This post will address the following common questions:
1) How competitive is EM?
2) How many programs do I need to apply to?
3) How many programs do I need to interview at?
4) How do I pick programs to apply to and interview at?
5) How many letters of recommendation should I obtain?
6) What are the most important things to find out at an interview?
EM is a moderately competitive field. It is more competitive than FP, IM, Peds, Gen Surg, Pathology, and Psychiatry and less competitive than Derm, Ortho, Optho, Plastics. It is approximately as competitive as Rads, Urology, OB/GYN. Approximately 93% of EM applicants secure an EM spot each year. There are usually 20-40 spots left for the scramble, and these all fill within hours. Post-scramble there are no EM openings in the nation.
Hopefully you will have decided on EM prior to August of your senior year. At that point you will need to obtain an EM advisor. The best advisor is someone who has recently been through residency. You can still obtain letters from the big names in the department, but you want the advice of someone who has relatively recently been through the match process and residency. Go over the list of 120-130 programs with your advisor. Ask him or her to point out programs that he or she would recommend not applying to, and also to share information on the programs he or she has firsthand information on. During this month you also want to ask for letters of recommendation. You will need at least 3 (it is expected that at least 2, and likely 3, will be from emergency physicians. 2 of them ought to be from academic physicians.) Also probe your faculty members for programs where they are well known. If you are applying to any of those programs, send a letter from the corresponding faculty member to that program. It is a small community, and it's better to have a good letter from someone the PD has heard of.
Next step, also to be done in August, is to decide how many programs you need to apply to. Here are some rough guidelines.
Student A: Step I 250, EM grade Honors, Student Body President
15-30 programs
Student B: Step I 215, EM grade High Pass, EMIG President
30-40 programs
Student C: Step I 182, EM grade Pass, Golf Handicap 7.
40-50 programs
Remember, up until 30, programs are very cheap to apply to. After that, the price goes up.
Now, also in August, you need to select which programs you are applying to.
Start with 120-130 programs.
Eliminate all programs your advisor warned you about. You now have a list of 115-125 programs.
Next, determine which programs will cause you to lose your significant other if you match at them. Eliminate all these.
1) Are you at your predetermined number of programs to apply to? If so, congratulations, send off your ERAS application. Do you have less than you need to apply to? Consider flowers, chocolates, and long discussions of the importance of support from your S.O. Do you still have too many programs? Continue on down this checklist until you get to the predetermined number.
2) Eliminate all programs in locations YOU aren't willing to live.
3) Determine how you feel about the 3 vs 4 year program question. If you are a 3 year person, eliminate the 4 year programs still on your list.
4) If you made it this far and are still above your predetermined number, congratulations, you're either very open-minded or lying to yourself.
5) Eliminate all locations you can't afford to live in.
6) Determine how new of a program you are willing to go to. If you don't want to go to a program that has been around less than 2,5, or 10 years, eliminate those.
7) At this point, if you still have too many programs, it might be worthwhile to review the curriculum found on the program website. Eliminate programs with more than 1 month of medicine wards, more than 6 months call as first year, or more than 8-12 months of call all together. (With allowances for 4 year programs if they are still on your list.)
8) Eliminate programs based on website design and voodoo.
Okay, so you've sent off your applications on September 1st. Now you will wait around hungrily for interview offers to start rolling in, beginning in October and lasting up until December 10th or so. As they come in, call immediately and schedule an interview. Make a reasonable attempt to schedule similar locations in the same time frame, but realize it is unlikely you will be able to plan it out perfectly.
As you begin to acquire more than 10 interviews, you need to begin considering which ones you are going to turn down. You should interview at 8-15 programs. 8 if you're cavalier, 15 if you're anal. Don't interview at more than 15. It will cost you money to rank more than 15 so what's the point. If you are lucky enough to get more interviews than you want to go on, you will need to do more research prior to going on interviews. Consider the following list of questions to ask yourself:
1) Which 5-6 actually have the possibility of being your number 1?
2) Which ones are geographically close, and chronologically can schedule an interview around the same time as those 5-6?
3) If you still have too many, use the list above to whittle them down.
4) If you still have too many, email residents, peruse the websites, talk to faculty from your school, and get your list down to 8-15.
5) Don't sweat numbers 6-15. The chances you will match at one of those is minimal. For the most part, they are back-up programs. It is likely that you will rank highly, and match at one of your "pre-interview" top 5. Surprises happen, but not very commonly.
A few special considerations:
Couples match: If your S.O. is applying in EM or a similarly highly competitive field, apply to more programs and interview at more programs.
Poor applicant: Someone hosed you with a bad letter and you only got 4 interviews. Go to your interviews, do your best, and make sure you're in town during match week in case you have to scramble. If you are scared things are looking bad for you (such as NO interview invites by the second week of November) consider sending out a few more "desperation applications" via ERAS to programs still accepting applications (be sure to check which ones are.) Also consider calling programs you haven't heard from. The worst they can tell you is no, and at best they'll see your interest and invite you over the phone.
IMG: Realize that many people will see your status as a negative. Plan to apply to and interview at (if possible) more programs than a US Grad.
Late applicant: You decided you want to do EM during your October rotation. It's not too late, but you will need to scramble to get your applications in and your letters off. Consider applying to more programs than the average joe to make up for your late decision.
The surprisingly competitive applicant: OK, you applied to 40 places, and now have 32 interviews scheduled. Be sure to cancel early, there are a lot of less competitive applicants who really want that interview which is your 27th back up.
Now for the interviews.
There are many things you may find out on your interview trip, but the important ones are:
1) Will I really enjoy living here?
2) Will my s.o. really enjoy living here?
3) Do I fit in with the faculty and residents?
4) Do I feel like I will get the education I want here?
5) Will I get the (fill in the blank) experience I am looking for? (Blanks are applicant dependent, and frequently are US, EMS, Peds, Trauma, Research, Procedures etc)
6) How long are shifts, how many will I work a month, is a month here 4 weeks or a full month, how soon after a shift do residents leave, what is the sign-out culture, how many months of call, any problems obeying the 80 hour work week etc?
7) Do I like the program director? Will she go to bat for me? Why is she the program director? etc.
7) Are there any big red flags?
Following the interviews assemble your match list after consulting with your advisor and those you care about. Pay special attention to the order of the top 5. It is unlikely you'll match below there, so don't sweat which program is your number 8 and which is your number 9. Rank them in the order you want to go to them, no matter what you tell anyone, or what anyone tells you. The match works, don't try to game it.
) to relevent SDN threads.