Wish I had applied to academic programs!

[acadianvoyager]

I only applied to community residency programs, since I thought I wanted to be a community doc and wouldn't want to do 4 years of residency. I also thought community practice would be less dependent on specialists than academic practice.

Now I really miss the strong academic atmosphere I experienced in medical school. I miss working with faculty with ongoing research projects and specific academic interests, I miss having clinical trials ongoing in the department, and on the off-service rotations I miss having faculty who are dedicated to teaching and research.

I really regret not applying to any 4 year programs. I'm considering seeing if there are any academic residents who wish they had matched to a community program, with whom I could arrange a swap. Not sure if this is done. Appreciate your thoughts.

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[surely]

I only applied to community residency programs, since I thought I wanted to be a community doc and wouldn't want to do 4 years of residency. I also thought community practice would be less dependent on specialists than academic practice.

Now I really miss the strong academic atmosphere I experienced in medical school. I miss working with faculty with ongoing research projects and specific academic interests, I miss having clinical trials ongoing in the department, and on the off-service rotations I miss having faculty who are dedicated to teaching and research.

I really regret not applying to any 4 year programs. I'm considering seeing if there are any academic residents who wish they had matched to a community program, with whom I could arrange a swap. Not sure if this is done. Appreciate your thoughts.

Correct me if I'm wrong, but aren't there plenty of 3-year academic programs?

 

[TheComebacKid]

Interesting post.

I am currently training at a 4 year academic program. I can tell you that there are pros and cons to training in every single setting, including academics or county. I have at several times thought to myself, "I wish I trained at a 3 year community program".

What I will say is that the most important thing you should get out of residency is to get great training in emergency medicine and to be able to practice well independently once you graduate. The vast majority of 3 year community programs will prepare you very well for this. While I am training at an academic place, and I enjoy working with faculty who are heavily published, getting involved in research projects, having 7 different fellowships, etc. this is not the most important thing about residency. You are going to be judged based on the quality of EM doc you are coming out of residency.

If you are interested in things like research, you can still partake in that during residency at a 3 year community program, although with the compressed schedule you likely will have less time compared to a 4 year program. Regardless, you can still definitely do a fellowship or work at an academic center once you graduate residency.

Also, we are definitely more consult heavy than you are in a community program. While I think we get great training overall, for instance we see some really crazy stuff and take care of lots of people with LVADs, balloon pumps, OSH transfers who are going to be cannulated on ECMO etc. But some procedures, for instance, peritonsillar abscesses or complicated reductions get punted to the specialists instead of just doing them on our own like many community EM docs practice. This is definitely a detriment to our training.

The grass is always greener.

 

[carbonizedeyesockets]

I only applied to community residency programs, since I thought I wanted to be a community doc and wouldn't want to do 4 years of residency. I also thought community practice would be less dependent on specialists than academic practice.

Now I really miss the strong academic atmosphere I experienced in medical school. I miss working with faculty with ongoing research projects and specific academic interests, I miss having clinical trials ongoing in the department, and on the off-service rotations I miss having faculty who are dedicated to teaching and research.

I really regret not applying to any 4 year programs. I'm considering seeing if there are any academic residents who wish they had matched to a community program, with whom I could arrange a swap. Not sure if this is done. Appreciate your thoughts.

You can still go into academics from a 3 year community program. Some 4 year programs may not take you right out of residency, but that isn't necessarily the rule.

Your goal in residency is to become a good doctor first and an academic second. Do a research fellowship if you really want to do research or do a fellowship in something you're really interested in. Also, its pretty rare for someone to switch to another EM program, nevermind "swapping" positions.

 

[BoardingDoc]

Correct me if I'm wrong, but aren't there plenty of 3-year academic programs?

Not wrong. There are plenty of 3 year academic programs. There is a much larger percentage of 4 year programs among academic programs than community ones, but it certainly isn't an overwhelming majority.

 

[gro2001]

I only applied to community residency programs, since I thought I wanted to be a community doc and wouldn't want to do 4 years of residency. I also thought community practice would be less dependent on specialists than academic practice.

Now I really miss the strong academic atmosphere I experienced in medical school. I miss working with faculty with ongoing research projects and specific academic interests, I miss having clinical trials ongoing in the department, and on the off-service rotations I miss having faculty who are dedicated to teaching and research.

I really regret not applying to any 4 year programs. I'm considering seeing if there are any academic residents who wish they had matched to a community program, with whom I could arrange a swap. Not sure if this is done. Appreciate your thoughts.

Unless you are very unhappy at your current program for some other reason, I would not recommend trying to switch at this point.

What you realized is that you are interested in pursuing a career in academic EM rather than community EM. That's totally fine. Just because you are going to graduate from a 3 year community program, does not mean that path is closed to you. Yeah, some four year programs probably won't hire you straight out of residency. Partly because of the awkwardness of having their PGY4s report to someone who is essentially a PGY4 from another institution. But more importantly, they might not hire you because you probably haven't really developed a solid academic niche for yourself. So now you have to ask yourself: "what do I want my academic niche to be, and how do I develop myself in that area?"

One relatively easy way is to do a fellowship. Then you can position yourself as "the ultrasound guy" or the "critical care gal" or whatever. The trick is picking something you are interested in and ideally something that you can see yourself both publishing in and doing teaching at a residency level.

You certainly don't have to do a fellowship to develop a niche, even if it's a niche that is typically associated with a fellowship. For example, I fell into doing ultrasound teaching for a medical school, even though I did not do an ultrasound fellowship. If you choose to go this route, see what in-demand skill you can demonstrably polish during residency. See what kind of courses, electives, certificates in that area you can get. It's a less sure footing (at least at first) than having fellowship credentials behind you, but it saves you a fellowship.

A non fellowship way you could become an asset to an academic (or any) department is by finding your niche on the operations side of things. If that appeals to you, see if you can get involved in QA/QI projects, get on some committees, maybe get some extra training in quality improvement or patient safety, try to complete an operations project while you are still in residency (bonus points if it gets published). The key is to work in an area that is in demand operationally and position yourself also as a person who can teach residents about these issues.

 

[Angry Birds]

Don't give up your current residency program. Just do an appropriate fellowship.

 

[namethatsmell]

Oh man, don't try to do this. Just don't.

Don't burn your mental/emotional/financial energy on this and risk burning bridges.

As others have said, you can always do a fellowship. Or don't, since you can still be an "academic" coming from a 3 year community program.

Most academic shops are not hyper-competitive to get a job at, and for the few shops that are--just try to do your fellowship there.

 

[acadianvoyager]

Interesting post.

I am currently training at a 4 year academic program. I can tell you that there are pros and cons to training in every single setting, including academics or county. I have at several times thought to myself, "I wish I trained at a 3 year community program".

What I will say is that the most important thing you should get out of residency is to get great training in emergency medicine and to be able to practice well independently once you graduate. The vast majority of 3 year community programs will prepare you very well for this. While I am training at an academic place, and I enjoy working with faculty who are heavily published, getting involved in research projects, having 7 different fellowships, etc. this is not the most important thing about residency. You are going to be judged based on the quality of EM doc you are coming out of residency.

If you are interested in things like research, you can still partake in that during residency at a 3 year community program, although with the compressed schedule you likely will have less time compared to a 4 year program. Regardless, you can still definitely do a fellowship or work at an academic center once you graduate residency.

Also, we are definitely more consult heavy than you are in a community program. While I think we get great training overall, for instance we see some really crazy stuff and take care of lots of people with LVADs, balloon pumps, OSH transfers who are going to be cannulated on ECMO etc. But some procedures, for instance, peritonsillar abscesses or complicated reductions get punted to the specialists instead of just doing them on our own like many community EM docs practice. This is definitely a detriment to our training.

The grass is always greener.

I don't think we do more procedures than you do...we're a community program with a LOT of specialists, so we actually hand off complicated reductions, etc, as well. Maybe at some of the smaller community sites they get more procedures.

 

[acadianvoyager]

Unless you are very unhappy at your current program for some other reason, I would not recommend trying to switch at this point.

What you realized is that you are interested in pursuing a career in academic EM rather than community EM. That's totally fine. Just because you are going to graduate from a 3 year community program, does not mean that path is closed to you. Yeah, some four year programs probably won't hire you straight out of residency. Partly because of the awkwardness of having their PGY4s report to someone who is essentially a PGY4 from another institution. But more importantly, they might not hire you because you probably haven't really developed a solid academic niche for yourself. So now you have to ask yourself: "what do I want my academic niche to be, and how do I develop myself in that area?"

One relatively easy way is to do a fellowship. Then you can position yourself as "the ultrasound guy" or the "critical care gal" or whatever. The trick is picking something you are interested in and ideally something that you can see yourself both publishing in and doing teaching at a residency level.

You certainly don't have to do a fellowship to develop a niche, even if it's a niche that is typically associated with a fellowship. For example, I fell into doing ultrasound teaching for a medical school, even though I did not do an ultrasound fellowship. If you choose to go this route, see what in-demand skill you can demonstrably polish during residency. See what kind of courses, electives, certificates in that area you can get. It's a less sure footing (at least at first) than having fellowship credentials behind you, but it saves you a fellowship.

A non fellowship way you could become an asset to an academic (or any) department is by finding your niche on the operations side of things. If that appeals to you, see if you can get involved in QA/QI projects, get on some committees, maybe get some extra training in quality improvement or patient safety, try to complete an operations project while you are still in residency (bonus points if it gets published). The key is to work in an area that is in demand operationally and position yourself also as a person who can teach residents about these issues.

Thanks for your detailed response, I really appreciate it.

 

[WildcatS11]

You can still go into academics from a 3 year community program. Some 4 year programs may not take you right out of residency, but that isn't necessarily the rule.

Your goal in residency is to become a good doctor first and an academic second. Do a research fellowship if you really want to do research or do a fellowship in something you're really interested in. Also, its pretty rare for someone to switch to another EM program, nevermind "swapping" positions.

I just wanted to clarify this - I think that actually IS the rule. A graduate of a 3-year program can not be an attending overseeing residents at a 4-year program in their 1st year out of residency - that essentially would be an equivalent amount of training for both attending and resident, which would obviously lead to some issues.

 

[carbonizedeyesockets]

I just wanted to clarify this - I think that actually IS the rule. A graduate of a 3-year program can not be an attending overseeing residents at a 4-year program in their 1st year out of residency - that essentially would be an equivalent amount of training for both attending and resident, which would obviously lead to some issues.

It's the rule that the grad in their first year out from a 3yr program can't supervise a PGY4. But I can guarantee that it does not mean that you won't be hired by a 4 year residency. I interviewed at one and multiple grads from my 3 yr residency have gotten jobs at this four year program. And it is in a top 10 biggest city and is associated with a MAJOR academic medical center (top 10 according to NIH funding).

 

[acadianvoyager]

Unless you are very unhappy at your current program for some other reason, I would not recommend trying to switch at this point.

What you realized is that you are interested in pursuing a career in academic EM rather than community EM. That's totally fine. Just because you are going to graduate from a 3 year community program, does not mean that path is closed to you. Yeah, some four year programs probably won't hire you straight out of residency. Partly because of the awkwardness of having their PGY4s report to someone who is essentially a PGY4 from another institution. But more importantly, they might not hire you because you probably haven't really developed a solid academic niche for yourself. So now you have to ask yourself: "what do I want my academic niche to be, and how do I develop myself in that area?"

One relatively easy way is to do a fellowship. Then you can position yourself as "the ultrasound guy" or the "critical care gal" or whatever. The trick is picking something you are interested in and ideally something that you can see yourself both publishing in and doing teaching at a residency level.

You certainly don't have to do a fellowship to develop a niche, even if it's a niche that is typically associated with a fellowship. For example, I fell into doing ultrasound teaching for a medical school, even though I did not do an ultrasound fellowship. If you choose to go this route, see what in-demand skill you can demonstrably polish during residency. See what kind of courses, electives, certificates in that area you can get. It's a less sure footing (at least at first) than having fellowship credentials behind you, but it saves you a fellowship.

A non fellowship way you could become an asset to an academic (or any) department is by finding your niche on the operations side of things. If that appeals to you, see if you can get involved in QA/QI projects, get on some committees, maybe get some extra training in quality improvement or patient safety, try to complete an operations project while you are still in residency (bonus points if it gets published). The key is to work in an area that is in demand operationally and position yourself also as a person who can teach residents about these issues.

Regarding your comment, "Unless you are very unhappy at your current program for some other reason..." I am actually pretty unhappy at current residency 2/2 the lack of interest in teaching and the very limited role for residents, especially on off-service rotations. The community hospital holds academics as a very low priority and does not give residents enough opportunities to get involved in codes and perform procedures, as these jobs are often performed by permanent employees (attendings or midlevels). "Getting the residents involved" is given lip service, but our education is very clearly not a priority. This is most prevalent on off-service rotations, but the active academic atmosphere was a big contributor to happiness in residency than I realized.

However, not sure how to discuss this with my PD without dissing on the program or blackmarking myself as someone who just can't be satisfied.

 

[acadianvoyager]

Interesting post.

I am currently training at a 4 year academic program. I can tell you that there are pros and cons to training in every single setting, including academics or county. I have at several times thought to myself, "I wish I trained at a 3 year community program".

What I will say is that the most important thing you should get out of residency is to get great training in emergency medicine and to be able to practice well independently once you graduate. The vast majority of 3 year community programs will prepare you very well for this. While I am training at an academic place, and I enjoy working with faculty who are heavily published, getting involved in research projects, having 7 different fellowships, etc. this is not the most important thing about residency. You are going to be judged based on the quality of EM doc you are coming out of residency.

If you are interested in things like research, you can still partake in that during residency at a 3 year community program, although with the compressed schedule you likely will have less time compared to a 4 year program. Regardless, you can still definitely do a fellowship or work at an academic center once you graduate residency.

Also, we are definitely more consult heavy than you are in a community program. While I think we get great training overall, for instance we see some really crazy stuff and take care of lots of people with LVADs, balloon pumps, OSH transfers who are going to be cannulated on ECMO etc. But some procedures, for instance, peritonsillar abscesses or complicated reductions get punted to the specialists instead of just doing them on our own like many community EM docs practice. This is definitely a detriment to our training.

The grass is always greener.

The detriment to our training at a community hospital (this one, anyways) is that our education is not very important to the institution. Many times I have seen a mid-level or attending put in a line, I/O access, pacers, etc with the residents just standing around, simply because the resident's education is not a priority. Does that go on at academic centers too?

 

[surgonc2017]

You're a first year resident right? Are you sure that your experience with not doing procedures/codes isn't a symptom of that?


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[acadianvoyager]

You're a first year resident right? Are you sure that your experience with not doing procedures/codes isn't a symptom of that?


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Touché. Certainly a possibility.

 

[gro2001]

Regarding your comment, "Unless you are very unhappy at your current program for some other reason..." I am actually pretty unhappy at current residency 2/2 the lack of interest in teaching and the very limited role for residents, especially on off-service rotations. The community hospital holds academics as a very low priority and does not give residents enough opportunities to get involved in codes and perform procedures, as these jobs are often performed by permanent employees (attendings or midlevels). "Getting the residents involved" is given lip service, but our education is very clearly not a priority. This is most prevalent on off-service rotations, but the active academic atmosphere was a big contributor to happiness in residency than I realized.

However, not sure how to discuss this with my PD without dissing on the program or blackmarking myself as someone who just can't be satisfied.

Are you at a brand new program with few/no senior residents? If you are, this could be part of the growing pains of a new program. In this case I would bring it up with your faculty mentor, APDs, and PD. Try to frame your comments less like a complaint/diss and more like asking for advice along the lines of "how would you suggest I advocate for myself in these situations so that I get the training I need?" You might be surprised at how useful the feedback might be. Maybe the issue is you and you just need to speak up more, express interest, or straight up ask to do the procedure the attending is about to perform. Maybe the issue are the attendings in the department, in which case the solution might be that they get a speaking to by the PD. Maybe the only problem is that you are an intern. This problem is easiest to fix and will be resolved by next year.

If you are at a more established program, talk to your senior residents. Did they experience the same problems? How did they deal with it? They might have a useful perspective and/or advice.

 

[carbonizedeyesockets]

Talk to your upper years about your experience with procedures and resuscitations. That is something that may change as you move up. Regardless, that sort of problem isn't necessarily a 3 vs 4 year problem or academic vs Community. There are plenty of places where interns have limited exposure to lines and intubation and running codes. again talk to your coresidents. If its a real problem, then others have had similar experiences and it should be brought up when the PD, etc elicit feedback about the program. You'll also have a chance to review your program through and ACGME survey later in the year. It is highly unlikely you'll be able to switch to another EM program. It has happened, but you need a pretty compelling reason and I don't think anyone will think your situation is compelling.

 

[Venko]

I just wanted to clarify this - I think that actually IS the rule. A graduate of a 3-year program can not be an attending overseeing residents at a 4-year program in their 1st year out of residency - that essentially would be an equivalent amount of training for both attending and resident, which would obviously lead to some issues.

I'm curious which organization you believe made this rule?

A three year program condenses the training into more hours and experiences so the fourth year resident usually does NOt have the same clinical experience as the first year attending from a three year program.

If someone finishes college and gets their degree in two years they have the same degree specific academic knowledge as someone who took six years to finish college...it's just about pacing the core material.

It doesn't mean there isn't a rule, but I'm not familiar with one and would love to know if you have found this written somewhere.

Clarification: pacing is not to imply they are getting more time off. The four year residents are usually doing more research, or deep dives into a specific area of focus, like ultrasound administration, quality improvement, wilderness medicine etc. I apologize for allowing for the interpretation that pgy4 programs allow more time off. With regards to clinical experience, a three year grad has had roughly the same clinical experiences as a four year grad. In their final years both are allowed to function as a sub attending. So a pgy4 resident is still learning that skill whereas a grad from a pgy3 program has had a year of it in my opinion; four year grads get a sub fellowship type of additional exposure though.

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[alpinism]

Regarding your comment, "Unless you are very unhappy at your current program for some other reason..." I am actually pretty unhappy at current residency 2/2 the lack of interest in teaching and the very limited role for residents, especially on off-service rotations. The community hospital holds academics as a very low priority and does not give residents enough opportunities to get involved in codes and perform procedures, as these jobs are often performed by permanent employees (attendings or midlevels). "Getting the residents involved" is given lip service, but our education is very clearly not a priority. This is most prevalent on off-service rotations, but the active academic atmosphere was a big contributor to happiness in residency than I realized.

However, not sure how to discuss this with my PD without dissing on the program or blackmarking myself as someone who just can't be satisfied.

This seems more residency specific rather than related to community vs academic programs.

If anything academic programs usually have less opportunities for procedures due to high numbers of subspecialists and demanding patients. This results in a very low threshold to consult or defer procedures normally within EM scope of practice. Common examples include calling ortho for reductions, plastics for lacerations, etc...

 

[alpinism]

This is all second hand knowledge but multiple PDs have told me while it depends on the program you can absolutely work at a 4 year program as a 3 year graduate.

The only restriction is that you usually can't work shifts where you a supervising a 4th year resident as a 4th year attending.

 

[Epinephreus]

I'm curious which organization you believe made this rule?

A three year program condenses the training into more hours and experiences so the fourth year resident usually does NOt have the same experience as the first year attending from a three year program.

If someone finishes college and gets their degree in two years they have the same academic knowledge as someone who took six years to finish college...it's just about pacing.

It doesn't mean there isn't a rule, but I'm not familiar with one and would love to know if you have found this written somewhere.


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I do not believe this to be an accurate assessment of the difference of 3 vs 4 year programs. It is not like residents at 4 year programs are sitting around, twiddling their thumbs for the first three years. They are probably working very similar hours to the residents at a 3 year program, equating to equal clinical experience. The key to a strong fourth year program is a 4th year that allows you to develop a niche academically and really run a department (which at academic center, means taking reports from all the learners).

Now, you can absolutely make an argument between a 3 yr + a fellowship or 3 yr + a working yr vs a 4 year, but saying that 3 years are at the same level of a 4th year when they both graduate is absurd.

 

[Venko]

What?! That is a very poor understanding of 3 vs 4 year programs. It is not like residents at 4 year programs are sitting around, twiddling their thumbs for the first three years. They are probably working very similar hours to the residents at a 3 year program, equating to equal clinical experience. The key to a strong fourth year program is a 4th year that allows you to develop a niche academically and really run a department (which at academic center, means taking reports from all the learners).

Now, you can absolutely make an argument between a 3 yr + a fellowship or 3 yr + a working yr vs a 4 year, but saying that 3 years are at the same level of a 4th year when they both graduate is absurd.

I have worked at both a four and a three year program. My understanding reflects what I have seen. It's possible it doesn't reflect every program, but it is founded in personal experience.

Many four year programs I know offer "Sub fellowships" and concentration tracks that are not directly clinically relevant. They are work and build an academic career but don't relate directly improved patient care.

As for "absurdity" I have taught both pgy4 and pgy3 final year residents and in my experience they are equivalent in clinical acumen allowing for differences between individual people.

In fact, I supervised on shift pgy4 residents when I was first year out of a three year EM residency. I was able to offer some things to the learners who are now wonderful colleagues and friends


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[WildcatS11]

I'm curious which organization you believe made this rule?

A three year program condenses the training into more hours and experiences so the fourth year resident usually does NOt have the same clinical experience as the first year attending from a three year program.

If someone finishes college and gets their degree in two years they have the same degree specific academic knowledge as someone who took six years to finish college...it's just about pacing the core material.

It doesn't mean there isn't a rule, but I'm not familiar with one and would love to know if you have found this written somewhere.

Clarification: pacing is not to imply they are getting more time off. The four year residents are usually doing more research, or deep dives into a specific area of focus, like ultrasound administration, quality improvement, wilderness medicine etc. I apologize for allowing for the interpretation that pgy4 programs allow more time off. With regards to clinical experience, a three year grad has had roughly the same clinical experiences as a four year grad. In their final years both are allowed to function as a sub attending. So a pgy4 resident is still learning that skill whereas a grad from a pgy3 program has had a year of it in my opinion; four year grads get a sub fellowship type of additional exposure though.

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I'm not sure about an overarching rule, but it sounds like we have all agreed that a 3-year grad in their first year out shouldn't supervise a pgy4. All the 4 year programs I am around utilize this practice. Like others have said, it does not mean you won't get hired by a 4 year place, but to do so in the first year out as a 3 year grad puts a lot of stipulations on when/where you can work.

Also, if you think that a PGY3 from a 3-year program and a pgy4 are equivalent, that's absurd, as has been mentioned. Doesn't mean 3 year grads are bad or inferior, but to assume that whole extra year of training accounts just for an "academic interest" or something is naive.

 

[theseeker4]

The detriment to our training at a community hospital (this one, anyways) is that our education is not very important to the institution. Many times I have seen a mid-level or attending put in a line, I/O access, pacers, etc with the residents just standing around, simply because the resident's education is not a priority. Does that go on at academic centers too?

If you are a resident standing there watching mid levels and attending physicians do procedures, run codes, etc. while you are watching, you need to be more proactive. When a resuscitation is coming in, ask the attending to allow you to run it. When a procedure needs to be done, ask to do the procedure. No one is going to go around begging you to do procedures or run a resus. You need to take the initiative and pursue these yourself. Now you won't always be told yes, especially regarding running a resus on a complicated, unstable patient as an intern, but until you show you WANT to do procedures, and show you know what you are doing, you can't say a lack of procedural experience is due to failings on the part of your residency.

Just make sure you know what you are doing before you ask to do something. If you ask to do an LP, but then ask the attending to give you step by step instructions, no one is going to take you seriously if you don't read up on how to do a procedure first. Now if you ARE proactive and well-prepared, and still being overlooked by multiple attending's, THAT is something to bring to your Program Director in an attempt to have things improved.

I would really give it more time though, if you are an intern you have been a Doctor at your program for less than two months, which is far too little time to decide your education as a whole is lacking.

 

[Rendar5]

Also, if you think that a PGY3 from a 3-year program and a pgy4 are equivalent, that's absurd, as has been mentioned. Doesn't mean 3 year grads are bad or inferior, but to assume that whole extra year of training accounts just for an "academic interest" or something is naive.

Are you basing that on personal experience dealing with both 3 year and 4 year program residents? Because you aredirectly refuting someone who has taught both types of residents.

 

[TheComebacKid]

The detriment to our training at a community hospital (this one, anyways) is that our education is not very important to the institution. Many times I have seen a mid-level or attending put in a line, I/O access, pacers, etc with the residents just standing around, simply because the resident's education is not a priority. Does that go on at academic centers too?

No, we just stand around and watch the consultant do it. At academic centers, resident education is definitely highly prioritized, especially when the resident is an orthopedic resident. I can't tell you how many reductions I have gotten jacked from me because we ended up calling ortho.

If anything academic programs usually have less opportunities for procedures due to high numbers of subspecialists and demanding patients. This results in a very low threshold to consult or defer procedures normally within EM scope of practice. Common examples include calling ortho for reductions, plastics for lacerations, etc...

This

Overall I feel like I go to a fairly procedure heavy academic program and I'm confident in my abilities now as a second year resident. That being said, when our department is blowing up, it's wayyyy easier to call the ortho resident to come in and do a reduction than it is to do it yourself. Because, after all, they are there 24/7. If you ask me, that greatly undermines your ability to manage a busy department and have a strong skill set in all types of EM procedures. It also isn't fair to your consultants who are already super busy, and when you can easily do the procedure on your own. That being said, there is definitely a culture in academics where you consult quite a bit more than I like to.

I obviously have never trained a community program. But I just get the sense that at community programs, consultants are at home. They don't necessarily have an ortho prresidencyogram. If you consult ortho, you are consulting the attending who is going to come in to see the patient. More than likely, you will just do the procedure on your own and become better as a result.

I'm not trying to say community rules and academics sucks. Overall I'm very happy with my academic program. But there are definitely a lot of pros to doing community as well, some of which you may be overlooking

 

[SpacemanSpifff]

Overall I feel like I go to a fairly procedure heavy academic program and I'm confident in my abilities now as a second year resident. That being said, when our department is blowing up, it's wayyyy easier to call the ortho resident to come in and do a reduction than it is to do it yourself. Because, after all, they are there 24/7. If you ask me, that greatly undermines your ability to manage a busy department and have a strong skill set in all types of EM procedures. It also isn't fair to your consultants who are already super busy, and when you can easily do the procedure on your own. That being said, there is definitely a culture in academics where you consult quite a bit more than I like to.

I obviously have never trained a community program. But I just get the sense that at community programs, consultants are at home. They don't necessarily have an ortho prresidencyogram. If you consult ortho, you are consulting the attending who is going to come in to see the patient. More than likely, you will just do the procedure on your own and become better as a result.

I'm not trying to say community rules and academics sucks. Overall I'm very happy with my academic program. But there are definitely a lot of pros to doing community as well, some of which you may be overlooking

Agreed!

You can find a happy medium(ish) in academic programs that have a strong community component. That's something I definitely looked for while interviewing.