Help please! DO FM Intern at MD program wants to switch to EM. COMLEX only. Advice? Chances?

[Disimpact22]

DO intern at ACGME FM program out west. Only took COMLEX: 540 step I, 600 Step II, great extra curriculars and LORs but no SLOEs or EM audition rotations. I matched at my top choice FM program. The people are great and the program has some amazing qualities. But I'm pretty certain I would switch to EM if I could.

I enjoy higher acuity, procedural and more rapid-paced medicine. I know EM isn't perfect but to be honest, I'm working 15 hour days but still I'm begging my program for MORE. More ultrasound, procedures like lines, intubations, tubes, taps etc. Every time I'm basically told "not gonna really happen here in any meaningful sense unless you're real lucky". I'm no gunner but I feel like I wont be happy unless I know I've pushed myself to my limits. The OB training is great here but I'll probably never use them regularly in the real world.

To the crux of this novel!:

- I need to know if I can switch residencies. It doesn't seem like I'm totally alone but If I can switch, how? Timing and logistics seem like they'd be a nightmare. But if it's worth it it's worth it. Will I have to wait till next year to audition rotate? Are auditions necessary?

- Should I finish my three years and do another res? Would applying this year without any SLOEs or ability to do anyway months be a waste? Should I wait until next year?

- As a DO with good COMLEX scores (at least step II), a Fulbright Fellowship, extensive international extracurriculars ( I'm 34, non-trad applicant) but no USMLE, research or, truth be told, all that much in the way of heavy ED time during med school, do I have a chance at a decent program? Have family in California and North Carolina. But quality training is the first priority.

Any advice would be much appreciated. Be blunt, please.
We have a graduate of our program who finished his 3 years as FM and went to do an EM residency in Iowa, now works at our hospital-- very happy and successful. Trying to get in touch with him as well.

Thank you folk.

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[Old_Mil]

Finish the residency you are in. There are plenty of EM jobs that don't require ABEM certification. It also gives you the flexibility to get out of hospital-based, CMS-funded medicine as the practice climate in the US continues to deteriorate.

 

[gro2001]

I agree with Old_Mil's advice. Switching would be difficult, not guaranteed, hurt your FM program, etc. Most importantly, it may be partly an issue of grass looking greener.

1) In the short term at least, you will likely be stepping down: having to repeat intern year and even maybe a lot of the rotations you are hating now. You might not get any credit for time you've done. At best you will get 6 months credit and just have more options for electives at the tail end of residency.

2) In the medium term you might realize that EM has its own negatives that are maybe not immediately apparent to you right now, and maybe even not that different from the negatives of FM. For example, you mention that managing HTN and DKA is not all that fulfilling... well, those kind of cases make up a big part of ED care; it's not all cracking chest, setting bones and saving lives. Its a lot of trying to get my patient plugged in with a PCP.

3) In the long term, you may be looking for ways to get out of doing ED time towards the end of your career. You might even find yourself wishing you had an FM clinic to go back to.

In terms of ED jobs that are available to FM grads: yes, they are fewer than before, and tend to be more rural. But it sounds like being rural is not a deterrent for you? In terms of 'shipping everything interesting/complex somewhere else', its true. There is still plenty of 'fun' bread and butter EM things to do in rural ERs (chest tubes, intubations, LPs, etc) and you probably shouldn't make career decisions based on the rare zebra that may come in to an academic ER.

Also, what's stopping you from pursuing you other interests (International, Wilderness) in FM?

My advice would be to finish the residency you are in and then see what kind of jo you can get. If you are still unhappy, then you can apply for a second residency. But I think you can find something you can be happy with.

 

[shoal]

EM isnt really full of procedures as you think. depends on your shop, but all the things you list are relatively uncommon for me now as an attending. none of them are exciting anymore.

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[northernpsy]

Another thing you may want to do is start talking to the kinds of places that do allow FM docs to do the kind of work you like (rural emergency departments or whatnot) to see what kind of realistic possibilities you have for jobs with your training as it is. It's really never too early to start looking at job options and you might find that there are options out there you can be happy with. I'm in Psych myself so I don't know the FM job market as well as psych but I suspect there is enough demand for FM docs that you'll find places will be willing to work with you a bit on making the job more of what you want.

 

[Disimpact22]

Thank you all. I appreciate the advice. I'm definitely staying through intern year and giving it my all. If I still want to switch after intern year or even do another residency after I finish here it'd be advisable to get as many audition rotations at EM programs as possible during electives 2nd and 3rd year right?

Also, does the FM EM fellowship confer any employment advantage over just being FM?

As a DO with COMLEX only step 2 598 what are my chances getting an acgme program after either intern year or full FM residency? Sounds crazy right? But there is a doc in our EM that did just that.

Thanks all.

 

[gamerEMdoc]

People make career choice mistakes. It happens. I wouldn't stay in a field that you absolutely hate, just to plan on doing another residency when you get done. If you can interview and match into an EM program now, especially a 3 year ACGME program, you'll have finished your training in 4 years, which isn't bad, there are a ton of four year graduates in EM, including all the AOA programs.

Obviously you'll be fighting an uphill battle, and I'm sure your PD isn't going to be happy that you're considering leaving. But it is what it is. Be honest, tell them you think you made a huge mistake, see if they'll help you. After all, if you don't match somewhere this year, you're going to need to stay in your program anyways and just finish it out.

Anyways, that being said, I'd interview you. Feel free to apply to my program (feel free to PM me if you plan to go this route and are interested). I've had one FP resident who matched here after switching one year in, who is terrific and joining our faculty after this year. I've had another FP resident that did his whole residency in FP, worked in a fast track, then went back and did an EM rotation. He was also excellent, but wasn't exactly thrilled about all the years of residency.

 

[monkeymoo123]

DO intern at ACGME FM program out west. Only took COMLEX: 540 step I, 600 Step II, great extra curriculars and LORs but no SLOEs or EM audition rotations. I matched at my top choice FM program. The people are great and the program has some amazing qualities. But I'm pretty certain I would switch to EM if I could.

I enjoy higher acuity, procedural and more rapid-paced medicine. I know EM isn't perfect but to be honest, I'm working 15 hour days but still I'm begging my program for MORE. More ultrasound, procedures like lines, intubations, tubes, taps etc. Every time I'm basically told "not gonna really happen here in any meaningful sense unless you're real lucky". I'm no gunner but I feel like I wont be happy unless I know I've pushed myself to my limits. The OB training is great here but I'll probably never use them regularly in the real world.

To the crux of this novel!:

- I need to know if I can switch residencies. It doesn't seem like I'm totally alone but If I can switch, how? Timing and logistics seem like they'd be a nightmare. But if it's worth it it's worth it. Will I have to wait till next year to audition rotate? Are auditions necessary?

- Should I finish my three years and do another res? Would applying this year without any SLOEs or ability to do anyway months be a waste? Should I wait until next year?

- As a DO with good COMLEX scores (at least step II), a Fulbright Fellowship, extensive international extracurriculars ( I'm 34, non-trad applicant) but no USMLE, research or, truth be told, all that much in the way of heavy ED time during med school, do I have a chance at a decent program? Have family in California and North Carolina. But quality training is the first priority.

Any advice would be much appreciated. Be blunt, please.
We have a graduate of our program who finished his 3 years as FM and went to do an EM residency in Iowa, now works at our hospital-- very happy and successful. Trying to get in touch with him as well.

Thank you folk.
.

Go for it. Plenty of people switch successfully. Also know that all your previous training will only benefit you. The individual (DO-no USMLE) I am rotating with switched from FM. I (DO-no USMLE) am switching as well from IM. EM is a great field. Please don't allow your fears to limit your heart's desire. Many people switch please just focus on meeting the requirements. You will likely have to apply broadly as many do. There are many programs that accept COMLEX in lieu of USMLE. You will need to do your homework and frequent the websites or make cold calls. It will be worth it in the end. If you are only in your 1st year then I would advice you to switch now before the decision gets harder. Don't worry. Believe in yourself!!!!

 

[deleted497653]

What do you foresee as being a negative of EM as a specialty?

You should try to consider both positives and negatives before you switch.

 

[Disimpact22]

Thank you all.
The issue now is that I have no LORs or SLOEs from EM docs or time to do sub-I rotations during intern year. If I had them I'd apply this year and see what happens. This is a major problem right? I can't consider applying without letters or sub I time I'm assuming. Damn ERAS deleted all applicant letters from last cycle (none were from EM but at least I'd have something).

Also my program doesn't have EM time built in until 2nd year. I know Id need to learn all the things I'm Learning now as an intern anywhere (EPIC, workflow organization, etc) so I'm giving training my all now. It doesn't look like I'll be going anywhere this year. Such is life i suppose- it's still a great program even If I'm away from family and kind of alone.

As far as the negatives of EM that I can think of off the top of my head without having had any real rotations as a PGY1:
- I've heard the shift work isn't really shift work in the sense that the erratic am/pm scheduling takes a lot out of you.
- You can get callous and your empathy depleted towards your drug seekers and system abusers/people who need an urgent care or PA triage not a doc.
- If you really care about follow up and long term outcome that can be a hassle
- getting bitched at by specialists... (Who cares really).

In truth, like I said in my first post, my EM exposure was very atypical so I'm pulling all this out of my a**. Truth is I don't know with certainty what EM is really like I just know it lit a fire somewhere in me late in 4th year, I'm drawn to the topics I read about in EM books and journals more than most FM topics and I get a lot of personal, day-day satisfaction and joy out of procedures, especially ones that make a real difference in a patients course. My current issue with being less organized than I'd like to be as an intern is easily resolvable with practice.

Anyways, thank you all very much. An further advice would be huge.

 

[monkeymoo123]

Thank you all.
The issue now is that I have no LORs or SLOEs from EM docs or time to do sub-I rotations during intern year. If I had them I'd apply this year and see what happens. This is a major problem right? I can't consider applying without letters or sub I time I'm assuming. Damn ERAS deleted all applicant letters from last cycle (none were from EM but at least I'd have something).

Also my program doesn't have EM time built in until 2nd year. I know Id need to learn all the things I'm Learning now as an intern anywhere (EPIC, workflow organization, etc) so I'm giving training my all now. It doesn't look like I'll be going anywhere this year. Such is life i suppose- it's still a great program even If I'm away from family and kind of alone.

As far as the negatives of EM that I can think of off the top of my head without having had any real rotations as a PGY1:
- I've heard the shift work isn't really shift work in the sense that the erratic am/pm scheduling takes a lot out of you.
- You can get callous and your empathy depleted towards your drug seekers and system abusers/people who need an urgent care or PA triage not a doc.
- If you really care about follow up and long term outcome that can be a hassle
- getting bitched at by specialists... (Who cares really).

In truth, like I said in my first post, my EM exposure was very atypical so I'm pulling all this out of my a**. Truth is I don't know with certainty what EM is really like I just know it lit a fire somewhere in me late in 4th year, I'm drawn to the topics I read about in EM books and journals more than most FM topics and I get a lot of personal, day-day satisfaction and joy out of procedures, especially ones that make a real difference in a patients course. My current issue with being less organized than I'd like to be as an intern is easily resolvable with practice.

Anyways, thank you all very much. An further advice would be huge.

Sent you a private post.

 

[monkeymoo123]

DO intern at ACGME FM program out west. Only took COMLEX: 540 step I, 600 Step II, great extra curriculars and LORs but no SLOEs or EM audition rotations. I matched at my top choice FM program. The people are great and the program has some amazing qualities. But I'm pretty certain I would switch to EM if I could.

I enjoy higher acuity, procedural and more rapid-paced medicine. I know EM isn't perfect but to be honest, I'm working 15 hour days but still I'm begging my program for MORE. More ultrasound, procedures like lines, intubations, tubes, taps etc. Every time I'm basically told "not gonna really happen here in any meaningful sense unless you're real lucky". I'm no gunner but I feel like I wont be happy unless I know I've pushed myself to my limits. The OB training is great here but I'll probably never use them regularly in the real world.

To the crux of this novel!:

- I need to know if I can switch residencies. It doesn't seem like I'm totally alone but If I can switch, how? Timing and logistics seem like they'd be a nightmare. But if it's worth it it's worth it. Will I have to wait till next year to audition rotate? Are auditions necessary?

- Should I finish my three years and do another res? Would applying this year without any SLOEs or ability to do anyway months be a waste? Should I wait until next year?

- As a DO with good COMLEX scores (at least step II), a Fulbright Fellowship, extensive international extracurriculars ( I'm 34, non-trad applicant) but no USMLE, research or, truth be told, all that much in the way of heavy ED time during med school, do I have a chance at a decent program? Have family in California and North Carolina. But quality training is the first priority.

Any advice would be much appreciated. Be blunt, please.
We have a graduate of our program who finished his 3 years as FM and went to do an EM residency in Iowa, now works at our hospital-- very happy and successful. Trying to get in touch with him as well.

Thank you folk.
.

Also remember that when you reach out to these individuals that they may or may not reply right away. Remember to not take it personally, they may have other things going on. Read my private post to you, hopefully that helps. Good luck.