What is it about your ED residency program that made you choose it?

[vtucci]

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Just looking for a little insight.

Thanks guys.

 

[Telemachus]

While I won't give a strict rank of how important various factors are, I'd group things as such:

Important -- location, faculty, happiness of current/past residents

Less important -- off-service rotations, co-residents (this is huge, but you can't know specifically who they'll be so this gets down-graded), medical center(s) facility and resources, patient population

Not important -- reputation (notoriously unreliable, based on source), salary/benefits (similar almost everywhere)

 

[kbrown]

Just looking for a little insight.

Thanks guys.

For me, my rank list was based on the people and location. With a few exceptions, most programs have a similar framework. That is mandated by the RRC. With regards to procedures (lines, tubes, lacs, lps, etc) RRC has minimum requirements, some programs far exceed them and some just meet them. Other than that, the main difference that exists is the people.

These are the people that you will be spending the next 3-4 years with. So you have to decide, are they going to make a bad shift worse or better? I looked for supportive faculty, a strong collegial relationship amongst the residents and strong ICU experience. It is important for me to feel like I can take care of ANY sick patient that will come strolling in the ED when I graduate.

After living in the midwest my entire life, I was looking to move out of the midwest and to a blue state, so that was a factor in my application process (not as much for the rank list).

That was basically how I sorted it out. Plus, I couples matched, so the decision wasn't mine entirely.

 

[docB]

I'd like to say it was more highbrow stuff but it was location.

 

[wook]

For me, it was location, faculty, resident happiness, resident camaraderie, asd well as opportunity to participate in DMAT (disaster medical assistance team) and tactical medicine.

Wook

 

[medivac]

For me, it was location first and foremost. My brother is an up and coming 3rd year at the school, most of my family was in the area, and I did undergrad work there. Is it bad that I think making my brother a scutmonkey might be fun? Plus, the ex-military friendly PD made me feel really welcome and the residents all seemed really healthy and happy

 

[Hercules]

One more vote for location, here. I interviewed at some programs with pretty decent reputations (Vandy, Carolinas, UNC, Emory) and while I was impressed and really liked them, in the end it came down to location. It helped that the residents are fun, the faculty is young and enthusiastic, and that UAB had the best physical facilities out of all the programs I interviewed. Come on though, lets hear from at least one person who says location isn't that important so we can get a new viewpoint on the thread. 🙂

 

[bulgethetwine]

One more vote for location, here. I interviewed at some programs with pretty decent reputations (Vandy, Carolinas, UNC, Emory) and while I was impressed and really liked them, in the end it came down to location. It helped that the residents are fun, the faculty is young and enthusiastic, and that UAB had the best physical facilities out of all the programs I interviewed. Come on though, lets hear from at least one person who says location isn't that important so we can get a new viewpoint on the thread. 🙂

Location, location, location....

 

[basementbeastie]

proximity to In n' Out....

 

[OSUdoc08]

proximity to In n' Out....

What's In n' Out?

Sounds like a gas station.

 

[kbrown]

What's In n' Out?

Sounds like a gas station.

one of the "most competitive" residencies in the country for EM
, or it's a burger joint on west coast, you take your pick

 

[EctopicFetus]

What's In n' Out?

Sounds like a gas station.

What I dont get is OSUdoc has been on this board for so long and somehow she didnt know this?

 

[12R34Y]

Another vote for location.

Based my entire list off of location, location and then location and after that some more location and then finally how happy the residents were and "vibe" I got on interview day (friendliness of faculty)

Oh and I forgot DID NOT RANK A PROGRAM THAT DID ANY ER SHIFTS LONGER THAN 9 HOURS!

My programs does 8's sweeeeeeeeet.

later

 

[OSUdoc08]

What I dont get is OSUdoc has been on this board for so long and somehow she didnt know this?

I've never been to the west coast.

I'll let the "she" reference slide for now, and assume it was a typo.

The only reason I know what White Castle is, is because of the movie.

I'm from Texas. We have Whataburger.

 

[Hawkeye Kid]

What I dont get is OSUdoc has been on this board for so long and somehow he didnt know this?

nevermind that--don't you know anyone from california??? it's practically all they ever talk about.

to answer the OP's question, i'll say that location really didn't play that big of a role in my decision. true, i'm from the midwest (screen name) and i matched in the midwest (indiana) but i applied all over and was game to moving.

i ended up ranking as numero uno a place that i rotated and really felt at home. i got along with the residents and really felt that my education and well-being were a priority. to echo 12R34Y, the shift length ended up being pretty important, but what impressed me is that the PD told me "the data says you stop learning after 9 hours, so you shouldn't be here longer than that." now, i don't know what studies he's talking about, but it showed me that i wasn't just there to work, which meant something to me. also, during my month there, it just seemed like i fit in with the residents and faculty, and it was an environment in which i felt that i could learn very well. now, maybe i'd fit in at a lot of places and maybe there's a better fit out there, but i'll take a known commodity over an unknown all other things being equal.

anyhoo, that's that. i really just wanted "fit" to have a vote since it seems to be outnumbered here (strange that it hasn't made a showing here since it's usually championed as the number one criterion). 👍

 

[kungfufishing]

yeah man Im gamey too, need to shower...

"fit" was equally or more important than location for me. You cant be sure how well you'll fit in someplace prior to matching, but the gestalt of objective criteria and resident/faculty interactions offer at least some idea.
You have enough time off in EM that many places are within a reasonable plane ride away.

 

[OSUdoc08]

nevermind that--don't you know anyone from california??? it's practically all they ever talk about.

to answer the OP's question, i'll say that location really didn't play that big of a role in my decision. true, i'm from the midwest (screen name) and i matched in the midwest (indiana) but i applied all over and was game to moving.

i ended up ranking as numero uno a place that i rotated and really felt at home. i got along with the residents and really felt that my education and well-being were a priority. to echo 12R34Y, the shift length ended up being pretty important, but what impressed me is that the PD told me "the data says you stop learning after 9 hours, so you shouldn't be here longer than that." now, i don't know what studies he's talking about, but it showed me that i wasn't just there to work, which meant something to me. also, during my month there, it just seemed like i fit in with the residents and faculty, and it was an environment in which i felt that i could learn very well. now, maybe i'd fit in at a lot of places and maybe there's a better fit out there, but i'll take a known commodity over an unknown all other things being equal.

anyhoo, that's that. i really just wanted "fit" to have a vote since it seems to be outnumbered here (strange that it hasn't made a showing here since it's usually championed as the number one criterion). 👍

I have a couple of friends from Cali. They talk about going to the beach and stuff. They, just like I, don't frequent fast food places, however.

 

[ewells]

Location and resident happiness were my only deal-breakers. Where the program was located was less important than the size of the city/town and how family friendly it was.

 

[turtle md]

The feel of the program mattered most to me. Location was important too - I wouldn't go anywhere that I wouldn't want to live. But I wouldn't go to a program that didn't feel right at the interview no matter how much I wanted to live in that location.

My wife accompanied me for all of my interviews. She was more about location, since she wouldn't be involved with the program. So there were a few places I liked the program, liked the location, but she didn't - so no go!

My advice, don't rank any program you wouldn't want to spend 3-4 years at, and don't move anywhere you wouldn't want to live.

 

[turtle md]

Plus, out of all the programs I looked at, the one I chose has more EM time both in 1st year and overall. I truly believe the best place to learn EM is in the ED 😀 .

 

[8744]

The feel of the program mattered most to me. Location was important too - I wouldn't go anywhere that I wouldn't want to live. But I wouldn't go to a program that didn't feel right at the interview no matter how much I wanted to live in that location.

My wife accompanied me for all of my interviews. She was more about location, since she wouldn't be involved with the program. So there were a few places I liked the program, liked the location, but she didn't - so no go!

My advice, don't rank any program you wouldn't want to spend 3-4 years at, and don't move anywhere you wouldn't want to live.

With respect, you need to rank every EM program you interview at even if you hate it. Fortunately, I liked every program where I interviewed except for one. Still, I ranked it because I'd rather suffer a little in a program that might not be a good fit rather than waste a year doing something else. Fortunately, again, I matched at a program that I really liked.

I would say don't interview somewhere where yu wouldn't want to llive because if you have no intention of moving there you're taking an ionterview spot from the guy who jsut missed getting an interview but would definitely move there.

 

[roja]

Location
resident happiness index
overall 'fit' (make sure the personality of the program fits your personality)
3 year

 

[Luba Licious]

I've never been to the west coast.

I'll let the "she" reference slide for now, and assume it was a typo.

The only reason I know what White Castle is, is because of the movie.

I'm from Texas. We have Whataburger.

I spent a little time in Texas in the military, and never understood why Whataburger is pronounce "Waterburger". Can you shed some insight on this?

 

[vtucci]

Thanks for your comments everyone. I know I am early in the process but I am really flexible and have no problem moving anywhere in the country. I am thinking I will probably want a big city though with a lot of patients and a higher acuity of care.

Did any of you focus on the number of patients treated yearly? If you did, do you want a program with 30K, 50K, 60K, 75K, 100+K? Why? What do you think are the benefits?

How many patients do you usually see each shift?

Thanks again.

 

[OSUdoc08]

I spent a little time in Texas in the military, and never understood why Whataburger is pronounce "Waterburger". Can you shed some insight on this?

In Texas, when you use the word "a", it sounds like "uh" instead of a long a.

Thus What-uh-Burger, when said quickly, sounds like What-er-Burger.

Since What-er is close to Water, people often just use that.

 

[EctopicFetus]

I chose my residency because as mentioned in previous threads U of AZ has the best looking and smartest residents.

Im glad I could deviate from the others..

 

[DeLaughterDO]

I spent a little time in Texas in the military, and never understood why Whataburger is pronounce "Waterburger". Can you shed some insight on this?

Probably because a lot of people (not all) have this weird dialect (a.k.a. "Southern Drawl") that causes them to say most words in the English (and frequently the Spanish) language incorrectly.

My grandmother used to say "Sugar" as "Sher-ger" (again, adding a mystery 'r') as well as "Daughter" as "Dar-ter" (again with the mysteriously added 'r'). Of course, she was "borned and raised" in Arkansas, so that may have something to do with it... Fortunately, I have been blessed with accent-neutral speech. Everytime someone asks me "Why don't you talk like you're from Texas" I thank them profusely! 👍

I think it has much to do with the regional dialect - for instance, why do people from Massachusetts never pronounce the 'r' at the end of words and replace them with an 'ah' sound? I could go on, but I won't...

"Pawk the caw and lets go have a beeah" anyone?

Sorry - I just realized this is so far off-topic as to be called a thread heist! My bad.

To the OP - I'll tell you when I actually apply for EM residencies... for now, I'm doing a year of TRI... But I can guarantee you that my reasons for choosing an EM residency will be, in no particular order:

- Somewhere my soon-to-be wife can also match Pediatrics
- Somewhere not so d@mned hot as Texas
- Somewhere with great collegiality between residents, nurses, and attendings
- Somewhere with few or no off-service rotations that have little educational
value for EM
- Somewhere with good exposure to EMS, EM Ultrasound, and Critical care

If anyone knows of such a place, please PM me ASAP. I'd like to take a look at that program!

jd

 

[turtle md]

With respect, you need to rank every EM program you interview at even if you hate it. Fortunately, I liked every program where I interviewed except for one. Still, I ranked it because I'd rather suffer a little in a program that might not be a good fit rather than waste a year doing something else. Fortunately, again, I matched at a program that I really liked.

I would say don't interview somewhere where yu wouldn't want to llive because if you have no intention of moving there you're taking an ionterview spot from the guy who jsut missed getting an interview but would definitely move there.

Opinions are like dinguses, everyone has one 😀 .

Your point is well taken. However, before interviewing, I didn't know I wouldn't like it. Thought the local was ok, but just didn't like the program. So in my case, I would rather open a dive shop in Honduras than go to those two particular programs. But there were a couple other less desirable that I still ranked, just last, b/c going to those would have been acceptable, if not a happy occasion.

Panda, I am happy for you that you matched where you think you will be happy. Congrats.

 

[Apollyon]

Opinions are like dinguses, everyone has one 😀 .

...and most of them stink!

 

[thierryh]

Factors most important to me:
Location, vibe, people, variety in training (trauma, sick medicine, poor, rich)

Volume doesn't matter as long as it's over a certain "critical mass". I'm thinking like 40k-50k.
You can only see so many people at a time. Don't think that a resident at a hospital that sees 200K a year sees 5 times more patients than a resident at a place with 40K. That being said, volume may dictate to some degree how you learn. Busier places give you more experience "managing the department" but slower places give you time to read a little about complicated and interesting patients.

Finally, don't read too much into numbers. Some EDs report all patients seen in ambulatory setting (ED, ambulatory care, fast track) and some report a "selected" population (only those seen by the ED residents and physicians). All the places with residents have sufficient volume to train you though, at least per the EM RRC.

Go Gunners (the soccer team, not the annoying kid behind you in pathology class), beat Barca.

 

[docB]

All this same stuff matters in recruiting for jobs after residency too. I was just at a conference and our recruiter put up a slide that said "BM3." It means "Beaches, mountains, mom or money." and if you want to attract you need one or more.

 

[EctopicFetus]

docB I think you are on point but...how come people come to chicago and milwaukee? No beaches or mountains and while I am sure mom is a factor for some many people just move here.

 

[Koko]

Location was down the list for me. I heard the location mantra over and over before interviewing, and while it was a consideration, I'm excited about EM and my training and knew what I wanted in a program. Regardless of the RRC, there is a great deal of variety in programs out there. Chose mine based on: culture of program and institution, caliber and character of residents/attendings/PD, financially flush medical institution that will not limit opportunities due to budget probs (e.g. away/int'l electives, etc.), reasonable shift lengths, exceptional off-service teaching, beautiful ED/hospital, ancillary staff, research opportunities, affordable/hi quality of life, superior sim man center. The couples match made life more interesting in the pre-ROL days, but it worked out well thankfully.

Be true to yourself and know what is important to you and what you need to be happy. You'll figure it out after you have a chance to visit. It's actually a lot of fun.

 

[OSUdoc08]

docB I think you are on point but...how come people come to chicago and milwaukee? No beaches or mountains and while I am sure mom is a factor for some many people just move here.

Beaches (flooding, hurricanes, and tsunamis) and mountains (too much snow and rain) aren't always major factors in location choice (for me at least!)

I think it should be based on whether or not the city has a pro NFL and/or NBA team.

You can always go on vacation to the beach or mountains!

 

[docB]

docB I think you are on point but...how come people come to chicago and milwaukee? No beaches or mountains and while I am sure mom is a factor for some many people just move here.

There are certainly other reasons for people to go here and there, they like that particular place, they had an opportunity to do somethng interesting (chair, etc.), they travel so a good airport is important. Vegas is attractive but it's got none of those. I thought the BM3 thing was a cute generalization but it is a generalization. Having worked with our recruiters though it is tough to sell people on places that are not overtly attractive. You'll notice that there are no open spots and the pay is relatively low in San Diego and Santa Barbara. Some rural spots have to pay premium which is tough if the volume is low and the payor mix is poor.

Of interest I just talked to one of our directors from Santa Barbara and he is having a tough time recruiting. The location is highly desirable but the pay is static while the real estate market is rising. That means that people are still getting the same $200-250 they have been but a basic house is >$900K and a nice house is >$1.2M.

If you're a student you don't need to worry about this. Just know that eventually you'll want to know about real estate prices and cost of living differences.

If you're in residency you want to start thinking about where you'd be willing to go and what the market is like there.

 

[EctopicFetus]

Beaches (flooding, hurricanes, and tsunamis) and mountains (too much snow and rain) aren't always major factors in location choice (for me at least!)

I think it should be based on whether or not the city has a pro NFL and/or NBA team.

You can always go on vacation to the beach or mountains!

Uhh Tucson.. mountains, no snow, minimal rain (its the desert) warm weather. No pro teams but the bball team is usually outstanding.. I will miss pro sports but I guess I can watch the Cardinals and suns... The Cardinals have really improved IMO... LEts see what Denny Green can do with that team now that he has Edge, Anquan, Fitgerald, Pope (the TE from UGa) and Leinart (who I think sits for a yr behind Warner).

 

[EctopicFetus]

There are certainly other reasons for people to go here and there, they like that particular place, they had an opportunity to do somethng interesting (chair, etc.), they travel so a good airport is important. Vegas is attractive but it's got none of those. I thought the BM3 thing was a cute generalization but it is a generalization. Having worked with our recruiters though it is tough to sell people on places that are not overtly attractive. You'll notice that there are no open spots and the pay is relatively low in San Diego and Santa Barbara. Some rural spots have to pay premium which is tough if the volume is low and the payor mix is poor.

Of interest I just talked to one of our directors from Santa Barbara and he is having a tough time recruiting. The location is highly desirable but the pay is static while the real estate market is rising. That means that people are still getting the same $200-250 they have been but a basic house is >$900K and a nice house is >$1.2M.

If you're a student you don't need to worry about this. Just know that eventually you'll want to know about real estate prices and cost of living differences.

If you're in residency you want to start thinking about where you'd be willing to go and what the market is like there.

I was just giving you a hard time. Please accept my apology. I like the BM3 thing but like most generalizations is wrong. Santa Barbara is quite $$$$... Its crazy how expensive LA is...

 

[OSUdoc08]

Uhh Tucson.. mountains, no snow, minimal rain (its the desert) warm weather. No pro teams but the bball team is usually outstanding.. I will miss pro sports but I guess I can watch the Cardinals and suns... The Cardinals have really improved IMO... LEts see what Denny Green can do with that team now that he has Edge, Anquan, Fitgerald, Pope (the TE from UGa) and Leinart (who I think sits for a yr behind Warner).

You're exactly right about Arizona.

What Program are you at?

Maricopa is one of my top 3.

 

[JackBauERfan]

I chose my residency because as mentioned in previous threads U of AZ has the best looking and smartest residents.

Im glad I could deviate from the others..

I thought we said Lincoln had the best looking residents. Since 3 of us voted on it.....

 

[EctopicFetus]

You're exactly right about Arizona.

What Program are you at?

Maricopa is one of my top 3.

U of Arizona... in tucson with Sam Keim, Harvey Meislin, Peter Rosen and John Sackles... Party on.. plus Mrs Fetus got a gig over at the law school.

 

[EctopicFetus]

I thought we said Lincoln had the best looking residents. Since 3 of us voted on it.....

Its good to have an opinion but i have the facts 😀

 

[irrka]

Thanks for your comments everyone. I know I am early in the process but I am really flexible and have no problem moving anywhere in the country. I am thinking I will probably want a big city though with a lot of patients and a higher acuity of care.


Thanks again.

define big city... i'm in a city with a large population where it's all suburban sprawl, does that count? it counted in the census!

 

[irrka]

Its good to have an opinion but i have the facts 😀

Yes, and you agreed to that fact from what i understand.... 🙄

 

[vtucci]

define big city... i'm in a city with a large population where it's all suburban sprawl, does that count? it counted in the census!

I live in tampa now and would not consider it a big city, I was thinking Chicago, St. Louis, Denver, San Fran, Las Vegas, Washington DC, NYC, Boston, New Orleans, Houston, Dallas and Miami (why oh why is there not an EM program here. ;-(. Not a fan of LA. Maybe Tuscon, richmond, JAX as second-tier smaller cities. However, I was more concerned about patient volume.

 

[EctopicFetus]

I live in tampa now and would not consider it a big city, I was thinking Chicago, St. Louis, Denver, San Fran, Las Vegas, Washington DC, NYC, Boston, New Orleans, Houston, Dallas and Miami (why oh why is there not an EM program here. ;-(. Not a fan of LA. Maybe Tuscon, richmond, JAX as second-tier smaller cities. However, I was more concerned about patient volume.

If you dont think Tampa is a big city how why would you say Vegas St Louis or Denver? Just curious..

 

[Dr.Evil1]

Thanks for your comments everyone. I know I am early in the process but I am really flexible and have no problem moving anywhere in the country. I am thinking I will probably want a big city though with a lot of patients and a higher acuity of care.

Did any of you focus on the number of patients treated yearly? If you did, do you want a program with 30K, 50K, 60K, 75K, 100+K? Why? What do you think are the benefits?

How many patients do you usually see each shift?

Thanks again.

I think the main reasons I ranked were as follows:

1 - Feel - you will know you like a program when you like a program
2- Location - important but often over rated. If you don't feel comfortable at ANY of the Chicago (or whatever location you desire) programs then you will know it.
3- Urban vs. Academic vs. Community - this is a huge one.
4- 1-3 vs 1-4 vs 2-4 - When I started applying I tried to pretend this wasn't a factor but truthfully it was a huge factor after it was all said and done.

You can basically screen to location and type then go with feel from then on. Current residents are the best source of info. Good luck

 

[OSUdoc08]

I live in tampa now and would not consider it a big city, I was thinking Chicago, St. Louis, Denver, San Fran, Las Vegas, Washington DC, NYC, Boston, New Orleans, Houston, Dallas and Miami (why oh why is there not an EM program here. ;-(. Not a fan of LA. Maybe Tuscon, richmond, JAX as second-tier smaller cities. However, I was more concerned about patient volume.

There is. Hooray for DO's!

Oh yeah, how did you leave out Phoenix, but mention Tucson?

 

[EctopicFetus]

Cause Tucson is where it is at... 😀

 

[irrka]

I live in tampa now and would not consider it a big city, I was thinking Chicago, St. Louis, Denver, San Fran, Las Vegas, Washington DC, NYC, Boston, New Orleans, Houston, Dallas and Miami (why oh why is there not an EM program here. ;-(. Not a fan of LA. Maybe Tuscon, richmond, JAX as second-tier smaller cities. However, I was more concerned about patient volume.

i'm with fetus or whoever mentioned this: if you don't count tampa a big city, don't count st.louis! (never been to vegas, don't know about it). this from a girl who said "cleveland is a big city, how bad could it be?" 😉 sorry, all you cleveland-loving people.

 

[vtucci]

I agree St. Louis is on the lower end of that-- but I have never lived there and so it goes up in my estimation. Sorry I left off Phoenix- I will add it to the list. ;-)