Advice For Late Switch (PGY1) To EM

[Detective SnowBucket]

Unmatched after applying 50+ DR programs and 1 IR program this cycle. I only got 5 DR interviews and 1 IR interview and only matched a TY.
I enjoyed my EM rotations and think it would be a cool career and there's no other specialty I could see myself in if I don't match rads again.

I'm a PGY1 now, my program said I would get 1 SLOE from them, I'll try to get an LOR from an EM attending when I do my EM rotation in 2 weeks and I'll have a letter from my TY PD so I should have the most basic requirements on that front. Any thoughts on how to not go unmatched again when EM PD's look at my cv and can clearly see I'm an unmatched rads re-applicant?

Anyways:
School: Solid state MD school.
Step 1: Pass
Step 2: 252
Pre-clinical: All pass and 1 high pass
Clinical grades: H in Obgyn, PC in psych & IM, the rest pass
Class ranking: no ranking
AOA: No
Awards: Small scholarship from school.

Research:
- 2 textbook chapters in pharmacology (random but I was told it was high reward so I applied for the team)
- 1 review article I wrote (3rd author) in college that got published when I was an M2
- 4 DR poster presentations from 1 long project (where I was anywhere from 1st to 4th author)
- 2 posters for DR case studies
- 1 poster from IR research
- I included a podium presentation I gave in college in humanities research because it was a plenary. idk it was cool.
- zero EM involvement

EC's:
- VP of IR club
- Lots of sports and some niche hobbies that all the interviewers loved to hear about

Goal: matched
What are my odds for round 2.

Addendum: after reading replies about why I didn't match radiology and not about my competitiveness for EM, I think I received so few interviews because I was gunning for IR the whole 4 years and only at the last moment switched to DR and applied to only one stand-out IR program that I had connections to.
This cycle, I will be applying to primarily IR over DR programs with a healthy dose of EM spots as backup. But the question remains, how many EM programs should I apply to?

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[mmmnmmm]

Unmatched after applying 50+ DR programs and 1 IR program this cycle. I only got 5 DR interviews and 1 IR interview and only matched a TY.
I enjoyed my EM rotations and think it would be a cool career and there's no other specialty I could see myself in if I don't match rads again.

I'm a PGY1 now, my program said I would get 1 SLOE from them, I'll try to get an LOR from an EM attending when I do my EM rotation in 2 weeks and I'll have a letter from my TY PD so I should have the most basic requirements on that front. Any thoughts on how to not go unmatched again when EM PD's look at my cv and can clearly see I'm an unmatched rads re-applicant?

Anyways:
School: Solid state MD school.
Step 1: Pass
Step 2: 252
Pre-clinical: All pass and 1 high pass
Clinical grades: H in Obgyn, PC in psych & IM, the rest pass
Class ranking: no ranking
AOA: No
Awards: Small scholarship from school.

Research:
- 2 textbook chapters in pharmacology (random but I was told it was high reward so I applied for the team)
- 1 review article I wrote (3rd author) in college that got published when I was an M2
- 4 DR poster presentations from 1 long project (where I was anywhere from 1st to 4th author)
- 2 posters for DR case studies
- 1 poster from IR research
- I included a podium presentation I gave in college in humanities research because it was a plenary. idk it was cool.
- zero EM involvement

EC's:
- VP of IR club
- Lots of sports and some niche hobbies that all the interviewers loved to hear about

Goal: matched
What are my odds for round 2.

If your SLOEs are strong, you will match. If your SLOEs are terrible you won’t. If they are middling you’ll probably match somewhere. Main thing is weaving a compelling story for why you’ve had a change of heart. Apply broadly. Get your letters/SLOEs to convey your genuine interest in the field through strong performance, work ethic, and interest.

 

[cyanide12345678]

If you apply to enough programs you will match given how uncompetitive EM has become.

Just shell out 5k and apply to hundreds of programs

If i was you though, id apply both diagnostic rads and ER. Spend basically all my money, 100+ programs for each. So atleast 200 programs that you apply to. Realistically you got 6 invites with 50 applications, if you applied to 100+ programs and 100 EM programs as backup, you will get in.

It’s a numbers game. On paper, 9 interviews is a 98 percent chance of matching.

Id save very aggressively during intern year and be ready to spend 5-6k on the next application cycle.

 

[hoot504]

How did you not match DR? Seems like you should have

 

[Rekt]

I’d recommend against it. If you’re the type to go into DR then you’ll hate almost everything single thing about EM. You likely remember the procedure aspects but nothing else and that’s like 1% of the job. Your app is obviously geared towards DR and will do you no favors for EM but it’s essentially so uncompetitive and dead some trash can HCA programs will take anyone with a pulse.

I’d recommend IM and do some type of fellowship if I was in your shoes.

 

[RustedFox]

I’d recommend against it. If you’re the type to go into DR then you’ll hate almost everything single thing about EM. You likely remember the procedure aspects but nothing else and that’s like 1% of the job. Your app is obviously geared towards DR and will do you no favors for EM but it’s essentially so uncompetitive and dead some trash can HCA programs will take anyone with a pulse.

I’d recommend IM and do some type of fellowship if I was in your shoes.

Quoted for truth.

 

[EctopicFetus]

If you didn’t match DR I would find out why. Something on your app is a red flag. Agree with others. It’s unlikely you will like EM.

 

[WhatJobDoIPick]

Unmatched after applying 50+ DR programs and 1 IR program this cycle. I only got 5 DR interviews and 1 IR interview and only matched a TY.
I enjoyed my EM rotations and think it would be a cool career and there's no other specialty I could see myself in if I don't match rads again.

I'm a PGY1 now, my program said I would get 1 SLOE from them, I'll try to get an LOR from an EM attending when I do my EM rotation in 2 weeks and I'll have a letter from my TY PD so I should have the most basic requirements on that front. Any thoughts on how to not go unmatched again when EM PD's look at my cv and can clearly see I'm an unmatched rads re-applicant?

Anyways:
School: Solid state MD school.
Step 1: Pass
Step 2: 252
Pre-clinical: All pass and 1 high pass
Clinical grades: H in Obgyn, PC in psych & IM, the rest pass
Class ranking: no ranking
AOA: No
Awards: Small scholarship from school.

Research:
- 2 textbook chapters in pharmacology (random but I was told it was high reward so I applied for the team)
- 1 review article I wrote (3rd author) in college that got published when I was an M2
- 4 DR poster presentations from 1 long project (where I was anywhere from 1st to 4th author)
- 2 posters for DR case studies
- 1 poster from IR research
- I included a podium presentation I gave in college in humanities research because it was a plenary. idk it was cool.
- zero EM involvement

EC's:
- VP of IR club
- Lots of sports and some niche hobbies that all the interviewers loved to hear about

Goal: matched
What are my odds for round 2.

Maybe didn't match Rads cause of clinical grades? Seems weird.

Anyway, EM sucks I would not advise anyone to start down the EM road in 2024.

I also advise IM with likely Cards fellowship if you like imaging (echo) or procedures (interventional). Interventional pulm is really cool too.

 

[Apollyon]

Advice? Don't.

EM almost killed me (literally). Don't do it.

 

[Kryptocoin]

554 spots went unmatched in 2023. 135 spots unfilled in 2024. EM is getting more competitive . Seems like applicants are not listening to SDN.

 

[risus_sardonicus]

554 spots went unmatched in 2023. 135 spots unfilled in 2024. EM is getting more competitive . Seems like applicants are not listening to SDN.

It’s not competitive those are IMGs and failed prior applicants like OP taking those spots that once were so recently coveted

 

[DeadCactus]

554 spots went unmatched in 2023. 135 spots unfilled in 2024. EM is getting more competitive . Seems like applicants are not listening to SDN.

I think that more reflects programs having a wake-up call and realizing they're previous recruiting, interview, and ranking strategies needed to change more than anything.

 

[Groove]

Dude, not only have I never seen a radiology resident switch to EM, I've never even heard of it. Unless you've had some sort of Phineas Cage injury to your frontal lobe that has drastically altered your personality, I'd wholeheartedly recommend against it as there's no way you'd thrive in EM if Rads was your initial choice. Hell, those of us who picked EM as first choice are barely thriving.

 

[Detective SnowBucket]

If you apply to enough programs you will match given how uncompetitive EM has become.

Just shell out 5k and apply to hundreds of programs

If i was you though, id apply both diagnostic rads and ER. Spend basically all my money, 100+ programs for each. So atleast 200 programs that you apply to. Realistically you got 6 invites with 50 applications, if you applied to 100+ programs and 100 EM programs as backup, you will get in.

It’s a numbers game. On paper, 9 interviews is a 98 percent chance of matching.

Id save very aggressively during intern year and be ready to spend 5-6k on the next application cycle.

Is that 9 for DR or for EM? If for EM, how many applications to get in that range?

 

[Detective SnowBucket]

If you apply to enough programs you will match given how uncompetitive EM has become.

Just shell out 5k and apply to hundreds of programs

If i was you though, id apply both diagnostic rads and ER. Spend basically all my money, 100+ programs for each. So atleast 200 programs that you apply to. Realistically you got 6 invites with 50 applications, if you applied to 100+ programs and 100 EM programs as backup, you will get in.

It’s a numbers game. On paper, 9 interviews is a 98 percent chance of matching.

Id save very aggressively during intern year and be ready to spend 5-6k on the next application cycle.

That was my thinking too, however, residency started in July which means I only have 6-7 pay periods to save enough up and I simply won't be able to spend more than 4k I think. he only other thing I have to consider is where all this time off rotations is going to come from if I apply to >200 programs this cycle all specialties included. Coordinator is not going to be happy with me.

 

[Detective SnowBucket]

If you didn’t match DR I would find out why. Something on your app is a red flag. Agree with others. It’s unlikely you will like EM.

I've liked my EM rotations so far. In 2 weeks I will be doing a month of EM as a PGY-1 so I hope that's a realistic look at the life of an EM resident. Also, I was shooting for IR the whole 4 years of med school and only switched to DR at the last minute and I do think that's a big difference in personality.

 

[Detective SnowBucket]

I think that more reflects programs having a wake-up call and realizing they're previous recruiting, interview, and ranking strategies needed to change more than anything.

what do you predict them doing? I've also heard that they kind of got the bottom of the barrel in terms of applicants and have been less than pleased with their residents' performance at many short of the top programs.

 

[Detective SnowBucket]

If your SLOEs are strong, you will match. If your SLOEs are terrible you won’t. If they are middling you’ll probably match somewhere. Main thing is weaving a compelling story for why you’ve had a change of heart. Apply broadly. Get your letters/SLOEs to convey your genuine interest in the field through strong performance, work ethic, and interest.

I have no idea what even goes into a SLOE. What do I do to stand out? How should I "study" for my EM rotation in 2 weeks?

 

[odyssey2]

How did you not match DR? Seems like you should have

DR has gotten much more competitive in recent years. OP still has a really good shot but it's a different ballgame now.

 

[HemorrhagicShock]

OP, If I were in your position, I would rather do as many surgical/TY prelim years as needed, trying each of those years to apply DR while addressing your deficiencies, than do EM.

That is how bad the specialty and the outlook have gotten.

Diagnostic Radiology is a far better specialty in every single category that could be evaluated when choosing a specialty.

Better work environment. Better pay. Better colleagues (you're the doctor's doctor, and you do not have to deal with low-brow homeless patients or angry Karens pissed that you can't place a port in the ED for her daughter's POTS/EDS for home fluid administration). Better specialty outlook.

Please do whatever you can to continue your path to Radiology (or anesthesiology if you want more hands-on or clinical aspects to your practice).

Whatever you do, DON'T waste your life making a brash last-minute decision to enter a specialty that you only know superficially.

Don't ruin your life; don't throw away the tuition and hard work you've put into your career thus far.

 

[Porfirio]

HCA is going to be using Viz AI to diagnose PEs and LVOs (this will expand). DR needs to adapt fast. The lack of DR docs is going to crush them like CT surgery not learning heart cath/TVAR and allowing IM-Cards to take that over.

I would go IR or IM-fellowship.

 

[Detective SnowBucket]

HCA is going to be using Viz AI to diagnose PEs and LVOs (this will expand). DR needs to adapt fast. The lack of DR docs is going to crush them like CT surgery not learning heart cath/TVAR and allowing IM-Cards to take that over.

I would go IR or IM-fellowship.

I dual applied IR/DR but changed course last minute and applied almost solely DR while I had been gearing my CV towards IR for the last 4 years.

But yea, my current institution already uses some sorta AI for PE's to alert the PERT team before a radiologist ever looks at the scan.

 

[Detective SnowBucket]

OP, If I were in your position, I would rather do as many surgical/TY prelim years as needed, trying each of those years to apply DR while addressing your deficiencies, than do EM.

That is how bad the specialty and the outlook have gotten.

Diagnostic Radiology is a far better specialty in every single category that could be evaluated when choosing a specialty.

Better work environment. Better pay. Better colleagues (you're the doctor's doctor, and you do not have to deal with low-brow homeless patients or angry Karens pissed that you can't place a port in the ED for her daughter's POTS/EDS for home fluid administration). Better specialty outlook.

Please do whatever you can to continue your path to Radiology (or anesthesiology if you want more hands-on or clinical aspects to your practice).

Whatever you do, DON'T waste your life making a brash last-minute decision to enter a specialty that you only know superficially.

Don't ruin your life; don't throw away the tuition and hard work you've put into your career thus far.

If I don't get into IR or DR again, I think I'd go into EM and do that for as long as I need to pay off my debt because if I don't get into IR/DR I think I'd leave medicine all together. I may just use EM as a job until I have the freedom to seek another job outside of medicine.
But yea, grass is always greener and I can't guarantee I'd like consulting or pharma or IB/VC or biotech any more than EM but I can say for sure I'd rather be in radiology but that's not 100% up to me, I may get in, I may not. Idk, either rads or EM->jump ship. Do you think it's so intolerable I'd regret staying even long enough to pay off my debt?

Now, the other thing is, I could see myself doing a fellowship after EM, namely PCCM or pain. Could maybe tolerate that enough to do as a career.

 

[Kryptocoin]

We've been using AI to read prelims at my facility for time sensitive studies. Accuracy so far is 99.9%. Human eyes still needed for final read but we don't wait for it to act. This could affect the radiology job market in the future.

For now rad>> EM but who knows what the future and AI brings.

 

[cyanide12345678]

We've been using AI to read prelims at my facility for time sensitive studies. Accuracy so far is 99.9%. Human eyes still needed for final read but we don't wait for it to act. This could affect the radiology job market in the future.

For now rad>> EM but who knows what the future and AI brings.

Is it almost an instant read from the AI bot?

 

[Brigade4Radiant]

We've been using AI to read prelims at my facility for time sensitive studies. Accuracy so far is 99.9%. Human eyes still needed for final read but we don't wait for it to act. This could affect the radiology job market in the future.

For now rad>> EM but who knows what the future and AI brings.

If that’s the case doctors in general are on the chopping block just have a NP and pan scan and overtest

When AI replaces Rad they will go after admin and CEO

 

[Apollyon]

Dude, not only have I never seen a radiology resident switch to EM, I've never even heard of it. Unless you've had some sort of Phineas Cage injury to your frontal lobe that has drastically altered your personality, I'd wholeheartedly recommend against it as there's no way you'd thrive in EM if Rads was your initial choice. Hell, those of us who picked EM as first choice are barely thriving.

There was a resident at SUNY Buffalo 25 years ago that I think started in Ortho, then went to rads, then went to EM, where he completed residency (finally). I remember the guy, because he physically assaulted me in the ED when I didn't immobilize a 90+ year old woman that had fallen - because she was an arthritic mess that I would have literally broken osteophytes to get her head on the backboard.

But he def came from rads before EM.

 

[WhatJobDoIPick]

I think there's a major grass is greener phenomenon going on here.

However, I wouldn't start down the EM path in 2024.

To be honest though, I wouldn't start down the medicine in general path in 2024.

It's just too much sacrifice in exchange for too much abuse and not enough money.

 

[dozitgetchahi]

I've liked my EM rotations so far. In 2 weeks I will be doing a month of EM as a PGY-1 so I hope that's a realistic look at the life of an EM resident. Also, I was shooting for IR the whole 4 years of med school and only switched to DR at the last minute and I do think that's a big difference in personality.

I’ll share that I was kinda sorta in your shoes as a med student.

Rads was one of my first 3rd year rotations, and I really liked it. I was going to pursue it at first, until I kinda realized that I liked clinic too and wanted to see patients. So I did IM => rheumatology and I’m happy with it. But I still like reviewing imaging and always check out all the x-rays, CTs, etc that I ordered.

At no time did I enjoy EM. I’m not real fond of chaos, procedures, etc. I didn’t like my ICU rotations as an IM resident. I like the clinic - I like being able to go more slowly and think about things. I think that’s part of why I liked radiology too - I was going to be able to spend a lot of time quietly doing work.

I second the poster who suggested IM and some sort of fellowship, if you don’t match rads. EM is just drastically different than DR.

 

[watermanMD]

Bro, just…don’t.

 

[Detective SnowBucket]

At no time did I enjoy EM. I’m not real fond of chaos, procedures, etc. I didn’t like my ICU rotations as an IM resident. I like the clinic - I like being able to go more slowly and think about things.

I did enjoy my EM rotations, I enjoy the chaos, I love procedures. I am currently enjoying my ICU rotation as a prelim and I absolutely despise clinic, so

 

[Detective SnowBucket]

Bro, just…don’t.

but why.
If I don't get into IR again, I'd rather go EM->fellowship than IM-> fellowship (based on the ones I'd be competitive for)

 

[Detective SnowBucket]

I think there's a major grass is greener phenomenon going on here.

However, I wouldn't start down the EM path in 2024.

To be honest though, I wouldn't start down the medicine in general path in 2024.

It's just too much sacrifice in exchange for too much abuse and not enough money.

How is being an EM attending more sacrifice than being an IM attending? And as to the money thing, it looks like gen EM salary is comparable to hospitalist salary

 

[Detective SnowBucket]

For now rad>> EM but who knows what the future and AI brings.

100% I'd rather match IR this cycle but I could very well just not match again, radiology is competitive. That being said, what's a better backup? I hate clinic and do not want to be a hospitalist.

 

[Detective SnowBucket]

I think there's a major grass is greener phenomenon going on here.

^Likely. But on the other hand, I know it's not as good as getting into IR/DR but I may simply fail to match again.

However, I wouldn't start down the EM path in 2024.

Why EM specifically. Are you an EM attending/resident?

To be honest though, I wouldn't start down the medicine in general path in 2024.

^Agreed, too late for that now.

It's just too much sacrifice in exchange for too much abuse and not enough money.

I just need to pay off my loans they we'll reevaluate.

 

[dozitgetchahi]

I did enjoy my EM rotations, I enjoy the chaos, I love procedures. I am currently enjoying my ICU rotation as a prelim and I absolutely despise clinic, so

Do you like anesthesiology? Sounds like you’d be well suited to anesthesia, and that’s a better job than EM in the year 2024.

 

[EctopicFetus]

I think there's a major grass is greener phenomenon going on here.

However, I wouldn't start down the EM path in 2024.

To be honest though, I wouldn't start down the medicine in general path in 2024.

It's just too much sacrifice in exchange for too much abuse and not enough money.

I’m pretty down on EM but i dont know about this. Medicine is one field where you are literally guaranteed 300k if you are willing to work hard and you can be the working rich. Most docs and especially EM docs are the working rich. Lawyers don’t earn like we do. Neither do engineers. Your bottom of the barrel med school grad can make 300k.. bottom of the barrel law school grad may take a while to crack 6 figures. Additionally, the top 25% of lawyers make much less than the top 25% of docs but the top 1-2% of lawyers outearn the top 1-2% of docs.

In the end it is guaranteed high income, in EM you can work fairly little to earn a lot of money. Not hard to find a super easy EM job making 200/hr and work 100 hours a month and get to 240k a year. I mean not a lot of jobs like that especially when you dont have to do any work at home for those “easy” em jobs.

 

[Detective SnowBucket]

Do you like anesthesiology? Sounds like you’d be well suited to anesthesia, and that’s a better job than EM in the year 2024.

Yea anesthesia would be cool but that's a competitive field and I have nothing on my cv that makes me a competitive for it.

 

[WhatJobDoIPick]

^Likely. But on the other hand, I know it's not as good as getting into IR/DR but I may simply fail to match again.

Why EM specifically. Are you an EM attending/resident?

^Agreed, too late for that now.

I just need to pay off my loans they we'll reevaluate.

1) Oversupply. You can read more on other threads but there's a massive supply problem coming secondary to too many residencies.

2) Cuts to reimbursement. EM has received the biggest post inflation cut to pay of any specialty in recent past

3) nights, weekends, holidays. Awful.

4) system is designed to make you lose. You can't be good, fast, have high PG scores, bill well, and complete all your charts before going home. It's impossible.

If you can min/max into a good SDG or high paying locums it could be ok, but odds are you'll be a staff doc for a hospital or CMG...and that blows

 

[Angry Birds]

I’m going to get massively downvoted here but I’ll say it again: you all are doing a massive disservice to your field by constantly crapping all over it.

 

[Detective SnowBucket]

I’m going to get massively downvoted here but I’ll say it again: you all are doing a massive disservice to your field by constantly crapping all over it.

idk, maybe if the issue is oversupply the market will correct? crapping on field = fewer applicants? Also could just be filled with IMG's etc.

 

[HemorrhagicShock]

I’m going to get massively downvoted here but I’ll say it again: you all are doing a massive disservice to your field by constantly crapping all over it.

This is interesting.

How so?

How is it different than literally every other specialty in medicine who craps on EM constantly?

 

[WhatJobDoIPick]

I’m going to get massively downvoted here but I’ll say it again: you all are doing a massive disservice to your field by constantly crapping all over it.

I highly doubt us giving honest advice to a potential applicant is damaging the field more than it already has been.

Like I said, min/max into high paying locums or a good SDG and you could be fine.

 

[Kryptocoin]

Is it almost an instant read from the AI bot?

Yeah. Almost instant. Pretty awesome. Honestly, I think that's the future.


Telerads are a joke these days. Too slow.

 

[Angry Birds]

This is interesting.

How so?

How is it different than literally every other specialty in medicine who craps on EM constantly?

The difference is between us crapping on our own field and others doing it. The latter is even more reason for us not to do it and thereby validate it.

 

[WhatJobDoIPick]

The difference is between us crapping on our own field and others doing it. The latter is even more reason for us not to do it and thereby validate it.

You think us not validating it moves the needle at all? People crap on our field because it's become crap. Why spend your life being an intellectual, and then enter the most non-intellectual field in all of medicine? Where speed and customer service matter more than getting it right?

Now don't get me wrong, I've fully adopted the mindset that this is "just a job" and from that perspective, I think EM is mostly fine.

 

[Apollyon]

The difference is between us crapping on our own field and others doing it. The latter is even more reason for us not to do it and thereby validate it.

But their crapping and ours are for different reasons. They do it because all we do, to them, is add to their work, and we don't know their specialty as well as they do. Us, on the other hand, is all stated here and elsewhere in the forum.

 

[Angry Birds]

You think us not validating it moves the needle at all? People crap on our field because it's become crap. Why spend your life being an intellectual, and then enter the most non-intellectual field in all of medicine? Where speed and customer service matter more than getting it right?

Now don't get me wrong, I've fully adopted the mindset that this is "just a job" and from that perspective, I think EM is mostly fine.

“the most non-intellectual field in all of medicine”?

Really, with friends like this…

You really think dermatology is more intellectual? Anesthesia? Radiology?

Give me a break. Most fields become routine, algorithmic work.

Honestly, you guys are doing a huge disservice to your own field and your own standing.

 

[odyssey2]

but why.
If I don't get into IR again, I'd rather go EM->fellowship than IM-> fellowship (based on the ones I'd be competitive for)

You can pretty easily get into IR from DR if you match a program with ESIR (these slots tend to stay open because residents discover that DR is better..) or even not if you do a two year fellowship. If you match DR you can do IR.

 

[larpleston]

“the most non-intellectual field in all of medicine”?

Really, with friends like this…

You really think dermatology is more intellectual? Anesthesia? Radiology?

Give me a break. Most fields become routine, algorithmic work.

Honestly, you guys are doing a huge disservice to your own field and your own standing.

Seconded

If you want to do an intellectual specialty do medical genetics and make 120k a year, or do a functional neurosurgery fellowship and compete with 20 other boarded neurosurgeons for 1 open faculty position making 1/3 of a PP salary. We’ve got standard of care treatments and EBM in modern medicine. Nobody is reinventing the wheel and doing deep intellectual work day to day. Unless you’re a researcher it doesn’t matter your specialty, medicine is a trade that you practice. This is in no way unique to EM. Now back to real problems with the specialty like circadian disruption and uncertain job prospects…