EM PD - Ask Me Anything

[deleted709753]

Thanks for answering answers. I enjoy reading your posts on here.

I'm having trouble deciding how many, and where to do my aways next year. VSAS opened up for us. Current MS3 here at an MD school who projects to be an average EM applicant after MS3 year and before starting MS4 year. Basically, I think I will be average, and that may change after MS4 aways--for better or worse. I don't know whether I desire a community, county or academic residency at this point. I can see positives in each setting.

That said, I will do my first home EM rotation at my school (at a busy community hospital) but we have no EM residency in my state. I'm thinking of doing either 2-3 away rotations. What are your thoughts on me, the average applicant, doing my first away rotation (after my home) at a small rural community program, my second away at a top county program in southern california, and my third away at a top academic program in northern cali?

Although I don't expect to be that competitive for those top programs in california, I am slightly wanting to shoot for the stars, and try to get at least good SLOEs that can carry a lot of weight.

Or should I be more realistic in my away choices and shoot for more realistic programs because I'm most likely to match at a program I did an away at?

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[gamerEMdoc]

Thanks for answering answers. I enjoy reading your posts on here.

I'm having trouble deciding how many, and where to do my aways next year. VSAS opened up for us. Current MS3 here at an MD school who projects to be an average EM applicant after MS3 year and before starting MS4 year. Basically, I think I will be average, and that may change after MS4 aways--for better or worse. I don't know whether I desire a community, county or academic residency at this point. I can see positives in each setting.

That said, I will do my first home EM rotation at my school (at a busy community hospital) but we have no EM residency in my state. I'm thinking of doing either 2-3 away rotations. What are your thoughts on me, the average applicant, doing my first away rotation (after my home) at a small rural community program, my second away at a top county program in southern california, and my third away at a top academic program in northern cali?

Although I don't expect to be that competitive for those top programs in california, I am slightly wanting to shoot for the stars, and try to get at least good SLOEs that can carry a lot of weight.

Or should I be more realistic in my away choices and shoot for more realistic programs because I'm most likely to match at a program I did an away at?

In general, for scheduling aways, I like the away rotation to check two boxes:
- It's at a program you would consider going to for residency
- It's at a program you think you could possibly have a chance of matching at.

Scheduling a rotation at a place you wouldn't want to train or that you think realistically you won't match at, is a waste of a very valuable month. The rotations are some of your best chances in the match. I'm not saying don't consider your dream program. If you get a rotation anywhere, then you are likely good enough to meet their criteria to rank (otherwise they wouldn't have you rotate). But if they dont offer a rotation, just move on. And consider not doing all your rotations in CA if you aren't a high tier candidate, it's going to be competitive to match in that state and if you have concerns about your competitiveness, I wouldn't pin all my hopes on that state.

 

[JustUnder9000]

Hello,

I appreciate you answering all of our questions. I unfortunately had to scramble last year with only 5 interviews. I am currently completing a prelim surgery year, and the application cycle went better for me actually this year with what I believe to be much better locations. But I’m still only ranking 8 places, so there’s a decent risk of not matching again. EM is the only thing I honestly want to do, my curent plan is to attempt to SOAP into a FM program and then Persue an EM fellowship. I have heard that if that’s what I do then my job prospects would be severely hindered— do you think this is a reasonable plan? Or would it in fact be very difficult to work as an ER doc with fellowship training?

Thank you

 

[gamerEMdoc]

Hello,

I appreciate you answering all of our questions. I unfortunately had to scramble last year with only 5 interviews. I am currently completing a prelim surgery year, and the application cycle went better for me actually this year with what I believe to be much better locations. But I’m still only ranking 8 places, so there’s a decent risk of not matching again. EM is the only thing I honestly want to do, my curent plan is to attempt to SOAP into a FM program and then Persue an EM fellowship. I have heard that if that’s what I do then my job prospects would be severely hindered— do you think this is a reasonable plan? Or would it in fact be very difficult to work as an ER doc with fellowship training?

Thank you

They will be hindered in the sense that you won't be able to work in academics training EM docs. Most jobs are going to prefer to hire a boarded EM doc before they hire you, so the chance of getting a unicorn job that is highly desirable is extremely unlikely. However, that being said, there will still be plenty of opportunities. Hopefully its a non-issue, the statistics of matching with 8 interviews is pretty good.

 

[TTPpentad]

Thank you for all of the advice you’ve given on this forum! As a student from a school without an EM department (or advising), it’s very helpful to read your posts on here.

I recently applied (through VSAS) to audition at a program that is one of my top choices and I noticed that my school hasn’t updated my transcript to include the honors grade on my EM rotation. Would this information make a big enough difference in selecting someone to audition that I should contact the program’s VSAS coordinator and mention it? If not, I don’t want to annoy them.

 

[gamerEMdoc]

Thank you for all of the advice you’ve given on this forum! As a student from a school without an EM department (or advising), it’s very helpful to read your posts on here.

I recently applied (through VSAS) to audition at a program that is one of my top choices and I noticed that my school hasn’t updated my transcript to include the honors grade on my EM rotation. Would this information make a big enough difference in selecting someone to audition that I should contact the program’s VSAS coordinator and mention it? If not, I don’t want to annoy them.

Probably unlikely to make a difference to be honest

 

[gamerEMdoc]

Hey I have a favor to ask for students/junior residents who are going through, will go through, or recently went through the match process. I've answered a lot of questions over the past few years, and this is the one and only time I'm doing this, but I want to ask a question of you all and get as many opinions as possible, whether its posted here or PM me. It's something we touched on before, but I want to hear from a students perspective. Here's the issue...

Post interview communication. The kind that is fully ok within the rules of the match. I've been getting the vibe from some students that have posted here in the past that when programs contact students it puts the student in an uncomfortable situation with sometimes awkward communication. A recent discussion here on SDN about post-match communication made me really start thinking about this, and shortly after our PD had contacted a small handful (less than 10) of our candidates after we finalized our list, I brought it up to him that we maybe should just not contact people at all. So we didn't. Outside of an initial very small few, we haven't reached out to anyone this year, and probably won't. (*Side note, if you did interview with my program please don't take the silence as disinterest*). We decided to go this route for a couple reasons. One reason was to just see what happens. We felt that we almost had to participate in this game for fear that disinterest may drive away some students who we really liked and planned to rank highly, but this is a perception, not based on any actual real data, so we thought that if we just took the leap one year and didn't contact anyone... maybe we would find out nothing is any different. Or maybe we'll find out it was a grand mistake. Regardless, it seemed reasonable to do this year until we ironed out what we should do in the future. And this is what I want advice on. So two questions:

1. As a student, do you prefer programs contacting you to let you know they are ranking you highly, or do you prefer not being contacted at all.

2. If you do prefer to be contacted, what do you think is the most appropriate way to go about it? Phone call? Email? Text?

3. If you believe students should be contacted and given an idea that they are highly ranked, how many should a program contact? Only those ranked to match? Only the top 1/3? The average number they go down to on their list?

My goal is to come up with a general idea of how to tackle this next year based on the preferences and opinions of people that are on the other end of the discussion. Do people care or want to be contacted at all? And if so, what means of contact makes this whole thing the least uncomfortable as possible for the student? Anyway, anyone who takes the time to lend their opinion, I greatly appreciate it.

 

[GolfUSA]

Hey I have a favor to ask for students/junior residents who are going through, will go through, or recently went through the match process. I've answered a lot of questions over the past few years, and this is the one and only time I'm doing this, but I want to ask a question of you all and get as many opinions as possible, whether its posted here or PM me. It's something we touched on before, but I want to hear from a students perspective. Here's the issue...

Post match communication. The kind that is fully ok within the rules of the match. I've been getting the vibe from some students that have posted here in the past that when programs contact students it puts the student in an uncomfortable situation with sometimes awkward communication. A recent discussion here on SDN about post-match communication made me really start thinking about this, and shortly after our PD had contacted a small handful (less than 10) of our candidates after we finalized our list, I brought it up to him that we maybe should just not contact people at all. So we didn't. Outside of an initial very small few, we haven't reached out to anyone this year, and probably won't. (*Side note, if you did interview with my program please don't take the silence as disinterest*). We decided to go this route for a couple reasons. One reason was to just see what happens. We felt that we almost had to participate in this game for fear that disinterest may drive away some students who we really liked and planned to rank highly, but this is a perception, not based on any actual real data, so we thought that if we just took the leap one year and didn't contact anyone... maybe we would find out nothing is any different. Or maybe we'll find out it was a grand mistake. Regardless, it seemed reasonable to do this year until we ironed out what we should do in the future. And this is what I want advice on. So two questions:

1. As a student, do you prefer programs contacting you to let you know they are ranking you highly, or do you prefer not being contacted at all.

2. If you do prefer to be contacted, what do you think is the most appropriate way to go about it? Phone call? Email? Text?

3. If you believe students should be contacted and given an idea that they are highly ranked, how many should a program contact? Only those ranked to match? Only the top 1/3? The average number they go down to on their list?

My goal is to come up with a general idea of how to tackle this next year based on the preferences and opinions of people that are on the other end of the discussion. Do people care or want to be contacted at all? And if so, what means of contact makes this whole thing the least uncomfortable as possible for the student? Anyway, anyone who takes the time to lend their opinion, I greatly appreciate it.

It's very refreshing to see that PDs are in the same boat as applicants in regards to feeling the pressure of post-interview communication. I woke up at 2 am this morning and couldn't go back to sleep thinking about my communication with programs despite the fact I have to go in and round on patients at 6:00 this morning. More time to mull over my rank list before certifying it tomorrow I guess. Thank you for all the thoughtful responses on this thread, here's my thoughts;

I assume when you say post-match communication you are referring to the period between applicant interview and rank list submission. In regards to communication on match day to people your program matched I would appreciate a phone call, but it's not a strong preference.

1. As a student, do you prefer programs contacting you to let you know they are ranking you highly, or do you prefer not being contacted at all.

It's a difficult question to answer, but I think the best thing would be to explicitly state your program's stance on how post-interview communication is handled during interviews. For example, you could state that your program will send a follow up email in January/February to make sure nobody has questions or alternatively that you do not plan to send an email but that you are open for communication at any time.

One of my concerns is that emails expressing interest initiated by applicants may have a large effect on a program's rank list, and I only sent one such email but am now thinking I should have sent another. Two programs told us up front in the interview that post-interview emails would not affect their rank list but that they were very open to communication. I found this to be a relief because I didn't feel pressure to play the game and one of them is in my top 3. I haven't contacted them about where they stand on my list and they haven't contacted me, and I really appreciated their program director's direct approach to addressing this.

On the other side of things, I received program-initiated emails from 8 of 14 programs I interviewed at regarding them ranking me highly and/or expressing general interest which was nice. Unfortunately, only one of my top 5 programs was on this list. This makes me feel very uneasy because while I liked all the programs that contacted me and responded to the emails expressing genuine interest, I feel the contrast of silence from my most preferred programs may mean these programs didn't see me as as much of a "fit" as I saw them.

On the other hand, these programs may have policies like what your program is doing surrounding limited communication (which I know is the case with one of them as above), and they are fairly "competitive" so maybe I just didn't meet the cut for an email for the others (discussed below). It would just be much better psychologically if they stated this to be the case because the contrast of silence makes me second guess my competitiveness for my favorites though I don't think I'll change it in the end. I'm ranking solely based on where I want to train the most.

2. If you do prefer to be contacted, what do you think is the most appropriate way to go about it? Phone call? Email? Text?

Email definitely. I think a phone call could put people in an awkward situation whereas an email is easy to reply to on your own time after some consideration and without pressure. As above, I received emails from a lot of programs I liked that are not at the top of my list but which I would still be very happy matching at.

3. If you believe students should be contacted and given an idea that they are highly ranked, how many should a program contact? Only those ranked to match? Only the top 1/3? The average number they go down to on their list?

I think this is difficult to define because if knowledge of your policy got out in the community that your program only contacted the applicants down to where they match on average or the top 1/3 it could change the interpretation of not receiving an email to very negative. Each year is different and this could have unintended effects in an outlier year meaning you end up turning off some good candidates and dropping further on your list than you would have otherwise. Alternatively, everyone who gets an email could interpret this as that they will match the program if they rank them at the top and this may change the cut off if enough people took it into account when ranking.

If you are going to contact applicants, a general email to all applicants you are going to rank expressing that your program enjoyed meeting them and that you are open to questions would likely be best. It's the least likely chance of turning people off, and it doesn't create the void of communication that's making me anxious currently. However, I think we all know it's best to rank based on genuine preference so it hasn't changed my approach, it's just made it harder to sleep hah. Thank you again for the insight!

 

[LaceyMD]

Hey I have a favor to ask for students/junior residents who are going through, will go through, or recently went through the match process. I've answered a lot of questions over the past few years, and this is the one and only time I'm doing this, but I want to ask a question of you all and get as many opinions as possible, whether its posted here or PM me. It's something we touched on before, but I want to hear from a students perspective. Here's the issue...

Post match communication. The kind that is fully ok within the rules of the match. I've been getting the vibe from some students that have posted here in the past that when programs contact students it puts the student in an uncomfortable situation with sometimes awkward communication. A recent discussion here on SDN about post-match communication made me really start thinking about this, and shortly after our PD had contacted a small handful (less than 10) of our candidates after we finalized our list, I brought it up to him that we maybe should just not contact people at all. So we didn't. Outside of an initial very small few, we haven't reached out to anyone this year, and probably won't. (*Side note, if you did interview with my program please don't take the silence as disinterest*). We decided to go this route for a couple reasons. One reason was to just see what happens. We felt that we almost had to participate in this game for fear that disinterest may drive away some students who we really liked and planned to rank highly, but this is a perception, not based on any actual real data, so we thought that if we just took the leap one year and didn't contact anyone... maybe we would find out nothing is any different. Or maybe we'll find out it was a grand mistake. Regardless, it seemed reasonable to do this year until we ironed out what we should do in the future. And this is what I want advice on. So two questions:

1. As a student, do you prefer programs contacting you to let you know they are ranking you highly, or do you prefer not being contacted at all.

2. If you do prefer to be contacted, what do you think is the most appropriate way to go about it? Phone call? Email? Text?

3. If you believe students should be contacted and given an idea that they are highly ranked, how many should a program contact? Only those ranked to match? Only the top 1/3? The average number they go down to on their list?

My goal is to come up with a general idea of how to tackle this next year based on the preferences and opinions of people that are on the other end of the discussion. Do people care or want to be contacted at all? And if so, what means of contact makes this whole thing the least uncomfortable as possible for the student? Anyway, anyone who takes the time to lend their opinion, I greatly appreciate it.

1. As a student, do you prefer programs contacting you to let you know they are ranking you highly, or do you prefer not being contacted at all.

I prefer no contact regarding rank status. I just think it's one more unnecessary stress point in an already extremely stressful process. The way I see it, if it results in a candidate moving a program on their list, it probably really only accomplishes two things most of the time - one, a candidate is told they're being "ranked highly" so they move a program up their list and get their heart set on it because they feel "loved", only to be disappointed on match day; or two, a candidate that had a program higher on their list hears that the program has contacted students but wasn't contacted and feels discouraged, so moves the program further down his/her list, resulting in not matching there.

If you're going the no-communication route in the future, I think it's important that the PD clearly set that expectation on interview day so people know that no communication doesn't mean "not interested" (especially as a program that did contact students in past years). I'm less concerned at this point by programs that clearly stated that they wouldn't be contacting us, than I am about those programs that didn't.

2. If you do prefer to be contacted, what do you think is the most appropriate way to go about it? Phone call? Email? Text?

If contact is going to happen, I prefer email. Text just seems too informal, and phone calls can be awkward (not to mention most of us are on rotations post-interview, so you're either interrupting our day or we're just not going to pick up).

I honestly think the best thing would be for the NRMP to ban post-interview rank status communications, because as long as it's not universal, students will be stressing out about whether silence during the ranking period means they aren't highly ranked or not. It's just another point of stress and confusion for us over-analytic medical students, and it sounds like it's just as much of a confusion point on the program's side too.

 

[r-e-l-a-x]

I think all post-interview communication regarding rank status should not be allowed. The match attempts to create the most fair, equitable, and objective process possible and all this communication introduces more "game playing" than should be allowed.

Some programs send stuff and whether it should or shouldn't it DOES affect students' rank lists, so programs who don't probably feel like they should, and it snowballs. And of course it goes the other way too, whether it should or shouldn't communication from students to programs CAN affect the programs rank lists (you can't tell me a program matches their 10 spots by their 11th rank without there being some game playing...) so then students feel they need to send something, and it snowballs.

At the end of the day, sending rank status updates in either direction is an attempt, whether subtle or not, to influence rank lists, and therefore should be banned.

 

[TheOne13]

1. As a student, do you prefer programs contacting you to let you know they are ranking you highly, or do you prefer not being contacted at all?
I prefer no contact. "Ranking highly" is pretty vague. Am I guaranteed a spot (i.e. top 7 at a program with 7 spots)? Top 1/3? Within their normal matching range? I've received some post-IV communication saying ambiguous things such as "we really hope you consider our program", "we really enjoyed you", "you'd be a great fit" etc. It just worsens the anxiety because now I'm over here thinking "What does that mean? Are they really into me or did everyone get one of those emails?" Some emails mentioned a very specific niche hobby and our chat about it. Since they were more specific, does that mean they really liked me?

After receiving the message, the question becomes do I need to respond? If I don't respond, will the program move me down? If I do respond but it's just a generic form email, will the program think I'm desperate? After you decide to respond, the question becomes "how do I respond". If it's a program that I wasn't ranking highly, I'd probably respond with a generic "I enjoyed my interview. Your program is fantastic, and I liked it a lot". Even if it's my #2, I'd still only say "I'm ranking you very highly", but then they'd probably figure they're not my #1 because I would've just said so if they were. Will programs move me down if I don't say they're my top choice in response to their communication? You would think that programs wouldn't be too affected, but PDs/faculty are human too so there inevitably will be some out there who want validation, who want to be able to say they only had to go to rank 15 to fill a class of 12, etc.

It also kind of feels bad when none of your top XXX programs sends you post-IV communication while other applicants got some. Does this mean I have no chance at those places? Will they just be disappointed if I end up with them?

Stating your program's policy might be a bit less anxiety-inducing. I had a few programs state explicitly they do not send individual "love" messages and that lack of a communication DOES NOT mean lack of interest. Other programs explicitly said that they contact the top 20% of their rank list. Again, it's disappointing not to get one from that program, but at least, they're honest about who gets a message.

2. If you do prefer to be contacted, what do you think is the most appropriate way to go about it? Phone call? Email? Text?
If programs do decide to contact, I want the PD to slide into my DMs. That way I know they're serious since they had to track down my social media account.
Seriously though, I prefer e-mail as it's more formal than a text and I personally hate talking on the phone and it's not always feasible to answer the phone during a rotation.

3. If you believe students should be contacted and given an idea that they are highly ranked, how many should a program contact? Only those ranked to match? Only the top 1/3? The average number they go down to on their list?
This is a tough one to answer. I would probably prefer those ranked to match because that is a very small group. Everyone else has no guarantee and could potentially set an applicant up for disappointment.


Personally, I think they should just ban all this communication that is not related to the program (questions, clarifications, details, updates, etc.) or a generic "thanks for interviewing" message that everyone gets. I'm typically not a super neurotic or anxious person, but this process has definitely changed that. Just way too stressful. Besides, you never know who is telling the truth and if someone (program or applicant) will change their mind all of a sudden.

 

[96asdfhlkj]

1. As a student, do you prefer programs contacting you to let you know they are ranking you highly, or do you prefer not being contacted at all?
NRMP should ban all communication that is not generic and sent to all applicants asking for additional questions and/or relevant updates on program. This is a really easy question in my opinion. The communication completely defeats the purpose of the match, which is simple: applicant ranks where they want to go and program ranks who they like most irrespective of anything else.

2. If you do prefer to be contacted, what do you think is the most appropriate way to go about it? Phone call? Email? Text?
100% email. I did not receive any phone calls and would have hated it especially since I would guess that none of us really have additional questions to be answered.

3. If you believe students should be contacted and given an idea that they are highly ranked, how many should a program contact? Only those ranked to match? Only the top 1/3? The average number they go down to on their list?
If NRMP does not ban it then I would prefer it only go to people who are ranked to match. That is completely unambiguous and given that programs ALWAYS match further down the list the 99% of us that did not get an email do not need to be stressed.

The post-interview communication has been the only stressful part of this process and I hate that.

 

[anon6134]

I was contacted by two programs and after actually receiving it, I felt awkward and that if I didn't respond appropriately it would hurt me with programs that would have otherwise been ranking me highly. Additionally I have seen programs I am very interested in contacting other people and I have not heard from them. Long story short all of this has messed with my head, my rank list, my confidence, etc. I have a new found respect for the few programs on my list that have not contacted me nor anyone else and I appreciate this small, insignificant gesture. I do not think programs should be contacting anyone at all for these reasons and I now respect the ones who don't.

Email and there isn't even a close second.

Ranked to match should be the only thing relayed, if anything at all. "Great fit" and "ranking you highly" is lukewarm, noncommittal, and no different than if I emailed all of my rank list that I was "ranking them highly". Commit to "ranked to match communication" or don't communicate anything.

Appreciate you taking the time to reach out to us and trying to better the process.

 

[gamerEMdoc]

Just wanted to congratulate everyone on certifying their lists last week. It's finally over. Nothing else you can do now but wait for the hands of fate / match algorithm to decide your next 3-4 years. I wish everyone the best of luck. While the next few weeks can be a bit stressful, remember, nothing is worse than being where you were a year ago, trying to navigate where to rotate, how to get rotations, figuring out the SLOE process, figuring out where you wanted to apply, how competitive you were, etc etc, etc. That's all over with now, and you'll never ever have to do that again! Best of luck everyone.

And third years... if you have questions... I'm here for you all whenever. Let the cycle begin again...

 

[Doots321]

3rd year question here. Seeing as my core site does not have a residency program and I am not done with third year until June, I was thinking of doing my first EM rotation at my core site in July (which would NOT give me an SLOE) to improve my abilities ect without worrying about an average SLOE... Then I would do my audition rotations in August, September, and October. My question is whether starting my auditions and getting SLOEs in August rather than July will hurt me more than just doing my first away in July? Thanks!

 

[ski89]

3rd year question here. Seeing as my core site does not have a residency program and I am not done with third year until June, I was thinking of doing my first EM rotation at my core site in July (which would NOT give me an SLOE) to improve my abilities ect without worrying about an average SLOE... Then I would do my audition rotations in August, September, and October. My question is whether starting my auditions and getting SLOEs in August rather than July will hurt me more than just doing my first away in July? Thanks!

As long as you get two SLOEs by oct 1st I think you’ll be fine. Coming from someone who just went through this, I can tell you that getting those always at the places you want is not always easy. If I were you, if there is a place or two places you really want to go for residency, make it a priority to get those always even if one has to be in July. There are other ways to prepare for an away other than your home rotation. For one you can really beef up your knowledge base with something like EMRA’s EM Fundamentals and I’m sure you could try and get a few shifts in before July at your home program to get a feel for the presentation style and workflow.. but bottom line is, it’s super important to get always where you want them and before October.

 

[gamerEMdoc]

3rd year question here. Seeing as my core site does not have a residency program and I am not done with third year until June, I was thinking of doing my first EM rotation at my core site in July (which would NOT give me an SLOE) to improve my abilities ect without worrying about an average SLOE... Then I would do my audition rotations in August, September, and October. My question is whether starting my auditions and getting SLOEs in August rather than July will hurt me more than just doing my first away in July? Thanks!

As stated above, as long as you have two SLOEs, that's adequate. However, I'd would discourage you from doing a 4th year EM "warmup" rotation at a non-residency site. It wastes a valuable audition month. Each audition month virtually guarantees you an interview spot. It gives you a SLOE, which you aren't forced to submit if you think its bad. Lets say you choose to do a warm up and not get a SLOE in July, then on your first or second audition in Aug/Sept, which you are relying on SLOEs, something happens during the rotation that you think is going to lead to a bad evaluation. At that point, you have no backup. Doing an EM month at a non-residency site to get experience, in my opinion, is something to do in your third year, not your fourth. The fourth year should be auditions at places you may want to end up for residency, and will all but guarantee you interviews at those places. Don't waste those months.

 

[anon6134]

Agree with not wasting a month. Talk to your home program and ask to do a few shadow shifts or regular shifts with an attending during weekends or half days whenever you can fit them in until July. Pay attention and work hard on your remaining rotations. You'll be alright

Edit: To add, this isn't talked about much on here but you should get a decent LOR (not SLOE) to have for ERAS. This way Sept 15 you can send in 2 SLOEs, 1 standard LOR, and add in a 3rd SLOE (4th total letter) when you get it in October. The 3 letters on Sept 15 will insure you are complete at every program you applied to on day 1 and won't be a hinderance. I didn't do this, had only 2 SLOEs until mid Oct when I got my 3rd SLOE in. I got the brunt of my interviews after that 3rd letter was made available including an instant invite once it uploaded, and I believe I wasn't complete at a handful of places until that letter came in.

 

[Doots321]

Thanks for the info! One more quick question. Are most programs fairly accommodating about audition rotation date changes after you have accepted an offer? For example if you were to accept an offer at a program that let you choose your date range, and then when applying to another program found that their date ranges were strict, and that their dates overlapped the previous program, how likely is the original program to let you "move back" your dates and start a week earlier? Is this a fairly common occurrence? Thanks.

 

[gamerEMdoc]

Thanks for the info! One more quick question. Are most programs fairly accommodating about audition rotation date changes after you have accepted an offer? For example if you were to accept an offer at a program that let you choose your date range, and then when applying to another program found that their date ranges were strict, and that their dates overlapped the previous program, how likely is the original program to let you "move back" your dates and start a week earlier? Is this a fairly common occurrence? Thanks.

I'd just be guessing here if I said I knew the answer to this. When this happens at our program, we try to accommodate if we have a spot open they want to switch to, but if we don't have a spot open for the dates the candidate wants to switch to, then its up to the student to decide which rotation they want to keep. Usually we can work it out though and its not an issue. How accommodating each site is, I honestly have no clue.

 

[pb34]

Are we required and/or encouraged to have a standard LOR in addition to 2/3 SLOEs? If so, where should this letter come from?

 

[cameraman342]

Right now I have an away rotation lined up for August, and another one (hopefully) coming for September. Will likely do my home rotation this spring but we are an orphan school so our sloe doesn't mean much. Is August too late in the year to do a first rotation, with the one sloe requirement for interviews in mind? I could potentially do a third away in June as well and I'm deciding if should do that or not. Thanks!

 

[PianoMedic]

Thanks for the info! One more quick question. Are most programs fairly accommodating about audition rotation date changes after you have accepted an offer? For example if you were to accept an offer at a program that let you choose your date range, and then when applying to another program found that their date ranges were strict, and that their dates overlapped the previous program, how likely is the original program to let you "move back" your dates and start a week earlier? Is this a fairly common occurrence? Thanks.

Through vsas, which is a huge chunk of programs, you were offered a specific time slot. If you declined that, you may not get an offer for a different slot. At most of the places I applied to through vsas (two years ago now), I would receive an offer for one slot and a rejection at any other time slot I had selected. I didn't tempt fate and decline any of the ones I ended up using as my auditions, but I would guess that your offer is your offer. As mentioned above, some places might accommodate, but I wouldn't bank on that.

 

[gamerEMdoc]

Are we required and/or encouraged to have a standard LOR in addition to 2/3 SLOEs? If so, where should this letter come from?

No. You need to have 2/3 SLOEs. Some places will mark your app as "complete" once they see you've submitted a max of four letters, so some people think that means you have to submit four letters to get interviews. That's not the case. Plenty of people apply with less than four letters. But if you want to get am additional LOR to add to your SLOEs, generally its based on a non-EM rotation that thought highly of you. A rotation where you got honors or stellar remarks from a faculty. Or based around a research rotation where you did a decent project.

 

[gamerEMdoc]

Right now I have an away rotation lined up for August, and another one (hopefully) coming for September. Will likely do my home rotation this spring but we are an orphan school so our sloe doesn't mean much. Is August too late in the year to do a first rotation, with the one sloe requirement for interviews in mind? I could potentially do a third away in June as well and I'm deciding if should do that or not. Thanks!

Nope. The majority of interviews don't get extended until after mid Oct, with the bulk of them coming in November. Will some interviews trickle in earlier? Sure. But most of them won't get extended to mid Oct at the earliest. You have plenty of time.

 

[deleted436726]

After somehow not matching with 10 interviews this year, I was able to SOAP into a Transitional Year residency at a smaller hospital with an attached EM residency, which is a *lot* better than nothing. That being said, how much of a disadvantage will I be at as a re-applicant?

 

[gamerEMdoc]

After somehow not matching with 10 interviews this year, I was able to SOAP into a Transitional Year residency at a smaller hospital with an attached EM residency, which is a *lot* better than nothing. That being said, how much of a disadvantage will I be at as a re-applicant?

Reapplicants are at a statistical disadvantage, but not every reapplicant is the same. Having a TRI at the site of a residency is a big advantage, assuming you perform well clinically during your intern year. We’ve now matched two former TRI’s into our em residency from our Im and surgery tri’s.

 

[gamerEMdoc]

Congratulations to everyone that matched!!! If you hit me up for advice this past year, please take the time to send me a quick message to let me know how you did and if you found my advice helpful, or if there was anything in particular you found unhelpful so I can tweak my advice for future classes if need be.

And if you rotated at or interviewed at my program and went in another direction in the match, any constructive feedback about what we could have done better to be more competitive on your list is always helpful for future years from a personal standpoint.

Congrats to all of you! This crazy process is finally over!

 

[miacomet]

Congratulations to everyone that matched!!! If you hit me up for advice this past year, please take the time to send me a quick message to let me know how you did and if you found my advice helpful, or if there was anything in particular you found unhelpful so I can tweak my advice for future classes if need be.

And if you rotated at or interviewed at my program and went in another direction in the match, any constructive feedback about what we could have done better to be more competitive on your list is always helpful for future years from a personal standpoint.

Congrats to all of you! This crazy process is finally over!

EM program numbers up 36.6% over 2015:

Residency Match Day Is Largest in History

 

[gamerEMdoc]

EM program numbers up 36.6% over 2015:

Residency Match Day Is Largest in History

To be fair, 2015 was basically the begining of the merger and 2019 is basically the end. There were like 60 EM AOA programs. Thats a ton of programs adding to the allopathic match over a 5 year period. But those residents all still existed beforehand, they were just in a different match.

 

[doc2be245]

What's the job market/fellowship search like in EM after residency. Is it safe to say that you can pretty much get a job/fellowship where you want?

 

[deleted547339]

What's the job market/fellowship search like in EM after residency. Is it safe to say that you can pretty much get a job/fellowship where you want?

Mostly. They say when it comes to the job, the location or the money, you can pick two. It depends what you want. EM is all supply and demand and opposite of most professions - you can expect much higher pay in rural areas as opposed to major metro areas. If you’re from a small town and want to go back, people would be falling all over themselves to get you to sign there and throw cash at you. If you want to go take mid-major city, you’ll be able to find a job - the quality and pay will be dictated by the local market forces. There are a few weird cities where a disproportionate amount of ER docs want to work (Denver, salt lake, Austin) - I can’t understand why, but these markets are tough to penetrate.

Fellowships aren’t competitive with few exceptions (a few of the CC programs and pain since you’re mostly competing with other specialties) because you get paid less during fellowship year than you would as an attending. Also, most fellowships are passion projects that’s don’t result in an increase in salary.

 

[homebaseddad112818]

Mostly. They say when it comes to the job, the location or the money, you can pick two. It depends what you want. EM is all supply and demand and opposite of most professions - you can expect much higher pay in rural areas as opposed to major metro areas. If you’re from a small town and want to go back, people would be falling all over themselves to get you to sign there and throw cash at you. If you want to go take mid-major city, you’ll be able to find a job - the quality and pay will be dictated by the local market forces. There are a few weird cities where a disproportionate amount of ER docs want to work (Denver, salt lake, Austin) - I can’t understand why, but these markets are tough to penetrate.

Fellowships aren’t competitive with few exceptions (a few of the CC programs and pain since you’re mostly competing with other specialties) because you get paid less during fellowship year than you would as an attending. Also, most fellowships are passion projects that’s don’t result in an increase in salary.

Which sites are the best place to look at potential jobs? I'm interested in getting a better feel for what the job market offers because it might impact where I decide to target for residency. Are there go-to platforms online for job-hunting?

 

[deleted547339]

Which sites are the best place to look at potential jobs? I'm interested in getting a better feel for what the job market offers because it might impact where I decide to target for residency. Are there go-to platforms online for job-hunting?

Usually fairly direct contact. Talking to people in your residency, faculty or alums. There are only so many ERs and it’s fairly easy to look it up.

Avoid head hunters like they plague, they will take your sign on bonus.

 

[gamerEMdoc]

Which sites are the best place to look at potential jobs? I'm interested in getting a better feel for what the job market offers because it might impact where I decide to target for residency. Are there go-to platforms online for job-hunting?

Acep and aaem have job boards, but honestly, You can virtually find a job anywhere. The best thing to do is narrow it down to where you are geographically want to be at, and then look for hospitals in that area. Most hospitals on their website advertise jobs directly if they have a need.

 

[homebaseddad112818]

Thanks for the responses. Do job postings on websites often list salary/benefits details as well? I wasn't sure when that information is shared or if it's something I'd only be given access to after applying?

 

[gamerEMdoc]

Thanks for the responses. Do job postings on websites often list salary/benefits details as well? I wasn't sure when that information is shared or if it's something I'd only be given access to after applying?

Not usually. Sometimes they do, but usually that isn't something that you see advertised.

 

[random122893]

My school's MS-3 year doesn't end until the first week of July. I currently have an offer from my top away program for August. Because of the dates, I can't fit in my home program's rotation in July, so I'll likely have to do this rotation in September (which stinks because I'd like to do my home program first, but such is life).

My plan is to just use the initial dead weeks in July to take Step 2 CK, do my top away program in August, and then my home program in September. My question is - should I try and do another away rotation in October? Outside of targeting a specific program, I don't see what it would do for me but I'm nervous since I'd only have 1 SLOE in when ERAS opens, and then my second SLOE (from my home program) would roll in around early October. Is that okay? Some fourth years have told me to use October to go to a specific program since I'll probably get an interview there, but I'm not sure spending a whole month somewhere is worth that alone? I'd like to boost my Step 2 score more to make up for my fine but unremarkable step 1 score.

My stats: upper 220s step; top honors in my class; pretty solid extracurriculars

 

[gamerEMdoc]

should I try and do another away rotation in October? Outside of targeting a specific program, I don't see what it would do for me but I'm nervous since I'd only have 1 SLOE in when ERAS opens, and then my second SLOE (from my home program) would roll in around early October. Is that okay?

You only need to do two rotations, and get to SLOEs, as long as both are average or better. The problem is, sometimes students don’t do as well on one of their first rotations, and if you only set up two, Then you are rolling with those two SLOEs.

So while a third rotation and SLOE is nice in the sense that pretty much guarantees another interview and gives you an extra SLOE in case one of the first two rotations doesn’t go as well as you’d like, it’s not necessary. There’s almost no program out there that requires applicants to have more than two so while a third rotation and SLOE is nice in the sense that pretty much guarantees another interview and gives you an extra SLOE in case one of the first two rotations doesn’t go as well as you’d like, it’s not necessary. There’s almost no program out there that requires applicants to have more than two SLOEs.

I wouldn’t worry about the timing. As long as you have one SLOE in by mid Sept you should be fine. Most people have their second one in by October. The majority of early EM interviews don’t come out until mid October, and I would venture to guess that the actual bulk of invites dont come until after November 1st.

 

[dotheDO92]

Gamerdoc... Is it important to get a SLOE from Level I trauma center? I'm scheduled for 2 at Level II's right now.. How much do programs put weight on level I or II for SLOEs?

 

[gamerEMdoc]

Gamerdoc... Is it important to get a SLOE from Level I trauma center? I'm scheduled for 2 at Level II's right now.. How much do programs put weight on level I or II for SLOEs?

I wouldn't worry about the level 1 vs level 2 thing, it really has no relation to how you do as a student on rotation. Will some high end places prefer to see SLOEs from other high end places? Sure, but if you are planning on trying to match at USC or Denver etc, you probably aren't doing rotations at community places with a level 2 anyways. A huge chunk of programs aren't going to care about the name of the place the SLOE comes from, but rather the content of the SLOE itself.

 

[IMinEM2020]

Hi there

So ill try to keep this brief,

I am a PGY-2 internal medicine resident at a moderate sized community hospital in the US. My plan is to finish residency and apply for Emergency Medicine. I went into IM because of my interest in Critical Care, yet I realized that I enjoy the ED much more. I know that I am a non-traditional applicant, so I have some questions that I was hoping you could help me with:

1. I have done several rotations in my local ED, and have gotten several letters of recommendation. I was told that it would be best to get them in SLOE format, but I was under the impression that they are only for medical students. Should I still go ahead and get SLOE’s, or just stick with traditional LOR’s?
2. I’ve read some mixed things about issues with funding after completing another residency. It is my understanding that Medicare pays for your training for 3 years (if you go into IM) but will not fund another residency position. Is this true? Will most programs have an issue with this?
3. Should I be looking for an away elective in Emergency Medicine, or do additional rotations shop?

Basics about me:

IMG-went to med school in Europe

STEP 1, 2 and 3 passed.

Several publications and posters at our local ACP meetings

1 Year Emergency Medicine research position at a large academic institution



Thanks for all the help!

 

[gutonc]

Hi there

So ill try to keep this brief,

I am a PGY-2 internal medicine resident at a moderate sized community hospital in the US. My plan is to finish residency and apply for Emergency Medicine. I went into IM because of my interest in Critical Care, yet I realized that I enjoy the ED much more. I know that I am a non-traditional applicant, so I have some questions that I was hoping you could help me with:

1. I have done several rotations in my local ED, and have gotten several letters of recommendation. I was told that it would be best to get them in SLOE format, but I was under the impression that they are only for medical students. Should I still go ahead and get SLOE’s, or just stick with traditional LOR’s?
2. I’ve read some mixed things about issues with funding after completing another residency. It is my understanding that Medicare pays for your training for 3 years (if you go into IM) but will not fund another residency position. Is this true? Will most programs have an issue with this?
3. Should I be looking for an away elective in Emergency Medicine, or do additional rotations shop?

Basics about me:

IMG-went to med school in Europe

STEP 1, 2 and 3 passed.

Several publications and posters at our local ACP meetings

1 Year Emergency Medicine research position at a large academic institution



Thanks for all the help!

I'm not Gamer, but I'll answer a couple of your more generic questions.

1. Definitely get one of those LORs as a SLOE...assuming it can be done that way, since SLOEs have to come from residency programs.

2. The funding thing is fundamentally misunderstood by the vast majority of applicants, and, it appears, a plurality of program PDs across specialties and possibly even GME offices. There is a very long answer that you can find by searching the Gen Res and IM forums for posts by myself and aProgramDirector on this topic. The short (and practical) answer is that your 2nd residency, or any fellowship for that matter, is paid for somewhere between 70-80% by CMS (100% IME/50% DME with the amount varying per institution). This assumes a CMS funded spot in the first place, which many new programs are not (100% institutionally funded) so may not be relevant to you.

3. You will need to convince your current program to pay your salary and cover your malpractice while you're off doing a completely unrelated specialty rotation at some other hospital. The likelihood of this happening approaches zero for (hopefully) obvious reasons. No reason not to ask if it's possible though.

 

[southerndoc]

Your residency funding is assigned to you based on your initial match. Since you matched into IM, you have 3 years of funding. If you had matched into surgery, you would've had 5 years of funding.

That funding is all you get. If you don't do your PGY-3 year in IM and do an EM-1 year instead, then 1 out of your 3 years of residency (or 4 if you match at a four-year program) will be funded. If you finish your IM residency and then match into EM, none of your EM years will be funded by CMS. If a surgery PGY-2 does his PGY3-5 years as an EM-1 through EM-3, then all of his/her EM years would be funded.

Transitional years do not count; however, if you matched into a residency following the TY then that will be the number of funding years you are assigned.

 

[southerndoc]

2. The funding thing is fundamentally misunderstood by the vast majority of applicants, and, it appears, a plurality of program PDs across specialties and possibly even GME offices. There is a very long answer that you can find by searching the Gen Res and IM forums for posts by myself and aProgramDirector on this topic. The short (and practical) answer is that your 2nd residency, or any fellowship for that matter, is paid for somewhere between 70-80% by CMS (100% IME/50% DME with the amount varying per institution). This assumes a CMS funded spot in the first place, which many new programs are not (100% institutionally funded) so may not be relevant to you.

This is not what our GME director has advised us and is counter to what I've learned throughout my career. Would love to see references for this. Hopefully I'm wrong because partial funding is better than no funding.

 

[gutonc]

This is not what our GME director has advised us and is counter to what I've learned throughout my career. Would love to see references for this. Hopefully I'm wrong because partial funding is better than no funding.

Hence my comment about a plurality of PDs and GME offices not knowing their head from their a**es on this topic.

This 2013 PPT document from AAMC covers it quite nicely. But I will quote the relevant sections for posterity (although I'm planning to have to refer back to this at least once a month until I stop participating on SDN):

8. What is an initial residency period, and how is it determined?

The initial residency period (IRP) is the minimum number of years required for a resident to become board eligible in the specialty in which the resident first begins training. The IRP for a specialty is based on the minimum accredited length of a residency program, as determined by the ACGME. Generally, Medicare determines the IRP at the time a resident first enters a training program. Every resident has just one IRP, and it does not change, even if the resident later changes specialties. It is very important to understand that the residency program in which you begin training determines the number of years Medicare will make full DGME payments to the hospital for your training (although the maximum number of years you can be counted as 1.0 FTE is five); any additional years will be funded at the 50 percent level. CMS has not published a list of specialties and IRPs since 1996, but you can find information on the minimum number of years of training required for each approved residency program on the ACGME’s Web site at: www.acgme.org.

Here’s an example: Dr. Smith begins an internal medicine residency on July 1, 2012. Internal medicine has an IRP of three years. Dr. Smith soon realizes that she’d rather do a surgery residency (which has a five-year IRP) and would like to begin training the following year. However, even if Dr. Smith is accepted into a surgery program and begins that program on July 1, 2013, her IRP remains three years (of which she has already spent one year training in internal medicine). She would be counted as 1.0 FTE during her first and second years of the surgery residency, but only as 0.5 FTE during her third, fourth, and fifth years. The hospital will be paid less for Dr. Smith’s last three years of training than it would have been paid for a resident who began training in surgery right out of medical school and had an IRP of five years.

Just to be clear, this is the "Direct" or DME portion I referenced above.

And here's the "Indirect" or IME portion from the same document:

10. Does Medicare cover any other teaching hospital costs?
Teaching hospitals also receive an indirect medical education (IME) adjustment from Medicare, but the label for this type of payment is actually a misnomer. These payments are designed to pay teaching hospitals’ increased patient care costs associated with treating more complex patients, requiring standby capacity in burn and trauma centers, etc., not resident training costs. The IME adjustment is an additional payment for each Medicare inpatient stay. Among other factors, the IME adjustment is based on a hospital’s ratio of residents-to-beds (often referred to as the intern and resident-to-bed ratio or IRB ratio). Residents may be counted for the IME adjustment if they are working in the inpatient or the outpatient department of the hospital or in a non-hospital setting, if certain conditions are met.
The IRP does not apply to IME payments. Thus, residents continue to be counted as 1.0 FTE for IME payments, even if they are training beyond their IRP for purposes of DGME.

 

[gamerEMdoc]

1. SLOEs are generally meant to compare 4th year students to 4th year students, written by places with an EM residency. Getting a SLOE as a 2nd year IM resident from a site without a residency, IMO, is probably pointless. Maybe if the place you've worked at has an EM residency, maybe then I'd go the SLOE route, otherwise I'd just get regular LORs
2. You are correct on how funding works. However, many places are over their alloted funding caps and privately fund a certain percentage of their spots every year. So in that case, matching a few people without funding isn't a huge deal for those places. I wouldn't worry too much about this to be honest
3. It would be helpful to do an EM rotation at a site with an EM residency, whether that is where you are training, or elsewhere if you can setup an away elective.

Hope that helps!

 

[IMinEM2020]

Great, Thank you all for the quick responses!

 

[Rivendell311]

Good morning. I have a question-I will be reapplying in the 2020 match. In the meantime, I will be in IM. I am wondering if one of the letters in the eras application must be my PD's letter although they will "know" me for only 2 months?

 

[gamerEMdoc]

Good morning. I have a question-I will be reapplying in the 2020 match. In the meantime, I will be in IM. I am wondering if one of the letters in the eras application must be my PD's letter although they will "know" me for only 2 months?

Generally it should be. Sure, you'll only be a resident for a few months, that's true. Make a good impression. You can always wait a little while for the PD letter too. Interviews for EM aren't usually coming out until late Oct for the most part, with a ton coming in November. So while ideally you'll have a LOR from your PD supporting you by mid Sept, if it comes a little later it probably won't be a big deal.