EM intern, where can I go from here?

[whatsthepoint]

---

Members don't see this ad.

EM PGY-1 here, long story short I SOAPed into EM after not matching a competitve surgical subspecialty. I never got to do an Anesthesia rotation until now, as an EM intern, and I fell in love with it. Anesthesia was never on my radar in medical school as I thought I was supposed to be a surgeon. Now, I realize what I miss is the OR, the pace, and all the fun things you do in Anesthesia. I'm a US MD grad with lots of research and decent scores.
Where can I go from here? The match cycle obviously just started but I'm sure I am too late at this point. I really don't want to stay in this program as my mental health has taken a steep downhill since I got here.
Should I apply to TYs?

 

[NicholasPavona]

Where can I go from here?

Anesthesia

 

[NicholasPavona]

I SOAPed into EM after not matching a competitve surgical subspecialty

Sorry to hear that. That's like asking the hottest cheerleader to the prom and ending up going with the ugly fat chick.

 

[whatsthepoint]

Sorry to hear that. That's like asking the hottest cheerleader to the prom and ending up going with the ugly fat chick.

LMAO, that's a summary of my year. I would love to pursue Anesthesia, but the match cycle just opened up and a lot of programs had their deadline on 9/25. Would it be a bad idea to apply to TYs?

 

[Gern Blansten]

LMAO, that's a summary of my year. I would love to pursue Anesthesia, but the match cycle just opened up and a lot of programs had their deadline on 9/25. Would it be a bad idea to apply to TYs?

Transitional years are super competitive because there are not that many and many competitive specialties have applicants applying for them to fulfill their PGY-1 year requirements. Plus, I assume you are doing an intern year equivalent year as part of your normal EM schedule. Probably need to apply for anesthesia programs and be willing to repeat a PGY 1 year if that is the only spot available in a particular program.
If you were applying to a competitive surgical subspecialty, I would assume your stats are at least relatively competitive.
The path of least resistance would be if the program at your current hospital had an opening that you could get an inside scoop on. Same deal with the medical school where you graduated. You still have to go through the match, though, so get the process going pretty quick, as others already have a several week jump on you. Otherwise, your only option will soon become to start your second year of EM. Once you start your second year, you should finish it. Then, if you are two thirds of the way into a residency, you might as well just complete the third year. Before you know it, you could be ten years into practice as an EM doc (which might end up being okay with you).
I guess what I am saying is, "the future is now...or pretty soon"

 

[dumbmedstudent]

Sorry to hear that. That's like asking the hottest cheerleader to the prom and ending up going with the ugly fat chick.

Don’t hate on the ugly fat chicks

 

[sevo00]

Did you really fall in love with anesthesia or is it just that you hate EM. lol

 

[whatsthepoint]

Transitional years are super competitive because there are not that many and many competitive specialties have applicants applying for them to fulfill their PGY-1 year requirements. Plus, I assume you are doing an intern year equivalent year as part of your normal EM schedule. Probably need to apply for anesthesia programs and be willing to repeat a PGY 1 year if that is the only spot available in a particular program.
If you were applying to a competitive surgical subspecialty, I would assume your stats are at least relatively competitive.
The path of least resistance would be if the program at your current hospital had an opening that you could get and inside scoop on. Same deal with the medical school where you graduated. You still have to go through the match, though, so get the process going pretty quick, as others already have a several week jump on you. Otherwise, your only option will soon become to start your second year of EM. Once you start your second year, you should finish it. Then, if you are two thirds of the way into a residency, you might as well just complete the third year. Before you know it, you could be ten years into practice as an EM doc (which might end up being okay with you).
I guess what I am saying is, "the future is now...or pretty soon"

Thanks for the advice. Is it not too late? A lot of programs had deadlines on 9/25.

Anyone know if Anesthesia research years exist?

 

[DET0897]

Talk to the anesthesia program director or chairman at your place. If you are lucky, there might be a spot outside the match...Yes, it happens.

 

[dabears505]

You need to stay put where you are. You can still do intubations, central lines, art lines as an er doc. The only thing you won't be doing are nerve blocks and epidurals. You are looking back fondly on the OR as if you were doing that for years when in reality you were there as a student for a very short time. 2 years goes by quickly, just get it done and enjoy life.

 

[nimbus]

You need to stay put where you are. You can still do intubations, central lines, art lines as an er doc. The only thing you won't be doing are nerve blocks and epidurals. You are looking back fondly on the OR as if you were doing that for years when in reality you were there as a student for a very short time. 2 years goes by quickly, just get it done and enjoy life.

Our ER docs are doing nerve blocks. Recently had a patient come up from ER who had a lidocaine femoral nerve block for a hip fracture 🤦🏻‍♂️

 

[GoSpursGo]

I generally try to stay out of this forum because your home mods do a great job. However, several very distasteful and offensive posts that are unrelated to the OP's original question were reported and have been deleted.

Let's try to stay on topic please.

 

[circleK]

I would say start the process and start working on getting into a program next year. Great advice here of first checking with the anesthesia dept at your current program and your medical school.

https://www.nrmp.org/wp-content/uploads/2024/04/2025-Main-Residency-Match-Detailed-Calendar.pdf

 

[NicholasPavona]

I generally try to stay out of this forum because your home mods do a great job. However, several very distasteful and offensive posts that are unrelated to the OP's original question were reported and have been deleted.

Let's try to stay on topic please.

Snowflakes got offended.

 

[Gator7]

I would just stick it out, then go make some money and move on with life.

Two years from now you can either be a senior EM resident applying for jobs (and probably getting a monthly stipend once signed) or be a CA1 facing one of the steepest learning curves in medicine and being yelled at to raise and lower a table.

You mentioned mental health is already an issue and being in training longer than needed is not going to help.

 

[whatsthepoint]

I would just stick it out, then go make some money and move on with life.

Two years from now you can either be a senior EM resident applying for jobs (and probably getting a monthly stipend once signed) or be a CA1 facing one of the steepest learning curves in medicine and being yelled at to raise and lower a table.

You mentioned mental health is already an issue and being in training longer than needed is not going to help.

But I can't stand working in the ED and I know that isn't going to change... I need to get back in the OR

 

[operaman]

Agreeing with the others - time to hustle and start working those personal connections. Reach out to the surgical sub mentors from med school and ask for intros to anesthesia faculty. Start talking with faculty where you are now. Those are your best bets for any kind of position, especially if they liked you and know you. Never underestimate the value to a program of matching a known quantity they know can be taught versus rando person who looks good on paper. If faculty on your anesthesia rotation liked you and you did well, then that can go a long way in opening doors.

Wouldn’t hurt to go ahead and apply via eras anyhow. Any program without a hard deadline is a no brainer. For those with deadlines, can’t hurt to send a short note to the PC saying what you’ve said here, that you found the field rather late after a PGY1 gas rotation, but know it’s what you want to do and ask if they’d consider reviewing your application despite missing the deadline.

Then the big question I don’t know the answer to but worth looking into: could your EM pgy1 year allow you to take a pgy2 anesthesia slot outside the match? I feel like I saw a lot of EM and Gas interns on various rotations with me as a pgy1 back when ent basically did a gen Surg intern year. Must be a lot of overlap in there.

 

[whatsthepoint]

I appreciate it. The other rate-limiting step is getting an Anesthesia LOR. My rotation was done mostly with CRNAs. I can't apply without a gas letter right?

 

[Agast]

Any interest in interventional pain management? Now that OR anesthesia is suddenly the hot chick, fewer grads are going into pain fellowship. This is the only anesthesia-based fellowship that accepts other specialties and the trend will probably expand.

Pros: hands-on, procedural, work/life balance

Cons: psychosocial nightmares, drug seekers, variable reimbursement

However the cons are pretty similar to what you’re going to see in emergency medicine

 

[NicholasPavona]

I can't apply without a gas letter right?

What's a gas letter? Might be better off with a solid letter or at the very least a liquid one.

 

[Realgassy]

Lots of good advice on here. Even if you hate Em do not drop out of the program. Stick it out and continue to work to the best of your ability - you have the best odds of success with your PDs support for the transfer. I have met many people over the years who have transferred to different locations or new specialties for various reasons and it’s not that unusual. But, you will need to put in the work to secure yourself a spot.

Now is the time to hustle and network. As others have mentioned meet with the anesthesia PD of your home program and med school. Reach out to other local programs (if there are any). For a letter suck it up and shadow on off days or post call for a bit to demonstrate sincere interest. Most of my friends who found a new position did so internally. If you can apply through the match, you should and keep an eye out for open spots on Freida during the year.

 

[whatsthepoint]

What's a gas letter? Might be better off with a solid letter or at the very least a liquid one.

Lol. Technically, one could call it a gas letter as it is sent over the internet IE through the air, gas.

 

[NicholasPavona]

Lol. Technically, one could call it a gas letter as it is sent over the internet IE through the air, gas.

Good point.

 

[operaman]

I appreciate it. The other rate-limiting step is getting an Anesthesia LOR. My rotation was done mostly with CRNAs. I can't apply without a gas letter right?

Even so, would meet with your local PD and discuss. You could maybe at least get some kind of summative letter like “XY rotated with us as a pgy1 and performed very well. People that worked directly with them noted ….”

That’s pretty much what most chairman/PD letters are. Our chair used to email us all the time for comments to put in someone’s letter he’d never worked with and I’ve seen the same pattern from many other institutions. You’d have at least one gas letter that way plus one has to be your current EM PD. Get 1-2 more from med school mentors and you’re all set.

 

[circleK]

I would think an anesthesia program would love to have a new resident who already had a year of EM training under their belt.

 

[whatsthepoint]

Thank you all!!

 

[lotsapain]

Thank you all!!

This is going to be painful but what you need to do is draft a letter of what you are looking for an literally email or snail mail such letter to every single anesthesia program in the country (yes its tedious but it works) and see who responds. There are always last minute unfilled spots or spots that are not advertised..... though you should think fast and hard ..... whether EM is such a bad idea......

 

[whatsthepoint]

This is going to be painful but what you need to do is draft a letter of what you are looking for an literally email or snail mail such letter to every single anesthesia program in the country (yes its tedious but it works) and see who responds. There are always last minute unfilled spots or spots that are not advertised..... though you should think fast and hard ..... whether EM is such a bad idea......

Would you recommend I just explain my situation and ask if they have any spots available outside the match, and email it to every program? Not sure how to go about finding those unpublished spots.

 

[dabears505]

Another thing, I'm not sure a lot of PDs are going to be gung ho in taking you on. You are already abandoning ER, and have minimal to no actual anesthesia experience. Why would they think you are going to commit and stay on in Anesthesia?

 

[lotsapain]

Would you recommend I just explain my situation and ask if they have any spots available outside the match, and email it to every program? Not sure how to go about finding those unpublished spots.

You can do that if you wish but this is more of an effective way of advertising one self but do as you will.

 

[lotsapain]

Another thing, I'm not sure a lot of PDs are going to be gung ho in taking you on. You are already abandoning ER, and have minimal to no actual anesthesia experience. Why would they think you are going to commit and stay on in Anesthesia?

This is your tunnel vision speaking... the guy wants to switch fields **** happens.... don't label a person a quitter because he does not fit your template of a perfect soldier

 

[Iso4ane]

Another thing, I'm not sure a lot of PDs are going to be gung ho in taking you on. You are already abandoning ER, and have minimal to no actual anesthesia experience. Why would they think you are going to commit and stay on in Anesthesia?

Let’s be honest, for lots of people, anesthesia is an unknown until medical school, then it was, ‘this stuff is actually kind of interesting’, why did let I find out about this sooner?