Give up on EM??

[soulrider]

Hey guys! I could use some advice on what to do next with my career.
I’ve always dreamed of pursuing a career as an emergency physician.
Here are some difficulties:
I am an US citizen IMG, graduated in 2009 and plan to apply for next year’s match. I got a step 1 score of 87/211 and have no publications.
I don’t have a SLOR and won’t be able to get one from my own school.
I will do an observership next year at Jackson Medical Hospital in Miami, but they don’t have an EM residency program. I’ve heard that SLORs can only be written by EM faculty of EM residency programs, but I searched CORD homepage and found no such information.
My question is: should I keep dreaming of matching in EM? Or should I give up and start thinking of something different to do?
I wouldn’t mind doing a combined residency program, if that meant that I could practice EM in the end, but I don’t know if these are more or less competitive than EM alone.
Is there a more reasonable path I could take in order to be an emergency physician in the US?

---

Members don't see this ad.

 

[JHACO WACKO]

How about applying to a transitional year or prelim year at a place that has an EM program? You may lose a little time that way, but you would hopefully be able to rotate in the department and get a letter/your foot in the door for the next match cycle.

 

[soulrider]

How about applying to a transitional year or prelim year at a place that has an EM program? You may lose a little time that way, but you would hopefully be able to rotate in the department and get a letter/your foot in the door for the next match cycle.

I heard transitional year is tougher than prelim. Let's say I aply to some prelim positions and match in one of them. On the next match, my chances of matching in EM will be increased? Won't the prelim year hurt my application?

 

[tegs15]

I heard transitional year is tougher than prelim. Let's say I aply to some prelim positions and match in one of them. On the next match, my chances of matching in EM will be increased? Won't the prelim year hurt my application?

Just my feeling ... but if you really want EM then you got to be willing to do what ever it takes (Transitional year vs. prelim for example). As a M4 others have more experience but If I were in your shoes (IMG with 211) I would try to get a intern spot at a location that also has a 2-4 EM program, ace the Step 2&3 and make contact/find a mentor in that ED and pray? Any other suggestions from those more experienced in these things?

 

[soulrider]

Just my feeling ... but if you really want EM then you got to be willing to do what ever it takes (Transitional year vs. prelim for example). As a M4 others have more experience but If I were in your shoes (IMG with 211) I would try to get a intern spot at a location that also has a 2-4 EM program, ace the Step 2&3 and make contact/find a mentor in that ED and pray? Any other suggestions from those more experienced in these things?

Thank you so much for your comments, you helped me a lot and gave me little bit of hope!
I think what I'll do is apply to EM programs as well as preliminary posotions and combined specialties as a back up plan.
I definitely feel like I'm destined for EM, and will do whatever it takes. I'm willing to do a prelim year or a combined residency, so I'll probably be spending a lot of money on next year's match..

 

[tegs15]

Last year at my school, we had someone that matched into a combined program even after failing Step 2 ( very unusual situation regarding the Step) but got into a combined program without much problem. There is hope for sure!

 

[soulrider]

How about applying to a transitional year or prelim year at a place that has an EM program? You may lose a little time that way, but you would hopefully be able to rotate in the department and get a letter/your foot in the door for the next match cycle.

ok, new question.. what happens if i do a preliminary year.. i will reapply for EM in the following match. now, would i be looking for PGY1 or PGY2 positions?
will i lose a year of funding? will someone have to drop out of a 2nd year spot?

 

[soulrider]

something else I was thinking about is to do an IM or FP residency, and after that, apply for a EM fellowship. does this make any sense?

 

[soulrider]

something else I was thinking about is to do an IM or FP residency, and after that, apply for a EM fellowship. does this make any sense?

 

[soulrider]

shoot.. i thought i had logged off and ended up sending a repeated message.. sorry...

 

[pratik7]

I dont know how the funding works. But thinking from a worse case perspective, If you end up doing IM or other primary care, a prelim will count as pgy1 so you will enter as pgy2. If you do ty year then you will have to repeat and enter as pgy1

 

[HIJay]

also if you do prelim or transitional and then apply for EM 2-4 then you be a pgy 2, but if you apply for EM 1-3 or 1-4 then you be a pgy1 again and the funding may be an issue

 

[HIJay]

something else I was thinking about is to do an IM or FP residency, and after that, apply for a EM fellowship. does this make any sense?

and i dont believe there are any EM fellowships. many FM trained ppl work in the rural ED because they lack EM trained ppl but thats not really a "fellowship"

 

[deleted109597]

also if you do prelim or transitional and then apply for EM 2-4 then you be a pgy 2, but if you apply for EM 1-3 or 1-4 then you be a pgy1 again and the funding may be an issue

Funding will not be an issue if you do a prelim/transitional year. It will be an issue if you get a categorical spot.

 

[soulrider]

Funding will not be an issue if you do a prelim/transitional year. It will be an issue if you get a categorical spot.

so if i don't match in EM, and match in a prelim/transitional. the following match, when i reapply for EM, will I have improved my application and maybe balanced my step 1 score/IMG status?
since you said funding is not a problem for premil/transitional, will I be seen like an ordinary applicant?

 

[deleted109597]

will I be seen like an ordinary applicant?

Yes, from a funding standpoint.

 

[Jwax]

and i dont believe there are any EM fellowships. many FM trained ppl work in the rural ED because they lack EM trained ppl but thats not really a "fellowship"

Incorrect. One of the bonuses to FM is you can do an EM fellowship after completion of the FM residency (I think it is 1 yr but could be 2). I'm under the impression that the general trend is to only hire EM residency trained docs for level 1 trauma centers in big cities, so if that's the ultimate goal it wouldn't be the best path. But, if you're okay with working in a suburban or more rural (which doesn't have to mean in the middle of nowhere... just a little more isolated than a city like LA or Vegas), this would be a workable option.

 

[VeerTheTIGuy]

Yes, from a funding standpoint.

What do you guys mean when you keep mentioning "funding"? I'm soon to be in a similar spot to the OP so would like to get all the info...

 

[USCDiver]

Most of a resident's salary is paid by Medicare funding. There are rules on how many years you can be funded for training based, I believe, on the type of program you initially match into; something like the duration of that program plus one year. So for instance, if you match into a 1-3 EM program and decide to switch to a 7 year Neurosurgery residency, you may only get 4 years of funding from Medicare. That's not to say that a residency program won't pay you if you switch, but the funding will have to come from the hospital/residency which makes you a less desirable candidate.

It's been a while since I dealt with this issue so I may be off on the specifics, but I think the general principle has not changed.

 

[VeerTheTIGuy]

ah, I remember reading about (in one of the FAQs i think!) but that definitely clears it up...thanks!