Crap? Really enjoying EM...and was not expecting it.

[GlowInTheDark]

I'm days from submitting my ERAS and am a few weeks into my schools mandatory EM rotation.

I had no specific interest in EM, likely due to lack of exposure. Now, I find myself really enjoying the work to an extent I haven't necessarily felt through most rotations.

Too late to throw in some applications? I'm at a pretty busy community hospital ED but my preceptors are more than willing to write any LOR.

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[DeadCactus]

Most likely, it is too late to put together a decent application. If you're a generally strong applicant, you could maybe throw something together and match somewhere. What are you applying for? In general, I think an applicant would be better off matching into whatever they have built their application for and using the rest of 4th year to get some more EM exposure with a plan to jump ship and switch to EM if it really does turn out to be the best option for you. Maybe apply for a few transitional years if you're really convinced you want to switch early enough in this years application process.

The biggest issue is you need at least one standardized letter of evaluation (SLOE) and to have a half-way decent application you really need at least a group SLOE from an academic program that writes many of them rather than one thrown together by a random community physician who has never written one. Even that is bare minimum as an away rotation or two with a SLOE from each is more typical of competitive EM applicants.

 

[GlowInTheDark]

Point well taken and essentially what I felt. I'm a DO applicant applying to a orthopedics.

At this point may take a crack at it with the old "throw the noodles at the wall and see what sticks" approach.

 

[gman33]

If you like ortho and can likely match, do that.

dont switch at the last minute and then match into neither.

Your em app would probably be weak with no sloe and no real commitment to the field.

 

[DeadCactus]

I would caution you against jumping ship at the last minute based on one rotation. Doubly so with your current course being orthopaedic surgery. I will be a lot easier to change from ortho to EM after your first year than to go from EM to ortho. EM is a great field but it has it's downsides and rotating students are not exposed to many of the negatives.

I'm not familiar with the DO landscape and application process for EM residency so nothing I say applies to that. If you're a reasonable candidate for an ACGME orthopaedic surgery residency, matching into an ACGME EM program should be attainable. Try to get an october EM rotation at a place with a residency program and get a SLOE. You won't be as strong of an applicant as you would be with some patience but if you're geographically flexible and matching into a competitive program isn't a priority for you, matching this year sounds attainable.

 

[racerwad]

I would caution you against jumping ship at the last minute based on one rotation. Doubly so with your current course being orthopaedic surgery. I will be a lot easier to change from ortho to EM after your first year than to go from EM to ortho. EM is a great field but it has it's downsides and rotating students are not exposed to many of the negatives.

I'm not familiar with the DO landscape and application process for EM residency so nothing I say applies to that. If you're a reasonable candidate for an ACGME orthopaedic surgery residency, matching into an ACGME EM program should be attainable. Try to get an october EM rotation at a place with a residency program and get a SLOE. You won't be as strong of an applicant as you would be with some patience but if you're geographically flexible and matching into a competitive program isn't a priority for you, matching this year sounds attainable.

I think that this is an often overlooked aspect of the medical student rotation in the ED, sub-i or not. The rotations tend to, intentionally or not, make things seem better than they are with less shifts, less non-clinical work, less circadian disruptions, etc. I think your plan to just see what sticks isn't a terrible one, but if you are competitive for DO ortho, you should just continue with that and heed the advice of those posting above. If, after a year of ortho, you really hate it and wish to switch to EM, you should reconsider your options then. A big roadblock at that point will be getting a SLOE on a busy surgical intern year. You'll just have to cross that bridge when you get there. Good luck.

 

[The White Coat Investor]

I'd switch as soon as you're sure that's what you want. Lots of people decide late. Just mention that at your interviews and maybe your essay. It shouldn't be much tougher than matching into ortho as a DO. You can continue to apply to ortho if you want, but I'd try to just make a decision this week.

 

[e30ftw]

If you are a decent ortho applicant with a few honors, Steps > 240, etc you should not have a problem matching EM as long as you:

1. Know that you want to be an Emergency Physician.

2. Get at least one honors SLOE from an EM residency program director.

 

[engineeredout]

This highlights what sucks about med school education. You don't get to experience a variety of fields because prior to 3rd year being over you're expected to know what you want to do already.

 

[gamerEMdoc]

Just interview for both and rank whichever one you want more. Late switches happen. One of my best residents (ACOEP resident of the year this year) was a late switch from Gen Surg and had no SLOEs. Another one of my best residents was going to do ortho, did a late rotation in our ED as mandated from his school, we loved him, and he switched and easily matched with us. Not everyone knows what they want to do immediately when they get to medical school.

Don't get me wrong. I'm not say throw caution to the wind, and put all your hopes in EM. But if you can get another rotation and 2 letters, and you are otherwise a decent candidate, I think you'd be nuts to settle for another field if you confirm that EM is truly right for you.

 

[theWUbear]

If you opt to apply ortho and wait until next year to reapply EM and bail on ortho, you will have this advantage: with the rest of you M4 year (e.g., March, April, May) you will be one of extremely few people seeking to do an away rotation at an ER. You could probably rotate at whatever EM residency you choose nationwide. You can then acquire SLOEs should you want to bail ortho after PGY1

 

[racerwad]

If you opt to apply ortho and wait until next year to reapply EM and bail on ortho, you will have this advantage: with the rest of you M4 year (e.g., March, April, May) you will be one of extremely few people seeking to do an away rotation at an ER. You could probably rotate at whatever EM residency you choose nationwide. You can then acquire SLOEs should you want to bail ortho after PGY1

Honestly, I am jealous I did not think to give this advice. As I and others have suggested, I would go ahead w/ AOA ortho and add ACGME EM if you feel like spending the money. If you are still feeling EM after this month, I would do as @theWUbear suggested and spend the latter half of your 4th year getting some SLOEs. Of course, they will be old come next application cycle, but it will at least get you something - you'll know some people and perhaps be able to go back there in your intern year for an elective to get a fresh SLOE. Then, if you decide not to continue in ortho and reapply, you can use the combination of old and new SLOEs and discuss the reasons why you went from one specialty to another in your PS.

 

[alexalex]

Hey! Do all your ortho stuff as planned. Also, get a SLOE from your school and a letter from the program director or assistant program director at your school and also apply to EM. Contact all EM programs that take away rotation students in your area and beg for a spot for next month. Having that extra month will help you decide a bit better whether EM is what you want. Then when you interview/rank you have a bit more of experience. That extra month will solidify things for you by experiencing a whole other ED and try and do more shifts than required to truly see if you think it's for you. You are clearly a good applicant in general, this **** happens all the time.

 

[gman33]

Applying to both sounds good, but can be difficult to make happen.

Are you really going to have time to go on 20 plus interviews?
10/10 in each.

Try to figure out which field you really want to do.
I still think you are going to have a hard time getting together a competitive EM app this late.

 

[DO1987]

I did the exact same thing last year. I gunned for ortho and realized on my first audition I my heart was in EM. I made the switch the last week of August before I submitted my app. I got two LOR's from third year preceptors and got a SLOE on my first EM audition in September. Luckily, most of the places I had set up auditions for ortho had some openings for EM. Other openings I filled up with what I could. I matched my #1. I took the risk of going somewhere I wasn't set on being so late in the game but I got lucky. I figured I'd rather train in EM in a place I wasn't ecstatic about rather than in a field I didn't like.

 

[gamerEMdoc]

If you opt to apply ortho and wait until next year to reapply EM and bail on ortho, you will have this advantage: with the rest of you M4 year (e.g., March, April, May) you will be one of extremely few people seeking to do an away rotation at an ER. You could probably rotate at whatever EM residency you choose nationwide. You can then acquire SLOEs should you want to bail ortho after PGY1

This isn't terrible advice, although it does add a year onto residency. And that's like a $300,000 difference in pay. I still think if you can scramble to get a decent application together, you should try. If you get >10 interviews in EM, you can probably safely bail on all your ortho interviews altogether. And if you don't get EM interviews, you can keep all your ortho intervies and do this as a backup plan.

 

[DissocativFugue]

This isn't terrible advice, although it does add a year onto residency. And that's like a $300,000 difference in pay. I still think if you can scramble to get a decent application together, you should try. If you get >10 interviews in EM, you can probably safely bail on all your ortho interviews altogether. And if you don't get EM interviews, you can keep all your ortho intervies and do this as a backup plan.

I would go ahead and switch one of the later blocks (October, November, December) for EM if possible. You can always add the SLOE to your application for this cycle. As long as it's in before ranking you should be ok. I'd go for EM. You literally have nothing but time and money for apps to lose. If you only apply ortho, you lose both time and money anyway and I'd argue a lot more of it.


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[GlowInTheDark]

You've all had some thought provoking insight.

The perk of my school is that EM is a mandatory 8 weeks, so I have a whole other rotation still to do. There's a residency program in town and I'll see if my school can pull some strings and sneak me in there. I've learned at this point that asking the somewhat impossible doesn't hurt.

Do SLOEs need to be from residencies? My rotations are at "community" hospitals but there's nothing small about them and some of the attendings have spent time training residents in prior jobs.

 

[racerwad]

You've all had some thought provoking insight.

The perk of my school is that EM is a mandatory 8 weeks, so I have a whole other rotation still to do. There's a residency program in town and I'll see if my school can pull some strings and sneak me in there. I've learned at this point that asking the somewhat impossible doesn't hurt.

Do SLOEs need to be from residencies? My rotations are at "community" hospitals but there's nothing small about them and some of the attendings have spent time training residents in prior jobs.

Must be from a ACGME or AOA residency.

 

[gamerEMdoc]

You've all had some thought provoking insight.

The perk of my school is that EM is a mandatory 8 weeks, so I have a whole other rotation still to do. There's a residency program in town and I'll see if my school can pull some strings and sneak me in there. I've learned at this point that asking the somewhat impossible doesn't hurt.

Do SLOEs need to be from residencies? My rotations are at "community" hospitals but there's nothing small about them and some of the attendings have spent time training residents in prior jobs.

SLOE should be from a residency site. Get a regular LOR from the community non-residency site.

 

[SarahBellum1]

As many have stated already, getting a SLOE at this point will be your limiting factor. I've also heard it's somewhat frowned upon to apply to an additional specialty outside of EM. But, if you're set on EM for this application cycle, apply like crazy if money is no object (and at this point it shouldn't be in your situation). And then maybe save all your ortho interviews for the latest dates they possibly offer so that if you get a certain number of EM interviews that you're satisfied with, then you can cancel those late ortho interviews, but if you don't, then you will still have those as a backup.

 

[NRAI2001]

I agree with what some of the others have said... dont change everything based on one rotation.. maybe try to schedule another rotation elsewhere to see if you truely like it enough to switch... untill then I guess apply to both fields in the match?