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Why would a person choose a 4 year residency over 3? This doesnt make sense to me unless a person just wants to be sure he learns <b>everything</b>.
What are the advantages of 1-4 or 2-4 over 1-3?
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i thought it was based on a number of things, such as most DO programs are 4 yrs, some programs are an extra for academic reasons, reasearch, etc... also some do an extra fellowship but i guess that is not part of the 4 yrs... maybe some sort of dual certification. others says it just makes better er docs... dunno..
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Read pro and con discussion on saem.org website. Comes down to individual preference. The biggest issue is you can't become faculty at at 4 year unless you have done a 4 year and/or a fellowship. Everyone will have an opinion but essentially there is no "right" answer.
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Well, there are no advantages. It is up to INDIVIDUAL programs to hire faculty based upon residency training or personal experience...not purely the 3 vs 4 year residency.
Indiana University (as an example) has multiple faculty that did 1-3 year residencies...that is a singular example of multiple that potentially could be named.
Many programs preferentially hire faculty that attended 1-4 residencies, but because of the SPARCE number of 1-4 or 2-4 residencies and the number of faculty needed, it simply doesn't add up.
Indiana University (as an example) has multiple faculty that did 1-3 year residencies...that is a singular example of multiple that potentially could be named.
Many programs preferentially hire faculty that attended 1-4 residencies, but because of the SPARCE number of 1-4 or 2-4 residencies and the number of faculty needed, it simply doesn't add up.
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As I think all of us here (except maybe 1) are doing 1-3 residencies you're not going to find much love for the 1-4 or 2-4 here. I would just as soon do that extra year in a felowship that adds something to my CV than spend it as cheap labor in the ED. But that's just my opinion. I think MudPhud did a 4 year at Denver, maybe he can speak up for the 4 year programs.
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Seaglass said:
I agree with seaglass. I interviewed at all of them (1-4,2-4, and 1-3). The only 2-4 I interviewed at was lilcon medical and ended up cancelling the rest. I definately didn't want to waste a year doing an internship that wasn't goign to SIGNIFICANTLY add to my knowledge base in the ED.
I only ranked a few 1-4's and that was to maximize my chances of ending up in NYC. (I ended with my first choice so it became moot). I basically realized that the 1-4's offered very little additional to my training. I dont' think you learn alot doing medicine floors, or acting as scut for cardiology consults. There are so few 1-4's that the whole 'can't get hired' thing is really a hold out that will eventually go the way of dinosaurs.
And I wanted to leave myself open to the possibilites of fellowship. If you do a 1-4, even a one year fellowship makes yourtraining time WAAAAY to long.
Plus, you can get all of the training you need in a 1-3. You can't really tell me that 85% of the EMP's coming out of residency are inadequately trained. Its a ridiculous notion.
What's more important to find out is HOW MUCH TIME DOES EACH PROGRAM SPEND IN THE ED? Since you will be an EMP, you need to spend residency training in the ED.
I ended up ranking only 4 year programs but it wasn't really because I wanted to do 4 years. It just happened that the places I was most interested in happened to be 4 year programs and I didn't think the extra year outweighed the other reasons for going to those programs. I was also actually very interested in doing a year of IM internship since I still had mixed feelings about not doing IM and I wanted one more year in NYC. I do think the four year programs have some advantages but they are probably transient and not necessarily worth that extra year. My wife and several friends did 1-3 programs so I have a good basis for comparison.
1. I did an IM internship that was virtually 100% inpatient/crit care. That combined with the ICU time during residency meant that I had nearly as much inpatient experience as some of the hospitalists I am admitting to. I think that gives me a better appreciation for inpatient issues than I might otherwise have and I think the extra experience in IM is useful if you end up in an IM heavy ED as many of us do.
2. The extra year gives you much more elective time, especially in 1-4 programs, which you can use for research, or to explore other interests. I think some 1-4 programs give up to 6 months of elective time.
3. I think the extra year does make your first year or two out of residency a little easier. We had so much independence our last year that being an attending didn't really seem any different. I notice a definite difference the first year or so out in 1-3 graduates but I don't think that difference lasts more than a year or two. So, do you get that extra year of experience making >150k/year or <50k/year? Its up to you.
4. The extra training and extra time to pad your CV makes you more competitive when applying for fellowships and academic jobs but since many of those spots aren't that competitive anyway it probably doesn't matter much. I do know of 1-3 graduates teaching at 1-4 or 2-4 programs
In the end I don't feel the benefits of the extra year are that compelling nor do I feel that the extra year is particularly burdensome. I would look at the specific programs and locations and decide on that basis and not on the basis of the extra year.
1. I did an IM internship that was virtually 100% inpatient/crit care. That combined with the ICU time during residency meant that I had nearly as much inpatient experience as some of the hospitalists I am admitting to. I think that gives me a better appreciation for inpatient issues than I might otherwise have and I think the extra experience in IM is useful if you end up in an IM heavy ED as many of us do.
2. The extra year gives you much more elective time, especially in 1-4 programs, which you can use for research, or to explore other interests. I think some 1-4 programs give up to 6 months of elective time.
3. I think the extra year does make your first year or two out of residency a little easier. We had so much independence our last year that being an attending didn't really seem any different. I notice a definite difference the first year or so out in 1-3 graduates but I don't think that difference lasts more than a year or two. So, do you get that extra year of experience making >150k/year or <50k/year? Its up to you.
4. The extra training and extra time to pad your CV makes you more competitive when applying for fellowships and academic jobs but since many of those spots aren't that competitive anyway it probably doesn't matter much. I do know of 1-3 graduates teaching at 1-4 or 2-4 programs
In the end I don't feel the benefits of the extra year are that compelling nor do I feel that the extra year is particularly burdensome. I would look at the specific programs and locations and decide on that basis and not on the basis of the extra year.
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Just as another testemonial... the issue of getting a job at a 4 yr after completing a 3 yr is only valid the first year out. After that point, everyone is equalized and the 3 yr grad with a year of attendinghood under their belt will probably be more confident since the solo-responsibility of patient care is not new.
Our (3 yr) program has had 2 fresh grads in the past year get hired by a local 4 yr program. When I interviewed with this particular program they tried to sell the fact that you needed a 4 yr program to go into academics and they would NEVER hire a new 3 yr grad. Guess they need to reeval their own salespitch...
Our (3 yr) program has had 2 fresh grads in the past year get hired by a local 4 yr program. When I interviewed with this particular program they tried to sell the fact that you needed a 4 yr program to go into academics and they would NEVER hire a new 3 yr grad. Guess they need to reeval their own salespitch...
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As a resident at a four year program, I think there is little argument either way. You really cannot generalize 3 year vs. 4 year. Just apply to a few of each and see if any of those programs seem really great.
my opinions:
4 year:The extra year is nice when you start residency because you are overwhelmed and you know that by the time you leave, you will have supreme confidence. You will have extra elective time to pursue interesting projects. Many of the four year programs are at places with amazing people who are at the forefront of EM. You will be running an entire ED as a fourth year (and even as a 3rd year).
3 year: You will get excellent training in a 3 year program and be confident enough when you leave to run an emergency department. The fourth year residents at my program run the ED and do an excellent job. I'm sure it's no different than if they were at another hospital running the ED after a 3 year program, except they can always ask the advice of a nearby attending if they want to. In a 3 year you have the benefit of an extra year at an attendings salary. Many of the three year programs are at places with amazing people who are at the forefront of EM.
I initially looked only at 3 year programs but applied to a few 4 year programs because they were in places I wanted to live. In the end, one of the 4 year programs fit me the best, all things considered. My rank list was #1: 4 year, #2: 3 year, #3: 4 year, #4: 3 year, #5: 3 year. Take the time to investigate your options.
That said, the idea of a 2-4 program makes me wince.
Rusty
my opinions:
4 year:The extra year is nice when you start residency because you are overwhelmed and you know that by the time you leave, you will have supreme confidence. You will have extra elective time to pursue interesting projects. Many of the four year programs are at places with amazing people who are at the forefront of EM. You will be running an entire ED as a fourth year (and even as a 3rd year).
3 year: You will get excellent training in a 3 year program and be confident enough when you leave to run an emergency department. The fourth year residents at my program run the ED and do an excellent job. I'm sure it's no different than if they were at another hospital running the ED after a 3 year program, except they can always ask the advice of a nearby attending if they want to. In a 3 year you have the benefit of an extra year at an attendings salary. Many of the three year programs are at places with amazing people who are at the forefront of EM.
I initially looked only at 3 year programs but applied to a few 4 year programs because they were in places I wanted to live. In the end, one of the 4 year programs fit me the best, all things considered. My rank list was #1: 4 year, #2: 3 year, #3: 4 year, #4: 3 year, #5: 3 year. Take the time to investigate your options.
That said, the idea of a 2-4 program makes me wince.
Rusty
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4 year programs are all about opportunities. Usually 4-year programs have more elective and critical care time. My program has 6 months of critical care time and 6 months of elective time, which we can do overseas or anywhere we please.
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southerndoc said:
I'm considering 4 year programs heavily because some of the best, most established programs out there are 1-4 format, namely Denver and Cinci. 2-4 programs seem like way too much work though.
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How is 2-4 any more work than 1-4?
Which brings another question to my mind. Does 2-4 mean spending your first year out as an intern instead of a resident? That would make sense of 2-4 being more work...
Which brings another question to my mind. Does 2-4 mean spending your first year out as an intern instead of a resident? That would make sense of 2-4 being more work...
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2-4 programs mean that you spend your first year doing a prelim/transitional year. Also means applying to and interviewing for that spot. Yuck!
As for 4 years having more critical care and elective time... my 3 year program spends 6 months in the unit and we have 3 weeks per year of research/elective time. Many people do international electives here. We also don't have ANY medicine/surgery floor months (big bonus)!
I don't have anything against 4 year programs... my second choice was a 4 year. Just wanted to show you can still get ample elective and critical care time without an extra year.
As for 4 years having more critical care and elective time... my 3 year program spends 6 months in the unit and we have 3 weeks per year of research/elective time. Many people do international electives here. We also don't have ANY medicine/surgery floor months (big bonus)!
I don't have anything against 4 year programs... my second choice was a 4 year. Just wanted to show you can still get ample elective and critical care time without an extra year.
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