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...