Dual applying!?

[wheatbar]

Will it be frown upon to dual apply to Psychiatry and Emergency Medicine with Psychiatry as my first choice if you have an interest in both fields? Is this an unusual choice? Will it be hard to have a strong application for both. I also plan to SOAP into EM if I don't match Psych. Is this a realistic plan?

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[Celexa]

Not too long ago (and by that I mean... About five years), psych was a backup specialty. Now we are not. At the same time EM's star has fallen and they are now very much a backup specialty.

No one likes being a backup specialty.

EM doesn't look like any more appealing this year than it did last year. Psych looks better and better. Unless you have a true and deep masochistic love of the emergency room and can accept being a private equity wage slave, it likely will be better to focus in psych. If you don't match, you'd have the option of SOAPing into family med or EM and then either continuing in that program or seeking a pgy2 psych spot.

I definitely would not waste time on away rotations etc for EM at this point even if that were my first choice specialty. The wasteland of their match this last year will live in legend (unless or until it's supplanted by this year's....)

 

[FlowRate]

Some programs (IMO inappropriately) care about whether you're dual applying. The only way to appease those programs is to not interview at both programs at the same institution.

Planning to SOAP EM makes sense since usually there are very few psych SOAP spots and recently lots of EM SOAP spots.

One challenge could be getting enough EM sub-I's to get the needed number of SLOE's while also getting some psych sub-I's and rec letters. That'll also show up on your transcript as your having done a lot of EM so you'll probably get questions from psych programs about dual applying.

But EM is a dumpster fire and very different from psych. Why both?

 

[Merovinge]

Great advice by Celexa, it would even be easy to spin an interest in mental health into ED SOAP given how large a percentage of patients present for psychiatric primary concerns. If psych is your true primary, then commit 100% and know you can always get into ED if needed these days (my how the tides have turned).

 

[Celexa]

Great advice by Celexa, it would even be easy to spin an interest in mental health into ED SOAP given how large a percentage of patients present for psychiatric primary concerns. If psych is your true primary, then commit 100% and know you can always get into ED if needed these days (my how the tides have turned).

It really is remarkable how much and fast things switched. I briefly considered EM and spoke with one of their faculty advisors... Who turned up their nose at my *above average* step score. Double digit numbers of my medical school classmates went into it and competition just for well timed subis was fierce. Now they're begging for bodies.

I can't be happy about it because the carnage in their specialty is a function of the rot in the American healthcare system which will eventually come for nearly everyone (but probably not cash only psychiatry...) but it's almost dizzying to observe the changes.

 

[annoyedpsychiatrist]

yeah at my program when I was a resident it mattered, and would be looked at as a negative. Its competitive and they want people dedicated to the field, who like what they do since four years is a long time to work with someone. If they get the sense that psychiatry is just an "option" then some programs will question if they're just a backup, and as said above, no one wants to be the backup. The assumption is people generally arent happy in their backup field, and an attending doesnt want to work four years with an unhappy resident. Not saying this is always the case, but its a process where programs use any possible reason to judge a candidate, because theres multiple people applying for the same spot.

 

[Merovinge]

It really is remarkable how much and fast things switched. I briefly considered EM and spoke with one of their faculty advisors... Who turned up their nose at my *above average* step score. Double digit numbers of my medical school classmates went into it and competition just for well timed subis was fierce. Now they're begging for bodies.

I can't be happy about it because the carnage in their specialty is a function of the rot in the American healthcare system which will eventually come for nearly everyone (but probably not cash only psychiatry...) but it's almost dizzying to observe the changes.

I am not happy when any field of medicine takes an L, the work of every person from PCP to sub-sub-specialist is critical for a healthy, thriving society. I am close with someone who is in Rad/onc and whilst it did seem a bit absurd how much money they make compared to people working considerably harder (e.g. trauma surgeons), it's still a shame what's happened to that field as well.

PE buyouts are absolutely an even larger threat to medicine writ large if they do go on to flex their lobbying might and prove capable of buying out essentially all of the US practice of medicine. There will be some hold outs like cash psychiatry and concierge medicine, but I think PE is a much bigger concern than AI for the future of the field in the medium term future.

 

[Sushirolls]

I wish we could cast PE is the biggest evil, but it isn't.
Big Box Shops
Weather they are a large non-profit health system
A large academic health system
and PE
They are all running amok in slightly different ways but with the same destructive potential.
I consider the VA a Big Box Shop too, but not (yet) as malignant as the others.

 

[shoomer]

Will it be frown upon to dual apply to Psychiatry and Emergency Medicine with Psychiatry as my first choice if you have an interest in both fields? Is this an unusual choice? Will it be hard to have a strong application for both. I also plan to SOAP into EM if I don't match Psych. Is this a realistic plan?

It may be hard to have a strong application for both, there's an opportunity cost to having to spend time to get SLOEs for EM when you could be getting psych rotations in. If psych is your true #1 choice, go 100% in on it and only do EM stuff if you have nothing left to do to strengthen your psych application.

SOAPing EM will be very doable based on last year's data. It's going to be uncompetitive for at least the next several years.

 

[comp1]

Ugh, I feel for the graduates. I can't imagine doing anything other than psych, never could after my clerkship. Fortunately it was a heck of a lot less competitive when I applied. I concur with the opportunity cost, but not sure what I would do in this hypercompetitive environment.

 

[Stagg737]

Just really looked at the 2022 match data for the first time, crazy that EM is the new FM/path.

Also interesting that the number of available positions per applicant (in all fields) has been steadily increasing since 2010 and that DO match rate is almost as high as US MD match rates (91.3 vs 92.9 respectively). Also absolutely bananas to me that only 31.3% of FM positions were filled by US MD seniors and 37.2% of IM was US MD seniors. So much for schools trying to promote students going into primary care....

 

[Celexa]

Just really looked at the 2022 match data for the first time, crazy that EM is the new FM/path.

Also interesting that the number of available positions per applicant (in all fields) has been steadily increasing since 2010 and that DO match rate is almost as high as US MD match rates (91.3 vs 92.9 respectively). Also absolutely bananas to me that only 31.3% of FM positions were filled by US MD seniors and 37.2% of IM was US MD seniors. So much for schools trying to promote students going into primary care....

Yeah it was bonkers. Many specialties have risen and fallen dramatically in competitiveness in their history but I genuinely wonder if any other specialty ever crashed as hard as EM did.

I see two possibilities for the EM match this year. One is that they straight up have the same or more spots open in SOAP. In that case a strong applicant will have lots of choices. There were spots open in TONS of historically strong and/or well established programs at major academic centers.

The second possibility is that EM PDs face facts, interview a wider range of candidates including many they wouldn't have even looked at previously, and there are fewer spots open in SOAP (in this scenario, I still think SOAPing EM will be easy, just not quite AS easy).

However, making scenario 2 less likely is this--it is quite challenging to figure out who you shoukd invite to interview in general, and it gets more so when the specialty is undergoing major shifts. The competitiveness shifts in psych have introduced much more uncertainty than years past. I've had conversations with PDs and faculty advisors all around the country (I am an official faculty advisor at my institution, and heavily involved in med ed) and no one feels they truly understand the shifting dynamics. We're all just doing the best we can to provide up to date advice to applicants and trying to be honest about the uncertainties.

EM is undergoing a much more dramatic shift than psych is, and so PDs abilities to adjust on the fly are only going to get them so far. Additionally, SOAP isn't always bad for some programs--some new residencies will SOAP all of their first class on purpose, because they can skim more competitive applicants out of the SOAP process than they would the actual match.

Anyway this is a very longwinded explanation where the tl;dr is that EM is going to be easy to SOAP until the economcis of their specialty change. I don't think it's going to happen this decade, and the collapse of the healthcare system might well come first.

 

[shoomer]

Also interesting that the number of available positions per applicant (in all fields) has been steadily increasing since 2010 and that DO match rate is almost as high as US MD match rates (91.3 vs 92.9 respectively).

Even with similar match rates, it doesn't mean they performed similarly. DO's have to aim lower specialty and program-wise.

Also absolutely bananas to me that only 31.3% of FM positions were filled by US MD seniors and 37.2% of IM was US MD seniors. So much for schools trying to promote students going into primary care....

Top 5 specialties for US MD Seniors were IM, Peds, FM, Psych, and Anesthesia. DO seniors were the same but EM instead of Anesthesia - which also helps explain the high match rate for DO's incidentally.

Primary care specialties are more accessible to IMG students so it's only natural that they'd fill so many of those spots.

 

[Stagg737]

Even with similar match rates, it doesn't mean they performed similarly. DO's have to aim lower specialty and program-wise.

Top 5 specialties for US MD Seniors were IM, Peds, FM, Psych, and Anesthesia. DO seniors were the same but EM instead of Anesthesia - which also helps explain the high match rate for DO's incidentally.

Primary care specialties are more accessible to IMG students so it's only natural that they'd fill so many of those spots.

Sure, but other than the highly competitive fields the numbers really weren't all that different if you look at charting the outcomes. US MD seniors had 89.6% match rate into their chosen field and DO seniors were 84.9% (4.7% difference). That gap is closing even from when I matched 5 years ago when they were 91.8% and 82.6% respectively (9.2% difference). US MDs obviously still have an edge in terms of matching in general, but that gap seems to be closing.

 

[mistafab]

The question is... why???

They are so different that it doesn't make sense to dual apply unless your application is sub-par for psych. If psych is a "reach" for you, then I guess go for it and best of luck.

The training across the 4 years of residency (or 3-4 for EM) is so disparate, that even if you wanted to work in a "psych ER" eventually, it makes no sense to apply both.

 

[wheatbar]

None of this really addresses the initial post question though.

 

[heartsink]

None of this really addresses the initial post question though.

I would say these replies have largely addressed the initial post. My take-away summary of what you've been told:

- it will be frowned upon at locations where you have applied to both of their EM and Psych programs
- it will likely be frowned upon at other locations if they learn of your dual applying
- it is an unusual choice
- it is not an unrealistic plan, but it will be hard to have a strong application for both

 

[FlowRate]

I would say these replies have largely addressed the initial post. My take-away summary of what you've been told:

- it will be frowned upon at locations where you have applied to both of their EM and Psych programs
- it will likely be frowned upon at other locations if they learn of your dual applying
- it is an unusual choice
- it is not an unrealistic plan, but it will be hard to have a strong application for both

Would add/amend just slightly to say that usually programs at the same institution don't share info about applicants. But if you're seen interviewing with a different specialty on a different day then that's when people noticed/cared (at least at my old institution.) So it's more about not interviewing at the same place for two specialties rather than not applying.

 

[Stagg737]

None of this really addresses the initial post question though.

If you want to go into psych, then just apply psych. It's more competitive but if you rank 8 programs you've still got over a 90% chance at matching, which isn't that different from in the past.

If you don't match then you SOAP into whatever, that includes EM. EM had almost 600 positions to SOAP into last year, I doubt that it'll suddenly be impossible to SOAP into EM even if you applied to another field.

 

[phonyreal98]

Would add/amend just slightly to say that usually programs at the same institution don't share info about applicants. But if you're seen interviewing with a different specialty on a different day then that's when people noticed/cared (at least at my old institution.) So it's more about not interviewing at the same place for two specialties rather than not applying.

Are interviews still virtual for residency? All mine for CAP fellowship are virtual. I think that virtual interviews would make it harder to be detected as a dual applicant.

 

[FlowRate]

Are interviews still virtual for residency? All mine for CAP fellowship are virtual. I think that virtual interviews would make it harder to be detected as a dual applicant.

You are so right. The last time I was involved in resident selection was 19-20. *insert homer "d'oh" meme*