Did not match into EM

[dococ121]

I recently did not match into EM. I want you to know where I was exactly so you have a little background information about me.

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[racerwad]

I'm sorry your in this situation. Based upon what you've told us, extending may be your best option. That way, your school will cover your insurance and help coordinate rotations so that you can get another set of SLOEs to reapply. Matching into a prelim year would limit the amount of flexibility you'd need to secure SLOEs and travel for interviews. It would, however, lead to a small paycheck versus additional loans as a 5th year. If you choose to do the 5th year, I'd really make sure to be productive so that it doesn't appear as though you just wasted time. Finally, when it comes time to reapply, I'd add a lot more safety and middle-0f-the-country programs. Good luck!

 

[alpinism]

Agree with the above.

Extend for a 5th year, do some EM clinical research, complete 3-4 more aways, get new SLOEs, apply very broadly to as many programs as possible in less desirable locations (not the coasts), and hopefully match next year.

Good luck!

 

[gamerEMdoc]

I recently did not match into EM. I want you to know where I was exactly so you have a little background information about me. I applied to 90 programs, big name programs, both on the East and West Coast. I ended up getting 9 interviews at mid-tier, but great programs. I had a Step 1 210 and Step 2 CK of 249. I had decent letters SLOEs, but not amazing SLOES, and not from big name people. I also had one bad comment one SLOE on an away with a physician I never worked with. I am a US grad from low 1/3 tier medical school.

I did some research as well with an EM program to connect with them. I have a business background, and two Masters degrees.

However, I failed Step 2 CS, and it came out during my rank list time. I assume that is why I am in this situation. I had a good feeling coming out of a majority of my interviews. But, no one has touched me at the SOAP, and I won't be able to scramble into a position until I have Step 2 CS back which would be in April 13th.


I just don't know which choice is the best for me going forward. I have the possibility of extending my 4th year into 5 years and getting new letters, and doing IM SUB-Is as a parallel, while doing clinical research
. I can also try to match into something Categorical after next week in something that most likely doesn't have a ED department. I guess what do you suggest I do. I am not sure what the best options are for me.

What are your suggestions? I am under a lot of stress, and a little depressed. What would a PD prefer? Should I just look at another field? Can you please PM also?

Just wondering, how do you how good (or bad) your SLOEs were, and about the bad comment on the SLOEs? All the SLOEs have you signing a letter saying you've waived a right to see the letter.

My guess is you had a few small red flags (ie bad comment on SLOE mixed with failing step 2 cs) and that was just too much for programs to overcome. Perhaps you applied to programs that were too competitive? I'm really still surprised there is little interest via the SOAP though. Although then again, I'm not sure how many unmatched EM spots there were.

A prelim/transitional intern year is not a bad idea, particularly if you can get one in a place with an ED residency. But you'll probably want to exhaust all of the scramble options first.

 

[shoal]

There was 1 unmatched em spot



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[gman33]

Sorry.

A fifth year seems like a waste of time and money.

How bad do you want em?
Try to contact some pd's and ask for specific advice.

I think a prelim year would be your best use of time and building clinical skills.

Make sure you apply to every program next year

 

[CyberDragoon]

I am in almost the exact same situation (I have different red flags which might change things). I feel your pain. PM me if you want to vent. I've had to do a lot of thinking and talked to a lot of different faculty about the options. Here are my thoughts.

1. Scramble into a prelim: At this point all the good ones are taken meaning many of the ones left do not have a local EM residency programs which will be key to rotating in the ED and getting EM faculty who teach and train EM residents. There are some surg prelims left that have EM programs but the problem is that they do not leave much time for interviews and some do not let you rotate in EM in intern year. Being an intern also restricts your ability to interview so you might only be able to attend a handful due to time constraints. I plan on applying EM and IM next time so I feel uncomfortable with that prospect. However, if you can get a prelim with an EM program that you can rotate in then doing well as an intern will be the BEST way to get into EM as intern level letters carry a LOT of weight. Also remember to consider the fact that any programs considering you will lose a year of Medicare funding so some may not want to look at you. I am trying for this but the likelihood of this is low.
2. Scramble into something else: While it is technically possible to break a contract and leave after a year this is generally a bad idea. You also need help from your PD to do so. However, you can also just finish out that residency and live with that. Only you can know how badly you want EM. For me, I could be happy in IM but I would be happiest in EM. I decided that I would try one more time and if it doesn't work out then that's just how it will be.
3. Extend med school: You can do some more rotations including an IM SubI for backup. Your next EM grade needs to be H. You need to have shown that you improved from your past EM rotations and that you "get" how the ED works. You will also need to do well on your IM SubI so you can get LORs for your IM app. This is what is causing me the most worry as it's been a while since I did any ward work due to how my school schedules things. However, you will likely be able to match IM so rest assured that you have a backup plan. I plan to also do an academic project. Generally, while research can help to make you stand out it's not particularly useful in general for EM so I was told. I was also limited in the number of extra rotations I could take due to certain max credit limits from my school. You need to ask about how many extra rotations you can take.
4. Research year, Masters degree, etc: You will not be a med student so you won't be able to rotate. This will make it impossible to get new SLOEs or do an IM SubI. I would advise against this.

I don't think I can get a good prelim at this point so I am making plans to extend med school. That way I can do my IM SubI, get one more EM rotation in, and then get about 6+ months of solid academic work on a project before reapplying. I don't think the project will help me much but it might help make me stand out. I am worried about how to explain away this added time to future EM and IM interviewers but that is a worry I am shelving (I have enough on my plate). I hope I can do well on my rotations. I plan to apply more strategically next year. Chances are I'll be matched into IM next year but I can't give up on my EM dreams just yet.

Good luck. We are all in this together.

 

[Leo Aquarius]

If things end up that you are forced to enter a different specialty, then I'm sure you will find a way to be happy and will look back after a few years and realize things happen for a reason. You will find contentment. The qualities that allowed you to enter medical school will allow you to enjoy more than one medical specialty.

 

[Tenk]

That sucks but unfortunately your chances of matching into EM next year are abysmal at best unless you personally know a PD who will rank you. EM is becoming an increasingly competitive field every year, and you will be competing against a fresh batch of applicants with higher step 1 scores, who did not fail step 2 CS and who did not need to take a 5th year. There is no reason why a PD would pick you over them. I'm sorry about your situation but I am just trying to show you the reality you face. My advice would be to try to match into a prelim or other specialty as soon as possible. Each year you are not an attending is hundreds of thousands of dollars lost + one additional career year added before retirement. Sometimes its best to just count your losses and move on. Good luck and I hope it all works out for you.

 

[gamerEMdoc]

So many great points here.

1. I agree with the 5th year of medical school. This would be a HUGE red flag from a residency program standpoint.
2. At least with a preliminary year, you are working towards something. When you interview, you could say that you initially were considering surgery, but wasn't sure, and did a prelim year first before deciding on EM. Is that plausible or believable? Maybe, maybe not, but its still looks better than just staying in medical school for a year. Plus, you are getting paid at least something and not taking out more loans for a year.
3. I agree with your best bet is going somewhere where a prelim year exists where an EM program also exists. One of our surgical prelims desperately wanted to do EM. He was one of a few surgical residents who worked hard and didn't complain despite daunting hours. He was an MD, and our ED residency was an osteopathic residency at the time (just getting ACGME accredidation now) so he had no option to stay with our program; unbeknownst to him, I wrote a personal letter to my former PD to give the guy a chance because he was such a nice guy and hard worker. He matched there despite only getting a few interviews in EM and has been successful there as I knew he would. Sometimes going the extra mile and impressing the right people really does work.
4. Losing a year of medicare funding is a definite issue for some places.
5. Sometimes, you just have to do something else. Going into FP and working at an Urgent Care, or a small town ED. Or doing IM and going into critical care. Or doing Surgery to go into Trauma Surgery.

Unfortunately (or fortunately if you are in my position) EM is getting more and more competitive every year. You are going to have to look deep inside and decide how much you truly want to do EM, and if so, how much risk you are willing to take to get there. And how much work. Do you really want to do a year of a Surgical Prelim year just to get there? That's a ton of hours and work for something that may not pay off in the end. Do you really want to do another year of medical school and take out loans for another year only to maybe in the exact same position next year? These are really tough questions, that I don't think anyone is going to be able to answer for you.

 

[DeadCactus]

An applicant with solid performance as a resident is going to sell a lot better than a even the most amazing 5th year medical student. In my opinion, you're out the fix my medical school performance arena. I don't see it working and it's going to cost you tuition and lost income which likely amounts to around $100k. Additionally, I think most people would find it psychologically easier to spend extra time as a resident than a medical student. You need to get into some sort of post-graduate training and make it clear that your intent is to make it to EM. You may need to finish a residency in another specialty and then re-evaluate whether you want EM enough to do a second residency. It's a longer path but at least you are being paid for it and it's more likely to succeed. The bottom line is that you need to move on, sweep medical school under the carpet, and focus your application performance in postgraduate education and networking. You need people who will vouch for taking a closer look at you as an applicant which means meeting people and giving them a reason to do so (stellar clinical performance and just being a pleasant person to work with).

 

[dococ121]

Yeah,

I am not sure what the right answer is . I was thinking of finishing up my masters and doing research and do more EM rotations, as well as IM. So, I am not really extending to a 5th year. This way I have a backup next year. I think doing a prelim year would help me match into EM, but I think if I did not match next year into EM residency then I don't have a job afterwards. I think leadership is giving me mixed advice. I understand the lost income opportunity. I think doing this might help me match into a better IM residency as well.