Residency Advice

So I need to make a decision, and this decision is pretty much going to affect the rest of my life.

When I started medical school, I was sure that I wanted to do Emergency Medicine. I have been an EMT for 20 years and I have always loved the idea of being in the ED. I have even rotated in several places and did a total of 11 weeks of emergency medicine. Then a few months ago, I discovered the Intensive Care Unit and I found out how much I truly liked being there as well. It is somewhat like the ED but without the drug seekers and the patients in the ICU are truly sick.

So during my interviews, I was only able to interview in 3 places for emergency medicine and 3 places for Internal Medicine. The place that I was pretty sure that I was going to get a residency turned out to be a dud, and this would have been in emergency medicine. I was then told by one of the Internal Medicine programs that they were going to rank me very high and after doing some research I decided to do the same. And since I was not feeling any love from any of the EM programs I was ready to go into my new field.

Well, things have gotten interesting. This evening I received a call from one of the dual EM/IM programs telling me that they are ranking me very high. So now I have to decide. Where to go.

I checked the salaries of both and they are both within $1000 of each other and both have very good benefits. They are both about the same distance from each other as well.

So, what to do? On the one hand I like the ED and on the other hand I also like the ICU. and there is no guarantee that I will get a Pulmonary/Critical Care fellowship either. Or at least one in the area that does not require me to move.

I only have a few days to ponder this and any advice would be appreciated.


Can I suggest that you email Dave directly with this as well posting. He not be online that much with his busy schedule and certainly would have the most insight on this particular topic.

Gabe, my suggestion is to do whichever you think you would envision yourself doing if you decide not to do a fellowship. You can do critical care from either EM or IM. Lots of critical care programs take EM trained people and some even prefer EM peeps. ABIM has recently come to an agreement with ABEM on allowing EM trained people to sit for the IM CC boards. That being said, the details are far from hashed out and there is no timeline yet released for when EM people will be able to sit for the IM CC boards. It also means that IM CC fellowships are likely to become more competitive as EM peeps pursue them instead of the surgery/anesthesia ones.

EM/IM certainly allows you a certain amount of flexibility. If you think you are interested in academia, this may be the route to go. However, if you think CC is really what you want to do, this is a 5 year residency plus the 3 year IM/Pulm fellowship. You can cut two years off your training by doing either IM/EM plus a CC fellowship.

I am wrestling with the whole CC thing myself. I would rather do a Surgical or Anesthesia CC program, largely because most IM programs are CC/Pulm and 3 years, while surg and anesthesia are 1 or 2 years. I have no interest in pulm. The whole board certification thing clouds the issue, though. I certainly think that for the immediate future, the inability to be board certified in CC is not going to be a hindrance to finding a job as there is overall a shortage of CC trained docs.

Definitely talk to Dave - as an anesthesia guy he’s outside of both the EM/IM realm and can probably give you some advice on if it really matters which route you take to get to critical care. I would tend to say that an EM residency actually better prepares you for a CC fellowship than IM. Here, the EM residents do more months of CC than the IM residents and this is the case in a number of residencies.

Again, though, I think I would look at the decision less through the eyes of fellowship and more through the eyes of what you think you want to do if you decide a fellowship is not for you or doesn’t work out.

Whatever you decide, good luck.

Oh - my other piece of advice: Absolutely do NOT do your rank list based on who you think is ranking you highly. Make your list based on where you think you really want to go. The match is geared so that if programs A, B, and C all rank you high enough to rank, you will match at whichever of those programs you rank highest. Every year I hear of students who don’t rank their favorite program number one because they don’t think the program will rank them high enough to match. If you don’t rank that program highly, you may never know. What’s the worst that happens? You end up at your 2nd or 3rd program anyways if you weren’t ranked high enough at your top choice?

Hey, Gabe. This is likely too late to be of much use to you, but perhaps for others… (BTW, this advice is for MD match and may or may not be applicable to DO but I have no knowledge of how that rank system works)

It is VERY important to understand that many (most?) residency programs do their best to make applicants believe that they are going to be ranked highly. Since, at least in the MD rank, they cannot outright say where they are going to rank you, will make suggestions as to how much they enjoyed you, how you will fit well within in their program, how you were one of their favorites, etc. So 50-100 people will all think they are going to be at near the top of any given program’s list.

I would STRONGLY suggest that a person NEVER rank programs based on where they think a program is going to rank the applicant. In no way will this increase the likelihood that you will match or match into any given program. ALWAYS rank the programs the way you feel about them, regardless of whether you think they are ranking you or how highly they are ranking you. I’m sure that you’ve seen the algorithm for matching, but if not check it out so that you can see this for yourself.

Best wishes in the match!