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Thread: Emergency Medicine Residency chances at matching

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    AUCMD2013 is offline Senior Member 527 points
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    Emergency Medicine Residency chances at matching

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    Hey all,

    I've recently completed my EM elective rotation and am absolutely in love. There is no specialty I would like to do more than EM. I am applying for the match in under 2 months and would like advice from those who have applied to EM before or know others who have. I intend to apply to every program on the East Coast and possibly a few others not too far from the east coast. What board scores and characteristics do PDs of EM programs look at? What were the stats of PEOPLE FROM BIG 3 CARIBBEAN SCHOOLS who matched in 2011 and 2012 into EM and what sort of programs did they match at? Are there any specific requirements for EM in terms of letters of recommendation that programs tend to need? Thanks in advance for any input.
    American University of the Caribbean School of Medicine - PGY-1 Categorical Internal Medicine

    Basic Sciences [X] Step 1 [X] Step 2 CS [X] Step 2 CK [X] Cores [X] Electives [X] Match [X] M.D. Diploma [X] Step 3 [Hidden Content ] IM Residency [Hidden Content ] Attending []

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    devildoc8404's Avatar
    devildoc8404 is offline Elite Member 11590 points
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    I am sure that you know already that EM is very competitive right now. With that in mind, you will want those USMLE scores as high as possible... while I know of people who matched EM a couple of years ago with Step 1 scores in the 210 range, I would not try to bank on that happening in the current environment. A 220-230 probably is a minimum to get an interview most places, from what I have been reading. Research probably isn't going to hurt, either, and don't forget that special EM LOR.

    However, the strongest advice I can think of is to apply broadly, whatever you do, and you REALLY need to start thinking beyond the freaking East Coast. Come on now... it's 3 (or 4) years for residency, and after that you can go wherever the hell you want. If the only place you can get a residency is in a so-called "flyover state," are you honestly going to risk not matching into the specialty for which you are professing your love simply because you didn't want to live in Oklahoma (or wherever) for X amount of years? Because that is what you are essentially saying, here. "I really-really love EM... but only if I can get it on the East Coast or someplace close." Frankly, in the current match situation -- and with EM especially -- that mindset ain't likely to cut the mustard. (My buddy just graduated his EM residency in Oklahoma, and is moving this week to his home state. Somehow, he and his wife made it through living there, even though it wasn't where they wanted to settle down, and now he's got his dream job in his dream location. I'd go ahead and ask him if he thought it was all worth it... but IMHO that would be a rather silly question at this point.)

    Would you be happier in FM (or IM, or Peds, or whatever the hell else) than EM, just because it allowed you to stay on the East Coast for a couple of years? That's the question, here. The match is already not on our side as FMGs, and it's getting tougher... so if we want a specific specialty, we had better be ready to sacrifice for it.

    Just my .02. Good luck!
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    AUCMD2013 is offline Senior Member 527 points
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    what special letter of recommendation are you referring to?
    American University of the Caribbean School of Medicine - PGY-1 Categorical Internal Medicine

    Basic Sciences [X] Step 1 [X] Step 2 CS [X] Step 2 CK [X] Cores [X] Electives [X] Match [X] M.D. Diploma [X] Step 3 [Hidden Content ] IM Residency [Hidden Content ] Attending []

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    devildoc8404's Avatar
    devildoc8404 is offline Elite Member 11590 points
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    It's called the SLOR, and it is specific to the specialty of EM.
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    This is the info you need for the SLOR. Hopefully, you did an EM rotation at a hospital with an EM residency so that you can get the SLOR filled out by the program director. Having done an elective somewhere with an ER residency and really doing well is probably the most important thing you can do to get yourself a spot. The SLOR is an absolute requirement for many programs, and highly recommended for most of the others.

    As devildoc already stated and I'm pretty sure I've also mentioned, EM is very competitive now and is getting more competitive each year; it seems to have turned into one of the lifestyle specialties. This year was the first year that there was not a single EM spot available for the SOAP. Also, as devil doc said, you really need to apply MUCH more broadly than the east coast!! There were only 5 or 6 EM matches from AUC this year, only one was on the east coast, and I'm pretty sure that hospital is primarily a DO program which is 4 years long. If you really want EM, you should be applying to nearly every EM program in the country and hope someone bites. Go through the match lists from AUC, Ross, and SGU for the past couple of years and apply to every program that took one of their students. Then, be prepared to watch the rejection letters roll in with a small handful of interview invites, if you're lucky. Your board scores should be 220's minimum to be looked at seriously. As far as what they're looking for, that varies a lot based on the individual program directors, so really can't say. Most of the people who matched with me were already members of ACEP and/or EMRA as a med student; some had even been to ACEP conferences. If you know someone currently in EM, don't underestimate the power of connections.

    Do yourself a big favor and also apply for family medicine or some other less competitive residency as a back up. I have no idea what your scores, grades, or history is like, but I do know that many people who applied for EM did not get it, some did not even get a single interview and they applied widely. I had decent scores, good grades, and tons of experience, and I had to do a year of family med first. That's not to say that you won't get EM this year, but just be smart and have a back up. It's better to have a spot that's not your first choice than no spot at all.
    Last edited by slevit1MD; 07-05-2012 at 12:41 AM.
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    dw9211 is offline Member
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    Just finished my clerkship at Case Western. I got an outstanding letter from the PD which hopefully will help, but he told me they weren't taking any IMG's this year. The program is only 4 years old. I guess it is just a sign of the times in ER. I will be waiting for all those rejection letters. I kinda wish I had gone to Ross, they seem to have a connection at some places ( Saginaw, mi). At SAEM this year there were about 20 Ross students. I think I was the only AUC guy. Slevit, what do you think is better to apply to as a backup prelim-med/transitional or categorical FM/medicine? I have heard differing opinions.

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    slevit1MD's Avatar
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    Quote Originally Posted by dw9211 View Post
    Just finished my clerkship at Case Western. I got an outstanding letter from the PD which hopefully will help, but he told me they weren't taking any IMG's this year. The program is only 4 years old. I guess it is just a sign of the times in ER. I will be waiting for all those rejection letters. I kinda wish I had gone to Ross, they seem to have a connection at some places ( Saginaw, mi). At SAEM this year there were about 20 Ross students. I think I was the only AUC guy. Slevit, what do you think is better to apply to as a backup prelim-med/transitional or categorical FM/medicine? I have heard differing opinions.
    It really pisses me off every time I hear a program director say something like that!! A similar thing happened to me at Hopkins where I did a sub-I, got great evaluations, got a great SLOR from the assoc program director, and was told by numerous attendings and residents that they'd love to have me and were sure I'd match. Of course, they wound up not even interviewing me and I later found out that they have an unwritten policy of not interviewing anyone from the caribbean.

    Anyway, yes, it is probably a sign of the times that lots of places aren't going to be looking at IMG's, and even fewer will take those that they do interview. My program is only in its 4th year also, and it's clearly already getting more competitive each year (no DO's this year, more US MD's, and they apparently didn't go far down on their list). However, I really do not think that Ross students (or any other caribbean student) has any kind of advantage over AUC students. We're all from the caribbean and thus all not looked at very highly. If there is any connection at one particular hospital, it's probably too small to be statistically significant.

    Transitional is definitely not your best bet because those programs are typically very competitive as well. It's usually the rads, gas, and other residents required to do a prelim year that are applying to those programs, so they'd be your competition. Due to the way funding for residency works (it's a long story that I don't know the details of), prelim surgery may actually be your best bet since you'll be funded for the longest. I had a pretty strong connection at a 4 year program but was told flat out that I wasn't going to be interviewed because of funding issues. However, family medicine will probably be the most useful, and the 3 year programs (which most are) would probably like that the most. Intern year of family medicine is the most similar to ER since you typically do OB, peds, some time on the floor, and maybe ER time as an intern. It's also not competitive, so you shouldn't have any trouble getting a spot somewhere if you apply broadly. That's what I did, and it worked for me! I also feel far more prepared for this year than any of my fellow interns.

    If I had to do it all over again, I'd still choose categorical family med. For one, it's going to be a huge help if you eventually match EM. But the other big reason is that worst case scenario, if you don't match EM the second time around either, at least you've got a spot for the next year. If you do a prelim program and don't match EM the next year, you may be stuck starting over somewhere else or with no spot at all! And yes, I do know people who applied to EM twice and still didn't get it!
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    dw9211 is offline Member
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    What did your family medicine program director say when you told he/she that you were leaving there program? Were they willing to write you a good letter? That would be my only worry that some program director would be mad that they will have an empty spot in their program. Did you tell them you might leave when you applied the spot?

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    Quote Originally Posted by dw9211 View Post
    What did your family medicine program director say when you told he/she that you were leaving there program? Were they willing to write you a good letter? That would be my only worry that some program director would be mad that they will have an empty spot in their program. Did you tell them you might leave when you applied the spot?
    I did not tell them when I interviewed for the spot that I was considering leaving the next year. When you're in the scramble (or SOAP now), your #1 goal is to get yourself a job and not sit out a year. Obviously, telling a categorical program that you might be leaving them in a year is not the best way to get yourself a job.

    I think I told my PD that I was reapplying for EM in September or October. You will definitely need a letter from your PD eventually, but it doesn't have to be available immediately. I was very lucky to have an outstanding program director for FM, and now have another one for EM. Although he obviously was not thrilled that I was leaving, he did try to help me do what I wanted to do and even said that I could stay if I didn't match. I haven't seen the letter, but I'm assuming it was good since I got a spot. He even let me do an away elective in EM to get more experience and improve my application, which is pretty much unheard of for an intern. Once I did match, he let me do another elective instead of geriatrics, which I had no interest in doing.

    Of course, this was just my experience with a very understanding PD. I have heard stories of program directors that will try to sabotage anyone that wants to leave.
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    Medical Moose's Avatar
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    Quote Originally Posted by slevit1MD View Post
    I did not tell them when I interviewed for the spot that I was considering leaving the next year. When you're in the scramble (or SOAP now), your #1 goal is to get yourself a job and not sit out a year. Obviously, telling a categorical program that you might be leaving them in a year is not the best way to get yourself a job.

    I think I told my PD that I was reapplying for EM in September or October. You will definitely need a letter from your PD eventually, but it doesn't have to be available immediately. I was very lucky to have an outstanding program director for FM, and now have another one for EM. Although he obviously was not thrilled that I was leaving, he did try to help me do what I wanted to do and even said that I could stay if I didn't match. I haven't seen the letter, but I'm assuming it was good since I got a spot. He even let me do an away elective in EM to get more experience and improve my application, which is pretty much unheard of for an intern. Once I did match, he let me do another elective instead of geriatrics, which I had no interest in doing.

    Of course, this was just my experience with a very understanding PD. I have heard stories of program directors that will try to sabotage anyone that wants to leave.
    This is a shock. You are one lucky dude. I honestly feel that a PD *should* do something like this, because it's not really in their best interest to put out a board certified FM doc that would really rather be doing something else, but for a PD to actually be that helpful and not spite you for wanting to leave a gap in their program is amazing.

    Just in case someone who wants to do ER does wind up in something else, FM is by far best choice; for all the reasons slevit1 said and because of the fact that an FM doc could basically work as an ER physician in some locations. This is very unlikely in a city hospital, but in many rural areas they don't have much of a choice, so they'll take what they can get. I can think of several examples of this, but one would include a small city in the mid-west of about 50,000 people and two hospitals. There are only three ER physicians at that one hospital and the rest of the ER shifts are covered by FM docs. But in that case, those FM docs are also still working in FM on other days (clinic & some inpatient).
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