What to do if I don't match tomorrow? SOAP/Prelim/Research year/etc.

[Iceberg Lettuce]

Long time lurker here, just wanting to start up this topic. I am a very low-tier, fairly uncompetitive applicant (Top 50 MD school with great EM program, Bottom quartile of class, <210 S1, <230 S2, Passed CS, P/HP, great evals and SLOEs according to 2 PDs and my advisor, significant extracurriculars/research/volunteering) who ranked 10/14 of my EM interview programs due to couples match logistics. We have 15 combinations in the same city/area, after which she matches into IM and I don't, and I managed to get interviews at some traditionally strong EM schools thanks to her awesomeness as a candidate (She's AOA, I'm Gold Humanism hahah). Which leads me to further think that matching might be difficult, and those were courtesy interviews (that I am still VERY grateful for having been offered, regardless). Her top IM programs after that have very strong EM programs as well, one of which interviewed me and one of which declined to interview me this cycle.

Long story short, I don't feel confident about matching tomorrow and am prepared for disappointment, which has been the story of my medical school career. But I want to know how best to try again next year, since it doesn't square with my self-perception to be unprepared or admit defeat. I'd try to match at the EM counterpart of wherever she winds up, and was considering SOAPing into a Prelim Surg or Prelim IM year where she is, with an early EM rotation if possible, reapplying there possibly with an early Step 3. Is there anything else anyone would recommend? Research year, perhaps? Another degree? It feels like those would be polishing my turd of an application, but can't hurt, right? If it doesn't work out, I'll also apply for IM there in the hopes of later going into CC, since I believe that to be an area of interest in either specialty. But EM is my one true love.

I thought this would be a good time and place to start a "What should I do next?" and "How can I make this work?" resource for those of us who are not certain of matching tomorrow, do not match tomorrow, or have similar fears in the future.

Best of luck to you all! And I hope this topic is irrelevant for everybody in this application cycle, come tomorrow.

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[@JackShephard]

Well... wait to worry.

You can't do anything about it today. No need to start planning just yet. Go do something else that's fun.

 

[doctorFred]

if your CV is really what you say, you shouldn't have much to worry about. i had very similar numbers and matched in my #2 program. the number of allopathic EM applicants who rank > or = 10 programs and fail to match is miniscule (maybe one in 50? it's been a few years since i've looked at the numbers.)

your backup plan sounds reasonable. if you're going to do a "research year", you need to come up with something impressive to put on your CV (i.e. not just a case report in a lower tier journal.)

 

[WarmFuzzies]

Bump d/t being in same boat.
I'm pretty set on trying to scramble into a prelim year if I don't match EM tomorrow. Can't decide if I should focus on surg prelim vs medicine prelim. I'd heard that prelim surgery is "tougher" and might look better if I plan to reapply (plus there are more unfilled spots), so I was planning on going for that, but then I realized that I don't know diddly about Surgery and the stories I've heard about being a surg intern aren't exactly uplifting. I don't mind working my a off it means a better chance at reapplying, but I honestly don't know if I'd do nearly as well at a prelim surg program as I would doing prelim medicine. Any thoughts?

 

[namethatsmell]

Bump d/t being in same boat.
I'm pretty set on trying to scramble into a prelim year if I don't match EM tomorrow. Can't decide if I should focus on surg prelim vs medicine prelim. I'd heard that prelim surgery is "tougher" and might look better if I plan to reapply (plus there are more unfilled spots), so I was planning on going for that, but then I realized that I don't know diddly about Surgery and the stories I've heard about being a surg intern aren't exactly uplifting. I don't mind working my a off it means a better chance at reapplying, but I honestly don't know if I'd do nearly as well at a prelim surg program as I would doing prelim medicine. Any thoughts?

First off, I'm sure you'll match just fine.

Should it become relevant though, first/foremost you probably want to do a prelim at a place with an EM residency to be able to start making connections. The bigger EM program the better as there will be more wiggle room to get an interview and hopefully match there. After that try to pick places with decent elective time to do EM rotations.

After that you can pick between med and surg...and if I had to pick I'd do medicine since I value my sanity. But you gotta pick what you think will make you happier.

Caveat: not speaking from experience here, just what I've seen/heard about from other applicants on the trail last year. Hopefully somebody more knowledgable will come along.

 

[BoardingDoc]

First off, I'm sure you'll match just fine.

WarmFuzzies posted elsewhere that they only had one ACGME interview after not matching AOA. Not trying to be Debbie downer, but I think planning for the SOAP is prudent at this point. That said, I hope I'm wrong.

After that try to pick places with decent elective time to do EM rotations.

If you are looking to get some electives in, that will almost certainly be a medicine and not a surgery prelim.

I'd heard that prelim surgery is "tougher" and might look better if I plan to reapply (plus there are more unfilled spots), so I was planning on going for that, but then I realized that I don't know diddly about Surgery and the stories I've heard about being a surg intern aren't exactly uplifting.

So here are my two cents about picking a surgery prelim. It isn't going to be fun. You are going to work like a dog and be yelled at a lot for the privilege. If that sounds like something you're interested in, then by all means, go for it. That said, the reputation of surgeons and surgery residencies being brutal exists for a reason. 20% of people who apply and are accepted to a general surgery residency (not just prelims but people who actually WANT to go into surgery) never complete residency.
Source: http://www.acssurgerynews.com/news/...sidents/9e2702b886d9fbc8ae8ccd37bbbbac17.html
Source: http://www.ncbi.nlm.nih.gov/pubmed/20739854
Source: http://skepticalscalpel.blogspot.com/2012/06/why-is-attrition-rate-of-general.html

If you're dead set on a surgery prelim or really think it will help, then by all means go for it. Just go for it with your eyes open.

 

[gman33]

If you need to scramble into something, pick something where you might be happy making a career.
People do match into EM after a year of something else, many don't.

Going into another field isn't the end of the world.
There are plenty of +/- to everything.

Don't do a surgical prelim unless you can see yourself becoming a surgeon.
You will just hate your life and likely not learn that much that will be applicable to whatever field you end up in eventually.

 

[foxtrot24]

Bump d/t being in same boat.
I'm pretty set on trying to scramble into a prelim year if I don't match EM tomorrow. Can't decide if I should focus on surg prelim vs medicine prelim. I'd heard that prelim surgery is "tougher" and might look better if I plan to reapply (plus there are more unfilled spots), so I was planning on going for that, but then I realized that I don't know diddly about Surgery and the stories I've heard about being a surg intern aren't exactly uplifting. I don't mind working my a off it means a better chance at reapplying, but I honestly don't know if I'd do nearly as well at a prelim surg program as I would doing prelim medicine. Any thoughts?

I was in the same boat last year, and went through basically the exact questions you're asking. During the SOAP process, I actually ended up turning down a surg prelim position for a research 'fellowship' at my med school (mostly because I was fortunate enough to get into a great research project with some pretty big-name people)... But in the process of making my decision, I talked to some of the surgery prelims at my home institution. They all pretty much said the same thing: as a surgery prelim, you'll be treated like crap by the upper level residents, especially when they find out you don't really want to do surgery, and you're really not likely to get to know any attendings well enough to get even decent LORs for the next year.

I can't tell you what's right for you, but from my experiences (and the experiences of others I know), a medicine prelim if you can get it would probably be better for your application next year. Good luck!

 

[scummie]

Any updates from you Iceberg?

 

[Iceberg Lettuce]

Any updates from you Iceberg?

I matched! And so did she! We couples matched! Thanks for asking!

I'm going to be an emergency medicine doctor, despite medical school thoroughly besting me at every turn. AND I'm going to keep my relationship that kept me going through rough times. I really cannot believe it.

 

[sylvanthus]

Awesome!

 

[namethatsmell]

I matched! And so did she! We couples matched! Thanks for asking!

I'm going to be an emergency medicine doctor, despite medical school thoroughly besting me at every turn. AND I'm going to keep my relationship that kept me going through rough times. I really cannot believe it.

Congrats man!

 

[deleted109597]

I'm glad all the students who haven't been to residency chimed in about surgery prelims. I'm sure their advice was helpful.
That being said, I did a surgery prelim after not matching. Worked a lot. Was basically on q4.5 call for a year. (Call is that thing residents used to do before mandatory nap time, work hours, etc). Still managed to do an away rotation at the place I ended up matching at. Had a plastic surgery elective as well, which helped with scheduling interviews.
If you go somewhere malignant, then you'll have a terrible time regardless of whether you do surgery or medicine. I decided on surgery because they do more procedures, and take care of sicker patients. Basically, that's what I do now, except for not going to the OR.
So for the litany of nonecdotes (n=0) up there, my n=1 vastly overpowers theirs. If I had it all to do over again, I would still do surgery over medicine. Hell, I would do surgery before residency again (preferably in the same city so as not to move multiple times as well).

 

[DocEspana]

I'm glad all the students who haven't been to residency chimed in about surgery prelims. I'm sure their advice was helpful.
That being said, I did a surgery prelim after not matching. Worked a lot. Was basically on q4.5 call for a year. (Call is that thing residents used to do before mandatory nap time, work hours, etc). Still managed to do an away rotation at the place I ended up matching at. Had a plastic surgery elective as well, which helped with scheduling interviews.
If you go somewhere malignant, then you'll have a terrible time regardless of whether you do surgery or medicine. I decided on surgery because they do more procedures, and take care of sicker patients. Basically, that's what I do now, except for not going to the OR.
So for the litany of nonecdotes (n=0) up there, my n=1 vastly overpowers theirs. If I had it all to do over again, I would still do surgery over medicine. Hell, I would do surgery before residency again (preferably in the same city so as not to move multiple times as well).

Additionally, I am coming off of a PGY-1 year which was technically transitional, but was VERY heavy surgery. Every program I interviewed at kept saying how vital my skills with patient management prodcdural and rescuss experience, and suturing skills (also did a plastic and burn month) would be in the ED. A surgical prelim (I technically had a few months off of surgery) would be a tough way to go, but only tough because surgical interns are worked like crazy. But it would pay dividends.

 

[WarmFuzzies]

Thank you all for your input! Didn't match but there was a higher than average number of unfilled EM spots this year, so I'm hopeful. I ended up splitting the rest of my available application spots between surg and prelim. Good luck to everyone else going through SOAP.

 

[Iceberg Lettuce]

Thank you all for your input! Didn't match but there was a higher than average number of unfilled EM spots this year, so I'm hopeful. I ended up splitting the rest of my available application spots between surg and prelim. Good luck to everyone else going through SOAP.

I hope this thread helps out others in your position! I couldn't find a solid resource anywhere when I was very worried. I feel lucky that it did work out and hope for the best for you. Good luck, friend.