EM PD - Ask Me Anything

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Hello! Would you recommend for a below average candidate to go to residency conferences, like SAEM in May, in order to network? I was recommended to do that per a resident, but I'm a bit hesitant as it's definitely a few hundred in the bucket and I'd have to request a few clerkship days off. I'm also wondering that if I "network" in May and my application won't even be seen until Sept-Oct, will that networking be of any benefit? Thank you!

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May is probably too early IMO. First, you don’t know how competitive of a candidate you are yet. You may get great SLOEs and tons of interviews. You may not. I like ACEP in October, because at that point ERAS is open for a few weeks and students can gauge a bit how many interviews they are getting the first few weeks, and decide if it is going to be worth it to them to attend the ACEP residency fair.
 
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May is probably too early IMO. First, you don’t know how competitive of a candidate you are yet. You may get great SLOEs and tons of interviews. You may not. I like ACEP in October, because at that point ERAS is open for a few weeks and students can gauge a bit how many interviews they are getting the first few weeks, and decide if it is going to be worth it to them to attend the ACEP residency fair.

Students this year are going to have to make an ACEP go/no-go decision with more limited information about their competitiveness than usual. ACEP 2018 is going to be from October 1-4, which is earlier than most years (usually it's late October). Very few interviews will have gone out by then. Plus, you have to register for it at least a couple weeks in advance or pay higher admission rates (last year, student prices jumped $100 if you registered fewer than 30 days in advance) and scramble for only the most expensive remaining lodging.

So OP, I guess you can see how your rotations go and try to decide if your SLOEs are going to boost your competitiveness...but it can be hard to gauge how strong your SLOE is, since not all rotation sites are transparent with their applicants.
 
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Just a solitary observation here, but I went to the ACEP residency fair this past fall, and I would say it's questionable whether or not it's actually helpful. Swarms of MS1-4s everywhere, people literally cold dropping CVs/business cards/stuff anywhere they can, jostling for position to talk to PD/APDs, popular programs with 15-20 minute waits, etc. I think it's worth an honest evaluation if your personality will shine through at the fair. Sure it's better than nothing, but I saw plenty of overwhelmed-looking students who were not aggressive or schmoozy enough to step in and chat with PDs, as well as tons who were far too pushy and monopolized time while PDs/students were obviously trying to move on.

TBH, my impression was that if you're really looking to secure interviews with the fair, it would be better to seek out some lesser-known programs in less desirable geographic locales at the fair, really talk to the PDs and chat them up, and focus your attention on fewer locations. For the rest, most of the programs had a sign-in sheet. Get in, put your face in and say hi, get out, and then follow up with an email afterwards.
 
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Just wondering, is there a lot of paperwork and documentation involved in EM? Do scribes help out a lot with that kinda stuff?
 
Students this year are going to have to make an ACEP go/no-go decision with more limited information about their competitiveness than usual. ACEP 2018 is going to be from October 1-4, which is earlier than most years (usually it's late October). Very few interviews will have gone out by then. Plus, you have to register for it at least a couple weeks in advance or pay higher admission rates (last year, student prices jumped $100 if you registered fewer than 30 days in advance) and scramble for only the most expensive remaining lodging.

So OP, I guess you can see how your rotations go and try to decide if your SLOEs are going to boost your competitiveness...but it can be hard to gauge how strong your SLOE is, since not all rotation sites are transparent with their applicants.

I totally agree. I would like to add that it's probably unnecessary for most candidates as well. I certainly don't want to give the impression that everyone has to go to ACEP in order to get interviews. Although, I'll likely be making my first appearance ever at the ACEP residency fair, so if any SDN'ers do attend, feel free and stop by and say hi!

Just a solitary observation here, but I went to the ACEP residency fair this past fall, and I would say it's questionable whether or not it's actually helpful. Swarms of MS1-4s everywhere, people literally cold dropping CVs/business cards/stuff anywhere they can, jostling for position to talk to PD/APDs, popular programs with 15-20 minute waits, etc. I think it's worth an honest evaluation if your personality will shine through at the fair. Sure it's better than nothing, but I saw plenty of overwhelmed-looking students who were not aggressive or schmoozy enough to step in and chat with PDs, as well as tons who were far too pushy and monopolized time while PDs/students were obviously trying to move on.

TBH, my impression was that if you're really looking to secure interviews with the fair, it would be better to seek out some lesser-known programs in less desirable geographic locales at the fair, really talk to the PDs and chat them up, and focus your attention on fewer locations. For the rest, most of the programs had a sign-in sheet. Get in, put your face in and say hi, get out, and then follow up with an email afterwards.

This is actually a good strategy. If you are a marginal candidate, waiting in line to try to get face time with a more competitive program is wasting time. Smart strategists will target the less competitive places if the goal is just securing interviews. Obviously, if you have genuine interest in a specific place, it may be worth the wait. But if you are someone who thinks they are on the bubble with matching, or worse, and are terrified about not matching and willing to match anywhere, the smart strategy is to find the places without lines obviously. Less competition = better chance of matching there. Less time in line = more programs visited. It's the most bang for your buck.
 
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Just wondering, is there a lot of paperwork and documentation involved in EM? Do scribes help out a lot with that kinda stuff?

There are no fields without paperwork, because documentation determines the complexity of the case in medicine, and that drives the RVUs, and that's how we get paid. Don't document = don't get paid as a physician. So you can't avoid it. I'm not sure what you consider "a lot" of documentation. An ED chart takes me maybe 2-3 minutes to dictate with dragon using some dictation templates for EPIC that I've made. It's not too bad.

But yes, scribes are a very popular staffing model, and drastically reduce the amount of documentation that's needed by the physician. Scribes are inexpensive and considerably increase the number of patients a physician can see on shift, and therefore bills for more care. I'm not sure about the statistics, but I'd venture to say that other than places with residents, the scribe model is probably more common than not out in regular practice, especially busy EDs.
 
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There are no fields without paperwork, because documentation determines the complexity of the case in medicine, and that drives the RVUs, and that's how we get paid. Don't document = don't get paid as a physician. So you can't avoid it. I'm not sure what you consider "a lot" of documentation. An ED chart takes me maybe 2-3 minutes to dictate with dragon using some dictation templates for EPIC that I've made. It's not too bad.

But yes, scribes are a very popular staffing model, and drastically reduce the amount of documentation that's needed by the physician. Scribes are inexpensive and considerably increase the number of patients a physician can see on shift, and therefore bills for more care. I'm not sure about the statistics, but I'd venture to say that other than places with residents, the scribe model is probably more common than not out in regular practice, especially busy EDs.

Thanks a lot! I guess I have an idea about IM and how much paperwork they have to do and then there is anesthesiology which seems like they don't have a lot of paperwork/documentation to do. So it seems like EM falls somewhere in the middle
 
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.

Thank you! A few more follow-up questions, if you don't mind...

1. If I have research (several publications and posters) in the specialty I did not match in, should I include them on my application for EM? I fear it may do more harm than good as far as making PDs think I'm not actually interested in EM but a different specialty?
2. Should I mention not matching in a different specialty and why I am switching specialties in my personal statement? How in-depth do I speak to this?
 
Thank you! A few more follow-up questions, if you don't mind...

1. If I have research (several publications and posters) in the specialty I did not match in, should I include them on my application for EM? I fear it may do more harm than good as far as making PDs think I'm not actually interested in EM but a different specialty?
2. Should I mention not matching in a different specialty and why I am switching specialties in my personal statement? How in-depth do I speak to this?

I'd list them. If you have publications, even if not in EM, I don't think it will hurt to list them. I'd probably explain honestly how you came to EM. People are going to know you didn't match, so you have to explain it, as best as possible how you came to decide EM was for you.
 
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@gamerEMdoc
What's your opinion on e-mailing away rotations to see when you might expect a decision via VSAS. I've seen in previous posts that people had more luck via e-mail but is there such a thing as e-mailing too early? For example I sent in an app a month ago for a program I really want to attend but the rotation's not until August. Is it too early to check in?

I should note that on VSAS it says students may be notified as early as 1/29, however, the application opened for rotations starting in March so I don't know if that was more in reference to early rotaitons.

Follow up: if you do recommend sending a check in e-mail do you have any advice on how to word it/what to say?
 
@gamerEMdoc
What's your opinion on e-mailing away rotations to see when you might expect a decision via VSAS. I've seen in previous posts that people had more luck via e-mail but is there such a thing as e-mailing too early? For example I sent in an app a month ago for a program I really want to attend but the rotation's not until August. Is it too early to check in?

I should note that on VSAS it says students may be notified as early as 1/29, however, the application opened for rotations starting in March so I don't know if that was more in reference to early rotaitons.

Follow up: if you do recommend sending a check in e-mail do you have any advice on how to word it/what to say?

I think a month is a reasonable time-frame to wait, so I don't think an email is unreasonable. But we don't use VSAS at my program, so I'm probably not the expert in VSAS etiquette. If/when you do email, I'd mention your interest in matching at the program, why you are interested in them (geography, etc), and the reason for emailing for an update (deadline to schedule fourth year rotations, securing an ED month in July/Aug for SLOEs, etc).
 
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@gamerEMdoc

Thank you for answering questions in this thread. Do you think it's okay to do an audition rotation either in late November or the month of January, to show strong interest in their program before ranking happens? (I've already secured housing and rotation at another institution nearby in September for a region I will not be applying to). However, I guess the risk of this is that this will overlap with interview season where most interviews would be handed out/scheduled. Thank you.

Yeah its totally fine. Too late for a SLOE, but they'll almost certainly interview you while you are there. When it comes to programs you have high interest in but can't get an early rotation, I always think its better to rotate at a place you are interested in late than not rotate there at all.
 
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Thanks a lot! I guess I have an idea about IM and how much paperwork they have to do and then there is anesthesiology which seems like they don't have a lot of paperwork/documentation to do. So it seems like EM falls somewhere in the middle

Anesthesiology certainly doesn't have to write notes in the same way IM has to do but I'd argue after giving medications and intubating a patient anesthesiology is exclusively paperwork/documentation...
 
@gamerEMdoc How prevalent is the "geographic filter" in EM. And if it is prevalent do other "filters" supersede it (i.e. if you have Good Step scores, AOA, honors in your EM electives etc will they look at the application before using a geographic filter) or do they cut based on geography first?
Any tips to getting around it (outside of doing an away rotation as we can only do so many).
 
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@gamerEMdoc How prevalent is the "geographic filter" in EM. And if it is prevalent do other "filters" supersede it (i.e. if you have Good Step scores, AOA, honors in your EM electives etc will they look at the application before using a geographic filter) or do they cut based on geography first?
Any tips to getting around it (outside of doing an away rotation as we can only do so many).

There are two ways to filter that I'm aware of. By permanent address and by the location of the students med school. Doing a rotation in another state doesn't mean you won't get filtered out by other programs in that state by the computer, although it does lend credence if the program looks at your app that you actually have interest in coming to that state. But it won't get you through the filters. How importance geography is to places is going to vary widely. This is just a guess, but highly competitive programs probably care less about geography to an extent, because they know they are going to be highly competitive. Less competitive programs have to be smart about their interview slots. If you are only going to interview say 80 people for 8 spots, you are going to want to make sure that a decent chunk of those people at least have some actual interest in your program. If you interview 80 people, all of which who rank you last on their list, you aren't really doing yourself any favors as a program. And programs know that geography is probably the one of the most common, if not most common, predictor in terms of where students choose to match.

In terms of "getting around" the geographic filter... first, I'd say, use it to your advantage and apply to places that are in the same state and surrounding states as your school and/or permanent address. And if there are places you really really would love to go to but couldn't rotate, I'd consider an email early in interview season to let them know of actual sincere interest (as opposed to spamming 150 programs) and maybe they will give your app more consideration if its been filtered out geographically.
 
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I was hoping you could give me some advice. I’m a current medicine resident. As a fourth year medical student, I couldn’t figure out what I wanted to do. I liked everything. Now, I can say that I really enjoy critical care and wish I had more practical training in terms of triage, procedures, managing the undifferentiated patient, etc. What are my chances at getting an EM/IM spot or an EM spot after I finish medicine? Would like to alternate critical care time with ED time when I’m done...
 
I mean you can definitely match EM after completing another residency, but it would be a really long haul. If you want to split time between critical care and the ED, then you would need to do a critical care fellowship. So you do IM, then a CC fellowship, then do an EM residency? Just so you can practice in two different fields? Personally, I don’t think its worth losing several years of income. Maybe it is to you. But that’s just too long of a haul. If you love critical care, then honestly, I’d just become a critical care doc and be done with it.

But if you really want to do EM instead of IM, and you finish IM and want to apply EM, its definitely possible to match.
 
I mean you can definitely match EM after completing another residency, but it would be a really long haul. If you want to split time between critical care and the ED, then you would need to do a critical care fellowship. So you do IM, then a CC fellowship, then do an EM residency? Just so you can practice in two different fields? Personally, I don’t think its worth losing several years of income. Maybe it is to you. But that’s just too long of a haul. If you love critical care, then honestly, I’d just become a critical care doc and be done with it.

But if you really want to do EM instead of IM, and you finish IM and want to apply EM, its definitely possible to match.

Thanks for the advice. It’s a pretty long haul. I’m just going into my second year of IM. I’ll keep mulling it over
 
Do you counsel residents on longevity and exit strategies in EM? What do you advise? The community is a tough row to hoe for thirty plus years, and one can't always find an academic spot. Thoughts?
 
Do you counsel residents on longevity and exit strategies in EM? What do you advise? The community is a tough row to hoe for thirty plus years, and one can't always find an academic spot. Thoughts?

Nothing formally, but I definitely talk to residents about it all the time. Share my personal story of burnout. I think EM is certainly doable for an entire career, but I really believe that having some side interest in EM or medicine is very healthy. Doesn't have to be academics. For me it was, because I always liked the social aspect of working in a residency as a resident. I liked hanging out with other doctors, discussing cases, and being around people with similar dark senses of humor while getting through the shifts. So when I got out on my own for four years, it was very isolating. Even when I'd have a great case, there was no one to really talk about it with. The day to day chest pain, abd pain, kid with fever, etc... just got so boring and I wasn't challenged intellectually at all. I legit hated going to work, because it wasn't at all what I imagined myself doing (working with students/residents). So when I got out of the military, I went to work in academics and it totally saved my career. I felt like I was back being a resident again, only with less shifts and more money. Much more money. The part of medicine that I enjoyed, the intellectual challenge, the social aspect of being around residents and students, residency recruitment, candidate evaluation and the match... everything I enjoyed about being a resident I had again, and it totally changed my career outlook. Again, I'm not saying academics are for everyone, I get that. My point is, to have good career balance in medicine, no matter what field it is, I think you need to find something you love about your field and focus on that to get by.

The other part of this is counseling residents about financial stuff, and really stressing the need for good financial planning. Because with good sound financial planning, the career doesn't have to be 30 years, at least not full time.
 
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Should I be worried if I have not heard back from a single place to do an away for over a month? TIA!
 
Nothing formally, but I definitely talk to residents about it all the time. Share my personal story of burnout. I think EM is certainly doable for an entire career, but I really believe that having some side interest in EM or medicine is very healthy. Doesn't have to be academics. For me it was, because I always liked the social aspect of working in a residency as a resident. I liked hanging out with other doctors, discussing cases, and being around people with similar dark senses of humor while getting through the shifts. So when I got out on my own for four years, it was very isolating. Even when I'd have a great case, there was no one to really talk about it with. The day to day chest pain, abd pain, kid with fever, etc... just got so boring and I wasn't challenged intellectually at all. I legit hated going to work, because it wasn't at all what I imagined myself doing (working with students/residents). So when I got out of the military, I went to work in academics and it totally saved my career. I felt like I was back being a resident again, only with less shifts and more money. Much more money. The part of medicine that I enjoyed, the intellectual challenge, the social aspect of being around residents and students, residency recruitment, candidate evaluation and the match... everything I enjoyed about being a resident I had again, and it totally changed my career outlook. Again, I'm not saying academics are for everyone, I get that. My point is, to have good career balance in medicine, no matter what field it is, I think you need to find something you love about your field and focus on that to get by.

The other part of this is counseling residents about financial stuff, and really stressing the need for good financial planning. Because with good sound financial planning, the career doesn't have to be 30 years, at least not full time.

It's hard, I guess, coming from academia, but not everyone can do academics. For most folks, it's nights and holidays that are the killer. I wish residencies would do a better job counseling residents on how to cope. There are, it seems, few exit strategies from this part of our field, except for UC, and most people would rather die!
 
It's hard, I guess, coming from academia, but not everyone can do academics. For most folks, it's nights and holidays that are the killer. I wish residencies would do a better job counseling residents on how to cope. There are, it seems, few exit strategies from this part of our field, except for UC, and most people would rather die!

I disagree about there being few exit strategies. I think EM provides a ton of flexibility. If you go work locums, you can choose exactly how many shifts you want to work. If you want to kill yourself as a new grad, work 20 shifts a month and make as much money as possible, you can. But if you start to burn out, you can work 6 shifts a month if you want. There is a ton of flexibility in EM that make it very doable longterm. The issue really comes down to, people wanted to get paid full time but don't want to work full time. In general, you aren't going to work 6 shifts a month and make 400k. But if you are happier making 200k and working way less, then part time is the way to go. I mean you could almost work full time by working one 24 hr shift a week in a sleepy ED that see's 10 patients a day if you want. There is a lot of flexibility out there IMO.
 
I disagree about there being few exit strategies. I think EM provides a ton of flexibility. If you go work locums, you can choose exactly how many shifts you want to work. If you want to kill yourself as a new grad, work 20 shifts a month and make as much money as possible, you can. But if you start to burn out, you can work 6 shifts a month if you want. There is a ton of flexibility in EM that make it very doable longterm. The issue really comes down to, people wanted to get paid full time but don't want to work full time. In general, you aren't going to work 6 shifts a month and make 400k. But if you are happier making 200k and working way less, then part time is the way to go. I mean you could almost work full time by working one 24 hr shift a week in a sleepy ED that see's 10 patients a day if you want. There is a lot of flexibility out there IMO.

I think that's true for people who like to work nights or are able to live in cheaper, more remunerative areas of the country. It's pretty hard to get a no nights job, even PT, and some people just can't work nights after 50 or 55. They are just unsafe. The most populous parts of the country where most ER docs live don't have 24 hour ERs that are sleepy, and that doesn't solve the nights issue which is very serious for many, many ER doctors. What would be your vision for their future? Palliative care? How easy is it to get a fellowship? Urgent care? Telemedicine?
 
Well understand that, you choose where you live, where you work, how many shifts, what shifts, etc. Some areas of the country don't have sleepy EDs where you can do a 24? Sure, but you can move somewhere that does. Or have a LOCUMs company pay you to travel to one. Want to work only days? As a locums, you can flat out just say you are only picking up day shifts. If you want flexibility, locums is defintitely a great start compared to being part of a group where you have to be more of a team player. It provides you with the flexibility to basically choose how many shifts, what shifts you want, and where you want to work (how busy you want to be).

Obviously there are other routes if someone wants to get out of EM altogether. Palliative care as you mentioned has always been in the back of my mind as a late career job if I just couldn't do EM. Urgent care, especially directing one, isn't a bad option and eliminates many of the stresses of the job because you no longer have to deal with consultants, multiple super sick people, patients who abuse the system and don't pay, intoxicated/violent patients, etc. All UC patients are paying customers, and if they are anything but simple in/out cases, you can just say go the the ER. No phone call. No transfer. You can call 911 if they need it. But you aren't bound by EMTALA, you don't need an accepting doc. And most UC jobs are for the most part daytime jobs. So while UC pays less, it really does eliminate many of the things that create stress in the long run. Telemedicine is DEFINITELY going to be a popular choice in the coming years, because insurance companies are going to love the idea of keeping their clients from actually going to the ED and getting tests, I think when telemedicine eventually comes around, it's going to really shake up the healthcare landscape and is going to compete with Urgent Cares.
 
I appreciate your insights and ideas especially on telemedicine, but wow. I am once again shocked by folks on this board who have such a cavalier attitude to moving and who also seem to assume that others have the same life options they do. Spouses have jobs and needs, aging family members may need care and not be able to relocate, people may have special needs kids, other family members may not be able to relocate. Single parents may need to be near family for child care needs. Other single parents may not be able to take off and leave their kids for days on end to do locums. People may live (and have extremely compelling reasons to live) in areas with jobs that have strict hours and night requirements. They may have a real need for more money and not be able to cut down on shifts.

I have colleagues with many of these problems and more. It's not so simple.

I have moved and done locums and have been very flexible but I would never assume that people can choose where they live like it's a flavor of ice cream or can offer the same flexibility that I have been able to. People have complex, entangled lives. It's not so easy for many people.
 
It may not be easy for many, but thats still a choice. If you choose to stay in an area, thats the choice you make. If you choose to move away from family, that's the choice you make. Its up to you. Everyone has different needs and priorities, there isn't one size fits all and the choices we make are determined by how we prioritize the different aspects of our lives. For every person who's spouse's job isn't moveable, there's one with a spouse who doesn't work and likes to move around. For every person with a special needs kid that needs to be in a specific area, there's someone without any kids who wants to work in 4 different states. For every person that wants to make 500k and is willing to kill themselves to do it, theres someone perfectly happy to make 200k and work in a much easier environment. I don't have a cavelier attitude about this, my point is, there's tons of flexibility in EM. Even for people that are geographically stuck to an area, because with some locums work, you can live remotely and get paid travel to go work your shifts then fly home. I'm certainly not saying any of this is the way to go for every person, but I do think EM provides docs with a TON more flexibility than many fields of medicine.
 
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It may not be easy for many, but thats still a choice. If you choose to stay in an area, thats the choice you make. If you choose to move away from family, that's the choice you make. Its up to you. Everyone has different needs and priorities, there isn't one size fits all and the choices we make are determined by how we prioritize the different aspects of our lives. For every person who's spouse's job isn't moveable, there's one with a spouse who doesn't work and likes to move around. For every person with a special needs kid that needs to be in a specific area, there's someone without any kids who wants to work in 4 different states. For every person that wants to make 500k and is willing to kill themselves to do it, theres someone perfectly happy to make 200k and work in a much easier environment. I don't have a cavelier attitude about this, my point is, there's tons of flexibility in EM. Even for people that are geographically stuck to an area, because with some locums work, you can live remotely and get paid travel to go work your shifts then fly home. I'm certainly not saying any of this is the way to go for every person, but I do think EM provides docs with a TON more flexibility than many fields of medicine.

I think it can, and the ability to earn six figures while taking chunks of time off is unparalleled. I also think some of that flexibility is a mirage.

EM applicants should know that while they are golden if they want to live in upstate NY, Florida, or Texas, jobs are extremely scarce in the Front Range, all of Utah, Bozeman, Flagstaff, Missoula, Boise, Portland (less so) and permanently nonexistent in Jackson Hole, that they will most likely be commuting by if they choose to work in these locales, and that their salaries will be very low for very hard work in the entire NE, and that an advanced practice nurse will be taking home the same as they are but with a pension. Those who have compelling reasons to work in one of these areas might want to reconsider.

They should also know that not working nights is very difficult outside certain SDGs and that many locums companies will be hesitant to work with those who can't do nights. That "flexibility" comes at the expense of working 50% of all the holidays, nights, and weekends forever. That exit strategies are not easy, although they certainly do exist.

I like EM, and I managed to score a remunerative gig in one of the above locales, but I do feel bad for the eager grads of Stanford/UCSF/Harvard etc who have worked very hard and who call us looking for jobs and are shocked when we tell them there is a waiting list. I feel bad for the older docs with no exit and who are having a tough time with nights.
 
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I work in an academic job. Our older docs have no nights. I make a fairly competitive salary compared to non-academics. And its in the Northeast. And our APPs make 1/3 of what we make. And its 12 shifts a month. And we ALWAYS have jobs open. I just don't think its as generalizably a tough market as you make it out to be. I have no doubt that if you want to get a great job with no nights making a killing in Salt lake city, then sure, you aren't getting that job straight out of residency. I totally agree. But I have yet to have a resident come straight out of residency and not find a job in the region they want to live in for a very competitive salary. I still think the job market is in our favor.
 
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I work in an academic job. Our older docs have no nights. I make a fairly competitive salary compared to non-academics. And its in the Northeast. And our APPs make 1/3 of what we make. And its 12 shifts a month. And we ALWAYS have jobs open. I just don't think its as generalizably a tough market as you make it out to be. I have no doubt that if you want to get a great job with no nights making a killing in Salt lake city, then sure, you aren't getting that job straight out of residency. I totally agree. But I have yet to have a resident come straight out of residency and not find a job in the region they want to live in for a very competitive salary. I still think the job market is in our favor.

Those are really, really good things to hear!

I agree people can get a regional job, although Colorado Springs is not Denver and Rock Springs is not Jackson Hole and that may or may not work for some people. Glad the NE is treating you well, and your situation honestly sounds great. Maybe I know the few people who have been trying to get into Jackson Hole, Boise, Boulder, and our shop as well as those trying to pay off loans in NYC, and all these folks seem to have a rough time. We don't have APPs, but my APP friend is making $150 an hour, no nights, no liability, but agreed that is (currently) rare. Although I guess some docs (hi emergentmd) are making $450 an hour, making it still 1/3.
 
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Do you counsel your residents on CMG pitfalls etc?
 
We definitely discuss it, but some residents really don't have a choice. There's some areas of the country where you can't get a job that isn't with a CMG. So if a resident is hell bent on moving to a specific area, sometimes CMGs are the only option. For some, they are flexible on location and are looking for the best job, period. For others, they are looking just to move back home, and are looking to find the best job within that narrow location preference. Everyone is different...
 
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We definitely discuss it, but some residents really don't have a choice. There's some areas of the country where you can't get a job that isn't with a CMG. So if a resident is hell bent on moving to a specific area, sometimes CMGs are the only option. For some, they are flexible on location and are looking for the best job, period. For others, they are looking just to move back home, and are looking to find the best job within that narrow location preference. Everyone is different...

Do you counsel against firefighting gigs and in favor of regular locums? I am floored by the number of new grads who seem so fully committed to destroying EM by doing firefighting gigs. I do not understand.
 
Do you counsel against firefighting gigs and in favor of regular locums? I am floored by the number of new grads who seem so fully committed to destroying EM by doing firefighting gigs. I do not understand.

Nope, I don't think that's ever come up.
 
Nope, I don't think that's ever come up.

Wow. I'm surprised. It comes up all the time on this board as a huge issue. It seems like a lot of new grads end up as firefighters, which is a terrible job and terrible for the field. Glad to know your grads have more sense:)
 
Wow. I'm surprised. It comes up all the time on this board as a huge issue. It seems like a lot of new grads end up as firefighters, which is a terrible job and terrible for the field. Glad to know your grads have more sense:)

Yeah I havent had any of my grads work as a CMG firefighter. Some have gone and worked for CMGs, a few have gone and done locums, most have gotten jobs with hospital systems, a few with private groups.
 
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Yeah I havent had any of my grads work as a CMG firefighter. Some have gone and worked for CMGs, a few have gone and done locums, most have gotten jobs with hospital systems, a few with private groups.

What kind of employment situations have your residents been happiest and most satisfied with? Are they all over the country?
 
Yeah, we have people all over the country. We have some one that is part owner in a small locums company and loves his job. We have some that stayed on as academic faculty and who are academic faculty elsewhere. People that work for independent groups, hospital employees, CMGs... its really variable, and for the most part gets dictated by where the person wants to live.
 
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Asked this on another page, but thought I get your thoughts as well:

Does doing an away in your own state close doors from receiving interviews/being ranked elsewhere to match?
 
I asked this in another thread but is it okay to do two aways affiliated with the same institution but at a different campus? Like SUNY, UC, UT, A&M, etc.

Totally fine, no problem at all.

Edit: Whoops, didn't realize which thread I was in! Thought I was responding in the generic application thread, not the APD AMA.
 
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For academic positionsafter residency, do universities ask for your ITE scores once you graduate before you’ve taken boards, or is it largely based on personality and LOR
 
I am trying to secure away rotations but haven't heard back from any yet. One program did get back to me but offered me an EM U/S rotation instead because their spots were full for the dates I requested. I've read that you should try to get two "true" EM SLOEs. I was planning on getting one from my home institution, and then hopefully two aways. Would it be a bad idea to schedule the U/S rotation as one of my aways? I'm just worried about turning down an offer when I haven't secured any aways yet. Thank you.
 
How do we escape EM??? More people want to switch out of this field than any other!
 
How do we escape EM??? More people want to switch out of this field than any other!

I'm not sure how to say this, I'm not trying to be rude or anything, I swear. But I love EM, and many people do. You don't have to keep blowing up this AMA thread with questions about leaving EM. There are plenty of options, we've discussed this already over multiple posts. You can always create a thread just to discuss this topic if you want, but I don't think its really appropriate to keep rehashing it over and over here in this thread for students trying to get into EM. EM is getting more and more popular, not less. There are people that desperately want to practice EM but can't match into it. Maybe you view yourself as having made a mistake in going into EM, but I assure you there would be a line of people who would do anything to have had the chance to train and practice EM. I'm happy to keep discussing this by PM, but this thread is mainly for students trying to find their way into EM, not for people trying to get out of it. I would never consider leaving EM or escaping, at least not until I'm about ready to retire. I love this field. I don't think you are going to find an answer here, although we've discussed multiple avenues out. I'm just not sure why you keep bringing it up, but like I said, I'm happy to discuss it via PM if you want.
 
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For academic positionsafter residency, do universities ask for your ITE scores once you graduate before you’ve taken boards, or is it largely based on personality and LOR

LOR and personality and academic achievements (research or fellowship) will far outweigh in training scores.
 
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I matched into a TY program this year. Planning to match into EM next year. I have 4 electives, which ones would you suggest I select? I will complete my EM rotation early so I can obtain a new SLOE. Additionally, I will sit for Step 3 in early September so my scores will be posted before October 1st. Are there any other actions I can take to increase my competitiveness?

At risk candidates, meaning people with a red flag, lower boards, previous match failures, etc... those are candidates that I think are best served going above and beyond. I've mentioned networking, and while I think its overkill for many candidates, I think going to ACEPs residency fair and hitting up less competitive programs is a great strategy for people who are more at risk. Obviously doing well on step 3 helps. If you have anyone who can give you any advice on your SLOEs, and possibly replace any lower SLOE with a new one or a LOR from your PD that will help.
 
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