Where can I find a EM residency program ranking by reputation?

[tarsuc]

if the doximity list is unreliable, and inaccurate.

p.s: I understand "fit" is more important than reputation, but just curious regarding reputations of programs I think I fit into.

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[surely]

if the doximity list is unreliable, and inaccurate.

p.s: I understand "fit" is more important than reputation, but just curious regarding reputations of programs I think I fit into.

The hive mind tried to come up with "tiers" of programs on the applicant spreadsheet last year, with no great consensus.

 

[OneTwoThreeFour]

I think you can somewhat make regional tiers but even that is a little fraught. There are too many variables that people value in different ways.

 

[InternistDO]

There are really only three tiers of EM residencies: Name brand programs (like LA County, Denver, Temple, Carolinas, etc--people will fight over who exactly is on this list), a couple questionable programs at the bottom, and then everything else in the middle.

And honestly, there are plenty of "middle" programs that will give you equally good clinical training when compared to a big name program, just without the SDN cool factor. Most people outside of EM don't even know who the "impressive" programs even are anyway.

 

[Brigade4Radiant]

EM doesn't have competitive fellowships like IM so it's meaningless unless you want to become an academic physician. In that case go to any EM program and then easily match into a academics ultrasound, education or simulation fellowship. What's the top tier ortho programs? The top tier plastic programs? After 5 years out no one really cares unless you are in academics.

 

[tarsuc]

Does getting an in-demand non academic job, depend on the reputation of the program at all?

 

[miacomet]

Does getting an in-demand non academic job, depend on the reputation of the program at all?

Not exactly. People like programs they know. If you want a job in a competitive market (Salt Lake, Denver, Portland, Seattle, Boise, Bozeman, Jackson Hole, Medford, Bend, Missoula, Flagstaff etc) you are best off either attending a program in close geographic proximity or that has sent many docs to said practice previously. Brigham and Kings County aren't getting you anywhere at my job (and might be a negative) but the local program and the chair's program might. EM is very, very regional, and it's who you know.

NYC jobs (hell on earth AFAIK) prefer people from NYC residencies (even the crap ones) due to general NYC provincialism and also because practicing there truly is uniquely painful and they want people to know what they are getting into.


White Coat Investor has several good posts on this.

 

[enalli]

Here's the honest truth:

Do you want to impress people in EM? Don't bother, nobody cares.

Do you want to impress other people in medicine? Don't bother, all they'll hear is that you're going into EM.

Do you want to impress your non-medical family and friends? Go to a program associated with a well-known university such as the Ivy league schools, Stanford, Duke, etc.

Do you want to impress yourself? Go literally anywhere and kick ass.

 

[Tenk]

Depends on what you want from a program . For me it was independence and money. I wanted to feel comfortable and be independent ASAP and make as much money during residency as possible. This means that all 4 year programs and programs that didn’t allow a lot of moonlighting were essentially worthless.

What you want will be different from me or anyone else which is why lists like this are pretty pointless and probably just a circle jerk.

 

[deleted547339]

Agree with above. Most EM markets aren’t competitive and being board eligible and having a pulse is adequate. The markets that are competitive are regional. If you want to live in California, you should try to residency in California. If NYC, then NYC. If Utah, then Utah.

If you’re looking for prestige, you’re in the wrong place. The house of medicine (wrongly) looks down on EM. You’re probably not going to get a ton of respect in academia, but who cares, get your lovin at home. That goes away outside of academia. Besides, no one outside of EM knows where the strong programs are. As an example, Carolinas and Indy are historically two of the best. If you tell your colleagues in IM you went there, they would assume you went to a subpar community program and a middle of the road academic program, respectively. And people outside of medicine will think you’re cool because you’re an ER doctor, but probably still ask you what kind of doctor you’re REALLY going to be.

Most EM programs are fine. Many are strong. Most have some problems. Few are actually bad. Students overrate trauma and procedures. When you’re ready to apply, print a list of all of them. Talk to an advisor about how competitive you are. Start crossing out cities where you refuse to live and circling programs you like. Keep going until the number matches what you think you should apply for. You’re not going to be able to interview everywhere you want because of scheduling concepts and money. Start scheduling every interview until you have “enough” and then immediately start canceling one for every additional one you take as to not screw every other applicant. Review the charting the outcomes data to see what “enough” is (hint: it’s probably around 10 and certainly no where near 20.). After you interview, sit down with whoever may be joining you for the next 3-4 years. Make a list in the order of exactly where YOU want to go in order (don’t muck around thinking about who you think will pick you, if doesn’t work like that). Your primary factors in deciding should be 1) where you will get the best training 2) where you can get the job you want 3) where you will be the happiest and 4) where you will graduate with the least debt (combination of cost of living, moonlighting and length of residency).

That’s it. There is literally almost nothing else you really need to know about where to go.

That rant went longer than expected...

 

[TheComebacKid]

If you want to find rankings best on reputation, honestly, the place is here, and what is fondly referred to as "the SDN circle jerk". LAC+USC, Denver, Cincy, Indy, Carolinas, Highland. A few others that I'm probably missing. They are household names in EM, and names that your parents will be disappointed in, but everyone on SDN knows and respects. They are all phenomenal programs.

Their reputation is based primarily on a combination of fantastic training, alumni network, age of the residency program, and just overall sex appeal. There are other programs out there that are equally as good but maybe lack that "SDN wow factor".

I went to the coasts for medical school, and I was one of the few people that left to go to the midwest for a program that I really liked. My priorities were quality of training, acuity, feel of the program, cost of living. I didn't care about being near the mountains or the ocean. If that's a priority to you then you should adjust your rank list accordingly.

One of the biggest things to consider, and one that I probably didn't consider enough, is what TNR referred to above. And that is trying to think about where you want to settle down when you are done. That can be hard to do. But if you want to settle down in Utah, and you know that going into interview season, it's best to do an away rotation in Utah, try your best to match there if you like the program (it's a phenomenal program BTW), and increase your chances of landing a job there.

To give you an example, my midwest program has a handful of people practicing in Utah. But compared to the Univ of Utah folks, they have a huge leg up and their alumni dominate the market. People know their faculty and it's much easier to make contacts there. Sure, if you come from LAC+USC which is a strong program, can you find a job in Utah? I would venture to say yes, but I would say it's probably overall much easier coming from a local program (the converse is probably rue if you are trying to find a job in LA)

 

[NurWollen]

Not exactly. People like programs they know. If you want a job in a competitive market (Salt Lake, Denver, Portland, Seattle, Boise, Bozeman, Jackson Hole, Medford, Bend, Missoula, Flagstaff etc) you are best off either attending a program in close geographic proximity or that has sent many docs to said practice previously. Brigham and Kings County aren't getting you anywhere at my job (and might be a negative) but the local program and the chair's program might. EM is very, very regional, and it's who you know.

NYC jobs (hell on earth AFAIK) prefer people from NYC residencies (even the crap ones) due to general NYC provincialism and also because practicing there truly is uniquely painful and they want people to know what they are getting into.


White Coat Investor has several good posts on this.

I'm not in EM, but Salt Lake, Boise, and Flagstaff are competitive markets? Actually, come to think of it, I don't find that hard to believe in the slightest. Fantastic cities. But the opposite of what a lot of premed and med school gunners think (NYC or bust).

Sent from my SM-G930V using SDN mobile

 

[miacomet]

I'm not in EM, but Salt Lake, Boise, and Flagstaff are competitive markets? Actually, come to think of it, I don't find that hard to believe in the slightest. Fantastic cities. But the opposite of what a lot of premed and med school gunners think (NYC or bust).

Sent from my SM-G930V using SDN mobile

NYC=poor pay, insane hospital culture, major dysfunction and ridiculous minimum work hours. Columbia, Cornell, most of the Mount Sinai affiliates and Kings County haven't been able to fill their ranks in years. I get emails for (insanely poorly paid) locums from one of the former each month. Another one of these couldn't even hire a single of their own grads, which one faculty member attributed to the residents being "princesses." Um, really? The funny thing is the docs in NYC are convinced they are in a really competitive market and it's just "hard to hire good people." If you have 15 open positions in a desirable city, the problem is you, folks.

Beyond the unique madness of NYC EM, larger markets are simply easier due to sheer volume. It's the smaller, highly desirable areas with decent remuneration that are roughest.

 

[alpinism]

As stated above the only people you'll be impressing with a "big name" residency is your grandparents.

While there are always exceptions I've been less than impressed with graduates of top 10 academic programs.

One of the favorite sayings of the PD at Harvard is to "load the boat" when it comes to sick or complex emergency patients which means to consult as much as possible and have them make all the decisions or do all the procedures to reduce the chances of a bad outcome or being sued. While this might work at a place like Harvard you have to ask yourself is this the best way to train future emergency medicine physicians.

 

[deleted547339]

While this might work at a place like Harvard you have to ask yourself is this the best way to train future emergency medicine physicians.

No you don’t, lol.

 

[miacomet]

As stated above the only people you'll be impressing with a "big name" residency is your grandparents.

While there are always exceptions I've been less than impressed with graduates of top 10 academic programs.

One of the favorite sayings of the PD at Harvard is to "load the boat" when it comes to sick or complex emergency patients which means to consult as much as possible and have them make all the decisions or do all the procedures to reduce the chances of a bad outcome or being sued. While this might work at a place like Harvard you have to ask yourself is this the best way to train future emergency medicine physicians.

Agreed. People in academia think their clinical work is the roughest, but they often flail in the community. They are used to consulting everyone and admitting anything they aren't sure about. This is not the real world. County programs are also not the real world- customer service matters, as does throughput. Docs can adjust, but I really wish both ivory tower and county programs would incorporate a few community hospital months.

 

[BAM!]

Go to the city where you think you'll want to find a job after residency. It will help with contacts and networking, which is really the most important thing.

 

[DrMcCoyDO]

Docs can adjust, but I really wish both ivory tower and county programs would incorporate a few community hospital months.

I’m lucky to be at a county program that has a couple community months. It’s one of the reasons I ranked it highly.

 

[takeurmeds02]

Agree with above. Most EM markets aren’t competitive and being board eligible and having a pulse is adequate. The markets that are competitive are regional. If you want to live in California, you should try to residency in California. If NYC, then NYC. If Utah, then Utah.

If you’re looking for prestige, you’re in the wrong place. The house of medicine (wrongly) looks down on EM. You’re probably not going to get a ton of respect in academia, but who cares, get your lovin at home. That goes away outside of academia. Besides, no one outside of EM knows where the strong programs are. As an example, Carolinas and Indy are historically two of the best. If you tell your colleagues in IM you went there, they would assume you went to a subpar community program and a middle of the road academic program, respectively. And people outside of medicine will think you’re cool because you’re an ER doctor, but probably still ask you what kind of doctor you’re REALLY going to be.

Most EM programs are fine. Many are strong. Most have some problems. Few are actually bad. Students overrate trauma and procedures. When you’re ready to apply, print a list of all of them. Talk to an advisor about how competitive you are. Start crossing out cities where you refuse to live and circling programs you like. Keep going until the number matches what you think you should apply for. You’re not going to be able to interview everywhere you want because of scheduling concepts and money. Start scheduling every interview until you have “enough” and then immediately start canceling one for every additional one you take as to not screw every other applicant. Review the charting the outcomes data to see what “enough” is (hint: it’s probably around 10 and certainly no where near 20.). After you interview, sit down with whoever may be joining you for the next 3-4 years. Make a list in the order of exactly where YOU want to go in order (don’t muck around thinking about who you think will pick you, if doesn’t work like that). Your primary factors in deciding should be 1) where you will get the best training 2) where you can get the job you want 3) where you will be the happiest and 4) where you will graduate with the least debt (combination of cost of living, moonlighting and length of residency).

That’s it. There is literally almost nothing else you really need to know about where to go.

That rant went longer than expected...

This and subsequent comments were extremely helpful and most directly answered the question.

 

[RustedFox]

Residency ranking EM programs is like those ESPN (... wait... LOL... ESPN) "power rankings" for any sport: wrong, bad, and pointless.

 

[thegenius]

EM doesn't have competitive fellowships like IM so it's meaningless unless you want to become an academic physician. In that case go to any EM program and then easily match into a academics ultrasound, education or simulation fellowship. What's the top tier ortho programs? The top tier plastic programs? After 5 years out no one really cares unless you are in academics.

When I matched 8 years ago, EM and one other specialty (I think Plastics?) were the only two that have 100% match rate. When I applied one had to apply to 8 programs to have about a 95% chance of matching, and 10 programs to have 99% chance of matching.

I might be off by a tiny amount, but my point is EM is very competitive. These days.

 

[boomshaketheroom]

Residency ranking EM programs is like those ESPN (... wait... LOL... ESPN) "power rankings" for any sport: wrong, bad, and pointless.

Although power ranking accuracy certainly improves the higher they rank my teams

 

[TheComebacKid]

Agreed. People in academia think their clinical work is the roughest, but they often flail in the community. They are used to consulting everyone and admitting anything they aren't sure about. This is not the real world. County programs are also not the real world- customer service matters, as does throughput. Docs can adjust, but I really wish both ivory tower and county programs would incorporate a few community hospital months.

I hope this doesn't come off as confrontational, but this is a one-sided argument. Both the community and academics side have pros and cons.

I'm at an academic/county hybrid program with several months of community rotations. I would say roughly 50% of the docs of the community site (board certified EM) don't know how to use an ultrasound machine, don't understand the principles of how to do an echo in a patient in shock, or how to place an ultrasound guided IV. They practice very little evidenced based medicine. They CT scan everything, and for anything they aren't comfortable with, they just transfer to the ivory tower.

I agree with you that on the academic side, it's easier when you have all your consultants in house, but I don't think our academic attendings "flail" when they go into the community. Some do better than others. Similarly, some community docs are very up to date on evidenced based guidelines. It's a little more complicated and not as black and white as you paint it.