Hi All, This is a throwaway account but I have been a member on these forums since I was in High School. I greatly appreciate any and all advice anyone has to offer. I'm feeling pretty down right now but if brutal honestly is what you have to offer, I'd prefer that than false hope. Brief Story (please ask for more info, this account won't allow me to be identifiable so I'm happy to give lots more info, I just don't want this to be a long post no one reads): - A lot of interest in EM apparent from my CV (volunteer FD/EMT for 8 years, Peds-EM research in undergrad) - Rough start to medical school, took LOA (voluntary, did not actually fail out) and restarted the next year - Mediocre M1 and M2, passed everything. - Dismal Step Scores: Failed Step 1, Passed with ~210 on second try, Step 2 ~215, Passed CS - OK M3 year with Honors on EM elective and High-Pass on Anesthesia (great clinical comments, but test taking crippled me from getting higher than pass most of the time) - Good M4 year with High Pass on Away 1 in EM, Pass at home institution (where the shelf was worth 55% of our grade, seeing a theme yet?), Honors on Away 2 in EM. Those were all the posted grades before ERAS opened. - Away 1 interviewed me while I was there, Home institution interviewed me later in the season, Away 2 called me back for an interview 3 months later in December, got one more EM interview from a lower tier place. Also, dual applied into FM and got 4 interviews. - Found out Friday that I matched into my 1st choice FM program. I was devastated. Now, I knew that with my stats I needed a backup, but I thought that Away 2 would give me a shot for sure. All the residents and attendings liked me, my clinical comments were stellar, and the rotation coordinator said I had one of the highest clinical scores of any of the students they have ever had there (quite possibly due to the fact that it was my 3rd EM rotation in a row). I knew I wasn't a shoe-in, but I thought I had a good shot. I spent most of Friday in a very depressed state and had no energy to do anything, but after talking with my Dean and a counselor, I felt better and have been keeping myself busy to try and move forward and not dwell on the past. I know I'm lucky to have a position for next year as there are thousands in a similar spot with no concrete plans for the next year. My question is this: I'm not ready to give up my dreams of being an EM physician, but I don't know what paths there are going forward for me. No matter what, I have to complete my PGY-1 year in FM so all of the following options are based on that, but I'm hoping that you guys can weigh in on which option(s) are better and make suggestions for any other options that might be out there for me: Option 1: Re-apply for the match in 6 months Essentially, start PGY-1 year in FM in July 2016, and try to get a PGY-1 position in EM in July 2017. The issue with this is other than killing it and getting a really good letter from my PD in FM, I don't have much more to offer. Of course the blemishes on my record of my Step Scores can't be changed anyways so there's not much I can do to improve my application unless you guys see something I don't. Option 2: Re-apply for the match in a year and 6 months. Finish PGY-1 in FM, start PGY-2, and try to match to a spot in EM in July 2018. Same issues as Option 1 except I now have more experience under my belt. Option 3: Finish my FM residency, and apply to EM as a second residency. Not sure how much weight the PDs put into someone wanting to do a second residency and once again, my step scores won't change but I'll be further out from them? Option 4: Work in outlying ERs as an FM grad for a few years, then re-apply to EM residencies. Not sure how PDs feel about someone already having had some ER experience as an ER Attending but FM trained. I could even do some EMS medical direction in the meantime to boost my resume (something I wanted to do with an EM residency anyways). Option 5: Give up on the EM residency. Work at an outlying ER as a FM trained physician and pick up EMS medical direction for some smaller FDs. This is the ultimate fallback plan for me. I would never be able to work in the city, and in a decade or so when there's enough EM trained physicians to go around, probably not even in a suburb of a big city at a community hospital, but at least I'd get to do what I want to do with my life. And the reality is that in my career, we'll probably never have enough EM trained physicians to staff all the rural ERs. Option 6: ??? I'm hoping that you all on here can give me some guidance as to what to do next. Part of the reason I am so upset is that I just don't know where to go from here. Certainly the dream can't have ended on Friday, but it sure does feel like it's a thousand miles further away than it was before. Thanks for any advice you guys can offer.