Didn't match...

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So, moving on with life...

Anyone have experience with applicants doing prelim years and then jumping into EM PGY-2?

As in if I go to a program and do a stellar job, are there positions that do/don't open up? Do people who do this generally fare well?

The thing is, if I can't do EM and/or it's very unlikely I will match PGY-2, then I might not want to do a prelim year. This is because the only other job I could see doing besides EM is psychiatry.

Thanks

It's more likely to do prelim, then go in as EM-1. As someone else posted, there are 4 IM/EM spots. Dollars to doughnuts, though, kids at the places where the spots are have already been notified.

I did prelim IM at Elmhurst when I didn't match, and did a month in the Elmhurst ED, and a month in the Mt. Sinai ED. Got a letter from Andy Jagoda, and an interview at Sinai (and Shelly Jacobsen made sure I wasn't ranked). I got more interviews the second time (when I was prelim) than the first time.

I didn't match either. Well, I did... I matched to a prelim IM spot in NYC. I knew it was a stretch to get EM this year, but I'm still bummed.

Originally Posted by Apollyon

It's more likely to do prelim, then go in as EM-1.

Ahh ok that actually makes more sense.

thanks

Sorry to hear you did not match into EM, hypo. I had the same fate last year, and managed to match this year after doing a year of research. Doing a prelim year for me was going to be too difficult to uproot my family for one year or live apart which I just didn't want to do.

Keep your head held up, and work hard. You will succeed the second time around.

Good luck to everyone else in the awful position of being unmatched. It certainly is not a pleasant year, however it does build character.

Matched at my prelim-medicine back up. Pretty bummed. Killer year though with no unfilled spots. Really not looking forward to doing this whole process again next year. Congrats to everyone who did match.

Any thoughts on what would make someone more competitive that can be done during a prelim year? take Step 3, find research, anything else?

Do your EM month in your prelim like a star - now as a doc, you can actually get results. Get that scheduled early - like August or September. Let the PD know (if there's an EM program there) that you are a reapplicant for EM. If you get an elective, see if you can take it early, and if you can take it at another hospital. Go to another ED with an EM program. Get letters from each. I don't know if you can get a SLOR as an intern (vs 4th year).

And, let me tell you - the only thing worse than scrambling is scrambling twice.

I got SLOR's as an intern. I remember one of the letter writers even wrote that I got honors in the clerkship.

FWIW, I went to an academic TY without an EM residency. Even though the letter I got was from a former PD of one, no one cared or mentioned it.

Much more talked about was how I had squeezed in an audition month into the June between graduation and internship. That SLOR counted more.

Thanks shoal.

Apollyon, I'm looking over the schedule of the place I matched, and IM doesn't have interns in the ED. Also, there's only 1 elective month and it looks like it's supposed to be an outpatient IM subspeciality and you have to do a couple MICU weekend calls on top of it. I'm going to of course ask if we can work anything out. If that's not possible, I hope it's not held against me too much. Maybe I should do another EM rotation before I start intern year like redrox...

Originally Posted by Hypomanics

Thanks shoal.

Apollyon, I'm looking over the schedule of the place I matched, and IM doesn't have interns in the ED. Also, there's only 1 elective month and it looks like it's supposed to be an outpatient IM subspeciality and you have to do a couple MICU weekend calls on top of it. I'm going to of course ask if we can work anything out. If that's not possible, I hope it's not held against me too much. Maybe I should do another EM rotation before I start intern year like redrox...

how do u already know where you've matched to??

Originally Posted by otacon88

how do u already know where you've matched to??

Because I ranked both categorical and preliminary positions on my primary ROL, but then matched prelim, I am eligible to scramble/soap into an advanced program. When this happens, NRMP will tell you where you matched in order to aid in your scramble process. They also tell couples match people who didn't fully match as well as those who matched only advanced but not prelim.

Op, keep your head up and good luck going forward. Keep things in perspective in making your next moves and try not to panic. Hopefully this is just a small speed bump....

DTL.

Originally Posted by Indryd

Anyone have experience with applicants doing prelim years and then jumping into EM PGY-2?

IIRC the last PGY2-4 EM program changed to PGY1-4 this year, so I don't think this is an option any more.

Anyhow, good luck with intern year. Perhaps I'll see you on the interview trail next year.

Originally Posted by Hypomanics

Thanks shoal.

Apollyon, I'm looking over the schedule of the place I matched, and IM doesn't have interns in the ED. Also, there's only 1 elective month and it looks like it's supposed to be an outpatient IM subspeciality and you have to do a couple MICU weekend calls on top of it. I'm going to of course ask if we can work anything out. If that's not possible, I hope it's not held against me too much. Maybe I should do another EM rotation before I start intern year like redrox...

I thought I responded to this. Sorry about that. Check again to see if you get an EM month as a PGY-1. Indeed, you need to ask them to do some modifying. It's not a stretch to consider your "outpatient IM subspecialty" month to be filled working in the ED. Recall that they are assuming you're doing your prelim before going into something that requires it.

Since it's prelim, it's not like you'll get in trouble with ABIM, and neither will the program. Work with them. Start calling now. Especially, be nice to the coordinators. If you are close enough to visit in person, do it, to make sure they know you're 1. nice and 2. not a mook. (If you are a mook, maybe not a good idea - I'm guessing "no", but, if you have facial tattoos, this might not be a time to show it.) If you are a regular, warm, responsible person, they might consider going to bat for you more than if you were absent or standoffish or cold or demeaning. Hack the "wetware" (the people). Kevin Mitnick, the hacker, said hacking the wetware was the easiest thing to hack, by far. Have you ever heard the term "Irish diplomacy"? That is "telling a person to go to Hell, and having them look forward to the trip". I am not saying to be overtly manipulative. I guess, distilled, I am saying be manipulative without appearing as such. It's a nuanced touch. It's more "getting to yes". (That's a book.)

Originally Posted by Apollyon

I thought I responded to this. Sorry about that. Check again to see if you get an EM month as a PGY-1. Indeed, you need to ask them to do some modifying. It's not a stretch to consider your "outpatient IM subspecialty" month to be filled working in the ED. Recall that they are assuming you're doing your prelim before going into something that requires it.

Since it's prelim, it's not like you'll get in trouble with ABIM, and neither will the program. Work with them. Start calling now. Especially, be nice to the coordinators. If you are close enough to visit in person, do it, to make sure they know you're 1. nice and 2. not a mook. (If you are a mook, maybe not a good idea - I'm guessing "no", but, if you have facial tattoos, this might not be a time to show it.) If you are a regular, warm, responsible person, they might consider going to bat for you more than if you were absent or standoffish or cold or demeaning. Hack the "wetware" (the people). Kevin Mitnick, the hacker, said hacking the wetware was the easiest thing to hack, by far. Have you ever heard the term "Irish diplomacy"? That is "telling a person to go to Hell, and having them look forward to the trip". I am not saying to be overtly manipulative. I guess, distilled, I am saying be manipulative without appearing as such. It's a nuanced touch. It's more "getting to yes". (That's a book.)

Sounds good, thanks. I can definitely hack the wetware.

To the OP (and any who may need this info later):

I didn't match last year, either, but I was in a different situation.

Long story short, I was thinking EM before and all during med school, then changed to ortho late in 3rd year based on what I thought were my career goals at that time. Really, I was interested in doing sports medicine and didn't know I could do it through EM. I was a competitive applicant and tried to match in orthopaedics - got a good number of interviews but in the end I didn't match. I was absolutely devastated and wouldn't wish that experience on my worst enemy.

I knew I couldn't have a pity party very long because time was going to keep marching on with or without me. Since I have a wife and 2 kids, I figured that I didn't want to just roll the dice and hope to land a spot in a residency that made me happy so I elected to do a research year and hoped to get some $$ for it along the way. I got my tail in gear and applied to do an MPH at my med school institution. I was accepted into the program and was also awarded a scholarship that paid full tuition and a living stipend. Not only was this a great blessing from the standpoint of not taking on more debt, but it gave me a support for my family too.

In addition, I delayed graduation so I stayed under the coverage of the med school's malpractice insurance policy and got to keep spending time in the ED this year sharpening my skills and staying active. Since I delayed graduation, I got to reapply this year as a "US Senior". I matched this year in EM and I am absolutely pumped about it. I know this was the right career decision and sort of wish I would have applied to EM last time, but my MPH will be invaluable and I'd never give up this past year.

Whatever you decide to do should take into account your family status, career plans, etc. but for me doing an MPH was absolutely the right thing to do. Looking back I wouldn't do anything differently, given the circumstances. I was told multiple times on the interview trail that doing an MPH was the wisest thing I could have done as it gave me additional knowledge (biostatistics, epidemiology, research project design) that I wouldn't have gotten in a preliminary year and actually gave me a very unique skill set.

Just something to think about. I'd be happy to take personal questions if you want to PM me. You have my total understanding and my absolute sincere best wishes that things turn out well in the end.

I already have an MPH underway. I will graduate with both MD & MPH this May. So it didn't help me at all apparently.

Don't give up, is the best thing I can tell you.

I was in your shoes last year, and by the grace of God, I matched this year in EM, Despite the fact that I got less interviews this year than last. Mind you, I'm a DO and I was couples matching last year. This year i didn't, so that's neither here nor there. If a DO with less than average usmle's (though comlex 3 was above the 95th percentile) reapplying from a traditional rotating internship can do it, there's hope for you yet.

I concur with everything that's said above. I would add that you should have a contingency plan, such as a back up specialty you'd be ok with if you didn't get EM again. I don't know about you, but I couldn't do the match year after year, so I didn't take any chances this time around, and applied to 3 specialties..I had a back plan, and a back up plan to my back up plan, to make damn sure I matched. You gotta move on at some point, so might as well be mentally prepared for the worst. And you don't have to tell any programs about this at your interview; there's almost no way they'd find out anyway.

Also, get a good letter from your PD from the prelim year. That's not as important as a strong SLOR, but I'd say it's a close second. People want to know how you performed overall as a resident.