As an incoming OMS-I at LECOM-SH, I am interested in the world of ACGME EM post 2020 merger. What are your general thoughts? Net benefit for DOs? Zero-sum benefit? My assessment is that while some MDs will be taking up spots in previous AOA EM residencies, with the merger I expect (hope) that ACGME residencies around the country will begin accepting a more noticeable amount of DOs than previously thus essentially offsetting those MDs entering the previous AOA EM residencies. I suppose my question is grounded in perceptions more than anything.
Also, could you talk about when or how you knew EM was right for you? I have worked as a ED scribe for 6 months, shadowed a EM doc beforehand, and even occasionally read articles in AAEM. I read these forums often trying to gain a mature and broad understanding of the field and I believe I like the field, but part of me also believes I may not have the personality for EM.
Finally, outside the importance of good board scores and pre-clinical grades, what additional activities could one do, say in the summer following OMS-I, that could help focus their CV towards EM? Research? Volunteering at a free clinic? I know you alluded to the relative insignificance of, say, being a secretary for a club, so what would stand out, or at least, what has stood out to you in your evaluation of applicants? I know I should be focusing on just getting a handle of med school, but I thought there's no harm in planning/ thinking ahead 🙂
Thank you for your time and insight!
God I wish I knew the answer to the merger question. I don't, because no one does. But I can speculate. I don't think it will make it easier, nor harder, for DO's to match in EM. I don't think programs that were traditionally DO programs are suddenly just going to start abandoning DO candidates. I just don't believe that's going to happen. Will some of those spots go to MD's? Sure. But I still think you will see very heavy DO #'s in the classes of those programs.
I do think the merger helps DO's by eliminating the AOA match. I can tell you, without a doubt, the two match systems hurts candidates, because it pigeon holes them into trying to choose between what they see as more of a sure thing vs potentially programs they may like better on the other side. It hurt some candidates this year on our rank list. I know several candidates that told me they wanted to go ACGME and would love to match at my program, but were too scared to do so because of their limited # of ACGME interviews. They played it safe and matched AOA, and I don't blame them at all. But I also know where they were on my list and several people easily would have matched who went AOA instead. In the end it benefits students by allowing them to rank their programs top to bottom, without having to make an artificial division to decide whether or not they want to play it safer in one match, vs go to the ACGME match where they may like the programs better (the 3 year draw is powerful).
As for EM being right for me. I fell into it. I had a random elective in my third year, and EM was assigned to me. I had always thought I was going to do something general, so I thought FP would be perfect. I thought FP docs were jack of all trade generalists. Then I rotated in FP and realized I was going to see mostly HTN and DM followups. I hated it. So at that point I was lost mid way through 3rd year. I rotated in Medicine, but didn't want to only see adults and really didn't enjoy rounding. I couldn't see myself specializing in one narrow field like cardiology or anything. I absolutely loved procedures, but equally hated being in the operating room for hours at a time. So basically, I was lost and had this random EM rotation. I was one shift in when I realized this was what I was looking for. In medicine, outside of teaching, my favorite thing that keeps me interested is the undifferentiated case. I love the mystery. I love trying to puzzle things together. Tough cases are awesome too me, I enjoy trying to figure them out. And nowadays, most diagnoses and workups are made and finalized in the ED. You don't usually work through cases over days on the IM floor trying to figure it out most times. The ED gives IM the answer, and then IM manages it. We have all the resources at our fingertips to rapidly evaluate cases and try to get to the bottom of them as fast as possible. Which is awesome to someone who loves the game of the mystery. That's what hooked me.
Oh yeah, and I like staying up all night. And toxicology. And critical care. And the team environment. And how informal everyone always is. And the fact that every once in awhile, you legitimately will save someones life in an instant. Doesn't happen often, but when something bad happens and you do something that rapidly saves their life and they survive, I promise you, this is a gateway drug that will keep you coming back to the ED over and over seeing abd pain after abd pain... just for one chance to do something heroic again.
And lastly, what to do after year 1. I got married and went to the Bahamas. Screw medicine man. LOL. First year was tough, and I think its important to recharge. After second year, you're going to be cramming for step 1 in your little time off. So if you get time off, take some time off. Hell, I'd rather here a story on the interview trail about someone scaling a mountain somewhere than talk about them gunning to do some research project in their two months of free time they got in all of medical school anyways. But if you feel like you must do something I think a medical mission trip is useful. It looks good on an application, allows you to actually get some hands on practice, do something good, and still see the world and have some fun. I think that's a nice compromise. But do whatever you want. There is no cookie cutter way into matching into EM, but there sure is a cookie cutter way into driving yourself crazy by working too hard. So at least consider taking some time off if you got it.
