EM PD - Ask Me Anything

[gamerEMdoc]

The couples match is a ****show, especially when people are going into two different fields and/or aren't both super competitive within their field.

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[hopefulERdoc251]

question for ya'll, what is the difference between level trauma designation by state vs american college of surgeons (there was one program that's level 2 by state, level 1 by american college of surgeons)

 

[WildcatS11]

The couples match is a ****show, especially when people are going into two different fields and/or aren't both super competitive within their field.

Also - couples match is the biggest **** show when BOTH are going into EM and are drastically different levels of competitiveness.

 

[gamerEMdoc]

Also - couples match is the biggest **** show when BOTH are going into EM and are drastically different levels of competitiveness.

Maybe but i think its less of an issue because the more competitive one can just compromise and go to a place the other person is more competitive for. I can tell you, I would take a couple in a heartbeat if one was mediocre and the other was a superstar just to get the superstar candidate.

People going into other fields dont have that luxury.

 

[gamerEMdoc]

question for ya'll, what is the difference between level trauma designation by state vs american college of surgeons (there was one program that's level 2 by state, level 1 by american college of surgeons)

I have no idea tbh, but I wouldnt put much stock in it regardless. Im at a level 1. The place I trained was sometimes a 1, sometimes a 2. They saw more trauma than we do. Why was it a 2? Sometimes research numbers. Sometimes bc they didnt have a trauma fellowship trained ortho on call for complex pelvic fractures. It never changed what came in the door. The only thing it changed was students perception of the program. Its a superficial designation.

A better question is what is your trauma admission volume, how many alerts do you see a day on average, and what traumas do you have to transfer after stabilization (which is also less of an issue bc all I care about in the ED is the stabilization part from a learning standpoint).

 

[WildcatS11]

Maybe but i think its less of an issue because the more competitive one can just compromise and go to a place the other person is more competitive for. I can tell you, I would take a couple in a heartbeat if one was mediocre and the other was a superstar just to get the superstar candidate.

People going into other fields dont have that luxury.

Oh man we have had this go so terribly in multiple different ways. I’m glad it hasn’t blown up for you but there are so many ways it can go wrong. To the point that it’s almost a non-starter now.

 

[gamerEMdoc]

Oh man we have had this go so terribly in multiple different ways. I’m glad it hasn’t blown up for you but there are so many ways it can go wrong. To the point that it’s almost a non-starter now.

All of our past couples matched residents were excellent. But one look at the physician divorce rate, and its easy to see how quickly it can blow up on you.

Come to think of it, oddly enough, since I've been here for the past 8 years, I don't think we've had a single resident get divorced in residency. Hell I can't think of an attending that has either. Super odd. Maybe the people that come to a more rural place, or who are focussed on things like cost of living being more money conscious, idk. I never even considered this until now.

 

[Dr Mantis Toboggan]

All of our past couples matched residents were excellent. But one look at the physician divorce rate, and its easy to see how quickly it can blow up on you.

Come to think of it, oddly enough, since I've been here for the past 8 years, I don't think we've had a single resident get divorced in residency. Hell I can't think of an attending that has either. Super odd. Maybe the people that come to a more rural place, or who are focussed on things like cost of living being more money conscious, idk. I never even considered this until now.

No intraclass affairs causing marital breakups? Or one resident banging another’s spouse? Your program is not very saucy.

 

[gamerEMdoc]

No intraclass affairs causing marital breakups? Or one resident banging another’s spouse? Your program is not very saucy.

Nooooooooope

 

[soccergirl1234u]

hi again doc! at this point, how many interviews should we be at to be in a good position? i know you said 5 prior to thanksgiving

 

[gamerEMdoc]

Yeah now that we are in Dec, I’d hope to see people somewhere in the 8 range by this week, though realize some won’t hit that. Shouldn’t be too hard to get to 12 if that’s the case ASSUMING that cancellations happen like they do every year and we don’t just have a bunch of interview hoarders.

Not everyone will get to 12 to be “safe” but realize that even getting to 8 at the end has you matched 90% of the time. 10 puts you at matching 95% of the time. Hell even 6 matches 80% or more. So don’t be too discouraged if the interview numbers don’t line up with the perfect situation. Cautiously guarded maybe, panic no.

 

[partypantss]

Yeah now that we are in Dec, I’d hope to see people somewhere in the 8 range by this week, though realize some won’t hit that. Shouldn’t be too hard to get to 12 if that’s the case ASSUMING that cancellations happen like they do every year and we don’t just have a bunch of interview hoarders.

Not everyone will get to 12 to be “safe” but realize that even getting to 8 at the end has you matched 90% of the time. 10 puts you at matching 95% of the time. Hell even 6 matches 80% or more. So don’t be too discouraged if the interview numbers don’t line up with the perfect situation. Cautiously guarded maybe, panic no.

Plus, would you agree that with people seeming to generally be less inclined to drop interviews, that your odds might be a bit better this year at matching at the places you do interview at? At least for places that didn't also add on a bunch of extra interview slots. All speculation I know, but the math would have to work out that way if there are really so many people holding onto interviews they would have normally dropped, without an equal amount of new slots to make up for it.

 

[gamerEMdoc]

Yeah statistically that makes sense.

 

[pepperonipizzas]

As interviews invites are coming in, looking to drop a few programs I'm less interested in. However, their interviews are coming up next week. what do you consider to short of notice to drop?

 

[gutonc]

As interviews invites are coming in, looking to drop a few programs I'm less interested in. However, their interviews are coming up next week. what do you consider to short of notice to drop?

I'm not @gamerEMdoc , but the old rule was as much notice as possible with 1 week a bare minimum. But since people can Zoom to interviews now, it's much more likely they'll be able to fill the spot if you bail now than it would have been in the dark ages of 2019.

 

[AppleB]

What constitutes a good vs bad interview? Are there any signs to tell applicants how things are going? Not sure if I’m bombing them or doing great haha.

 

[boolin_1]

I'm not @gamerEMdoc , but the old rule was as much notice as possible with 1 week a bare minimum. But since people can Zoom to interviews now, it's much more likely they'll be able to fill the spot if you bail now than it would have been in the dark ages of 2019.

i've read that >48 hours is the new norm

 

[gamerEMdoc]

As interviews invites are coming in, looking to drop a few programs I'm less interested in. However, their interviews are coming up next week. what do you consider to short of notice to drop?

First, it doesn't matter really, because its not like the program has any means of ruining your chances elsewhere. It would be insanely petty to start reaching out to other programs, and even if they wanted to, how would they know where else you are interviewing.

Second, common courtesy was always a week before, but honestly now, I'd say 2 days before seems reasonable. The earlier the better. But don't worry about it, either way. If you don't want the interview, cancel. You are doing programs a favor and other students a favor by not taking up a spot you aren't interested in.

 

[gamerEMdoc]

What constitutes a good vs bad interview? Are there any signs to tell applicants how things are going? Not sure if I’m bombing them or doing great haha.

How easily conversant the applicant is and their level of insight into your questions.

 

[boolin_1]

How easily conversant the applicant is and their level of insight into your questions.

I’ve been getting lots of “that’s a very insightful answer” LFGGGGGGG

 

[Oligodinero]

I've been asking PDs what their first-time pass rate is for oral and written boards, but have no idea what constitutes good answer. Does anyone know what percentages separate a good program from an "OK" program?

 

[pillowsnice]

I’ve been getting lots of “that’s a very insightful answer” LFGGGGGGG

hmm I've been getting a lot of "great, sounds good" and then they move on lol feel like I'm bombing all of mine

 

[The Knife & Gun Club]

I've been asking PDs what their first-time pass rate is for oral and written boards, but have no idea what constitutes good answer. Does anyone know what percentages separate a good program from an "OK" program?

IMO at or near 100% should be the goal.

By and large programs don’t prepare people for the boards - but they can definitely hamper ability to succeed by crushing their residents with tons of shifts or non-clinical duties.

 

[gamerEMdoc]

IMO at or near 100% should be the goal.

By and large programs don’t prepare people for the boards - but they can definitely hamper ability to succeed by crushing their residents with tons of shifts or non-clinical duties.

Agreed. But also take into perspective that board performance is most predicted by past board performance. So a super competitive program that is matching people with really high board scores, they could work people to death and those residents could have zero time to study, and I guarantee you they’ll all pass their boards. Because people who are great testtakers and have a large fund of knowledge before even starting residency or not going to have any problem passing the EM board when they get out.

Im not saying that the program is not going to have an effect on people scores, I’m sure it will. But I think where you see the effect of the program is in people who start out with a lower fund of knowledge or who have struggled with standardized tests in the past.

My point is, I’m not impressed if UCLA has a 100% board pass rate if their match class is filled with people in the 240-270 range. If they didnt I’d be shocked. But a random community EM residency in the middle of nowhere taking people in the 210 (or comlex 450) range, if they are near 100%, then they’re doing something right.

Because if you figure the 10% of people are going to fail the written board, those people are almost certainly people that failed a board before, or nearly did. And those people dont match at big name programs. It’s all a selection bias thing IMO.

 

[Shawno19]

Should we anticipate another round of interview invites next week, after Thanksgiving holiday?

Also, worst case scenario. If I don't match EM this year, do you have any advice in terms of doing a TY/Prelim to hopefully match EM next year. I imagine, the best bet would be to find a TY/Prelim at a site that has an EM residency correct? I might be overthinking it, I have 6 EM invites, but I just want to be prepared.

I'm also curious to hear advice on TY/Prelim year for people worried about not matching. Like should I apply now to some programs before apps close or just scramble? BTW I am not interested in changing specialty.

I'm moved through the stages of grief to acceptance that there is a strong possibility that I won't match and honestly am ok with that possibility now. I have meet a few IMG on rotation who haven't matched after a couple years and I realize doing a TY is far from the worst thing that has ever happened to anyone.

I definitely overestimated my competitiveness

• 500/560 level 1/2, 220 step1
• First graduating class of a DO program
• But 7 years medical experience, no red flags, worked throughout med school, 2 jobs during my first 2 years

And make some strategic mistakes

• Didn't take step 2
• Only applied to 40 programs, although I thought I applied smartly
• Didn't go balls to the wall to get an away rotation through VSAS at a place where I could get a eSLOE early enough

But on the plus side I have great a girlfriend I live with who has great career that is amenable to relocating a couple times in the next few years, and I will be able to continue to split custody of my kids 50/50 with my ex for another year if I stay here. Trying to look on the bright side, lol.

 

[gamerEMdoc]

I definitely think if you’re not getting enough interviews, or at least not enough of them to be comfortable, it makes sense to apply to Prelims as a back up. If you wait for the soap, the spots are going to go quickly, and trying to nab one that is in the same hospital as an em residency (which is ideal) is tough.

 

[HashimotosThyroiditis]

Anything interesting going on on the PD listserv?

 

[Hobbes95]

have you heard anything about a master PD excel sheet where they're going to keep track of how many interviews applicants are doing? Seems kinda crazy.. Wouldn't that be a match violation?

 

[gamerEMdoc]

No. Also, theres no way of doing this. And yes thats a match violation. And I can’t imagine any way any PDs are actually doing this.

 

[WildcatS11]

i've read that >48 hours is the new norm

Dropping an interview just a few days out is considered extremely poor form. Let's say you drop an interview 3 days early. PC sees it 2 days before. It is now extremely difficult to fill this spot, and the program likely loses one spot on their rank list, more importantly loses the opportunity to interview someone else who may be a very good fit.

In the zoom era, at least a week still is reasonable. 2-3 days will get your name remembered and cause some (maybe minimal, maybe a lot) of ill will.

 

[12jas]

Dropping an interview just a few days out is considered extremely poor form. Let's say you drop an interview 3 days early. PC sees it 2 days before. It is now extremely difficult to fill this spot

In the zoom era, at least a week still is reasonable. 2-3 days will get your name remembered and cause some (maybe minimal, maybe a lot) of ill will.

I would say 2-3 days is annoying for sure and disrespectful to the program but I disagree on it being hard to fill the spot. Literally you could call applicants on your waitlist and have the spot filled in 15 minutes or less. What is worse than dropping an interview 2-3 days out is keeping the interview you don't want and wasting the program's time and hurting an applicant who needs/wants that interview.

 

[gamerEMdoc]

I would say 2-3 days is annoying for sure and disrespectful to the program but I disagree on it being hard to fill the spot. Literally you could call applicants on your waitlist and have the spot filled in 15 minutes or less. What is worse than dropping an interview 2-3 days out is keeping the interview you don't want and wasting the program's time and hurting an applicant who needs/wants that interview.

I agree. It was far more disrespectful in previous years, when it was virtually impossible to fill an interview only a few days out. But these days, you could fill the spot the day before the interview, easily, because of the lack of travel and time commitment of virtual interviews.

Also, I highly doubt there are many PDs out there trying to extract revenge on late cancelling students. I’m not saying its never happened, there are some crazy people out there in all walks of life, so I’m sure there are horror stories, but I can’t tell you the name of a single student who cancelled their interview in the past. I mean most of the time I don’t even know that someone cancelled, the PC just adds the next one up on the waitlist to fill the spot.

I honestly wouldn’t worry about cancelling. If you don’t want the interview, its far more rude to the program to waste their time interviewing someone who isn’t going to rank them when there are students out there that would love the shot.

 

[Aerus]

Does the PC have any say about who gets an interview (from a WL)? I sent an LOI to the PC after they sent out a waitlist email but not the PD. The PC replied but should I have also CCed the PD at least? Thank you!

 

[ijustwantajobpls]

So realistically sitting at 6 interviews and a waitlist rn, should I be freaking out or is it still too early for this? I still can’t gauge what the general consensus is for this cycle

thanks for the help in advance!

 

[WildcatS11]

I agree. It was far more disrespectful in previous years, when it was virtually impossible to fill an interview only a few days out. But these days, you could fill the spot the day before the interview, easily, because of the lack of travel and time commitment of virtual interviews.

Also, I highly doubt there are many PDs out there trying to extract revenge on late cancelling students. I’m not saying its never happened, there are some crazy people out there in all walks of life, so I’m sure there are horror stories, but I can’t tell you the name of a single student who cancelled their interview in the past. I mean most of the time I don’t even know that someone cancelled, the PC just adds the next one up on the waitlist to fill the spot.

I honestly wouldn’t worry about cancelling. If you don’t want the interview, its far more rude to the program to waste their time interviewing someone who isn’t going to rank them when there are students out there that would love the shot.

Remember you are getting n=2 opinions here, both of us on are in program leadership, albeit gameremdoc has far more experience, in a different style of program than myself.

If you cancel an interview regularly, sure, PD won't know or care. If you do it within a couple days, they would 100% know on a regular year, and will probably know now. Maybe my program is different, but the EM world is small, especially the academic EM world, and the people we interview are typically on that path or hope to be. We might see each other again. I don't think there is a ton of purposeful revenge going on, but I wouldn't want my name remembered for unprofessional behavior if I was seeking a job or fellowship at that institution in the near future. Thats my 0.02.

Now here is where my take is a little different that most student's take - if you cancel your interview 2 days before, and the program still fills that slot, great. Now when you do that, because of how everything is set-up (pre-interview virtual social, application review, etc) you make a lot more work for my coordinator. Our applications all are reviewed at least 2 days early (and a summary sheet uploaded) so we have to switch one of those out, reading another application cover to cover, creating more work for one of the faculty no matter what our clinical schedule is like in the next 2 days before interviewing. Maybe our coordinator had to call/e-mail 5-10 people to fill that slot, creating more work for them in a time-sensitive manner.

So sure maybe it isn't the end of the world and the program isn't going to go unfilled next year - but by cancelling in 2 days, you are creating a lot of work for a lot of people already working hard during interview season.

 

[gamerEMdoc]

Remember you are getting n=2 opinions here, both of us on are in program leadership, albeit gameremdoc has far more experience, in a different style of program than myself.

If you cancel an interview regularly, sure, PD won't know or care. If you do it within a couple days, they would 100% know on a regular year, and will probably know now. Maybe my program is different, but the EM world is small, especially the academic EM world, and the people we interview are typically on that path or hope to be. We might see each other again. I don't think there is a ton of purposeful revenge going on, but I wouldn't want my name remembered for unprofessional behavior if I was seeking a job or fellowship at that institution in the near future. Thats my 0.02.

Now here is where my take is a little different that most student's take - if you cancel your interview 2 days before, and the program still fills that slot, great. Now when you do that, because of how everything is set-up (pre-interview virtual social, application review, etc) you make a lot more work for my coordinator. Our applications all are reviewed at least 2 days early (and a summary sheet uploaded) so we have to switch one of those out, reading another application cover to cover, creating more work for one of the faculty no matter what our clinical schedule is like in the next 2 days before interviewing. Maybe our coordinator had to call/e-mail 5-10 people to fill that slot, creating more work for them in a time-sensitive manner.

So sure maybe it isn't the end of the world and the program isn't going to go unfilled next year - but by cancelling in 2 days, you are creating a lot of work for a lot of people already working hard during interview season.

I def agree with this sentiment. It does create more work. And absolutely if you needed something from that program in the future, you are shooting yourself in the foot. No doubt.

 

[gamerEMdoc]

So realistically sitting at 6 interviews and a waitlist rn, should I be freaking out or is it still too early for this? I still can’t gauge what the general consensus is for this cycle

thanks for the help in advance!

Freaking out? IDK, depends on your risk tolerance. Six interviews still has a pretty good chance of matching. Not a guarantee, but not terrible odds. I think your best hope is for more is timely LOI emails to programs during the Dec/Jan interview weeks, hoping to nab a spot that gets cancelled.

 

[gamerEMdoc]

Does the PC have any say about who gets an interview (from a WL)? I sent an LOI to the PC after they sent out a waitlist email but not the PD. The PC replied but should I have also CCed the PD at least? Thank you!

Depends on the place. I'm very protective of who gets invites, so I have a ranked waitlist so the PC knows who to invite next. However, the PC also can just forward the email on to the PD, or APD, whoever is reviewing apps. It's totally fine IMO to just email the PC.

 

[Reboa]

Do you have any advice for a family medicine attending interested in doing another residency in EM in regards to securing a position?

 

[Le MD]

I definitely think if you’re not getting enough interviews, or at least not enough of them to be comfortable, it makes sense to apply to Prelims as a back up. If you wait for the soap, the spots are going to go quickly, and trying to nab one that is in the same hospital as an em residency (which is ideal) is tough.

Im sitting at 7 interviews right now, and applied to 60+. 10+ LOIs with no interview offers.

I'm an average applicant across the board (No red flags, middle 50th percentile on MSPE, average Step 1 and step 2, US MD school). Only thing that I can think of for my lack of interviews would be my SLOE.


Should I apply for a prelim/transitional year? Anything else I should do at the moment?

 

[Rekt]

Do you have any advice for a family medicine attending interested in doing another residency in EM in regards to securing a position?

Honestly a really bad idea with job market prospects. You have much more mobility/prospects in FM.

 

[camtheram1815]

Just wanted to offer some solidarity:

I'm a US MD with: Step 1 235-240 range, Step 2 >250, reportedly strong LORs (H on SLOE rotation,received very positive feedback on other LORs during interviews), unique EC's/leadership, no red flags to my knowledge, etc..

Per my Dean recommendation (they warned it would be a very strange year) I over applied to ~75 programs. I have received 13 II, about half are places I have connections to, the other half are completely random. I will be sticking to attending 12 interviews, and I can't complain because I am happy with my list. I'm especially excited about my top 5 ranks so overall I'm thankful and satisfied.

My only point in sharing this is: this cycle is a complete crapshoot, and I wanted to offer solidarity that it sucks. If I had listened to the typical PD 30-40 applications, I'd probably be at 7 or 8 II and sweating bullets big time. I'm not sure how I will advise my M3 mentees on our post match panel...

Best of luck everyone.

 

[Doctor_Strange]

Just wanted to offer some solidarity:

I'm a US MD with: Step 1 235-240 range, Step 2 >250, reportedly strong LORs (H on SLOE rotation,received very positive feedback on other LORs during interviews), unique EC's/leadership, no red flags to my knowledge, etc..

Per my Dean recommendation (they warned it would be a very strange year) I over applied to ~75 programs. I have received 13 II, about half are places I have connections to, the other half are completely random. I will be sticking to attending 12 interviews, and I can't complain because I am happy with my list. I'm especially excited about my top 5 ranks so overall I'm thankful and satisfied.

My only point in sharing this is: this cycle is a complete crapshoot, and I wanted to offer solidarity that it sucks. If I had listened to the typical PD 30-40 applications, I'd probably be at 7 or 8 II and sweating bullets big time. I'm not sure how I will advise my M3 mentees on our post match panel...

Best of luck everyone.

I would still maintain if someone is at 7-8 he or she should not be stressing that much. Based off recent EMRA call, about half have less than 10 invites. Even if it overestimates which it did likely a still not insignificant # of applicants don't have >10.

 

[LibBum]

So where was the memo motivating applicants to over apply and saturate the available interview spots per program this year? I'm couples matching and initially applied to about 60 programs. Later to see everyone got all click happy and screwed the cycle for us average applicants. #solidarity.

 

[DragonSalad]

Hi @gamerEMdoc, thanks so much for continuing to answer these questions. I wanted to know when is the latest I can have Step 2 CK scores in for you to consider them before finalizing rank lists? Currently scheduling my exam for early to mid January.

 

[12jas]

So where was the memo motivating applicants to over apply and saturate the available interview spots per program this year? I'm couples matching and initially applied to about 60 programs. Later to see everyone got all click happy and screwed the cycle for us average applicants. #solidarity.

Yeah except they didn't.... here is data from the NRMP. Applicants applied to the same as usual the average barely changed.

 

[gamerEMdoc]

Everyone assumes their year is the worst, but overapplication has been a problem for awhile. Also, anyone on Oct 30 with 7-8 interviews, or 13 invites, would have been like "things are going well" in most years. That's where we are in the time frame. We are 6 weeks into interview season.

I'm not saying this year will shake out well for everyone. But I really really doubt, in the end, this year will be that far off from any other year in the number of unmatched EM spots. I highly doubt there are a small number of students who are taking up all the interviews for everyone.

Are there some who are going on too many. Absolutely. This happens every year. I still doubt it will be such a huge problem that it will leave programs with tons of open spots unfilled because they all interviewed the same people.

 

[gamerEMdoc]

Hi @gamerEMdoc, thanks so much for continuing to answer these questions. I wanted to know when is the latest I can have Step 2 CK scores in for you to consider them before finalizing rank lists? Currently scheduling my exam for early to mid January.

Depends on when programs certify their lists. Typically they do so in early to mid Feb. They are due the same time candidates lists are due. This year I think that is the beginning of March if I'm not mistaken.

When should you get the score back? I'd want it back by February. So you probably aren't going to have them in if you are taking the board in January.

 

[gamerEMdoc]

Past the point of the cancellation trickle? No. Most years that's Dec/January. So this year it will likely be Jan and early February.

 

[boolin_1]

it's been reaaaaaaaaaaaaaaaaaal quiet for a few weeks. maybe i'm not on many waitlists