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[Diligence]

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[Jball43]

I’ve seen a lot of people wish they did IM when that had a passion for the fellowships that chose EM because it was “shorter” or “the money was great.” I did a lot of contract work for ER doctors switching jobs (or specialties) back when I was working in law. So I get where you’re coming from. Statistically, you will make less money in just IM but probably not if you’re fellowship trained. Your career in EM will also likely be much shorter than IM due to overwhelmingly high burnout and absurdly low job satisfaction. So short term versus long term gain might be the calculation.

I’ve never heard of a prematch agreement so I’m not 100% sure here, but I think residency swap makes sense, you can also just request a release from your agreement. You might have to find a replacement though. I doubt any of your EM time would count for IM so you’d have to start over if you pick that option.

Other options include critical care fellowship from EM or even palliative care.

 

[gutonc]

Currently feeling a lot of things: I am a visa-requiring IMG, YOG 2021, Step 2: 260+, with some USCE and a few publications. I recently accepted an EM prematch. My application was exclusively for IM, and I applied to only two EM programs as a backup. Not having much luck with IM and not wanting to risk going unmatched with only one interview, I took the EM prematch. Now, it’s not that I don’t like EM—in fact, I love the work in the ER and would definitely enjoy being a part of it. During the week after my EM interview, I prayed so much to get that spot, planned my career as an EM physician, and even considered doing a fellowship in EM. Money was also a factor that made me accept EM, as I believed it had more earning potential than IM. I was very excited to get the offer and took it instantly. I have never been a person of regrets, but over the past couple of weeks, I have been second-guessing my decision and thinking of ways I might still be able to pursue IM. I had always desired and aimed for IM, planning to become a hospitalist, and it now feels like I gave up that dream too soon. I’ve also started worrying about losing the possibility of doing a fellowship in Cardiology or Endocrinology.
My Questions:
1.Now that I have signed the offer, is it even possible for me to switch to IM through residency swap?

Not until you've fulfilled the 45 (or is it 90?) day requirement.

2. Can I reapply to IM after PGY-1?

Yes. But what reason do you have to think you will have better luck the 2nd time around?

3. Is it realistic to do an IM residency after finishing EM? Please understand and offer suggestions. 🙏🏽

It's possible. Not common, but possible.

 

[DeadCactus]

You need a visa, you're several years out of medical school, and it sounds like you did very poorly this application cycle. I'd strongly consider finishing the residency with a smile and then re-evaluating options between a job, a fellowship, or a second residency once you're in a more secure position.

 

[johhnybgood]

You need a visa, you're several years out of medical school, and it sounds like you did very poorly this application cycle. I'd strongly consider finishing the residency with a smile and then re-evaluating options between a job, a fellowship, or a second residency once you're in a more secure position.

Agree. You have a guaranteed residency. You will get licensed. You will have a future. I wouldn’t risk it. EM is broad. There are opportunities to be Ed doc and cover hospitalist position as well at small hospitals. Sounds terrible to me but might scratch your itch.

 

[Jabbed]

It makes me sad for our specialty that we’re backup to IM and people can apply and match without any EM-specific background.

I’m assuming that you pre-matched at Insight Chicago.

1. You can switch to IM after starting.

2. You cannot re-apply in the sense of applying for Match, but you can transfer into a PGY-1 IM position.

3. It is possible to do a second residency.

All of these options are unlikely but not impossible due to: 1) positions being under-/unfunded by CMS, 2) needing host-institution sponsoring visas, 3) your new PD is unlikely to assist you as you represent funding walking out the door, and 4) despite step scores and research you have not matched in 4 years.

You will be looking for a unicorn program that’s flush with cash, willing to sponsor visas, and willing to take you next year even though they don’t want to take you this year.

 

[Diligence]

You need a visa, you're several years out of medical school, and it sounds like you did very poorly this application cycle. I'd strongly consider finishing the residency with a smile and then re-evaluating options between a job, a fellowship, or a second residency once you're in a more secure position.

Thankyou.

 

[EctopicFetus]

Do em then do critical care. Too many unknowns for you and all your knowns are weak / pain points.

 

[WhatJobDoIPick]

Now we have IMGs using EM as a backup. This is the evisceration of our specialty. A special thank you to the "academics" on here who pushed residency expansion over your brothers and sisters in the pit.

 

[EctopicFetus]

Now we have IMGs using EM as a backup. This is the evisceration of our specialty. A special thank you to the "academics" on here who pushed residency expansion over your brothers and sisters in the pit.

Just wait.. it will get so much worse.. I have spoken to some people and hospitals are continuing to add residencies. Maybe we can hope that the 4 year push will leave a bunch of programs empty and force them to close? On the other hand it could make having a residency even more lucrative. I dont know the finances here but I hear of other residencies expanding, and some more new ones about to open.

Hopefully some of these dumpster Em residencies will close but im guessing the voracious appetite for $$ and cheap labor makes having an EM residency a financial win in which case we can and should assume that it will grow.

 

[Rekt]

Do em then do critical care. Too many unknowns for you and all your knowns are weak / pain points.

I can’t imagine a program that takes someone with zero EM background and I’m guessing no SLOEs would provide the adequate requirements for CCM fellowship unless it’s a four year program. Let alone a CCM program want to take them unless it’s a bottom tier SICU program.

 

[EctopicFetus]

Bottom tier EM residency… —> bottom tier fellowship. What’s the surprise?

 

[gutonc]

OP has deleted their post. Closing.