EM residency applicant with prior EM work history - need advice!

[gloucester]

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Hey all, hope you are able to provide me with some advice.

I trained originally in a non-EM specialty, and subsequently began practicing in various ED's large and small, rural and urban, over the past 5 years.

I've come though to feel that I'd like to practice at higher level facilities than I currently have access to as a non-EM boarded physician, so am planning an application for EM residency.

The question though is how to play this in my application, given the widespread negative view of non-EM trained physicians working in EM.

One thought is to avoid this conversation altogether, and focus instead on the hospitalist work I've done in the past few years, and my main motivator for EM residency being my exposure to EM through this route.

Or would you think with some programs it could be viewed more positively that I've worked in EM, but now want the training?

Any thoughts?

 

[Hercules]

I would assume that most programs (and your future employers) would view your experience as a positive, especially when coupled with the fact that it drove you to seek further training.

 

[ucbsmd]

I would imaging that one of your biggest hurdle will be finding a program that is willing to take on an unfunded applicant since you have already used your medicare funding for training.

 

[The White Coat Investor]

Repeat this often at the interview and in the application:

"I realized I needed additional training to be an outstanding emergency physician."

As a military EM faculty member, a month out of a 3 year residency, I was tasked to train a PGY4 who had previously completed an FP residency, practiced for 10 years, and outranked me by two ranks. A great doc, super humble, and willing to learn what he could from me (and I from him.) He's probably a general now. You need to show at your interview that you're going to be that doc.

 

[Birdstrike]

I would assume that most programs (and your future employers) would view your experience as a positive, especially when coupled with the fact that it drove you to seek further training.

Yes, yes and yes.

Gloucester,

Having already completed a residency and having had ED experience, albeit non-boarded, will put you light years ahead of any other intern in experience and efficiency. You won't need to prove this to anyone, it'll be obvious, so don't bother. I agree also, that you definitely want to be humble about it, and acknowledge you have tons to learn to become a BC/BE EP. That will score many more points than trying to act like you're "already an EM attending," above the interns, and just there to do time to get your rubber stamp from ABEM. That guy is likely to be cocky, annoying and question all his BC/BE EM attendings and be annoying for three years. I think most EM attending will have mad respect for anyone as dedicated to your craft that you'll go back and do the proper training. I think it's a plus.

The negatives you have to address: 1-The funding issue, to the extent that's an issue or not, 2-Not being too cocky, and 3-The inevitable question, "Did you hate your first specialty and if so will you just end up hating EM?" or in other words, "Are you a chronic malcontent?"

Not saying any of these are true or deal breakers; they're just questions you should be ready to address properly.

Good luck.

 

[WilcoWorld]

Hey all, hope you are able to provide me with some advice.

I trained originally in a non-EM specialty, and subsequently began practicing in various ED's large and small, rural and urban, over the past 5 years.

I've come though to feel that I'd like to practice at higher level facilities than I currently have access to as a non-EM boarded physician, so am planning an application for EM residency.

The question though is how to play this in my application, given the widespread negative view of non-EM trained physicians working in EM.

One thought is to avoid this conversation altogether, and focus instead on the hospitalist work I've done in the past few years, and my main motivator for EM residency being my exposure to EM through this route.

Or would you think with some programs it could be viewed more positively that I've worked in EM, but now want the training?

Any thoughts?

I have worled at 3 different EM programs (all solid-to-excellent in my not so humble opinion) and each of these programs have matched applicants who used up their Medicare funding during a different residency. These were humble docs who wanted EM trining for the right reasons, and we felt that their prior experience would more than make up for the funding gap.

Feel free to PM me with questions.

 

[DeadCactus]

1. Most EM physicians understand that not every place has the opportunity to hire an ABEM graduate and would not fault someone for filling the need. What they are against is non-EM trained physicians trying to sell themselves as equivalent to an ABEM residency trained physician either through work history or non-ABEM training. This is partly personal pride in one's own training, partly a genuine belief in the value of ABEM certified training, and partly just a sound personally protective economic strategy. In either case, a physician with years of experience who not only believes residency training would benefit him or her but is actually willing to pursue it would mesh very well with these ideas. Your concern should not be downplaying your experience but making sure you convey a willingness to learn and be trained. A resident with solid real-world experience to rely on is an asset, a resident too used to being the attending and already fixed in their way of doing something is a liability.

2. The funding issue is constantly overstated on these boards. You're still eligible for the vast majority (~70%) of your Medicare GME funding. In addition, many institutions have long since run out of enough Medicare allocations to cover all of their GME and thus rely on other funding sources for positions. It can be a negative but nowhere near the death sentence people perceive it as.

 

[gloucester]

These posts all seem to ring true.

It made me think of a colleague I had in med school, who was really a super smart guy, in terms of his numbers academically and in general medical knowledge.

Around the attendings though he put on this Gomer Pyle type routine that was absolutely brillant, and he did very very well on his rotations as well.

Fortunately for me, I'm really not so set in my ways that I'd be arguing points with my attendings, but it's definitely harder having an experience base to draw on, and not have more formed opinions than my training-level peers.

Hopefully there will be a program that will be able to view me as "non-threatening," and allow me to grow from the place I'm at.

 

[RustedFox]

Dude (or dudette),

When I was a senior resident, we matched a guy who was an FM attending. Long past "medicare funding whatever, lolz".

Guy was (and I'm sure, still is) a total rockstar.

Good luck to yah.