EM PD - Ask Me Anything

[surely]

I would add that if you are a brilliant iconoclast, do not do EM. It's a field for average-bright folks, not the brilliant, unless you want a 100% tox career, which is a rarity.

Which field of medicine should the brilliant iconoclasts flock to, though?

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[eatkalteenbars]

Is it too much to do 3 aways? I have my home rotation in August and aways in September and October from which I plan to get SLOEs. Just got an offer for November at a really competitive program. It's in my home state, where I'd ideally like to match. I'm a little worried about burnout and that it'll affect my interview schedule, but I'm a fairly average applicant (Step 1 234) so I'm hoping it could be a foot in the door at a place I might not otherwise be interviewed. Is there any real downside to doing the November rotation (I won't be getting a SLOE from them) if I don't meet their presumably very high standards?

 

[gamerEMdoc]

Which field of medicine should the brilliant iconoclasts flock to, though?

Im trying to figure this out for my second career. There needs to be a brilliant iconoclast AMA on SDN so I have someone to ask.

 

[gamerEMdoc]

Is it too much to do 3 aways? I have my home rotation in August and aways in September and October from which I plan to get SLOEs. Just got an offer for November at a really competitive program. It's in my home state, where I'd ideally like to match. I'm a little worried about burnout and that it'll affect my interview schedule, but I'm a fairly average applicant (Step 1 234) so I'm hoping it could be a foot in the door at a place I might not otherwise be interviewed. Is there any real downside to doing the November rotation (I won't be getting a SLOE from them) if I don't meet their presumably very high standards?

No I dont see any downsides to doing one. I dont think its necessary to do that many EM months, but if the only way you can get a rotation at one of your top sites is later in interview season, then I dont see any negative in doing a fourth rotation.

I will say, if you are worried about burnout, after four months in the ED as a student over a five month period, Im a little worried about your choice of EM though. There is no escape from EM as an attending and the pressure of the job is infinitely harder than that of a student. You really shouldnt be getting burnt out on rotation, and if you are I seriously think EM may not be right for you. Im not saying you shouldnt do EM, but I do think burnout as a student should be a big red flag to people considering this field.

 

[eatkalteenbars]

No I dont see any downsides to doing one. I dont think its necessary to do that many EM months, but if the only way you can get a rotation at one of your top sites is later in interview season, then I dont see any negative in doing a fourth rotation.

I will say, if you are worried about burnout, after four months in the ED as a student over a five month period, Im a little worried about your choice of EM though. There is no escape from EM as an attending and the pressure of the job is infinitely harder than that of a student. You really shouldnt be getting burnt out on rotation, and if you are I seriously think EM may not be right for you. Im not saying you shouldnt do EM, but I do think burnout as a student should be a big red flag to people considering this field.

Thanks for the response! Just wanted to make sure there weren't any hidden downsides to doing the rotation. In regards to burnout, I'm really excited about all four of my rotations and I don't foresee getting burned out from the actual work in the ED; it's just that I keep hearing from M4s that it's exhausting to move to different hospitals around the country and find housing/get used to a new system every month. If it means getting my foot in the door, though, I can deal with the nomad life for a few months.

 

[mymembernames]

Is it too much to do 3 aways? I have my home rotation in August and aways in September and October from which I plan to get SLOEs. Just got an offer for November at a really competitive program. It's in my home state, where I'd ideally like to match. I'm a little worried about burnout and that it'll affect my interview schedule, but I'm a fairly average applicant (Step 1 234) so I'm hoping it could be a foot in the door at a place I might not otherwise be interviewed. Is there any real downside to doing the November rotation (I won't be getting a SLOE from them) if I don't meet their presumably very high standards?

Similar issue...Do you think we will have enough free time to interview during aways?

 

[LostinLift]

No I dont see any downsides to doing one. I dont think its necessary to do that many EM months, but if the only way you can get a rotation at one of your top sites is later in interview season, then I dont see any negative in doing a fourth rotation.

I will say, if you are worried about burnout, after four months in the ED as a student over a five month period, Im a little worried about your choice of EM though. There is no escape from EM as an attending and the pressure of the job is infinitely harder than that of a student. You really shouldnt be getting burnt out on rotation, and if you are I seriously think EM may not be right for you. Im not saying you shouldnt do EM, but I do think burnout as a student should be a big red flag to people considering this field.

Out of curiosity how many EM rotations did you do as an M4? I wouldn’t say I was burnt out from the medicine, but being evaluated constantly each shift knowing that this would directly affect my residency options was draining. In addition to that, although I was friendly and generally had a good time on each shift, there isn’t as much time to build relationships - which is a huge part of residency/working in an ED.

Definitely looking forward to residency rotations more than medical student rotations.

 

[gamerEMdoc]

Similar issue...Do you think we will have enough free time to interview during aways?

There generally is. I mean, I can't speak for every program, but our students do 16 shifts and we try to bend over backwards when possible to allow them to fit in interviews. Audition and interview season overlap, and any reasonable program out there should be accomodating to allow you to get at least a few interviews in.

 

[gamerEMdoc]

Out of curiosity how many EM rotations did you do as an M4? I wouldn’t say I was burnt out from the medicine, but being evaluated constantly each shift knowing that this would directly affect my residency options was draining. In addition to that, although I was friendly and generally had a good time on each shift, there isn’t as much time to build relationships - which is a huge part of residency/working in an ED.

Definitely looking forward to residency rotations more than medical student rotations.

I did one towards the end of my M3, two during M4, and an EM research month.

I get the issue of the constantly trying to make a good impression, and always being stressed out about it causing people to need time off. But still, the stress of working in EM as a resident and attending is far greater than anything I experienced as a student rotating in EM. It's not even comparable. As a student you have no documentation and really very little actual responsibility outside of seeing a patient or so an hour. When you get pulled in a 1000 directions to take medical command, sign ECGs, keep up with your charting, get called to triage to see something simple, maintain your productivity, deal with a complaining patient, and then surprise, someone drops off someone who is nearly dead by private vehicle... Its just constantly trying to make a good impression as a student doesn't even compare.

Believe me, I get it, I'm not trying to minimize the stressful situation students are in, it is a stressful process and one of the reasons I come here to post and try to help students as much as I can. But one of the biggest reason we burnout in this field is people go into it thinking its going to be easy, not because they enjoy working in a chaotic highly stressful area. I would just make sure you enjoy it early on, because while the shift count goes down as you advance from student to resident to attending, the responsibility, workload, and stressors just increase.

 

[gamerEMdoc]

I dunno- I see a lot of docs screwing up and admin not really caring, interestingly, and not just at my shop.

Agreed with everything else you said, and I would add that if you are a brilliant iconoclast, do not do EM. It's a field for average-bright folks, not the brilliant, unless you want a 100% tox career, which is a rarity.

I don't think it's a thing where smarts/brilliance is a hindrance to being good at EM. The issue is, it's not the most important quality in what makes you good at EM. Multi-tasking, being efficient, thinking on your feet, being good with people, being good in a team environment, and handling stress well are all way more important skills than being brilliant. If you have all those, and you are brilliant, I'm sure you would be an amazing ED doc. The brilliance isn't a hindrance. Its just that we all have things we are good at, and the likelihood of finding someone who has all those qualities and is brilliant is hard to find.

An analogy for the sports fans out there:

Ever wonder why there are very few MLB pitchers out there that are good hitters? Anyone who played baseball growing up experienced that many of the best players on the team both were great hitters and great pitchers. Yet, outside of an extremely rare occurance, why don't you see players who are both great hitters and great pitchers at a MLB level? Well, the answer is statistical. Of everyone who ever plays baseball, lets say there is 1/10,000 that are good enough to hit major league pitching, and 1/10,000 who are good enough to pitch in the major leagues. So the chance of one single athlete being good enough to do both successfully at the MLB level is extraordinarily low, 1/100,000,000. It's happened pretty much twice in the history of baseball with Babe Ruth and now with Shohei Ohtani.

So being a good enough pitcher to pitch in MLB doesn't make you a bad hitter any more than being brilliant makes you bad at EM. It's just that, statistically, finding someone who is the total package and absolutely great at everything is rare.

 

[mymembernames]

There generally is. I mean, I can't speak for every program, but our students do 16 shifts and we try to bend over backwards when possible to allow them to fit in interviews. Audition and interview season overlap, and any reasonable program out there should be accomodating to allow you to get at least a few interviews in.

Thanks!! Does that mean we will have about 12 days off then?

 

[gamerEMdoc]

It's going to depend on where you rotate. But about that. Granted, you may have to attend conference too, and if that falls on an off day, then it takes up a day. Conference is required for students that rotate with us, but we don't require them to be there if they have an interview that day. Like I said, some places may be more accommodating than others. If you are planning on rotating somewhere in the November or December time-frame, you may want to find out way ahead of time how many shifts you work and how flexible they are with accommodating interviews.

 

[Newyawk]

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!

Thanks! Im doing an EM elective soon but was wondering if you think EM is a good fit for me. Ik this list is very brief but i really tried narrowing the scope so that i can be more focused bc im all over the place.
I think ive narrowed my ultimate goals/passions to this:
I love diagnosing patients and i want a field that will allow me to see varied pathology and apply pathophys and all that good stuff.
I also want a field where my coworkers are chill - can shoot the **** and arent uptight.
I want free time for family and hobbies and i want control over my schedule.

 

[gamerEMdoc]

I love diagnosing patients and i want a field that will allow me to see varied pathology and apply pathophys and all that good stuff.

EM offers this more than any other field IMO.

I also want a field where my coworkers are chill - can shoot the **** and arent uptight.

Definitely would like EM.

I want free time for family and hobbies and i want control over my schedule.

Well.... this last ones more tricky. Many people view EM as a lifestyle field because of the number of shifts you work vs the number of days in the hospital or clinic that other fields do. Sure, by the hour, we work less than most fields and make a really good living. But I can tell you, it really depends on how your boy reacts to the scheduling, night shifts, circadian disruption, changing times of shifts, and the stress of the job. For many people, the day after a night shift isn't really like a day off for most people, you sleep most of the day and spend the rest feeling hung over. You'll work on days when all your friends/family are off, and you'll be off when no one else is. And you will only really have control over your own schedule if you make the schedule for your group, or you become a locums and dictate exactly when you work.

 

[Newyawk]

EM offers this more than any other field IMO.



Definitely would like EM.



Well.... this last ones more tricky. Many people view EM as a lifestyle field because of the number of shifts you work vs the number of days in the hospital or clinic that other fields do. Sure, by the hour, we work less than most fields and make a really good living. But I can tell you, it really depends on how your boy reacts to the scheduling, night shifts, circadian disruption, changing times of shifts, and the stress of the job. For many people, the day after a night shift isn't really like a day off for most people, you sleep most of the day and spend the rest feeling hung over. You'll work on days when all your friends/family are off, and you'll be off when no one else is. And you will only really have control over your own schedule if you make the schedule for your group, or you become a locums and dictate exactly when you work.

Thanks! The circadian rhythm thing is definitely gonna be an issue for me but im not sure how much of an issue.
Also how does it work with weekends? Ill work on some weekends but surely ill have others off?

 

[DwightKShruteATTRM]

Thanks! The circadian rhythm thing is definitely gonna be an issue for me but im not sure how much of an issue.
Also how does it work with weekends? Ill work on some weekends but surely ill have others off?

The groups who staff at my student rotations have the attendings rotate weekends unless you volunteer to work all the night or swing shifts. You can have preferences as long as it is "I only work on weekdays from 6A-6P with most holidays off." That will never happen for the entirety of your career in EM.

 

[Newyawk]

The groups who staff at my student rotations have the attendings rotate weekends unless you volunteer to work all the night or swing shifts. You can have preferences as long as it is "I only work on weekdays from 6A-6P with most holidays off." That will never happen for the entirety of your career in EM.

right but its not the same attending every time I imagine?
could an EM attending describe their schedule in a typical week/month? all this talk about it not being a lifestyle specialty is confusing me. yea I get you work nights weekends and holidays but not all nights, weekends, and holidays.

 

[gamerEMdoc]

Most of our attendings work four weekend shifts a month, so you work about half the weekend shifts available. The way the schedule works out that doesn't always mean two full complete weekends (off Sat/Sun the same weekend). You could have one Saturday off but work Sunday two weeks in a row, then have a full weekend off, and that's still 4 weekend days off. The major holidays (that people want off when we sat down as a group and decided) are generally divided evenly. Working on a holiday pays more, so if someone wants to work them, so others don't, they can.

There's nothing to confuse you. It's not a lifestyle specialty, period. There are easier more relaxing fields than EM. We have the highest burnout rate of any specialty in medicine, to consider it a lifestyle field when more people quit your specialty than any other field is obviously short sighted. If you are looking for a specialty specifically based on it being an easy specialty, this isn't it. Don't look at it as such, because if you do, once you go into it, you'll likely be one of those people that burnout.

That being said, for those that love the chaos and stress of the job, and can physically deal with the shift work and circadian disruption, who don't mind working at bizarre hours, it's an incredibly rewarding field. I personally still love it 10 years into my career.

 

[Newyawk]

Most of our attendings work four weekend shifts a month, so you work about half the weekend shifts available. The way the schedule works out that doesn't always mean two full complete weekends (off Sat/Sun the same weekend). You could have one Saturday off but work Sunday two weeks in a row, then have a full weekend off, and that's still 4 weekend days off. The major holidays (that people want off when we sat down as a group and decided) are generally divided evenly. Working on a holiday pays more, so if someone wants to work them, so others don't, they can.

There's nothing to confuse you. It's not a lifestyle specialty, period. There are easier more relaxing fields than EM. We have the highest burnout rate of any specialty in medicine, to consider it a lifestyle field when more people quit your specialty than any other field is obviously short sighted. If you are looking for a specialty specifically based on it being an easy specialty, this isn't it. Don't look at it as such, because if you do, once you go into it, you'll likely be one of those people that burnout.

That being said, for those that love the chaos and stress of the job, and can physically deal with the shift work and circadian disruption, who don't mind working at bizarre hours, it's an incredibly rewarding field. I personally still love it 10 years into my career.

Ok thanks for the honesty. I guess ill see if i really like it on my elective month. I have a feeling i might like it based on the aforementioned reasons. What it sounds like youre saying is that if you do like it then you should definitely pursue it because its a great field despite the tough lifestyle.
Whats confusing to me is how it can be difficult to work 36 hours a week (if you just ignore the work on weekends and holidays as a negative lifestyle factor).

 

[Vandalia]

Ok thanks for the honesty. I guess ill see if i really like it on my elective month. I have a feeling i might like it based on the aforementioned reasons. What it sounds like youre saying is that if you do like it then you should definitely pursue it because its a great field despite the tough lifestyle.
Whats confusing to me is how it can be difficult to work 36 hours a week (if you just ignore the work on weekends and holidays as a negative lifestyle factor).

I will go with another sports analogy: NFL players only work about 3 hours a week and they only do that only about 16 times a year. Compare that with MLB players who work about 3 hours a day 161 days a year.

It is not only the number of hours, it is the intensity of those hours.

An academic surgeon might spend only 12 hours operating a week, while a primary care physician is seeing patients for 40 hours a week. Again, it is not only the number of hours, it is the intensity with which they are spent.

A university professor might only teach 9 hours a week, but that is considered full time compared with an elementary school teacher teaching 35 hours a week. But there is a difference in intensity that comes from standing and lecturing consistently rather than watching children read or fill out worksheets.

None of these examples are submitted for the truth of the individual matters, but rather to show that it is not just the number of hours you work, but the intensity at which you work.

 

[gamerEMdoc]

Ok thanks for the honesty. I guess ill see if i really like it on my elective month. I have a feeling i might like it based on the aforementioned reasons. What it sounds like youre saying is that if you do like it then you should definitely pursue it because its a great field despite the tough lifestyle.
Whats confusing to me is how it can be difficult to work 36 hours a week (if you just ignore the work on weekends and holidays as a negative lifestyle factor).

Because number of hours worked doesn’t equate to how good a field is for a lifestyle. The NFL analogy is a great one. They may only play 16 game seasons, yet their careers are shorter than pretty much any sport? Why? The game is tougher on them physically than other sports and their bodies cant recover as easy as they get older.

EM can be grueling work. Its thankless. Just about everyone in the hospital thinks you are a ***** and thinks they could do your job better (hint: they cant). And the job is much harder as you get older for many reasons. Circadian disruption is way worse. Its harder to balance the shifts with family life. The job gets harder as you advance from student to resident and resident to attending. So sure we may work less hours than say Derm, but Dermatologists also get a lunch break, probably have time to use the bathroom when they need to, arent lying wide awake at 3am desperately trying to sleep bc they work the next morning but cant because they are switching from nights to days, dont have to do rape exams, tell parents their kids are dead, be screamed at by consultants for merely asking them to do their job, etc. Hell, statistically you have a 50% chance of being physically assaulted at work if you work in the ER. Tell me another field that works under physical threat of violence at times in medicine?

Again, Im not purposely trying to paint EM in a bad light, just a realistic one. Everyone here knows I love this field. But its not a lifestyle field and students going into it need to know that, or we will continue to have people trained in EM and immediately try to get out of it in a few years and continue to lead the burnout rate.

 

[Newyawk]

Understood. Thanks for the insight.

 

[miacomet]

Because number of hours worked doesn’t equate to how good a field is for a lifestyle. The NFL analogy is a great one. They may only play 16 game seasons, yet their careers are shorter than pretty much any sport? Why? The game is tougher on them physically than other sports and their bodies cant recover as easy as they get older.

EM can be grueling work. Its thankless. Just about everyone in the hospital thinks you are a ***** and thinks they could do your job better (hint: they cant). And the job is much harder as you get older for many reasons. Circadian disruption is way worse. Its harder to balance the shifts with family life. The job gets harder as you advance from student to resident and resident to attending. So sure we may work less hours than say Derm, but Dermatologists also get a lunch break, probably have time to use the bathroom when they need to, arent lying wide awake at 3am desperately trying to sleep bc they work the next morning but cant because they are switching from nights to days, dont have to do rape exams, tell parents their kids are dead, be screamed at by consultants for merely asking them to do their job, etc. Hell, statistically you have a 50% chance of being physically assaulted at work if you work in the ER. Tell me another field that works under physical threat of violence at times in medicine?

Again, Im not purposely trying to paint EM in a bad light, just a realistic one. Everyone here knows I love this field. But its not a lifestyle field and students going into it need to know that, or we will continue to have people trained in EM and immediately try to get out of it in a few years and continue to lead the burnout rate.

Gamer's comments are spot on, and even more meaningful coming from someone who likes the field. The prospective EM docs on this board are lucky to have someone explain this while you are still students.

Everyone who is not independently wealthy needs an exit strategy from this field, and I wish ACEP and AAEM would take this more seriously.

 

[miacomet]

Understood. Thanks for the insight.

Also, Newyawk, it's extremely underpaid, more stressful, busier, and comes with even higher liability in NYC. Columbia, Kings County, and Sinai can't even fill their attending lines because it's such a tough place to work.

 

[ShowtimeKaner88]

Do you have any advice/input as to what you'd like to see in the experiences section of ERAS? How far back should we go with college experiences?

So far, I have 5 work (including 2 jobs from college), 5 volunteer, and 2 research (1 from college). Just a little bit of confusion/anxiety so any input is much appreciated. Thanks for everything you do here on the forums!

 

[gamerEMdoc]

Do you have any advice/input as to what you'd like to see in the experiences section of ERAS? How far back should we go with college experiences?

So far, I have 5 work (including 2 jobs from college), 5 volunteer, and 2 research (1 from college). Just a little bit of confusion/anxiety so any input is much appreciated. Thanks for everything you do here on the forums!

This is a great question, one I don't think has been asked here before. I think the best way to approach that section for work/volunteer experiences is to put actually meaningful things that were a time commitment. So often the section gets watered down by people listing 100 different things, many of which were like a one hour volunteer experience. Any and all past job employment should be listed. Volunteer experience that you were a leader in, or that was a big time commitment should be listed. But something like you walking a 5k for charity can probably be skipped, etc

Hope that helps!

 

[Waterlover]

This is a great question, one I don't think has been asked here before. I think the best way to approach that section for work/volunteer experiences is to put actually meaningful things that were a time commitment. So often the section gets watered down by people listing 100 different things, many of which were like a one hour volunteer experience. Any and all past job employment should be listed. Volunteer experience that you were a leader in, or that was a big time commitment should be listed. But something like you walking a 5k for charity can probably be skipped, etc

Hope that helps!

So you'd say meaningful volunteer/leadership experiences from college specifically are fine?

 

[gamerEMdoc]

So you'd say meaningful volunteer/leadership experiences from college specifically are fine?

Yep. This is true for any CV you build going forward for the rest of your career. As your career progresses, you won't remove everything off your CV from college, med school, residency, etc, but you'll remove much of it, and really only leave the most meaningful awards, experiences, publications, etc.

 

[gamerEMdoc]

I've talked to a ton of students on this board over the last two years, but I just wanted to take a second break from discussing student issues to to drop by and post something to all the new PGY1's about to start.

Congratulations to every one of you that made their way into this field. It's an incredible honor and a huge responsibility. Things are about to get hard. Sometimes really, really hard. But I promise you, despite all the challenges residency can bring, the good far outweighs the bad. You won't always see it that way while going through it, and sometimes you will be counting down the hours or days until the end of your shift, your trauma month, or your residency. But in the end, when your 3 (or 4) years are over, you will never have an experience like residency ever again and I promise you, you will look back and miss it. The friends you make among your co-residents and attendings while working under immense pressure and the fun you'll have blowing of steam outside of work are tough to replicate when you are done and graduated. Almost a decade later I still think about and miss my own residency, as crazy as that sounds. So enjoy it. Even in the hard times. Because it will be over in a blink of an eye. Get ready to do great things!

And congratulations to all the PGY3/4's that graduated this month and are about to start their careers. Kudos. I wish all of you the best of luck heading out there on your own.

 

[doc2be245]

Hey @gamerEMdoc. Was checking out fellowship opportunities for EM residents recently and found out more about the EM Critical Care Path. What do you think about the idea of working in both an Emergency Room and in the ICU as an intensivist? Do you find that IM CC fellowships are open to accepting EM residents without resistance? Just thought it was a unique because it's one of the few fellowship opportunities in EM that allows you to branch out and work in different areas of the hospital.

 

[gamerEMdoc]

Hey @gamerEMdoc. Was checking out fellowship opportunities for EM residents recently and found out more about the EM Critical Care Path. What do you think about the idea of working in both an Emergency Room and in the ICU as an intensivist? Do you find that IM CC fellowships are open to accepting EM residents without resistance? Just thought it was a unique because it's one of the few fellowship opportunities in EM that allows you to branch out and work in different areas of the hospital.

I had a graduating resident 2 years ago that went into a CC fellowship who planned to do just that after fellowship. Whether or not a CC fellowship takes EM applicants is up to them. Recently more and more are open to it because EM folks can now sit for the CC boards after a 2 year fellowship.

Here's a list on EMRA's website of CC fellowships that are EM friendly:

Critical Care Fellowships

 

[ShowtimeKaner88]

This is a great question, one I don't think has been asked here before. I think the best way to approach that section for work/volunteer experiences is to put actually meaningful things that were a time commitment. So often the section gets watered down by people listing 100 different things, many of which were like a one hour volunteer experience. Any and all past job employment should be listed. Volunteer experience that you were a leader in, or that was a big time commitment should be listed. But something like you walking a 5k for charity can probably be skipped, etc

Hope that helps!

Follow up question if you don't mind! Do you think it is preferred to have the description section of experiences in ERAS to be in a typical bullet point format of a CV or is narrative form better? My thoughts with applying to emergency medicine I would expect the bullet point format with key details expressed to be superior, but I wanted to get some input.

Thank you again!

 

[gamerEMdoc]

Follow up question if you don't mind! Do you think it is preferred to have the description section of experiences in ERAS to be in a typical bullet point format of a CV or is narrative form better? My thoughts with applying to emergency medicine I would expect the bullet point format with key details expressed to be superior, but I wanted to get some input.

Thank you again!

I think you are bound by the format that ERAS allows. You list the job history and in the next section volunteer activities, and can put a brief narrative description of that experience if you wish.

 

[gamerEMdoc]

Hello quick question. Do you believe an away rotation at California is necessary to open doors for California interviews?

I think its hard to break the CA barrier unless you are from CA (permanent address) or go to a west coast school. Obviously a rotation helps if they look at your app, but you can only geographically filter by those two things (home and school location) not by where people rotated. If there is no other link to CA, then rotating there and then trying to network is about your best chance in, but its a longer shot unless you are just an absolute star.

 

[gamerEMdoc]

So it should be fine as long as the home address is from California and the CV experiences/undergraduate is all from Cali? Thank you.

Define "fine"? If you have a CA address and went to college in CA, then yes, you'll be less apt to get screened out of CA programs compared to out of state applicants. But that doesn't mean you'll definitely match in CA, its probably the most competitive state to match in. But you have an advantage having a permanent address from there, at least in terms of getting your app looked at.

 

[surely]

Well, I guess "fine" as in they won't screen me out compared to someone who doesn't live there but has done an away rotation in California. It is not my top state to match in, but would be a good place to end up in overall. Thanks!

I don't think anyone can tell you whether being from CA means as much or more than doing an Away in CA. All you can do in this crazy game is try to beef up your chances as much as you can. If being in CA is important to you, do the Away there just to be safe.

 

[Donald Kimball]

Well, I guess "fine" as in they won't screen me out compared to someone who doesn't live there but has done an away rotation in California. It is not my top state to match in, but would be a good place to end up in overall. Thanks!

I have no West coast ties, but I matched to the best coast. I believe you can brute force your way past geographical screens with a strong application, especially at "big name" programs that know people will want to go there. If I had to do it all over again, I would've done an away out here just to further improve my chances. Most of my classmates (but not all!) have some ties.

 

[gamerEMdoc]

The away wont get you past geographic screens. There is no eras screen based on where people rotate at. I wish there was, it would be another level to add. But there isnt. Where rotating in a state does help is if you can network a bit, or if you email a program about interest and they look at your app and see you rotated close by. It lends some credence to you actually having some genuine interest.

 

[mymembernames]

Noticed the 2018 NRMP data is out, would you agree that EM competitiveness has stayed about the same compared to the data we have from 2016?

 

[gamerEMdoc]

Noticed the 2018 NRMP data is out, would you agree that EM competitiveness has stayed about the same compared to the data we have from 2016?

I havent seen the 2018 data to compare them yet, but subjectively, there’s not really a big difference over the three-year period. It’s hard to see a difference over such a short period of time. Sure, if you compared EM 10 to 15 years ago versus today, you would see a much more competitive field. But three years is too short of a timeframe to see any major trends I would imagine. Ill have to take a close look here at the numbers at some point.

 

[DrGainzzz]

Incoming OMS1 and just have a few questions

1. How do you view someone with only comlex scores? Being that the new merger is coming soon, our school recommends taking both exams. How many aways do students usually do and can crushing those help get ones foot in the door into a program?

2. Are fellowships helpful to avoid burnout in the EM world?

3. What are some qualities that you look for in an applicant? What are turn offs?

4. Does research matter at all or will it only matter in certain programs?

5. What should I be focusing on first year aside from classes? Would networking at conferences be helpful and/or reaching out to EM docs back Home to shadow during M1 summer?

Thanks for the help!

 

[LimitLess]

Incoming OMS1 and just have a few questions

1. How do you view someone with only comlex scores? Being that the new merger is coming soon, our school recommends taking both exams. How many aways do students usually do and can crushing those help get ones foot in the door into a program?

2. Are fellowships helpful to avoid burnout in the EM world?

3. What are some qualities that you look for in an applicant? What are turn offs?

4. Does research matter at all or will it only matter in certain programs?

5. What should I be focusing on first year aside from classes? Would networking at conferences be helpful and/or reaching out to EM docs back Home to shadow during M1 summer?

Thanks for the help!

I'll give my opinion on the first question. I recommend you take both exams. if you're studying for one, you'll be pretty much studying for the other exam (aside for OMM). Some EM programs require usmle step1/2 scores to rank you, I wouldn't risk not taking the exams. The only scenario I wouldn't take usmle is if you're bombing multiple nbme practice exams. My advice is start preparing for step 1 early (around december of second year), make your goal to have finished uworld twice by end of dedicated, along with using first aid, pathoma, sketchy micro/pharm and you should score above average with no problem. But key to success for usmle/comlex is uworld! It just takes alot of time to do all that stuff i mentioned so start early.

Regarding your other questions he has answered a good amount of these already in this thread. Since you're only a first year, you have plenty of time ahead prior to starting your application process for EM. I would definitely read this whole thread as he has provided a lot of great insight to students pursuing EM. For now focus on surviving first year of medical school and enjoy any free time you get as it will decrease as the time goes on.

 

[gamerEMdoc]

1. How do you view someone with only comlex scores? Being that the new merger is coming soon, our school recommends taking both exams. How many aways do students usually do and can crushing those help get ones foot in the door into a program?

DO's should probably do 3 aways (since they usually don't have a home program). For allopaths with a home program, 1-2 aways should be good enough. How important are they? The letters you get (SLOEs) are the single most important thing in your application, and are the key to either matching or not matching. Nothing else in the application caries the same weight as your SLOEs. So yeah, crushing your rotations is important.

Re: comlex scores, I have no problem extrapolating comlex to usmle, so I don't really care if people take two exams, and I think its ridiculous to expect students to. But that's likely a minority opinion, and you are probably shutting some doors by not taking two. Then again, the programs that won't even look at COMLEX probably aren't the most DO friendly anyways. I think the safest thing to do is to take two exams, as much as it pains me to say that. But you can still match in EM if you don't.

Boards just arent' that important when it comes to matching EM. It's important to know you didn't fail. It's important not to be in the bottom tier of scores. But other than that, all most programs care about is SLOEs which are you letters based on your 4th year AIs which rank you vs other students that rotate.

2. Are fellowships helpful to avoid burnout in the EM world?

Depends. Many fellowships lead you to making less money. If you do a 3 year Peds EM fellowship, you'll graduate and make less money than had you just got a job straight out of residency. Want to do an US fellowship? Great, but you have to realize you are unlikely to get paid more than anyone else at the hospital you end up at afterwards. Does that mean you shouldn't do fellowships? Absolutely not, I encourage my residents to do them if they have a passion for a subspecialty of EM. But the fact of the matter is, most ED docs graduate and just want to get out and work and make money and pay off their loans. In terms of burnout, I think fellowships could help in the sense that many people who do them do so to go into academics and academics just has a lower burnout rate.

As always, do a fellowship because you love the field, not because you want to use if for more money or burnout protection or anything else. Choose your field because you love it.

3. What are some qualities that you look for in an applicant? What are turn offs?

Mainly people who are good at task management and multi-tasking, who can succinctly summarize a case presentation, and who are good at thinking on their feet when it comes to formulating a ddx. And who are fun to hang out with, because so much of EM is spent working together as a team.

Turn offs: Overly clingy people, people that don't get that there is a time to socialize and that time isn't when there is 10 patients on the next to be seen list, overly arrogant people (unless they can really back it up), and anyone who can't get along with my residents.

4. Does research matter at all or will it only matter in certain programs?

Only will help with research heavy programs

5. What should I be focusing on first year aside from classes? Would networking at conferences be helpful and/or reaching out to EM docs back Home to shadow during M1 summer?

Nope it's way to early. Join your schools EM interest group (if they have one) and go to their meetings. Way to early to network otherwise. Do well in year 1/2, do well on Step 1. And try to enjoy your life a bit. Don't waste your off time shadowing in an ED unless you just want to find out if EM is right for you. Just enjoy what time off you have. Once you get into year 3, start honing your skills at presenting cases, and getting better at summarizing things quickly. Learn to come up with your own plans on the fly, which so many students just don't do. Force yourself to become more time efficient when seeing patients no matter what rotation you are on (FP, Peds, IM admits, etc). So when it comes time to rotate in the ED in your fourth year AIs, you aren't in the room 20 minutes getting a history for someone with abdominal pain and then come out of the room and not be able to succinctly discuss the case in a minute or so to the attending. All of that takes skill and repitition, and if you find aspects of your third year rotations to allow yourself to try to hone the skills you'll need for your AIs, you'll be in a much better starting position.

 

[DrGainzzz]

DO's should probably do 3 aways (since they usually don't have a home program). For allopaths with a home program, 1-2 aways should be good enough. How important are they? The letters you get (SLOEs) are the single most important thing in your application, and are the key to either matching or not matching. Nothing else in the application caries the same weight as your SLOEs. So yeah, crushing your rotations is important.

Re: comlex scores, I have no problem extrapolating comlex to usmle, so I don't really care if people take two exams, and I think its ridiculous to expect students to. But that's likely a minority opinion, and you are probably shutting some doors by not taking two. Then again, the programs that won't even look at COMLEX probably aren't the most DO friendly anyways. I think the safest thing to do is to take two exams, as much as it pains me to say that. But you can still match in EM if you don't.

Boards just arent' that important when it comes to matching EM. It's important to know you didn't fail. It's important not to be in the bottom tier of scores. But other than that, all most programs care about is SLOEs which are you letters based on your 4th year AIs which rank you vs other students that rotate.




Depends. Many fellowships lead you to making less money. If you do a 3 year Peds EM fellowship, you'll graduate and make less money than had you just got a job straight out of residency. Want to do an US fellowship? Great, but you have to realize you are unlikely to get paid more than anyone else at the hospital you end up at afterwards. Does that mean you shouldn't do fellowships? Absolutely not, I encourage my residents to do them if they have a passion for a subspecialty of EM. But the fact of the matter is, most ED docs graduate and just want to get out and work and make money and pay off their loans. In terms of burnout, I think fellowships could help in the sense that many people who do them do so to go into academics and academics just has a lower burnout rate.

As always, do a fellowship because you love the field, not because you want to use if for more money or burnout protection or anything else. Choose your field because you love it.



Mainly people who are good at task management and multi-tasking, who can succinctly summarize a case presentation, and who are good at thinking on their feet when it comes to formulating a ddx. And who are fun to hang out with, because so much of EM is spent working together as a team.

Turn offs: Overly clingy people, people that don't get that there is a time to socialize and that time isn't when there is 10 patients on the next to be seen list, overly arrogant people (unless they can really back it up), and anyone who can't get along with my residents.



Only will help with research heavy programs



Nope it's way to early. Join your schools EM interest group (if they have one) and go to their meetings. Way to early to network otherwise. Do well in year 1/2, do well on Step 1. And try to enjoy your life a bit. Don't waste your off time shadowing in an ED unless you just want to find out if EM is right for you. Just enjoy what time off you have. Once you get into year 3, start honing your skills at presenting cases, and getting better at summarizing things quickly. Learn to come up with your own plans on the fly, which so many students just don't do. Force yourself to become more time efficient when seeing patients no matter what rotation you are on (FP, Peds, IM admits, etc). So when it comes time to rotate in the ED in your fourth year AIs, you aren't in the room 20 minutes getting a history for someone with abdominal pain and then come out of the room and not be able to succinctly discuss the case in a minute or so to the attending. All of that takes skill and repitition, and if you find aspects of your third year rotations to allow yourself to try to hone the skills you'll need for your AIs, you'll be in a much better starting position.

Thanks a lot for the great advice!

 

[mymembernames]

Any advice on how to prepare for the SVI?

 

[gamerEMdoc]

Well, I never had to take it, obviously. My one tip would be not to sweat it too much. It's like the personal statement. Unless you are epicly bad, it's not going to make a difference in your application. Don't lose sleep over the SVI.

Here's some resources if you want to prepare:

AAMC - prep tips, sample questions, and even 2 practice SVI tests

https://students-residents.aamc.org/applying-residency/article/prepare-svi/

Tips from CORD:

The Standardized Video Interview

 

[druidboy05]

I just spend the last 24 hours reading through every post on this 20-page thread, and I have to say, @gamerEMdoc, you are a gem - I sincerely hope that you will still be around SDN and willing to help us out in a couple of years!

Like you, I've always been interested in the academic side of medicine/teaching and mentoring others. Which is why I'm considering taking an extra year between 2nd and 3rd year to be a teaching fellow. During this year, I have the option to get my MBA as well - while being on admin is a possibility wayyy down the line, I've never really considered getting a MBA. For the more competitive EM programs (like say EM programs in CA), how does an additional degree like a MBA or MPH look on an application? I know you've reiterated many times that SLOEs are #1 then board scores. So should I just save money and not go for an extra degree during that time? For those competitive programs in CA, should one consider research?

You also mentioned that you did a month of EM research - was that at your medical school or did you arrange for that?

All depends on the length of the shifts, but yeah, for the most part, you get off about 2 days a week or more on average. Programs can work you a maximum of five 12 hour shifts a week (20 12's a month). Many programs don't do 12's though, so the shift numbers can be more than 20 technically. For my program, we work 9's. Our residents work:

ACGME allowable hours/month: 240

PGY1: 20 9's (180 hrs)
PGY2: 19 9's (171 hrs)
PGY3: 18 9's (162 hrs)

Our goal is to go nowhere near the max number of hours per month. I personally am opposed to 12's because they lead to very little personal time off when you are in a stretch of shifts. You basically work, go home, sleep, and get up for work. It leads to a grueling lack of work/life balance with little time to do anything else. Because our curriculum has a decent amount of self study intertwined into our conference, we've always wanted to be far under the max work hours to allow residents to have ample time to actually read and study EM.

After reading through all your posts, I am genuinely interested in checking out your program - is it taboo to reveal where you work? If so, I'll just PM you!

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?

What are sleepy EDs? Tried to do a simple Google search without any luck.

 

[deleted715884]

I just got my step score, it's in the 200-210 range (US Student) even though I spent 9 months preparing along side my classes and seemed to spend more hours studying than my classmates. I know EM is growing rather fast and becoming more competitive. Realistically, how many programs do you think would not filter me out? What would you say I need to get on step 2 to even consider trying to match into EM if I'm willing to send out 100+ applications? Any advice for someone in my position other than trying to kill step 2?

 

[alpinism]

Besides killing step 2: Go on at least a couple aways and get amazing SLOEs.

Also focus on less competitive and newer programs in midwestern and southern states.

 

[DO3]

I just got my step score, it's in the 200-210 range (US Student) even though I spent 9 months preparing along side my classes and seemed to spend more hours studying than my classmates. I know EM is growing rather fast and becoming more competitive. Realistically, how many programs do you think would not filter me out? What would you say I need to get on step 2 to even consider trying to match into EM if I'm willing to send out 100+ applications? Any advice for someone in my position other than trying to kill step 2?

Going to have to kill step 2. Auditions will be very important for you, and your SLOEs from those rotations will have to be glowing. In addition, assuming you kill step 2, I would also write interest emails to program coordinators and PDs at programs you’re interested in. It’s not impossible to match with your score, but, some programs will screen out your application based on only the step 1 score. In addition, you will also have to apply early and very broadly for audition spots, as some programs, again, will screen out your vsas application based only on the step 1 score. Your best shot at matching will be at one of your audition sites, again, assuming you perform well.