Advice/help needed...only 3 residency interviews w/ no more offers...

[RynoTheGuy]

Hey everyone. Yes, yes I've searched and read similar threads but was curious as to what your thoughts were for my situation. I've only had 3 interviews, and have no more offers as of today. I've been wait-listed at one program as well.

I received an email today from my dean asking if I wanted to consider a parallel pathway and apply FM or IM. To be honest, I can't fathom doing anything but EM. My application isn't the best score-wise, however, I have very strong letters and performed very well in my home-school EM rotation, as well as in my away-rotation, earning honors in both. Everything else on my application is very good filled with all of the typical mumbo-jumbo that programs like to see...aside from two pesky lower board scores...

Step 1: 207
Step 2: 212, passed CS

At this point I'm hitting panic mode. I applied broadly to 53 programs, 32 initially, and an additional 21 within the past couple of days. Almost all of these are community-based programs, with a few larger universities thrown in the mix, spread throughout the east/west coasts, with a healthy few in the middle.

At this point, is my freaking out premature? I would like to think/hope more offers will come as we get into December/January as people cancel so I can hit at the very least, the magical *10* interviews. Any help would be deeply appreciated.

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[The White Coat Investor]

Yes, it's time to freak out. You've got a very high chance of not matching. You need to get on the phone and let any program you haven't heard from know how interested you are in their program and ask them to call you if they have any cancellations. Once you're in the door, in some ways you're back in the game.

 

[blutie202]

Have you sent any emails to programs expressing interest?

 

[tsbqb]

Are you a US student or FMG?

 

[gman33]

Poor advising. 32 programs is not applying broadly with your board scores.
You needed to apply to every program and/or apply to a ton of less competitive programs.
If you want to go EM or bust, take a look at the list of programs.
Apply to every one not in a big city or an otherwise desireable area.

If you don't want to do this, start sending out IM/FM applications or whatever.

I wish I had something more encouraging to say.

I also wouldn't recommend going to route of doing a prelim year and trying to apply again next year.
The problem with your applications are your scores. A year doing something else isn't going to fix that problem.

If you want to send me a PM, I'll give you a few suggestions on programs to which I would apply.
I don't want to name them there, as they are good programs, just in locations which make them hard to fill.

 

['murica]

charting the outcomes with 3 ranks gives you a 62% chance of matching EM. in reality, maybe a little lower, because who ranks 3 programs? ballers and people who only interviewed at 3 places. So you can estimate your chances are probably a little bit lower than 62%, maybe. but who really knows? 62% means you have a better chance matching EM than going unmatched, so keep your head up, and be confident at the interviews you have! Interviews are still trickling down. I've gotten 2 in the past 2 weeks and cancelled 2 others. I hope you get some from the programs you added, just looking on interview broker for a few programs there are still some spots open. good luck!

 

[littlejuan]

Poor advising. 32 programs is not applying broadly with your board scores.
You needed to apply to every program and/or apply to a ton of less competitive programs.
If you want to go EM or bust, take a look at the list of programs.
Apply to every one not in a big city or an otherwise desireable area.

If you don't want to do this, start sending out IM/FM applications or whatever.

I wish I had something more encouraging to say.

I also wouldn't recommend going to route of doing a prelim year and trying to apply again next year.
The problem with your applications are your scores. A year doing something else isn't going to fix that problem.

If you want to send me a PM, I'll give you a few suggestions on programs to which I would apply.
I don't want to name them there, as they are good programs, just in locations which make them hard to fill.

I agree with this. People with great scores apply to 20-30 programs initially. You should seriously think about applying to pretty much every program left at this point, assuming it is not too late, which it very well might be. Also get on the phone and call call call all the programs you have already applied to. Tell them how interested you are in the program and ask if they have an update for you. Some might tell you that you were rejected, some will tell you they are still reviewing, some will forward your app to the PDs attention, some will ask you to write an email to the PD, etc. You need to do this right now.

 

[SoyMilk]

I've met many people who have done EM after a prelim year or switching from another residency (usually gen surg). You might consider doing IM prelim with the plan of trying to match EM next year. If you then fail to match, you could perhaps continue IM at that institution and at least you're on track to earn money. Although you would probably argue that you would not be happy in IM, I would argue that you would be more unhappy being financially precarious. It's all about maslow's triangle. Once you meet your needs, perhaps you will be able to feel self-actualized outside of EM, in another specialty, or outside of medicine.

Without a job next year good luck with the bottom two. At the end of the day medicine is a job.

Lastly, don't do family medicine if you can avoid it. Internal medicine offers wonderful fellowship options and can be a sweet gig as a hospitalist.

 

[Birdstrike]

The majority of what you're actually going to spend time doing in any specialty of Medicine is identical:

EMR data entry and mouse clicking (or reviewing a scribe or PA's mouse clicks)

Honestly, I think pre-meds and med students (myself at the time included) obsess way too much about specialty choice. There are more similarities than differences. It all becomes a job at some point. As a surgeon you're not likely to get the warm and fuzzies doing your 600th appy at 3am like you did with the first one. As an ER doctor you're no more likely to get euphoric over a chest pain in the ED 10 yrs into your career than you would as an experienced internist or cardiologist would. Yet as medical students, you all obsess over "What's going to make me happy?"

I know to a large extent you have to, you have to follow your dreams and try to do what makes you happy, but you also need to decide what's not going to make you unhappy when the thrill is gone. Having a functioning life (raising halfway decent kids, having a halfway decent marriage, being a decent person, making memories with those important to you) outside of work is what is more likely to provide happiness. Work is a means to support that, while not being allowed to threatened that which it exists to support.

Are you going to live off of the adrenaline rush of a 3am STEMI on Christmas morning or instead of Thanksgiving with your family as a cardiologist, or a trauma code as an ER doctor? Or is it not so bad to do something a little more boring and less "sexy"? Maybe, Yes. Maybe, No.

I don't know. I don't have all the answers. I just think these are questions worth pondering for a minute or two. I think this mentality of "There's only one specialty I could ever do, and if I don't get into it, I'm quitting or doing something drastic," misses the point. All areas of Medicine have their own strengths and have more similarities than you think. You'll be able to do very important work in any specialty.

70% of what you do in any specialty will consist of burying your head in an EMR making a thousand us clicks per day. It's more important to know you'll love "data entry and mouse clicking" rather than obsessing over the 30% or smaller minority of your time you'll actually be doctoring. It's a job. And maybe it's much more than that sometimes, but it's not worth getting too depressed over. Stay strong, keep plowing ahead. You'll be able to support yourself and have a good life. You'll find your way.

 

[pandahunter]

i am yet again depressed by Birdstrike.

 

[Birdstrike]

i am yet again depressed by Birdstrike.

Pandahunter. You are picking the negatives out and ignoring the positives in what I write. What's depressing about this?

...Having a functioning life (raising halfway decent kids, having a halfway decent marriage, being a decent person, making memories with those important to you) outside of work is what is more likely to provide happiness...

= Positive

...All areas of Medicine have their own strengths and have more similarities than you think. You'll be able to do very important work in any specialty....

= Positive

.... it's not worth getting too depressed over. Stay strong, keep plowing ahead. You'll be able to support yourself and have a good life. You'll find your way.

= Positive

I don't know. Some people like what I write. Some don't. Some hit the "like" button. Others say a post "depresses" them. Put me on ignore, maybe? Or just write me off as "negative" and "glass half empty" and ignore my posts like lots of people do. Or, look for the positives. Just whatever you do, don't let anything I write make you depressed.

 

[SoyMilk]

Pandahunter is still looking for the warm and fuzzies. People finishing medical school really should be better acquainted with the cold hard truth of what medicine is and is not. (hint: one syllable, 3 letters, starts with the letter J)

 

[The White Coat Investor]

i am yet again depressed by Birdstrike.

It's really pretty impressive isn't it. You'd think someone who hated it so much would have escaped already. As I recall, he isn't working EM shifts any more, but is doing something like a free-standing urgent care or something.

It's quite a contrast to a trauma surgeon I know who works 80 hours a week and loves it. His only wish is that he had more time for the other stuff he's doing in his life, which include doctoring for free, mountain biking, and spending time with his family. While I wish I had his enthusiasm for medicine (I don't, 30 hours a week is about right for me), I consider the amount I have (apparently far more than Birdstrike) to be quite precious. Medicine can still be a calling, even if many aspects of it are a job. I'll tell you what makes it a lot more enjoyable- not having to do it. That means no student loans, a manageable mortgage, a million bucks in the retirement accounts, and a second job on the side with which I could support the family. FU money. That's what brings back the joy to medicine. That and control over your work environment. The more the better.

 

[littlejuan]

Pandahunter is still looking for the warm and fuzzies. People finishing medical school really should be better acquainted with the cold hard truth of what medicine is and is not. (hint: one syllable, 3 letters, starts with the letter J)

Jam? It's the jam!

 

[SoyMilk]

Jam? It's the jam!

Yes it is Jam!!!

 

[SoyMilk]

It's really pretty impressive isn't it. You'd think someone who hated it so much would have escaped already. As I recall, he isn't working EM shifts any more, but is doing something like a free-standing urgent care or something.

It's quite a contrast to a trauma surgeon I know who works 80 hours a week and loves it. His only wish is that he had more time for the other stuff he's doing in his life, which include doctoring for free, mountain biking, and spending time with his family. While I wish I had his enthusiasm for medicine (I don't, 30 hours a week is about right for me), I consider the amount I have (apparently far more than Birdstrike) to be quite precious. Medicine can still be a calling, even if many aspects of it are a job. I'll tell you what makes it a lot more enjoyable- not having to do it. That means no student loans, a manageable mortgage, a million bucks in the retirement accounts, and a second job on the side with which I could support the family. FU money. That's what brings back the joy to medicine. That and control over your work environment. The more the better.

I've often wondered, does having lots of money as a physician put you at greater risk of a financially damaging high payout lawsuit? I'm not talking about the risk of getting sued. Lets say you get sued beyond your malpractice maximum. Normally, you would simply have to declare bankruptcy depending on the amount remaining. If you are wealthy, you risk losing your hard earned cash. Could this scenario occur for you WhiteCoat? I always figured that if I ended up going into business after residency I would simply have to stop practicing medicine because of the potential risk of medmal.

 

[Birdstrike]

Huh. One of you're first posts I've seen that I thought was off base.

Give credit where credit is due. Many of my posts are entirely off base.

Pm&r vs obgyn vs pathology. 70% similar? Not even close. Not even comparable, between lifestyle, patient population, clinical responsibilities, compensation, etcetc.

To clarify, I didn't write what you quoted above. I wrote:

"70% of what you do in any specialty will consist of burying your head in an EMR making a thousand us clicks per day. "

Maybe putting a number as specific as "70%" is a little overly specific, but I think you'll find that matter what specialty you choose, a huge portion of your time will be spent doing tasks other than doctoring patients, regardless of specialty. Those menial tasks, a large portion of which is documenting on an EMR, are common to all specialties. Other time is spent doing clerical work (physician order entry), talking to administrators, attending meetings, arranging care (ED physicians: coordinating incoming/outgoing transfers; PCPs = coordinator home health/PT/referrals, signing disability forms/handicap placards), or billing/coding.

The majority of time spent being a doctor is not spent being a doctor. That time is spent doing administrative tasks mentioned above, that are common between all specialties.

"During a typical 10-hour shift, a doctor clicked up to 4,000 times if he or she saw an average of 2.5 patients per hour."

http://www.informationweek.com/heal...ehr-takes-44--of-doctors-time/d/d-id/1111808?


"The mean percentage of time spent on data entry was 43% (95% confidence interval, 39%-47%). The mean percentage of time spent in direct contact with patients was 28%."

http://www.ajemjournal.com/article/...tract#/article/S0735-6757(13)00405-1/abstract


"Overall, physicians with EHRs in their exam rooms spend one-third of their time looking at computer screens, "

http://medicaleconomics.modernmedic...sicians-patient-encounters-study-sa?page=full


“The most important thing we do at the hospital,” she continues without flinching, “is paperwork.”"

http://www.nytimes.com/2010/04/08/health/08chen.html?_r=1&

 

[dotcb]

Getting back to the original post – you really need a backup plan. It's pretty likely you won't match in EM this year. I'd recommend internal medicine as an alternative. You may try to transfer to EM or something else during residency or after.

 

[Perrin]

Jam? It's the jam!

Sir we've been jammed!

 

[Birdstrike]

It's really pretty impressive isn't it. You'd think someone who hated it so much would have escaped already.

I don't hate my job. I like my job. It's quite good. Good money, good hours. It's not bad at all. But it's totally different than what I envisioned being right for me in Medical School and residency. You know darn well it's more than just "a job" to me. Otherwise, I wouldn't take it to heart like I do, and write about it like I do.

... a trauma surgeon I know who works 80 hours a week and loves it.

I call BS on that. No such guy exist. Yet, strangely, I know plenty of them. They all claim to "love" their 80 hr per week job. Not one of them does though. That's a compulsion, destructive to family life, not "love." They're called "workaholics," not "star cross lovers of their jobs."

...I wish I had his enthusiasm for medicine (I don't, 30 hours a week is about right for ... what makes it a lot more enjoyable- not having to do it.

You love your job so much, your favorite thing about it is not doing it?

Okay.


I'm just going to think about turkey, now. And stuffing and gravy. That's what I like. And pumpkin pie. With extra whipped cream. Double-secret, extra whipped cream.

I have the next 4 days off to chill, get fat and hang out with my clan of crazies. Life is good.

Happy Thanksgiving SDNers!!!!

 

[pandahunter]

happy thanksgiving, birdstrike

 

[The White Coat Investor]

I've often wondered, does having lots of money as a physician put you at greater risk of a financially damaging high payout lawsuit? I'm not talking about the risk of getting sued. Lets say you get sued beyond your malpractice maximum. Normally, you would simply have to declare bankruptcy depending on the amount remaining. If you are wealthy, you risk losing your hard earned cash. Could this scenario occur for you WhiteCoat? I always figured that if I ended up going into business after residency I would simply have to stop practicing medicine because of the potential risk of medmal.

Asset protection is an important part of financial planning. A certain percentage of my assets are exposed to creditors who exceed the limits of my professional and personal liability insurance. A larger percentage are not. Asset protection law is very state specific and you should know the rules in your state.

I do know docs who have been advised to quit practicing as the risk of loss was far larger than potential gain.

 

[The White Coat Investor]

I call BS on that. No such guy exist. Yet, strangely, I know plenty of them. They all claim to "love" their 80 hr per week job. Not one of them does though. That's a compulsion, destructive to family life, not "love." They're called "workaholics," not "star cross lovers of their jobs."

I guess he could be lying, or delusional. Doesn't seem to be, but I can't say its impossible. Certainly, when you see the excitement in his eyes when he talks about a patient, their family, or a recent surgical dilemma, you lean toward believing him.

You love your job so much, your favorite thing about it is not doing it?

Okay.

I think you missed a word. One of my favorite parts is not HAVING to do it. Meaning I get to do it because that's what I choose to do with my time. If I don't go to work, nothing bad happens to my family's financial situation. Does that make sense? Want to see a miserable doc? Look around for a divorced hospitalist working 28 nights a month to make alimony, mortgage, and car payments. Avoid those issues and taking care of patients is a lot more fun.

 

[Birdstrike]

Want to see a miserable doc? Look around for a divorced hospitalist working 28 nights a month to make alimony, mortgage, and car payments.

Oh, I know. I know that guy, too.

 

[MSmentor018]

to the OP, are you a do or md? regardless have you applied to the new combined do/md programs? what about less desirable programs? time's running out real fast. call/email programs, email residents that like you to put in a good word. call the places you got denied from and check for cancellations/offers. your future career is at stake so pull out all the stops

 

[WalkingCorpse]

A few positive words for you OP, several people in my graduating class last year matched EM with only 2-3 interviews. Off the top of my head I can think of 4 people. All but 1 of these 4 matched to a program where they had an outstanding away rotation. So if you rotated at one of these places you interviewed and got a strong SLOE, I wouldn't give up hope of matching. It only takes 1 program to match... Definitely be prepared with a backup plan though!

 

[Venko]

Huh. One of you're first posts I've seen that I thought was off base. Pm&r vs obgyn vs pathology. 70% similar? Not even close. Not even comparable, between lifestyle, patient population, clinical responsibilities, compensation, etcetc.

My wife is PM&R. She and I have very similar discussions and days. Once you say I saw patients, I taught residents, I returned email, I went to meetings, I got behind on charting, I'm tired...it all sounds very similar.

The details are different but like bird says, I'm not riding the high of seeing a stemi, ischemic gut, etc. I do love seeing the residents succeed and get excited. I usually enjoy meeting a few people or families each shift but at the end of the day I would much rather be with my wife and son.

 

[RynoTheGuy]

Thank you everyone for your replies. To answer a couple questions:

Yes, I'm a US medical graduate (6 months from now...), at an MD program.

Also, I had an interview at one of the places that I did an away-rotation and did a lot of work with when I was a first year. I performed very well and was given very positive feedback and received a strong SLOE. I had one of the residents tell me that they expect to see me in July next year. I know that these are all good things, but I know still aren't anything to hang a hat on.

Two questions:

Is it viewed negatively to contact programs that I've received rejections from?

I had heard of the DO/MD programs, but I thought that those were not opening until next year/match cycle?

 

[MSmentor018]

Thank you everyone for your replies. To answer a couple questions:

Yes, I'm a US medical graduate (6 months from now...), at an MD program.

Also, I had an interview at one of the places that I did an away-rotation and did a lot of work with when I was a first year. I performed very well and was given very positive feedback and received a strong SLOE. I had one of the residents tell me that they expect to see me in July next year. I know that these are all good things, but I know still aren't anything to hang a hat on.

Two questions:

Is it viewed negatively to contact programs that I've received rejections from?

I had heard of the DO/MD programs, but I thought that those were not opening until next year/match cycle?

not at all, I hooked 2 more interviews that way
maybe you're right about the merger. it starts july 1 2015 and all programs combined by 2020
http://www.osteopathic.org/inside-a...e-medical-education-accreditation-system.aspx

 

[RynoTheGuy]

Just to round this out and bring it back full circle (now what 5 years later?, lol). I matched into a superb and competitive EM program at a large university and completed residency and have been enjoying EM attending life. For those of you out there who may feel like the odds are against you, and they may be, things still work out. Tell the nay-sayers to suck it. As long as you do everything in your power to get where you want to be then it will work out.

 

[gamerEMdoc]

My application isn't the best score-wise, however, I have very strong letters and performed very well in my home-school EM rotation, as well as in my away-rotation, earning honors in both.

I’d bet your sloes arent what you think they are. Your grade does not equal your sloe rank. Some places give 80-90% honors. If you had top 1/3 or above sloes for both, no way would you only have 3 interviews. I’d be shocked. Virtually everytime someone asks me to look at their app bc they cant figure out why they arent getting invites, its the SLOEs. It is ALWAYS the sloes.

Your boards arent great but good sloes wouldve made up for them. I know people with comlex scores in the 400s which projects to lower scores than yours with way more interviews than this. Because they have good sloes.

More than likely your sloes are mid 1/3 and not making up for your scores, at least at the narrow window you applied. Adding more programs and LOIs should help you if this is the case because you should still be able to secure some invites. At worst they are low 1/3 and you are in real trouble with only 3. Not impossible to match, but you gotta think backup if you dont secure more.

 

[Rekt]

Just to round this out and bring it back full circle (now what 5 years later?, lol). I matched into a superb and competitive EM program at a large university and completed residency and have been enjoying EM attending life. For those of you out there who may feel like the odds are against you, and they may be, things still work out. Tell the nay-sayers to suck it. As long as you do everything in your power to get where you want to be then it will work out.

EM is about as competitive as landing an acceptance at DeVry nowadays so you can just walk right in anyway.

 

[RynoTheGuy]

EM is about as competitive as landing an acceptance at DeVry nowadays so you can just walk right in anyway.

EM is not orthopedic competitive, however it is still competitive - roughly on par with OB/GYN and gen surg traditionally.
Comments such as "you just walk right in" and comparing it to DeVry are not true, have no basis in reality and cheapen an otherwise excellent speciality and residency experience.
Read:

How Competitive was Emergency Medicine in the 2018 Match? The answer might surprise you.

Dr. Mike Gisondi leads us through a deep-dive of the 2018 Match results for Emergency Medicine, and highlights trends over the past 8 years of data!

www.aliem.com

 

[cyanide12345678]

Hey everyone. Yes, yes I've searched and read similar threads but was curious as to what your thoughts were for my situation. I've only had 3 interviews, and have no more offers as of today. I've been wait-listed at one program as well.

I received an email today from my dean asking if I wanted to consider a parallel pathway and apply FM or IM. To be honest, I can't fathom doing anything but EM. My application isn't the best score-wise, however, I have very strong letters and performed very well in my home-school EM rotation, as well as in my away-rotation, earning honors in both. Everything else on my application is very good filled with all of the typical mumbo-jumbo that programs like to see...aside from two pesky lower board scores...

Step 1: 207
Step 2: 212, passed CS

At this point I'm hitting panic mode. I applied broadly to 53 programs, 32 initially, and an additional 21 within the past couple of days. Almost all of these are community-based programs, with a few larger universities thrown in the mix, spread throughout the east/west coasts, with a healthy few in the middle.

At this point, is my freaking out premature? I would like to think/hope more offers will come as we get into December/January as people cancel so I can hit at the very least, the magical *10* interviews. Any help would be deeply appreciated.

Edit: Nevermind, just realized that op brought back to life a 5 year old post.

Glad it worked out for you.

 

[thegenius]

EM is about as competitive as landing an acceptance at DeVry nowadays so you can just walk right in anyway.

Don't know how competitive it is these days, but when I was a resident (2010-2014), there was one year where EM was the only match along with Derm and maybe plastics that had 100% match rate. It was extremely competitive to get in. So I can't imagine that these days, getting into EM is like walking into DeVry's

 

[Rekt]

EM is not orthopedic competitive, however it is still competitive - roughly on par with OB/GYN and gen surg traditionally.
Comments such as "you just walk right in" and comparing it to DeVry are not true, have no basis in reality and cheapen an otherwise excellent speciality and residency experience.
Read:

How Competitive was Emergency Medicine in the 2018 Match? The answer might surprise you.

Dr. Mike Gisondi leads us through a deep-dive of the 2018 Match results for Emergency Medicine, and highlights trends over the past 8 years of data!

www.aliem.com

Don't know how competitive it is these days, but when I was a resident (2010-2014), there was one year where EM was the only match along with Derm and maybe plastics that had 100% match rate. It was extremely competitive to get in. So I can't imagine that these days, getting into EM is like walking into DeVry's

I figured it was obvious I was being facetious. Regardless, with the current landscape it's only going to get easier to match EM.