"There are no bad programs..."

[Hard24Get]

If I buy you a beer (to replenish the calorie), will you get off my case?

I just wanted to clarify one more time why people are reasonable to ask what Amory and others have asked. When I went to college, people said - "just go to the place that is right for you", then when the time comes to apply to med school, you hear that going to a certain type of college matters. When the time came to choose a medical school, people told me "wherever you fit in is fine, US News rankings are bunk, etc, etc". Now that I am applying to residency, people tel me the med school does indeed matter. And every other residency program says it does matter where you receive your residency training. So why are we anything but intelligent to ask, "really?"?

That being said, it is obvious that ER-ER-Oh is right - many fabulous programs are often overlooked. And it seems to be true that most programs in your area of interest will do from EM, at least from my perusal of the background of current faculty members I would like to replace. I just hope, with EM getting more and more competitive, that it is still that way when we graduate.

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[roja]

I have been holding off putting in my .02 but as I am sitting here, not doing much, I thought what the heck?

Will you ever get a straight awnser to this question? absolutely not. That is not because people are obnoxious but because there is NO RIGHT AWNSER. Hence why the solid advice of finding the place that fits YOU as an applicant is most important (just like it was for medical school... and college.)

So, does name matter that much? Not so much, but it doesn't hurt either. But BKN gave the most sound advice on here: it is not so much the residency as the RESIDENT. Average residents come out of 'great' programs. OUTSTANDING residents come out of 'average' programs.

*THAT* is why finding the place that is right for you is most important. You need a place that fits you, your life, your family life, etc so that, as a resident, you can excel.

In the end, what matters in the job market is your CV. This is going to be filled and impressive if you are at a place that gives you the most happiness, security and opportunities. You will be more likely to take thes opportunities if you are happy and comfortable in your training.

Yes, a name might open a door but it is no gaurantee that you will be allowed to walk through it if you have a mediocre CV compared to someone with a stacked full CV.

eg, St. Luke's- Roosevelt is rarely mentioned in these 'power-house' residencies. And yet, last year, one of our grads took the GW international fellowship out of about 60 HIGHLY QUALIFIED applicants, many from 'awesome' residencies. Why? because she was happy in her residency and was given many opportunities to develop her CV in lots of ways, which she took. She had an amazing CV. There are many other stories similar to this and this is the question you want to ask, as you look at programs, is where are all their grads going? And match that to where you think you want to go.......

 

[Roy7]

Well what's the most competitive residency? I was posting in another thread that no one ever seems to rate based on competitiveness - it seems to me that if everyone wants to go to so-and-so school, it's either because it'a a nice place to be, nice faculty, nice pay, or something nice!

Likewise, if I at least knew where the most competitive places are I'd be able to consider some more schools simply based on reputation as "competitive".

Thanks in advance.

 

[southerndoc]

If I buy you a beer (to replenish the calorie), will you get off my case?

Make it a 6-pack and we have a deal.

 

[TraumaCheers]

Well what's the most competitive residency? I was posting in another thread that no one ever seems to rate based on competitiveness - it seems to me that if everyone wants to go to so-and-so school, it's either because it'a a nice place to be, nice faculty, nice pay, or something nice!

Likewise, if I at least knew where the most competitive places are I'd be able to consider some more schools simply based on reputation as "competitive".

Thanks in advance.

Good theory. Dumb resident.

 

[WallowaWanderer]

All programs are equal, but some are more equal than others . . .

 

[Roy7]

Good theory. Dumb resident.

I dont get it... (maybe going with the second part).

 

[vtucci]

I think Amory's question is fair. With ERAS opening soon, I understand Roy7's question as well. I do not think either of them are soliciting for lists of the best places but looking for discussion and recommendations.

With respect to "competitive" programs, I think this question keeps getting asked because it may be slightly more fluid in EM than internal or surgery programs. Also, many students are probably considering how many programs they should apply to in view of their unique characteristics (class standing, Step I and II scores, research etc). Most students do not want to broadcast their stats (other than the ones who clearly want to brag with the 250+ scores etc and rightly get the FMF response) and are trying to judge how they stack up in the applicant pool in general and in specific for certain programs.

At this point, we are usually directed to the NRMP most recent tables with average step I scores, number of research projects/papers etc. for the various specialties. That is absolutely helpful for a starting point. However, for those of us truly committed to EM, it is not as helpful in narrowing the field of programs based on our individual stats and the individual program stats. Even in reviewing FREIDA, EMRAmatch information and program-specific websites, this information is not usually publicly available to applicants. It is not like when applicants applied to medical school and could see the average MCAT score per program, average age and other demographics.

We are not always in the know about that program who does not interview candidates whose Step I score is under fill-in the blank score or who prefers students only from top 10 medical schools. Our advisors are helpful to a certain degree in this regard but many students from state institutions are applying to programs all across the country and not all advisors are familiar with the inner workings of a program 2000 miles away from the candidate's school especially if the school has not sent anyone there before or had anyone in recent memory apply there.

For what it is worth, part of my competitiveness analysis has been looking at the number of applicants and the number of interviews offered per position.

 

[vtucci]

The question is what do you want to be great at? Look, the best academic docs would be awful in a community setting, the community guys would likely be overwhelmed at a 100K visit urban ED, and those urban EPs would be lost in the ivory tower.

If you ask a more direct question such as "I think I want to be an urban EP, what would be the best residency in the Chicago area or Ohio (because I've got family in those places)?" and you will get a better answer than in-and-out burger. But the question of "which residency is THE best?" is simply too variable to answer.

- H

Trying to tailor my question as specifically as possible per Foughtfyr, I would like to hear your thoughts on academically-oriented/research-oriented programs with extremely strong clinical training in large cities/urban setting with a higher patient volume (Boston, NYC, Chicago, Philadelphia etc) or a stone's throw from a major city.

I am interested in finding the best fit for me. If I cannot have all of the above, I am most interested in an academic environment with strong research and clinicals. It can be in the middle of nowhere but would be truly awesome if in a major city.

I have been trying to find "academic" programs and "research-oriented" programs and compiled a list partly based on number of research publications, chapter/book publications etc. However, I recognize that this can change from year to year and would welcome other thoughts on how to approach this.

I absolutely agree with BKN that we will take from residency what we put into it. I would like to surround myself with people who will push me to become the best EP and for whom I can do the same and hopefully, we will all have a great time doing so.

 

[theCamel]

fwiw i think that for me the 'best' program is the one that inspires me to strive for growth within the field personally/professionally while always pushing my limits and making me feel like i'm in a place that i can enjoy life after work. it also helps that i'll feel confident working in a diverse avenue of environments after grad as well as having instant credibility just based on my residency's name doesn't hurt either. ialsoapparentlyloverunonsentences.

i also respect and hope that other people match at places they think are the best (for them).

there is no substitute for patient volume and diversity of patient chief complaints in my opinion. i also think that it helps if your ED is autonomous or close to it. e.g. the high-powered ortho dept doesn't let you do anything/rads limits your u/s experience, etc.

 

[roja]

Trying to tailor my question as specifically as possible per Foughtfyr, I would like to hear your thoughts on academically-oriented/research-oriented programs with extremely strong clinical training in large cities/urban setting with a higher patient volume (Boston, NYC, Chicago, Philadelphia etc) or a stone's throw from a major city.

I am interested in finding the best fit for me. If I cannot have all of the above, I am most interested in an academic environment with strong research and clinicals. It can be in the middle of nowhere but would be truly awesome if in a major city.

I have been trying to find "academic" programs and "research-oriented" programs and compiled a list partly based on number of research publications, chapter/book publications etc. However, I recognize that this can change from year to year and would welcome other thoughts on how to approach this.

I absolutely agree with BKN that we will take from residency what we put into it. I would like to surround myself with people who will push me to become the best EP and for whom I can do the same and hopefully, we will all have a great time doing so.

I am going to go off the top of my head. (caveat: not familiar with Boston/Chicago programs in terms of research/culture)

UPitt: Judd Hollander has a great research assistant program = lots of research in the department. Very academic environment (from what I hear) with lots of geeking out over dinners/research. Plenty of research $$ is the scuttlebutt.

SLR: Similar research assistant program (minus the funding but some *might* be in the works). Both clinical and bench (tox) research done. Obviously, I am slightly biased.

NYPresb: I am not sure how much research these guys are putting out right now, but has a very academic culture. Plus, you have Pete Wyer, an EBM guru and awesome all around guy.

NYU: Again, not sure how much research, outside of tox, these guys are putting out, but also a very academic environment. Morning reports are the stuff of legend there. Plus, if you like tox, it is one of *the* places to be.

Stony Brook: Not sure what is meant by stone's throw. Stony Brook is on the island of long. They put out a good amount of research. Well loved program. It is in the burbs. By train, about 2 hours (despite it being about 40 miles from NYC) or by car, I hear an hour, from the city.

North Shore (also on LI but its pretty close to the city): Not sure how much publishing they do, but I know several people there. Ultrasound is strong, and they have one of the few critical care fellowships. I imagine the environment is academic.


Phili programs I am not so familiar with.

 

[Hawkeye Kid]

UPitt: Judd Hollander has a great research assistant program = lots of research in the department. Very academic environment (from what I hear) with lots of geeking out over dinners/research. Plenty of research $$ is the scuttlebutt.

For what it's worth, Hollander is at Penn. Not sure which program you're referring to, but I think both turn out some pretty good research.

 

[domer621]

I just want to go to a place where the EM residents have autonomy and get great training, do not compete with residents from other departments, and are treated and taught well by the EM department. I'd ideally like to practice community for 5-10 years after residency, then move into academics, so a program that leaves the door open for academia is a plus for me as well. Geography is not really an issue.

Any programs come to mind?

The process of narrowing down my list of programs for ERAS has been pretty frustrating, because it seems like every EM doc has a different opinion about the same program!

 

[Hawkeye Kid]

sorry, double post

 

[vtucci]

I am going to go off the top of my head. (caveat: not familiar with Boston/Chicago programs in terms of research/culture)

UPitt: Judd Hollander has a great research assistant program = lots of research in the department. Very academic environment (from what I hear) with lots of geeking out over dinners/research. Plenty of research $$ is the scuttlebutt.

SLR: Similar research assistant program (minus the funding but some *might* be in the works). Both clinical and bench (tox) research done. Obviously, I am slightly biased.

NYPresb: I am not sure how much research these guys are putting out right now, but has a very academic culture. Plus, you have Pete Wyer, an EBM guru and awesome all around guy.

NYU: Again, not sure how much research, outside of tox, these guys are putting out, but also a very academic environment. Morning reports are the stuff of legend there. Plus, if you like tox, it is one of *the* places to be.

Stony Brook: Not sure what is meant by stone's throw. Stony Brook is on the island of long. They put out a good amount of research. Well loved program. It is in the burbs. By train, about 2 hours (despite it being about 40 miles from NYC) or by car, I hear an hour, from the city.

North Shore (also on LI but its pretty close to the city): Not sure how much publishing they do, but I know several people there. Ultrasound is strong, and they have one of the few critical care fellowships. I imagine the environment is academic.


Phili programs I am not so familiar with.

Thanks Roja.

I am very interested in clinical research v. basic science but I am open to learning. Having grown up on long island, I do not see myself going back there anytime soon but I love the Big Apple and would be happy to go back to NYC. Maybe our paths will cross as I am very interested in SLR and San Francisco is an awesome city.

 

[Termwean]

Great community program....Great tailgating at LSU football games. My #1 for many reasons (and because I can remain to live where I do...and not take my 6 y/o out of her french immersion school or my wife away from her family and because I want to remain in LSU system which has been so good to me).

Good luck this yr everyone!

 

[SoCuteMD]

Really, people! It's not even interview season - let's hold off on the ROLs for a few weeks, kay?

 

[Universe_Explorer]

vtucci,

When I was looking at programs last year, I was initially most interested in the "academic" ones that produced the most research. I also looked in a lot of the same regions you mentioned. When it came to research, these were the standouts:

Philly region: Penn, without a doubt. Hollander is an amazing resource, and the basic sci there is top notch as well (Dr. Nuemar and some others have great labs). It's not in the Philly region per se, but obviously Pitt has some of the strongest research in EM as well. They have a ton of clinical stuff via EMS, and some great basic sci labs (pubmed search Cliff Callaway).

NYC: Oddly enough, the NYC programs have very little basic sci research (North Shore has a couple labs and some collaboration with the Feinstein Institute though). As far as clinical research, there is a lot of opportunity at SLR, and lots of potential at NYP. NYU/Bellevue, while hosting a world class Tox research at NY Poison Control, actually isn't the most fertile research environment in my opinion.

Chicago: I didn't end up interviewing there, but UofC seems to have fabulous stuff

Boston: Again, I didn't interview there, but BIDMC seems to be the place, and I would imagine BWH/MGH is very supportive

Balt/DC: You didn't mention this locale, but you should definitely check out UMD, which has one of the finest all-round EM programs in the country as far as I'm concerned (including research and faculty development), Hopkins, which has changed the entire curriculum to essentially force a ton of research experience and development (on top of a program with very well-published faculty), and WHC, the baby in the group but with a lot of clinical research potential.

Just remember to keep an open mind and follow your heart - not the # of publications. If you fit somewhere, you'll probably do well regardless...

 

[DocFrog]

I just want to go to a place where the EM residents have autonomy and get great training, do not compete with residents from other departments, and are treated and taught well by the EM department. I'd ideally like to practice community for 5-10 years after residency, then move into academics, so a program that leaves the door open for academia is a plus for me as well. Geography is not really an issue.

Any programs come to mind?

The process of narrowing down my list of programs for ERAS has been pretty frustrating, because it seems like every EM doc has a different opinion about the same program!

To reply to Domer:

York Hospital in York, PA...community type hospital, busy ED, trauma training at Shock Trauma, unopposed residency (except FP), good salary, not a dangerous area, director is very friendly, struck me as a great program when I interviewed there and I know of at least one of their graduates who is now on faculty at Hopkins. My only hesitation was some of their residents seemed a little bit apathetic during my interview.

 

[domer621]

To reply to Domer:

Thanks.

 

[deleted109597]

I just want to go to a place where the EM residents have autonomy and get great training, do not compete with residents from other departments, and are treated and taught well by the EM department.

Corpus Christi comes to mind. Jacksonville, FL. Augusta, Ga. El Paso has a new program where EM is an integral part of the medical schools curriculum starting with the practice of medicine as first years. They're also building a new ED.
I can't think of any places where the EM residents are second class to the other residencies, except maybe MUSC, simply because it is so new. Then again, I haven't been out west much, or in the northeast.

 

[roja]

Penn. Sorry. I was in the midst of my third SF<->NYC trip this month. Brainfried doesn'n tcover it.

 

[Rendar5]

Is North Shore the same as the LIJ program that offers IM/EM? I always get the LIJ ones confused since there seem to be two of them. Two attendings that I really respect come from that one.

 

[roja]

Different programs.

 

[vtucci]

vtucci,

When I was looking at programs last year, I was initially most interested in the "academic" ones that produced the most research. I also looked in a lot of the same regions you mentioned. When it came to research, these were the standouts:

Philly region: Penn, without a doubt. Hollander is an amazing resource, and the basic sci there is top notch as well (Dr. Nuemar and some others have great labs). It's not in the Philly region per se, but obviously Pitt has some of the strongest research in EM as well. They have a ton of clinical stuff via EMS, and some great basic sci labs (pubmed search Cliff Callaway).

NYC: Oddly enough, the NYC programs have very little basic sci research (North Shore has a couple labs and some collaboration with the Feinstein Institute though). As far as clinical research, there is a lot of opportunity at SLR, and lots of potential at NYP. NYU/Bellevue, while hosting a world class Tox research at NY Poison Control, actually isn't the most fertile research environment in my opinion.

Chicago: I didn't end up interviewing there, but UofC seems to have fabulous stuff

Boston: Again, I didn't interview there, but BIDMC seems to be the place, and I would imagine BWH/MGH is very supportive

Balt/DC: You didn't mention this locale, but you should definitely check out UMD, which has one of the finest all-round EM programs in the country as far as I'm concerned (including research and faculty development), Hopkins, which has changed the entire curriculum to essentially force a ton of research experience and development (on top of a program with very well-published faculty), and WHC, the baby in the group but with a lot of clinical research potential.

Just remember to keep an open mind and follow your heart - not the # of publications. If you fit somewhere, you'll probably do well regardless...

Thanks UniverseExplorer. I absolutely agree that it is about finding the right fit. I would pick a program that has no recent publications (even if it meant being the first resident in awhile to do so) if it was the right one for me over a paper factory with a malignant atmosphere.

Definitely like the clinical research though and think I will thrive in an academic environment and so have SLR, UMD, Penn, BIDMC, UofC, Christiana and Carolinas all at the top of my list. Cross fingers for me that I will like them as much in person as on paper (and of course, that they will like me too. ).

Thanks all.

 

[Spaceman Spiff]

The "best program" comes down to what you want to get out of it. Some people are interested in academics, some interested in urban gun/knife club, some in community EM. Each program has strengths in one of the general areas.

The problem with the whole match system is that someone may really want to do academic medicine, but due to board scores, etc may end up in a community setting. Likewise the person who loves gun/knife medicine may not get the big urban E.D. experience like at LAC-USC or Cook.

If someone is really set on a certain type of EM, and only ranks those types of programs they risk not matching.

I really wanted to do academic EM, but ended up in the gun/knife club residency, and am finishing at a community EM residency. I still want to do academics.

As far as "general" EM goes, I think that the smaller community programs prepare people just as well as the big academic or urban residencies. Obviously a small community hospital can't offer the same specialized experience, however I know a lot of people in academics who've come out of non-academic programs.

I don't know if this thread is still going, but in reading it I found GeneralVeers comment to really get to the heart of the matter. It all boils down to what style of residency/practice you want, cross-referenced against your own qualifications. While reviewing different programs, they all have something interesting or special to offer, and all, at least those that I've seen, strive to provide a minimum (read mandated) curriculum. So after hearing the old line "you'll get good training no matter where you end up", I'm starting to believe. Which means that I have to think deeper about what it is that I actually want. I enjoy academics, but as far as my EM training goes, I want to be neck deep in sick and broken people, so I will focus my efforts on the County-type EM programs with the high volume and high acuity... in cities that have easy access to doing all the outdoor stuff I love to do.

IMHO, as far as a desire to do academics goes (or anything for that matter), you may have to accept something that's not entirely in sync with your desires in the short run, but you can get to where you want to be if you REALLY want it. It's the long-view, the end-game that counts. That's what I've learned, that's the story of my life.

PS Also, among the many great posts to this thread, I really enjoyed ER-ER-Oh's post, which was right to the point! Especially his final comment on his first post: "You feel you need to be coached by the best, seek them out. If you feel you need a lot of room and less interference by the staff, seek out that. But you're always going to be only as good as what you've got inside of you, no matter what kind of program you attend."
And that's the name of THAT tune!

 

[StealthNerd]

I don't know if this thread is still going, but in reading it I found GeneralVeers comment to really get to the heart of the matter. It all boils down to what style of residency/practice you want, cross-referenced against your own qualifications. While reviewing different programs, they all have something interesting or special to offer, and all, at least those that I've seen, strive to provide a minimum (read mandated) curriculum. So after hearing the old line "you'll get good training no matter where you end up", I'm starting to believe. Which means that I have to think deeper about what it is that I actually want. I enjoy academics, but as far as my EM training goes, I want to be neck deep in sick and broken people, so I will focus my efforts on the County-type EM programs with the high volume and high acuity... in cities that have easy access to doing all the outdoor stuff I love to do.

IMHO, as far as a desire to do academics goes (or anything for that matter), you may have to accept something that's not entirely in sync with your desires in the short run, but you can get to where you want to be if you REALLY want it. It's the long-view, the end-game that counts. That's what I've learned, that's the story of my life.

PS Also, among the many great posts to this thread, I really enjoyed ER-ER-Oh's post, which was right to the point! Especially his final comment on his first post: "You feel you need to be coached by the best, seek them out. If you feel you need a lot of room and less interference by the staff, seek out that. But you're always going to be only as good as what you've got inside of you, no matter what kind of program you attend."
And that's the name of THAT tune!

LOVE the user name/pic. Man, I miss Calvin & Hobbes.

 

[pinipig523]

Such a tough question to answer, I pondered over Amory's question when I applied last year.

I do not know all the programs so I cannot say which is the best, however, I made my rank list based on what I thought was best for me.

The ideal program is:
1. Huge patient diversity - you want to see what can be seen.
2. Huge patient load - you want to see enough.
3. Awesome ancillary stuff - who get things done at a moment's notice. No need to wait 1 hour to get someone to draw a CBC.
4. Unlimited resources - you want a CT scan? No wait!
5. Great variety of attendings - so you can get a feel for a myriad of emergentologists.
6. Easy access to admission - no need to sell your patient
7. Great off service rotations - so you can bring something back with you to the ED once you return.
8. Great facility - I want a cafeteria open all night long and nice patient rooms with every instrument/monitor I need.
9. Fantastic city - you can't live/eat/breathe EM all the time, can you?

Based on that, I ranked my programs. No matter how your "ideal list" turns out, you need to rank programs based on how you want to live the next 3-4 years of your life, not how a program is ranked against all others. Find your niche and you will be successful.