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Didn't match...now what?

Discussion in 'Emergency Medicine' started by emeddoc39, Mar 12, 2007.

  1. emeddoc39

    emeddoc39 Go Hoosiers

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    Congrats to all those who matched. For those of you who didn't....I know how you feel. I might have to change my screen name. My question is, if I don't get one of those 6 spots, should I try for Prelim surgery, prelim medicine or transitional year? Which one would make me a better candidate for the next match?
     
  2. USCDiver

    USCDiver Percocet-R-US
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    I'll post what I wrote to another scrambler in a PM:

    As for advice, you should look first to unfilled FM spots (letting them know of course that your first love is EM and you'll be applying again next year). This is advantageous for two reasons. One, you will get rotations in Peds, Ob, GenMed and likely EM your first year which would hopefully carry over to your eventual EM program. Secondly, if you fail to match next year, you would already be 1/3 of the way through a residency that would still leave many EM practice opportunities open. Downside is clinic time.

    Next I would look to Prelim Medicine spots. Largely for the same as number one above, rotations that could transfer: GenMed, cards, renal, MICU, ED etc. Upside is no clinic time (usually), downside is all inpatient rotations.

    Surgery Prelim spots would be helpful for skills purposes, but unless you want to be a surgeon, it really isn't much use if your first love is EM.

    Transitional years are not something I know much about, but if you can find a program that is pretty flexible with your rotations, you may be able to taylor it to 'pre-EM' setting up rotations you would likely get in a majority of EM programs (not all programs have exactly the same curriculum, but most are pretty similar).
     
  3. NinerNiner999

    NinerNiner999 Senior Member
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    I would avoid prelim surgery - not for the work load but because of the experience. You most likely will not be in the OR (unless they need to squeeze residents into cases to stay within the 80 hour rule). You will spend your entire year doing floor scut and rounding on patients. The only way this would be remotely useful for you is if there was a ton (4 months or more) of SICU/ICU exposure.

    Medicine prelim may be a better fit because you will broaden your clinical base more so than surgery. Be sure to get ICU exposure (at least 2 months).

    If you can find a program that will let you do so, a Transitional Year program where you can customize your rotations would be your best bet. I would focus on 3 months of medicine, 3 months of surgery, 3 months of ICU (MICU, SICU, CCU) and a month or two of outpatient medicine/surgery.

    Good Luck!
     
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  4. GeneralVeers

    GeneralVeers Globus Hystericus
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    Speaking as a former "scramblee", my advice is to apply to all of the EM spots regardless of their location and your preferences. Simultaneously, on scramble day apply to Transitional year programs. As Niner said, it has a somewhat customizable curriculum which will be useful for EM, and it's only 1 year, so you're not committed to a 3-year FM program. I'd stay away from the preliminary medicine/surgery rotations except as a last resort. These programs will just scut you out for a year.

    I was lucky enough to scramble into EM, however I got offered positions at two Transitional programs as well (North Dakota, and Pennsylvania).

    Good luck, and you definitely have my sympathies.
     
  5. Praying4EM

    Praying4EM Junior Member
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    Congrats to all who matched. I didn't match either and was wondering what to do now. USCDiver, you mentioned that you recommend doing FM as a first choice backup to EM. Can you, or anyone else for that matter, maybe elaborate on how receptive the FM PD will be to you mentioning that you only are "using" this spot as a springboard to reapply to EM the following year? Other than the moral reasons for not wanting to "screw" a program by going into it knowing that I'll be dropping out after a year, there's the practical reason of needing the programs support during the app process next year.

    If you're right, and FM is a better way to go than IM and surgery prelims, that's good news to me, cuz there are a lot more FM spots to choose from and it would probably be a lot better than being scutted as a prelim for a year. Not to mention, as an IMG, FM programs tend to be more friendly than surgery and med departments. So I guess I just want to hear other peoples thoughts on that, and/or USCDiver elaborate on why you feel it's safe to take an FM spot knowing you'll be leaving a year later.

    Thanks for all the advice guys...
     
  6. trkd

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    I would have thought that telling an FM PD that you will be going into EM ASAP would be an awful idea and would almost beg for a "screw you" response. That said, maybe others have more experience with this. I would think that if, like me, you possibly had some interest in FM it wouldn't be a half bad idea because you may end up loving it. Otherwise, if you think that with a broader application to more EM programs next year that you would be successful and EM is definitely what you want to do, scoring a prelim would be better based on the likelihood of getting a couple useful months in AND getting a spot closer to where you would like to be next year (possibly in the same hospital). Just a thought backed by no experience.

    Good luck folks. :oops:
     
  7. pinbor1

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    One thing I would be concerned about is the ACGME years that you can be funded. If you scramble into FM, it may be difficult to get into a program next year as the programs will potentially have to fund you with out medicare dollars your last year.

    I think that a transitional or IM prelim is a good choice if you are not successful in scrambling into EM. I am pretty sure that this will allow you to be funded by medicare dollars once you eventually match into EM next year.

    Good luck
     
  8. step1

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    This is good advice.

    Transitional year would be the best, but they are more difficult to obtain. I have not checked the stats, but my guess is that there are probably not many open transitional spots.

    On the other hand, Medicine prelims are much easier to obtain.
    Good luck...

    I did not match before myself... the scramble is actually kind of fun in a wierd way. Programs WANT you, talk to you over the phone for a few minutes after sending your app, and bam you can get a spot.

    If you shoot for a competitive specialty to scramble, you may not hear from them for weeks. So choose your programs wisely when the 12:00 dot hits.
     
  9. EM2BE

    EM2BE Elf
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    Thank you all for your input!! I know I still have a few years before I have to worry about all this, but it is good to know what options lie ahead.
     
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  10. downhilldoctor

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    First I want to say that I am very sorry for all those that did not match this year. It is a terrible terrible feeling. I know because I also did not match last year and wasn't able to scramble an EM spot. It really puts your pride to the test. I was embarrassed, ashamed, and so frickin' tired of answering everyone's questions about what I was going to do and why I didn't Match, etc, etc. And I did it all with a smile. But like the OP above, I stopped posting on SDN under my original screen name once I found out. It truly is humbling. I say this only to let you know, I feel your pain when I read, "I didnt match."

    I'm here to let you know, there is hope. Get your head out of the gutter and FOCUS. I have spent countless hours replaying scenarios in my head over the last year. So I am not replying on a whim here, pay attention.

    The scramble...

    First thing you need to do is get together a scramble. If your school offers help for this.... GREAT! If not, get a friend or loved one to help you out. You will be calling and faxing these EM programs all day... and listening to many busy signals. You will be emailing all day, and getting no replies. There will be about 2000 people trying to scramble into those 6 spots. Call the people that wrote your LORs and ask if they will call the programs as well. I actually had a couple directors call my house once I got the letter writers involved. In the end, no avail. I had to scramble outside of EM.

    Scrambling outside of EM...

    If you are a DO and are trying to scramble, look for a rotating osteopathic internship at a hospital with an allopathic EM residency. These are noncompetitive spots and WILL have many openings. I did not see the list this year, but hospital such as Christ, Resurrection, Albany, St. Vincent's in Toledo, OH all had openings last year. These are great options for our DO's and will offer the best options for next year... whether that be Allo EM, Osteo EM, or finishing out 2 more years of FP since DO FP transitions nicely from a rotating internship.

    If you are an MD, I would go for FP or IM as mentioned above. (FP would be better than IM and I will explain below). I have put so much thought into this. I am convinced that looking for FP or IM positions at hospitals that have EM programs is your best option. You can use electives to rotate with the EM attendings and get great LORs from known EM attendings in the field. I would tell the scrambling PD that you had a hard time deciding between FP (or IM) and EM... but FP was definitely high on your list. Telling them upfront that you want to reapply to EM may hurt your chances of getting into the program, BUT it will help you in the long run as they will be much more forgiving when interview season comes around. (I PERSONALLY WOULD NOT TELL THEM). If you decide not to tell them upfront however, I would tell them shortly after starting your program, so they know your intentions. Sit down with the PD and explain your intentions, let her/him blow off some steam over it and reassure them with the following... "I really like FP, I just like EM better, and if I do not match again this year, I will certainly stay another 2 years and finish out your program here."

    Preliminary and transition years...

    Preliminary and Transition years are NOT the way to go. They offer you nothing to fall back on. I have heard of folks doing three preliminary years of surgery never to match into a categorical surgical spot. The only way these help is that they know upfront that you have to interviews in December and January. I am not saying that it cant work... I am merely saying that they offer no guarantees for you to match EM or any other specialty next year.

    FP over IM...

    I would choose FP over IM because traditionally they are more forgiving people and will likely bend a little to help you out. It should be easier to get time off to interview... which any resident will tell you is very very difficult. Once that call schedule is in place, its every man/woman for himself. You may be in for a fight to complete your interviews. There is one case in which I would recommend IM. If you are a student that liked IM and would consider IM as a career choice or if you are someone that just despises FP, then I would say you might want to go with IM instead. All else being equal, FP is the choice.

    Funding...

    Many people will try to tell you that programs will not get enough funding for you from the govt... blah, blah, blah. All I can say is, don't believe the hype. Its been done 100s of times before and will continue. If your application is good next year, you will easily find a spot. End of story.

    The good news...

    Last year was extremely humbling for me. As a principle, I think that you should take responsibility for the things that happen in your life. Playing the victim gives you no options. Its the weak way out. That being said, I can honestly say that I got royally f***ed last year. A lot of the reason I had to scramble was that I got hosed by a LOR from an attending that I considered a mentor. I was clinically sound and a great guy. A really great guy. I would have ripped right through an EM program without a problem last year. But whatever... it is what it is. Now, my attitude is horrendous. Hey I'll admit it. This year, I have added some skin to my a**, acquired a sh*** attitude, put on a "F*** the world" t-shirt and matched in EM. If anyone has a problem with that, I'll tell them where they can go.

    You do not have to be as contemptuous as I am, but I believe if you want EM, you can get it. Just keep pressing on. In the end, another year is not so bad. Look at the 4 year and 1+3 year programs out there. You will be creating a 1+3 program for yourself. In the big picture, this beaurocratic BS called "The Match" is not why we went to med school. We went to med school to take care of patients. Next year, you WILL have the opportunity to do just that. Be a good doctor for them. They do need you.

    Hang in there...
     
  11. Apollyon

    Apollyon Screw the GST
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    From my experience, this is an abstract point. If anything, having PGY experience under your belt makes candidates more attractive (very usually, but not global). If they want you, and you look better this year than last, it won't be a consideration.
     
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  12. trkd

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    I had an idea last night and thought I would share. The people who have scrambled in the past can YAY or NEY as to whether it is a good or bad idea. I would make sense to me that if you went to a kinko's and scanned all your documents, it would be faster to just send many programs an email and your scanned documents instead of sitting around faxing to one program at a time. In your email, you can say you will be calling them and even if they are busy, they will be expecting your call and can take a look at what you have sent before you call (and in the case the line is busy). Even if you wait until after you call, you can send it in a matter of seconds as you are talking, and have the fax machine as backup. Just a thought. Seems easier. The 2-4 minutes that it would take to fax 8-10 pages (a guess) would seem like forever if you are trying to race other people. PLUS, I bet the fax machine at these places gets backed up with others also faxing. Furthermore, you could send it both ways to be sure.

    Also, if any of the places were in town, I would just drive up there but I think that is obvious. Good luck.
     
  13. GeneralVeers

    GeneralVeers Globus Hystericus
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    All of the scramble programs accept submissions through ERAS only. Faxing documents to them will not help, unless they specifically request something from you.
     
  14. trkd

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    Got it! People always seemed to say "be there ready with some friends and a fax machine" sort of thing and I thought you had to do all the work yourself. Cool then.
     
  15. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    Of course, after the first 20 minute rush, it is just sitting here and waiting.
     
  16. trkd

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    Did your SO match or did she do all couple's spots?
     
  17. c.bear

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    Maimonides Medical Center has two spots apparently that were approved after the match. Just got an email from them (I guess they sent it out to all of their applicants or interview candidates).

    Hope this helps someone.

    Good-Luck.
     
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  18. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    We only did couple's opportunities, so we are both sitting here.
     
  19. SoCuteMD

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    Thinking of you guys!

    ETA: What field did your SO apply to?
     
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  20. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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  21. MDWoochie

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    So We did the couple's match too. (he no match EM, me match FM).He's scrambling, I matched. not sure which is worse. Now he has to decide if he will look only in my match city or all over. Nightmare.
     
  22. DeLaughterDO

    DeLaughterDO Ghost in the Machine
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    The couples match is really a raw deal, in my opinion. Causes much heartache
     
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  23. c.bear

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    Next year we need to post a strong warning to those considering this couples match thing. I had no idea it would so negatively effect so many. Gosh...I am glad everyone sounds at least employeed now.
     
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  24. GeneralVeers

    GeneralVeers Globus Hystericus
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    Two of our residents will be PGY-2s there starting this month. They've been very helpful with taking displaced residents.
     
  25. AR1776

    AR1776 Flying through
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    How would your SO even know what your match city is? That sure seems like a raw deal. Sorry!
     
  26. AR1776

    AR1776 Flying through
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    I was told that the match reveals the city that your SO matches in. At least the match gives you that. I would be impossible to not know otherwise.
     
  27. ricanrage2

    ricanrage2 New Member
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    I disagree with previous statements that the couples match is a raw deal. My wife and I matched (OB/GYN and EM). We are also D.O.'s that matched into an allopathic residency.
     
  28. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    Well, if it works, it is great. However, the days of it helping aren't true. Both my wife and I would have matched separately, I have spoken to 2 other programs about this, and she scrambled into one she ranked. So, the problem wasn't that we weren't good, it was that we were in different places on their rank lists.

    So, like I said, it can help you and hurt you. This year was tough for EM. I'm not a bad candidate numberswise.
     
  29. Hard24Get

    Hard24Get The black sleepymed
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    So ERAS doesn't let you mix and match the RoL? ie, So. Florida program A/So. Fl program B? You can only do A/A or B/B, if you know what I mean?
     
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  30. Dakota

    Dakota Senior Member
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    You can mix and match. The problem is adding more slots to your ROL costs money and becomes tedious, and means you'll be apart. So you can do A/A, B/B, C/C, A/B, A/C, B/A, B/C, C/A, C/B etc, but you start eating up your "free" spots and extra ones cost, and as I said, if program aren't in the same city then you're saying you're ok being apart.

    This makes things interesting because it means you could couples match with your arch-nemesis and rank all your programs so you end up a minimum of 2000 miles apart, etc.
     
  31. Dr.McNinja

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    We did that with a few at the end, but only ones that we could live between the programs and commute to work. We didn't want the match to make us live in separate houses. In retrospect, it might not have been a bad idea to just go ahead and fill it up with all kinds of scenarios, but I don't think that would have made either of us any happier.
     
  32. CueDoc

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    IM really dumb. I dont see how if you couples match how 1/2 of the pair can match? unless you ranked places independently of couples matching
     
  33. randomedstudent

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    Usually after all your desired possible combinations, you would then started ranking so that one person can match and the other person enters "no match" in that slot on their list. So if you move that far down on your list then potentially one person could match and the other would not.
     
  34. pinbor1

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    I agree that it can be abstract point, but I do know that some residencies consider this strongly when offering interviews and again when ranking. Particularly some state-based institutions that are limited by GME dollars. I have seen it as less of a problem with residencies based out of private institutions or county programs. Just speaking from my observed experience, I haven't seen too many people get dinged for doing a prelim or transitional year, the biggest factor I have seen discussed is their strength as a candidate, their interest in EM, maturity, etc.
     
  35. SkunkLuver

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    Does anyone know a lot about the couples match? I mean do you have to rank the cities in the same order? What if you would have matched with your #1 and your other half doesn't rank at all (say if they were trying to get a radiology residency......) would you still get your #1 choice? :confused:

    the match scares me...
     
  36. Dakota

    Dakota Senior Member
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    The couples match gets complicated. Someone who's actually gone through it feel free to chime in.

    The short of it is the two of you apply to lots of places and go on lots of interviews. Then you come up with a joint list. So, the number one choice for the couple is program A/ program A. Now, if you would have gotten program A matching on your own, but your spouse would not, then the algorythm checks number two on your list. Lets say that is B/B. You can imagine how this will continue. Now, lets say you applied to a few big cities with lots of programs. Your number 3 overall choice might be A/C. If you match at program A, and she matches at program C, then hooray. You sucessfully couples matched. Now, say this doesn't work out. You can't start rankings like A/no match. Now if you match at A then your spouse has no match. The theory here is this way at least one of you matched and only one of you has to scramble.

    Clear as mud I bet . . .
     
  37. Brwnidgrl

    Brwnidgrl DO/MBA 2007

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    Downhilldoctor ~ thanks for sharing your story....I'm in your shoes this year...any advice on how to prepare for this process again this fall? Passionate about doing EM. Scrambled D.O. for a traditional rotating with option to actually do an IM track....any thoughts on that as well?
     
  38. randomedstudent

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    I will chime in as someone who went through couples match (unsuccessfully I might add), that the above is essentially correct. However, the catch is that usually the options with one matching and the other with "no match" are so far down the lists that other people who ranked that place higher than you did have already taken all the spots. Not as much of a problem for something with 20+ spots like medicine, but in specialties with fewer positions per program, I'll just say things get dicier. I will also say that a large number of our scramblers (about 1/3) were trying to couples match for what it's worth. What a horrible process. (Can you tell I'm bitter)
     
  39. Auscultate

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    I just wanted to point out that the statement in bold is NOT TRUE. It doesn't matter how far down you ranked the prog A/ no match option, if you are ranked higher on prog A's list than another person who ranked prog A higher, you would still bump them and take the spot. So people should not worry about that.
    There are definitely other issues at work with the couples match though.
    Sorry about your plight - hope it works out in the scramble.
     
  40. 8744

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    I am the King of the Scramble ****-ups and, with respect, some of this is not good advice (although it doesn't matter now as the scramble for this year is over).

    First of all, although Family Medicine programs are desperate for residents, even they will not scramble somebody who is just going to use them as a transitional year. The program director does not want a prima donna hanging around spending the whole year getting ready to bail and leaving him with an unfillable hole in his roster. I woud say not to even waste your time on this as long as there are preliminary or transitional years that you have a shot of scrambling into. Yeah, the OB and peds would be nice but these are not a requirement to start as an EM intern.

    As some of you know, in 2005 I failed to match EM and, instead of just walking upstairs and asking for a preliminary spot which I could have plucked like a low-hanging fruit, in a little move I like to call the "Biggest ****ing Mistake of my Life" scrambled into a Family Medicine categorical position...and spent the next year hating it and trying to match into Emergency Medicine (which I did).

    This little adventure cost us fifteen thousand dollars in Real Estate losses, moving expenses, hate, discontent, stress, and all manners of trouble which could have been avoided if I was just thinking straight on scramble day which I was not.

    Second, although you can work in Emergency Departments as a Family Practice physician, you are never going to get board certified and the movement is away from letting non-boarded doctors practice Emergency Medicine. It will be a long time, if ever, until there are enough board certified EM physicians to fill every slot but you are pretty much relegating yourself to the second and third string jobs if you don't train specifically for EM.

    If you want to do EM, do a good transitional year, start impressing now to get good letters, and apply to twice as many programs the next time. It's only a year. Don't settle for something you won't like...and believe me, you won't like FM.
     
  41. 8744

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    Bad, bad advice. For those of you next year who may ressurect this thread, don't do this. It's dishonest. That should be enough. (To my credit, I thought I was going to stick with FM before experienced the horror of it and was honest when I scrambled.) The PD is sure going to be thrilled to have a wannabe EM resident getting disgruntled and staying disgruntled for three years.

    No no no. An intern year in FM is almost as demanding as any other intern year. You may do a lot of peds, for example, but it's peds wards with a rigid and inflexible call schedule. I had to almost threaten to walk to get time to interview. In fact, because FM programs are often a few resident short, but not short enough to back out of their service requirments, you may find FM programs to be extremely inflexible with scheduling, especially for a guy who lied his way into the program and now want to be treated as if he were special.

    Don't you mother-****ers read my blog?
     
  42. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    Yes. I was offered FM spots (as well as a Med/Peds spot) and turned them down, because I felt it would be dishonest to take them for only a year.
    Plus, I didn't really want to do either of them.
     
  43. Sweet Tea

    Sweet Tea Girl Next Door
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    That's exactly what I did, too (b/c Dr. McNinja and I are application twins). Our peds department and our med/peds departments here like me and would have given me a spot, and while that's incredibly flattering I didn't want to take a 3 or 4 year spot that I was only going to be in for a year. Plus, it would have made me go batsh!t insane to have to do nursery or 3 mos of gen med. So I have a prelim surgery spot and I'll try again for EM next year. Worse things have happened than delaying my career goals for a year, plus, I'll get crazy good at lines and suturing this way.
     
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  44. 8744

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    You and Ninja have my deepest sympathies. Without getting all slobbery and empathetic, I know exactly how you feel. It is only a year and I know you will be successful next year. It is worth it. Emergency Medicine is a great specialty. Everything else blows big donkey johnson.
     
  45. GeneralVeers

    GeneralVeers Globus Hystericus
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    My sympathies as well. Although I scrambled into EM, my residency experience so far has been nothing but chaos, financial losses, and moving back and forth across the country. Hopefully most of this is settled now.

    For those who were not able to scramble, keep at it, and hopefully you'll match next year. If you are willing to come to Texas, let me know this Fall, and I'll put you in touch with the right people here.
     
  46. roja

    7+ Year Member

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    GV- are you in Tx yet? are you adjusting? I am born and bred.. until residency I lived there my whole life.. but never made it to Corpus!

    You will probably develop a wicked addiction to Tex-Mex. Not to be confused with Cal-Mex or true Mexican food. :) And if you want to make an interesting trip into the hill country, to eat the FINEST BBQ ever, drop me a line. I'll steer you right. :D
     
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  47. GeneralVeers

    GeneralVeers Globus Hystericus
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    I just got into town on the 3rd, but haven't been able to enjoy it much. They stuck me on trauma right away, so between that and moving it's been stressful. At least there's a fishing pond behind my apartment, so I get some recreation.

    It definitely has to be an improvement over L.A., a city which I hope falls into the ocean one day.
     
  48. Dakota

    Dakota Senior Member
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    It would be just like "Escape from LA!" I wonder who would become the Surgeon General of LA?
     
  49. nascarmedc

    nascarmedc nascarmedc

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    I have experienced exactly the same thing that you have. I didn't match in EM as a MS-IV in 2005 and this year I only got two interviews so I knew it would be tough. My IMG status continues to haunt me and program directors STILL bring up my sub-200 Step 1 score even though I did extremely well on Steps 2 and 3 and have had the highest score in my class on our FP in-service exams for the past two years.

    It is very frustrating, especially when you are a PGY-II who has excelled in residency and has an extensive EMS background. Apparently, EM directors would rahter take someone with no experience - less threatening, I guess..

    I will reapply next year - I am in a state-funded residency program so I have all of my GME funding available for a second residency - and I think my chances will be better because I will not be looked at suspiciously for abandoning my program.

    The bottom line is: you just keep trying. Do not settle for a residency in which you will be miserable. Life is just too short.....I like my FP program because we have a rural ER track and I have finished all of my OB requirements for FP so at least I don't have to do a lot of that anymore and can focus on EM-related electives in my last year.

    RC
     
  50. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    I was actually told this when I called one of the programs I applied to (and felt good about). The basic message was "the more experience you have, the more they worry about how 'teachable' you are". I figure the only thing I can do is go somewhere and prove that I am teachable, because arguing really serves no purpose.
     

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