Currently peds intern; want to reapply in EM. Possible? Please advise.

[PalmTreeDreamer]

So all through medical school, up until the end of my third year, I wanted to go into EM. After going through my rotations, I felt like I would miss having any kind of continuity of care with my patients, so I started considering other specialties. I like kids, and I enjoyed my peds rotation, had some great faculty, so I went with that. About halfway through fourth year I began questioning my decision. Figuring that I had made the choice for a reason, and that maybe just nerves were settling in, I stuck with it. That feeling has only gotten worse. I know we aren't very far into intern year, but this just isn't the right fit for me. Hasn't been right since January. I've done hundreds of hours of shadowing in our ED--my main mentor is an attending there--so I'm familiar with the work, and I know it's what I want to do. My question is, is it even possible?

My step 1 is average, step 2 pretty well above average, and step 3 just kind of above. Great clinical grades from school. I think my biggest issue is my school didn't have an EM residency, and I did a general rotation at home but the only EM away I did during fourth year was a 2 week peds EM rotation. So I have no way of getting a SLOR from a program at all. Does this matter since I'd be coming from residency, not school? I can get a great letter from my mentor, and solid ones from other faculty. I don't mind starting the residency process over at square one, but I'm not quite sure where to start, and mostly just wondering if I've squandered all my chances of doing EM. Any advice is appreciated. Thanks.

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[The White Coat Investor]

You can still do it. Work with your mentor to apply for the match this year. Since you're sure, and committed, might as well go full bore.

I wouldn't say your test scores or grades or prior choices are going to limit you all that much.

 

[PalmTreeDreamer]

You can still do it. Work with your mentor to apply for the match this year. Since you're sure, and committed, might as well go full bore.

I wouldn't say your test scores or grades or prior choices are going to limit you all that much.

Thanks for the reply. I'm mostly worried about the lack of SLOR/away rotation. You don't think this will be an issue?

 

[The White Coat Investor]

I think you have to get a SLOR from someone (it's been a while for me) but that can't be insurmountable. This sort of thing is much easier if you're sure about what you want. Then it's not such a big deal burning bridges.

 

[Makati2008]

So all through medical school, up until the end of my third year, I wanted to go into EM. After going through my rotations, I felt like I would miss having any kind of continuity of care with my patients, so I started considering other specialties. I like kids, and I enjoyed my peds rotation, had some great faculty, so I went with that. About halfway through fourth year I began questioning my decision. Figuring that I had made the choice for a reason, and that maybe just nerves were settling in, I stuck with it. That feeling has only gotten worse. I know we aren't very far into intern year, but this just isn't the right fit for me. Hasn't been right since January. I've done hundreds of hours of shadowing in our ED--my main mentor is an attending there--so I'm familiar with the work, and I know it's what I want to do. My question is, is it even possible?

My step 1 is average, step 2 pretty well above average, and step 3 just kind of above. Great clinical grades from school. I think my biggest issue is my school didn't have an EM residency, and I did a general rotation at home but the only EM away I did during fourth year was a 2 week peds EM rotation. So I have no way of getting a SLOR from a program at all. Does this matter since I'd be coming from residency, not school? I can get a great letter from my mentor, and solid ones from other faculty. I don't mind starting the residency process over at square one, but I'm not quite sure where to start, and mostly just wondering if I've squandered all my chances of doing EM. Any advice is appreciated. Thanks.

Good luck in your journey. Any consideration for Peds EM?

 

[DeadCactus]

Pediatrics to another specialty seems to be a particularly popular transition in my limited experience. I think some people end up realizing they like kids but being a pediatric [blank] is a better fit than being a pediatrician. Anyway, the door to EM is still open. Your options are transfer next year, finish peds and apply to EM, or do a peds EM fellowship. Pros and cons to each but ultimately comes down to how much you want to see adults and how much of your practice you want to be pediatric patients. You don't elaborate much on what it is that draws you to EM, but pediatric critical care and pediatric cardiology may be worth considering as both frequently draw the same personalities that like EM.

I don't know if you technically need a SLOR but you're really going to want one. If you're ready to commit to transferring, talk to your PD/Chiefs and try to do an EM rotation with an elective block. Maybe half EM and half Peds EM.

 

[Angry Birds]

Do you have any elective blocks? Try scheduling them for as soon as possible and ask your PD to let you do them as away rotations at a place with an EM residency. Then get a SLOR from there.

Of course you would need to tell your PD. The level of understanding and support of your PD cannot be understated.

 

[josephmedman]

What about the funding issue? Aren't you only funded for 3 years? My thought is that unless you find an advanced pgy2 spot in a 3 year program the program wouldn't get funding for your final year since you already used one. I may be wrong but that's how I understood it

 

[PalmTreeDreamer]

Thanks for the replies everyone. My current program is kind of small, our schedules have been set for a while, and there's not a lot of wiggle room-- meaning no time for an emergency elective this fall. I've thought of doing a fellowship in either peds EM or peds intensive care, but I've also really been missing the variety that comes with adults. If switching doesn't work out, maybe I'll go the fellowship route. But currently, I'd rather switch to straight EM. And in reference to the funding, yes, I'm only funded for three years, but some programs will cover your salary for the third year. It just depends on what their budget looks like and the way their institution does things. I've known several people who have switched among various specialties even though they weren't fully funded. That's one of the aspects that I'm hoping just plays out right.

 

[EDParallax]

Many programs will pay for you if they want you. You have to apply very broadly because you don't know those programs that are willing to pay until you apply. You need your program directors support as well as great em recs. Not sure about sloe. PM me if you'd like to talk more.

 

[DeadCactus]

The funding thing is bull**** that keeps getting propagated. For one, many residency spots are funded through alternative means that aren't at all affected by the Medicaid rules. Those rotations you do at th VA, community hospitals, etc.? Most of the time they outside institution is funding a residency spot or two. Medicaid funding dried up long ago and new programs keep opening. Second, even if you do find yourself under the medicaid rules you don't lose all funding. You lose a relatively small percentage of the funding; something like a quarter. Is that a mark against you? Yea, but not the death sentence people keep trying to sell it as.

 

[EDParallax]

Those outside hospitals and VA get cms dollars to fund spots. My hospital's internal med program is 1/3 VA funded.

For the OP, who this was really all about: I am repeating what program directors mentioned when I interviewed in a similar situation to the OP. Some hospitals are more flexible with their funding and some have just decided not to deal with potentially "more expensive" candidates as it was put to me.