Training at Home vs Away, alumni network & name matter?

[EMcactus]

I am really struggling with staying to complete residency at my home institution (3yr) vs moving away for a 4 year program at top institutions on the other side of the country away from family. I want to become the best EM physician I can and am interested in academics and fellowship (and doing things outside of clinical duties - research, advocacy). What is the influence of alumni networks and name/caliber of program on job prospects, particularly in academic EM? I have heard two camps - go to the best program that will take you vs you will get good training anywhere. I LOVED the three programs I am considering (people!!!, opportunities!!, location more or less) and appreciate the structure of 4 year programs a little more due to time to explore niche and do things outside of clinical duties, trying to stay open minded. Any guidance is much appreciated!!!

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[gamerEMdoc]

I am really struggling with staying to complete residency at my home institution (3yr) vs moving away for a 4 year program at top institutions on the other side of the country away from family. I want to become the best EM physician I can and am interested in academics and fellowship (and doing things outside of clinical duties - research, advocacy). What is the influence of alumni networks and name/caliber of program on job prospects, particularly in academic EM? I have heard two camps - go to the best program that will take you vs you will get good training anywhere. I LOVED the three programs I am considering (people!!!, opportunities!!, location more or less) and appreciate the structure of 4 year programs a little more due to time to explore niche and do things outside of clinical duties, trying to stay open minded. Any guidance is much appreciated!!!

My personal advice would be do NOT transfer to a four year program at this point. Finish at the 3 year and just do a fellowship if you really want to do academics. My program is a community EM program in the middle of nowhere. My residents match in fellowships. Most fellowships aren't that competitive, you do not need to go to a 4 year program with name recognition to get into a fellowship. The fellowship will open more doors in academics than doing a 4th year of residency. You'll get paid more as a fellow than a 4th year. Your CV will be better.

Either way, you can do whatever you feel is best for you. But if you are really interested in academics, I'd just finish in the 3 year program and go the fellowship route personally. I think it is a better career move.

 

[EMcactus]

My personal advice would be do NOT transfer to a four year program at this point. Finish at the 3 year and just do a fellowship if you really want to do academics. My program is a community EM program in the middle of nowhere. My residents match in fellowships. Most fellowships aren't that competitive, you do not need to go to a 4 year program with name recognition to get into a fellowship. The fellowship will open more doors in academics than doing a 4th year of residency. You'll get paid more as a fellow than a 4th year. Your CV will be better.

Either way, you can do whatever you feel is best for you. But if you are really interested in academics, I'd just finish in the 3 year program and go the fellowship route personally. I think it is a better career move.

Oh my gosh I just realized my wording was super unclear! I am applying for residency currently as a medical student. I apologize, I meant “stay here at my home institution for residency vs leaving my home town to attend a 4 year program.” Thank you for your thoughtful reply!

 

[gamerEMdoc]

Oh my gosh I just realized my wording was super unclear! I am applying for residency currently as a medical student. I apologize, I meant “stay here at my home institution for residency vs leaving my home town to attend a 4 year program.” Thank you for your thoughtful reply!

Ohhhhhh. That makes more sense. I thought you were saying your were a 2nd year resident.... I was like, THIS IS MADNESS!

From a students perspective, I still personally think 3 years + fellowship makes more sense than 4 years if you want to go the academic route, but a 4 year program could be an alternative. I've never really personally been a fan of a 4th year, I just don't think its necessary. But thats just my personal opinion, and I realize that there are others with the complete opposite opinion.

 

[BoardingDoc]

I am really struggling with staying to complete residency at my home institution (3yr) vs moving away for a 4 year program at top institutions on the other side of the country away from family. I want to become the best EM physician I can and am interested in academics and fellowship (and doing things outside of clinical duties - research, advocacy). What is the influence of alumni networks and name/caliber of program on job prospects, particularly in academic EM? I have heard two camps - go to the best program that will take you vs you will get good training anywhere. I LOVED the three programs I am considering (people!!!, opportunities!!, location more or less) and appreciate the structure of 4 year programs a little more due to time to explore niche and do things outside of clinical duties, trying to stay open minded. Any guidance is much appreciated!!!

If you are set on academics, 3 + fellowship is arguably the best use of your time. 4 year programs will definitely give you a chance to do other things besides pure clinical medicine, at the expense of adding an additional year to your training. Personally, I would much rather work my ass off for 3 years as opposed to having a lighter workload at the cost of spreading it out for another year. You might feel differently, in which case a 4 year program would be great.

Alumni networks play a large role in getting an attending job. Generally speaking, if you train where you ultimately want to work afterwards, you're in good shape. You can absolutely train somewhere and then go work on the other side of the country, but you probably won't have as many contacts on the other side of the country as you do around your program.

 

[Vandalia]

A point to keep in mind if you are set on academics (not clinical track at a university program): Promotion and tenure decisions are ultimately made at the medical school level. Therefore, the committee members are often not familiar with the specifics of EM training. A candidate from a 3 year program with a fellowship will likely be viewed more favorably than a candidate from a 4 year residency since the former will have the "fellowship" box checked even though the two will have had the same length of training and close to identical experience.

 

[Porfirio]

3+fellowship is the only way to go. Better pay out, better looking CV, more specialized, and you get the benefits of 2 alumni networks (residency and fellowship).

Good luck, and don’t be shocked if you change your mind heading into 3rd year of residency and you see those big Dollar $ign$ at the end of that long black tunnel.

 

[gamerEMdoc]

3+fellowship is the only way to go. Better pay out, better looking CV, more specialized, and you get the benefits of 2 alumni networks (residency and fellowship).

Good luck, and don’t be shocked if you change your mind heading into 3rd residency and you see those big Dollar $ign$ at the end of that long black tunnel.

Yet another advantage of the 3+fellowship. You arent locked in. You can change your mind if you decide you dont want to do academics and just graduate and get a job. You dont have that flexibility to leave after 3 in a 4 year program.

 

[Mbekweni]

Typically the 3+ fellowship will give you a faster track but it also depends on how the program is structured. I had a 4 year residency but it didn't have as many shifts for 3rd years and even fewer for 4th years so I was able to do a fair amount of moonlighting and did some nice income smoothing for 2 years making into the 6 figures for my last 2 years of residency. Some 3 year programs will allow that, but I know several others where this would be really difficult. I really got a lot out of the last part of residency taking all my moonlighting experience and being able to take those cases and other questions back to attendings to further refine my practice. In short, a 3 year vs 4 year program can be equivalent if you can do extra moonlighting and/or get other good experiences out of it.

I agree with prior posters that for academics having a fellowship is increasingly required. Alternative pathway is to stick it out as a per diem faculty for 1-3 years after residency and become a beloved clinical instructor and then finally get your big break with an official position- but that's harder to do and also not as efficient with your time.

 

[gamerEMdoc]

In short, a 3 year vs 4 year program can be equivalent if you can do extra moonlighting and/or get other good experiences out of it.

I'm not sure this is true. In a 3 year program that the resident moonlights in year 3 they easily make 6 figures as well. So even if you made 150k in both years 3 and 4, that still doesn't bridge the gap of the lost year. Because 3rd years at a 3 year program are moonlighting. So really you are looking at your 4th year salary+moonlighting vs an attending salary, and that's going to be on average about a 200k loss for that 4th year if you are moonlighting (and more if you aren't). Plus you aren't adding a fellowship to your CV for academia.

I'm not totally against a 4th year if money isn't an issue, but I do believe its a bad financial decision if that's important to people.

 

[Tenk]

When I was a student my number one choice was a four year program. It was in my home town, very well known program, and seemed like the ideal fit for me. I can’t tell you how happy I am I did not match there. Like there is absolutely no way in hell I would ever pick a 4 year program over a 3 in retrospect.

Pick the 3 and never look back.

 

[gamerEMdoc]

When I was a student my number one choice was a four year program. It was in my home town, very well known program, and seemed like the ideal fit for me. I can’t tell you how happy I am I did not match there. Like there is absolutely no way in hell I would ever pick a 4 year program over a 3 in retrospect.

Pick the 3 and never look back.

I agree with you. But I also realize that everyone has different interests and priorities. I think the vast majority of us prefer a 3 over a 4. But there are definitely some out there that see value in a 4 year program, and I don't fault them for it. To each their own.

 

[suckstobeme]

I went to a 4. I really liked my program, but it's overkill. Go to the best 3 year program you can and go to fellowship if you want academics or just get a job. Also, all programs will not train you adequately.

 

[JAFERD_MD]

I went to a good 4yr program and did some moonlighting. Many of my classmates moonlighted and made >100K (I chose not to since I didn't have crushing debts or expenses). I have no regrets. I liked my program, and personality-wise, I'm not confident and often second-guess myself, so that extra year helped me build confidence, extra skills, etc. under some supervision and refine my own teaching and supervision skills to junior residents. It also helped me get my dream job at an academic spot through alumni networking. No fellowship.

 

[gamerEMdoc]

all programs will not train you adequately

I’m not sure I agree with that statement. There’s certainly variations on where you go, but training to the standard of ”adequate”... I think accreditted programs can train people adequately to work in an ED. I’ve met HORRIBLE locums docs who went to big name programs. Great docs who went to places I’ve never heard of. I’m sure every program churns out people they are proud of who are great, and people who are less than ideal. But on average, in terms of “adequate” training, I think that’s the point of accreditation.

 

[deleted547339]

I went to a good 4yr program and did some moonlighting. Many of my classmates moonlighted and made >100K (I chose not to since I didn't have crushing debts or expenses). I have no regrets. I liked my program, and personality-wise, I'm not confident and often second-guess myself, so that extra year helped me build confidence, extra skills, etc. under some supervision and refine my own teaching and supervision skills to junior residents. It also helped me get my dream job at an academic spot through alumni networking. No fellowship.

Is it your dream job though? I did 3+ fellowship and I have my dream job. What makes a lot of people love academics and EM is being able to do it part time. Having a niche that your chair values and gives you protected time. I can’t tell you how much fun it still is going EM 5-8 days/month. Being EM trained at a 4 year program may make you more attractive as a candidate for a faculty position at a residency program over a 3y (although certainly not over 3+fellowship), but does it give you any ability to negotiate for less clinical time to do something else?

 

[JAFERD_MD]

Yep, I often tell people I stumbled into this job, and there is zero possibility I would have known about, applied for, or been hired without my residency alumni network. I am happier than I have ever been, never thought I'd actually *like* going to work, and short of something catastrophic happening, I'm planning to stay until retirement. My chair allows me to do anything as long as there is a way to show you are indeed doing something, i.e. lecture evaluations, publications, medical student mentorship, FOAMed, etc. I work ~90 clinical hours a month.

The caveat is that although it's an academic institution, the rotating residents are non-EM. Not sure if that really matters.

This isn't to say 4 is better than 3, but a 4 year program opened up opportunities for me and gave me the confidence I wanted, at the cost of 2/3rds a year's attending salary (remember, you're still making residency+moonlighting money your 4th year), which I thought was worth it for me because I had no crushing debts or expenses or other financial/family obligations (key words: no crushing debts). YMMV, n=1.

 

[The Knife & Gun Club]

I’m not OP but this is something I’ve also been wrestling with.

In terms of academics, how important is name and prestige? I dropped a couple “big Doximity name” 3 yr programs down my list a bit for a couple lesser known (but still large academic center) places, because the job prospects just worked better for my SO.

 

[UCLABruwins]

^Also having a lot of difficulty with this for my ROL. Anyone have an idea specifically for SoCal post-residency jobs how much a difference training at one of the well known 4 years like Harbor or UCLA-OV makes in comparison to lesser known 3 year programs like UCR/Loma Linda? I definitely prefer a 3 year, but at this stage am not sure how important the "name" brand of a program really is for post-grad connections.

 

[BoardingDoc]

I’m not OP but this is something I’ve also been wrestling with.

In terms of academics, how important is name and prestige? I dropped a couple “big Doximity name” 3 yr programs down my list a bit for a couple lesser known (but still large academic center) places, because the job prospects just worked better for my SO.

If you're looking at academics, programs will be interested in you if you do a fellowship, if they have hired other grads from whatever residency program you go to, and if you have a good academic track record during residency. If you are going to a program which has a good reputation for research, that will help. Absolutely no one (aside from med students) cares about where a program is ranked on Doximity.

 

[gamerEMdoc]

If you're looking at academics, programs will be interested in you if you do a fellowship, if they have hired other grads from whatever residency program you go to, and if you have a good academic track record during residency. If you are going to a program which has a good reputation for research, that will help. Absolutely no one (aside from med students) cares about where a program is ranked on Doximity.

I was going to say absolutely this. Big name academic programs are more going to care if you are fellowship trained if trying to get a job early on with past faculty experience. You can get a faculty job at some community EM programs straight out without a fellowship. They may or may not want you to be clinical faculty for a year or so first before making you core.

 

[SamtheWise]

In terms of academics, how important is name and prestige? I dropped a couple “big Doximity name” 3 yr programs down my list a bit for a couple lesser known (but still large academic center) places, because the job prospects just worked better for my SO.

I think 'big Doximity name' programs tend to just be older and well established, i.e. there's a large alumni base and graduates are a known quantity to certain groups in certain geographic areas and are thus hired preferentially, but that doesn't necessarily mean they offer the best or most up to date training, or even have the best fellowship placements. If you look at the top 10 or whatever Doximity programs they all tend to be some of the oldest EM programs (correct me if I'm wrong, I haven't looked at the list in a while).

Regarding the 3 vs 4 year thing, in some sense 4 year programs are sort of a racket, if you want to train at a famous program in a desirable location (LAC, Harbor, Highlands, Cinci?) you have to do the 4th year. That's not to say it doesn't have value, it's more time in the ED learning from great faculty, however I suspect that a 3rd year resident at LAC is just as prepared if not more so than a 3rd year resident at a 3 year program to go practice in just about any setting (I don't think LAC has a 'watered down' shift schedule spread over 4 years, they just work an extra year). That being said I'm not sure in terms of clinical experience, fellowship placement or academic advancement the 4th year really buys you much compared to a 3 year residency + 1 year fellowship.

 

[gamerEMdoc]

I think 'big Doximity name' programs tend to just be older and well established, i.e. there's a large alumni base and graduates are a known quantity to certain groups in certain geographic areas and are thus hired preferentially, but that doesn't necessarily mean they offer the best or most up to date training, or even have the best fellowship placements. If you look at the top 10 or whatever Doximity programs they all tend to be some of the oldest EM programs (correct me if I'm wrong, I haven't looked at the list in a while).

Regarding the 3 vs 4 year thing, in some sense 4 year programs are sort of a racket, if you want to train at a famous program in a desirable location (LAC, Harbor, Highlands, Cinci?) you have to do the 4th year. That's not to say it doesn't have value, it's more time in the ED learning from great faculty, however I suspect that a 3rd year resident at LAC is just as prepared if not more so than a 3rd year resident at a 3 year program to go practice in just about any setting (I don't think LAC has a 'watered down' shift schedule spread over 4 years, they just work an extra year). That being said I'm not sure in terms of clinical experience, fellowship placement or academic advancement the 4th year really buys you much compared to a 3 year residency + 1 year fellowship.

Also, if you compare two potential hires who started residency at the same time, a 4 year grad just graduating vs. 3 year grad with a year of attending experience, which is more likely to get a desirable job? Personally, if I'm the chair that is hiring, and I have someone with attending experience on their own and I talk to their current chair and they are seeing 2+ patients an hour and doing a good job, liked by staff/patients, etc. then I'm taking that person all day over a four year grad who is just graduating. Doesn't matter about the name of the residency at that point. The 3 year grad with a year of experience has already proven themselves while the residency grad, regardless of residency, is still an unknown quantity.