[2019-2020] Emergency Medicine Application Thread

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I rotated at a new community EM program and i could definitely tell the difference between non teaching faculty who had probably been out of an academic setting for several years. The level of explanation and reasoning was just not there. Albeit I’m sure they were excellent clinicians, but the teaching aspect just wasn’t adequate in my opinion. But there was core faculty, & they took the time to teach.

Thanks for the response! Did you feel like this hindered resident learning or did the residents seem on par with residents at other programs?

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I’m going to a second look next weekend. Should I take it on good faith that this a neutral event, meaning that the program’s rank is set and I’m legit just learning more about the program? I’m more so concerned about dropping rank than moving up (they’ve sent me a RTM email).

Yeah I dont think you’ll hurt yourself at all.
 
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Thanks! Do you think it is different at a newer program where a lot of the non-teaching faculty are community docs who never intended to get into teaching? Or is there still something to learn from the way these attendings work even if they don't break everything down on shifts and going into long explanations?

Probably. I mean clinical faculty at places that are established have often times been teaching/supervising for awhile. Or they are younger docs who want to become core faculty.
 
Thanks for the response! Did you feel like this hindered resident learning or did the residents seem on par with residents at other programs?
The residents seemed on par to me! At the end of the day, you’ll get the most learning from seeing patients.
 
Finished up my interview season and never had a chance for one of those coveted peeks at my SLOEs/SLOE grades. Do we ever find out after match? It's not a big deal but it would be cool to see what was written.
 
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Finished up my interview season and never had a chance for one of those coveted peeks at my SLOEs/SLOE grades. Do we ever find out after match? It's not a big deal but it would be cool to see what was written.


Hush, you have all top 10% SLOEs that only comment on how perfect and amazing you are and you know it ;).
 
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Finished up my interview season and never had a chance for one of those coveted peeks at my SLOEs/SLOE grades. Do we ever find out after match? It's not a big deal but it would be cool to see what was written.

You’ll probably never know. But Im pretty sure you can guess by the number of interviews, and where you got them, how they were. Otherwise, some things are meant to be a mystery.
 
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By the way, I have no idea what my 2 SLOEs said in 2005, and I haven't spent a second thinking about it since you asked that. Once you get into residency, who cares what some evaluation said? It's not important anymore.
 
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RIP to the Google Doc Spreadsheet. It is now locked and I doubt anyone will contribute without anonymity. It's sad that a few trolls destroyed such a valuable asset.
 
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I'm not necessarily suspending it forever. I'm not going to tolerate someone posting n****r over and over (in addition to the other drama of someone deleting things non stop). So it's down for a while and when it's back up I'll post on here to let everyone know. I really really hope that's not a fellow candidate. People can still post their ROL via the link on the ROL thread here and on reddit.

Edit: anyone is welcome to jump back on, but you need to request access with a google account
 
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I'm not necessarily suspending it forever. I'm not going to tolerate someone posting n****r over and over (in addition to the other drama of someone deleting things non stop). So it's down for a while and when it's back up I'll post on here to let everyone know. I really really hope that's not a fellow candidate. People can still post their ROL via the link on the ROL thread here and on reddit.

This is super upsetting that someone would do that. I am so sorry Stephanop. You have put up with so much on that spreadsheet. I just don't understand people and it's so disheartening, albeit, with the current political climate, not unexpected. Thank you again for everything that you do.
 
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with the current political climate, not unexpected.
lol whatever dude there are jackasses everywhere has nothing to do with politics

unless youre talking about the msnbc anchor that just said that live on air lol
 
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Probably a dum question but is there any point of hitting up places I was waitlisted at to see if they have any spots or any Skype interview possibilities ? Just two places I really loved but ended up on the never ending waitlist.
 
Probably a dum question but is there any point of hitting up places I was waitlisted at to see if they have any spots or any Skype interview possibilities ? Just two places I really loved but ended up on the never ending waitlist.
do it
y not
 
I'm not necessarily suspending it forever. I'm not going to tolerate someone posting n****r over and over (in addition to the other drama of someone deleting things non stop). So it's down for a while and when it's back up I'll post on here to let everyone know. I really really hope that's not a fellow candidate. People can still post their ROL via the link on the ROL thread here and on reddit.

Edit: anyone is welcome to jump back on, but you need to request access with a google account

Where on reddit are people posting their ROL?
 
it's a real shame that it had to come down to freezing the spreadsheet but I 100% support what you did OP.
 
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I'm not necessarily suspending it forever. I'm not going to tolerate someone posting n****r over and over (in addition to the other drama of someone deleting things non stop). So it's down for a while and when it's back up I'll post on here to let everyone know. I really really hope that's not a fellow candidate. People can still post their ROL via the link on the ROL thread here and on reddit.

Edit: anyone is welcome to jump back on, but you need to request access with a google account

I’m really sorry you’ve gotta deal with all that man. Your efforts are deeply appreciated by everyone else on here.
 
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I’m really sorry you’ve gotta deal with all that man. Your efforts are deeply appreciated by everyone else on here.

All good! Not a big deal, I'm happy to help and I enjoy keeping up with it. There's people on now posting relevant information and it's nice to see that vs the garbage talk that was on there.
 
I'm not necessarily suspending it forever. I'm not going to tolerate someone posting n****r over and over (in addition to the other drama of someone deleting things non stop). So it's down for a while and when it's back up I'll post on here to let everyone know. I really really hope that's not a fellow candidate. People can still post their ROL via the link on the ROL thread here and on reddit.

Edit: anyone is welcome to jump back on, but you need to request access with a google account

Last years was a ****show by match day too
 
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Is the spreadsheet locked permanently now unless you log in? If so, and we log in and submit our ROL will it still be anonymous? I honestly don't trust it to be anonymous anymore.
 
You don't have to log-in to submit your ROL, just use this link and it will be submitted anonymously

FORM

Edit: I use extreme caution to protect everyones identity with what they submit/post.
 
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ROLs will essentially be dead anyway with the spreadsheet locked and the fear of being IDd
 
Big shout out to programs that send copy+paste rejection letters as opposed to programs that let me wait till February thinking that there is still hope
 
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Big shout out to programs that send copy+paste rejection letters as opposed to programs that let me wait till February thinking that there is still hope

To be honest, this is something I just havent figured out how to do correctly. We’ll interview about 90, Ill look at maybe 300 based on multiple different filters I use. Select about 120 or so in a rolling fashion figuring some won't accept the interviews or will cancel. Any leftover go to the waitlist. Some of the ones I dont select get waitlisted. Some are incomplete (no sloes) and frankly many are rejected bc they are too competitive (didnt rotate here, not from our region, two top 10 sloes, great boards, etc) and I know they arent going to match at our site so its pointless to interview them over someone else.

I then go and look at more apps once I have an idea how many accepted their invites to either schedule more or build a waitlist. Plus I look at all the apps of the people I meet at the residency fair and anyone who contacts us. I keep the waitlist updated as a ranked waitlist so the PC can grab the next one to invite as spots open.

The problem is, this process goes well into November, and people are still emailing and Im looking at apps into December. Theres still hundreds of apps I never get to see, but if I outright send rejections in October, that closes the door on someone I actually may have looked at later.

I just have not figured out a way to do this with how large the numbers of apps are, and how reviewing them gets spread out over much of the entire season.
 
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You don't have to log-in to submit your ROL, just use this link and it will be submitted anonymously

FORM

Edit: I use extreme caution to protect everyones identity with what they submit/post.

Thank you so much! Submitting mine tonight!
 
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To be honest, this is something I just havent figured out how to do correctly. We’ll interview about 90, Ill look at maybe 300 based on multiple different filters I use. Select about 120 or so in a rolling fashion figuring some won't accept the interviews or will cancel. Any leftover go to the waitlist. Some of the ones I dont select get waitlisted. Some are incomplete (no sloes) and frankly many are rejected bc they are too competitive (didnt rotate here, not from our region, two top 10 sloes, great boards, etc) and I know they arent going to match at our site so its pointless to interview them over someone else.

I then go and look at more apps once I have an idea how many accepted their invites to either schedule more or build a waitlist. Plus I look at all the apps of the people I meet at the residency fair and anyone who contacts us. I keep the waitlist updated as a ranked waitlist so the PC can grab the next one to invite as spots open.

The problem is, this process goes well into November, and people are still emailing and Im looking at apps into December. Theres still hundreds of apps I never get to see, but if I outright send rejections in October, that closes the door on someone I actually may have looked at later.

I just have not figured out a way to do this with how large the numbers of apps are, and how reviewing them gets spread out over much of the entire season.
Thank you for the thought-out response to my random frustration! I assumed most programs had a similar process; but specifically it would be really nice to get an email after your last interview day, stating that interview season is over for you.

I was considering writing follow-up LOIs for a few programs, believing that they must go into February since I hadn’t heard back anything yet... and then I broke down and checked the student-run Match Spreadsheet to find that they finished interviewing 2 weeks ago.
 
Do programs have to submit their list on the same day that applicants do? I'm going to wait to post mine. Call me paranoid but you just never know and people are sensitive.
 
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Okay, this is going to be long, so hang on to your hats, fam.

Was gonna post on the spreadsheet, but feel now it may not get the wattage I'd hope for. Anyway, hope this is an appropriate forum for me to post to and seek feedback on, although I also expect most answers will center around the genuine and still appreciated: "Only you know the answer to this, you do you, homie." Perhaps @gamerEMdoc has some insight from his time submitting his ROL or an alternatively valuable perspective from his position as an APD, or even, any residents here or attendings having gone through residency, can shed light on what they thought was important when choosing their #1 and making their ROL, then, once in residency, what they realized actually was more important and how their ROL may have changed had they known then what they knew now. In any case, here's my dilemma:

I am perplexed and on the fence, day in day out, between my top 2. The rest of my list including my top 3 and 4 are pretty much set, with some minimal weekly variably in the middle of my list every couple days or so, but overall pretty set.

My top 2 are as below:

-One is a smaller program, in a small town, giant name in academia, super happy residents, incredible (almost unbeatable) extra-EM opportunities (meaning academics/research/education, just name it), plus also very legit and impressive EM training. Great, great, great people. Everyone super friendly, this would feel like a new home to me, completely new region of the country I've never lived in before, which is simultaneously scary/exciting. I say smaller program b/c in terms of # of residents and Faculty, feels like a tight-kit, family atmosphere. BIG focus on resident wellness, work-life balance, having a life outside of work, supporting your interests and initiatives, career support, name it. 8 hours shifts. Community/Academic hybrid. A big plus for me is it's 3 years.

-The other is a slightly larger program (by # of residents), in one of the nation's largest and most diverse cities, with literally so much to do outside of work you'll never run out of activities and culture. Have somewhat more of a support network here, if you can call it that, in that I have lots of friends from undergrad who live here, but it's not like I'd hang out with any of them on a daily or weekly basis, I guess it's more that it's just nice mentally (potentially, not sure it really will make all that much of a difference day in day out) and somewhat more of a mental buffer/cushion if that makes sense, if even that. Awesome super duper good positive vibes on interview day, but the residents definitely work hard, e.g., harder than at the other program by a mile. Though I did get a sense of family here too, it's a much larger program by # of residents/Faculty/size of hospital/ancillary staff/name it. Not sure if that's a good or bad thing, just pointing out the facts as I see them. Significant Spanish-speaking population, sounds like that would be more work, cuz' it would be, because I know myself and would absolutely be forced to learn (at least medical) Spanish by the end of intern year, and the geek/intellectual in me love that that's one more string I'd add to my bow. Like I said, will work harder here, but definitely got the so-called and oft-mentioned feel of, will come out a "bad-ass" from here, FWIW (again, not sure that's even worth anything 5-10 years down the line except self-pride, which it's not like it's something I feel I need to be happy). 12 hour shifts to start, then mix of 8-10-12 hour shifts in years 3/4. County/Academic hybrid. 4 years, which I'm not a fan of.

Don't have immediate family or a SO in either location, so that's not a tie-breaker. Other things that aren't tie-breakers (which makes this so hard) is both programs have excellent reputations, both have awesome PD's that I truly feel would go to bat for you, both have excellent APD/Leadership teams, both place their residents in academic jobs across the country (my ultimate path that I aspire to), both have great and geographically diverse alumni networks (slightly more regional for the first program, but I got a genuine sense that's sincerely because the residents want to stay around and more are from the surrounding states, whereas program #2 attracts applicants from all over the country and they end up practicing all over too, though no doors are closed graduating from either program for sure). Both are absolute powerhouses in medicine (not specifically in EM, just medicine in general), and I feel I'd pretty much get equivalent EM/clinical training from either program. Both have outstanding, some of the best bedside teaching, attract Faculty truly interested in and committed to teaching, and I did not get an ounce of malignant vibes at either place. Residents I met at either place seemed super happy, but definitely more tired at program #2 (that said, not even close to other programs I interviewed/rotated where the residents were really super mega tired and majorly burned out, I didn't get that feeling at all at program #2).

I got the feels or whatever you want to call it at program #1. I really like program #1, but am just more "scared" cuz it's a new region in the country and less peripheral support (but again, that's on the fringes, it's not like I got a family member or partner waiting for me in either place), but I also know myself, and feel that all those "fears" just might be awash 1 week in as I make friends very easily (and it's not like I have an insta-support network in place at either program). The second program is more "exciting" by mere fact of its location in a big city, which on paper/interview day sounds like a big plus, but realistically, again, on a day-to-day basis, I just might not care as much since obviously at either place, most of my time will be spent in the hospital.

I think my dilemma ultimately comes down to, when I think of program #1, I smile/become giddy when thinking of the hospital/program itself, but less so the location/town. When I think of program #2, I smile/become giddy when thinking of the city, imagining myself there, coming out of my apartment every day. Program #1 "scares" me because of the location, program #2 "scares" me because of how hard I feel the residents work (honestly that's probably an overblown perception, I'm just not used to/have never done 12 hour shifts before). When I think of the PROGRAM specifically, I want to rank #1, well, #1, and when I think of the city, I want to rank #2, #1.

Because of the merciful schedule at #1, I would have more time to develop/expand my niches, publish, etc.; I could do that at #2 and that was a BIG focus of my interviews as they strongly stated they will do everything they can to support me in those endeavors and are excited about me using their vast network of resources/Faculty/name it to develop those interests, but that'll definitely be more of a challenge.

If all this has to come down to wellness/wellbeing, #1 has a big focus on that and better work/life balance, which counts for a lot, but program #2 has this amazing city that would also tremendously contribute to my happiness by mere fact of just living in it (BUT if I'm just tired all the time, that may become awash as I might not even be able to appreciate all that there is to do around me and develop my other EM+ interests which bring me joy, but the problem is, it's very difficult if not impossible for me to know for sure until I match, e.g. until I'm the midst and thick of it, experiencing it and residency, I feel).

(To be clear, I'm not fooling myself, residency is residency, it'll be hard and a lot of work at either place, clinical duties come first, but that's the context I'm working with.)

When I think of #1, I feel it would be a once-in-a-lifetime opportunity to match at this specific program, and when I think of #2, I know it would be a once-in-a-lifetime opportunity to live in that city. #2 is in a region I used to live in for years (just not the specific city), so more culturally similar and in sync, I'd say, with my values, #1 would be a completely new region to me. Either way, I almost certainly won't live/work/establish myself in either place long-term.

My med school advisors, who are all wonderful and provide (generally speaking, occasionally not) sound advice, basically said: "You can't go wrong with either program!" in terms of EM training. With a subtext of "Roll the dice, both sound great!" but, ya know, I still need to put one first, and I'm not a roll the dice kinda person lol.

I realize asking advice of strangers on the Internet may be fraught with risks, but I have felt very lucky to find a supportive community on SDN with excellent advice from gamerEMdoc and several others.

And sometimes, advice from the outside and/or a complete stranger can churn out an unexpected perspective that unleashes new avenues for making this quite important decision.

Okay. I know that was insanely long. Any thoughts/advice greatly appreciated and welcomed. Thanks fam.
 
Okay, this is going to be long, so hang on to your hats, fam.

Was gonna post on the spreadsheet, but feel now it may not get the wattage I'd hope for. Anyway, hope this is an appropriate forum for me to post to and seek feedback on, although I also expect most answers will center around the genuine and still appreciated: "Only you know the answer to this, you do you, homie." Perhaps @gamerEMdoc has some insight from his time submitting his ROL or an alternatively valuable perspective from his position as an APD, or even, any residents here or attendings having gone through residency, can shed light on what they thought was important when choosing their #1 and making their ROL, then, once in residency, what they realized actually was more important and how their ROL may have changed had they known then what they knew now. In any case, here's my dilemma:

I am perplexed and on the fence, day in day out, between my top 2. The rest of my list including my top 3 and 4 are pretty much set, with some minimal weekly variably in the middle of my list every couple days or so, but overall pretty set.

My top 2 are as below:

-One is a smaller program, in a small town, giant name in academia, super happy residents, incredible (almost unbeatable) extra-EM opportunities (meaning academics/research/education, just name it), plus also very legit and impressive EM training. Great, great, great people. Everyone super friendly, this would feel like a new home to me, completely new region of the country I've never lived in before, which is simultaneously scary/exciting. I say smaller program b/c in terms of # of residents and Faculty, feels like a tight-kit, family atmosphere. BIG focus on resident wellness, work-life balance, having a life outside of work, supporting your interests and initiatives, career support, name it. 8 hours shifts. Community/Academic hybrid. A big plus for me is it's 3 years.

-The other is a slightly larger program (by # of residents), in one of the nation's largest and most diverse cities, with literally so much to do outside of work you'll never run out of activities and culture. Have somewhat more of a support network here, if you can call it that, in that I have lots of friends from undergrad who live here, but it's not like I'd hang out with any of them on a daily or weekly basis, I guess it's more that it's just nice mentally (potentially, not sure it really will make all that much of a difference day in day out) and somewhat more of a mental buffer/cushion if that makes sense, if even that. Awesome super duper good positive vibes on interview day, but the residents definitely work hard, e.g., harder than at the other program by a mile. Though I did get a sense of family here too, it's a much larger program by # of residents/Faculty/size of hospital/ancillary staff/name it. Not sure if that's a good or bad thing, just pointing out the facts as I see them. Significant Spanish-speaking population, sounds like that would be more work, cuz' it would be, because I know myself and would absolutely be forced to learn (at least medical) Spanish by the end of intern year, and the geek/intellectual in me love that that's one more string I'd add to my bow. Like I said, will work harder here, but definitely got the so-called and oft-mentioned feel of, will come out a "bad-ass" from here, FWIW (again, not sure that's even worth anything 5-10 years down the line except self-pride, which it's not like it's something I feel I need to be happy). 12 hour shifts to start, then mix of 8-10-12 hour shifts in years 3/4. County/Academic hybrid. 4 years, which I'm not a fan of.

Don't have immediate family or a SO in either location, so that's not a tie-breaker. Other things that aren't tie-breakers (which makes this so hard) is both programs have excellent reputations, both have awesome PD's that I truly feel would go to bat for you, both have excellent APD/Leadership teams, both place their residents in academic jobs across the country (my ultimate path that I aspire to), both have great and geographically diverse alumni networks (slightly more regional for the first program, but I got a genuine sense that's sincerely because the residents want to stay around and more are from the surrounding states, whereas program #2 attracts applicants from all over the country and they end up practicing all over too, though no doors are closed graduating from either program for sure). Both are absolute powerhouses in medicine (not specifically in EM, just medicine in general), and I feel I'd pretty much get equivalent EM/clinical training from either program. Both have outstanding, some of the best bedside teaching, attract Faculty truly interested in and committed to teaching, and I did not get an ounce of malignant vibes at either place. Residents I met at either place seemed super happy, but definitely more tired at program #2 (that said, not even close to other programs I interviewed/rotated where the residents were really super mega tired and majorly burned out, I didn't get that feeling at all at program #2).

I got the feels or whatever you want to call it at program #1. I really like program #1, but am just more "scared" cuz it's a new region in the country and less peripheral support (but again, that's on the fringes, it's not like I got a family member or partner waiting for me in either place), but I also know myself, and feel that all those "fears" just might be awash 1 week in as I make friends very easily (and it's not like I have an insta-support network in place at either program). The second program is more "exciting" by mere fact of its location in a big city, which on paper/interview day sounds like a big plus, but realistically, again, on a day-to-day basis, I just might not care as much since obviously at either place, most of my time will be spent in the hospital.

I think my dilemma ultimately comes down to, when I think of program #1, I smile/become giddy when thinking of the hospital/program itself, but less so the location/town. When I think of program #2, I smile/become giddy when thinking of the city, imagining myself there, coming out of my apartment every day. Program #1 "scares" me because of the location, program #2 "scares" me because of how hard I feel the residents work (honestly that's probably an overblown perception, I'm just not used to/have never done 12 hour shifts before). When I think of the PROGRAM specifically, I want to rank #1, well, #1, and when I think of the city, I want to rank #2, #1.

Because of the merciful schedule at #1, I would have more time to develop/expand my niches, publish, etc.; I could do that at #2 and that was a BIG focus of my interviews as they strongly stated they will do everything they can to support me in those endeavors and are excited about me using their vast network of resources/Faculty/name it to develop those interests, but that'll definitely be more of a challenge.

If all this has to come down to wellness/wellbeing, #1 has a big focus on that and better work/life balance, which counts for a lot, but program #2 has this amazing city that would also tremendously contribute to my happiness by mere fact of just living in it (BUT if I'm just tired all the time, that may become awash as I might not even be able to appreciate all that there is to do around me and develop my other EM+ interests which bring me joy, but the problem is, it's very difficult if not impossible for me to know for sure until I match, e.g. until I'm the midst and thick of it, experiencing it and residency, I feel).

(To be clear, I'm not fooling myself, residency is residency, it'll be hard and a lot of work at either place, clinical duties come first, but that's the context I'm working with.)

When I think of #1, I feel it would be a once-in-a-lifetime opportunity to match at this specific program, and when I think of #2, I know it would be a once-in-a-lifetime opportunity to live in that city. #2 is in a region I used to live in for years (just not the specific city), so more culturally similar and in sync, I'd say, with my values, #1 would be a completely new region to me. Either way, I almost certainly won't live/work/establish myself in either place long-term.

My med school advisors, who are all wonderful and provide (generally speaking, occasionally not) sound advice, basically said: "You can't go wrong with either program!" in terms of EM training. With a subtext of "Roll the dice, both sound great!" but, ya know, I still need to put one first, and I'm not a roll the dice kinda person lol.

I realize asking advice of strangers on the Internet may be fraught with risks, but I have felt very lucky to find a supportive community on SDN with excellent advice from gamerEMdoc and several others.

And sometimes, advice from the outside and/or a complete stranger can churn out an unexpected perspective that unleashes new avenues for making this quite important decision.

Okay. I know that was insanely long. Any thoughts/advice greatly appreciated and welcomed. Thanks fam.


After reading this it seems like number 1 is where you should go in my opinion, here's my reasons why

-these undergrad buddies in city 2, do you actually hang out with them? It doesn't sound like it, and if not, it shouldn't factor into your ranking. However, if these are buddy buddies that you'd go get a margarita with after a long 12 hour shift then hell yeah, let it influence you.

-city 2 works 12's, and they do it for 4 years. I do not believe in the fourth year and honestly you likely will be burned out by the time year 4 rolls around and you're still pulling (some) 12's while the majority of us are starting our attending careers. IDK that just sounds awful to me so I would carefully consider that quality of life factor. I worked 12's as a medic for a long time, my rural shifts were super chill (for the most part) but my in-city shifts, where we ran non-stop, and often didn't get a pee break for 12-13 hours- was taxing. On those days, for most people, all you end up doing is working. It's hard to factor in time to workout and do something fun because you're in the hospital all day and then you come home exhausted.

-city 1 is new, but sounds rural? semi-rural? I mean is there anything to do? if it's in east bumble **** then I guess I would lean back to city 2.

-does city 2 have a lot of traffic? commute times? these are also big QOL factors

these are my opinions on it, and this is coming from a fellow ms iv that's applying this year. Life is too short, go to the other cool place that will let you go after 3 years and not make you work 12's (which could easily turn into 13-14 hour shifts) and still give you great training. You can go wherever you want after residency.
 
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hey @gamerEMdoc 2 spots I IVed at (abrazo and health quest) are being opened with teamhealth backing

After this infamous email was sent out by TH about cutting pay to mds, do you think "any of the **** is gonna roll downhill" ?

should that be a concern?

anybody work with TH that can speak to this?
 
After reading this it seems like number 1 is where you should go in my opinion, here's my reasons why

-these undergrad buddies in city 2, do you actually hang out with them? It doesn't sound like it, and if not, it shouldn't factor into your ranking. However, if these are buddy buddies that you'd go get a margarita with after a long 12 hour shift then hell yeah, let it influence you.

-city 2 works 12's, and they do it for 4 years. I do not believe in the fourth year and honestly you likely will be burned out by the time year 4 rolls around and you're still pulling (some) 12's while the majority of us are starting our attending careers. IDK that just sounds awful to me so I would carefully consider that quality of life factor. I worked 12's as a medic for a long time, my rural shifts were super chill (for the most part) but my in-city shifts, where we ran non-stop, and often didn't get a pee break for 12-13 hours- was taxing. On those days, for most people, all you end up doing is working. It's hard to factor in time to workout and do something fun because you're in the hospital all day and then you come home exhausted.

-city 1 is new, but sounds rural? semi-rural? I mean is there anything to do? if it's in east bumble **** then I guess I would lean back to city 2.

-does city 2 have a lot of traffic? commute times? these are also big QOL factors

these are my opinions on it, and this is coming from a fellow ms iv that's applying this year. Life is too short, go to the other cool place that will let you go after 3 years and not make you work 12's (which could easily turn into 13-14 hour shifts) and still give you great training. You can go wherever you want after residency.

Excellent advice, @Stephanopolous, you hold up to your reputation as the standard-bearer of online's EM advice web!

City 1 IS in bumble*** nowhere BUT with a HUGE city 1 hour drive, and still with all the conveniences of modern living (good restaurants and bars, gyms, hiking, outdoors activities, etc.)

Much food for thought here, thanks :)
 
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Okay, this is going to be long, so hang on to your hats, fam.

Was gonna post on the spreadsheet, but feel now it may not get the wattage I'd hope for. Anyway, hope this is an appropriate forum for me to post to and seek feedback on, although I also expect most answers will center around the genuine and still appreciated: "Only you know the answer to this, you do you, homie." Perhaps @gamerEMdoc has some insight from his time submitting his ROL or an alternatively valuable perspective from his position as an APD, or even, any residents here or attendings having gone through residency, can shed light on what they thought was important when choosing their #1 and making their ROL, then, once in residency, what they realized actually was more important and how their ROL may have changed had they known then what they knew now. In any case, here's my dilemma:

I am perplexed and on the fence, day in day out, between my top 2. The rest of my list including my top 3 and 4 are pretty much set, with some minimal weekly variably in the middle of my list every couple days or so, but overall pretty set.

My top 2 are as below:

-One is a smaller program, in a small town, giant name in academia, super happy residents, incredible (almost unbeatable) extra-EM opportunities (meaning academics/research/education, just name it), plus also very legit and impressive EM training. Great, great, great people. Everyone super friendly, this would feel like a new home to me, completely new region of the country I've never lived in before, which is simultaneously scary/exciting. I say smaller program b/c in terms of # of residents and Faculty, feels like a tight-kit, family atmosphere. BIG focus on resident wellness, work-life balance, having a life outside of work, supporting your interests and initiatives, career support, name it. 8 hours shifts. Community/Academic hybrid. A big plus for me is it's 3 years.

-The other is a slightly larger program (by # of residents), in one of the nation's largest and most diverse cities, with literally so much to do outside of work you'll never run out of activities and culture. Have somewhat more of a support network here, if you can call it that, in that I have lots of friends from undergrad who live here, but it's not like I'd hang out with any of them on a daily or weekly basis, I guess it's more that it's just nice mentally (potentially, not sure it really will make all that much of a difference day in day out) and somewhat more of a mental buffer/cushion if that makes sense, if even that. Awesome super duper good positive vibes on interview day, but the residents definitely work hard, e.g., harder than at the other program by a mile. Though I did get a sense of family here too, it's a much larger program by # of residents/Faculty/size of hospital/ancillary staff/name it. Not sure if that's a good or bad thing, just pointing out the facts as I see them. Significant Spanish-speaking population, sounds like that would be more work, cuz' it would be, because I know myself and would absolutely be forced to learn (at least medical) Spanish by the end of intern year, and the geek/intellectual in me love that that's one more string I'd add to my bow. Like I said, will work harder here, but definitely got the so-called and oft-mentioned feel of, will come out a "bad-ass" from here, FWIW (again, not sure that's even worth anything 5-10 years down the line except self-pride, which it's not like it's something I feel I need to be happy). 12 hour shifts to start, then mix of 8-10-12 hour shifts in years 3/4. County/Academic hybrid. 4 years, which I'm not a fan of.

Don't have immediate family or a SO in either location, so that's not a tie-breaker. Other things that aren't tie-breakers (which makes this so hard) is both programs have excellent reputations, both have awesome PD's that I truly feel would go to bat for you, both have excellent APD/Leadership teams, both place their residents in academic jobs across the country (my ultimate path that I aspire to), both have great and geographically diverse alumni networks (slightly more regional for the first program, but I got a genuine sense that's sincerely because the residents want to stay around and more are from the surrounding states, whereas program #2 attracts applicants from all over the country and they end up practicing all over too, though no doors are closed graduating from either program for sure). Both are absolute powerhouses in medicine (not specifically in EM, just medicine in general), and I feel I'd pretty much get equivalent EM/clinical training from either program. Both have outstanding, some of the best bedside teaching, attract Faculty truly interested in and committed to teaching, and I did not get an ounce of malignant vibes at either place. Residents I met at either place seemed super happy, but definitely more tired at program #2 (that said, not even close to other programs I interviewed/rotated where the residents were really super mega tired and majorly burned out, I didn't get that feeling at all at program #2).

I got the feels or whatever you want to call it at program #1. I really like program #1, but am just more "scared" cuz it's a new region in the country and less peripheral support (but again, that's on the fringes, it's not like I got a family member or partner waiting for me in either place), but I also know myself, and feel that all those "fears" just might be awash 1 week in as I make friends very easily (and it's not like I have an insta-support network in place at either program). The second program is more "exciting" by mere fact of its location in a big city, which on paper/interview day sounds like a big plus, but realistically, again, on a day-to-day basis, I just might not care as much since obviously at either place, most of my time will be spent in the hospital.

I think my dilemma ultimately comes down to, when I think of program #1, I smile/become giddy when thinking of the hospital/program itself, but less so the location/town. When I think of program #2, I smile/become giddy when thinking of the city, imagining myself there, coming out of my apartment every day. Program #1 "scares" me because of the location, program #2 "scares" me because of how hard I feel the residents work (honestly that's probably an overblown perception, I'm just not used to/have never done 12 hour shifts before). When I think of the PROGRAM specifically, I want to rank #1, well, #1, and when I think of the city, I want to rank #2, #1.

Because of the merciful schedule at #1, I would have more time to develop/expand my niches, publish, etc.; I could do that at #2 and that was a BIG focus of my interviews as they strongly stated they will do everything they can to support me in those endeavors and are excited about me using their vast network of resources/Faculty/name it to develop those interests, but that'll definitely be more of a challenge.

If all this has to come down to wellness/wellbeing, #1 has a big focus on that and better work/life balance, which counts for a lot, but program #2 has this amazing city that would also tremendously contribute to my happiness by mere fact of just living in it (BUT if I'm just tired all the time, that may become awash as I might not even be able to appreciate all that there is to do around me and develop my other EM+ interests which bring me joy, but the problem is, it's very difficult if not impossible for me to know for sure until I match, e.g. until I'm the midst and thick of it, experiencing it and residency, I feel).

(To be clear, I'm not fooling myself, residency is residency, it'll be hard and a lot of work at either place, clinical duties come first, but that's the context I'm working with.)

When I think of #1, I feel it would be a once-in-a-lifetime opportunity to match at this specific program, and when I think of #2, I know it would be a once-in-a-lifetime opportunity to live in that city. #2 is in a region I used to live in for years (just not the specific city), so more culturally similar and in sync, I'd say, with my values, #1 would be a completely new region to me. Either way, I almost certainly won't live/work/establish myself in either place long-term.

My med school advisors, who are all wonderful and provide (generally speaking, occasionally not) sound advice, basically said: "You can't go wrong with either program!" in terms of EM training. With a subtext of "Roll the dice, both sound great!" but, ya know, I still need to put one first, and I'm not a roll the dice kinda person lol.

I realize asking advice of strangers on the Internet may be fraught with risks, but I have felt very lucky to find a supportive community on SDN with excellent advice from gamerEMdoc and several others.

And sometimes, advice from the outside and/or a complete stranger can churn out an unexpected perspective that unleashes new avenues for making this quite important decision.

Okay. I know that was insanely long. Any thoughts/advice greatly appreciated and welcomed. Thanks fam.

You lost me at 12 hour shifts and 4 years of residency. Up until that I could see why it may be a close call. I'd go tightnit 3 year residency with reasonable work hours in a small town ALL DAY. But then again, I work in a tightnit 3 year residency with reasonable work hours in a small town. So... I may be biased.
 
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Hey guys, I lost a bunch of my notes due to a tech issue (like a dummy that didn't backup) and was hoping that people could share the shift schedules for the following programs. Thanks so much.
UT Southwestern Medical Center
Hofstra Staten Island
University of Arkansas
U Mississippi
Southern Illinois University
U Louisville
U Oklahoma at Tulsa
U Missouri Columbia
 
hey @gamerEMdoc 2 spots I IVed at (abrazo and health quest) are being opened with teamhealth backing

After this infamous email was sent out by TH about cutting pay to mds, do you think "any of the **** is gonna roll downhill" ?

should that be a concern?

anybody work with TH that can speak to this?

I mean it can't be a good sign obviously. It may not roll downhill to residency salaries, but if you lose faculty because they quit when they have their salaries axed, that would directly affect your residency.
 
How much weight would you put on # of EM months/blocks during residency? I was trying to compare curriculums of my top 4 programs and noticed a large discrepancy ... 1 of the programs only has 19 blocks where as the other 3 have 27, 27 and 24. Would this be a big enough factor to bump it down? the program with 19 months was 3rd in my mind, but now I'm thinking of moving it to 4?
 
How much weight would you put on # of EM months/blocks during residency? I was trying to compare curriculums of my top 4 programs and noticed a large discrepancy ... 1 of the programs only has 19 blocks where as the other 3 have 27, 27 and 24. Would this be a big enough factor to bump it down? the program with 19 months was 3rd in my mind, but now I'm thinking of moving it to 4?

19 doesn't seem too many. 27 in 3 years seems like a lot, I'm not sure how you fit in all the other rotations if you are doing 9 months/year in the ED. I think low to mid 20's is pretty common.
 
You lost me at 12 hour shifts and 4 years of residency. Up until that I could see why it may be a close call. I'd go tightnit 3 year residency with reasonable work hours in a small town ALL DAY. But then again, I work in a tightnit 3 year residency with reasonable work hours in a small town. So... I may be biased.

Thanks! See, when you put it that way, and I feel good with the advice received, it totally puts things in perspective and gives me an additional data point to come up with my final ROL. :)
 
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@Stephanopolous and others, is there an EM or EM application-specific thread on Reddit, or any info to be gained is simply from the Medical School thread?

No. There is an EM subreddit that students sometime post questions on. And some post them on the med student subreddit. But there isn't an EM application specific subreddit. Personally, I find SDN more helpful than reddit when it comes to application questions. I subscribe to both those subreddits I mentioned and answer questions when they arise there at times, but honestly, I think the conversation about application related stuff is much more active here.
 
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@Stephanopolous and others, is there an EM or EM application-specific thread on Reddit, or any info to be gained is simply from the Medical School thread?

Not that I know of or frequent. I personally have always come here because gamer is nice enough to help everyone out with any question we have about this whole process. If I’m on the Med school reddit threads it’s mostly for the memes.


Sent from my iPhone using SDN
 
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Excellent advice, @Stephanopolous, you hold up to your reputation as the standard-bearer of online's EM advice web!

City 1 IS in bumble*** nowhere BUT with a HUGE city 1 hour drive, and still with all the conveniences of modern living (good restaurants and bars, gyms, hiking, outdoors activities, etc.)

Much food for thought here, thanks :)

It’s in the middle of no where, but New Haven does have great pizza.
hey @gamerEMdoc 2 spots I IVed at (abrazo and health quest) are being opened with teamhealth backing

After this infamous email was sent out by TH about cutting pay to mds, do you think "any of the **** is gonna roll downhill" ?

should that be a concern?

anybody work with TH that can speak to this?
I interviewed at a TH program where the residents earned $10k less than any other program I interviewed at, whereas the attendings (based on a very honest pgy3 who just signed on there) earned higher than National EM average. They kept selling the low cost of living for the area, but the discrepancy of those two salaries made me feel like residents were viewed as cheap labor (more so than we already are).
 
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