Tiers in EM Residencies?

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Music MD

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Which EM programs are considered to be more competitive?

Haven't been able to find a general consensus.. I really hate to use the word "tiers", but I'm just trying to get an idea of what programs I should avoid applying to/doing away rotations.. I remember when applying to medical school I did pretty well to apply broadly but limit my applications to reasonable options. For example I didn't send a primary to Penn or Hopkins and I think that made a lot of sense back then. Is that the case here as well? Or should I just apply everywhere I'd be willing to go and see how many interviews I can get?

I'm a fairly average student it seems.. 227 step I. Few high pass in first two years.. 1 hon/2hp/2p so far in 3rd year. good evals thus far. literally one EC, non medical but it was a leadership role. Hoping to do well on step II and get decent letters. Anyway I don't want this to be about my stats, but as you can see I'm not going to radiate in any particular way.. is it still worth applying to top programs?

I'm particularly interested in Albany, Maine, Denver, Temple, and the NYC area programs.. if anyone can comment on their competitiveness I'd really appreciate it! Thanks -musicmd
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Competitiveness is also determined by what you want in residency. For example, I wanted a 3yr, community based residency, not in a huge city. So that ruled out a lot of places.

From the places you mentioned, they have no seemingly constant thread (ie. mix of 3vs4yr, academic vs community, large vs small city, NE vs west, etc.). All of the places you mentioned are quality residencies, but you really should just define what you want from residency/atmosphere you want to train in. That will help a lot. Then you can talk about competitiveness more easily.

If you just want a list of general competitive programs, read the sticky'd FAQ section. There are other things to consider as well, like East->West is very difficult.
 
Shall we play this game again, amigos ?

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(FWIW: Denver is turbo-competitive).
 
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RustedFox said:
Shall we play this game again, amigos ?

_ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _

(FWIW: Denver is turbo-competitive).
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Really? The OP's not asking about what programs are the best or which will allow him to get a job in San Diego after residency. He just wants to know which one's aren't so competitive that he'll be able to get an interview or match at.

I get that it's offensive to your sensibilities that different programs are of differing levels of competitiveness and even that some residencies provide better training than other. But do you really have to jump on someone just for having the gall to wonder what programs he has a shot at? I don't see why every time any question related to this topic is asked, the OP is shouted down w/ cries of "Fatty McFattty Pants", "In-N-Out" or "it's been discussed to death already".

I mean, it really is hard for prospective applicants to figure out a good application list. There aren't, w/ good reason, widely accepted tiers like for IM or Surgery, and people are extremely tight lipped about it, both on this board and in real life (my experience at least).


Back to the topic at hand. Denver's considered a top program by most and is thus extremely competitive. Maine's also fairly competitive by virtue of being pretty small and in a desirable area. If I were you, I'd go through the SAEM Directory and pick out every program in a location acceptable to you and cross out 3 or 4 year programs (whichever you don't want) and then hopefully you'll have a list of 30-50 or so. Then talk to an adviser and talk about your list to find out if there are any you've overlooked or any you should get rid of.
 
I think the hard part is that "competitive" means something different in EM than it does in other specialties. The kinds of people that tend to choose EM (forgive me for generalizing) tend to be people that are slightly more outwardly focused. So they make choices about residency as a choice about what lives they want to lead while a resident, rather than just about the residency program itself. In medicine and surgery, the distinction is clear: academic programs are more "prestigious" than non-academic programs. In EM that is not the case--there are excellent programs in both academic and community settings (and also unlike IM, many excellent community programs you could argue are in fact better than their academic counterparts). Therefore location, desired patient population, practice style, proximity to outdoor sports, etc., end up playing larger roles in decision-making. In sum: it's complicated.

This makes it incredibly difficult for applicants to figure out the reputation of a program--everyone's got their own opinion about what they're looking for and therefore feels strongly that certain programs make more sense to them. I think that the methods people have proposed above make sense (starting with location, weeding out the types of programs you don't want). The fortunate thing is that across the board programs will prepare you clinically to be an excellent EM doc--that's the bottom line. Whatever else it is you're looking for in training (research, rural medicine, lots of consultants, few consultants, academic settings, community settings, 3 year programs, 4 year programs) is really what will end up determining what places appeal to you.

There are programs that have been around a long time, and are difficult to get an interview at (cincinnati, denver, highland, to name a few.) But here's the point: not everyone wants to go to these places, even though they're really established and difficult to get a toe in the door. Because we don't all want the same thing. We don't all want to end up in the same place. We don't all want to practice the same kind of emergency medicine.
 
member11223344 said:
I think the hard part is that "competitive" means something different in EM than it does in other specialties. The kinds of people that tend to choose EM (forgive me for generalizing) tend to be people that are slightly more outwardly focused. So they make choices about residency as a choice about what lives they want to lead while a resident, rather than just about the residency program itself. In medicine and surgery, the distinction is clear: academic programs are more "prestigious" than non-academic programs. In EM that is not the case--there are excellent programs in both academic and community settings (and also unlike IM, many excellent community programs you could argue are in fact better than their academic counterparts). Therefore location, desired patient population, practice style, proximity to outdoor sports, etc., end up playing larger roles in decision-making. In sum: it's complicated.

This makes it incredibly difficult for applicants to figure out the reputation of a program--everyone's got their own opinion about what they're looking for and therefore feels strongly that certain programs make more sense to them. I think that the methods people have proposed above make sense (starting with location, weeding out the types of programs you don't want). The fortunate thing is that across the board programs will " Whatever else it is you're looking for in training (research, rural medicine, lots of consultants, few consultants, academic settings, community settings, 3 year programs, 4 year programs) is really what will end up determining what places appeal to you.

There are programs that have been around a long time, and are difficult to get an interview at (cincinnati, denver, highland, to name a few.) But here's the point: not everyone wants to go to these places, even though they're really established and difficult to get a toe in the door. Because we don't all want the same thing. We don't all want to end up in the same place. We don't all want to practice the same kind of emergency medicine.
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For the most part, I agree with this post. It's complicated, as explained above.

And the most important thing is to find the "type" of training you are looking for (3v4, academic v community, etc), the locations you (or your significant other) can live in, and then rank out the programs in competitiveness and apply to them all!

However, do not fall into the fairy-tale world where all EM programs will "prepare you clinically to be an excellent EM doc." That's not true and not the bottom line.

I still don't understand why we, as a specialty, won't admit that there are programs that are insufficient. It is preventing those programs from becoming stronger (or eliminated) and preventing us, as a specialty, from improving. Sad.

HH
 
I was in a position of looking for less competitive residencies last year when I started applying, and like the OP had some frustration in discerning which places are competitive. I think turkeyjerkey presents a good strategy. When I was looking though (as an unremarkable applicant), I wanted to ensure I maximized my opportunities for an interview, so in addition to any place I was in love with, I selected the majority of programs I applied to in midwestern states with lots of programs (especially relative to population). I especially looked for community programs that are not well know to the masses.

My thinking was that people from across the country are going to gravitate to the coasts, the big cities and the big names, since most of us applicants are operating with a similar degree of ignorance. It's not a perfect system since you will inevitably end up applying to some of the community powerhouses that 11223344 is talking about, but I think it can help you in getting to a starting point if you have concerns about getting the 14ish interviews that you want.
 
Deuce Doc said:
I was in a position of looking for less competitive residencies last year when I started applying...
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Damn dude, what program did you go to that allowed you to start first year as an attending? Now that's something to be tight lipped about!

:eek:
 
I should probably contribute to this thread rather than make asinine posts...

I think you would be well suited to find a good mentor at your institution, my friend. Like you, at almost this exact time last year, I met with a mentor with my up to date (and slightly above average) grades, and step 1 score (which was worse than yours, and slightly below the national average). I was told to take step 2 early, and get honors in my last two rotations. I had a list of all the programs I wanted to go to (that I generated from researching via SAEM, this forum, and personal preferences). My mentor said, let's see how you do on your last two rotations and step 2, and we'll talk about where you should apply.

I crushed step 2 and finished the school year strong. We met up, and he said apply where you want, you should be fine. This was nice.

I think you will fall in the same boat. Finish the year strong, take step 2 early (and do well) and get some good SLORs for your application and you won't need to be counseled on which programs you need to apply to for safeties, reaches, etc. Denver is allegedly very competitive, and I was shocked to be offered an interview there, so don't let the remarks that it is "turbo-competitive" cause you to not apply.

Apply broadly, and to the places you want to go. I got offers at places I NEVER thought would interview me, and didn't get offers at places I thought I was a shoe-in. There is some resemblance to medical school applications, in that sometimes it's a crap shoot, but also don't underestimate that interviews from more distant regions (NW & west coast, coming from the east coast) may be harder. It certainly doesn't mean it's not worth a shot. If you do as I did, and perform well before the application is due, you'll be in great shape and will probably need to apply to 25-30 programs to get the amount of interviews you want.

Good luck, man. It's a fun (though slightly stressful) process to undergo, and you're right at the beginning. Feel free to ask away on this forum, and ignore the unproductive comments, because every once in awhile, you'll get some valuable feedback.
 
Dane07MD said:
Damn dude, what program did you go to that allowed you to start first year as an attending? Now that's something to be tight lipped about!

:eek:
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I noted this also. Giggled a bit when I saw your post.
 
Basically it sounds like do well on step 2, do well on rotations, then apply everywhere I want to go.. pick 30 programs if all goes well. I guess I could just pick more if I do average on step 2 or anything goes awry with my app. Ok thanks much appreciated.

As far as choosing programs.. I'm not sure I care that much about 3 vs 4yr, +/- research, community vs academics.. should I? For me, I think lifestyle/location will inevitably trump those characteristics.

That said, I do know what I don't want: to be a total scut monkey and not be actively taught by the faculty. It would be really nice to find out any malignant/underdeveloped programs if they do exist so they can be avoided.
 
Originally Posted by Dane07MD
Damn dude, what program did you go to that allowed you to start first year as an attending? Now that's something to be tight lipped about!

:eek:
IIRC, EM will be his/her 2nd residency after practicing in a previous specialty.
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They have a special name for people like me on July first: Intern....(I hope).
 
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Music MD said:
Basically it sounds like do well on step 2, do well on rotations, then apply everywhere I want to go.. pick 30 programs if all goes well. I guess I could just pick more if I do average on step 2 or anything goes awry with my app. Ok thanks much appreciated.

As far as choosing programs.. I'm not sure I care that much about 3 vs 4yr, +/- research, community vs academics.. should I?.
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Yes

For me, I think lifestyle/location will inevitably trump those characteristics.
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Please develop an idea of what you want out of your career besides the number of days off a month and what you do in your leisure time. You'll be happier in the long run.
 
Hamhock said:
However, do not fall into the fairy-tale world where all EM programs will "prepare you clinically to be an excellent EM doc." That's not true and not the bottom line.
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Care to expound on this with any specific examples or characteristics of programs you think would offer subpar training?
 
namethatsmell said:
Care to expound on this with any specific examples or characteristics of programs you think would offer subpar training?
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Exactly, please list. So many people say, ...well some won't give you a good education...but no one is ever willing to actually give examples.
 
Music MD said:
As far as choosing programs.. I'm not sure I care that much about 3 vs 4yr, +/- research, community vs academics.. should I? For me, I think lifestyle/location will inevitably trump those characteristics.
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You'll need to really think hard about those first few things within the next few months. Maybe you should schedule some away rotations at a few places to help you figure it out if you really aren't sure.

The point of residency is to prepare you for the rest of your life. The idea isn't to minimize the amount of input. It is to learn as much as you can to get as good of a doctor as you can and to set you up to land your dream job. You'll get out what you put in.

Each residency you interview at will want to know: "Why us?" No one wants you at their program if you don't want to be there. You'll either need to be sincere or a very good liar to convince them that you actually want to be there. I would assume that most residency programs have such a narrow gap between the difference in most applicants that if you don't have the numbers or SLOR to stand out, you're going to find yourself moved down the list if they don't think you are really interested in their program. If they think you are really interested, then you may get bumped up some.

Listen, I'm not trying to tell you that you have decide right this very instant what type of job you want when you are done, but you'll need to have an idea. A lot of people end up at jobs that they didn't initially expect to be at. A lot of people discover they like things that they didn't initially believe they would. A lot of people do change their minds. But, most programs expect a level of maturity consisting of the fact that have put serious thought into answering these questions. They are also likely to ask you what subtopic of EM you are most interested in. Remember that most programs have their own little "world expert" on some topic.

One last thought: I've heard it said that the most important location for residency is "72 and flourescent." If you're going to spend 95% of your waking time at a hospital you can't stand, working with people you don't get along with you'll be miserable even if it is 75 and sunny outside every day.
 
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NEATOMD said:
One last thought: I've heard it said that the most important location for residency is "72 and flourescent." If you're going to spend 95% of your waking time at a hospital you can't stand, working with people you don't get along with you'll be miserable even if it is 75 and sunny outside every day.
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This might be true for interns (or other residencies like IM or surgery), but many EM programs front load the numbers of shifts per block with like 20-22 as R1, but by R3 and R4 I saw as low as 16. That's 12 days off (out of 28)! Even if some of those are days recovering from nights, there is still time to do stuff. Better be in a place, and with people one likes.
 
SepulvedaMD said:
This might be true for interns (or other residencies like IM or surgery), but many EM programs front load the numbers of shifts per block with like 20-22 as R1, but by R3 and R4 I saw as low as 16. That's 12 days off (out of 28)! Even if some of those are days recovering from nights, there is still time to do stuff. Better be in a place, and with people one likes.
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Sure seems like you're gonna have plenty of free time doesn't it. My program is the same way. I work eighteen 10.5 hour shifts per month as a 3rd year. Oh, but you'll still have conference 5 more days a month. Want a job? You'll be sorting that out 3 rd year. Plan on devoting a couple days a month at least (on average). Planning on moonlighting? That's 3 more shifts a month. Got your research done? that's more time each month. There went 11 of your days off. Plus, you'll lose days recovering as you mentioned. Trust me, having been through it. You'll have less time as a third year than you think.

Listen, if impressing people with an exotic location is important to you, then rank as such Just realize that your free time as a resident will be severely limited no matter where you go.
 
SepulvedaMD said:
This might be true for interns (or other residencies like IM or surgery), but many EM programs front load the numbers of shifts per block with like 20-22 as R1, but by R3 and R4 I saw as low as 16. That's 12 days off (out of 28)! Even if some of those are days recovering from nights, there is still time to do stuff. Better be in a place, and with people one likes.
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As fourth years at University of Mississippi; we worked about 12. I think the most anyone in my class worked was 13, and as chiefs we did 9 or 10. Those were 12 hour shifts; many people have their research about sewed up by then so we did have tons of free time off. Although, most people worked that many shifts again moonlighting...
 
NEATOMD said:
Sure seems like you're gonna have plenty of free time doesn't it. My program is the same way. I work eighteen 10.5 hour shifts per month as a 3rd year. Oh, but you'll still have conference 5 more days a month. Want a job? You'll be sorting that out 3 rd year. Plan on devoting a couple days a month at least (on average). Planning on moonlighting? That's 3 more shifts a month. Got your research done? that's more time each month. There went 11 of your days off. Plus, you'll lose days recovering as you mentioned. Trust me, having been through it. You'll have less time as a third year than you think.
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I see where you are going, but even this explanation is faulty.

#1 Most conferences are 5 hours in the morning, that's like a half day. You really have conference 5 times per month?

#2 Are you really spending 8hours a day looking for a job on your day off?

#3 True every program has some scholarly project component. Can't get around that.

#4 18 shifts/block as an R3 is definitely on the high side that I saw on the trail

#5 moonlighting, though very attractive and valuable, is still a choice.

Basically, just because you might have things to do on a day off, doesn't mean it's not a day out of the hospital.
 
SepulvedaMD said:
I see where you are going, but even this explanation is faulty.

#1 Most conferences are 5 hours in the morning, that's like a half day. You really have conference 5 times per month?

#2 Are you really spending 8hours a day looking for a job on your day off?

#3 True every program has some scholarly project component. Can't get around that.

#4 18 shifts/block as an R3 is definitely on the high side that I saw on the trail

#5 moonlighting, though very attractive and valuable, is still a choice.

Basically, just because you might have things to do on a day off, doesn't mean it's not a day out of the hospital.
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#1 I have conference every Thursday. That means 4 or 5 per month every month. Conference is about 6 hours a week which is a pretty significant chunk of anyone's day. In addition to these educations requirements we also have CORD/EM challenger assignments each month.
#2 I never spent 8 hours any day job hunting. But, I did spend countless hours researching jobs, networking, and researching some more. Most significantly, I spent about two to four days traveling and interviewing each month until I signed. Since signing I have spent on a good amount of time doing paperwork/etc related to that job (Way more than I ever expected).
#3 Agreed.
#4 I would put my residency at around average. But, I don't know where you interviewed so I can't compare that. And, I interviewed several years ago so programs may have changed their staffing since then. Either way, if you go back to my original post you can see my thoughts on that. Also, considering that I'm in a three year program, I will be working 0 shifts in a residency next year. So, comparing it to 4 year programs isn't going to be beneficial in that respect.
However, I would advise you to look into the hours per shift and sign out type since this has a potential to add a lot of extra hours as well.
#5 In my experience, most residents decide to maximize their moonlighting (everyone seems to work within their limits). And it really does significantly affect your free time.

I seem to have offended you. And for that I am sorry. I don't want to debate this with you. Whether you believe me or not, I think you'll find it all out soon enough.
 
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Tier 1: Where you would absolutely LOVE to train & live for 3-4 years
Tier 2: Where you would really enjoy either the training atmosphere or the city/environment, but Not both
Tier 3: Not amongst your dream programs on either level, but still a "good fit"
Tier 4: Everything just feels "OK", more negatives than above, but you'd be willing to overlook them
Tier 5: Please don't let me end up here....but holy hell please let me match...so, yes.

actually, this was a meager attempt at bumping this thread so that some people more "in the know" might start busting out real tiers similar to commonly seen on IM thread.

Can't explain it, but there is just something inherently addicting in reading other people's opinions/banter on how various programs stack up. Is there a support group for this?
 
DreamingTheLive said:
Tier 1: Where you would absolutely LOVE to train & live for 3-4 years
Tier 2: Where you would really enjoy either the training atmosphere or the city/environment, but Not both
Tier 3: Not amongst your dream programs on either level, but still a "good fit"
Tier 4: Everything just feels "OK", more negatives than above, but you'd be willing to overlook them
Tier 5: Please don't let me end up here....but holy hell please let me match...so, yes.

actually, this was a meager attempt at bumping this thread so that some people more "in the know" might start busting out real tiers similar to commonly seen on IM thread.
Can't explain it, but there is just something inherently addicting in reading other people's opinions/banter on how various programs stack up. Is there a support group for this?
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Why would you want that kind of psychopathology over here? I'm a mod on the IM forum and every time I see one of those threads it takes all my willpower not to delete it and ban the person who posted it for being a useless douchecanoe.

I come to the EM forum for the relative sanity (and to laugh at Veers and Apollyon for their lack thereof)...don't ruin it.
 
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Sorry. But, I've come to enjoy your and jdh's rather candid responses to said posts. It's a vice I have, maybe I'll give it up for lent.

Ya, I've noticed you around these EM parts quite a bit. Didn't know it was for respite. Can respect that.
 
DreamingTheLive said:
Tier 1: Where you would absolutely LOVE to train & live for 3-4 years
Tier 2: Where you would really enjoy either the training atmosphere or the city/environment, but Not both
Tier 3: Not amongst your dream programs on either level, but still a "good fit"
Tier 4: Everything just feels "OK", more negatives than above, but you'd be willing to overlook them
Tier 5: Please don't let me end up here....but holy hell please let me match...so, yes.

actually, this was a meager attempt at bumping this thread so that some people more "in the know" might start busting out real tiers similar to commonly seen on IM thread.

Can't explain it, but there is just something inherently addicting in reading other people's opinions/banter on how various programs stack up. Is there a support group for this?
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The only people that have any intelligent idea about where their EM programs rank in terms of other programs have absolutely no reason to do so. As a medical student, it's very important to you to try and assess which is the "best" program for you. As a resident, unless you are currently being disciplined and expecting to be fired, negative comparisons of your training to that of your EM cohort are unhelpful at best and psychologically damaging at worst. There is no incentive to be critical of your training experience in global terms since doing so devalues your own accomplishments during residency and would only hurt your job prospects afterwards.

Intra-program variation in resident quality is larger then inter-program variation, so the idea that "every program prepares you to be a quality EM physician" is never going to go away unless some objective ranking system is imposed (Core Measures for EM Residencies?). And I can't think of any specialty where such a system would be so vigorously opposed as ours.

Now there are programs that are so specialized in what they do that the transition out of that particular environment is quite difficult initially. However, even among the big county shops where you spend most of residency pushing patients to and from radiology, more residents than not are going to go into PG driven community shops and still succeed.
 
Why do students get so caught up in this 'tier' stuff?

I think what has been said here is spot on. I dont think there are many EM programs that are much better than others. Most of us think the program we went to was the best. EVERY program has some bad apples that were mesirable and think the program sucked... regardless, I bet they go out and become BC and do well.

I've heard my alma mater (University of Mississippi) come across as a 'less desirable place' or lower tier.... but it was in Jackson, MS (deep south..not so attractive to someone from the NE or west coast... I like deer hunting, rural living, taking care of poverty patients, etc.. I really enjoyed it) and it was a four year program. Regardless, I made a CRAP load of money moonlighting, learned everything I needed to learn to practice Emergency Medicine, passed my qualfying exam without issue, interviewed at jobs I asked for interviews at, accepted at a place with a very stable environment and rare hires (3 new full time folks in last 7 or so years.. including me). I've had other job offers asking me to leave the one I am at and I have only been at it here 7 months. I have no desire to leave though.

Residency is largely what you make it. I think going to a place where you are relatively happy is the utmost importance. EM is just different than IM and the more scholarly/big named area programs. Maybe one day some programs will really stand out as big powerhouses, but currently I just dont see it. ACEP presidents are from all over the place, many chairs/PDs are from random places. EM is truly a field that if you work hard you can be a part of important roles of our 'house of medicine'. Much of IM gets off on the 'lineage' of your education; we just dont do that and personally I hope we never do.

Make sure the program has no huge RRC issues; new programs are a different topic and there are threads on that, and go where you and your family will be happy.
 
Just as a refresher.. I posted originally to get the top tier programs so as to know how many of those I should limit applying to. This was supposed to be in terms of competitiveness, not necessarily quality.

From where I sit now, its been very difficult to find out which programs aren't going to look twice at my application before tossing it and which are going to send me an interview. There is no resource that says the average stats at a program, whether having no research on my application basically makes me a shoe-out. My point was that I don't want to pick my favorite 20 programs and come to find that those are the 20 most competitive in the country, as I am an average applicant.

Since the response has been so limited in naming actual programs.. can applicants assume the big medical school names (Duke, Penn, Georgetown, Yale, etc) are typically the most competitive?
 
Music MD said:
Just as a refresher.. I posted originally to get the top tier programs so as to know how many of those I should limit applying to. This was supposed to be in terms of competitiveness, not necessarily quality.

From where I sit now, its been very difficult to find out which programs aren't going to look twice at my application before tossing it and which are going to send me an interview. There is no resource that says the average stats at a program, whether having no research on my application basically makes me a shoe-out. My point was that I don't want to pick my favorite 20 programs and come to find that those are the 20 most competitive in the country, as I am an average applicant.

Since the response has been so limited in naming actual programs.. can applicants assume the big medical school names (Duke, Penn, Georgetown, Yale, etc) are typically the most competitive?
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Competitiveness can be divided into various reasons on why they're competitive, including reputation, location, etc. If it's in a desirable area, it's probably more competitive. If it's a more well known name, it's probably more competitive.
 
Music MD said:
Since the response has been so limited in naming actual programs.. can applicants assume the big medical school names (Duke, Penn, Georgetown, Yale, etc) are typically the most competitive?
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No. The most competitive are generally those in geographically desirable locations and/or the oldest (Denver, Cinci, all the CA programs). If you search old threads about programs you will see various names come up. I know what you're looking for but you really just have to cast a wide net if you are worried about it. You probably aren't going to be able to predict where you get interviews based on some sort of imagined ranking from SDN. I know it would help if you could, but that isn't how this game is played.
 
Music MD said:
Since the response has been so limited in naming actual programs.. can applicants assume the big medical school names (Duke, Penn, Georgetown, Yale, etc) are typically the most competitive?
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I don't think you can make that assumption.
Some "big name" schools have competitive programs, some don't.
I'd say that some of the programs at schools known for research, make research a big part of what they look for in EM applicants.

The application process is somewhat random.
I am an average applicant.
I got interviews at "competitive" and got no love from places that some would consider less desireable.

I'd just say to apply to all the places that you'd like to go or at least check out.
Apply to more places than you think you need.
Don't just apply in CA or in the NE.

:luck:
 
Music MD said:
Just as a refresher.. I posted originally to get the top tier programs so as to know how many of those I should limit applying to. This was supposed to be in terms of competitiveness, not necessarily quality.

From where I sit now, its been very difficult to find out which programs aren't going to look twice at my application before tossing it and which are going to send me an interview. There is no resource that says the average stats at a program, whether having no research on my application basically makes me a shoe-out. My point was that I don't want to pick my favorite 20 programs and come to find that those are the 20 most competitive in the country, as I am an average applicant.

Since the response has been so limited in naming actual programs.. can applicants assume the big medical school names (Duke, Penn, Georgetown, Yale, etc) are typically the most competitive?
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But applying is cheap and there aren't all that many EM programs (compared to, say, IM or Gen Surg)...156 by my count (not including PR), 2/3 of them East of the Mississippi, 1/3 of them West. So for a grand (about what it will cost you to fly across the country and interview at 3 programs if you stay in hotels for the 4 days it will take you to do that), you can apply to half of the EM programs in the country (and if you've got $3500 burning a hole in your pocket, you can apply to all of them).

And as others have pointed out, the process is pretty damn random, even more so in EM where "fit" seems to be a bigger issue than a lot of other specialties. So pick a few parts of the country where you'd like to live, apply to a bunch of programs there and see what happens.
 
But applying is cheap and there aren't all that many EM programs
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I think this is the key. It's all about volume since the things that catch the programs' interest on a (non-stellar) application are tough to discern. I spent the grand on 60 applications, but I kinda wish I had dropped another 1000 to get 40 more (especially after reading the Caribbean grads' posts, that applied to all of them).

Once you have taken the Steps, the number of PDs that look at your app is the only number left that you have any control over.
 
Music MD said:
Since the response has been so limited in naming actual programs.. can applicants assume the big medical school names (Duke, Penn, Georgetown, Yale, etc) are typically the most competitive?
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I've always understood that in EM particularly the "Big Names" are not necessarily the best programs. It makes sense when you think about why they're "Big Names" in the first place; usually because of very strong, traditional medicine/surgery departments. EM is a new specialty, which has had to carve out a well-deserved niche for itself over the past 40 years. How did EM create its niche? In part by taking "turf" from medicine and surgery..

so it stands that the "big name" EM programs will be places without as much baggage from other specialties where EM was able to flourish early on and develop in the institution to full department status. EM programs at the big name places that you mentioned generally started later and have had to fight harder to get recognition.

I didn't interview at any of the programs you mentioned in the OP so I can't comment on their competitiveness. I'll say that based on what I heard about Denver on the trail, I'm glad I didn't apply there..

from my persective interviewing, EM programs are all about the "fit". Will you be happy working with the residents? Will the PD stick up for your department when the hospital bean-counters go to work? Will the PD work with you so that your residency training prepares you for your dream community/academic/whatever job? Will you (and SO) be happy living there?

Whether or not the name of the program's associated institution is respected from the perspective of the "great halls of academic medicine" isn't something to worry about imo.
 
i understand the frustration of the commenters regarding lack of names. i'm from the west coast. i've heard any and all of the following programs names as exceptional and awesome (this is not me endorsing any one program, just what i heard others say on the trail--i know i'm probably forgetting some): highland, usc, harbor, olive view, ohsu, davis, loma linda, stanford, ucsf, utah, denver, unm. please note, this is like 75% of the programs in the west, period. this is why no one is answering your questions directly--ask ten different people, and you'll get 50 different answers regarding the top 10 programs in the country. so, the question can and should revolve around personal priorities over all else.
 
If you want a random list, you can add Vandy, Carolinas, UPMC, Cincy, Indiana, Maine, Harvard, every program west of Nebraska/Kansas/Oklahoma if you live in the east (OHSU, Denver, UNM, ...) and that doesn't include Philly/NYC programs as I know nothing about them as I didn't even look in those cities nor care to ever live there.

But again, I agree, fit is a much better indicator.
 
Music MD said:
Just as a refresher.. I posted originally to get the top tier programs so as to know how many of those I should limit applying to. This was supposed to be in terms of competitiveness, not necessarily quality.

From where I sit now, its been very difficult to find out which programs aren't going to look twice at my application before tossing it and which are going to send me an interview. There is no resource that says the average stats at a program, whether having no research on my application basically makes me a shoe-out. My point was that I don't want to pick my favorite 20 programs and come to find that those are the 20 most competitive in the country, as I am an average applicant.

Since the response has been so limited in naming actual programs.. can applicants assume the big medical school names (Duke, Penn, Georgetown, Yale, etc) are typically the most competitive?
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From the replies it should be obvious, but perhaps not.

Pull out a map and look at where the programs are located. If its a popular place to live, then chances are that program is going to be slightly more competitive.

If you have 'average step scores' and have no black marks (failed a class, terrible LOR, failed a step before getting the average score) then I think that even perhaps 'popular' places are not out of question for you. With that said, apply to a good mix of 'popular living places' and places that are a bit more off the beaten path.

Those places off the beaten path to the masses do not provide any less education, and in some ways may offer better education. Its just harder to attract students there so they are probably a bit 'less competitive'.
 
Thank you to everyone who has commented here.. its been very helpful. If you're a resident I'm sure you remember being lost in this world of residency program research and this made it a little easier. Thanks everybody
 
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If you want a random list, you can add Vandy, Carolinas, UPMC, Cincy, Indiana, Maine, Harvard, every program west of Nebraska/Kansas/Oklahoma if you live in the east (OHSU, Denver, UNM, ...)
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I'm a seattle native in med school in ohio, and my program rank is going to be basically how far from seattle the program is. Do I count as "living in the east" or does your region of origin factor in at all?
 
I wouldn't think of residencies as tiers but more spectrum. You will find that there a slew or ton of amazing residencies and each place has its pluses. what may not work for someone will a plus for another; for example, being in a busy inner city ED may turn off an applicant who wants a less hectic environment but a person who enjoys the autonomy and opportunity to do a ton of procedures would fit well in there.

I would recommend like everyone has said already- ask people in EM their opinion of the program and try to do away rotations that would fit your needs- location, clinical exposure, training.
 
DCBFan said:
I'm a seattle native in med school in ohio, and my program rank is going to be basically how far from seattle the program is. Do I count as "living in the east" or does your region of origin factor in at all?
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Did u go to undergrad and/or work in Washington? If so, then you should be considered as being "from the west coast", although it depends on the program and the PD.
 
I hate that nobody in this forum will actually answer this question. I agree that it is more difficult to answer than in other specialties, but most people have a rough list of tiers in their head when it comes to programs. I will answer you based on the regions I applied. My list is a compiliation of information gathered from mentors, attendings, residents, and reading SDN forums. I limited my applications mainly to California, NYC, and Chicago (with some big names sprinkled in for fun).

California
Tier 1
USC, Highland, Harbor (I think there is an argument to be made for any one of these being considered the top program in California. I think that if I HAD to rank them, it would be: 1. Highland 2. Harbor (because it is 3 years) 3. USC (basically same program as harbor but 4 years).

Tier 2
UCLA/Olive View, UCSF, UCD, Stanford, Loma Linda, UCI (probably in this order too)

Tier 3 and beyond
UCSD, UCSF-Fresno, Kern county (in no particular order)

NYC
Tier 1
NYU, Jacobi, Kings, NYP (4 year programs rule NYC, I liked NYU the most but I think it depends what you want. All of these are top tier and if I had to rank these it would be: 1. NYU 2. NYP 3. Jacobi 4. Kings)

Tier 2
Mt. Sinai (I thought this was as good as the tier 1 programs but for some reason not considered top tier), SLR (best 3 year program)

Tier 3
BI, Lincoln, Maimonides

Tier 4
Metropolitan, Methodists, the rest

Chicago
Tier 1
Cook County, University of Chicago (cook rules this town)

Christ (some think of Christ as Tier 1)

Tier 2
Northwestern, I would place Christ here

Tier 3
Resurrection, UIC

Other Tier 1s (no particular order):
Vandy, Carolinas, BMC, Brown, Cincinnati, Denver, Maricopa, Hennepin, Maine


hope this helps/answers your question.
 
Tier 1: Where ever you think you can become a happy physician with your potential maximized
Tier 2: Every where else.

So far, the only thing I have seen is that the only advantage name brand Residencies have over other programs, is their graduate fellowship acceptance rate.
 
My experience this cycle has definitely been that I got some that seemed more competitive and was rejected by some I thought were less. It does seem to be a bit of a crapshoot. I think as long as you apply to >30, you should be fine if you have good stats. If you have averagey/below average stats I'd just apply to more like 40 and see what happens. Do your away rotation in EM early, like immediately after your home EM...I think that makes a big difference.
 
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