EM Residency paths

[oneredice]

Hello all.

I am a recent Caribbean grad. I want to pursue EM residency. I see the stats on how poor the chances are for non US grads to match into EM.

So my question is, are there any relatively "easier" ways to go about getting an EM residency? Specifically, I want to know if it is possible to do 1 year of either prelim IM, prelim surg, or transitional year to potentially become a better candidate for EM the following year. Does anyone know of anyone that has followed a pathway similar to eventually get into EM?

I would appreciate any help on this matter. Thank you.

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[dyeguy21]

Prelim and transitional years are even harder to get into. People that apply Derm, Rad-Onc, Optho are vying for those spots already.

I've met people that applied Family or Internal Medicine and then changed career paths halfway through. You have to restart, but at least you gave yourself a way in.

 

[oneredice]

As I understand, what you are saying about prelim-IM is correct; they are usually highly competitive due to the fact there are so many people that apply that are going for advanced specialties. However, prelim-surgery is something that goes unfilled every year and from what I have heard so far, is relatively easier to match into. Is this information not correct? Secondly, would it be possible to go into EM after a year of prelim-surgery?

 

[NotAProgDirector]

Yes, and no.

Yes, you can go into EM after a year of prelim surgery. There are no rules that prevent you from doing that. But the question is whether it will help you -- i.e. would you get an EM spot that you wouldn't get applying straight out of school.

The benefit of doing a prelim GS year is clinical experience. You'd get lots of experience, letters, etc.

The problems are the following:

1. Applications open 9/15. If you start in a prelim GS program, you won't have much time to ask for LOR's. You'll need to ask for letters in August so that you can have them submitted by September. That means that the letters might say "oneredice just started here and so far is OK, but hard to tell".
2. You'll need time to interview for spots. Your prelim GS program might, or might not, be flexible.
3. Funding for residencies are complicated. Doing a year of prelim GS uses one of your years of funding. If you then match to EM, the last year might not be fully funded. If not, then you might find that EM programs are less interested in you. [This is very complicated because EM used to be 4 years long, so I don't know if the funding for EM is 3 or 4 years]

Bottom line:
1. It would likely help you at that site. If that program has an EM opening, they might consider you more strongly.
2. It will not offset other problems with your application. If your USMLE scores are too low, no one will care.
3. You would need to do well in the early part of your prelim GS program. Don't forget that most everyone else will want to do well for the same reason.

 

[oneredice]

Thank you so much aProgDirector!

In terms of scores, I would say that if I were a US grad they would be competitive, however as I am a Caribbean grad I think programs would want to see slightly higher scores.

Do you have any advice on how I can (perhaps eventually) get into an EM program besides directly applying to EM residency right now (which I will be doing regardless). I am very passionate about EM and am very open to landing into EM no matter what route I would have to take.

 

[kmb1908]

I am a USIMG from a Caribbean school (Ross) that is currently an EM intern. I matched to my #1.

• Firstly, yes it's tougher for us to get in, but not impossible. Don't be discouraged. If you want this, it's definitely possible.
• Secondly, you're right on the money to have a back up plan. Mine was IM (even though I truly hate IM). I think your idea of a prelim surgery year is awesome. You can use your SLOEs as your letters. Have a back up plan!! I applied to EM heavily and very weakly to my back up (80/20)
• Speaking of SLOEs, make sure you have at least 2 for your app, make sure that they're strong. When you submit your app, make sure everything is in: Step 1, CK, CS and all of your SLOEs. Some programs start looking and inviting before they receive MSPEs.
• If you do not have SLOEs, you can pretty much guarantee that you will not be matching in EM. Please make sure your SLOEs are written from faculty/PDs from EM residency programs. An EM LOR does not equal a SLOE. I'm sure you know that...but a lot of people that were applying to EM with me did not understand the difference and subsequently did not match in EM.
• APPLY BROADLY. I do mean broadly. If EM is what you want, now is not the time to count your pennies. Go full throttle.
• Have an advisor/mentor. Being from a Carib school its tough for them to advise you. We send way more people into IM, FM and Peds. However, I had a mentor that I found through EMRA. She ended up being a Rossie too. She was extremely instrumental in guiding me through interview season. If you do have someone you can reach out to via your school, do so (if you haven't already).
• Once you get your interviews, be your most positive version of yourself but don't forget to have fun! I ended up seeing some of the same people on the interview trail. Make some friends. These are your future colleagues.
• If you really like a program, stay in touch! Send thank you notes, ask to come back for a second look and/or ask to hang back in the department after your interview to really get a feel of the place. For my program, I just happened to know that they were "my people" at the dinner, but it was confirmed after I did a second look.

I hope this was of some help to you. Feel free to PM me if you need further support.

 

[oneredice]

kmb1908, thank you so much for all the information! You are right, we have absolutely no mentors for EM at my school. Per your guidance, I signed up for a mentor at EMRA. Unfortunately, I only have 1 SLOE - long story short, I never intended to apply to EM till I did a rotation in EM, which was my second to last rotation of med school. However, I do see that a lot of programs require 2 like you said so I am planning on doing an externship in EM in the next month or so to get another SLOE. I'm not sure that it will be in time for the '16 match but perhaps I can use it towards the next match in the event that I do not match this year (and if I do match, yay extra experience).

In terms of applying, I am applying to community, university, rural, every program that IMGs are eligible to apply to in each of the 50 states. I'm not sure if that's what you mean by broad - please advise if I can do something better. The only programs I haven't really given a look is to programs not part of NRMP...are there any?

I will use your magnanimous invitation to PM for further help if needed. Thank you again!

 

[Apollyon]

3. Funding for residencies are complicated. Doing a year of prelim GS uses one of your years of funding. If you then match to EM, the last year might not be fully funded. If not, then you might find that EM programs are less interested in you. [This is very complicated because EM used to be 4 years long, so I don't know if the funding for EM is 3 or 4 years]

Has that changed? "Back in my day", if it didn't lead to board certification, it didn't start the clock. That was right out of the "green book".

As far as EM as 3 or 4 years, actually, 30+ years ago, the first programs were 2 years long! However, the VAST majority are 3 years, and only a paltry few are 4 years. What went away are "2-3-4" programs - any that needed a prelim became 4 year programs. The Medicare payment for EM, though, is 3 years, so any 4 year programs pick up the cost of that 4th year.

 

[NotAProgDirector]

Has that changed? "Back in my day", if it didn't lead to board certification, it didn't start the clock. That was right out of the "green book".

Sort of. From what I know, a prelim year doesn't "set" the clock, but does count.