Advice for OSTEOPATHIC EM Residency Chances

[8studentdoc8]

Ok, I have a feeling I'm going to get assaulted/slaughtered here....but I was hoping for realistic advice on OSTEO EM PROGRAMS:

I have essentially screwed myself over-- I failed my boards (COMLEX 1 and 2) multiple times but have managed to eventually pass. I have ALWAYS wanted to be an EM doc and wouldn't be happy in any other field-- but now i'm wondering realistically what my chances are with the upcoming application cycle. All other parts of my application are absolutely perfect including 4 LORs from EM folks (directors of the ED, PDs, attendings, etc.) and never failed anything else besides boards (which I know is HUGE).

1) should I just give up and put all of my energy into a primary care field?? I will prob. end up hating my entire life forever/regretting that I ever pursued medicine in the first place but at least I will have a career and be able to pay back my loans, right? I'm also worried that basically I won't even be considered given my boards alone-- anyone want to realistically confirm this??

2) even if I somehow miraculously get into EM (let's pretend....ok??)-- i'm worried about passing the specialty boards and oral boards at the end of residency given how much trouble I had for the comlex (which, yes, I eventually was able to pass....but, a failure on specialty boards even looks worse...esp. if there's ever a lawsuit). For those who have taken these boards-- how does it compare to the comlex (easier, more difficult, ??)-- i'm not a good test taker but I'm confident in my clinical skills for the ED and would be an AMAZING ED doc.

For those who have been there and done it....or have some experience about applying to give advice-- what do you think?? I'm worried that if I don't at least go for my dream and have someone else tell me NO, I will be saying "what if" for the rest of my life......or on the flip side, if my dreams come true, I have no idea if I would be able to make it through the boards later on (i'm 100% NOT worried about the clinical part...I have it nailed down!). Ugh, after all the COMLEX trauma my confidence is a little bit shot.

Advice anyone??

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[EM_Rebuilder]

Ok, I have a feeling I'm going to get assaulted/slaughtered here....but I was hoping for realistic advice on OSTEO EM PROGRAMS:

I have essentially screwed myself over-- I failed my boards (COMLEX 1 and 2) multiple times but have managed to eventually pass. I have ALWAYS wanted to be an EM doc and wouldn't be happy in any other field-- but now i'm wondering realistically what my chances are with the upcoming application cycle. All other parts of my application are absolutely perfect including 4 LORs from EM folks (directors of the ED, PDs, attendings, etc.) and never failed anything else besides boards (which I know is HUGE).

1) should I just give up and put all of my energy into a primary care field?? I will prob. end up hating my entire life forever/regretting that I ever pursued medicine in the first place but at least I will have a career and be able to pay back my loans, right? I'm also worried that basically I won't even be considered given my boards alone-- anyone want to realistically confirm this??

2) even if I somehow miraculously get into EM (let's pretend....ok??)-- i'm worried about passing the specialty boards and oral boards at the end of residency given how much trouble I had for the comlex (which, yes, I eventually was able to pass....but, a failure on specialty boards even looks worse...esp. if there's ever a lawsuit). For those who have taken these boards-- how does it compare to the comlex (easier, more difficult, ??)-- i'm not a good test taker but I'm confident in my clinical skills for the ED and would be an AMAZING ED doc.

For those who have been there and done it....or have some experience about applying to give advice-- what do you think?? I'm worried that if I don't at least go for my dream and have someone else tell me NO, I will be saying "what if" for the rest of my life......or on the flip side, if my dreams come true, I have no idea if I would be able to make it through the boards later on (i'm 100% NOT worried about the clinical part...I have it nailed down!). Ugh, after all the COMLEX trauma my confidence is a little bit shot.

Advice anyone??

The chances of you matching are going to be very very slim. I think I would still give it one honest shot. Are you applying this year?

I would make sure to do 2-3 Away rotations in places that are not popular to live as the competitiveness tend to be less there. You need to literally be the best student they have ever worked with.

I would then apply to essentially every single EM program in the country. I would probably also have a backup plan of FM or IM. Not that we tend to endorse it here, but you can find a job in an 'ER' somewhere in the country probably.... its probably going to be a smaller place and not in the most happening place to live... But you still can do what you wanted.

You concerns are very valid about passing the qualfying exam.. this will be a reason why most PDs would cite as to why they are not very interested in someone that has failed a major exam in the past. Its reflected poorly on the program if you fail that test, and too many people failing that test can lead to RRC citations....

Good Luck.

 

[DrMediterranean]

If he took and passed the USMLE on his first try would that help him get into ACGME programs? I'm thinking they wouldn't even bother looking at COMLEX... Any thoughts on this?

 

[EM_Rebuilder]

If he took and passed the USMLE on his first try would that help him get into ACGME programs? I'm thinking they wouldn't even bother looking at COMLEX... Any thoughts on this?

Not a bad thought... My concern is that I think the COMLEX and USMLE are essentially similiar tests... If he were to take the USMLE and fail; that makes the already big red flag even better. Now, I agree, if he happens to take it at gets a 220+ on them, then the red flag would shrink...

The chances of him failing/barely passing are the most likely outcome... simply because thats what already happened on the COMLEX.

To me the RED option is take the USMLE, the BLACK option is DONT. How lucky do you feel?

 

[ensuii]

Not a bad thought... My concern is that I think the COMLEX and USMLE are essentially similiar tests... If he were to take the USMLE and fail; that makes the already big red flag even better. Now, I agree, if he happens to take it at gets a 220+ on them, then the red flag would shrink...

The chances of him failing/barely passing are the most likely outcome... simply because thats what already happened on the COMLEX.

To me the RED option is take the USMLE, the BLACK option is DONT. How lucky do you feel?

I think part of it should stem from why he thinks he failed. If OMT were the perceived problem, then it should make him think a little bit more about the USMLE since the OMT portion of the COMLEX can be fairly large and may be weighted more than other questions. If he felt that OMT were a strong point of his, I don't think it would even be worth taking an NBME practice test.

One thing that hasn't been discussed is that OP appears to be looking towards an AOA program. In my eyes, even though AOA EM programs are still mildly competitive (no unfilled spots this year as with ACGME programs), a lot of weight is placed on your audition rotation. OP I would strongly consider rotating at smaller AOA programs that are known for heavily weighting a rotation in the department and at the least, apply to those programs and have primary care fields as backups.

 

[DrMom]

EM_rebuilder gives excellent advice. Do aways at the less competitive programs and blow them away while you are there. Just understand that a significant number of the programs are not going to seriously consider an applicant that failed 2 steps as they need graduates who pass the 3 board cert exam steps without failure. Be sure to have a backup plan for FM or IM so that you're ready if you need it.

 

[Cynic]

I would apply to every D.O. EM program in the country, with a decent amount of backups... consider Traditional Rotating Internships too...You may not land a spot this year, but if you went to a TRI in a hospital with an EM program, you'd be set back a year, but could at least pursue your dream, and in the grand scheme of things, that's what matters. Heck, you may even get some credit for it too....

FM is a good idea too. Just don't look for employment in anything that's not the middle of nowhere.

Trouble is, the specialty's only getting more competitive...That being said:

The big point that shouldn't be lost in all this is to just BE YOURSELF during the interviews. Relax. Be confident, not desperate. Nobody's perfect. Emphasize being teachable, and not that you'll somehow become a fantastic test taker, and they'll like you. EM is a small community, DO EM even smaller. If your letters are as good as you make them sound, you'll pull off a few interviews, though I would still rotate (and get letters from) more places if you can.

So relax, be confident, have a plan B. Good things come to humble people. Best of luck.

 

[Pigg-O-Stat]

If I were in your shoes, I would focus on EM programs that have trouble matching all their spots, both DO and MD. Rotate there and get a spot. I know If I was in any other field, life would suck. Do what you gotta do.

Incidentally, the COMLEX is a horribly written test.

 

[dotcb]

Are you applying this year? If so, you're a bit late asking how to remedy what happened. The thing would've been to take the USMLE 1 or 2 and destroy it. That said, if it's too late, just do your best to match in EM. Don't try to hide your score or make excuses, but do explain why you had so much trouble on that test (red flag) and yet were able to do well in clinical clerkships and shelf exams. Then try to match in EM and have a less competitive specialty as a back-up. I tried to help a similar student match in EM this year who was unsuccessful due to failing something. Fortunately for him, he matched in family medicine as a back-up. Hope for the best, plan for the worst.

 

[Megalofyia]

EM_rebuilder gives excellent advice. Do aways at the less competitive programs and blow them away while you are there. Just understand that a significant number of the programs are not going to seriously consider an applicant that failed 2 steps as they need graduates who pass the 3 board cert exam steps without failure. Be sure to have a backup plan for FM or IM so that you're ready if you need it.

Consider what DrMom says. She's speaking with wisdom.
Not to be a wet blanket but the chances of matching ER are going to be slim to none. *I* would still try and apply to ALL the ER programs (MD and DO) in case you get lucky.
Do NOT do a traditional year. It's a crappy choice and wont help with anything! I failed step 1 (It was unexpected and due to a traumatic event) but passed steps 2 and 3 on the first try; I also did USMLE I and did much better on that than COMLEX. I got a couple of EM interviews; as well as peds since I want(ed) to do peds ER, but ultimately ended up scrambling into IM. I wish I had applied to IM at the same time I applied to peds and EM so that I maybe would have had more of an option of where I ended up. Scrambling/SOAPing is not worth it.

 

[8studentdoc8]

".. this will be a reason why most PDs would cite as to why they are not very interested in someone that has failed a major exam in the past. Its reflected poorly on the program if you fail that test, and too many people failing that test can lead to RRC citations....

Good Luck.

I just wanted to thank everyone so much for your candid advice and opinions-- I was expecting an onslaught of negativity (yes, yes, I already know how screwed I am...thanks for reminding me!) but i'm relieved to hear some solid advice. I was wondering why PDs wouldn't take someone who has failed a major exam (such as the comlex) in the past and how that leads to RRC citations--> for the majority of the states (or states I would be practicing in)-- the attempts on the comlex are unlimited (so one can fail multiple times and still be able to get licensed)-- this is NOT true for the USMLE which has more strict/rigid guidelines. It makes sense for a PD to be worried about a resident failing the specialty EM written and oral boards-- yes, that reflects poorly on the program, but if a student can demonstrate the ability to pass-- shouldn't that count for something?

So here's my dilemma-- yes, i'm VERY late in the game to set up audition rotations as they are all booked (EM is VERY popular these days). I have set up FM rotations and i'm on one right now-- but I'll be honest, I HATE IT!!! I feel out of my skin-- it doesn't feel right for me partially because i'm not very good at it and don't have any passion for it. I feel at home in a faster-paced environment taking care of acute problems with procedures thrown in to break up the monotony. So is there is anything I can do at this point other than submit my application to EM programs and pray?

USMLE Step 2 is out of the question-- it's too late and I think my attempt would be feeble- i've passed comlex 1 and 2 and will run away with that in one solid piece. My situation is very dire-- it just sad that the direction of my entire career (and happiness) is based on a one-day exam whereas my grades/clinical evals/etc. doesn't seem to matter as much.

Anyway, if anyone else has any solutions or advice- I would be incredibly GRATEFUL! I'm reaching for straws here....not sure what else actively I can do at this point.

 

[DrMom]

I was wondering why PDs wouldn't take someone who has failed a major exam (such as the comlex) in the past and how that leads to RRC citations--> for the majority of the states (or states I would be practicing in)-- the attempts on the comlex are unlimited (so one can fail multiple times and still be able to get licensed)-- this is NOT true for the USMLE which has more strict/rigid guidelines. It makes sense for a PD to be worried about a resident failing the specialty EM written and oral boards-- yes, that reflects poorly on the program, but if a student can demonstrate the ability to pass-- shouldn't that count for something?

But the vast majority of applicants have passed their step 1 & 2 licensure exams the first time. You did not so that makes PDs concerned that you may run into similar issues with the board certification exams. So, while you have eventually passed your COMLEX 1 & 2, what you have proven is not so much that you can eventually pass but that you can fail multiple times. That is a *huge* concern for PDs. They don't want to take on residents who may very well fail one or more exams for board certification.

As to whether it counts for something, it really doesn't. Everyone going into residency *has* to have passed those licensure exams and nobody can start residency without having done so which means that you have passed the minimum requirements to start residency after multiple failures.

I'm not trying to be harsh. You must to be honest with yourself about the huge uphill battle you have so that you can have a chance to overcome it.

If you're doing a FM or other rotation at a site that has an EM program you should ask the EM PD if you can do some shifts in the ED on the days you're not working on your assigned rotation. Some will let you do this and it would be a way for you to get yourself in front of them so that you have a chance to be considered. We would do this at my residency program.

 

[Old_Mil]

Ok, I have a feeling I'm going to get assaulted/slaughtered here....but I was hoping for realistic advice on OSTEO EM PROGRAMS:

I have essentially screwed myself over-- I failed my boards (COMLEX 1 and 2) multiple times but have managed to eventually pass. I have ALWAYS wanted to be an EM doc and wouldn't be happy in any other field--

1) should I just give up and put all of my energy into a primary care field?? I will prob. end up hating my entire life forever/regretting that I ever pursued medicine in the first place but at least I will have a career and be able to pay back my loans, right? I'm also worried that basically I won't even be considered given my boards alone-- anyone want to realistically confirm

Multiple board failures is going to be a high hurdle to overcome to get interviews, let alone match. Your best bet would be to do some introspection as to why this happened to you and see if it is something that you can identify and fix. If you are going to get to an EM residency it will be because you rotate there, prove that you can do the job in person, and have the PD overlook your Comlex history. Do not take the USMLE unless you are 100% sure that your failures on the Comlex are secondary to a OMM/OMT issue.

However, if you really want to work an ER, your best bet going forward would be to go to a family medicine program that has a low OB track and multiple electives that you can use to spend on ER. Then do an EM fellowship. I would much rather see a smaller ER staffed by a appropriately trained family physician than a noctor or an independently practicing PA.

Keep in mind that with Obamacare being upheld, being a primary care physician who can open his or her own cash practice outside the world of CMS and whatever the future state single payer solution looks like may in the long run be a better path.

Good luck, and wherever you do end up remember that sometimes in life we spend so much time looking at the doors to happiness that have closed that we do not notice the one that remains open.

 

[Hamhock]

I have essentially screwed myself over-- I failed my boards (COMLEX 1 and 2) multiple times but have managed to eventually pass. I have ALWAYS wanted to be an EM doc and wouldn't be happy in any other field-

probably too harsh...so I am deleting...

 

[gasolino]

I did a back to back EM rotation to began my 4th yr med school at the hospital i wanted to go to and I made sure they know I wanted to do residency there, came early, stay late, bust my butt. My scores were decent, not great (60-70th percentile). They gave me an interview during my second month rotating and I kind of knew I was in.
Scores are part of it but they look at personality and hard work in deciding who they pick (I mean they're gonna be working with you for the next 4 yr).
So if you want to do EM, go for EM and go for it hard. One thing being EM attending, I love my job.
Good luck