the rest?

I think the question should be 'What's the best EM program for me?' and that question can't be answered on a message board.

 

[EctopicFetus]

What I always wonder is, do they have these discussions on the other specialties' fora? Are there consensus 'best' programs for other specialties? Certainly there are crappy IM, FM, Surg, etc programs, but are there 1 or 2 programs that are head and shoulders above the rest?

I think the question should be 'What's the best EM program for me?' and that question can't be answered on a message board.

I think the reps of places helps. As someone who went through this process last yr I can tell you what makes EM different is that the traditional programs dont have a lock on being "the best".

Not to offend but some of the "bigger name" programs are Cincy, Indy, Denver, Carolinas etc for various reasons but in the older more traditional fields you cant stick with the Ivies and do well for yourself. In IM Harvard, Penn, UCSF, and a slew of the more nationally known places are often considered the "best".

Part of this is that EM is new and we tend to respect one anothers programs more than what often happens in medicine where due to the shear number of programs there are those places that tend to fill with IMGs which therefore gives an IM program the APPEARANCE of not being as good.

Just my 2 cents..

 

[bulgethetwine]

I think the reps of places helps. As someone who went through this process last yr I can tell you what makes EM different is that the traditional programs dont have a lock on being "the best".

Not to offend but some of the "bigger name" programs are Cincy, Indy, Denver, Carolinas etc for various reasons but in the older more traditional fields you cant stick with the Ivies and do well for yourself. In IM Harvard, Penn, UCSF, and a slew of the more nationally known places are often considered the "best".

Part of this is that EM is new and we tend to respect one anothers programs more than what often happens in medicine where due to the shear number of programs there are those places that tend to fill with IMGs which therefore gives an IM program the APPEARANCE of not being as good.

Just my 2 cents..

I think you've done a disservice to what this thread was about in the first place by naming four EM programs that you/your med school advisor/your friends/your fellow residents/your PD/other influential person in your life/ think qualify as "bigger names".

Every 4th year medical student that has ever asked me -- personally -- about which programs have the best reputation, I tell them to make a list of 5 factors. Then we go through the list and identify programs that seem to fit that criteria. That's better than any elitist's ill-defined notion of what are the most "reputable" programs.

Fetus -- you've built up enough cred around here that I didn't really take issue with your post... I'm being a bit of Devil's advocate here. But I just found it ironic that in a thread that started out as an insightful, thoughtful comment on why we can't define what is the "Best EM Program" it only took 4 posts for someone to post their own personal list.

 

[quinsy]

What I always wonder is, do they have these discussions on the other specialties' fora? Are there consensus 'best' programs for other specialties? Certainly there are crappy IM, FM, Surg, etc programs, but are there 1 or 2 programs that are head and shoulders above the rest?

I think in some other specialties there can be more variability, whereas EM seems to have an overall high standard at any program. For example, my best friend is doing anesthesia, and he's been extremely disappointed with a number of the programs he's visited because they are based in a private practice and so not as academic. Although as someone pointed out, these programs could be a good fit for specific applicants, I think overall most people applying to anesthesia are not looking for private practice groups to run their training. Also the variability in hours worked seems to be enormous - some programs letting you out by 4pm each day and giving two golden weekends per month with q6 call, some programs keeping you til 6-7pm each day, working every weekend, and q3 call. yikes! In EM you can have 8s or 12s but either way, you're not exactly hurting in comparison because there's no call.

Also, I initially was interested in a surgical sub-specialty (before I had my EM rotation!), and met with the chairman of that department about programs. He immediately asked me for a list of the top ten programs I wanted to apply to, which I had, and he went down the list variously praising or condemning the programs based on knowledge he had of the program directors or the reputation of the program for academics. In contrast to that, when I met with my EM advisor about applying, he just said "apply to 30 programs, because EM is competitive. It doesn't matter which ones, because they're all good." Having been on about 12 interviews so far, I can confirm that I have enjoyed all the programs I've visited and could only rank them based on personal preference. 30 programs was an overshoot for me personally, though.

 

[EctopicFetus]

I think you've done a disservice to what this thread was about in the first place by naming four EM programs that you/your med school advisor/your friends/your fellow residents/your PD/other influential person in your life/ think qualify as "bigger names".

Every 4th year medical student that has ever asked me -- personally -- about which programs have the best reputation, I tell them to make a list of 5 factors. Then we go through the list and identify programs that seem to fit that criteria. That's better than any elitist's ill-defined notion of what are the most "reputable" programs.

Fetus -- you've built up enough cred around here that I didn't really take issue with your post... I'm being a bit of Devil's advocate here. But I just found it ironic that in a thread that started out as an insightful, thoughtful comment on why we can't define what is the "Best EM Program" it only took 4 posts for someone to post their own personal list.

Thanks for giving me some cred. I didnt mean to imply those are on my list of top programs. FWIW there is only one best program in this country and it happens to be the one I am at

The ones listed were meant to show that those programs are seen by some as "better" and generally have the rep they do for reasons either being historic or otherwise. I also meant to show that some of the traditionally "strong" programs in other fields like IM and GSurg arent necessarily the ones people think are the best in EM. I really did not mean to imply that they are better than others. FWIW I was offered interviews by some of those on the list and I turned all of them down.

When people ask me "which program is best" the first thing I tell them is that the question should be "which program is best FOR ME?" your true choice will generally boil down to geography and if you really dont care about geography (rare) then it comes to program strengths and experiences.

For example some places do a lot of Flight, others offer a better experience with Peds, or EMS, some are more research focused etc..

Bulge, I prob should have been more careful with my post!

Everyone should now In n out is #1 the rest are just trying to keep up..

of course I still havent heard back from Dr McFattyPants....

 

[crewmaster1]

Well, I think the whole "pick the program that is the best fit for you" advice is great, but I think the name does play a role. Maybe I'm wrong, and if so I'd love to hear it. But, I'm from Seattle, this means I must go far, far away for residency. However, I want to come back to the Seattle area. Yeah, I could probably go to any EM residency and come back without a problem, but I may end up working in a large pimp group that scalps off your income and rotates you to several different hospitals. I would like to get into a small, democratic group that contracts with one hospital and keeps all of their profits (Can be a differene of up to 100,000K/yr in salary I have heard). I have a hard time believing that coming from a big name residency (yeah, we all know the names) will help me. I think this is also evident where the physicians trained who are in these groups...Overlae hospital: U. cinci, Denver. Evergreen hospital: U. Az. I could go on. My point is reputation cant hurt. I have a two programs that I totally love, one is a big name, one is not. I'm going to rank the big name first because I think it will give me a better opportunity for jobs in the future.

 

[EctopicFetus]

Well, I think the whole "pick the program that is the best fit for you" advice is great, but I think the name does play a role. Maybe I'm wrong, and if so I'd love to hear it. But, I'm from Seattle, this means I must go far, far away for residency. However, I want to come back to the Seattle area. Yeah, I could probably go to any EM residency and come back without a problem, but I may end up working in a large pimp group that scalps off your income and rotates you to several different hospitals. I would like to get into a small, democratic group that contracts with one hospital and keeps all of their profits (Can be a differene of up to 100,000K/yr in salary I have heard). I have a hard time believing that coming from a big name residency (yeah, we all know the names) will help me. I think this is also evident where the physicians trained who are in these groups...Overlae hospital: U. cinci, Denver. Evergreen hospital: U. Az. I could go on. My point is reputation cant hurt. I have a two programs that I totally love, one is a big name, one is not. I'm going to rank the big name first because I think it will give me a better opportunity for jobs in the future.

While there is a regional preference I think it is isnt based on the name of the program but rather based on relationships. For example, my program has been around for a while and as such we have a fair number of grads. To be fair we are on the west coast so most grads are on the west coast. There are certain groups who have a number of residents who graduated from my program. As such if my PD or Chair puts in a call to Dr X who graduated in 1995 from my program (our PD has been at this a long time) it will carry more weight than some big wig who the person may have heard of but doesnt really know.

I believe in most established programs these relationships are there. There are groups where a number of our residents go into because they are not advertised jobs and word trickles down.

So in the end I dont think it is the name as much as the relationships..

When I interviewed I always asked where do your grads go? How many academics vs community?

one place i interviewed had all their people stay in the city (with real good jobs) but they couldnt get away this made me very nervous.. Ill end it there..

 

[Dr. Will]

Well, I think the whole "pick the program that is the best fit for you" advice is great, but I think the name does play a role. Maybe I'm wrong, and if so I'd love to hear it. But, I'm from Seattle, this means I must go far, far away for residency. However, I want to come back to the Seattle area. Yeah, I could probably go to any EM residency and come back without a problem, but I may end up working in a large pimp group that scalps off your income and rotates you to several different hospitals. I would like to get into a small, democratic group that contracts with one hospital and keeps all of their profits (Can be a differene of up to 100,000K/yr in salary I have heard). I have a hard time believing that coming from a big name residency (yeah, we all know the names) will help me. I think this is also evident where the physicians trained who are in these groups...Overlae hospital: U. cinci, Denver. Evergreen hospital: U. Az. I could go on. My point is reputation cant hurt. I have a two programs that I totally love, one is a big name, one is not. I'm going to rank the big name first because I think it will give me a better opportunity for jobs in the future.

You should have gone to Cook County. There is a group in Seattle that has been taking 4-5 County grads for the last few years. No doubt, it would get you back there if you wanted.

 

[Ex-44E3A]

it's already been said; the best program is the one where you are comfortable, can learn your craft, and make those critical contacts. Much more than program, it's who you know... and you never know when a contact will come in handy. Never burn bridges.

I'm a partner in a small democratic group, and this job found me because I'd dropped off a CV and spoken for a few minutes with the medical director years before a slot came open... they simply kept my CV in their file. I hadn't heard from them in several years, and I was getting ready to sign a contract to become a member of a hospital employee group, when I got an email from my current group. They made me an offer I couldn't refuse, and away we went.

Democratic groups can be hard to find, but are worth the effort. Why work for the man when you can work for yourself?

 

[EctopicFetus]

You should have gone to Cook County. There is a group in Seattle that has been taking 4-5 County grads for the last few years. No doubt, it would get you back there if you wanted.

I dont believe that this was true for the last graduating class unless something drastic changed.

I too have heard of this. the thing is a job is more than just location but if you want to go to the NW I would imagine my program and Oregon do very well at putting people back in the NW.

 

[leviathan]

The best "EM" residency is contingent upon your subjective definition of what criteria makes it best.

 

[rndmguy21]

Wait,wait,wait. I dont post too frequently here, but I read many of the posts. I felt I should respond to this one because I think we need to be careful with some of these responses.
We need to be careful when telling prospective residents that "reputation doesnt matter". Many of us have said this both directly and indirectly. This thread certainly implies it.

While I think it is very true that "The best "EM" residency is contingent upon your subjective definition of what criteria makes it best.", it is also true that reputation will carry alot of weight when seeking employment at the end of your residency. We rightly try to deemphasize this point to med-students so as to avoid it being the major driving force in their decision. However, sometimes we may be leading them astray by suggesting that it doesnt matter at all.

I think what crewmaster1 said is particularly true and it needs to be emphasized.

I am currently a 3rd year at a very large, urban, "well respected" program. I have just completed a job search in an entirely different geographical area and I can tell you all that my programs reputation played a MAJOR role in the number and type of interviews I received. I heard CONSTANTLY from employers things like "Wow, you went to --------". And "isnt Dr. ------ at that program, you must really know you're management of --------".

At the same time, a friend from Medical School with similar characteristics as myself except that he went to a small, community program not known for its strength was interviewing in the same area and received fewer interviewers and even fewer offers. Without a doubt, the perception of ones program can and will have an impact on your future. (at least in the short term)

So I would submit to all prospectives to heed leviathan's advice "The best "EM" residency is contingent upon your subjective definition of what criteria makes it best." HOWEVER, that CRITERIA for many people may (and probably should) include reputation. Please do not totally discard this as a factor. While it shouldnt be the most important, it certainly should be considered.

Respectfully,
Rndm

 

[Dr. Will]

I dont believe that this was true for the last graduating class unless something drastic changed.

I too have heard of this. the thing is a job is more than just location but if you want to go to the NW I would imagine my program and Oregon do very well at putting people back in the NW.

Yup it is. Dr. Bowman told us it started with the class two years ago. A few went up there, so they asked for more the following year, and are asking for this year.

 

[bulgethetwine]

Wait,wait,wait. I dont post too frequently here, but I read many of the posts. I felt I should respond to this one because I think we need to be careful with some of these responses.
We need to be careful when telling prospective residents that "reputation doesnt matter". Many of us have said this both directly and indirectly. This thread certainly implies it.

While I think it is very true that "The best "EM" residency is contingent upon your subjective definition of what criteria makes it best.", it is also true that reputation will carry alot of weight when seeking employment at the end of your residency. We rightly try to deemphasize this point to med-students so as to avoid it being the major driving force in their decision. However, sometimes we may be leading them astray by suggesting that it doesnt matter at all.

I think what crewmaster1 said is particularly true and it needs to be emphasized.

I am currently a 3rd year at a very large, urban, "well respected" program. I have just completed a job search in an entirely different geographical area and I can tell you all that my programs reputation played a MAJOR role in the number and type of interviews I received. I heard CONSTANTLY from employers things like "Wow, you went to --------". And "isnt Dr. ------ at that program, you must really know you're management of --------".

At the same time, a friend from Medical School with similar characteristics as myself except that he went to a small, community program not known for its strength was interviewing in the same area and received fewer interviewers and even fewer offers. Without a doubt, the perception of ones program can and will have an impact on your future. (at least in the short term)

So I would submit to all prospectives to heed leviathan's advice "The best "EM" residency is contingent upon your subjective definition of what criteria makes it best." HOWEVER, that CRITERIA for many people may (and probably should) include reputation. Please do not totally discard this as a factor. While it shouldnt be the most important, it certainly should be considered.

Respectfully,
Rndm

Ah. The 'ol reputation prepetuation argument. Nepotism at its best. Well argued.

 

[docB]

I stand by my initial statements. I light of some of the ensuing comments I'll add a few points.

My main goal with this thread was to explain to newbies and lurkers who don't understand why the weekly "Best EM Residency" questions go the way they do. I'm not saying no one should ever care about reputation but to ask a blatent "Who's the best?" is garbage in and justifiably gets garbage out. It will get you much better answers to ask stuff like "Who's got the best rep for EMS?", "Who is the best in NYC?" and so on.

I agree that reputation shouldn't be totally unimportant. However, it also shouldn't be higher than about fifth on anyone's list of criteria. For the record I think people should look at:
#1 - Geography - regional and urban vs. suburban vs. rural
#2 - Fit
#3 - Academic vs. community
#4 - Specific faculty or interests you want to persue
#5 - 123 vs. 234 vs. 1234
#6 - reputation (maybe)
So actually on my list it's 6th.

Reputation is a little tricky to really judge. For the job hunting issues mentioned previously it's really more about networking and who knows who. I can tell you that when my group hires we put program rep waaaaaaaay behind how we think you'll fit based on the interview.

 

[Notzfall]

I'm a 10-year veteran paramedic and researcher for a large, urban Emergency Medicine program w/ strong EMS and flight connections. I'm starting med school in August and plan to specialize in EM. This is what I know from my experiences...

Everyone goes to one program...and no one else really 'knows' their program aside from the one they attended. With that said, I've received a great undergraduate education as an MS applicant, but had a difficult time convincing someone I just met my true, academic background. I believe the interviews and offers I received reflected this barrier. In any case, I'm in (whew).

It's true that you should select the residency right for YOU. But, chances are, where you want to work in the end is "in line" with the residency program you choose (ie, urban, EMS exposure, and research). Most of these 'type-programs' know about each other. So now, the question still lingers, "Which residency do YOU want to go to that has this list of components?" Residency A (not one of the heavy-hitters that are frequently mentioned), has these things, but residency B (Big name) has them too....and the person you're interviewing with knows the names; again, the network/reputation of same 'type-programs'.

Reputation is like word-of-mouth when it comes to marketing; it has a reputation for a reason, right? WHENEVER (100%) I've talked to others, including interviewers, about my academic past they ask for my grades, where you got them, and what you studied while you were there...in that order...always. Reputation may not be the most important thing, but it factors in at #2 (side note: I think major should've swapped with reputation, but, again, that's the way it is). It just opens more doors. If you've ever worked your butt off at a place without a name, you may have learned, like I, that reputation does matter. My point here is that reputation is not based on YOUR perception, but the preception of those whom you need to impress.

We all want to be great physicians for our patient's sake and personal fulfillment. Because of that, we work hard regardless of where we go. We all dont need to go to Residency B based on where we want to work, but for those of us that do...let's recognize it and don't kid ourselves. 20 years from now it wont matter (like the MCAT), but when you're right there at that point....it does.

 

[Mary Jane Watson]

It's funny, I don't remember our class having this nauseating debate last year. I have a lot of friends at various programs through EMRA and we really don't discuss it either. Do your research; go where you'd be a good fit; what are your interests? I didn't want to "have to" fly, so that moved Cinci and Indy down. I wanted a fantastic emergency experience, I did not want to go somewhere with "graduated responsibility," neither my husband nor I wanted ANY part of cold weather, snow or salt on my car, and I had to consider my spouse's job opportunities. I fit in here, everyone was laid back and chill, you get to do a ton. Warm weather. My husband had some work contacts. Those were biggies for me. YOU have to pick what's important to you. The RRC-EM is WILDLY strict about accreditation of programs, so we are all going to get good training.

As it is true in most any profession, it can be about who you know. People hire people they know. I knew that Dr. OKeefe knew Carey Chisholm, Linda Lawrence and Bob Suter (among many others). Dr. Sanson spoke at AAWEP last year, so has contacts that way (and others). Dr. Derr trained at Maricopa. My mentor in med school is at William Beaumont and was at Denver for many years. My former chair is now at Penn State. And on and on. I have made my own contacts through ACEP and EMRA. A friend of mine is one of your fellow interns Fetus! These are definitely things to research and consider as you are choosing a residency, a job, and leadership opportunities as well. Just know that it isn't just the docs at the "big names" that have the contacts. This is a VERY small world.

MJ

 

[BTS]

I'm not an EM doc, only know folks who have done EM residency - so take what I'm about to say with a grain of salt (or 10).

I get that residency is mostly about "fit". But, there are residencies where you see more interesting things, and get to do more interesting things. There are some hospitals that have "the latest and greatest" and others that get by on a shoestring budget. Fact of life. Assuming that residency is about getting as much exposure (seeing and doing) as much as possible there ARE going to be residencies that are better than others.

And the excuse that all ER residencies are awesome because of the strict requirements is a bunch of c*%$. At best it sounds naive, at worst it sounds arrogant.

 

[margaritaboy]

It's funny, I don't remember our class having this nauseating debate last year. I have a lot of friends at various programs through EMRA and we really don't discuss it either. Do your research; go where you'd be a good fit; what are your interests? I didn't want to "have to" fly, so that moved Cinci and Indy down. I wanted a fantastic emergency experience, I did not want to go somewhere with "graduated responsibility," neither my husband nor I wanted ANY part of cold weather, snow or salt on my car, and I had to consider my spouse's job opportunities. I fit in here, everyone was laid back and chill, you get to do a ton. Warm weather. My husband had some work contacts. Those were biggies for me. YOU have to pick what's important to you. The RRC-EM is WILDLY strict about accreditation of programs, so we are all going to get good training.

As it is true in most any profession, it can be about who you know. People hire people they know. I knew that Dr. OKeefe knew Carey Chisholm, Linda Lawrence and Bob Suter (among many others). Dr. Sanson spoke at AAWEP last year, so has contacts that way (and others). Dr. Derr trained at Maricopa. My mentor in med school is at William Beaumont and was at Denver for many years. My former chair is now at Penn State. And on and on. I have made my own contacts through ACEP and EMRA. A friend of mine is one of your fellow interns Fetus! These are definitely things to research and consider as you are choosing a residency, a job, and leadership opportunities as well. Just know that it isn't just the docs at the "big names" that have the contacts. This is a VERY small world.

MJ

Well said.

 

[roja]

Just know that it isn't just the docs at the "big names" that have the contacts. This is a VERY small world.

MJ

Well said. and hence why perhaps so many people are anti-name here. This world is small and *name* doesn't have so much to do with contacts. And because its small, pretty much, you can do six degrees an get there in about 3.

Your happiness and productivity (directly related!) are most important in residency.

(not to mention that the programs that are most well known in some specialties are not the 'named' programs in others...... so, you can't go based on the name of the reigning institution)

 

[docB]

I'm not an EM doc, only know folks who have done EM residency - so take what I'm about to say with a grain of salt (or 10).

I get that residency is mostly about "fit". But, there are residencies where you see more interesting things, and get to do more interesting things. There are some hospitals that have "the latest and greatest" and others that get by on a shoestring budget. Fact of life. Assuming that residency is about getting as much exposure (seeing and doing) as much as possible there ARE going to be residencies that are better than others.

And the excuse that all ER residencies are awesome because of the strict requirements is a bunch of c*%$. At best it sounds naive, at worst it sounds arrogant.

There are residencies where you get to see and do more interesting things. BUT, and this is why many EM people are so anti name dropping, that doesn't coorelate well with the program's national reputation. The "shoestring budget" places tend to be gritty urban centers that teach autonomy and produce docs who who have seen it all and think on thier feet.

I believe that the whole reputation issue gets blown way out of proportion because med students are by definition ambitious overachievers. At the same time they don't really know anything about the medical job market, medical politics at the local level and community medicine. To deal with this many try to get into the "best" residency because they think it will assure them their choice of jobs down the road. That just is not the case.