Residency Questions

Ok, realize that I’m a second year and haven’t

even begun board study at this point – woohoo, that starts in January…

I’m starting to think about residency and my particular situation. I had to repeat first year after a pretty dismal performance during the year (average of low 70s and failed the last class) – the repeat year and thus far in 2nd year have been good but not outstanding — I’m right in the middle of the pack in terms of grades.

My class rank is abysmal – both of my first years were averaged which put me in the bottom 25%. My dean has been very, very encouraging saying that we’ll take care of the failure in the dean’s letter. When I’ve asked about some specialities I’m interested in, he’s mentioned that he’s seen nothing in my grades that would bar me from entering those residencies but I’d probably have to move…

So, here’s my question – I’m thinking about Emergency/FP. My ideal residency would prepare

me to handle just about anything – I want to be able to stablize a critical patient until they can be moved to a hospital setting. I want to have the skills that if I have to, I can do an appendectomy or set bones or do that sort of thing

until the patient can be transported to better facilities. What I regard as medical mission type of stuff…

Is that sort of thing available any more? EM sounds almost like it but with two kiddos entering the middle/jr. high stage that’s a LOT

of time away from the family…plus I’m not 30 anymore…

Anyone care to comment?

EM is getting more and more competitive from what my colleagues going into this specialty are talking…FM is much more forgiving regarding grades/boards/research. Although FM does get some surgical experience I do not think that they would do an appendectomy, at least here in the US. Maybe some others will comment.

EM is an excellent base for international medicine and probably as close as you are going to get to having the background to deal with a wide variety of presentations (don’t know about doing surgeries, though). As efex said, EM is getting more and more competitive. Definitely more competitive than family medicine. The good news for you is that board scores and third year grades are MUCH more important that first and second year grades. Study hard for your boards and work hard in your third year rotations.

Why do you think that EM is going to be a lot of time away from your family? In all honesty, the hours in EM are not at all bad and that is part of why it is becoming quite popular. The latest surveys show that EM attendings are averaging less than 40 hours a week. I doubt you’ll find very many FPs that are only putting in 40 or so hours a week. The toughest part of EM for many people can be the shift work aspect - you typically have to rotate between days and nights, especially your first few years.

I don’t know where I got the idea that EM works an insane amount of hours. Bad assumption on my part.

Shift work is no problem. Been doing that since I graduated from engineering school.

I received the EMRA book that discusses various aspects of emergency medicine last night and it sounds like an interesting career. One thing I kept noticing over and over wasw the stress and burnout factor. The book did mention that most of that was associated with people who got into it for the wrong reasons or didn’t really realize what they were getting into.

Being chronoligcally enhanced, can anyone out there speak to that in terms of how you’re treated in residency? Any special situation to overcome? Especially in EM?

So bust it for boards and 3rd year? Ok. I’m finding I like second year a whole lot better than first. Makes more sense and is way more interesting…

Dave -

I highly recommend you cruise over to SDN and check out the Emergency Medicine forum (one of the few times I do so). Lots of good info and discussion about the profession. Make sure you read the FAQ posting first and just hang out in the forum for awhile observing before posting questions - newbies tend to come on and ask about burnout, what are my chances, that type of thing and the regulars get a bit sarcastic when answering those kinds of questions (which are asked over and over).

As for age in residency, there’s been some discussion about that topic on SDN that you might look up. I don’t think age is any detriment. Just like there are more and more older applicants to medical school, there are more and more older EM residents.

I also got the EMRA book yesterday. Haven’t had a chance to look through it yet. I agree with the stress and burnout thing - people make a big deal out of it, but I don’t think it’s any worse in EM than in any other specialty. Like you said - it tends to be more a function of people picking a specialty for the wrong reasons or not researching it well. I think the important thing is that you maintain a life outside of EM. A lot of the people that burn out are those who are money hungry for whatever reason and work too many extra shifts.

I’m with you on the first year/second year thing. I really struggled first year (in fact, I almost ended up repeating the year). I did much better second year (didn’t fail a single test) and did decently on the boards. Keep working hard and you’ll be alright.

Dave, “back in the day” you could get a good bit of surgical training as part of an FM residency. Since I wasn’t interested in this, I didn’t look at residency programs that featured it, but they’re still out there - rural residencies in the Northwest and upper midwest in particular.

You know this already, but do be sure to keep your mind open as you start to experience third year. You may be surprised by what appeals to you. FM wasn’t even on my radar until my third year rotation and now look where I am.


I agree that third year can totally change your perspective and ideas on what you want to do.

Depending on where you go to school, your fellow students/residents/facult y may perceive FM as very limited vs. endless in scope. The east coast and midwest schools in general seem to perpetuate the idea that FM docs don’t do much more than refer and treat things like hypertension and diabetes. Out in the west, that’s not true at all. I’ve worked with FM docs who cover the ED, the ICU, inpt medicine, and obstetrics at the local hospital, do C-sections, and also have a busy outpt clinic practice. (I’m sure there are docs like this back East, too.)

EM is very competitive this year; classmates with a lot of good EM experience and polished resumes are still getting few interviews. FM is by no means a shoo-in, but there are many, many more options available and the numbers are in your favor.

There are students in my class who really want to enter very competitive fields, but have mediocre to poor academic records. They are applying to residency in their #1, but they also have a fully developed Plan B in another field. This requires more time and effort, but they also have a lot more control over where they will end up (very important for those with families).

good luck

Thanks all — I don’t know if I’m being neurotic by starting to think about this or not. My parents are elderly and I’m the only one to take care of them so staying in the area is a concern. But I remember after years of engineering, I got bored pretty easy and don’t want that to happen in medicine. FM sounds like fun as does EM. Here in Tejas, in FM you can pretty much do what you want and feel competent in doing. I know some FM types who delivery babies, perform colonoscopies, and have all kinds of good times. I know others who script and refer.

There’s a really good FM residency here at JPS and the director is a smokin’ hot, extremely top drawer physician with a photographic memory. He teaches some of our classes and it looks like I’ll be rotating with him 3rd year. Could be interesting. There’s also a new EM program opening at JPS but I have no clue how to judge one residency program over another. Anyone have any knowledge about that?

And yes, I’m figuring 3rd year will solidfy a lot. Observing something being done vs. actually doing it are worlds apart. I can watch an engine being built but that doesn’t mean I can build one myself…

My sister’s husband is a FP in the Navy. His residency training included training and certification in appendectomy’s, vasectomies, c-sections,…He does them all and works in the ED and has his own FP clinic in Naples Italy. Not many people can do both.

In my experience with our EM/IM residents they have a hard time transitioning between the 2 specialities. It is hard to going from knowing everything there is to know about a person to having 5 minutes to do a focused H&P and move on to the next emergency. Obviously you spend more time when there is a critical patient - but not much, especially if you are working by yourself in a community ED and you have 5 other patients waiting.

The past EM/IM residents of our program are mostly doing EM…it pays more and therefore they can pay off loans faster and you have more time with your family. It is also harder for them to do both.

Anyone else have thoughts or experiences?

Rachel Yealy

You’ll typically hear the topic of continuity of care come up when discussing choosing between FM and EM.

Family physicians speak of this in positive terms, Emergency Physicians not so much.

I had an epiphany the other day while talking to a family physician friend. I told him how much of my soul was sucked out as I dealt with the same patients who kept coming back to the ED for their new manifestations of anxiety. He told me how much he loved watching families grow.

My epiphany is we weren’t talking about the same patients. The patients that my friend loves to see in clinic don’t come to see me. The ones I see in the ED (the ones w/o an emergency that I can’t help) don’t go see him.

My point is that the perceived value of continuity is heavily dependent on which group of patients you’re continually seeing. I think, with the majority of responsible patients that go to clinic, continuity can be very rewarding.

Keep in mind, though, no specialty is perfect and you’ll always have less than rewarding interactions with patients. The majority of them, in any specialty, will be positive though.

Hope this little rumination helps your decision instead of muddying it up more.

Take care,


Great information, Jeff. Thank you.

I re-read some of this thread in its current resurrection. As someone who came very close to walking away from her residency, specialty. and medicine several times over the past 3 years, I came to several conclusions:

– Every specialty has a subset of problems it addresses that you will not like (in neurology, for me that is headache)

– Residents’ views about specialties are skewed by their setting (i.e. community vs tertiary vs quaternary care center). I realized that I disliked headache patients because all of the ones that get sent to our clinic are the ones who have failed management at their PCP and local neurologist level. I think I may actual enjoy taking care of the “bread-and-butter” migraine patient out in community practice (there is also that comfort of knowing I can send them to a tertiary care center if I cannot help them). Those who do their residency at a quaternary care center (i.e. Mayo, Cleveland Clinics) see 99% insured patients (they screen) and may not have the frustrations of seeing their patients bounce back secondary to non-compliance.

– The business-side of medicine cannot be ignored and telling the billing office that your job is patient care not billing will not make their annoying e-mails and chart-returns go away. So learn what boxes need to be checked, what phrases used, regardless of whether they contribute to the patient’s care, to make your life easier.

Just my two cents…