Ok....long time reader, first time poster. Couldn't hold out from sharing my experience
Exactly 1 year ago I was you. Same story except I'm an MD and steps were slightly higher. Realized halfway through IM internship that I wanted to do EM. I looked for advice on this website and talked to some people. I literally was filled with fear after reading these forums and thought that I wouldn't be able to match. Last week I matched at a great program, not to mention, my first choice. I applied to 30 programs, was offered 15 interviews. So I'd like to give you some encouragement regarding my experience and debunk a few myths.
Myth # 1 - "You will have funding limitations and that will make programs want you less."
Reality - Some programs do have funding limitations and fund resident spots out of their departmental budgets (as above). Those are usually community programs / private programs. I applied to 3 of those types of programs and was offered an interview at 1. Academic programs often have less budget constraints and that doesn't matter as much if at all. In my opinion it is completely overstated and should be a consideration, albeit a small one. Certainly it should not impact your decision whether or not to switch.
Solution: Apply to academic and community programs
Myth #2 - "You are less competitive the second time around."
Reality - You are a doctor with experience. Please tell me how this makes you less competitive. It is just not true.
Solution - Live in reality.
Myth #3 - "Do a critical care fellowship after IM instead of doing EM because they're basically the same"
Reality - Again, please tell me how they are the same? I mean seriously --- in the ICU you take care of sick patients all day, manage vents, and have long family meetings about goals of care. ICU is such a sexy topic in EM circles now that people actually think it is a substitute for EM. There are definitely similarities, but they are not interchangeable. Not to mention, the fellowship is usually in Pulmonary & Critical Care medicine. Who wants to talk about the alphabet soup of lung disease? ER type people? No.
Solution: Don't listen to people that say those things. Respectfully, they have no idea what they're talking about.
My main point is this: Do whatever the heck you need to do and don't let what anyone says stop you. Get a good letter from your current PD and do it the right way, with integrity - don't sneak around or be dishonest. Lay it out truthfully and your program will accept it and help you accomplish your dream. Get SLOEs from your home EM program, apply broadly, email programs displaying interest if you have to, and go for it. If you're going to be miserable in IM, move on. 1500 people reapply for the match every year and about half of them successfully match. That's all comers - not people with your stats / no red flags. You sound like you will definitely match.
Like me.
