What are the actual benefits of going to a "powerhouse" program?

[DragonSalad]

This thread is prompted by the thread made by Helodoc a little while ago before he/she was banned. It seems like the general consensus was that the benefit of a 4-year "powerhouse" residency really is minimal if anything at all when looking for a good job in the community (i.e. good location and compensation).

I was already leaning towards 3 year programs, but can anyone help me understand what are the actual benefits of let's say going to Cinci if you just want to be a community doc in Texas?

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[Lexdiamondz]

This thread is prompted by the thread made by Helodoc a little while ago before he/she was banned. It seems like the general consensus was that the benefit of a 4-year "powerhouse" residency really is minimal if anything at all when looking for a good job in the community (i.e. good location and compensation).

I was already leaning towards 3 year programs, but can anyone help me understand what are the actual benefits of let's say going to Cinci if you just want to be a community doc in Texas?

PGY4 currently in the middle of a job search.

I think for jobs in competitive areas or in academia, coming from a well known residency program with strong training may help a bit. It's easier to build some sort of niche (however 3 yr + fellowship is probably better for this) and 4 yr programs in general tend to come with more resources for research and other academic pursuits.

That being said, networking and geography overall matter more IMO. You aren't gonna snag a job in Colorado coming from a "powerhouse" program in Boston on name alone.

 

[SpacemanSpifff]

This thread is prompted by the thread made by Helodoc a little while ago before he/she was banned. It seems like the general consensus was that the benefit of a 4-year "powerhouse" residency really is minimal if anything at all when looking for a good job in the community (i.e. good location and compensation).

I was already leaning towards 3 year programs, but can anyone help me understand what are the actual benefits of let's say going to Cinci if you just want to be a community doc in Texas?

In the absence of any alumni in your desired destination, minimal.

The primary benefits of these programs are realized for academic-minded graduates.

 

[DragonSalad]

PGY4 currently in the middle of a job search.

I think for jobs in competitive areas or in academia, coming from a well known residency program with strong training may help a bit. It's easier to build some sort of niche (however 3 yr + fellowship is probably better for this) and 4 yr programs in general tend to come with more resources for research and other academic pursuits.

That being said, networking and geography overall matter more IMO. You aren't gonna snag a job in Colorado coming from a "powerhouse" program in Boston on name alone.

Does this mean if I know I simply want to practice in Texas, and I don't care about academia, I should just stay in Texas for residency?

For what it's worth, I went to medical school here so I would already have networking/connections if I left and came back.

 

[Lexdiamondz]

Does this mean if I know I simply want to practice in Texas, and I don't care about academia, I should just stay in Texas for residency?

For what it's worth, I went to medical school here so I would already have networking/connections if I left and came back.

Basically yes.

Department Chairs and HR people involved in hiring generally will hire new grads from places they are familiar with. Even if you went to med school in Tx if you aren't coming highly recommended by someone they know, they aren't as likely to offer you a job.

Especially as things have gotten tighter in the EM job market, having local ties and being a known quantity in general are underrated assets.

 

[Rekt]

Does this mean if I know I simply want to practice in Texas, and I don't care about academia, I should just stay in Texas for residency?

For what it's worth, I went to medical school here so I would already have networking/connections if I left and came back.

If you're dead set on Texas you need to rank every texas program first. The market there is already desolate. You'll be looking 2-3hrs outside any of the major cities but 3 years from now you'll need every connection you got, especially with the 2-3 more residencies opening in texas alone.

 

[goodoldalky]

This thread is prompted by the thread made by Helodoc a little while ago before he/she was banned. It seems like the general consensus was that the benefit of a 4-year "powerhouse" residency really is minimal if anything at all when looking for a good job in the community (i.e. good location and compensation).

I was already leaning towards 3 year programs, but can anyone help me understand what are the actual benefits of let's say going to Cinci if you just want to be a community doc in Texas?

let me clear the air here, once and for all: there’s zero benefit to going to a four year program.

zero.

 

[RoyBasch]

This thread is prompted by the thread made by Helodoc a little while ago before he/she was banned. It seems like the general consensus was that the benefit of a 4-year "powerhouse" residency really is minimal if anything at all when looking for a good job in the community (i.e. good location and compensation).

I was already leaning towards 3 year programs, but can anyone help me understand what are the actual benefits of let's say going to Cinci if you just want to be a community doc in Texas?

The advantage is significant for people interested in academic careers. If you want to be a staff physician on a tenure professor track at a "power house" program, it is very helpful and possibly essential to have graduated from a similar "power house" program yourself.

I think for community jobs where the goals are compensation, location, practice quality--as other posters have already said ad nauseum--it doesn't matter much except for possibly a wider and deeper alumni network.

That may have more to do with the age of the program rather than it's quality (more years going, more alumni currently in practice), and also where you want to practice (a lot of people ultimately practice within 500 miles of their program, ergo if you go to East coast power house U and are looking for jobs in Oregon, it's less helpful as they're are fewer contacts).

 

[RoyBasch]

Does this mean if I know I simply want to practice in Texas, and I don't care about academia, I should just stay in Texas for residency?

For what it's worth, I went to medical school here so I would already have networking/connections if I left and came back.

Yes, doing Residency in Texas would be beneficial. Contacts made in residency are going to be much stronger/more valuable than those from school or before as these are people who can directly attest to your clinical acumen working as an ER physician. Being a good student or scribe or whatever is not going to be as interesting to me (as someone who would potentially view a new candidate for the group) compared to a practicing physician I respect who said they knew you as a resident and thought you were strong.

 

[DragonSalad]

If you're dead set on Texas you need to rank every texas program first. The market there is already desolate. You'll be looking 2-3hrs outside any of the major cities but 3 years from now you'll need every connection you got, especially with the 2-3 more residencies opening in texas alone.

Rekt, are you talking about post-COVID? I didn't realize it was that bad here. I realized Austin and now Houston was saturated, but practicing 45min out is fine with me. Are you saying even that is hard now?

 

[DeadCactus]

I think it's important to separate 2 arguments that get muddled together: 1) 4 year vs 3 year program and 2) value of a strong brand. There are many 3 year programs with a strong brand and there are some 4 year programs with pretty mediocre brands.

The 4 year vs 3 year thing has been argued ad nauseum here. I think a 4 year program can be a reasonable sacrifice if you love the program (the people, the city, the city, the hospital, etc).

The issue of brand name is different. In academic careers, the brand and academic network are going to be valuable for the kinds of opportunities that keep an academic career going forward. There's a reason the same few dozen people dominate the podcasts and blogs and leadership positions in academic medicine and it's not inherently because they're the most knowledgeable or skilled (not to argue the opposite is true either). If you're going more the community route, than local program and network are going to outweigh a national academic reputation. Ideally you want a strong brand in the local region, whether that means a nationally strong brand that happens to be in your geography of choice or a regionally strong brand in your geographic region of choice.

None of this comes down to quality of training, it's all just networking and much of it is self-propagating. The national "powerhouse" programs attract academic faculty because of their academic resources and brand and also attract residents who want to go into academic careers so the whole alumni and contact network is going to heavily biased toward academics. Places like Cinci, Denver, USC, Harvard, etc. are likely to have an alumni or close contact on the faculty at any randomly chosen academic center. In contrast, people tend to stick around the area they trained, especially if not being pulled in and so community jobs are more likely to have 3 people from the local residency than anyone from a remote "powerhouse" program.

Bottom line: If you want a job in a specific area, train in that area. If you want a job in academics, train at a large nationally known academic center.

 

[JacobMcCandles]

let me clear the air here, once and for all: there’s zero benefit to going to a four year program.

zero.

Close but not quite. There's benefit but it just isn't to the resident's benefit. I think the hoopla surrounding needing to go to a 4 year program to get into academics is ridiculous but it has continued to be pushed...mainly by 4 year academic programs.

 

[Rekt]

Rekt, are you talking about post-COVID? I didn't realize it was that bad here. I realized Austin and now Houston was saturated, but practicing 45min out is fine with me. Are you saying even that is hard now?

Yes absolutely its bad. Was really bad pre covid obviously because oversupply but also a bunch of FSEDs got dumped and attendings filled a bunch of spots.

I mean I don't understand how people don't think this is a huge ordeal. Go to the EMRA map and look at the map of residencies. Take TX for example. They're in nearly every city. Each of these places pumping out 8-22 residents a year. JPS dumps 13. Dallas dumps 22. Kills the entire market there. SA, Austin, houston, temple, el paso, etc, etc. Most EM docs are very young. They won't be leaving soon. There's not many places for all these residents to go. Then add all the new **** tier residencies opening that will be competing too plus everyone that fled to TX years ago for the previously high rates. This is happening in every state.

 

[thierryh]

You won’t be considered at our SDG in San Diego where we train residents from 4-year residency programs. Probably some other similar situations around the EM-verse. Otherwise, judging by comments from this forum, most CMGs couldn’t care less where you train. Totally depends on how competitive a job you’re looking at. COVID and more new grads coming out only going to make desirable jobs more competitive. As has been posted here before again again, most CMG jobs just looking for a warm body that’s not likely to get sued.

 

[gamerEMdoc]

In my opinion, the one advantage of going to a 4 year “powerhouse” program is if you want to do academics at a “powerhouse” program. Still, I think 3 + fellowship is still the better route if that’s what you are looking for. And you can get into academics at community programs. It’s not hard to get clinical faculty jobs, then work your way into a core faculty spot. Once you are core faculty anywhere, you can start working on your academic CV which will in turn allow you to get academic jobs ”more prestigious” places.

Other than that, I don’t see any benefit. At all. I‘m the APD at a residency in the middle of nowhere. My graduates go on to do fellowships if they want them. They get decent jobs. I had one graduate last year get a job in Austin Texas with zero ties to the area, which others claim is impossible. Another got a faculty job straight out of residency in California. We aren’t special. For the most part, your job prospects aren’t going to change based on where you train.

So pick a place based on what is important to you. That may be geography. That may be “prestige” bc that is important to you. It may be the salary/benefits. It may be what there is to do in the area. It may be the attendings/mentors. It may be the vibe you got from the people there. Whatever Is important to you.

 

[DragonSalad]

You won’t be considered at our SDG in San Diego where we train residents from 4-year residency programs. Probably some other similar situations around the EM-verse. Otherwise, judging by comments from this forum, most CMGs couldn’t care less where you train. Totally depends on how competitive a job you’re looking at. COVID and more new grads coming out only going to make desirable jobs more competitive. As has been posted here before again again, most CMG jobs just looking for a warm body that’s not likely to get sued.

Your SDG wouldn't consider a doc from a 3 year program at all, or you mean right after they graduate?

 

[Rekt]

Your SDG wouldn't consider a doc from a 3 year program at all, or you mean right after they graduate?

It doesn't matter. Essentially a statistical insignificance unless you wanted to go to that specific shop. There's more SDG 3 year programs than 4, but overall of all programs a very tiny amount are SDGs. Most 4 years are employed or cmg. It's a moot point anyway because you'll be standing in line behind all the other residents waiting for a spot. Connections and networking matter the most.

 

[EctopicFetus]

It doesn't matter. Essentially a statistical insignificance unless you wanted to go to that specific shop. There's more SDG 3 year programs than 4, but overall of all programs a very tiny amount are SDGs. Most 4 years are employed or cmg. It's a moot point anyway because you'll be standing in line behind all the other residents waiting for a spot. Connections and networking matter the most.

This is exactly right. A good SDG job these days wont take a new grad. Why? Because there is a line of 5-10 people waiting for that job.

In regards to brand I think it matters. Ive said before and I will say again I will black ball any hire from an HCA residency. If you go to a brand new residency with no volume in the middle of nowhere in Mississippi you wont get hired. Connections matter. One of my residents got into a prestigious sdg on the west coast last year. The reason was he was a stud and I did residency with 3 of the partners in that group and vouched for him.

There was a 0% chance he gets that job otherwise. Brand matters but connections matter more. Its one thing for someone you don't know to rave about a resident. its another thing to have an off the record honest discussion and vouch for someone on and off the record.

SDGs want no drama and no issues. they want someone who will make them stronger and wont leave. SDGs are like getting married (long term business relationship) whereas a CMG is more like speed dating. They may dump you when the next cheaper option comes along and you may leave as soon as a 'better" job opens up. There is no intention of marriage.

Im sad for our specialty as most urban centers are full, thousands of new docs are being dumped into a saturated market with 400k+ in debt in some instances and few good options. the CMGs have won.

 

[DragonSalad]

This is exactly right. A good SDG job these days wont take a new grad. Why? Because there is a line of 5-10 people waiting for that job.

In regards to brand I think it matters. Ive said before and I will say again I will black ball any hire from an HCA residency. If you go to a brand new residency with no volume in the middle of nowhere in Mississippi you wont get hired. Connections matter. One of my residents got into a prestigious sdg on the west coast last year. The reason was he was a stud and I did residency with 3 of the partners in that group and vouched for him.

There was a 0% chance he gets that job otherwise. Brand matters but connections matter more. Its one thing for someone you don't know to rave about a resident. its another thing to have an off the record honest discussion and vouch for someone on and off the record.

SDGs want no drama and no issues. they want someone who will make them stronger and wont leave. SDGs are like getting married (long term business relationship) whereas a CMG is more like speed dating. They may dump you when the next cheaper option comes along and you may leave as soon as a 'better" job opens up. There is no intention of marriage.

Im sad for our specialty as most urban centers are full, thousands of new docs are being dumped into a saturated market with 400k+ in debt in some instances and few good options. the CMGs have won.

As an MS4 it looks like the future of this specialty is so grim - are there any states or regions that actually still have an under supply for EM docs?

 

[alpinism]

You should absolutely do residency in Texas if you want to practice in Texas doing community medicine.

The market there has unfortunately been getting worse for the past few years even before the coronavirus.

 

[turkeyjerky]

I would say that connections matter most for finding good jobs w/ SDGs. Going to a 'name-brand' residency probably helps in this regard if you lack connections, but you're likely out in the dark with the rest of us for any non-advertised positions unicorn type positions. It seems like most academic postings are requiring a fellowship at this point.

I doubt connections matter to CMGs. I mean, honestly I don't know. Do their medical directors even make the decision on who to hire?

I graduated several years ago from a 'regional brand-name' program (won't impress your in-laws, but several of my med school classmates who matched at good programs weren't even invited to interview). I'm currently in the midst of a job search and it's.....interesting. My feeling is that the perceived prestige of your program will matter more and more as the job market continues to tighten. Hopefully programs comply and jettison the old refrain of 'all programs give good training'. We owe it to our future colleagues.

As an MS4 it looks like the future of this specialty is so grim - are there any states or regions that actually still have an under supply for EM docs?

No. Maybe northern Wisconsin, southern IL and rural MS. But not for long.

 

[alpinism]

Right now the best EM job opportunities are in medium sized cities in midwestern states.

For example if you move to Kansas there are still a large number of quality high paying jobs.

 

[ThreadStalker]

Generally agree with most of what's been said already. It's certainly easier to find a job in the region that you train in, so if you want to work in X state, it makes sense to train in X state. The groups will know your program better and you'll have far more contacts with docs in the region. On the other hand, some of the long established "powerhouse programs" have nation-wide networks of grads and contacts that help in the job hunt. I was lucky enough to train at one of these places (they must have dipped waaay down on their rank list the year I matched), so I've seen the benefit first hand. Even the residents graduating during COVID are still getting job offers across the country, so clearly networks and name recognition will aid you. My advice would be:

1 - Interview at as many programs as you can in the region you want to live and work in. You're probably not going to go wrong staying local unless the program is very new or poorly regarded in your region.

2 - Get information from the fancy name programs on where their graduates actually work after graduation. Do they have a significant presence in the region you want to return to after training? You should be able to get some amount of real data from the program.

3 - Talk to the current residents during whatever zoom-enabled "pre-interview social" is available to you this year. Ask them how the program assists them in their job hunts near the end of residency. Talking to the residents from different programs about the current job market may give you a sense of how well connected their programs are.

One last thought, it's a time-honored tradition of medical students and residents to continually gripe and question whether they are getting the best quality education wherever they are. So, if nothing else, I'd say there's at least a small psychological benefit to training at the "best" program you can.

 

[emergentmd]

Outside of Academics, there are absolutely alot of benefits doing a 4 yr vs a 3 yr program. Don't let anyone tell you otherwise because they would be lying to you.

Benefits
1) Hospital/CMG gets low paying labor for 1/6 of what an attending pays
2) Hospital/CMG gets a doc that will work up to 2x the amount of hours for the above pay
3) Hospital/CMG gets to put you on other rotations to cover call that would cost them hundreds of thousands stipend for a specialist
4) Hospital/CMG gets free educational labor instead of having an attending do a piss poor job while kicking/screaming
5. Hospital/CMG gets someone who they can mold and not complain
6) Hospital/CMG gets someone that will cover nights, weekends, holidays without complaining or getting a stipend
7) Hospital/CMG gets someone to who actually wants to teach interns
8) Hospital/CMG gets to save money that would costs to recruit a new attending instead of a group of 10-15 that is "begging" to do the above 1-7
9) Hospital/CMG gets a warm body for 4 years to work in the dumpster whereas an attending worth his weight would go through the revolving door in 1 yr

Anyone who tells you they learned more in a 4 yr program over someone who did 3 yrs+1 attending is fooling themselves. Attend a 4 yr vs a 3 yr with connections and you will be left wondering how the 3 yr got the job when you never even saw a posting. Its bc most good jobs don't need to post.

 

[YeOleBoneWiz]

What’s a powerhouse program something EM BROS made up to feel smart

 

[Franzd'Epinay]

Arguments in favor of four-year residencies always boil down to the name/reputation of the hospitals offering said residencies. Everything else is just sleight-of-hand or comparing apples to oranges: "Did you know that 48 months is actually longer than 36 months?!"

Even if you are dead-set on academics, I don't see the benefits of a four-year residency vs. a three-year residency + fellowship.

 

[gamerEMdoc]

Arguments in favor of four-year residencies always boil down to the name/reputation of the hospitals offering said residencies. Everything else is just sleight-of-hand or comparing apples to oranges: "Did you know that 48 months is actually longer than 36 months?!"

Even if you are dead-set on academics, I don't see the benefits of a four-year residency vs. a three-year residency + fellowship.

I totally agree personally. 3 year + Fellowship makes more sense for academics than just graduating as a 4 year. Going to a 3 gives you more flexibility, because if you decide mid-way through that you don't want to do academics, you can just graduate after 3 and enter the work force. Or if you want to do academics and find an academic gig without fellowship, you can just graduate and get to work. Going to a 4 year program locks you in.

But to each their own. Everyone has things they value over others.

 

[TheComebacKid]

Powerhouse programs DO NOT under any circumstances equal better training. Without naming names, I have friends who are training at "powerhouse county programs" who hate it because of all the scut work and homelessness they deal with. That being said, the reputation of these places is still top notch because they are generally older programs.

The powerhouse programs probably have more connections/contacts just by nature of how long they have been around and how many grads they've put out. If you want a job at a CMG (God help you), train wherever you want, you will get a job as long as you have a pulse. If you want a job in a tight market, or with a highly coveted SDG or an academic group, I think a powerhouse program may offer you a leg up.

I also think powerhouse programs probably carry more weight when applying for fellowships, but that is just probably something I made up in my head and I have no evidence to prove the contrary. There are so many unfilled EM fellowship positions that I don't think it makes that much of a difference unless you want a highly coveted fellowship i.e. NY Poison Control Center or something along those lines...

 

[TheComebacKid]

Close but not quite. There's benefit but it just isn't to the resident's benefit. I think the hoopla surrounding needing to go to a 4 year program to get into academics is ridiculous but it has continued to be pushed...mainly by 4 year academic programs.

I trained at a 4 year program in a highly desirable city. I can tell you that very, very few of the faculty who worked there trained at 3 year programs. 4 year programs do not want residency graduates who have equivalent training as their seniors. 3 years + fellowship is slightly different story.

There are very many EM residencies in desirable cities. The vast majority of them are 4 years. It is what it is.

 

[gamerEMdoc]

I trained at a 4 year program in a highly desirable city. I can tell you that very, very few of the faculty who worked there trained at 3 year programs. 4 year programs do not want residency graduates who have equivalent training as their seniors. 3 years + fellowship is slightly different story.

There are very many EM residencies in desirable cities. The vast majority of them are 4 years. It is what it is.

Right but that's not the debate. If you want to get into being faculty at an EM residency in a desirable city as you suggested, the debate isn't 4 vs 3. It's 4 vs 3+Fellowship. And I'd argue, 3+Fellowship makes you more attractive as someone applying for an academic job than a 4 year grad with no fellowship.

 

[SpacemanSpifff]

Right but that's not the debate. If you want to get into being faculty at an EM residency in a desirable city as you suggested, the debate isn't 4 vs 3. It's 4 vs 3+Fellowship. And I'd argue, 3+Fellowship makes you more attractive as someone applying for an academic job than a 4 year grad with no fellowship.

Probably at a three year program, but not a four year. Breezing through the faculty pages of four year programs in desirable cities (Boston, Denver, LA, NY, etc) the vast majority trained at four year programs and quite a few are fellowship trained. Unfortunately fellowship is probably going to become almost required to be considered for these jobs in the near future.

 

[DragonSalad]

I always assumed when people said the benefit of a 4 year program is getting into those academic jobs that won't take 3 year grads, they were talking about immediately after residency. Which, as @gamerEMdoc said, can easily be rectified by doing a 3+1 fellowship.

Are you saying being a graduate of a 3 year program, even one with a fellowship, would make it harder to work in some big academic centers in desirable cities for the rest of someone's career?

 

[SpacemanSpifff]

Are you saying being a graduate of a 3 year program, even one with a fellowship, would make it harder to work in some big academic centers in desirable cities for the rest of someone's career?

Yes. Look at the faculty listings for any of the traditional four year academic programs. Other than docs who are home grown, the remainder are primarily graduates of other four year programs, plus or minus fellowship.

 

[JacobMcCandles]

I trained at a 4 year program in a highly desirable city. I can tell you that very, very few of the faculty who worked there trained at 3 year programs. 4 year programs do not want residency graduates who have equivalent training as their seniors. 3 years + fellowship is slightly different story.

There are very many EM residencies in desirable cities. The vast majority of them are 4 years. It is what it is.

I'm not sure what that has to do with anything. I think everyone here would agree that no 4 year academic place is going to hire someone straight out of a 3 year residency. That isn't because you need an extra year to practice EM safely and competently, it's because they don't want those optics. If they started doing that then 4 year programs would only get applicants who had to be in that area.

 

[JacobMcCandles]

Yes. Look at the faculty listings for any of the traditional four year academic programs. Other than docs who are home grown, the remainder are primarily graduates of other four year programs, plus or minus fellowship.

That's just a function of the environment that they've created. Only 4 year academic places care if you went to a 3 or 4 year residency.

 

[TheComebacKid]

Right but that's not the debate. If you want to get into being faculty at an EM residency in a desirable city as you suggested, the debate isn't 4 vs 3. It's 4 vs 3+Fellowship. And I'd argue, 3+Fellowship makes you more attractive as someone applying for an academic job than a 4 year grad with no fellowship.

Yes, but anecdotally I can tell you that doesn't seem to be the case. I agree the value of fellowship training when you come from a three year program, and it makes you more competitive for sure.

But in desirable cities, think Seattle, Denver etc... There are a ton of 4 year graduates from those local programs who ALSO did fellowship. And as stated above, if you look at the faculty make up of these places, there are still a vast majority of 4 year graduates compared to 3 year graduates + fellowship. Being a known entity in a desirable city/difficult market also carries a lot of weight.

While it seems stupid to 99% of people on this forum, I really think going to a 4 year program closes ZERO doors. Yes, huge financial sacrifice associated with it, but for people who absolutely want to stay in desirable cities particularly along the coasts and PNW and practice in an academic setting etc I think going to a 4 year program should be a strong consideration and gives you the most career options. Doesn't mean it can't be done coming from a 3 year program, but I do think you have a leg up.

It is what it is, and I fully concede, it doesn't make a whole lot of sense.

 

[SpacemanSpifff]

That's just a function of the environment that they've created. Only 4 year academic places care if you went to a 3 or 4 year residency.

Correct, and many of those four year academic programs happen to be in traditionally desirable cities at academic institutions.
To be clear, I'm not specifically advocating for these programs (see my earlier post in this thread, #3). I'm simply answering the question posed by @DragonSalad. LA, NYC, San Francisco, Chicago, Boston, Seattle - there are certainly three year programs around, but the traditional academic programs are four years. And they hire four year grads almost universally.

 

[DragonSalad]

My original question was not so much 3 vs 4, which is already well discussed, but what are the exact benefits of "powerhouse" programs. There are even several 3 year programs considered top tier:

Hennepin
Carolinas
Indiana
Pitt
Vanderbilt
BIDMC
Mayo
Parkland
Advocate Christ
Metro/CCF

 

[SpacemanSpifff]

My original question was not so much 3 vs 4, which is already well discussed, but what are the exact benefits of "powerhouse" programs. There are even several 3 year programs considered top tier:

Hennepin
Carolinas
Indiana
Pitt
Vanderbilt
BIDMC
Mayo
Parkland
Advocate Christ
Metro/CCF

Asked and answered, see above.

 

[deleted547339]

Yes, but anecdotally I can tell you that doesn't seem to be the case. I agree the value of fellowship training when you come from a three year program, and it makes you more competitive for sure.

But in desirable cities, think Seattle, Denver etc... There are a ton of 4 year graduates from those local programs who ALSO did fellowship. And as stated above, if you look at the faculty make up of these places, there are still a vast majority of 4 year graduates compared to 3 year graduates + fellowship. Being a known entity in a desirable city/difficult market also carries a lot of weight.

While it seems stupid to 99% of people on this forum, I really think going to a 4 year program closes ZERO doors. Yes, huge financial sacrifice associated with it, but for people who absolutely want to stay in desirable cities particularly along the coasts and PNW and practice in an academic setting etc I think going to a 4 year program should be a strong consideration and gives you the most career options. Doesn't mean it can't be done coming from a 3 year program, but I do think you have a leg up.

It is what it is, and I fully concede, it doesn't make a whole lot of sense.

I promise you as an academic faculty a couple years out, I matters absolutely 0% after your first job. Chairs care about $$$$. If you can bring in research money and publish, help start/augment another service line or fill another gap in the program, they will hire you.

 

[deleted547339]

Correct, and many of those four year academic programs happen to be in traditionally desirable cities at academic institutions.
To be clear, I'm not specifically advocating for these programs (see my earlier post in this thread, #3). I'm simply answering the question posed by @DragonSalad. LA, NYC, San Francisco, Chicago, Boston, Seattle - there are certainly three year programs around, but the traditional academic programs are four years. And they hire four year grads almost universally.

Although they didn’t formally offer a job, the place I did fellowship (4y program) did casually ask more than once if I was interested in a job. I went to a 3 year program. I’m pretty confident I could get a job at any 4 year program that is hiring in my niche.

 

[FetchThePliers]

I'm not sure what that has to do with anything. I think everyone here would agree that no 4 year academic place is going to hire someone straight out of a 3 year residency. That isn't because you need an extra year to practice EM safely and competently, it's because they don't want those optics. If they started doing that then 4 year programs would only get applicants who had to be in that area.

I can tell you for a fact that some 4 year programs will hire new grads from 3 year programs. They might schedule the person so that they are not working with a pgy4 for their first year, however. I was hired by one and interviewed at another (“Ivy League”, but def not “powerhouse”). I’m sure some programs can be more discerning, but some are not.

 

[emergentmd]

The OP question was if there was any benefits for a community job in Texas.

The answer is go do a residency in Texas. Nothing else matters.

 

[SpacemanSpifff]

Although they didn’t formally offer a job, the place I did fellowship (4y program) did casually ask more than once if I was interested in a job. I went to a 3 year program. I’m pretty confident I could get a job at any 4 year program that is hiring in my niche.

Probably. Nothing is an absolute. My only point was the vast majority of these faculty come from four year programs.

 

[deleted547339]

The OP question was if there was any benefits for a community job in Texas.

The answer is go do a residency in Texas. Nothing else matters.

Agreed. This answers the question.

 

[doggydog]

The OP question was if there was any benefits for a community job in Texas.

The answer is go do a residency in Texas. Nothing else matters.

But...there are no powerhouse four year programs in Texas?

How will they feel superior?

 

[DeadCactus]

But...there are no powerhouse four year programs in Texas?

How will they feel superior?

Texans don't need a 4 year program to feel superior.

 

[emergentmd]

Texas has 5, or is it 10 four yr programs. Just remediate a year if you want and I am sure they all would love to have free cheap labor.

 

[Guitardoc4]

3 years + attending year>>>4 years. From what I have seen if you want academics, a 4 year program only offers an advantage in getting an academic job at a 4 year program as your first job. Otherwise it is just bad luck that you ended up at a 4 year program unless you had no better choices.

 

[TheComebacKid]

I really agree, for the most part, about how 3 year programs offer a significant advantage compared to a 4 year residency.

That being said, people have complex reasons for why they go to a certain program. If you have strong ties, family reasons etc to live in Seattle, SF, LA, San Diego, Denver, Chicago, Boston, NY, there's a very high chance you are ending up in a 4 year residency program. For some folks, the benefits of being in a particular locale outweigh the the extra year of training. In fact, even more so than 3 vs 4 year training, the number 1 deciding factor that people use to generate their rank list is location.

There are many fantastic "powerhouse" 3 year programs. But for a lot of folks, packing up and moving to Indianapolis, or Pittsburgh, or wherever else for 3 years, is not an option.

The majority of 4 year programs in this country have a good reputation, with fine job prospects. For me, if I had to go to a 4 year program in a city with great job prospects for my spouse, it would be a no-brainer. I ended up at a 4 year residency by way of the couples match. And I was happy with my training and residency experience albeit I did suffer a financial loss.