EM PD - Ask Me Anything

[H7D16]

Hi gamerEMdoc, I had a good interview with a dream program. They were the only program that the apd, pd, and faculty responded to my thank you email. I felt like I connected and made an impression on everyone. I really want to match here but my scores are below average for em and I'm a US img. Just wondering in your experience, if you would rank a student higher or lower based on the interview over scores. Or if you think them responding to my thank you email would be a good sign. Thanks

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[Dr.Bruh]

Hi gamerEMdoc, I had a good interview with a dream program. They were the only program that the apd, pd, and faculty responded to my thank you email. I felt like I connected and made an impression on everyone. I really want to match here but my scores are below average for em and I'm a US img. Just wondering in your experience, if you would rank a student higher or lower based on the interview over scores. Or if you think them responding to my thank you email would be a good sign. Thanks

Homie look at the PD survey. The top five factors that determine rank for PDs are all interview/personality stuff. Boards aren’t even top five for ranking.

 

[gamerEMdoc]

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

The last few weeks of interview season were the 5th and 6th week of interviews. Are people usually canceling their interviews in bulk a little more over a month in? For waitlists to move, cancelations have to happen, and people don't cancel a few weeks in, not in big enough numbers to see the needle move.

Certianly, speculation will be that "cancellation season" and movement off waitlists won't be as much as usual bc of the convenience of virtual interviews, as well as the shortened timeframe of the interview season. But its all speculation. We have no idea. This is an unprecedented year. No one knows.

 

[gamerEMdoc]

Hi gamerEMdoc, I had a good interview with a dream program. They were the only program that the apd, pd, and faculty responded to my thank you email. I felt like I connected and made an impression on everyone. I really want to match here but my scores are below average for em and I'm a US img. Just wondering in your experience, if you would rank a student higher or lower based on the interview over scores. Or if you think them responding to my thank you email would be a good sign. Thanks

Homie look at the PD survey. The top five factors that determine rank for PDs are all interview/personality stuff. Boards aren’t even top five for ranking.

This. The interview ranks up there with SLOEs as the most important part of the rank list.

 

[Packers12]

Got an interview invite from a big name program after I sent them an LOI because someone canceled on them this past Monday for an interview this upcoming Friday. I honestly don't know if I got the interview because the program is genuinely interested in me or because I got lucky and emailed them at the right time. How much review goes into applications because I got the II the same day I sent the email? I'm grateful for the interview but honestly feel like I got it on luck vs my own merits.

 

[gamerEMdoc]

Got an interview invite from a big name program after I sent them an LOI because someone canceled on them this past Monday for an interview this upcoming Friday. I honestly don't know if I got the interview because the program is genuinely interested in me or because I got lucky and emailed them at the right time. How much review goes into applications because I got the II the same day I sent the email? I'm grateful for the interview but honestly feel like I got it on luck vs my own merits.

it’s both. This is why I tell people to wait with LOI ‘s. I think them being timely in and around the time interviews get canceled make way more sense than sending them earlier in the season. Because when people cancel last min, and the coordinator has someone in their email asking for an interview, and that person meets the criteria, the easy thing is to just give it to that person. So I do think there is a bit of luck and/or gamesmanship on getting off a waitlist this way.

But rest assured, if they are interviewing you, then you have a chance to match there.

 

[H7D16]

This. The interview ranks up there with SLOEs as the most important part of the rank list.

@Dr.Bruh and @gamerEMdoc thank you.

Not gonna lie. It's been tough trying to convince myself I'm a good applicant as everyone else since I made it to the interview but there's also a part of me that can't help but think, maybe I'm just a "safety net" applicant for the program. Especially around the whole issue of more top applicants hoarding and applying to more programs. I understand programs are probably also worried so probably sending out more interviews than usual

 

[gamerEMdoc]

@Dr.Bruh and @gamerEMdoc thank you.

Not gonna lie. It's been tough trying to convince myself I'm a good applicant as everyone else since I made it to the interview but there's also a part of me that can't help but think, maybe I'm just a "safety net" applicant for the program. Especially around the whole issue of more top applicants hoarding and applying to more programs. I understand programs are probably also worried so probably sending out more interviews than usual

Idk, I’m not interviewing any more than usual. I also don’t specifically target the “top applicants” that apply. I target 88 people that I think are qualified and are matchable. Some are more of a reach than others of course. Some are safer than others. But all are at least potentially matchable in my mind.

 

[joh13562]

I haven't been told one way or another and I've read as much CORD, forum, spreadsheet, etc information as I could but is being a reapplicant in itself count as a red flag? Asking as most advice recommends red flag applicants should aspire towards a few extra interviews. Thanks again for committing to this thread and always offering a solid perspective.

 

[gamerEMdoc]

I guess its how you look at it. There's a reason someone didn't match the first time around, which is why they are a reapplicant. So is it them being a reapplicant or the reason they are a reapplicant? The data for reapplicants definitely show its an uphill battle however it is most definitely possible to rehab your app and reapply. All depends on what the reason for not matching is. Bad SLOEs? You can change letters. What you can't change are violations at your school for ethics stuff like cheating or harassing another student. So it really depends on what the reason is someone didn't match.

 

[Doctor_Strange]

@gamerEMdoc, I hate ask, but what's your crystal ball saying about the future employment of EM docs. Today I had a local EM doc pretty much say it's dark times ahead for the next several years and without any optimism in sight. He wasn't some grumpy old doc too who believes in QAnon lol its a normal middle aged guy. He seemed genuinely anxious for the specialty and it made pretty sad to hear his take.

 

[gamerEMdoc]

@gamerEMdoc, I hate ask, but what's your crystal ball saying about the future employment of EM docs. Today I had a local EM doc pretty much say it's dark times ahead for the next several years and without any optimism in sight. He wasn't some grumpy old doc too who believes in QAnon lol its a normal middle aged guy. He seemed genuinely anxious for the specialty and it made pretty sad to hear his take.

I personally don't want to get into it on this QA, because it will just snowball like most of the threads here on the topic. I'm happy to discuss via DM. But I really don't want this thread to become yet another discussion about the future of EM employment. If anyone wants my personal thoughts, feel free to DM me.

 

[hopefulERdoc251]

@gamerEMdoc

Hey gamer, quick q...what are things to look for to see if a newer program is legit? I interviewed at a program that just graduated their first class this year and they're at an academic institution that seems to definitely have the infrastructure available to succeed as a good EM residency and I really vibed with the PD/APD/residents. I'm just hesitant because they just graduated one class and I have other programs on my list that are more established but didn't vibe as much as I did at this program. They were able to recruit faculty from all over the country from strong academic institutions and have many fellowship trained personal on staff, and 30% of their first class matched at fellowships.

 

[gamerEMdoc]

Every program has to start somewhere. Having good faculty, hospital resources (not farming out all the non-em rotations elsewhere), and having a preexisting GME dept with experience with other residencies is helpful. Otherwise comes down to volume and acquity.

 

[boolin_1]

According to Twitter, the PD list serv is talking about the unequal interview distribution. Is there anything that can be done besides just *hoping* people will drop?

 

[gamerEMdoc]

According to Twitter, the PD list serv is talking about the unequal interview distribution. Is there anything that can be done besides just *hoping* people will drop?

Nope. Nothing that can be done at this point. This is all controlled by the AAMC and the NRMP; PD's don't control the match anymore than students do. There's a lot of chatter about people being upset that middle of the road students aren't getting as many interviews as usual. This was a completely predictable problem that virtually everyone saw coming with the rise of virtual interviews. Until the AAMC comes up with an application cap system, or we go back to in person interviews (and therefore financial restraints of travel cause an artificial cap), there will be no end in site.

We'll see how it all plays out. Still basically just over the mid-way point right now. There may be mass cancellations in Jan. There may not. We may see more open spots in the SOAP, we may not. No one knows.

 

[The Knife & Gun Club]

Nope. Nothing that can be done at this point. This is all controlled by the AAMC and the NRMP; PD's don't control the match anymore than students do. There's a lot of chatter about people being upset that middle of the road students aren't getting as many interviews as usual. This was a completely predictable problem that virtually everyone saw coming with the rise of virtual interviews. Until the AAMC comes up with an application cap system, or we go back to in person interviews (and therefore financial restraints of travel cause an artificial cap), there will be no end in site.

We'll see how it all plays out. Still basically just over the mid-way point right now. There may be mass cancellations in Jan. There may not. We may see more open spots in the SOAP, we may not. No one knows.

My theory is that it will all end up being a wash in the end because while there’s more interviews being concentrated at the top now, the total number of applicants and programs is more or less the same.

Programs and students may both fall further down their lists this year, but the whole point of the match is to allocate residency spots as efficiently as possible.

Some “top 10%” person can be an idiot and interview at 34 places if they want (true story), but they can still only match at one.

 

[gamerEMdoc]

My theory is that it will all end up being a wash in the end because while there’s more interviews being concentrated at the top now, the total number of applicants and programs is more or less the same.

Programs and students may both fall further down their lists this year, but the whole point of the match is to allocate residency spots as efficiently as possible.

Some “top 10%” person can be an idiot and interview at 34 places if they want (true story), but they can still only match at one.

I tend to agree with this. We may see a higher match rate than usual at interview numbers like 4-6. Because programs may fall farther on their list. That or there will be far more open spots in the SOAP. Ultimately, if the number of applicants and spots are roughly similar, then even with interview hoarding, it doesn't really change the ultimate outcome of people filling spots.

 

[blue.jay]

I tend to agree with this. We may see a higher match rate than usual at interview numbers like 4-6. Because programs may fall farther on their list. That or there will be far more open spots in the SOAP. Ultimately, if the number of applicants and spots are roughly similar, then even with interview hoarding, it doesn't really change the ultimate outcome of people filling spots.

Same with IM subspecialty match. For the same reasons, people anticipated more SOAP spots this year but surprisingly most specialities and most programs filled more spots this year than previous years.

 

[astronauticaldoc]

@gamerEMdoc I have a question regarding how to "gauge a virtual interview". How are we supposed know if we interviewed well?
My experience varies depending on the program. Virtual is difficult because many of the body language, inflections in voice, eye contact etc.. is reduced. My experience has ranged from programs discussing my work/leadership experience to the "tell me about a difficult situation you encountered and how did you manage it?" type questions. The interviews where it felt like the programs were reading questions from a list, seemed so sterile. In contrast to the programs that asked about my application, or interests/hobbies which felt more personal. It might be difficult, to answer, but how are we supposed to know if an interview went well?

To be completely honest with you, I literally have no idea, how a program is able to decipher from a zoom interview, how to differentiate applicant A from B. Unless, of course an interviewee is just completely a robot personality, or wasn't prepared for the interview, or showed lukewarm interest. It's starting to seem like these interviews, now 6 weeks into it, maybe the burnout is there from a program standpoint, perhaps realizing that the Zoom thing isn't as useful as was initially anticipated..

 

[gamerEMdoc]

@gamerEMdoc I have a question regarding how to "gauge a virtual interview". How are we supposed know if we interviewed well?
My experience varies depending on the program. Virtual is difficult because many of the body language, inflections in voice, eye contact etc.. is reduced. My experience has ranged from programs discussing my work/leadership experience to the "tell me about a difficult situation you encountered and how did you manage it?" type questions. The interviews where it felt like the programs were reading questions from a list, seemed so sterile. In contrast to the programs that asked about my application, or interests/hobbies which felt more personal. It might be difficult, to answer, but how are we supposed to know if an interview went well?

To be completely honest with you, I literally have no idea, how a program is able to decipher from a zoom interview, how to differentiate applicant A from B. Unless, of course an interviewee is just completely a robot personality, or wasn't prepared for the interview, or showed lukewarm interest. It's starting to seem like these interviews, now 6 weeks into it, maybe the burnout is there from a program standpoint, perhaps realizing that the Zoom thing isn't as useful as was initially anticipated..

I 100% disagree. I think its just as easy to interview someone over zoom as it is in person. I haven't found it any more difficult to hold a conversation over zoom. You'll have boring interviews with people reading their standard questions off a list in person, just as you'll have more organic conversation type interviews as well. It's not zoom, its just that some people are good at interviewing and some are not.

People ask this same question in non-zoom years? How do I know if my interview went well? The fact is you just aren't going to know. You can't. And that's fine. This process will drive you crazy if you are trying to constantly try to figure out everything. Just do your best, let the chips fall where they may.

 

[partypantss]

@gamerEMdoc I have a question regarding how to "gauge a virtual interview". How are we supposed know if we interviewed well?
My experience varies depending on the program. Virtual is difficult because many of the body language, inflections in voice, eye contact etc.. is reduced. My experience has ranged from programs discussing my work/leadership experience to the "tell me about a difficult situation you encountered and how did you manage it?" type questions. The interviews where it felt like the programs were reading questions from a list, seemed so sterile. In contrast to the programs that asked about my application, or interests/hobbies which felt more personal. It might be difficult, to answer, but how are we supposed to know if an interview went well?

To be completely honest with you, I literally have no idea, how a program is able to decipher from a zoom interview, how to differentiate applicant A from B. Unless, of course an interviewee is just completely a robot personality, or wasn't prepared for the interview, or showed lukewarm interest. It's starting to seem like these interviews, now 6 weeks into it, maybe the burnout is there from a program standpoint, perhaps realizing that the Zoom thing isn't as useful as was initially anticipated..

I feel like I've had interviews that have gone well and also ones that haven't. Generally, the ones I feel good about included both of us joking, laughing and having a good conversation, where the interviewer seemed genuinely engaged and we sort of had an understanding. The ones that didn't go well felt "off" to me. Like I didn't give great answers to their questions, or the conversation never felt organic. It's the same cues you use in real life. Also, for the standardized questions, if they're nice a lot of them will respond to answers they consider good with agreement how "that's so true" or say how insightful your answer was. Those sorts of things all indicate it's going well to me. I've also gotten some green flags from places with PDs that have mentioned how they would be very happy to see me on their final list, or that I'm the type of personality they're looking for, or just that I am strong on paper and on the interview. Overall you can never know for sure, and some people will be stone-faced or just plane grumpy with everyone, while some are just probably super nice, but I definitely think I have a decent idea of places where I nailed it and a couple of places where I feel like I sorta blew it.

 

[pillowsnice]

I feel like I've had interviews that have gone well and also ones that haven't. Generally, the ones I feel good about included both of us joking, laughing and having a good conversation, where the interviewer seemed genuinely engaged and we sort of had an understanding. The ones that didn't go well felt "off" to me. Like I didn't give great answers to their questions, or the conversation never felt organic. It's the same cues you use in real life. Also, for the standardized questions, if they're nice a lot of them will respond to answers they consider good with agreement how "that's so true" or say how insightful your answer was. Those sorts of things all indicate it's going well to me. I've also gotten some green flags from places with PDs that have mentioned how they would be very happy to see me on their final list, or that I'm the type of personality they're looking for, or just that I am strong on paper and on the interview. Overall you can never know for sure, and some people will be stone-faced or just plane grumpy with everyone, while some are just probably super nice, but I definitely think I have a decent idea of places where I nailed it and a couple of places where I feel like I sorta blew it.

I agree. Some I've felt like the conversations flowed well and we were able to talk about hobbies and such, but others felt forced and interrogation like with back to back questions with almost no response after my answer. I definitely try not to think too much about it cause I'll drive myself crazy overthinking everything I've said. Only one has said to be that I'd fit well at the program, but even that I take with a grain of salt. With that said, how much does the interview actually matter considering you're a strong applicant with strong SLOES? If you are an average interviewer (which I think I am), can these drop you so much that they do not rank the applicant to match? @gamerEMdoc

 

[gamerEMdoc]

I agree. Some I've felt like the conversations flowed well and we were able to talk about hobbies and such, but others felt forced and interrogation like with back to back questions with almost no response after my answer. I definitely try not to think too much about it cause I'll drive myself crazy overthinking everything I've said. Only one has said to be that I'd fit well at the program, but even that I take with a grain of salt. With that said, how much does the interview actually matter considering you're a strong applicant with strong SLOES? If you are an average interviewer (which I think I am), can these drop you so much that they do not rank the applicant to match? @gamerEMdoc

according to the PD survey the interview and the sloes are the two biggest aspect of the rank list decision. Will that be the case everywhere? No. But it is definitely a huge factor in helping determine the rank process.

 

[cbeck8]

Hi, I’m currently browsing the CORD website and see that they recommend getting only one SLOE from a home rotation, it isn’t super clear to me whether getting only one non academic EM SLOE from an EM doc who is not in any way affiliated with a residency is sufficient because that’s all my school has to offer. I wanted to get one from him and also do an audition rotation for an ESLOE, what would be the best route to abide by COVID recommendations but also have appropriate SLOEs and evaluations?

Thank you
-CB OMS-III

 

[astronauticaldoc]

Hi, I’m currently browsing the CORD website and see that they recommend getting only one SLOE from a home rotation, it isn’t super clear to me whether getting only one non academic EM SLOE from an EM doc who is not in any way affiliated with a residency is sufficient because that’s all my school has to offer. I wanted to get one from him and also do an audition rotation for an ESLOE, what would be the best route to abide by COVID recommendations but also have appropriate SLOEs and evaluations?

Thank you
-CB OMS-III

This past application cycle most of us got 1 SLOE from a site that had an EM Residency. And 1-2 O-SLOEs from either a core EM rotation that didn't have an EM Residency program, or from an EM Ultrasound / EM Pediatrics at a facility that had an EM Residency, or from another specialty like an IM Doctor who filled out an O-SLOE. Long story short, just 1 official SLOE from an EM Residency program. Having a SLOE from an EM Non-residency program will put you at a high disadvantage in my opinion. Reason being, it's a relatively useless measure of your competency in the ED because it does not compare you in an ED setting where you're auditioning, working compared to your peers. You're instead in a much more passive role as compared to an EM Audition at a residency program, constantly being giving escalating responsibilities.

 

[gamerEMdoc]

Hi, I’m currently browsing the CORD website and see that they recommend getting only one SLOE from a home rotation, it isn’t super clear to me whether getting only one non academic EM SLOE from an EM doc who is not in any way affiliated with a residency is sufficient because that’s all my school has to offer. I wanted to get one from him and also do an audition rotation for an ESLOE, what would be the best route to abide by COVID recommendations but also have appropriate SLOEs and evaluations?

Thank you
-CB OMS-III

The COVID recommendations made by CORD were for this years 4th years. They have not weighed in at all about next year. I actually don't expect them to stick with the "only 1 SLOE" recommendation. They may go with "no more than 2", but I would be really surprised if they still think students should only go on one rotation.

These recommendations were made when there was a ton of uncertainty and lack of PPE. With a full year of watching this play out, along with the vaccine, I can't imagine there will be the same limitation for next year, at least not to the same degree.

 

[Papa Oso]

Been getting a few interviews and dropped a few within the past. There are definitely people dropping January interviews out there so if you're still not at a comfortable number, now may be a good time to send out "timely" LOIs to snag these open slots.

 

[ace_inhibitor111]

This past application cycle most of us got 1 SLOE from a site that had an EM Residency. And 1-2 O-SLOEs from either a core EM rotation that didn't have an EM Residency program, or from an EM Ultrasound / EM Pediatrics at a facility that had an EM Residency, or from another specialty like an IM Doctor who filled out an O-SLOE. Long story short, just 1 official SLOE from an EM Residency program. Having a SLOE from an EM Non-residency program will put you at a high disadvantage in my opinion. Reason being, it's a relatively useless measure of your competency in the ED because it does not compare you in an ED setting where you're auditioning, working compared to your peers. You're instead in a much more passive role as compared to an EM Audition at a residency program, constantly being giving escalating responsibilities.

This varies by institution because my friend’s non-residency EM rotation was very similar experience-wise to his audition EM rotation. Are you really saying that an ULTRASOUND rotation where you literally just sit around waiting for ultrasound cases is more indicative of how you’ll perform as a resident? It’s assumptions like these that really hurt applicants this cycle

 

[Dr.Bruh]

This varies by institution because my friend’s non-residency EM rotation was very similar experience-wise to his audition EM rotation. Are you really saying that an ULTRASOUND rotation where you literally just sit around waiting for ultrasound cases is more indicative of how you’ll perform as a resident? It’s assumptions like these that really hurt applicants this cycle

My US rotation was designed to be an audition. We did 9 regular ED shift and 7-8 scanning shifts. Also did sim and didactics each week with a presentation at the end. Basically exactly same as my regular EM sloe but like 4 less shifts.

 

[The Knife & Gun Club]

This varies by institution because my friend’s non-residency EM rotation was very similar experience-wise to his audition EM rotation. Are you really saying that an ULTRASOUND rotation where you literally just sit around waiting for ultrasound cases is more indicative of how you’ll perform as a resident? It’s assumptions like these that really hurt applicants this cycle

A good US rotation you’re not sitting around wishing for scans, you’re usually the MS4 paired with a US attending and a resident on their US rotation.

Although I agree most US rotations won’t have a good measuring stick to compare you to other MED students unless you’re doing a true subI

 

[gamerEMdoc]

Seeing a good bit of cancellations for January, which was expected. Now is the time to fire off LOI emails to dig up invites if you are someone who is still hurting for those last few.

 

[gamerEMdoc]

I reference SDN and this AMA thread in here... haha

First Person: Students and Residents Saved My Career, and I ... : Emergency Medicine News

An abstract is unavailable.

journals.lww.com

 

[Doctor_Strange]

Just to sort of prove @gamerEMdoc's point, back in early November I was extremely worried and mentally getting ready to SOAP with only 4 interviews. He said sit tight and let it play out. Currently sitting at 12 interviews -- will even be canceling one of them in the coming days due to an unavoidable schedule conflict.

 

[Packers12]

Seeing a good bit of cancellations for January, which was expected. Now is the time to fire off LOI emails to dig up invites if you are someone who is still hurting for those last few.

When do you predict this wave of cancellations will end? Sitting at 8 IIs and haven't heard back from anywhere in a month now. My guess is if I hear nothing by the end of next week I'll get no more invites the rest of this cycle. Is that safe to assume?

 

[gamerEMdoc]

When do you predict this wave of cancellations will end? Sitting at 8 IIs and haven't heard back from anywhere in a month now. My guess is if I hear nothing by the end of next week I'll get no more invites the rest of this cycle. Is that safe to assume?

End of January. There probably will still be some that interview into the first week or two of February though, so I suppose a few stragglers could still come in. But I'd expect invites from waitlists to come in all month depending on how many cancellations occur.

 

[gamerEMdoc]

Just to sort of prove @gamerEMdoc's point, back in early November I was extremely worried and mentally getting ready to SOAP with only 4 interviews. He said sit tight and let it play out. Currently sitting at 12 interviews -- will even be canceling one of them in the coming days due to an unavoidable schedule conflict.

Every year this happens. First weeks of invites, people start freaking out they don't have 12. 12 is by the end of interview season, not 2 weeks in. For some, they get there right away. For others, its a slow crawl. Some never get quite to 12, but are still statistically in a really good place (8+ or so). But one thing is true, where you are after the first wave of invites is rarely where you will be in January. You just have to have patience, which I realize is easy for me to say from the other side of the aisle.

 

[gamerEMdoc]

From the 2020 PD survey, this was for EM and I thought it was useful to illustrate for future classes how interviews roll out in normal (non-shortened) years.

Despite ERAS opening in Sept, only 11% of invites go out in Sept (I'd venture to guess many of these go to students that have rotated already). 54% of invites come in October, with diminishing numbers in each of the next 3 months. You can see that 2/3 of invites are out by the end of October, there isnt a major second wave, but rather a steady trickle of invites after that to the end, typically when people decline and or with cancellations.

On the other hand, the interviews themselves (helpful for planning lighter months) are mostly Nov-Jan with only 15% coming before November.

 

[Dr.Bruh]

Just wanted to chime in with my anecdote which supports that cancellations are happening. After a month+ of nothing but a few rejects I have received 3 more invites this week. And all of them were at programs I would rank in top 1-5. I had totally given up any hope or dream at ending up at these places until this week.

 

[LikelyProcrastinating]

Hi GamerDoc! MS4 here making my rank list. Do you feel like residents have to get along really well with program directors in order to be successful? I have not met a single PD I have disliked, and most of them seem like they really care about their residents, however there have been a few that I think personality-wise don't mesh as well with me as others. I think of them as people I would be ok going to for professional support, but not really life advise/"emotional" support. An advisor I really trust at my school said your thoughts on the PD should be one of the most important factors in deciding your rank list, so I'm a bit conflicted, since I otherwise loved some of these programs and got along well with most of the staff I interviewed with. It's all just leaving me a bit confused on how much a PD can impact my experience.

 

[risus_sardonicus]

Not going into EM, surgery intern going into IR, however as a finance enthusiast I have a genuine question regarding the EM job market. Is there truly a concern for market saturation given the recent boom in subpar residencies and even more so the seemingly unstoppable explosion of midlevels (particularly NPs) being able to masquerade as equivalent to board-certified EM attendings?

 

[Dr Mantis Toboggan]

Not going into EM, surgery intern going into IR, however as a finance enthusiast I have a genuine question regarding the EM job market. Is there truly a concern for market saturation given the recent boom in subpar residencies and even more so the seemingly unstoppable explosion of midlevels (particularly NPs) being able to masquerade as equivalent to board-certified EM attendings?

Quality troll. Well done sir.

 

[risus_sardonicus]

Quality troll. Well done sir.

It was a genuine question. Not trying to troll.

 

[Dr Mantis Toboggan]

It was a genuine question. Not trying to troll.

The answer is yes. It’s what half the threads here are about now.

 

[gamerEMdoc]

Hi GamerDoc! MS4 here making my rank list. Do you feel like residents have to get along really well with program directors in order to be successful? I have not met a single PD I have disliked, and most of them seem like they really care about their residents, however there have been a few that I think personality-wise don't mesh as well with me as others. I think of them as people I would be ok going to for professional support, but not really life advise/"emotional" support. An advisor I really trust at my school said your thoughts on the PD should be one of the most important factors in deciding your rank list, so I'm a bit conflicted, since I otherwise loved some of these programs and got along well with most of the staff I interviewed with. It's all just leaving me a bit confused on how much a PD can impact my experience.

One persons personality is going to make or break your residency. PDs clinical hours are cut down considerably, so chances are you’ll work with your PD 1-2 times a month, if that. You’ll have plenty of faculty that can be mentors. Now if a PD is unresponsive to resident concerns, malignant, dismissive, etc... then that’s totally different. But if they are a fair PD who does their job effectively and has the best interests of the residents at heart and you just dont have a good social connection, its not a big deal at all.

 

[12jas]

How much does training in a particular area influence your ability to get a job in the same area post-residency? There is a new program that is in the location I want and area I want to work in post-training but I am not crazy about the program itself. There are much higher quality programs I've interviewed at but the locations aren't as good. Really struggling with where to rank this program.

 

[gamerEMdoc]

How much does training in a particular area influence your ability to get a job in the same area post-residency? There is a new program that is in the location I want and area I want to work in post-training but I am not crazy about the program itself. There are much higher quality programs I've interviewed at but the locations aren't as good. Really struggling with where to rank this program.

I think it helps in the sense that you can more easily moonlight in the area, get job contacts in the area, etc. Many residents end up in and around the area where they train. I think this has less to do with residents getting recruited within the area though, and more to do with residents frequently picking the geographic region they want to live in when they select their residency. A student who is from Ohio who wants to move back to Ohio for residency will likely end up wanting to live in Ohio afterwards. This isn't everyone, but it is a huge chunk of residents.

Honestly, I'd say 80% of my resident graduates go back to the state where they are from to work. The in state students stay in state. The ones from Texas move to Texas, New York back to NY, California back to California, etc... it's very predictable. Rarely we have a "free agent" resident who really doesn't care at all where they want to end up and looks all over the place. But this is the exception, not the rule.

 

[pillowsnice]

I think it helps in the sense that you can more easily moonlight in the area, get job contacts in the area, etc. Many residents end up in and around the area where they train. I think this has less to do with residents getting recruited within the area though, and more to do with residents frequently picking the geographic region they want to live in when they select their residency. A student who is from Ohio who wants to move back to Ohio for residency will likely end up wanting to live in Ohio afterwards. This isn't everyone, but it is a huge chunk of residents.

Honestly, I'd say 80% of my resident graduates go back to the state where they are from to work. The in state students stay in state. The ones from Texas move to Texas, New York back to NY, California back to California, etc... it's very predictable. Rarely we have a "free agent" resident who really doesn't care at all where they want to end up and looks all over the place. But this is the exception, not the rule.

In that sense, do you try to rank applicants higher who you believe will end up staying near your program? As someone who is interviewing at out of state programs, I hope I dont end up lower on the list just based on geography and them assuming I want to stay in my big city.

 

[gamerEMdoc]

Not really. Can be a tie breaker of sorts I guess. Local people are more likely to rotate with you. They are more likely to rank you high, etc. That's why they tend to end up in those areas. If you have two people with fairly similar apps, and one you've known for years bc they are local, shadowed, then rotatated with you, did other rotations in the hospital, etc... of course you'll take the known over the unknown. But if the local person is an average student, you wouldn't rank them over the all star candidate.

 

[justalurker]

Hey! I think my top program's last interview day is coming up this week. I don't know when they are going to have their final rank list meetings but I would ideally like to get my letter of intent sent in before those discussions take place. At the same time, I don't want to send it too early either. Do you have any thoughts on what the optimal time would be to send it out? In past years there have been recommended time frames but things are so wonky this application cycle, I doubt they hold true this year. I know LOIs probably aren't going to make or break me but at the same time I want to do everything I can to ensure a good match. I still have 2 interviews left but I'm nearly certain that they will not be able to dislodge my top spot. Should I just go ahead and fire off my LOI a day or two after their last interview day?