advice on pivoting from an EM residency to general surgery residency?

[EMhopeful987]

I'm currently an MS4 who will be starting EM residency in July (4 year academic program in a major city). Going into application season I knew the prospective job market was bad in EM but I decided to go through with applying to EM since I already had put a lot of work into auditioning and receiving SLOEs. However the ACEP webinar from this past week, which projects that in 2030 there will be a surplus of 9000 EM physicians that won't be able to find a job has left me scared ****less. It's crazy to fathom that I could go through 4 years of residency and not be able to find a job afterwards.

During my rotations in 3rd year I was torn between deciding on either EM or general surgery. I ultimately chose EM because of the variety of cases you see and the shift work lifestyle but now that kinda means nothing to me if I can't find a job afterwards. The residency I'm going to is well established (multiple decades old) but I've been hearing stories of how people from established residencies are still gonna have trouble finding jobs. I liked the procedural aspect of surgery and being able to work with your hands. Other than EM that's pretty much the only specialty I could see myself doing. I definitely do not like primary care (hated my rotations) and don't find anesthesia or rads particularly interesting either. How hard would it be to pivot out of an EM residency into a general surgery residency? My residency site does have a general surgery residency and I know we rotate with them for rotations like trauma surgery. Any advice on how to go about establishing connections so that I could secure a spot for next year? Or am I completely out of my mind and I should just stick to my spot in my EM residency? Thanks in advance for all the input.

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[deleted50541]

Stick with EM for now and find out how the recent grads in your program did on the job market. Or did they go on to fellowships because the job market was bleak?

Jobs are there, but not necessarily in your desired location or larger cities. COVID has definitely had an impact on the amount of money EDs were bringing in and in turn, recruiting for new physicians. In four years, the situation may be better as COVID dies down, cash flow improves, and older physicians retire.

That side, the transition from one residency to another can be done. But I don't get the sense you have a strong passion for surgery from your post. Switching just because you think the job prospects in EM aren't as good isn't a reason to go into surgery.

 

[LucidSplash]

Stick with EM for now and find out how the recent grads in your program did on the job market. Or did they go on to fellowships because the job market was bleak?

Jobs are there, but not necessarily in your desired location or larger cities. COVID has definitely had an impact on the amount of money EDs were bringing in and in turn, recruiting for new physicians. In four years, the situation may be better as COVID dies down, cash flow improves, and older physicians retire.

That side, the transition from one residency to another can be done. But I don't get the sense you have a strong passion for surgery from your post. Switching just because you think the job prospects in EM aren't as good isn't a reason to go into surgery.

Is this true? I am not EM but have been reading about estimated glut of EM physician in the next few years as the feeling is that there are currently too many residency spots for a specialty that is increasingly being outsourced to companies that favor using NPs and PAs in the ER instead of physicians. Several of my EM colleagues are extremely concerned and and I have seen the number 9000 thrown around a lot as the estimated excess of EM docs in the next 10 years.

I’m not saying that’s a reason to choose surgery, but I certainly would consider another specialty if I were in the OPs shoes.

 

[EMhopeful987]

Stick with EM for now and find out how the recent grads in your program did on the job market. Or did they go on to fellowships because the job market was bleak?

Jobs are there, but not necessarily in your desired location or larger cities. COVID has definitely had an impact on the amount of money EDs were bringing in and in turn, recruiting for new physicians. In four years, the situation may be better as COVID dies down, cash flow improves, and older physicians retire.

That side, the transition from one residency to another can be done. But I don't get the sense you have a strong passion for surgery from your post. Switching just because you think the job prospects in EM aren't as good isn't a reason to go into surgery.

Thank you for your response. The one thing I do have going for me EM wise is that I am going to a well established EM residency in a major city so I would have a good alumni network in terms of making connections to obtain a job after residency. To my understanding the graduating seniors this year in the program were able to get jobs/fellowships. That being said however I'm not sure how much of a difference it will make because apparently the job market is just gonna get worse and worse here on out in the future. Furthermore I would be able to see myself doing surgery, specifically trauma surgery (I feel like it draws a lot of parallels to EM in terms of pace and procedural aspects). My plan going forward though will be to do my PGY-1 year in EM and see how the graduating seniors from my program do next year in terms of job/fellowships placement. If the seniors start having trouble and some go unemployed then I'm thinking of taking that as a sign and using residentswap.com to see if I can trade my EM spot with a GS spot (if someone wants to switch) or if someone drops out of GS completely then maybe just taking their spot altogether. I've read that general surgery has a 20% attrition rate so I figured there is a remote chance that it could work. Although I'm not too familiar on the technicalities of how residentswap.com works. I know both PDs from both programs that are involved in the switch or substitution have to sign off on it but aside from that (in terms of submitting an application, board scores, etc for the position you want) I'm not sure how that all works. To be honest this is all very new to me and I'm figuring it out as I go.

 

[EMhopeful987]

Is this true? I am not EM but have been reading about estimated glut of EM physician in the next few years as the feeling is that there are currently too many residency spots for a specialty that is increasingly being outsourced to companies that favor using NPs and PAs in the ER instead of physicians. Several of my EM colleagues are extremely concerned and and I have seen the number 9000 thrown around a lot as the estimated excess of EM docs in the next 10 years.

I’m not saying that’s a reason to choose surgery, but I certainly would consider another specialty if I were in the OPs shoes.

Yes from the data presented it is very true. Given, it is still a prediction and not a "prophecy" but I still think its a very well supported prediction. The rapid expansion of EM residencies and midlevel creep have seriously jeopardized the specialty. General surgery was just the only other speciality outside of EM that I truly enjoyed. I honestly can't see myself doing anything else if I couldn't do EM. Overall, its just a crappy situation to be in lol

 

[solitarius]

I think it will be really difficult to switch from EM to GS because it's generally harder to go from a less competitive field to a more competitive field. I would say a categorical spot is out of the question.

Your best bet is to re-apply to the match to a prelim year surgical internship, and then re-apply again to a second-year preliminary spot. The spots are available, but your job security is on the line every year until your program decides to bring you on.

 

[EMhopeful987]

I think it will be really difficult to switch from EM to GS because it's generally harder to go from a less competitive field to a more competitive field. I would say a categorical spot is out of the question.

Your best bet is to re-apply to the match to a prelim year surgical internship, and then re-apply again to a second-year preliminary spot. The spots are available, but your job security is on the line every year until your program decides to bring you on.

Thank you for your reply. Even if I were somehow able to find a GS resident to swap positions with me (via residentswap.com), do you still think I would face pushback from the PD at the program to accept me?

 

[Banco]

I'm unsure how "swapping" would work, because you likely will have to restart as an intern and won't be able to jump into PGY2 Surgery.

Re-applying might be the "better" option but it's tough to do so. You'll need to get letters and do the whole ERAS thing again. You'll also have to apply very broadly. I've known of one case who successfully did the EM -> GS switch after intern year.

But I'll also say, ruminate on this news for a bit. See how the dust settles over the next few months and re-evaluate how you like EM vs. Surgery. An EM -> IM transition would likely be much easier.

 

[LucidSplash]

Yes from the data presented it is very true. Given, it is still a prediction and not a "prophecy" but I still think its a very well supported prediction. The rapid expansion of EM residencies and midlevel creep have seriously jeopardized the specialty. General surgery was just the only other speciality outside of EM that I truly enjoyed. I honestly can't see myself doing anything else if I couldn't do EM. Overall, its just a crappy situation to be in lol

Sorry, my “is this true” was referring to:

Jobs are there, but not necessarily in your desired location or larger cities. COVID has definitely had an impact on the amount of money EDs were bringing in and in turn, recruiting for new physicians. In four years, the situation may be better as COVID dies down, cash flow improves, and older physicians retire.

 

[ThoracicGuy]

Thank you for your reply. Even if I were somehow able to find a GS resident to swap positions with me (via residentswap.com), do you still think I would face pushback from the PD at the program to accept me?

All of these swap sites are really offering mostly hypotheticals. For a swap, you have to have two residents that want to swap PLUS two PDs that would agree to each swap. What if one PD doesn't think the other person is a good fit for their program? I suspect the success rate for any resident based swapping attempts has been approaching zero.

 

[ACSurgeon]

I'm currently an MS4 who will be starting EM residency in July (4 year academic program in a major city). Going into application season I knew the prospective job market was bad in EM but I decided to go through with applying to EM since I already had put a lot of work into auditioning and receiving SLOEs. However the ACEP webinar from this past week, which projects that in 2030 there will be a surplus of 9000 EM physicians that won't be able to find a job has left me scared ****less. It's crazy to fathom that I could go through 4 years of residency and not be able to find a job afterwards.

During my rotations in 3rd year I was torn between deciding on either EM or general surgery. I ultimately chose EM because of the variety of cases you see and the shift work lifestyle but now that kinda means nothing to me if I can't find a job afterwards. The residency I'm going to is well established (multiple decades old) but I've been hearing stories of how people from established residencies are still gonna have trouble finding jobs. I liked the procedural aspect of surgery and being able to work with your hands. Other than EM that's pretty much the only specialty I could see myself doing. I definitely do not like primary care (hated my rotations) and don't find anesthesia or rads particularly interesting either. How hard would it be to pivot out of an EM residency into a general surgery residency? My residency site does have a general surgery residency and I know we rotate with them for rotations like trauma surgery. Any advice on how to go about establishing connections so that I could secure a spot for next year? Or am I completely out of my mind and I should just stick to my spot in my EM residency? Thanks in advance for all the input.

Critical care fellowship for job security?

 

[ACSurgeon]

Thank you for your reply. Even if I were somehow able to find a GS resident to swap positions with me (via residentswap.com), do you still think I would face pushback from the PD at the program to accept me?

Your better bet is to find a vacant spot somewhere and be at the “right place at the right time”. A lot of luck and networking is involved here which may or may not pan out...

 

[EMhopeful987]

All of these swap sites are really offering mostly hypotheticals. For a swap, you have to have two residents that want to swap PLUS two PDs that would agree to each swap. What if one PD doesn't think the other person is a good fit for their program? I suspect the success rate for any resident based swapping attempts has been approaching zero.

Yeah that makes sense, I would assume the GS PD would want an equal or higher caliber candidate to the one that he's losing/switching out on. Unfortunately for me my step scores aren't exactly the greatest (I suspect I matched into my #1 choice for EM by doing really well on my audition there) and I don't currently have any letters for GS nor do I currently have the connections to obtain one. I'll probably just stick to EM for now and just pray there's a job waiting for me.

 

[EMhopeful987]

Critical care fellowship for job security?

To be 100% honest with you, I actually did a critical care rotation and just didn't like it lol. It wasn't as fast paced as I imagined it to be and wasn't as much patient interaction as I expected (given that most pts were on vents). I'll prob just stick to trying to find an ER attending job after residency and pray for the best. I'm willing to move to undesirable parts of the country if need be.

 

[EMhopeful987]

Your better bet is to find a vacant spot somewhere and be at the “right place at the right time”. A lot of luck and networking is involved here which may or may not pan out...

As I'm reading more about trying to switch into GS I'm realizing that what you're saying is true and it pretty much comes down to that.

 

[DoctwoB]

All of these swap sites are really offering mostly hypotheticals. For a swap, you have to have two residents that want to swap PLUS two PDs that would agree to each swap. What if one PD doesn't think the other person is a good fit for their program? I suspect the success rate for any resident based swapping attempts has been approaching zero.

Yup. It's like when a sports team gives a player permission to seek a trade. You can find a trade, but if both GMs doesn't like it it means bupkis.

 

[miacomet]

FYI unless you are staying in your area where you attended residency is meaningless for community jobs.

 

[Listen2Savage]

I'm currently an MS4 who will be starting EM residency in July (4 year academic program in a major city). Going into application season I knew the prospective job market was bad in EM but I decided to go through with applying to EM since I already had put a lot of work into auditioning and receiving SLOEs. However the ACEP webinar from this past week, which projects that in 2030 there will be a surplus of 9000 EM physicians that won't be able to find a job has left me scared ****less. It's crazy to fathom that I could go through 4 years of residency and not be able to find a job afterwards.

During my rotations in 3rd year I was torn between deciding on either EM or general surgery. I ultimately chose EM because of the variety of cases you see and the shift work lifestyle but now that kinda means nothing to me if I can't find a job afterwards. The residency I'm going to is well established (multiple decades old) but I've been hearing stories of how people from established residencies are still gonna have trouble finding jobs. I liked the procedural aspect of surgery and being able to work with your hands. Other than EM that's pretty much the only specialty I could see myself doing. I definitely do not like primary care (hated my rotations) and don't find anesthesia or rads particularly interesting either. How hard would it be to pivot out of an EM residency into a general surgery residency? My residency site does have a general surgery residency and I know we rotate with them for rotations like trauma surgery. Any advice on how to go about establishing connections so that I could secure a spot for next year? Or am I completely out of my mind and I should just stick to my spot in my EM residency? Thanks in advance for all the input.

Tell your PD early and ask for extra trauma rotations, trauma rotations with the surgery team - not the ED trauma rotations
I originally wanted EM - didnt match and soaped into gen surg, couldnt be happier
The surplus of ED residencies plus the cell phone/CT monotony making it easy for midlevel to compete in would scare the **** outta me if i was you
A midlevel will never cut anyone in the OR
Its not too late to change boss - people do it every year

 

[Listen2Savage]

also correct me if im wrong but if OP starts EM training his funding will be all jacked up

 

[Lem0nz]

Yea I don't know much about it but my understanding, mostly from secondhand reading on SDN, is that once you match you're allocated a certain amount of years for funding and you simply don't have enough to lateral into a general surgery program and your *only* route is to go back into the match. I could be wrong but I think that's how it works.