Newly established residency programs

[cdj215]

Being a relatively young field, there are new EM residency programs popping up all over the place these days. I keep hearing people say, "It's a new program, with all the good and bad that goes along with it." Could some people who are either in a new program now or who went through a new program please comment on what, exactly, these good and bad aspects were?

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[DrQuinn]

Being a relatively young field, there are new EM residency programs popping up all over the place these days. I keep hearing people say, "It's a new program, with all the good and bad that goes along with it." Could some people who are either in a new program now or who went through a new program please comment on what, exactly, these good and bad aspects were?

WOOSH, in comes Quinn.

I attended and just graduated from the University of South Florida, based at Tampa General Hospital. It created its new program for my year, 2003, and we just graduated our first class. I'll break it down since its probably easiest that way to read.

Pros:
1) The faculty/staff/hospital is extremely energetic to have a new residency, there is support for absolutely everything. Don't feel you have enough space? The residency/hospital will accomodate you. Oops, they forget to get you computers? 6 brand new Dells for the EM residents in their own call room in the hospital. Since the residency is brand new, there is generally a budget for "oops we forgot," whcih is nice. They generally want to really accomodate you and get you what you need, to start up the new program. Plus all teh nurses/hospital administration treats you like Gods because generally they view the EM residents as a way to help improve patient flow in the ED.

2) The learning experience. As an intern, I was the ONLY intern rotating in the ED at the time (occasionally there was a medicine intern or OB intern too but, they slacked most of the time). If something cool came in, a code, a good procedure, whatever, guess who got to do it? Me. I ran two codes my very first shift in the ED. By the end of my intern year, we had a significant # of procedures under our belt, likely more than the genearl EM PGY1, strictly because no one was there to "take" my procedures away. And when it came time to see patients, a lot of my attendings would say "don't go see that BS back pain or CP, go see this one" and generally would cherry pick for me. Now as an attending at a new program with its first class, I know what its like, and I do the same. I tell my interns their job is to learn and not "move the meat," hence, I let them look up articles, read chapters in textbooks in between patients.

3) Personalized attention. Your first year, or two, at a new program, there aren't THAT many residents around. My intern year at Grand Rouds, there might be 3 or 4 of us in the auditorium. Good for personalized attention and a "close feel," bad if you liked to sleep during GR. You didn't feel like you were just a # at a program. Obviously once hte program gets going and it has its full 3 or 4 years, it becomes more like an established program.... I can't beileve some of the programs out there that have 12, 17, 18 residents a class.

4) You create your own niche. The new EM intern on OB? Let them know what YOU want to do. Third trimester triage/evaluate. Deliver babies. See a C section once or twice. That's it. No rounding on L&D, no post partum rounds, etc. Let me do the stuff I want/need to know. Anesthesia? I'm only here to intubate. I am NOT checking the little dots on your anesthesia form every 5 minutes, thank you. I am going to intubate as many times and as many ways as I can, that's my job. I believe at some programs when you have an established residency, things get kind of too structured and sometimes you're put in roles where its not 100% beneficial. Obviously most PD's will try to change it, but here, your fate is in YOUR hands, which is nice.

5) Your voice is HEARD. The PD's and the faculty WANT to create and help make the program stronger, so your input is USED and listened to. This is a nice feeling and you get a better appreciation of the academic side of EM, as literally you are helping and formulating plans for RRC visits, requirements from ABEM/ACEP, etc etc. Kind of cool, and if you are into academic EM, it helps a litle, I think. If you're not into academics, atleast you can have a hand in helping your program get better. Programs that have been around for 15-20 years probably dont' need the reisdent input much (besides the requirements from RRC).

Cons: Definately a con is you do not have an upper level resident (if you are teh very first class) to bounce ideas off of. Besides the attendings in the ED, I neve rreally had anyone to ask a question to, or to say "you've been here before...." Its different asking an attending than a fellow resident. We didnt' have anyone we could ask about the in-service (yeah we had a few attendings who were only several years out, but...), the boards, the orals, job search, etc. You learn to use other resources (SDN!) and just find it on your own. This is probably the biggest con.

2) Name recognition. "USF? They have an EM program now?" This'll change in 4-5 years, but its only mildly annoying that no one knows where or that they even had a program. It only affects the ego inside.

That's about it. Hope it shed some light.

Q

 

[cdj215]

Thanks - that's all very helpful.

 

[basementbeastie]

q: you forgot to mention that new EM residencies require that only babe-a-licious applicants match...(see usf website for details)...

 

[JackBauERfan]

q: you forgot to mention that new EM residencies require that only babe-a-licious applicants match...(see usf website for details)...

precisely the reason I didn't get picked haha.

 

[deleted109597]

Dr. Q,
Do you think that it is beneficial to go to a new residency if you want to say, stay on staff there after graduation? I figure they are hiring at the same rate as anyone else, but there are a few places that I would like to remain at rather than have to jump out into the job market.
Georgetown probably isn't one of them though. I don't know if I could live that close to my mom.

 

[DrQuinn]

Dr. Q,
Do you think that it is beneficial to go to a new residency if you want to say, stay on staff there after graduation? I figure they are hiring at the same rate as anyone else, but there are a few places that I would like to remain at rather than have to jump out into the job market.
Georgetown probably isn't one of them though. I don't know if I could live that close to my mom.

It probably is. When I was interviewing here for an attending position, my dept chair told me that "our program is going to create physicians we want to hire." I thought that was kind of a nice saying! And where I graduated, three of our grads who were staying in FL were offered positions to stay. So, I bet it probably is helpful!

Q

 

[Apollyon]

It probably is. When I was interviewing here for an attending position, my dept chair told me that "our program is going to create physicians we want to hire." I thought that was kind of a nice saying! And where I graduated, three of our grads who were staying in FL were offered positions to stay. So, I bet it probably is helpful!

Q

Actually, this is counter to the conventional wisdom - our division chief (in residency) said that, among current department chairs/division chiefs, it is almost mantra that you do NOT hire internally from the first or second classes the program graduates. The program is still maturing, and you need new blood (even if the new blood themselves are immediate residency graduates) to develop a "critical mass".

 

[deleted109597]

Ok, so the vote is 1 for yes, 1 for no.

Maybe I should make a poll....

Anyone else? BKN?

 

[bulgethetwine]

Ok, so the vote is 1 for yes, 1 for no.

Maybe I should make a poll....

Anyone else? BKN?

It might be 1-1, but it also represents philosophical differences between instituions and, to a large extent, PDs.

I can see Apol's PD sticking to a hard and fast rule just for the sake of it. I can see Qs PD being a little more flexible, on a case-by-case basis.

I think it brings up a broader point beyond just for new residency programs --

What is the criteria and pros/cons, for both institution and graduate, for being hired at the program you trained at, immediately after finishing residency?

 

[BKN]

Ok, so the vote is 1 for yes, 1 for no.

Maybe I should make a poll....

Anyone else? BKN?

When I was a chair I hired the best I could. Sometimes that was one of our new grads, sometimes somebody from another club, sometimes one of our old grads. I don't think a rule is needed.

From the grads point of view, some are ready for faculty duties right after residency, some need to do a fellowship and some need to do some private practice so that they are alone with their decisions. As to staying at your home club, sometimes it's fine, other times both the faculty and the grad need a time out. On occasion for about 40 years.

 

[DrQuinn]

Remember, it is VASTLY different for a new program than an established one. If you go to an established program, they probably are not hiring as many people anyways, whereas a new program likely is trying to improve its strength, and if a new grad has a skill at teaching, and obviously the PD and Dept Chair know the resident, they realize it probably would behoove them to hire them. Obviously its a case by case basis, but the rule "diluting the strength of the program by hiring within" is probably more aimed at established programs.

Q

 

[Apollyon]

Remember, it is VASTLY different for a new program than an established one. If you go to an established program, they probably are not hiring as many people anyways, whereas a new program likely is trying to improve its strength, and if a new grad has a skill at teaching, and obviously the PD and Dept Chair know the resident, they realize it probably would behoove them to hire them. Obviously its a case by case basis, but the rule "diluting the strength of the program by hiring within" is probably more aimed at established programs.

Q

I'm just saying that our division chief said the opposite - it's more aimed at new programs that, given two equal new grads from different programs, they'll go with the outside person.

It's similar to the PhDs - where you get your phud essentially closes the door for getting faculty there (and, if someone else has done it in the past 10 or so years, no matter how much of a superstar, you ABSOLUTELY won't get it). Once the program is established, it's easier to stay on. (Iserson talks about this in his "Getting Into Residency" book.)

Since no one from my class wanted to stay, it wasn't an issue. This year's seniors (the 3rd class), if someone wanted to stay, they'd consider it.

 

[ASDIC]

Its kinda interesting that family medicine residency programs are being closed down and new emergency medicine programs are springing up....mirroring the trends of today's pts who avoid their PCPs and run straight to the ER for anything.

 

[bulgethetwine]

Its kinda interesting that family medicine residency programs are being closed down and new emergency medicine programs are springing up....mirroring the trends of today's pts who avoid their PCPs and run straight to the ER for anything.

I never thought of it that way.... this should be a separate thread.

Is there a way I can automatically 'bump' it to its own?

 

[ASDIC]

I never thought of it that way.... this should be a separate thread.

Is there a way I can automatically 'bump' it to its own?

go for it!!!

 

[trkd]

2) Name recognition. "USF? They have an EM program now?" This'll change in 4-5 years, but its only mildly annoying that no one knows where or that they even had a program. It only affects the ego inside.

Q

How much does name recognition matter in getting a residency or fellowship?

 

[DrQuinn]

How much does name recognition matter in getting a residency or fellowship?

Don't think it makes any differences. Fellowships in general are pretty uncompetitive (atleast compared to anything we've ever known.... med school apps and residency apps). IM fellowships are vastly more competitive than EM.

Q

 

[Hard24Get]

How much does name recognition matter in getting a residency or fellowship?

Blast from the past BUMP - how much does residency age/recognition matter for getting a job? In other words, how do new residency grads do in terms of getting academic and community jobs? Are these programs perceived as being easier to get into, etc, or less tried and true? I ask because a lot of established places I have been love to crow about how their grads are well-known and proven to be great and are thus lusted after....

Thanks

 

[DrQuinn]

Don't think it makes that much of a difference. My graduating class of 2006 from USF (the first grduating class) got very competitive jobs (three academic). Last year 1 went into fellowship and 5 into very lucrative community jobs. This upcomign class I know of one going to Vegas and one into an academic job.

I am at Georgetown now and our grads are already being hounded for jobs. Pehraps its more name recognition because of Georgetown though....

Q

 

[EdEmEr]

The market needs more EP's and will for a while, but what about 5, 10, 15 years down the road?

Also to consider is the name of the institution. I could personally give a poop whether the program is named Harvard or McDonald's happy clown school of medicine emergency medicine program at fedex field in halliburton stadium.

However, for those of us that may want to go into Academics or into Administration, it HAS to help that you are from the Rosey Methane school of medicine. The board of directors at some hospital will not know that Carolinas is one of the best programs in the country, but they will raise an eyebrow if it says Rosey Methane on your CV.

Caveat: I am a 4th year Medstud and there is a %50 chance that %50 of my opinion is wrong.

 

[southerndoc]

The market needs more EP's and will for a while, but what about 5, 10, 15 years down the road?

Also to consider is the name of the institution. I could personally give a poop whether the program is named Harvard or McDonald's happy clown school of medicine emergency medicine program at fedex field in halliburton stadium.

However, for those of us that may want to go into Academics or into Administration, it HAS to help that you are from the Rosey Methane school of medicine. The board of directors at some hospital will not know that Carolinas is one of the best programs in the country, but they will raise an eyebrow if it says Rosey Methane on your CV.

Caveat: I am a 4th year Medstud and there is a %50 chance that %50 of my opinion is wrong.

No, you're right. Some department chairs value names very much, whether it's warranted or not. I remember one 3-year program chair ooing and ahing over someone from a top medical school interviewing at his program. You could tell he was interested in the guy just by the name of his school.

However, a name doesn't mean better training, it just means better recognition. You have to find a combination of what YOU want in training, not what someone else might want. Having said that, you must also weigh your career decisions. The perfect community program might not land you the perfect academic job. It won't be impossible to get an academic job from a strong community program, but if the faculty aren't doing enough research, it may be hard for you to get research experience that is desired for an academic job.

 

[roja]

However, a name doesn't mean better training, it just means better recognition.
.

Well said.


New vs old is a difficult question and if you ask 12 chairs you will get 15 answers to the question.

You need to make the decision about what is best for you. new programs do listen to your input more. They tend to be more progressive and open to improvements that come from the residents themselves. This is a plus or a minus. (my personal opinion is that ALL good programs have this element of flux as programs should be on a continual improvement path. all programs can be better adn what makes better changes over the years)

Older programs may or may not have better name recognition. Again, depends on who is staffing the 'new' program.