Backdoor to EM?

[etothehizzo]

I'm a DO applying ACGME EM. I decided on this late in the game so I haven't got a SLOE yet. USMLE and rank are good, but no interviews thus far, and I'm concerned about not matching. I hear people throwing around the idea of using Transitional Years, Prelim Gen Surg, or Prelim IM as a way to reapply more competitively to EM. Anyone have comments on this?

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[sanityonleave]

You are almost always a less competitive applicant as a reapplicant, even if you've done a prelim or TY - you're a year out from your SLOEs and most of your prelim/TY doesn't count toward your EM residency (with exception of a few off service months). The exception to this is that if you applied too narrowly (either geographically or "more competitive" programs), you might have a better chance of matching with a broader application the second time around.

That said, two things:
1) it's early - just because you haven't had interviews yet doesn't mean they won't be forthcoming
2) it's early - you can broaden your application now and still be early enough to be ahead of most program's deadlines. If you feel like you might not have applied broadly enough, you should expand your application to include a broader number of programs - especially less competitive or geographically less desired programs. If you have good letters and scores and no red flags, you should match, but it is absolutely worth spending an extra $1k+ on applications to save yourself a year and applying as a less competitive applicant the second time around. You can always turn down interviews later!

I would not bank on having better success in your application after another year - again, it's extremely rare that someone becomes a more competitive applicant the second time around, and it's 10x harder to go through ERAS and the interview season as an intern than it is as a 4th year med student.

 

[JediZero]

Ditto that. Match the first time if you can. You can give it another shot if you don't match (like I am currently), but I wouldn't recommend it.

 

[The White Coat Investor]

it's extremely rare that someone becomes a more competitive applicant the second time around,

Except in the military match. You actually get points for time on active duty, and that extra year of training is time on active duty.

 

[etothehizzo]

You are almost always a less competitive applicant as a reapplicant, even if you've done a prelim or TY - you're a year out from your SLOEs and most of your prelim/TY doesn't count toward your EM residency (with exception of a few off service months). The exception to this is that if you applied too narrowly (either geographically or "more competitive" programs), you might have a better chance of matching with a broader application the second time around.

That said, two things:
1) it's early - just because you haven't had interviews yet doesn't mean they won't be forthcoming
2) it's early - you can broaden your application now and still be early enough to be ahead of most program's deadlines. If you feel like you might not have applied broadly enough, you should expand your application to include a broader number of programs - especially less competitive or geographically less desired programs. If you have good letters and scores and no red flags, you should match, but it is absolutely worth spending an extra $1k+ on applications to save yourself a year and applying as a less competitive applicant the second time around. You can always turn down interviews later!

I would not bank on having better success in your application after another year - again, it's extremely rare that someone becomes a more competitive applicant the second time around, and it's 10x harder to go through ERAS and the interview season as an intern than it is as a 4th year med student.

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Well that is upsetting. I was hoping to have a good backup plan. I did apply VERY broadly to competitive and noncompetitive programs. I'm glad you said it's still early, because I've been seeing a lot of other people getting 2-4 EM interviews already (unless theyre lying, which is possible), which is discouraging. I guess all I can do is sit and grind my teeth and wait.

 

[hoot504]

I don't think they're lying, the invites are definitely starting to come out. That said, it is still early. A month from now you could be sitting on a pile of interviews

 

[sylvanthus]

OP you need an SLOE and likely 2, this is why you are not getting interviews.

 

[gman33]

The SLOE is the one of the most important parts of your app.
Without this, some programs won't even review your app.
Try to get this in ASAP.

 

[hrain]

The interviews are slowly starting to come, but I think there's a long way to go. I've actually been told specifically by my (current) favorite program's PD that they go through all the applications first and then send out 90% of interview invites on the same day in mid-late October...I'm not sure how many programs do this. If you're worried, apply to a few more programs. I'm in a similar situation re: SLOEs...finishing up my first externship now and hoping to get one from it and from my second externship that ends mid-November. Otherwise I have a pretty strong app, I think, and granted I'm an md applicant. I've received a couple interview invites so far, but not as many as I'd been hoping. I just sent some e-mails out to PDs at my top programs explaining (briefly) why my SLOEs are going to be a little late and requesting basically that my current LoR in non-sloe form act as placeholders until my SLOEs come in...hopefully it'll help! You could always consider that, although I'm not sure it's necessary.

 

[etothehizzo]

The interviews are slowly starting to come, but I think there's a long way to go. I've actually been told specifically by my (current) favorite program's PD that they go through all the applications first and then send out 90% of interview invites on the same day in mid-late October...I'm not sure how many programs do this. If you're worried, apply to a few more programs. I'm in a similar situation re: SLOEs...finishing up my first externship now and hoping to get one from it and from my second externship that ends mid-November. Otherwise I have a pretty strong app, I think, and granted I'm an md applicant. I've received a couple interview invites so far, but not as many as I'd been hoping. I just sent some e-mails out to PDs at my top programs explaining (briefly) why my SLOEs are going to be a little late and requesting basically that my current LoR in non-sloe form act as placeholders until my SLOEs come in...hopefully it'll help! You could always consider that, although I'm not sure it's necessary.

yeah i definately emailed all the programs explaining what's up with my sloe. most of them emailed me back saying they made a notation in my file, so hopefully it'll pan out. i tried calling a few, but the conversations didn't really pan out so i stopped. sounds like we're in a similar situation, aside from me being a DO, which I'm sure is an additional strike against me on top of the late SLOEs. if I find anything else out ill post it.

 

[etothehizzo]

so anyone familiar with the process of using Transitional Years, Prelim Gen Surg, or Prelim IM as a way to reapply more competitively to EM (in case I don't match)??

 

[Druggernaut]

I'm a DO applying ACGME EM. I decided on this late in the game so I haven't got a SLOE yet. USMLE and rank are good, but no interviews thus far, and I'm concerned about not matching. I hear people throwing around the idea of using Transitional Years, Prelim Gen Surg, or Prelim IM as a way to reapply more competitively to EM. Anyone have comments on this?

Do you know when your SLOE might be uploaded? And do you have another one in progress? That's almost certainly your hold up, unless we have very different interpretations of "good" as far as your USMLE and rank. I received two interview invites the day my second one was uploaded, but I think my only interview prior to that was at a site I rotated at.

If you're even thinking about backup plans to matching to an ACGME program as a DO, you should probably be shotgunning some applications to AOA programs. It doesn't make sense to try to do one year somewhere else and hoping to match into a three-year program next year if you can get into a four-year one this year and guarantee you get to do EM. If you don't have a second SLOE cooking now, I'd recommend this even more highly. I think AOA EM is more willing to consider your application "complete" with one SLOE. If I were you, I'd submit your first SLOE and whatever other letters you can get together to AOA programs as soon as possible before all their interviews dry up.

It sounds like it's not time to panic yet for people who haven't received many or any ACGME interviews despite having their applications complete. But with some places taking two months or more to write a SLOE and most ACGME places requiring two of them, I don't know that you're in a position to stay the course...

 

[etothehizzo]

Do you know when your SLOE might be uploaded? And do you have another one in progress? That's almost certainly your hold up, unless we have very different interpretations of "good" as far as your USMLE and rank. I received two interview invites the day my second one was uploaded, but I think my only interview prior to that was at a site I rotated at.

If you're even thinking about backup plans to matching to an ACGME program as a DO, you should probably be shotgunning some applications to AOA programs. It doesn't make sense to try to do one year somewhere else and hoping to match into a three-year program next year if you can get into a four-year one this year and guarantee you get to do EM. If you don't have a second SLOE cooking now, I'd recommend this even more highly. I think AOA EM is more willing to consider your application "complete" with one SLOE. If I were you, I'd submit your first SLOE and whatever other letters you can get together to AOA programs as soon as possible before all their interviews dry up.

It sounds like it's not time to panic yet for people who haven't received many or any ACGME interviews despite having their applications complete. But with some places taking two months or more to write a SLOE and most ACGME places requiring two of them, I don't know that you're in a position to stay the course...

First SLOE up this weekend. Second ~4 weeks from now. I've got a few AOA apps out, but I agree about shotgunning more ASAP. I'm looking into the Transitional Years, Prelim Gen Surg, or Prelim IM as backups. USMLEs 239, 251. Any more thoughts?

 

[gutonc]

First SLOE up this weekend. Second ~4 weeks from now. I've got a few AOA apps out, but I agree about shotgunning more ASAP. I'm looking into the Transitional Years, Prelim Gen Surg, or Prelim IM as backups. USMLEs 239, 251. Any more thoughts?

Find a time machine and go back to July and August to get your SLOEs.

And if you're hoping to have the chance to interview for a 2nd residency during an intern year, DON'T DO A PRELIM SURG YEAR!

 

[etothehizzo]

Find a time machine and go back to July and August to get your SLOEs.

And if you're hoping to have the chance to interview for a 2nd residency during an intern year, DON'T DO A PRELIM SURG YEAR!

Any specific reason why you say to avoid the prelim surg year?

 

[hoot504]

Any specific reason why you say to avoid the prelim surg year?

Just guessing.. because you probably won't have any time to actually go interview.

I've heard prelim surgery tends to be a busy year

 

[discostu42]

Preliminary surgery years are an evil way for a program to suck time and work from you without giving anything in return (aside from prelim surgery at top institutions that work to get you where you want to be). This on top of the fact that you will be working outrageous hours all intern year without anytime to take for interviews. Worst case scenario for you imo

 

[discostu42]

As an additional aside, I'm a DO going ACGME EM this cycle with similar stats, and I can assure you the lack of SLOEs are the hold up at this point.

 

[Mad Jack]

You are almost always a less competitive applicant as a reapplicant, even if you've done a prelim or TY - you're a year out from your SLOEs and most of your prelim/TY doesn't count toward your EM residency (with exception of a few off service months). The exception to this is that if you applied too narrowly (either geographically or "more competitive" programs), you might have a better chance of matching with a broader application the second time around.

That said, two things:
1) it's early - just because you haven't had interviews yet doesn't mean they won't be forthcoming
2) it's early - you can broaden your application now and still be early enough to be ahead of most program's deadlines. If you feel like you might not have applied broadly enough, you should expand your application to include a broader number of programs - especially less competitive or geographically less desired programs. If you have good letters and scores and no red flags, you should match, but it is absolutely worth spending an extra $1k+ on applications to save yourself a year and applying as a less competitive applicant the second time around. You can always turn down interviews later!

I would not bank on having better success in your application after another year - again, it's extremely rare that someone becomes a more competitive applicant the second time around, and it's 10x harder to go through ERAS and the interview season as an intern than it is as a 4th year med student.

If you're applying to 4-year EM programs, wouldn't the prelim/TY count toward the first year? Or not so much?

 

[hrain]

Any chance you've worked with an EM physician who would be able to write a traditional LoR instead of a SLOE to get it in faster? I have no sloes yet (as mentioned above), and mine might not be in until mid-november (for the 1st) and mid december for the second. But I went ahead and submitted three LoR -- two from surgeons I worked with, including one letter which I know was probably very strong, and one from my EM clerkship director at my home institution. Since we don't have a residency program, he couldn't write it in SLOE form. However, I think some programs must be putting enough weight on those LoR to offer me interviews (I got two more since I posted yesterday, so they're starting to come in faster I guess...knock on wood). If you have other non-SLOE LoR, esp from EM physicians, I'd suggest uploading at least a few of them and then submitting SLOEs into any additional letter slots as soon as they're available.

PS - We're basically on par for board exams, too...you're slightly above on Step 1, I'm slightly above on Step 2. Only major difference seems to be the MD vs DO thing. So hopefully your interviews start rolling in soon!

 

[hrain]

If you're applying to 4-year EM programs, wouldn't the prelim/TY count toward the first year? Or not so much?

I don't think you can do a pre-lim/transitional year and then match into 4 yr EM programs as a second year, since most aren't PGY 2-4 anymore (they used to be). I might be wrong, though.

 

[Mad Jack]

I don't think you can do a pre-lim/transitional year and then match into 4 yr EM programs as a second year, since most aren't PGY 2-4 anymore (they used to be). I might be wrong, though.

Good to know. You can match into a categorical DO 4 year as a PGY-2 because of the way they integrate a TRI as year 1, but he'd have to do an osteopathic TRI if he wanted to go that route, didn't realize the MD side of things was so different.

 

[hrain]

I think occasionally you can -- for instance, I have a friend who is switching from anesthesiology to EM after his second year, and he was told by the EM residency at his home program that *if* they had room (ie if one of their EM residents had dropped out) that they would accept him for the leftover position. However, my understanding is that that generally only occurs in ACGME if one of the other residents has dropped out.

 

[DocEspana]

Good to know. You can match into a categorical DO 4 year as a PGY-2 because of the way they integrate a TRI as year 1, but he'd have to do an osteopathic TRI if he wanted to go that route, didn't realize the MD side of things was so different.

Nah. That's not true. Most AOA programs want nothing to do with you if you've done a TRI. The way they integrate the 4 years (with some exceptions) they don't treat the first year as a TRI but rather as a chunk of your overall emergency room requirements. The handful of exceptions that have a true TRI first year don't have the space to take a PGY2 unless a PGY1 dropped out and made a spot (unlikely as TRI years are cush).

 

[W19]

What is a SLOE?

 

[Pons Asinorum]

What is a SLOE?

Google. Come on.

 

[deuist]

so anyone familiar with the process of using Transitional Years, Prelim Gen Surg, or Prelim IM as a way to reapply more competitively to EM (in case I don't match)??

They hurt more than help. When I was a medical student applying for residency, I was offered 10 interview invites out of the 15 or so programs I applied to. The military then said that I couldn't do emergency medicine and forced me into a prelim surgical year. The next year, as a surgical intern, I received only six interview invites from the 30 or so EM programs I applied to. The first question from every interviewer was, "Why are you switching from surgery to emergency medicine?" I had to give a long explanation about how the military match works and I'm not sure it satisfied everyone. I eventually was allowed to complete a residency in emergency medicine, but I definitely think that having to apply as an intern for me at a disadvantage compared everyone else.

 

[jl lin]

What is a SLOE?

Here you go: http://www.cordem.org/i4a/pages/index.cfm?pageID=3743

 

[JediZero]

so anyone familiar with the process of using Transitional Years, Prelim Gen Surg, or Prelim IM as a way to reapply more competitively to EM (in case I don't match)??

The ONLY way a transitional year of any kind is going to make you more competitive is if you do it at an institution with an EM residency you're targeting. If you use your time there wisely, spend as much time in the ED as your program permits, get to know the residents and program directors, and get good evaluations from your own PD, that will likely give you an inside track at that one program.

Otherwise, a transitional year is a wash at best and seen as a detriment at worst.