EM PD - Ask Me Anything

[Gray Fox]

In regards to "top" medical schools, here's a brief breakdown from 2017:
12 from U of Pittsburgh
8 from U Chicago (typically smaller classes compared to other medical schools)
13 from WashU
19 from Case Western
11 from Hopkins
4 from Stanford (they have a much smaller class in general, so smaller numbers)
7 from Cornell

I would definitely disagree that medical students from top programs are not choosing EM.

A lot from UCSF and Yale as well. I chuckled when I read that post, because so many posters have no idea what they're talking about.

I go to a "top tier" school, and the number of people interested in going EM next year is in the double digits. EM is hawt across the board.

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[DubbiDoctor]

Are you worried about a potential glut in EM physicians, which will decrease compensation and make it more difficult to find work decent areas? In March 2017, the HRSA projected an increase in demand for EM doctors of 9% by 2025 but an increase in supply of 18%. For neurology, however, they projected an increase of supply of 11% but an increase in demand of 16%. Should medical students considering a career in EM consider these trends and projections?

Health Workforce Projections | Bureau of Health Workforce

 

[slurpy15]

Are you worried about a potential glut in EM physicians, which will decrease compensation and make it more difficult to find work decent areas? In March 2017, the HRSA projected an increase in demand for EM doctors of 9% by 2025 but an increase in supply of 18%. For neurology, however, they projected an increase of supply of 11% but an increase in demand of 16%. Should medical students considering a career in EM consider these trends and projections?

Health Workforce Projections | Bureau of Health Workforce

Yes, although I think those projections are often wrong, and people burnout very fast in EM and I doubt if HRSA takes this into account. NYU follows their grads for years- look how few of them are practicing EM after even a few years: Alumni | Ronald O. Perelman Department of Emergency Medicine

 

[gamerEMdoc]

I'm not worried, one bit, about the over-saturation of the market for EM docs to be honest.

 

[CajunMedic]

Alright. Now that that is finally over, who out there is ready to start preparing for next years match?

Yup. Adjusting my personal statement, doubled my preliminary application list, updating my CV, and planning on reaching out to a couple of places I interviewed for some feedback when the post-match flurry of activity dies down. Most of all, studying for Step 1-definitely not any easier as a 4th year.

 

[OneTwoThreeFour]

Yes, although I think those projections are often wrong, and people burnout very fast in EM and I doubt if HRSA takes this into account. NYU follows their grads for years- look how few of them are practicing EM after even a few years: Alumni | Ronald O. Perelman Department of Emergency Medicine

So @slurpy15 I'm trying to figure out what you're saying. I see you being upset about EM and the burnout but it isn't clear-are you a resident? a student? Your previous posts seem to imply you're both. What do you get from this page that you posted? It's a fact that NYU's residency program has grown over the years-they mention it on their interview day. Nowhere does it mention which of these physicians are still practicing and which ones are out of the business, it is just a list of names. Burnout is real, far be it for me to suggest it isn't. I just hope we're all being honest with our intentions here.

 

[slurpy15]

So @slurpy15 I'm trying to figure out what you're saying. I see you being upset about EM and the burnout but it isn't clear-are you a resident? a student? Your previous posts seem to imply you're both. What do you get from this page that you posted? It's a fact that NYU's residency program has grown over the years-they mention it on their interview day. Nowhere does it mention which of these physicians are still practicing and which ones are out of the business, it is just a list of names. Burnout is real, far be it for me to suggest it isn't. I just hope we're all being honest with our intentions here.

I'm a community EM attending. I googled a few of the older residents out of curiosity- many were in admin, wellness etc. A surprising number, actually. Then again, it's EM in a very stressful part of the country where burnout is real and there are many other opportunities. It's just interesting.

 

[DubbiDoctor]

I'm a community EM attending. I googled a few of the older residents out of curiosity- many were in admin, wellness etc. A surprising number, actually. Then again, it's EM in a very stressful part of the country where burnout is real and there are many other opportunities. It's just interesting.

If you could have done medical school again - can't make the choice to do something else - what specialty would you have applied to?

 

[slurpy15]

Oncology or PM&R. EM is a poor choice. There are some great jobs (I actually have one, for now) and many terrible jobs.

 

[HopefulEMed]

Oncology or PM&R. EM is a poor choice. There are some great jobs (I actually have one, for now) and many terrible jobs.

Slurpy15, I understand your frustrations. However, I do have to let you know that you are bringing us down. There are some of us that are really looking forward to becoming an EM Physician and are very grateful that we have an opportunity to help people on their worst day. Yes, there are downsides to this job...as there are with all jobs. In addition, just because EM physicians are no longer practicing Emergency Medicine does not mean that they hated the job. Some of us chose EM because of it offers so much more flexibility than other fields in Medicine (otherwise, I would be in OB or Surgery). I am really looking forward to being a part-time clinician and working in administration in 3-4 years after my residency, working to lead a healthcare system forward. It's normal and healthy to brew your passions and gain additional skills to migrate to a slightly different job, especially if you are really unhappy with your current one.

 

[Perfect Hair Day]

Slurpy15, I understand your frustrations. However, I do have to let you know that you are bringing us down. There are some of us that are really looking forward to becoming an EM Physician and are very grateful that we have an opportunity to help people on their worst day. Yes, there are downsides to this job...as there are with all jobs. In addition, just because EM physicians are no longer practicing Emergency Medicine does not mean that they hated the job. Some of us chose EM because of it offers so much more flexibility than other fields in Medicine (otherwise, I would be in OB or Surgery). I am really looking forward to being a part-time clinician and working in administration in 3-4 years after my residency, working to lead a healthcare system forward. It's normal and healthy to brew your passions and gain additional skills to migrate to a slightly different job, especially if you are really unhappy with your current one.

Add an MBA on to that MD/DO.

 

[HopefulEMed]

Add an MBA on to that MD/DO.

Helpful, but lots of MD CEOs out there without an MBA. It can be done, but would require significant experience in administration. But yes, planning on it.

 

[slurpy15]

Slurpy15, I understand your frustrations. However, I do have to let you know that you are bringing us down. There are some of us that are really looking forward to becoming an EM Physician and are very grateful that we have an opportunity to help people on their worst day. Yes, there are downsides to this job...as there are with all jobs. In addition, just because EM physicians are no longer practicing Emergency Medicine does not mean that they hated the job. Some of us chose EM because of it offers so much more flexibility than other fields in Medicine (otherwise, I would be in OB or Surgery). I am really looking forward to being a part-time clinician and working in administration in 3-4 years after my residency, working to lead a healthcare system forward. It's normal and healthy to brew your passions and gain additional skills to migrate to a slightly different job, especially if you are really unhappy with your current one.

It's a great career if you want to go into administration. But not great if you want to be a clinician.

 

[ScoutQ4]

Random question: Does it really matter where you train for residency? There obviously exist a difference in new vs established programs but focusing on programs that have been around for 20+ years -- does it really matter where you train? I didn't match to my top program (top-20 program per Doximity) but rather matched into what I consider a strong mid-tier program. I go to a top MD school and all my peers are going some big name places and I kind of feel inferior. Any thoughts?

 

[slurpy15]

Yes and no. For academics, perhaps. Geographically, absolutely. If you want to work in NYC or Chicago there will always be a job for you, but geography matters if you want a job in a competitive market like Denver, Salt Lake, Boise, Bozeman etc.

 

[slurpy15]

I got asked by one of the administrators if I would be interested in starting up an EM related "ask me anything" thread, and I was thrilled to get the opportunity. I've answered tons of questions over the past year, but thought this would be a good way of trying to condense down the advice to one thread for people looking for advice in the future.

So if anyone has any burning questions about Emergency Medicine as a specialty, balancing life outside of EM, applying to EM, succeeding on your clerkship's, or any other questions that come to mind, feel free to ask away!

Do you have grads who went into nonclinical roles? Or left EM? What did they do?

 

[gamerEMdoc]

Random question: Does it really matter where you train for residency? There obviously exist a difference in new vs established programs but focusing on programs that have been around for 20+ years -- does it really matter where you train? I didn't match to my top program (top-20 program per Doximity) but rather matched into what I consider a strong mid-tier program. I go to a top MD school and all my peers are going some big name places and I kind of feel inferior. Any thoughts?

For the vast majority of jobs in EM, they don’t care where you went. I’d venture to say most places don’t even care how you do. I have had interns sign future contracts a few months into their residency. EM docs are in such high demand, employers aren’t about to get picky. Besides, for clinical EM, no one really cares what research you did in residency, what presigious attending you worked with, etc. They want to know, are you going to be a headache, will you be nice to the nursing staff, and can you carry a decent patient load. That’s it.

Now for academics, prestige may play a role. You can probably get a job in a community EM residency that is at a less competitive place right out of residency no matter where you train, but if you want to go work at a prestigious place, they are probably going to expect you to be coming from a presigious place.

I wouldn’t worry at all about where you match.

 

[gamerEMdoc]

Do you have grads who went into nonclinical roles? Or left EM? What did they do?

Not really. The program I’m at has had about 6-7 graduating classes. Some of our grads are split time with admin jobs. We have a few APDs out there. A few EMS directors. But no one that flat out left EM, with the exception of one resident who 3/4 of the way through residency realized she didn’t want to do EM. We rallied around her, supported her to finish with the goal of doing Urgent Care when she got done. She got an Urgent Care director job right out of residency and probably makes more money that I do. Lol. Sometimes is it all just works out.

Part of training residents out in the community is, they know what they are getting into when they finish, so there are no surprises.

 

[slurpy15]

Not really. The program I’m at has had about 6-7 graduating classes. Some of our grads are split time with admin jobs. We have a few APDs out there. A few EMS directors. But no one that flat out left EM, with the exception of one resident who 3/4 of the way through residency realized she didn’t want to do EM. We rallied around her, supported her to finish with the goal of doing Urgent Care when she got done. She got an Urgent Care director job right out of residency and probably makes more money that I do. Lol. Sometimes is it all just works out.

Part of training residents out in the community is, they know what they are getting into when they finish, so there are no surprises.

As I said, you sound like a lovely APD.

 

[slurpy15]

Not really. The program I’m at has had about 6-7 graduating classes. Some of our grads are split time with admin jobs. We have a few APDs out there. A few EMS directors. But no one that flat out left EM, with the exception of one resident who 3/4 of the way through residency realized she didn’t want to do EM. We rallied around her, supported her to finish with the goal of doing Urgent Care when she got done. She got an Urgent Care director job right out of residency and probably makes more money that I do. Lol. Sometimes is it all just works out.

Part of training residents out in the community is, they know what they are getting into when they finish, so there are no surprises.

Agreed. I wonder about the all-county programs in this respect. They are obsessed with being "clinical monsters", but what happens if and when they land in PG/CMG world?

 

[gamerEMdoc]

I do believe that any resident who trains in an ACGME program can handle working in pretty much any EM job. But its going to be a culture shock when you get there for some, and it will take time to adapt.

One of the best pieces of advice I got while a resident was, you need to do something in your career that you find rewarding that isn’t working clinically. You can work full time clinically. But you have to do something else that keeps you sane, because just gutting out shift after shift gets so monotonous after awhile and the stress is pretty brutal if you let it be. So no matter what job a new grad takes, I think its always good to find something that you are interested in to persue as a side interest.

 

[slurpy15]

I do believe that any resident who trains in an ACGME program can handle working in pretty much any EM job. But its going to be a culture shock when you get there for some, and it will take time to adapt.

One of the best pieces of advice I got while a resident was, you need to do something in your career that you find rewarding that isn’t working clinically. You can work full time clinically. But you have to do something else that keeps you sane, because just gutting out shift after shift gets so monotonous after awhile and the stress is pretty brutal if you let it be. So no matter what job a new grad takes, I think its always good to find something that you are interested in to persue as a side interest.

Agreed. That can be hard to find and even harder to get paid for.

 

[gamerEMdoc]

Agreed. That can be hard to find and even harder to get paid for.

True, but its not always about the money. There’s a point where you make enough, and after that, any more work you have to do to make more is basically not worth it. I do academics because I find it really rewarding, not for the money (though I do get paid, which is nice).

Afterall, I spend a decent amount of my time on here talking to students trying to help them navigate the match. All free. And yet its one of the more rewarding things I get to do.

 

[emergentmd]

Oncology or PM&R. EM is a poor choice. There are some great jobs (I actually have one, for now) and many terrible jobs.

EM doc here for 18+ yrs. Did everything from Community 60k+, Level 1 trauma center for a huge geographical footprint, In the middle of nowhere ERs where I am by myself, FSER, Sleepy ERs, director of said 60K ER, Board member of SDG, MEC/credentialing members, etc.

I can tell you EM gives any doctor about as much flexibility as you want. If you want to make 600K+/yr, you will work alot and in difficult environment.

If you are happy making 3-400K a year, you can pick whatever practice environment you want and in 95% of the cities in the country. Throw your name with a Locums company and you will get constant offers/emails/calls wanting help.

If you want to just make 300K a yr you can

1. Work 90 hrs a month at a busy high paying ER
2. Work 140 hrs a month at a FSER watching netflix 80% of the time
3. Work 120 hrs a month at a slow ER seeing 1.5pph
4. Work 140 hrs a month at an urgent care

Do locums and you can make your own schedule, mix and match whatever you want above.

I have done full time SDG, full time CMG, now doing almost all locums.

I do 40% FSER, 40% busy high paying ER, 20% somewhat easy community ER.

Almost finished my taxes and I took in 550k doing an avg of 150/mo. This seems like alot but I am sleeping and watching TV 60 of those hours. SO I work hard about 90 hr a month. Plus not going to meetings, dealing with metrics, Press Ganey, etc is worth atleast 10hrs a month to me.

Do I feel burnt out? I guess when I am on my 4th straight busy shift.
Could I work full time a busy ER until I am 60? I guess so and I have partners that do. But why when I am close to having enough in retirement in my mid 40's and happy watching Sports while getting paid 175/hr?

 

[slurpy15]

EM doc here for 18+ yrs. Did everything from Community 60k+, Level 1 trauma center for a huge geographical footprint, In the middle of nowhere ERs where I am by myself, FSER, Sleepy ERs, director of said 60K ER, Board member of SDG, MEC/credentialing members, etc.

I can tell you EM gives any doctor about as much flexibility as you want. If you want to make 600K+/yr, you will work alot and in difficult environment.

If you are happy making 3-400K a year, you can pick whatever practice environment you want and in 95% of the cities in the country. Throw your name with a Locums company and you will get constant offers/emails/calls wanting help.

If you want to just make 300K a yr you can

1. Work 90 hrs a month at a busy high paying ER
2. Work 140 hrs a month at a FSER watching netflix 80% of the time
3. Work 120 hrs a month at a slow ER seeing 1.5pph
4. Work 140 hrs a month at an urgent care

Do locums and you can make your own schedule, mix and match whatever you want above.

I have done full time SDG, full time CMG, now doing almost all locums.

I do 40% FSER, 40% busy high paying ER, 20% somewhat easy community ER.

Almost finished my taxes and I took in 550k doing an avg of 150/mo. This seems like alot but I am sleeping and watching TV 60 of those hours. SO I work hard about 90 hr a month. Plus not going to meetings, dealing with metrics, Press Ganey, etc is worth atleast 10hrs a month to me.

Do I feel burnt out? I guess when I am on my 4th straight busy shift.
Could I work full time a busy ER until I am 60? I guess so and I have partners that do. But why when I am close to having enough in retirement in my mid 40's and happy watching Sports while getting paid 175/hr?

Thank you. This is what I have thought for awhile- the future of EM is locums. I see fewer and fewer mid-late career docs committing themselves to one job as it's just not worth it! Might you be willing to share which companies you use or which you would avoid? How many licenses do you have? Do you do any telehealth?

 

[medstudnt14]

Thanks for doing this. I'm looking for advice about applying. I'm a US Senior who didn't match into a surgical specialty and will be completing a prelim year. I intend to reapply for next year's match in EM.

Step 1 - 250s
Step 2CK - 250s
Step 2CS - Pass

Working on getting one SLOE before graduation and another during prelim year. Unfortunately, I won't be able to do any away rotations, but there are a handful of programs I'm very interested in (geographic preference). Will I be looked at as "damaged goods" going through the match a second time compared to US seniors applying? Any advice/strategy you can give me to ensure I match successfully and hopefully in desired location without being able to complete aways, I'd greatly appreciate!

 

[slurpy15]

I'm mid career and bored (as we all know from my previous posts). I've had a fantastic run at my current gig, but it's declining, I'm bored and want to try something new. Is it weird to apply for a fellowship now? How would I even begin to go about it?

 

[Wroooong]

gamerEMdoc,

Thanks for all the great advice this past year. Matched my #1 and now my wife and I get to go back home to the west coast. Your feedback during application season played no small part in that success. Cheers!

 

[gamerEMdoc]

Thanks for doing this. I'm looking for advice about applying. I'm a US Senior who didn't match into a surgical specialty and will be completing a prelim year. I intend to reapply for next year's match in EM.

Step 1 - 250s
Step 2CK - 250s
Step 2CS - Pass

Working on getting one SLOE before graduation and another during prelim year. Unfortunately, I won't be able to do any away rotations, but there are a handful of programs I'm very interested in (geographic preference). Will I be looked at as "damaged goods" going through the match a second time compared to US seniors applying? Any advice/strategy you can give me to ensure I match successfully and hopefully in desired location without being able to complete aways, I'd greatly appreciate!

Obviously you have good scores. Will your prelim year SLOE be from an EM residency? If you can get two EM sloes that are decent before applying next year, I think you’ll be fine. But I wouldn’t put all my hopes in one geographic area, ESPECIALLY if it is a competitive area. You went unmatched this year, and you certainly don’t want to do that again. The more competitive a place is, the more they can just overlook your app because they get hundreds of apps with scores as good as yours. Apply broadly, have some less competitive backup programs on your list, even if you have to go outside of your geographic comfort zone.

 

[gamerEMdoc]

gamerEMdoc,

Thanks for all the great advice this past year. Matched my #1 and now my wife and I get to go back home to the west coast. Your feedback during application season played no small part in that success. Cheers!

You are welcome. Congrats on the West Coast!

 

[gamerEMdoc]

I'm mid career and bored (as we all know from my previous posts). I've had a fantastic run at my current gig, but it's declining, I'm bored and want to try something new. Is it weird to apply for a fellowship now? How would I even begin to go about it?

You could certainly do a fellowship. Many fellowships for EM go unfilled. For instance, if you wanted to do an EMS fellowship, you could walk into a pretty sweet gig. The problem with being out for awhile and going back and doing a fellowship is the financial hit. Often, fellows make a bit more than residents, so to a resident, they see the fellowship job as another step up. But for someone who is already out, going from making say 350K to all of a sudden 80K.... well, that’s a big loss, and one that few docs who’ve been out for awhile are willing to take.

If you are looking for something different just out of boredom, and are willing to make a little less, you may want to consider a job where you work with residents. It may reignite your passion for EM. Surrounding yourself who are still passionate about the job, who get excited when they get to work through a case, etc... it really can be invigorating. And while getting a core faculty position can be difficult if you are looking at a more prestigious place, or should you not really want to do any of the academic work, you could always consider a clinical faculty job. Just working shifts and supervising residents, without all the other academic responsibility.

Just a thought to consider.

 

[Geraltofrivia]

Hello all,

I applied initially for psychiatry, didn't match, and now will be doing a TRI. My last rotation of medical school is EM and I actually really enjoy it (I'm in it right now). My stats are 225/239 (508/505). My TRI has an affiliated EM residency. One of my attendings said he wouldn't mind writing me a letter but doesn't know how the SLOE process works. Any recommendations / is it worth it to try for EM? Thank you

 

[enalli]

I'm mid career and bored (as we all know from my previous posts). I've had a fantastic run at my current gig, but it's declining, I'm bored and want to try something new. Is it weird to apply for a fellowship now? How would I even begin to go about it?

Which fellowships are you thinking of doing?

 

[gamerEMdoc]

Hello all,

I applied initially for psychiatry, didn't match, and now will be doing a TRI. My last rotation of medical school is EM and I actually really enjoy it (I'm in it right now). My stats are 225/239 (508/505). My TRI has an affiliated EM residency. One of my attendings said he wouldn't mind writing me a letter but doesn't know how the SLOE process works. Any recommendations / is it worth it to try for EM? Thank you

SLOEs from rotations that aren't affiliated with an EM residency are unlikely to make a huge difference in your application. If you are seriously considering EM, here's what I would do:

- If you can, in the last month or two of 4th year, do an EM rotation at a place with an EM residency and get a SLOE from them
- Try to get your EM month in your TRI as early in the year as possible and have them write you a SLOE

If you can do either of those two, you would have at least one SLOE. Which is better than none. You could have the faculty at the recent rotation write a non-residency affiliated SLOE, but you really will need at least one good residency affiliated SLOE if you are going to get interviews the next year.

 

[DSM_302.0]

EM doc here for 18+ yrs. Did everything from Community 60k+, Level 1 trauma center for a huge geographical footprint, In the middle of nowhere ERs where I am by myself, FSER, Sleepy ERs, director of said 60K ER, Board member of SDG, MEC/credentialing members, etc.

I can tell you EM gives any doctor about as much flexibility as you want. If you want to make 600K+/yr, you will work alot and in difficult environment.

If you are happy making 3-400K a year, you can pick whatever practice environment you want and in 95% of the cities in the country. Throw your name with a Locums company and you will get constant offers/emails/calls wanting help.

If you want to just make 300K a yr you can

1. Work 90 hrs a month at a busy high paying ER
2. Work 140 hrs a month at a FSER watching netflix 80% of the time
3. Work 120 hrs a month at a slow ER seeing 1.5pph
4. Work 140 hrs a month at an urgent care

Do locums and you can make your own schedule, mix and match whatever you want above.

I have done full time SDG, full time CMG, now doing almost all locums.

I do 40% FSER, 40% busy high paying ER, 20% somewhat easy community ER.

Almost finished my taxes and I took in 550k doing an avg of 150/mo. This seems like alot but I am sleeping and watching TV 60 of those hours. SO I work hard about 90 hr a month. Plus not going to meetings, dealing with metrics, Press Ganey, etc is worth atleast 10hrs a month to me.

Do I feel burnt out? I guess when I am on my 4th straight busy shift.
Could I work full time a busy ER until I am 60? I guess so and I have partners that do. But why when I am close to having enough in retirement in my mid 40's and happy watching Sports while getting paid 175/hr?

Thank you for sharing this clear and useful information! I'm a 32 y/o M0 entering into a 5 year program, so am trying my best to think about where medicine will be in a decade. Do you think the future looks just as flexible for EM? Flexibility is something I value highly, and variety as well, which makes me think EM is for me, but I would considered other options I'm interested in if the future doesn't look quite as flexible. Thanks for your time!

 

[Tunnelvision_1]

Hi gamerERdoc! First of all I hope this finds you in good health. My question is this: I have read on a couple of forums that as far as your board scores go, one thing which matters in addition to how good your scores are is the "trend" of scores going from step 1 to step 2 CK. that is, an average step 1 score followed by an excellent step 2 score shows an impressive learning curve and demonstrates an expanding fund of working medical knowledge. On the other hand a drop in scores from step 1 to step 2 CK is alarming bc it depicts you in a (at least relatively) bad light. So how important is this really? If at all? I mean if there are two applications which match on everything else competitiveness wise (just assuming), who will have an edge, someone with a step 1 of 250 and step 2 ck of 230 or someone with a step 1 of 230 and step 2 ck of 250? Thanks in advance

 

[HopefulEMed]

[Wrong thread, edit]

 

[gamerEMdoc]

Thank you for sharing this clear and useful information! I'm a 32 y/o M0 entering into a 5 year program, so am trying my best to think about where medicine will be in a decade. Do you think the future looks just as flexible for EM? Flexibility is something I value highly, and variety as well, which makes me think EM is for me, but I would considered other options I'm interested in if the future doesn't look quite as flexible. Thanks for your time!

Well no one knows the future, but if the last 30 years is any predictor, no field of medicine will lead to more flexibility than EM.

 

[gamerEMdoc]

Hi gamerERdoc! First of all I hope this finds you in good health. My question is this: I have read on a couple of forums that as far as your board scores go, one thing which matters in addition to how good your scores are is the "trend" of scores going from step 1 to step 2 CK. that is, an average step 1 score followed by an excellent step 2 score shows an impressive learning curve and demonstrates an expanding fund of working medical knowledge. On the other hand a drop in scores from step 1 to step 2 CK is alarming bc it depicts you in a (at least relatively) bad light. So how important is this really? If at all? I mean if there are two applications which match on everything else competitiveness wise (just assuming), who will have an edge, someone with a step 1 of 250 and step 2 ck of 230 or someone with a step 1 of 230 and step 2 ck of 250? Thanks in advance

Personally, I don't care. I mean, I don't even consider the trend. When I score applications, I average the two scores together. And I don't place a high importance on board scores to begin with.

But I've heard what you said before by students on SDN. I'm not sure how much truth there is to it in practice. Theoretically, you'd rather see someone improve than regress, obviously. But is it better to have someone go from a 210 to a 230 vs regress from a 260 to a 240? One improves, one regresses, but the one that regresses still is smarter. Who knows. Board scores are what they are. They are a marker of how likely you are to pass future standardized tests. That's about it.

 

[slurpy15]

Well no one knows the future, but if the last 30 years is any predictor, no field of medicine will lead to more flexibility than EM.

I hope so. But hospitals are realizing residents are cheaper than PAs and I don't see an end to residency expansion.

 

[gamerEMdoc]

I hope so. But hospitals are realizing residents are cheaper than PAs and I don't see an end to residency expansion.

Im not sure this is true. I'm sure someone can figure out the economics of it. Remember, PAs work all of their shifts in the ED full time. Residents are only in the ED for like 1/2 their residency. So if they were a shift for shift replacement, you need 2 residents for every PA in terms of ED staffing. Plus, you have to pay a PD a decent salary and they only work 50% of their time clinically. Plus an APD who is only going to work 11 shifts a month or so and still get compensated for their academic time. Plus the academic time pay for the faculty. Research budget. Stipends for other faculty roles. Etc.

So yeah, PA salary is more than a residents salary, but there is a ton of cost to running a residency that probably outweighs that difference. I've always thought economically, PA's were probably way cheaper in the long run.

I think the biggest reason for residency expansion is recruiting and shortages. Many places are finding how easy it is to hire doctors when you have a residency. Not only to docs like working with residents, but many residents like to stay around where they train.

 

[Waterlover]

Hi gamerEMdoc, sorry if this has been addressed already. My 3rd year rotations are graded H/HP/P/LP/F. If someone has multiple Ps (but some H and HP still), how does that look in terms of applying to EM, assuming board scores are fine?

 

[gamerEMdoc]

Hi gamerEMdoc, sorry if this has been addressed already. My 3rd year rotations are graded H/HP/P/LP/F. If someone has multiple Ps (but some H and HP still), how does that look in terms of applying to EM, assuming board scores are fine?

The only grades most people are going to care about are your EM grades, in particular your SLOE rankings. The other clinical grades are going to mostly be an afterthought.

 

[gamerEMdoc]

It's that time of year when 3rd years are starting to figure out how to match in EM over the next 12 months. I've attached a few helpful files from CORD. One is a general application advice file, the second an FAQ, and the third is a resource list with links to many different resources to make you a better candidate as well as improve your clerkship grade.

Also, checkout two other helpful links:

CORD SLOE FAQ:
SLOE FAQ - Medical Students - Council of Emergency Medicine Residency Directors

EM Advisor Blog:
EM Advisor

Best of luck! And as always, I'll be around for questions!

 

[gamerEMdoc]

Also, a quick handy pdf reference with a one page approach to common symptom based complaints in the ED as well as other handy info for your clerkship.

 

[Geraltofrivia]

SLOEs from rotations that aren't affiliated with an EM residency are unlikely to make a huge difference in your application. If you are seriously considering EM, here's what I would do:

- If you can, in the last month or two of 4th year, do an EM rotation at a place with an EM residency and get a SLOE from them
- Try to get your EM month in your TRI as early in the year as possible and have them write you a SLOE

If you can do either of those two, you would have at least one SLOE. Which is better than none. You could have the faculty at the recent rotation write a non-residency affiliated SLOE, but you really will need at least one good residency affiliated SLOE if you are going to get interviews the next year.

Would I have to do this through VSAS?

edit: I'm going to start gunning and calling programs up to see if they can make special accommodations or something for me to try to get a SLOE. Does 2 week v 4 week rotation matter?

 

[gamerEMdoc]

Would I have to do this through VSAS?

edit: I'm going to start gunning and calling programs up to see if they can make special accommodations or something for me to try to get a SLOE. Does 2 week v 4 week rotation matter?

Most places would probably be willing to write you a SLOE based on 2 weeks, but I’d ask them when I set it up. And most places do use VSAS but not everyone does.

 

[arandazzo88]

What's your advice on earning the respect of your peers and attending?

 

[Sayvak87]

What's your advice on earning the respect of your peers and attending?

Work hard, show up early, always do your best, always go home and read something, don’t be a terrible person

 

[gamerEMdoc]

Work hard, show up early, always do your best, always go home and read something, don’t be a terrible person

Can’t sum it up any better than that.

Id add mentorship to that. Help people junior to you. Be someone junior residents or students look up to. That’s been a theme running in the back of my mind for the past 6 years of my career when I entered academics and it has served me well.