5 years vs. 6

The main difference is usually a year of dedicated research. Some places allow moonlighting during that time, so you can earn a few extra bucks. However, with the new 80 work week, you are likely to take call during your research year so moonlighting might not be an option.

I have heard of some 6 year programs where your chief year is more like a fellowship.....but I don't know enough about those programs to really comment on the topic. There are some previous posts addressing this topic.

You have to decide if this is an advantage or disadvantage.
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there is no way i would do a six year program unless that was the only place i could match. I am not keen on research and if i am gonna do a fellowship i would like to choose what/where, not be scutted out as a trauma superchief for another year. These are only my personal opinions, but a lot of residents (and this years current interviewees) have told me basically the same thing. Now if academics is your goal then its a different story, but most people just go into private practice. Just my 2 cents
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Even for dedicated academics, very few of the most academically prestigious programs are 6 years. If you want to do academics, then you want to be able to choose when and in what area you do your research, not unlike Bonedoc's comments about fellowship. Some 6-year programs offer some autonomy in planning research projects, others assign you. Be careful on this point.

On the flip side, the research year is probably a much needed break in the middle of tough years for some.

I agree with the above posts about the pros and cons, with academic pursuits obviously being easier to pursue with the extra year.

I believe that more and more programs will be forced to convert to six years. The reason for this is the 80 hour work week requirement. Most programs simply cannot comply with this requirement unless one of two things happen:
1. attendings directly back up juniors so more senior residents have fewer nights on call (i.e. get tossed into the mix for in house call, putting more residents into the available pool for first call). I don't think many attendings would be willing to do this and take the lower salaries associated with academic practice. Plus, when would they have time to actually do their research?
2. They have more residents to spread the call and workload. The ACGME does not appear to be willing to expand all residencies' accredited clinical programs, so to get around this programs will add a "research year" that is not officially counted against programs clinical resident numbers. This way they can plug the "research" guys into call schedules to keep them clinically sharp while they are in the lab (or on the golf course as the case may be). This is an easy way to get more night time manpower so your clinical residents have fewer hours logged. This will open up more spots for hopeful orthopods in the making, but at some point if all residencies are doing this it will dilute the incredible talent pool from which ortho has always been able to draw. This is just my take, but I've already seen it start to happen. I really don't see any other way for programs to comply with the new requirements because there is X amount of work and only Y number of residents to do it. The amount of work is only going to go up, so something has to give here. Personally I don't like the 80 hour work week, I think it detracts from our experience. There are obviously valid arguments for it in certain cases of people being too tired to perform, but I don't think a cap on hours is the right way to ensure patient safety.

I would love to hear other comments, particularly from attendings.

Brown has a great six year program that I would not be so quick to blow off in applying to. Their trauma fellowship is hardly a scut position. Talk to someone who trained there--if you find someone not very pleased with his experience please post it here.

funny you should say that because when i interviewed at brown last year i met one of the trauma fellows/superchief. after a little conversation, he was definitely not shy about saying that he did not like the position of scut attending/superchief/non-accredited fellow. just because everyone smiles doesn't mean that they are absolutely happy. that being said, i did think that brown was a great program if you are into trauma. however, my impression is that the last thing you need after training there is a trauma fellowship.