[2019-2020] Emergency Medicine Application Thread

[Rekt]

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Is it considered poor form to ask a program how many people they waitlist, approximately how much the waitlist moved in the past, and/or if they are able to disclose your rank on the list? I got waitlisted at a program I'm REALLY interested in and would have to move other interviews around to make their dates work.

Don't do that.

 

[gamerEMdoc]

Im pretty much in the same boat. 3 interviews from home/away, 2 invites from small places, and 1 waitlist. Each PD I have talked to has said I have no red flags, but specifically noted that clinical grades are just average. Thats their only explanation. Did well on rotations, 2 letters specifically said mid third

I wouldve loved that feedback in person before getting backstabbed during application season and tanking my entire lifes work and future carer

Im not sure how you were backstabbed. You said your grades are average. You got middle 1/3 (average) sloes. Depending on how competitive the places you applied, you have about the number of interviews you’d expect for an average candidate at this point.

Why is it considered a program backstabbing you if you are a self admitted average student and they gave you an average evaluation?

 

[gamerEMdoc]

It’s also possible this year is just way more competitive compared to previous years and we are all in for a ride.

Doubtful. Ive been hearing “this year EM is just more competitive” for the last five years... and it just isnt. Interviews are a little more complex to get and time because of overapplying but in the end, match rates are holding steady. I wouldnt worry.

 

[LawnChair]

Im not sure how you were backstabbed. You said your grades are average. You got middle 1/3 (average) sloes. Depending on how competitive the places you applied, you have about the number of interviews you’d expect for an average candidate at this point.

Why is it considered a program backstabbing you if you are a self admitted average student and they gave you an average evaluation?

Well I'm certainly not getting average number of interviews. It feels different when my whole life is on the line

 

[gamerEMdoc]

Well I'm certainly not getting average number of interviews. It feels different when my whole life is on the line

I know it does. But if you applied to competitive places, thats about the average number of interviews Id expect at this point. You’ll get more. I get the anxiety.

 

[LawnChair]

I know it does. But if you applied to competitive places, thats about the average number of interviews Id expect at this point. You’ll get more. I get the anxiety.

Thats the thing, I applied to a ton of programs, all within my region which I of course have significant ties to everywhere. I was aware of competitiveness, and applied to mostly mid tier programs. Im already trying to get FM letters which makes me want to die

 

[E=mc^2]

You think so? Where I rotated is unfortunately super competitive and while I did a solid med student job, I dont think Im in consideration for either tbh

I do wonder how much it helps/hurts to rotate at prestigous places, weather it be academic prestige or county prestige.

I feel like it may be a negative. You are more likely to get a bottom 1/3rd SLOE and you are constantly compared to the best who are on their 2nd, 3rd or 4th EM rotation.

 

[LawnChair]

I do wonder how much it helps/hurts to rotate at prestigous places, weather it be academic prestige or county prestige.

I feel like it may be a negative. You are more likely to get a bottom 1/3rd SLOE and you are constantly compared to the best who are on their 2nd, 3rd or 4th EM rotation.

I sure feel like that. It was my 5th rotation ever, at this particular prestigious place. But, I got a HP on the rotation, pretty well on the test, and actually had really good comments written. I was told they take the year in school into account... but idk anymore

 

[gamerEMdoc]

I do think that people who outpunt their coverage do run the risk of it backfiring. If you are a midtier candidate, rotating a top tier program is unlikely to help you unless you are way better clinically than you think you are. It always makes sense IMO to rotate at places you think you’d be competitive at.

 

[gamerEMdoc]

Thats the thing, I applied to a ton of programs, all within my region which I of course have significant ties to everywhere. I was aware of competitiveness, and applied to mostly mid tier programs. Im already trying to get FM letters which makes me want to die

Apply to any lower tier programs in your region if you havent already. Send out some LOIs. Its only Oct 25. As bad as things seem to you now, I have this conversation nearly every year and it almost always works out just fine. If you are sitting on 5 now, you should easily get to 8, and probably more by the end of November. That gives you an excellent chance of matching EM.

Too many people act like if they dont get 12 they cant match. 12 is just the 95% match rate. The likelihood of matching with 8 interviews is like 90%. After 8 or 9 is actually where the curve starts to flatten out quite a bit, where additional interviews really arent adding that much to your chances. The difference between 6 and 8 was like 20%, but the difference between 8 and 10 is <5%.

 

[LawnChair]

Apply to any lower tier programs in your region if you havent already. Send out some LOIs. Its only Oct 25. As bad as things seem to you now, I have this conversation nearly every year and it almost always works out just fine. If you are sitting on 5 now, you should easily get to 8, and probably more by the end of November. That gives you an excellent chance of matching EM.

Too many people act like if they dont get 12 they cant match. 12 is just the 95% match rate. The likelihood of matching with 8 interviews is like 90%. After 8 or 9 is actually where the curve starts to flatten out quite a bit, where additional interviews really arent adding that much to your chances. The difference between 6 and 8 was like 20%, but the difference between 8 and 10 is <5%.

I in fact applied to more programs a couple days ago, but I had already hit everything in my region tbh. Haven't heard anything. I've got over 120 apps out now. I feel bad contributing to the bloat, and still kind of feel like a failure

 

[ace_inhibitor111]

I saw a SLOE from a very competitive prestigious program that gave 50% top 10% and 45% top 1/3 sloes this year. They had 2 mid 1/3 sloes and zero low 1/3’s.

Now granted, the students that rotate there are Im sure mostly all very good. But how can 50% of people be the top 10% of your list? And are you telling me they didnt get one bad student the whole year?

It just completely makes you question the credibility of sloes like that. Im ok with a little inflation, but theres some places where its just absurd.

If a rotation actually gave 1/3 of their students bottom 1/3, then everyone would avoid that site altogether. From what it sounds like, bottom 1/3 is an app-killer, death sentence, future-ruiner. If even 20% of students got bottom 1/3rd I would avoid that place like the plague.

Better to get honors from a place that gives everyone honors (and have all PDs be guessing), rather than go to an “honest” place and literally shoot yourself in the foot. I stand by the fact SLOEs are a broken system.

 

[Shmoclo]

i didnt even get to work with the lady who wrote my sloe... idk why they make it out to be this great way of stratifying applicants.

 

[gamerEMdoc]

i didnt even get to work with the lady who wrote my sloe... idk why they make it out to be this great way of stratifying applicants.

Typically the program as a whole decides how to rank the students, not the single author.

As for the low 1/3’s, its rarely truly a third of the candidates, nor should it be. Honestly, most of the students that rotate are known quantities, so when it comes to ranking them, the vast majoirity will fall in the top 2/3s of the list. There are weaker students that wont, but most do.

More typically, there will be few top 10s, and the top 1/3 and mid 1/3 will be even, with few bottom 1/3s. And I bet if you looked at the programs rank list, thats pretty much how it works out in practice as well.

The most important question on the sloe is where do you anticipate ranking this student on your rank list. You are not just comparing say 30 students against eachother, but against the entirety of your rank list hypothetically based only the competitiveness of your usual anticipated rank lists. So if you have a great group of students rotate one year, with no weak links, they might all be middle third students at the very lowest, with a bunch of top/thirds And some top 10s.

 

[The Knife & Gun Club]

If a rotation actually gave 1/3 of their students bottom 1/3, then everyone would avoid that site altogether. From what it sounds like, bottom 1/3 is an app-killer, death sentence, future-ruiner. If even 20% of students got bottom 1/3rd I would avoid that place like the plague.

Better to get honors from a place that gives everyone honors (and have all PDs be guessing), rather than go to an “honest” place and literally shoot yourself in the foot. I stand by the fact SLOEs are a broken system.

Not to be annoying because I understand this process is a ****-show, but that’s really not accurate. Low 1/3 isn’t an app killer and a sizable portion of people match with that every year. Not at Highland, but they match at solid sites with good training.

My home discloses their breakdown and it goes
20% - Top 10
30% - top 1/3
30% - middle 1/3
20% - bottom 1/3

so really only a slight skew towards inflation.

if you’re an IMG that’s different, but as a US student the overall match rate is still extremely high.

edit: to follow up, here’s a recent post of ALiEM. In the entire match, there was only 77 unmatched USMDs and another 130 unmatched independent applicants. Out of almost 2500 available positions. So def not an app killer

EM Match Advice: Program Directors Reflect on the 2019 Residency Match

EM Match Advice: Program Directors Reflect on the 2019 Residency Match | Listen to this podcast and review view the 2011-19 NRMP data.

www.aliem.com

 

[ace_inhibitor111]

Not to be annoying because I understand this process is a ****-show, but that’s really not accurate. Low 1/3 isn’t an app killer and a sizable portion of people match with that every year. Not at Highland, but they match at solid sites with good training.

My home discloses their breakdown and it goes
20% - Top 10
30% - top 1/3
30% - middle 1/3
20% - bottom 1/3

so really only a slight skew towards inflation.

if you’re an IMG that’s different, but as a US student the overall match rate is still extremely high.

edit: to follow up, here’s a recent post of ALiEM. In the entire match, there was only 77 unmatched USMDs and another 130 unmatched independent applicants. Out of almost 2500 available positions. So def not an app killer

EM Match Advice: Program Directors Reflect on the 2019 Residency Match

EM Match Advice: Program Directors Reflect on the 2019 Residency Match | Listen to this podcast and review view the 2011-19 NRMP data.

www.aliem.com

More than likely the bottom 1/3 get a few warning signs: a "pass" for the rotation and a signal from their PD to switch specialties. Otherwise there are A LOT of low quality EM residencies that have been popping up that you don't want to end up in even if you do match. Especially with the rapid increase in new EM graduates, you don't want to be the guy who came from a "who?" community ED with 30k/pts a year.

 

[gamerEMdoc]

Yeah every candidate is different. A US MD grad with a single low 1/3 sloe from a prestigious program, another ok sloe, and good boards is not the same as a DO with questionable boards and a low 1/3 sloe from a low tier place. Its all relative.

I will say though, its not always the low 1/3 sloe, but what is said in it, that can really be an app killer. When you see “overbearing and untrainable” written, you run the other direction as a program.

 

[Shmoclo]

which are these "low quality" residencies? so i can throw an app their way lol

 

[Listen2Savage]

i didnt even get to work with the lady who wrote my sloe... idk why they make it out to be this great way of stratifying applicants.

Lol fawk

 

[gamerEMdoc]

which are these "low quality" residencies? so i can throw an app their way lol

I don't know about low quality, some of the less competitive programs offer great training. Generally community programs not in cities nor touristy locations are way less competitive.

 

[takeurmeds02]

It can help the process if your first two sloes arent great. But if your first two sloes are good sloes (top 1/3 or above) it adds nothing and always risks there being a blindsided bad sloe. If you already have a ton of interviews based on your first two, then they are good and a third sloe, even if its also good doesnt add much. The only thing it can do is hurt, so why take the risk?

Now, if one of your first sloes is good and one is mediocre, a third can act as a tie breaker for ranking.

Idk, I dont think adding a 3rd usually makes sense if you get success with the first two. Programs have already made their opinion based on your first two. If its a good opinion, then the risk/benefit of a 3rd doesnt add anything and can only hurt you if its unexpectedly bad.

Was thinking the same thing, thanks!

 

[The Knife & Gun Club]

which are these "low quality" residencies? so i can throw an app their way lol

my barometer is if you need to google the name of the city to know what state it’s in, then that’s what you’re looking for lol.

and it’s not so much low quality as low competition. You can get some amazing training without being very competitive if you’re willing to go places most other applicants aren’t.

I did one of my aways in a town that’s 3 hours from the nearest major population center, where most of the residents were IMGs, from smaller DO schools, or career switchers. And their training/acuity/skill level seemed just as good as the big name top Doximity program I went to after (admitted as a student I’m sure there’s intricacies I missed).

EM is a field where there seems to be quite a few diamonds in the rough.

 

[The Knife & Gun Club]

What are everyones thoughts on rejections this early in the season? I got a couple over the last few days, one from an affiliate school/other campus of one of my aways.

I’ve had an otherwise solid yield so far, but something just unnerves me about getting an R In October from the sister campus of a place I got a SLOE from.

I know it’s all just trying to read the tea leaves but I’ve got nothing better to worry about on my Saturday night.

 

[gamerEMdoc]

What are everyones thoughts on rejections this early in the season? I got a couple over the last few days, one from an affiliate school/other campus of one of my aways.

I’ve had an otherwise solid yield so far, but something just unnerves me about getting an R In October from the sister campus of a place I got a SLOE from.

I know it’s all just trying to read the tea leaves but I’ve got nothing better to worry about on my Saturday night.

Dont read too much into it. Spots are limited everywhere, so getting rejected from a single place while doing well as a whole isnt worrisome. Almost 1/3 or more of our spots go to people that rotate. Theres only so many spots left to go around for 800 some applicants. You cant interview everyone.

 

[STEMI_voy]

How much would something like an absurdly low number of vacation days (eg, 9-12, with avg at other programs being around 21) dissuade you from an otherwise perfect program? Is it really worth taking this into consideration?

 

[8741empls]

How much would something like an absurdly low number of vacation days (eg, 9-12, with avg at other programs being around 21) dissuade you from an otherwise perfect program? Is it really worth taking this into consideration?

What do you mean by otherwise perfect? Is resident wellness/happiness otherwise emphasized? I don’t mean buzzword talking points, powerpoints about yoga and meditation, and a candy drawer. Are residents valued and treated well and does it show in their demeanor? Or is this one signal that they aren’t treated fairly? Do they also work >20/28 days with 10-12 hour shifts for 3 years? Do the residents seem worn out? The number of vacation days wouldn’t kill it for me but it would certainly be one thing to consider when imagining what life would be like as a resident.

 

[gamerEMdoc]

my barometer is if you need to google the name of the city to know what state it’s in, then that’s what you’re looking for lol.

and it’s not so much low quality as low competition. You can get some amazing training without being very competitive if you’re willing to go places most other applicants aren’t.

I did one of my aways in a town that’s 3 hours from the nearest major population center, where most of the residents were IMGs, from smaller DO schools, or career switchers. And their training/acuity/skill level seemed just as good as the big name top Doximity program I went to after (admitted as a student I’m sure there’s intricacies I missed).

EM is a field where there seems to be quite a few diamonds in the rough.

You 100% nailed it. So often competitive programs often are only competitive because of their location, not their experience. Im sure there experience is great too, but thats not the reason they can stack their classes with the top tier students they get.

As a proud member of the “middle of nowhere” club, I can tell you, we have had a first time board pass rate of over 95% (1 failure in a decade who passed the second time) and 100% for the oral boards. Way over the national average. Despite a match where Comlex scores in the 400-500 is still competitive and Usmle scores of 210.

An MD grad with 250 boards just aren't going to apply unless they are from our town. It is what it is. But it doesn't matter to me. We find great clinical gems others choose to overlook year in and year out and turn out excellent graduates. I’d go to battle with my graduates in any ED any day.

 

[Apollyon]

You 100% nailed it. So often competitive programs often are only competitive because of their location, not their experience. Im sure there experience is great too, but thats not the reason they can stack their classes with the top tier students they get.

As a proud member of the “middle of nowhere” club, I can tell you, we have had a first time board pass rate of over 95% (1 failure in a decade who passed the second time) and 100% for the oral boards. Way over the national average. Despite a match where Comlex scores in the 400-500 is still competitive and Usmle scores of 210.

An MD grad with 250 boards just aren't going to apply unless they are from our town. It is what it is. But it doesn't matter to me. We find great clinical gems others choose to overlook year in and year out and turn out excellent graduates. I’d go to battle with my graduates in any ED any day.

"Talk is talk, but the biscuit speaks for the cook". Believe it or don't, but that was Andrew Taylor Still.

 

[LawnChair]

You 100% nailed it. So often competitive programs often are only competitive because of their location, not their experience. Im sure there experience is great too, but thats not the reason they can stack their classes with the top tier students they get.

As a proud member of the “middle of nowhere” club, I can tell you, we have had a first time board pass rate of over 95% (1 failure in a decade who passed the second time) and 100% for the oral boards. Way over the national average. Despite a match where Comlex scores in the 400-500 is still competitive and Usmle scores of 210.

An MD grad with 250 boards just aren't going to apply unless they are from our town. It is what it is. But it doesn't matter to me. We find great clinical gems others choose to overlook year in and year out and turn out excellent graduates. I’d go to battle with my graduates in any ED any day.

I hope I applied to your program

 

[Drdan007]

I hope I applied to your program

Lol I have been thinking the same, I hope @Apollyon is right and you are in PA!

 

[Apollyon]

Lol I have been thinking the same, I hope @Apollyon is right and you are in PA!

I know, but, I ain't tellin'!

 

[gamerEMdoc]

I know, but, I ain't tellin'!

I don’t know what yinz guys like apollyon are talking about regarding my dialect.

 

[FMER]

Hello everybody,

I got an email informing me I am on the wait list. Its through the interview broker, any advice what I need to do?

 

[attitudeofgratitude]

I don’t know what yinz guys like apollyon are talking about regarding my dialect.

Wait I thought everyone was saying you were at a Philly area. My family is all in Pitt and I've heard zero from west PA programs. Might need to CC the APDs with these LOI I'm about to fire off....

So how many total? Sorry to hear that but if you’re at 5-7ish right now you will match

Yea, my overall number is fine. It's just frustrating that none of these places have graduated classes, so how can you really tell how good the training is? Looking in the thread on the new PHX program and eveyrone trashing new programs. Then again I guess it'd be a lot more frustrating if there WEREN'T new programs and my interview total was 2.

 

[tinaboo27]

Long shot but if anyone was wait-listed in ERAS for the Oak Hill Hospital program in Brooksville, FL, I just cancelled my interview on Jan 16th. It's the only spot open currently so take it if you want it.

 

[gamerEMdoc]

Wait I thought everyone was saying you were at a Philly area. My family is all in Pitt and I've heard zero from west PA programs. Might need to CC the APDs with these LOI I'm about to fire off....

Philly. Good god no I was born and raised a yinzer. Shoot me a PM. I thought I looked at every in state app in existence, but maybe I missed some folks.

 

[boolin_1]

rising 3rd year interested in EM. rooting for all of you guys.

 

[Listen2Savage]

rising 3rd year interested in EM. rooting for all of you guys.

I'll take it, thanks bro

 

[Stephanopolous]

I did one of my aways in a town that’s 3 hours from the nearest major population center, where most of the residents were IMGs, from smaller DO schools, or career switchers. And their training/acuity/skill level seemed just as good as the big name top Doximity program I went to after (admitted as a student I’m sure there’s intricacies I missed).

EM is a field where there seems to be quite a few diamonds in the rough.

Agree, I had a great experience doing a sub-I at a place that is notoriously bad mouthed on these forums due to its HCA status. Honestly, as a student trying to figure all of this out, I think there's no better way to know about these places than to go there for yourself and make your own opinion.

 

[gamerEMdoc]

Agree, I had a great experience doing a sub-I at a place that is notoriously bad mouthed on these forums due to its HCA status. Honestly, as a student trying to figure all of this out, I think there's no better way to know about these places than to go there for yourself and make your own opinion.

Everyone has different things that are important to them in this process. Ultimately your rank list is your own. It should always be based on the things you value or your own experiences. Talking to people about their opinions of places is important, but in the end those opinions are jaded by their own things they value, and it may not align with your own.

 

[MrsDoctor90]

Is there Anyway students can review there entire application? Currently sitting at 1 interview and trying to strategize these next couple months.

 

[boolin_1]

lol I check this thread all the time and I feel for all your anxiety. keep on truckin

 

[Stephanopolous]

Is there Anyway students can review there entire application? Currently sitting at 1 interview and trying to strategize these next couple months.

you can print it off on ERAS to review if that's what you're looking to do. Otherwise I would say try and get with a school advisor or a mentor associated with a a residency program so maybe they can give you an overall idea of what's up by looking at your app on their end. I believe it would need to be someone from a program you applied to but not 100% sure on that.

 

[gamerEMdoc]

Is there Anyway students can review there entire application? Currently sitting at 1 interview and trying to strategize these next couple months.

you can print it off on ERAS to review if that's what you're looking to do. Otherwise I would say try and get with a school advisor or a mentor associated with a a residency program so maybe they can give you an overall idea of what's up by looking at your app on their end. I believe it would need to be someone from a program you applied to but not 100% sure on that.

At this point, if you are sitting at one interview, the problem isn't something you are going to see in reviewing your ERAS app. It's in your SLOEs. You have something in at least one, if not more than one, that is scaring programs away.

 

[Listen2Savage]

hey @gamerEMdoc, my first away didnt write me a SLOE

I handed out the "forms" after shifts instead of during didactics, sure a lot of people just forgot to do them.

Overall it was a good rotation, came in on days off, got good feedback from residents, no reason why they would just ghost me.

During interviews should I address this or only if the interviewer brings it up?

Currently have 7 IVs, with 2 other strong SLOEs, thanks

 

[gamerEMdoc]

hey @gamerEMdoc, my first away didnt write me a SLOE

I handed out the "forms" after shifts instead of during didactics, sure a lot of people just forgot to do them.

Overall it was a good rotation, came in on days off, got good feedback from residents, no reason why they would just ghost me.

During interviews should I address this or only if the interviewer brings it up?

Currently have 7 IVs, with 2 other strong SLOEs, thanks

So wait you sent a sloe request and they just never wrote it? Did they say why? That seems odd for a program to just flat out not write one.

I wouldnt even bring it up. You need 2 sloes. You have 2 sloes. You’d just be wasting valuable interview time trying to explain something that is irrelevant at that point aince you have 2 sloes. If someone brings it up, then you can explain it. But otherwise dont worry about it.

 

[Listen2Savage]

So wait you sent a sloe request and they just never wrote it? Did they say why? That seems odd for a program to just flat out not write one.

I wouldnt even bring it up. You need 2 sloes. You have 2 sloes. You’d just be wasting valuable interview time trying to explain something that is irrelevant at that point aince you have 2 sloes. If someone brings it up, then you can explain it. But otherwise dont worry about it.

thanks thats good to hear

I take ownership of not getting the SLOE... but the program was unprofessional as fawk, still haven't sent out IVs.

One of my forms was given to the cheif and then lost, others failed to do them/turn them in

played catch up trying to get them all in with the coordinator telling me tough titties

 

[gamerEMdoc]

thanks thats good to hear

I take ownership of not getting the SLOE... but the program was unprofessional as fawk, still haven't sent out IVs.

One of my forms was given to the cheif and then lost, others failed to do them/turn them in

played catch up trying to get them all in with the coordinator telling me tough titties

Man that is unbelievable. I just always assume other places are as OCD about this as I am about getting these out on time.

 

[MedDoctor92]

I have 9 IVs + 3 (from places I rotated). I haven't heard back from about 3/4 of my top programs. I was at ACEP and was told not to send emails of interests. Should I just do it? Around what time should I give up on my other top programs? I understand I am at an advantageous place with my number of IVs and I dont plan to go on any more than 10-11 (non home, non away) IVs but I would just like to know what to expect.

Thanks!

 

[gamerEMdoc]

I have 9 IVs + 3 (from places I rotated). I haven't heard back from about 3/4 of my top programs. I was at ACEP and was told not to send emails of interests. Should I just do it? Around what time should I give up on my other top programs? I understand I am at an advantageous place with my number of IVs and I dont plan to go on any more than 10-11 (non home, non away) IVs but I would just like to know what to expect.

Thanks!

You have 12 interviews. You don't need any more. There is still plenty of time to get more interviews, but you don't need any more. If your dream programs come through, and allow you to drop one of your others great. Otherwise, you are just fine where you are.

Here's the thing, many programs get annoyed by LOIs. That's a risk you run by emailing them. It may backfire on you, and if you have an app that they were waiting on inviting you for, and you annoy them by emailing and hounding them, it may have the opposite effect you want. LOIs won't help everywhere, and may only help at some places. So why do some people get advised to send them? Well, if you are sitting on say 4 interviews right now, and LOIs do help at SOME programs, what's to lose at that point. But if you are already in a good position, chances are you still may get an interview at those dream places. Personally, I wouldn't risk annoying them at this point. If you want to email in December if you haven't heard from them, then great, at that point there's little to lose.