unique situation...need help!!

[medlaw06]

Hey guys....I have recently finished my EM rotation and never thought I would like it so much as I did. I was hell bent on doing IM and thought that rounding was something that every IM resident just has to go through. In any case, I am realizing more and more than IM in not as good of a fit for me as I previously thought and that EM would be a better profession for me in terms of my personality, what I want out of life, what I want out of my patients, how much (and how long) I want to care for my patients, and a slew of other things (personality types, etc). In any case, I have read more and more about EM in the threads on this to get a better idea of what residency is like. I have visited Freida, ACEP, and other web sites to get a better idea as well. I am not being whimsical about this, especially as time approaches to make a decision as to what to do with my life, my priorities, etc. i have given it serious thought and "consulted" my fiance, my parents (mom is an MD), my cousins (2 are MDs), and lots of my med school friends, as well as the PD, with whom I had a very serious and long discussion.

I have a unique situation that I am hoping you guys could shed some light into. I am an 4th year osteopahtic student who has taken USMLE Step 1 and will be taking USMLE Step 2 EARLY because I did not do as hot as I wanted to on Step 1. I will be applying ONLY to NYC and north Jersey programs since my fiancee is in NYC for her residency. I have heard that NYC programs while not necessarily ANTI DO, are not the most receptive to DOs (programs like NYU, Columbia, Cornell ARE out no matter how good you are) which makes me even more nervous since I am geographically limited.

In any case, in addition to the DO, I also have a JD and have heard from ED docs that it is a very good thing to have. Do you guys think that my JD will help in the application process? I plan on doing above 235 on Step 2 and am studying rediculously hard for it to make up fpr my Step 1 screw up. I have already gotten a LOR from my PD here who is the immediate past president of the ACOEP. It was a very strong letter. I will be doing some of my electives (the first being in November...AHHH!!) in EM at various programs in NYC. I have TONS of extra-curicular activities, but they are apparently not as useful when applying to EM programs as per one of the closed threads that discussed the strenghts and weaknesses of an applicant. I did an EMTALA PP presentation for the residents and attendings which the PD was very impressed by and said it was "at the level of attendings." I can speak 3 languages aside from english (yes...that DID sound rediculous, but isn't that a good quality to have especially in an inner city place like NYC...especially NYC, the melting pot of America!?!). I had ALL HPs in my rotations except for surgery (H) and will most likely get an H in EM as well (was told by the PD, but grades aren't in until a month or so from now). I had 75% H, 20% HP, and 5% P in second year, and about half P and half HP first year, WITH THE EXCEPTION of freakin' Histo (yes...I failed that useless class!!!! ) Wow..I've never been SO honest with people I have never met before! I am NOT writing these things to boast about myself or to give you my CV; on the contrary, my intention in doing that is so you guys could have a better idea of what kind of an applicant I will be.

EM has gotten VERY tough these last 2 years and I see it being even more competitive when applications start this September. I am quite dejected by this because I do not know if I even have a chance (trust me...my step 1 score is SO bad that it's shameful to even put it...put another way, I would rather have wanted to fail than to have passed with the score I have). I had ALOT of family situations which I am sure you guys really don't want ot hear about it, and neither do the PDs care, but the truth is the truth. This is why I am taking my Step 2 early in hopes of doing REALLY well.

So, after the long winded stuff (alright...alright...no lawyer jokes, please) that i just wrote, here are the questions:

1) will a JD help?
2) how well do you think I need to do on Step 2 to even be competitive at programs like St. Lukes/Roosevelt, LIJ, Jacobi/Montefiore, Beth Israel (NY), Maimonides, Mt. Sinai, and Downstate. I have already kissed Columbia, Cornell, NYU goodbye. Should I kiss the programs that I listed good-bye as well? (be brutally honest please!)
3) have a LOR from PD here who was past president. Will that help?
4) anything else I should do or consider when applying?

Thanks alot for your input! Your advice is GREATLY appreciated. I take what you guys say seriously (which is why I am taking step 2 early, as someone else had previously suggested), and I am hoping you guys can be brutally honest with me (and serious as well)

Thanks again!!

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[anonymousEM]

Do the best you can on Step 2, apply as broadly as you can, and rotate at the place you really want to go if it's not too late. None of those things alone will make or break you but geographic limitation cuts down your chances. Be positive and be yourself on interviews. Best of luck!

 

[jazz]

this may be obvious but you didn't specifically mention the saem.org website.

under residency catalog, all the programs in the country are listed (i think md and md/do programs). you can check out the sites. some programs will list their residents and will give you a general idea if a program will take a DO. certain programs will never take a D.O., that's a fact of life. but enthusiasm goes a long way. your training is equivalent to an MD and you should have a shot at matching in EM. good luck with step 2

 

[DrQuinn]

Hey bro-
fellow DO here. Best advice I can give you, apply to nearly all teh NYC/NJ programs and see how you do. In your PS, TALK about the fact you are a JD. Its your ace in the hole and will set you apart from everyone else. Do a couple elective rotations and kick ass in them... rotate at the 1 or 2 places you would love to be a resident at... and show them that you got the stuff.

You may be applying to 20-30 programs, but, hey, that's the breaks for a DO. I applied to 40+ (I think 42 or 43). It doesn't matte rif you think your scores are competitive, if a JD is helpful, or if the LOR is going ot be good enough... you just need to apply.

I guarantee you will match at SOME place... just maybe not your top choice. But you need to be proactive and let people see how good you are.

SDN is an awesome resource, use it!

Q

 

[la gringa]

i think you've misjudged the nyc EM programs a bit... you'll find that in EM the hospital name reputation in IM is not the same as the EM reputation.

 

[roja]

You should not kiss ANY NYC program goodbye. Some are very competitive and some are not. NYP (Cornell) is not as competitive as you think for 2 reasons: its brand new. Its a four year. However, that doesn't mean it is easy either.

The best thing you can do is do amazingly well on your step two and completely kick tail on your rotation. Realize that NYC is an amazingly small community in EM. ALL teh program directors know each other. They can make or break you. The one piece of advice I can give you is to NEVER bad mouth a program to someone else in NYC.

Do really well on your Step 2. And if you can possibly do a rotation earlier than Nov, do that.

 

[jf]

As a DO student that successfully matched into a NY EM program, I can tell you that most of the NY programs are DO friendly. That being said, programs such as NYU/Bellevue, NYP/Cornell, and Mount Sinai are not. The other programs you mentioned are good programs and you should certainly apply to them. You have two options regarding your USMLE scores. First, you can choose to not release the scores of your USMLE and simply base your app on your comlex scores. Second, you can take USMLE step 2 and kick butt. Unfortunately, you must release your step 1 usmle scores if you want your step 2 scores released. I think more importantly than scores, you must kick butt on your EM rotation. If they like you during your rotation, it will take you far. Make sure you rotate at programs that you are interested in going to.

As far as being a lawyer, that can only enhance your app and help set you apart from the many other candidates. As long as you didn't do med malpractice, I don't think they will hold it against you.

Finally, letters are important and the fact that you got one from a well known person is great!

Enjoy your fourth year and good luck!

 

[medlaw06]

hey all....i REALLY appreciate your help in this!! I am kind of baffled by all this especially since it caught me so off guard (my liking of EM that is). You guys AND this website are an AWESOME tool for anyone!! I SINCERELY appreciate all your help in this...

a couple of things that concern me that some people mentioned (one being my mom who I know is looking out for my best interests) and I am looking to you guys for help/clarification is:

1) if one goes in IM, they can work in a hospital and then if they get sick and tired of it, then they can open up a clinic or join a private practice. It doesn't seem like that is an option for EM docs (I don't mean to come off as an a*****e). The question is, then, lets say an EM doc leaves a hospital or is fired from a hospital, what are some of the OPTIONS available to him/her?

2) I was checking out salary.com for how much an EM doc makes in various locations across the country. Now PLEASE don't go down my throat about $$ and medicine, but I have $220,000 debt (+$150,000 for the fiancee) WITHOUT looking at the interest so $$ for me is not necessarily a luxury, but a necessity in order for me to pay off my loans before my kids end up in college, which God only knows how much tuition will be by then. My $$ is not for me, but for my family. I am not a $$$-grubing prick who likes to show off my Benz (yes...even lawyers can be like this! ), but I would like to have nice life (I think I've paid my dues, pun intended, for it). Anyways, just a disclaimer to what I wanted to ask you all: I saw that the salaries for EM docs are, on average, about equivalent to GI (I realize the nuiances of that GI has malpractice/overheads/etc. that an EM doc--I am guessing--doesn't which could alter the ACTUAL salary of the GI). However, what about the GROWTH potential in EM vs. something like GI (or whatever for that matter)? Is there room to grow in EM?

3) One of the disadvantages that IM has is that people are smokescreened by what is HOT today (look at cardio and GI) which may not be the case in future (personally, I think heme/onc and pulmo are the next wave, but that's irrelevant). People get sucked into by the salaries that these guys are making TODAY, which may not be the case 10 years from now. Now, EM has to take in everyone irrespective of their ability to pay. Adding the costs of labs, etc, this means $$$ lost for the hospital. So, WHERE are EM docs' salaries coming from? Is the gov't (Medicare/aid) paying them? And, MOST IMPORTANTLY, do you see that same path in the future? Will salaries be stable in the future? (please read disclaimer in #2 re: $$$) Or will the gov't (or whoever is paying ED) say that our banks are drained so we can't pay you anymore? I am TOTALLY confused about how ED docs earn a salary!!

I told you guys that I have given this some MAJOR thought!!!

 

[medlaw06]

hey jf...could i ask you which one (can understand if you don't wanna answer that)

 

[ERMudPhud]

I am TOTALLY confused about how ED docs earn a salary!!

Many of us work in hospitals where the patients have insurance and/or pay their bills. In that setting the ED is a big net money maker for the hospital

 

[medlaw06]

Many of us work in hospitals... In that setting the ED is a big net money maker for the hospital

I realize that, but what about innner city hospitals? Don't mean to argue with you, but I'm just trying to get an understanding.

 

[ERMudPhud]

I realize that, but what about innner city hospitals? Don't mean to argue with you, but I'm just trying to get an understanding.

You are exactly right that in the inner city the ED can be a net loser and in that case the hospital supports them as a necessary evil. Thats why when Columbia built their new hospital they left the ED in the old hospital several blocks away. In some cases though the ED can still be a net winner for the hospital. Denver Health is inner city and has a very large uninsured population but the ED, trauma surg, and ortho still made money for the hospital because it is a trauma center in an area with lots of auto trauma in a state that requires mandatory auto insurance.

 

[wthomp03]

Don't forget about Stony Brook. I think the program is underrated because we live in the shadow of NYC. We are DO friendly (our PD is a DO) and many people here have families. It's a bit of a trip, but it is an awesome program (residents are happy and well prepared for the real world). I'm sure that if you were to live somewhere in western Suffolk County or eastern Nassau, you and your fiancee could share in the commute.

Think about it and feel free to PM me.

 

[roja]

Stony Brook is a great program. I loved it when I interviewed there (finally!! two hours on the train later!) but it is a large commute if you want to really be 'in' the city. How
wthomp is right. Unfortunately, most people who apply to NYC want to be city bound. and people who like the suburbs forget about stony brook because it is lumped in with 'city programs'. they have lots of great people, lots of research and what I saw of the area was very pretty.

 

[Molly Maquire]

Actually, the EM program director at Methodist Hospital in Brooklyn is a DO (he graduated from the osteopathic residency at St. Barnabas). A number of NYCOM students matched there this year.

Agree with roja re: Stony Brook. It's located in a very nice, suburban area. But living in Manhattan and commuting to eastern Long Island every day would be virtually impossible, in my opinion.

The program at North Shore Manhasset also takes NYCOM grads.

 

[medlaw06]

Don't forget about Stony Brook.

how can i forget about suny-sb. My mom is an attending there!!! Even she said that the commute from NYC can be a drag!! But you are ABSOLUTELY correct; it IS a VERY under-rated program!! I love the area too. definitely gets overshadowed by NYC programs!!! However, the commute from SUNY-SB to NYC is approximately the same in time from the commute from here in South Jersey to NYC. Just the thought of having to commute from here to NYC makes me wanna not get out of bed!

don't mean to beat a dead horse, but no one's answered the other 2 questions that i posted and i am REALLY curious to know from you guys! If you guys have the time, please get back to me on the other 2 questions. Either PM or post a reply. I am VERY frustrated and even more so as time approaches to start my essay and stuff!

BUT I was reading an article on SAEM (I think) that something like 2/3 of residents chose to go into EM because they had some experience as an EMT or something along those lines. The point is is that they HAD experience. for me, the decision is relatively recent as I just finished my EM rotation and fell in love with it (see previous posts) and no...I don't have any previous experience in this field. That makes me VERY hesitsant in applying to EM because PDs will (obviously) question my dedication to the field and there is no way that I can compete with those guys who have years of experience.

Anyone else out there who is in EM but did not have previous experience in EM!?!?!?!?!

 

[kungfufishing]

there is no way that I can compete with those guys who have years of experience.


sure you can.

there is no way of knowing what score you need on step 2, so try to get them all right and see how it turns out.
If you did well on comlex step 1, I wouldnt even bother with the USMLE as your bad step one score wont do you any favors. If you did bad on both of them, get off sdn and bury your nose in your step 2 study material.

apply widely, not just NYC, and apply everywhere you want to go regardless of speculation about your competitiveness.

You can make plenty of money in EM.

 

[medlaw06]

...get off sdn and bury your nose in your step 2 study material.

don't you know how addicitve this website is?

 

[roja]

medlaw:

Unfortunately, I can't make myself read deeply into salary questions, etc. I personally find them ridiculous and boring (not a reflection on you, just my own personal bias). As a MD, you wil be making well above the average person's salary. So when I hear people talking about 200,000/year not being 'much', I tend to just roll my eyes and ignore everything else that comes after. However your point about loans is something I hear ad nauseum. Here is a key point to think about when you are frantically scrambling to pay off your student loans: They are non-inheritable. That means should you die or become permenantly disabled, the loans go away. No one in your family is responsible for them.

Also, with consolidation, there is no reason to not look at them as an investment of sort. There is no reason to bankrupt yourself paying them off in 5-10 years.

Just my view.

Regarding not wanting to go into EM until late, I was in the same boat. I planned ALL through med school to do a uncommon peds subspecialty. I never volunteered in an ER, not even as a premed. Mid 3rd year, when I realized I HATED peds, I had no idea what I was going to do. considered psych, Rheumatology, etc etc. Ended up hanging out with a guy who wanted to do EM during my VERY last month of medicine in the ED. I had no idea what I wanted to do and he started to sell me on EM. I was introduced to the ED dirctor, spent some time shadowing and then did a rotation and LOVED it. I got a little research under my belt (very small amount) and only because I just missed being in the ED. I joined the right associations.

There was not a single question about my 'dedication' because I hadn't been a paramedic. One person in our class was all set to match neurology and switched last minute. It happens. I would take a deep breath, relax and just chill. If you are insecure about your decision, others will pick up on it.