How Competitive is it to Get an EM Residency?

[16846]

Hi Everybody!

I have a couple of questions related to EM Residencies:

1. How competitive is it to get an EM residency compared to other residencies (i.e.: Derm, Rads, FP, IM Etc...)?

2. Is EM considered a generalist field?

3. Is it difficult for an IMG to get an EM residency if they have good step 1 scores?

Any information you can provide is appreciated. Thanks a lot.

Infinite

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[foreignmd]

InfiniteUni, I am going to answer your question #3:
No matter how good is your Step 1 score, it is not enough to secure an EM spot. If you are an IMG, it is really difficult to get into an EM residency. Try to get as much US clinical experience as you can, and get letters from US EM attendings. Good luck!

 

[Silvertip]

foreignmd-

Maybe the reason you have had difficulty with US EM residencies is that you have failed to master the English language.

"No matter how good is you Step 1 score, is not enough to secure an EM spot."-

Just a thought.

 

[edinOH]

EM is moderately to highly competitive depending upon where you apply and where you are from. US grads, MD and DO, will usually match EM assuming they apply to enough places and subsequently rank enough places. "Enough places" can be pretty subjective but in general you can't go wrong ranking 10. Ten seems to be the magic number since many PDs like to interview a ratio of 10:1 applicants to spots available.

Derm is arguably the most competitive field to obtain currently. Rads is getting very competitive as well. Family is pretty much a joke. If you have a pulse, you match. The same is essentially true of IM. That is not to say that the people going into these two fields are jokes because that is not the case at all. There are just many more positions available than US applicants, especially in FP. And some of the more prestigious IM programs are extrememly competitive.

If I were to rank the realtive competitiveness of each field (which I will because medical students love to rank things) it would go like this.

1. Derm
2. NES
3. Ortho
4. ORL
5. Uro
6. Ophtho
7 Rads
8. EM
9. Anes
10. Gen Surg
11. IM
12 Peds
13 FP

Now before everyone jumps up my ass with all the reasons this list is wrong, I should point out that this is meant as a general guide as I see it off the top of my very hung-over head.

Many people consider EM to be a "generalist" field in practice if not in name. It isn't considered a primary care field as defined by the government however. Spend some time in the ED and you will see that EM is often a "primary care" specialty.

There is alot of bias against FMGs. Some legit, some not in my opinion. I think if you are a socially intelligent FMG who can play well with others and don't spend your entire interview complaining about how life as an FMG isn't fair, you should have a decent shot at an EM residency. You will most likely find yourself in NY, Detroit, or downtown LA for residency. These places tend to be the least sought after locations for US grads and therefore are willing to look at FMGs. There are many programs in these places who have excellent FMGs as residents and inturn provide excellent training. And yes, good (as opposed to proper) english is a must!

 

[ispic]

Hi,

I'm also interested in EM, and I found out something really interesting yesterday. It looked like several EM spots that I thought were "choice" places for training had several slots left to fill. It seems that these spots were in the same places that edinOH was talking about. I thought that those places might be better for EM since they give you a better opportunity to experience a lot more in EM than, say, another hospital in a smaller or more affluent part of town. Maybe I'm speaking out of ignorance, but just something that I was thinking about. As far as I go, if do decide on doing EM, I would look for the program in a large city that would expose me to more aspects of EM that would a smaller city, am I wrong in this assumption?

I understand that larger is not necessarily better, but don't larger cities give a practitioner a broader patient base from which to draw their medical training from?

 

[DrQuinn]

Each location has its pros/cons. I did a month at a Philly EM program, and saw (I swear) as 50% of my patients dental pain/bleeding fajitas.

I did a month at the Univ of MD and saw (I swear) 50% of my patients who had a history of IVDU and were HepC positive. I saw none of that up in Philly.

You will be fine no matter where you go for residency. The RRC is very strict for EM accredidation (look how they closed Howard's program).

Q

 

[Apollyon]

Originally posted by edinOH
2. NES
4. ORL

I figured the first to be "neurosurgery" (which I abbreviate as "NSx"), but the second one had me perplexed, until I realized it was otorhinolaryngology, which then clarified it; I use the much more casual "ENT" parlance (although I read in a book that, on the interview circuit, you never call it 'ENT' - that's the 4-letter word on the ORL tour).

 

[sgufmg]

Answer to #3:

I am a foreign medical graduate myself and just matched at my number #1 choice for emergency medicine. I had 12 interviews during the interview season. In addition, a least a dozen other SGU classmates matched in EM. So is it impossible, no! Apply regardless of your scores, grades, dean's letter, and LOR. You would be surprised how many places interview FMGs. If you're interested in specific places, let me know.

I will recommend 4 things beyond doing well on Step I/II, clinical grades, etc.

1) Do 2 EM rotations at EM Residency Programs
2) Obtain a LOR on the official SAEM SLOR form from a program director, assistant/associate program director, research director
3) Become a member of ACEP, AAEM, EMRA, SAEM and become knowledgeable about the important issues of EM.
4) Before your interviews, find out what research the PD/RD participates in and ask him questions about it.

 

[16846]

Thanks everybody for giving such great feedback, it really helps me to put everything into prespective. I also learned alot particularly with respect to what I need to do beyond grades and step I/II scores. I cant seem to find it now, but someone sent me a link to an ERAS page listing percentages of each specialty that are filled by AMG, IMG, and total number of spots filled and percentage in comparison to those that are available. I was really surprised when I found out that only 80% of the EM residency spots are filled by AMG's, meaning 1 in 5 EM residents is an FMG as the total percentage filled was 98 point something %, certainly indicating that it is not impossible. As far as my other post, I guess I will have to do the clerkship for EM before I can make a decision if its the life for me or not. Thanks again and good luck to everyone that is starting residency in the not too distant future.

Infinite

 

[Apollyon]

http://www.ama-assn.org/vapp/freida/spcstsc/0,2654,110,00.html

It's not impossible, but EM is not so FMG-friendly. That 80% is US Seniors - the balance of the 20% is DO's and Canadians, and US Physicians (those people who've already done a residency, or part of one) - all not FMG's, by definition, and the balance left is foreign grads. That page above from FREIDA says 3.4%. EM is possible for a foreign grad (especially if you are a USFMG, or English is your first language), but, from personal experience, you have to ROCK Step I (which I didn't), and apply widely.

 

[Wrangler]

To ispic:

You're city vs. smaller town approach can be wrong (as I found out when I really finally got to know the programs). Some seemingly small town programs with wierd names can have huge volumes (b/c they draw from large areas), great diversity, and powerful EM departments. In contrast some of the super-city programs I looked at had no diversity b/c their (small catch area) section of the city was all HIV, or homeless, or executives, or whatever. In addition, those programs with big reputations in med and surg may have relatively weak EM departments and really unhappy EM residents and faculty so be careful. Ask around to those who have interviewed at some of the places to find the real deal. Of course some places that seem great, really are too!