Advice For Late Switch (PGY1) To EM

[Detective SnowBucket]

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.

I know, I applied very broadly to DR last time and I will again. DR is a very competitive field and I may not match it either.

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[Detective SnowBucket]

Now back to real problems with the specialty like…

...like how I'm gonna match

 

[WhatJobDoIPick]

...like how I'm gonna match

If you can't match EM in 2024 something is profoundly wrong

 

[Detective SnowBucket]

If you can't match EM in 2024 something is profoundly wrong

how many programs should someone with my stats and a late switch apply to? I don't wanna end up at HCA but I also don't think I'm a shoe-in for Stanford EM so where do I cut the list?

 

[always.chillin]

how many programs should someone with my stats and a late switch apply to? I don't wanna end up at HCA but I also don't think I'm a shoe-in for Stanford EM so where do I cut the list?

You’re dodging a bullet by avoiding Stanford. 4 year program and stuck with demanding ppl because “Stanford.” Consider yourself lucky.

 

[Detective SnowBucket]

You’re dodging a bullet by avoiding Stanford. 4 year program and stuck with demanding ppl because “Stanford.” Consider yourself lucky.

Stanford was obviously an euphemism. I already cut the 4-year programs from my list.

 

[BoardingDoc]

Stanford was obviously an euphemism. I already cut the 4-year programs from my list.

Euphemism

 

[hoot504]

If he used Stanford em as a stand in for ivory towers with obnoxious attendings and patients, no I think he understands what it means.

 

[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.

Quoted for truth.

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

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.

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.

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.

OK, with 14 days until applications are due, I've cut it down to 194 EM programs I'd be eligible to apply to. Should I cut it down further? How strong or middling of programs should I target, seeing as I'm a reapplicant from a different field?

(Yes, I will also be applying to >200 IR + DR positions BUT, I still may not match radiology again)

 

[RustedFox]

OK, with 14 days until applications are due, I've cut it down to 194 EM programs I'd be eligible to apply to. Should I cut it down further? How strong or middling of programs should I target, seeing as I'm a reapplicant from a different field?

(Yes, I will also be applying to >200 IR + DR positions BUT, I still may not match radiology again)

Hey, it's your funeral if you match EM.

 

[Detective SnowBucket]

Hey, it's your funeral if you match EM.

bub, if I don't match, I don't have a job.
I'll take EM over that.

 

[HemorrhagicShock]

If you:

A) Speak English
B) Have a pulse

and can't match EM in 2024 after carpet-bombing an application to 194 programs, then you should strongly consider doing something else with your life that doesn't involve patient care

 

[RustedFox]

bub, if I don't match, I don't have a job.
I'll take EM over that.

FM and IM would like a word.

 

[Detective SnowBucket]

If you:

A) Speak English
B) Have a pulse

and can't match EM in 2024 after carpet-bombing an application to 194 programs, then you should strongly consider doing something else with your life that doesn't involve patient care

Agreed. Now, what's a more financially manageable number to apply to?

 

[HemorrhagicShock]

Agreed. Now, what's a more financially manageable number to apply to?

10 if you're carefully selecting programs based on how competitive you are and how desirable the program is

20 if you're throwing darts at a board, and I think even that would be overkill as long as its not all super-desirable urban city programs

 

[Rekt]

Realistically around 50 programs. 10 or 20 is not enough these days imo.

 

[Detective SnowBucket]

Realistically around 50 programs. 10 or 20 is not enough these days imo.

That sounds reasonable. What tiers should I be aiming for? I'm truly jumping into the EM game at the last second and have no idea where I stand.

 

[EctopicFetus]

Realistically around 50 programs. 10 or 20 is not enough these days imo.

Why? Super non competitive

 

[Dr. Pineal Gland]

Hey, it's your funeral if you match EM.

why are you still practicing EM if you just **** on it for a living on the internet? Working at an Urgent care or doing something else isn't an option? Not insulting just curious.

 

[EthylMethylMan]

why are you still practicing EM if you just **** on it for a living on the internet? Working at an Urgent care or doing something else isn't an option? Not insulting just curious.

It’s a lot easier to start in a better specialty as opposed to jumping there from EM after you’re an attending. That’s why a lot of the attendings on here try to be brutally honest with med students. It’s only gonna get harder to jump ship.

 

[Apollyon]

why are you still practicing EM if you just **** on it for a living on the internet? Working at an Urgent care or doing something else isn't an option? Not insulting just curious.

By saying "Working at an Urgent care" means you don't know about which you speak.

 

[RustedFox]

why are you still practicing EM if you just **** on it for a living on the internet? Working at an Urgent care or doing something else isn't an option? Not insulting just curious.

1. When I started EM 15 years ago, it was something completely different.

2. Doing something else is an option. However, it's a very difficult option to pursue. I started my "exit plan" about two years ago and and am parlaying myself out of EM and into something else. I will probably share my escape plan after I've escaped, because right now, it wouldn't be wise to do so.

3. I was once (probably) a lot like you are, and I wish I would have listened to the "people like me on the internet" 15 years ago, just like so many others on this forum. But, here I am.

4. Urgent care is where all medicine goes to die. I need something far more cerebral.

 

[Dr. Pineal Gland]

1. When I started EM 15 years ago, it was something completely different.

2. Doing something else is an option. However, it's a very difficult option to pursue. I started my "exit plan" about two years ago and and am parlaying myself out of EM and into something else. I will probably share my escape plan after I've escaped, because right now, it wouldn't be wise to do so.

3. I was once (probably) a lot like you are, and I wish I would have listened to the "people like me on the internet" 15 years ago, just like so many others on this forum. But, here I am.

4. Urgent care is where all medicine goes to die. I need something far more cerebral.

I see. Thanks for the response. What specialty do you wish you considered more and why?

 

[Dr. Pineal Gland]

Well I know a few docs that went that route, some go on to own their own or franchise them. Some transitioned into it later on even though it was always cough and cold stuff.

By saying "Working at an Urgent care" means you don't know about which you speak.

 

[Apollyon]

Well I know a few docs that went that route, some go on to own their own or franchise them. Some transitioned into it later on even though it was always cough and cold stuff.

Urgent care is where you go to get moldy. It's soul crushing from the absolute boredom.

 

[RustedFox]

I see. Thanks for the response. What specialty do you wish you considered more and why?

Right on. I'll also take the time to say I'm not being adversarial in my response. - It's often difficult to strike the correct tenor on here.
Your question is totally valid, and I am one of the more outspoken anti-EM people on here.

IM/FM/Anes.
Why? Far more flexibility in practice setting, variability, autonomy, etc.
An ER doc... needs an ER.

 

[Dr. Pineal Gland]

Right on. I'll also take the time to say I'm not being adversarial in my response. - It's often difficult to strike the correct tenor on here.
Your question is totally valid, and I am one of the more outspoken anti-EM people on here.

IM/FM/Anes.
Why? Far more flexibility in practice setting, variability, autonomy, etc.
An ER doc... needs an ER.

No worries, no offense taken.

I am on IM rotation right now and I am totally bored. After morning rounds you’re sitting there chart surfing and monotonously putting in Orders.
Outpatient clinic bores me and dealing with overhead is a **** show. Insurance, follow up issues, etc.

Probably a sign of ADD, but I like procedures and always have something to tend to. I like the acuity and working things up rather than managing. I enjoy the pace of it. Anesthesia was a bit slower paced and I didn’t like working with a surgeon for a living. I’ll explore other options when the time comes but for the pay and nature of the job it’s more to my persona. Perhaps I am going in naive but I just can’t get excited about anything else.
Maybe critical care fellowship but through EM if I have to have some type of slow down of pace when I’m older. So it goes.

 

[RustedFox]

No worries, no offense taken.

I am on IM rotation right now and I am totally bored. After morning rounds you’re sitting there chart surfing and monotonously putting in Orders.
Outpatient clinic bores me and dealing with overhead is a **** show. Insurance, follow up issues, etc.

Probably a sign of ADD, but I like procedures and always have something to tend to. I like the acuity and working things up rather than managing. I enjoy the pace of it. Anesthesia was a bit slower paced and I didn’t like working with a surgeon for a living. I’ll explore other options when the time comes but for the pay and nature of the job it’s more to my persona. Perhaps I am going in naive but I just can’t get excited about anything else.
Maybe critical care fellowship but through EM if I have to have some type of slow down of pace when I’m older. So it goes.

@Rekt had such a good paragraph on EM that I copied it down and saved it to a word file:


"Do emergency medicine if you want weekly homicidal threats against you and your staff, police dumping off meth heads and alcoholics so it’s not their problem, constant revolving door of “psych” patients that are beyond unfixable (plot twist: 99% of the time it’s drugs!), constant barrage of patients that take zero accountability for their health and can barely walk to the bathroom at baseline wanting you to fix all their problems, grown ass adults screaming like children for their pain meds or because the call light isn’t immediately answered, daughter from California syndrome dropping off 98 year old grandpa Joe at 2am demanding an MRI for chronic lightheadedness, Jabba the hut nursing home dumps most with missing limbs and dementia, seeing an uncountable amount of 20-40 year olds with neon hair, neck tattoos, and dirty pajamas with extremely vague chest or abdominal pain that’s really just somatization of mental illness or childhood abuse, critical drug shortages, staffing shortages, complete ED nursing turnover every 6-18mo because it’s such a beat down, boarding, corporations, incompetent administration, absurd metrics not based in reality (I resuscitated a dying young peds pt with brain tumor hypoxic arrest from aspiration and i got a extremely positive patient eval saying i saved their kid but it was 8/10 instead of 9 so it counted as a negative), incompetent mid levels, VIPs that have already called 8 consultants before they got there because ER docs are too dumb to do anything, absolute sheer disrespect from every other physician in the hospital and outpatient too (not that any of them could even last 30 minutes in a real ED without pissing their pants), decreasing pay yearly (because you essentially start at your max and you’re never getting a raise with inflation) increasing post Covid litigation, your employment contract being handed around like a hooker in Vegas, and most importantly the market that WILL be flooded in the next 8 years, etc

Could go on for ages. There’s no reason to do EM. I used to have the immature thoughts of hurr durr clinic is boring, 9-5 is boring, etc. you know what sounds better than anything right now? 250-400k working 9-5 where most of the dregs of society are filtered out and you can fire any that make it through."

 

[watermanMD]

Heed these words.

 

[endo]

My God, that captures my experience in the ER exactly and it gives me a visceral response reading it.

 

[RustedFox]

My God, that captures my experience in the ER exactly and it gives me a visceral response reading it.

Yep. The kids have no idea. Academia shelters them and they think: "Wow, EM is so cool because you do all the things!"

90% of EM is simply adult babysitting.

Correction: HIGH RISK adult babysitting.

 

[Porfirio]

@Rekt had such a good paragraph on EM that I copied it down and saved it to a word file:


"Do emergency medicine if you want weekly homicidal threats against you and your staff, police dumping off meth heads and alcoholics so it’s not their problem, constant revolving door of “psych” patients that are beyond unfixable (plot twist: 99% of the time it’s drugs!), constant barrage of patients that take zero accountability for their health and can barely walk to the bathroom at baseline wanting you to fix all their problems, grown ass adults screaming like children for their pain meds or because the call light isn’t immediately answered, daughter from California syndrome dropping off 98 year old grandpa Joe at 2am demanding an MRI for chronic lightheadedness, Jabba the hut nursing home dumps most with missing limbs and dementia, seeing an uncountable amount of 20-40 year olds with neon hair, neck tattoos, and dirty pajamas with extremely vague chest or abdominal pain that’s really just somatization of mental illness or childhood abuse, critical drug shortages, staffing shortages, complete ED nursing turnover every 6-18mo because it’s such a beat down, boarding, corporations, incompetent administration, absurd metrics not based in reality (I resuscitated a dying young peds pt with brain tumor hypoxic arrest from aspiration and i got a extremely positive patient eval saying i saved their kid but it was 8/10 instead of 9 so it counted as a negative), incompetent mid levels, VIPs that have already called 8 consultants before they got there because ER docs are too dumb to do anything, absolute sheer disrespect from every other physician in the hospital and outpatient too (not that any of them could even last 30 minutes in a real ED without pissing their pants), decreasing pay yearly (because you essentially start at your max and you’re never getting a raise with inflation) increasing post Covid litigation, your employment contract being handed around like a hooker in Vegas, and most importantly the market that WILL be flooded in the next 8 years, etc

Could go on for ages. There’s no reason to do EM. I used to have the immature thoughts of hurr durr clinic is boring, 9-5 is boring, etc. you know what sounds better than anything right now? 250-400k working 9-5 where most of the dregs of society are filtered out and you can fire any that make it through."

Man, making 250-400k would suck at this stage of my life.

Clinic is boring.