How to cope with residency rejection with future aspirations in academic EM

[FutureEMAcademician]

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I'm an EM resident who matched in his 16th of 16 programs last year. Home program didn't take me, programs I rotated at didn't take me. They all said great things about me - I am a hardworking person who gets along great with ancillary staff, patients, but barely passed step II and that was probably what did me in. I have a lot of research under my belt, and I have a passion for teaching and working with underserved communities. I see myself in academia. When I think back at how much I loved being in the inner city hospital I was at for medical school, I can't help but feel betrayed (the word 'betrayed' is unjustified I'm sure - they surely ranked me fairly due to my academic shortcomings - it's just how I feel) because of the extremely close bonds I had with nursing, faculty, and everyone in that department and my being passed over. In fact, having applied to pretty much every program in the eastern half of the country and ranking every program that interviewed me and only matching at the last one, it seems that every single academic department in the eastern half of the US passed on me.

Anyone have advice for my feeling discouraged having been 'rejected' by every academic center and having a desire to be in academia? I know that finishing residency and finding a job is far easier than finishing med school and matching. And I've had perfect job reviews so far, with my PD saying "the sky's the limit" for me. It's just the lingering/nagging feeling in the back of my head that I wasn't good enough to be hired at any of these places when every single one of them reviewed my applications for residency last year.

 

[TheComebacKid]

If you come out a baller ED doc you will come away with the last laugh. At the end of the day, it's their loss.

You seem very insightful and I suspect you recognize that your situation could be a lot worse if you didn't get your 16th choice. You can continue to seize the opportunity and work towards your goals. Nothing is off the table. Do a fellowship or whatever you want and get to where you want to be whether it's academics or treating the underserved.

One day you will have a sick patient roll through the door and you will probably bring them back from the dead. At that time, all of this will seem pretty insignificant.

 

[Dr Mantis Toboggan]

Here’s one approach.

You take a job at your home medical school, fill out all the credentialing paperwork, say you want all weekend nights “cuz it’s better for my family and I want to jump right in starting July 4th weekend”, get put on the schedule, and then...ghost. Just don’t show up at all.

Seriously, getting passed over does sting, but all you can do is your best in residency and then pick the job that’s best for you. In time nobody really cares where anyone trained or who ranked who where. It’s an imperfect science.

 

[GonnaBeADoc2222]

I find that big academic programs (I trained at one) sometimes think they have "it all figured out" with regards to resident selection. Anecdotally, I've seen some residents that I'm sure the program thought were going to be "rockstars" because of test scores, research experience, "leadership" experience absolutely s**t the bed clinically in terms of judgement, speed, procedural skills, etc. So much so that I would not entrust the care of a family member or friend to them.

There are so many different career opportunities in EM between locums, community, community-academic, academic. You might cycle through all of these in your career and each will mature you as a physician and person.

If Ivy League University X doesn't want you cause you don't have this or that, move on, it's truly their loss.

 

[gro2001]

I'm an EM resident who matched in his 16th of 16 programs last year. Home program didn't take me, programs I rotated at didn't take me. They all said great things about me - I am a hardworking person who gets along great with ancillary staff, patients, but barely passed step II and that was probably what did me in. I have a lot of research under my belt, and I have a passion for teaching and working with underserved communities. I see myself in academia. When I think back at how much I loved being in the inner city hospital I was at for medical school, I can't help but feel betrayed (the word 'betrayed' is unjustified I'm sure - they surely ranked me fairly due to my academic shortcomings - it's just how I feel) because of the extremely close bonds I had with nursing, faculty, and everyone in that department and my being passed over. In fact, having applied to pretty much every program in the eastern half of the country and ranking every program that interviewed me and only matching at the last one, it seems that every single academic department in the eastern half of the US passed on me.

Anyone have advice for my feeling discouraged having been 'rejected' by every academic center and having a desire to be in academia? I know that finishing residency and finding a job is far easier than finishing med school and matching. And I've had perfect job reviews so far, with my PD saying "the sky's the limit" for me. It's just the lingering/nagging feeling in the back of my head that I wasn't good enough to be hired at any of these places when every single one of them reviewed my applications for residency last year.

First of all, I think it's important to acknowledge your feelings as valid. I think your feelings of resentment are very understandable. Just don't let them hold you back. In a few short years you are going to be a board certified EM attending. Keep your eyes on that prize.

In terms of advice, it's no different from anyone else considering a career in academic EM: find a niche. That may mean doing a fellowship. Or not. But your niche is going to be a far bigger determinant of your academic career success than your Step II scores.

 

[EctopicFetus]

Keep in mind when job time rolls around no one cares or asks about your step scores. Being a good test taker doesn’t make you a good doc. Some good docs are good test takers.

One of the hardest things for all people is looking at a weakness and being willing to put in the work to minimize said weakness or turn it into a strength. Study hard for your in service. This will give you confidence after you rock the tests. Read and keep reading. There is so much information out there it is difficult to stay on top of stuff but some people do it. Be that person.

Getting a job is still very doable. Many of those “academic” institutions pay crappy and have high turnover because of it. You will be able to get a job in the location of your choice. You will also be able to get a job that fits what you want. You will be able to get a job where you can make a good living. It will be hard to get one job that is all 3 but you can surely find a job that has 1 of the criteria and likely at least 2.

As someone else said find a niche.. IMO dont do Ultrasound.. That is getting overly saturated. Do pain, do critical care, do hyperbarics. Do something others aren’t doing and own and master it.

 

[engineeredout]

You matched into the speciality you wanted. As disappointed as you might feel, trust me, it could be worse.

 

[gamerEMdoc]

Here’s my advice. Get a faculty job when you finish residency, and help change the culture. Recruit people who will be badass ED docs based on skill, not test scores. Find a program that values the students like you were. You’ll long forget about being passed over by the high and mighty, and will find great joy in training like minded people who clinically can hang in the arena with the best.

 

[Arcan57]

Here’s my advice. Get a faculty job when you finish residency, and help change the culture. Recruit people who will be badass ED docs based on skill, not test scores. Find a program that values the students like you were. You’ll long forget about being passed over by the high and mighty, and will find great joy in training like minded people who clinically can hang in the arena with the best.

Your long term success is going to be based in a large part on resilience. Especially in academia where the grant and advancement process feel capricious even to superstars, the ability to learn from your mistakes while continuing to move forward toward your goals is mission critical. Take what you need to take from this (your test prep needs buffing) and leave the rest in your rear view.

 

[HopefulEMed]

John Simpson, the guy who invented the first over-the-balloon catheter for coronary angioplasty, got rejected from ALL medical schools. Bernard Gersh of Mayo Clinic failed his first year of medical school. Richard Schatz, the guy who invented the Palmaz-Schatz coronary stent, found himself at the bottom of his medical school class. Don't even get me started on women or racial minority pioneers in Medicine and Surgery. You really think you would achieve greatness in life or your career without the trials and tribulations that fate has in store for you? Get up, dust yourself off, and keep going. Don't let one thing stop you from doing what you want to do.

 

[gamerEMdoc]

Time for a speech from Rocky Balboa



"But somewhere along the line, you changed. You stopped being you. You let people stick a finger in your face and tell you you're no good. And when things got hard, you started looking for something to blame, like a big shadow. Let me tell you something you already know. The world ain't all sunshine and rainbows. It's a very mean and nasty place and I don't care how tough you are it will beat you to your knees and keep you there permanently if you let it. You, me, or nobody is gonna hit as hard as life. But it ain't about how hard you hit. It's about how hard you can get hit and keep moving forward. How much you can take and keep moving forward. That's how winning is done! Now if you know what you're worth then go out and get what you're worth. But ya gotta be willing to take the hits, and not pointing fingers saying you ain't where you wanna be because of him, or her, or anybody! Cowards do that and that ain't you! You're better than that!"

 

[HopefulEMed]

Time for a speech from Rocky Balboa



"But somewhere along the line, you changed. You stopped being you. You let people stick a finger in your face and tell you you're no good. And when things got hard, you started looking for something to blame, like a big shadow. Let me tell you something you already know. The world ain't all sunshine and rainbows. It's a very mean and nasty place and I don't care how tough you are it will beat you to your knees and keep you there permanently if you let it. You, me, or nobody is gonna hit as hard as life. But it ain't about how hard you hit. It's about how hard you can get hit and keep moving forward. How much you can take and keep moving forward. That's how winning is done! Now if you know what you're worth then go out and get what you're worth. But ya gotta be willing to take the hits, and not pointing fingers saying you ain't where you wanna be because of him, or her, or anybody! Cowards do that and that ain't you! You're better than that!"

Lolz. This speech is on repeat mode whenever it's time for to work out (among a few others). It's the only to get my butt off the couch and go run those 4-5 miles every day. Haha. #M4Lyfe

 

[Birdstrike]

I'm an EM resident who matched in his 16th of 16 programs last year. Home program didn't take me, programs I rotated at didn't take me. They all said great things about me - I am a hardworking person who gets along great with ancillary staff, patients, but barely passed step II and that was probably what did me in. I have a lot of research under my belt, and I have a passion for teaching and working with underserved communities. I see myself in academia. When I think back at how much I loved being in the inner city hospital I was at for medical school, I can't help but feel betrayed (the word 'betrayed' is unjustified I'm sure - they surely ranked me fairly due to my academic shortcomings - it's just how I feel) because of the extremely close bonds I had with nursing, faculty, and everyone in that department and my being passed over. In fact, having applied to pretty much every program in the eastern half of the country and ranking every program that interviewed me and only matching at the last one, it seems that every single academic department in the eastern half of the US passed on me.

Anyone have advice for my feeling discouraged having been 'rejected' by every academic center and having a desire to be in academia? I know that finishing residency and finding a job is far easier than finishing med school and matching. And I've had perfect job reviews so far, with my PD saying "the sky's the limit" for me. It's just the lingering/nagging feeling in the back of my head that I wasn't good enough to be hired at any of these places when every single one of them reviewed my applications for residency last year.

My advice is to go to the program that's overjoyed to have you, the one you matched at, and be the most kick a*s EM resident ever to train there. Make the fact that the other programs didn't rank you 1st, their most embarrassing mistake in those programs' history. If it makes you feel better, I didn't get accepted at my first (or second) choices for residency or fellowship. Regardless, I've been very successful, and have led a charmed life. Looking back, I wouldn't have done it any other way.

No matter how many doors stay closed, the only one's that matter, are the ones that open for you. The others are irrelevant. Take the opportunities you have, and cast those you don't have to the garbage heap of the past, never to be given another thought.

What happened, happened for a reason. In time, you'll find out why. Until then, realize that many successes and good things, await you. Go out and make them happen.

 

[Psai]

John Simpson got rejected from every medical school he applied to but ended up going to Duke then Stanford and became a pioneer in balloon angiography.

 

[FutureEMAcademician]

Thank you guys so much for providing me that catharsis. I will continue to work my hardest at my current program, and focus on making myself a great candidate at the next level

 

[Mighty Mouse]

Thank you guys so much for providing me that catharsis. I will continue to work my hardest at my current program, and focus on making myself a great candidate at the next level

If all the medical examples don't work -- there's always the Tom Brady example. Passed over until pick 199. Works harder than everyone else. Seizes his opportunity. Wins a boat load of Super Bowls and marries a model.

Everyone gets knocked down in life. The true character of a person is defined by how they get back up.

 

[gman33]

Your "rejection" is in the past.
Just move on.

As far as academics, getting a job there is not that hard.
Pay is bad. Ends up with a lot of hours with all the non clinical duties.
Most docs don't want anything to do with these jobs.

If you want a job, you should probably do a fellowship.
Make sure you get some publications in residency and find a niche.

 

[Tenk]

I didn’t get into my top choice for residency and it was at my home city. Every moment of medical school I worked to get back there.

Not a day goes by that I’m not incredibly grateful to where I matched. Met my wife, had a fun three years, made life long friends and an ass ton of money.

Ride it out and keep a positive attitude. Don’t dwell on the past and things you can’t change or you’ll just wind up a living regret.

 

[The White Coat Investor]

I'm an EM resident who matched in his 16th of 16 programs last year. Home program didn't take me, programs I rotated at didn't take me. They all said great things about me - I am a hardworking person who gets along great with ancillary staff, patients, but barely passed step II and that was probably what did me in. I have a lot of research under my belt, and I have a passion for teaching and working with underserved communities. I see myself in academia. When I think back at how much I loved being in the inner city hospital I was at for medical school, I can't help but feel betrayed (the word 'betrayed' is unjustified I'm sure - they surely ranked me fairly due to my academic shortcomings - it's just how I feel) because of the extremely close bonds I had with nursing, faculty, and everyone in that department and my being passed over. In fact, having applied to pretty much every program in the eastern half of the country and ranking every program that interviewed me and only matching at the last one, it seems that every single academic department in the eastern half of the US passed on me.

Anyone have advice for my feeling discouraged having been 'rejected' by every academic center and having a desire to be in academia? I know that finishing residency and finding a job is far easier than finishing med school and matching. And I've had perfect job reviews so far, with my PD saying "the sky's the limit" for me. It's just the lingering/nagging feeling in the back of my head that I wasn't good enough to be hired at any of these places when every single one of them reviewed my applications for residency last year.

What are you talking about man? 70 = MD. Matched at # 16 is MATCHED. You think anyone is going to care what place you were in your med school? I've never been asked that. I've only been asked for board scores once (it was weird and due to pretty unique circumstances.)

Congratulations on your match! You are the success story that all the people who show up on this forum trying to figure out how to get into EM despite barely passing their boards want to be!

But you should probably take a board review course before your written boards. Because your strength is clearly not the standardized tests in medicine.

If it makes you feel any better, I barely passed my oral boards and nobody cares. P = ABEM

 

[Angry Birds]

Congrats on matching!

 

[The White Coat Investor]

Keep in mind when job time rolls around no one cares or asks about your step scores. Being a good test taker doesn’t make you a good doc. Some good docs are good test takers.

That's actually not true. I've heard of one time that someone cared and asked about them. And it happened to me. Luckily, that was not my particular weakness.

True story. They had an issue with a prior hire having trouble passing boards so they were hypersensitive about their next hire being academically strong. Which was weird, since I was already board certified at the time. But seriously, I was asked for and provided my board scores, all three steps and maybe even my EM written board score too, but I think just my USMLEs. We've never asked for it from any hire since, but apparently it helped me get my "unicorn" job. Now that I'm reminded of it, I'm going to go ask some of the older partners "WTH?"

 

[EctopicFetus]

That's actually not true. I've heard of one time that someone cared and asked about them. And it happened to me. Luckily, that was not my particular weakness.

True story. They had an issue with a prior hire having trouble passing boards so they were hypersensitive about their next hire being academically strong. Which was weird, since I was already board certified at the time. But seriously, I was asked for and provided my board scores, all three steps and maybe even my EM written board score too, but I think just my USMLEs. We've never asked for it from any hire since, but apparently it helped me get my "unicorn" job. Now that I'm reminded of it, I'm going to go ask some of the older partners "WTH?"

I dont know. I interviewed at some really good high end jobs and not one asked about my grades, scores etc. They cared I was a chief, they cared about what I accomplished in residency.

I have gotten 2 unicorn jobs. the references mattered way more. You know my 1st job.. was pretty competitive.

 

[The White Coat Investor]

I dont know. I interviewed at some really good high end jobs and not one asked about my grades, scores etc. They cared I was a chief, they cared about what I accomplished in residency.

I have gotten 2 unicorn jobs. the references mattered way more. You know my 1st job.. was pretty competitive.

It's purely anecdotal. I've never even heard of it happening to anyone else. But the story is true. I agree it's nuts.

 

[acadianvoyager]

I'm an EM resident who matched in his 16th of 16 programs last year. Home program didn't take me, programs I rotated at didn't take me. They all said great things about me - I am a hardworking person who gets along great with ancillary staff, patients, but barely passed step II and that was probably what did me in. I have a lot of research under my belt, and I have a passion for teaching and working with underserved communities. I see myself in academia. When I think back at how much I loved being in the inner city hospital I was at for medical school, I can't help but feel betrayed (the word 'betrayed' is unjustified I'm sure - they surely ranked me fairly due to my academic shortcomings - it's just how I feel) because of the extremely close bonds I had with nursing, faculty, and everyone in that department and my being passed over. In fact, having applied to pretty much every program in the eastern half of the country and ranking every program that interviewed me and only matching at the last one, it seems that every single academic department in the eastern half of the US passed on me.

Anyone have advice for my feeling discouraged having been 'rejected' by every academic center and having a desire to be in academia? I know that finishing residency and finding a job is far easier than finishing med school and matching. And I've had perfect job reviews so far, with my PD saying "the sky's the limit" for me. It's just the lingering/nagging feeling in the back of my head that I wasn't good enough to be hired at any of these places when every single one of them reviewed my applications for residency last year.

Hey man, I don't have any advice for you, but I share your feelings very strongly. I'm also a resident who matched at my #6/15, a community hospital. I was shocked at my match, as I also was very well-reviewed. I'm constantly frustrated by the private practice environment and share your feelings of betrayal by my home program and away programs (even though I know they hold no hard feelings and honestly just had better applicants than me). I take some comfort in knowing that I least I will be a practicing EM physician, which is truly my dream job. Most of the advice I've gotten is to make the most of whatever program you're at and to do a fellowship, like critical care or ultrasound or whatever interests you. That's my current plan. Feel free to PM me if you want. I feel your pain!

 

[MechEDoc]

Congratulations on matching! While it is frustrating that you failed to match your first 15 choices none of that matters from this point forward. Read a lot, learn everything you can, become a kick butt doctor during residency. If standardized tests are a challenge for you, you probably should do lots of questions all throughout residency - Rosh review, PEER, and Hippo EM are great resources. Be sure to rock each years in-service exam you'll be ready for your boards.

I've been asked precisely one time details about my educational background. I was in a small town in Idaho in the middle the night and just finished assessing a pregnant lady with abdominal pain, after reviewing the treatment plan I asked if they had any further questions the significant other asked "yeah, where did you train?". While he was just being a smartass, I took a deep breath and politely answered "undergraduate at the University of Vermont, PhD at Cambridge University, premed at Bryn Mawr, medical school at the University of Rochester, and residency at the University of Wisconsin", "how about yourself?" He mumbled something about a local tech college and then said "I guess that settles that". It did🙂

 

[Angry Birds]

Congratulations on matching! While it is frustrating that you failed to match your first 15 choices none of that matters from this point forward. Read a lot, learn everything you can, become a kick butt doctor during residency. If standardized tests are a challenge for you, you probably should do lots of questions all throughout residency - Rosh review, PEER, and Hippo EM are great resources. Be sure to rock each years in-service exam you'll be ready for your boards.

I've been asked precisely one time details about my educational background. I was in a small town in Idaho in the middle the night and just finished assessing a pregnant lady with abdominal pain, after reviewing the treatment plan I asked if they had any further questions the significant other asked "yeah, where did you train?". While he was just being a smartass, I took a deep breath and politely answered "undergraduate at the University of Vermont, PhD at Cambridge University, premed at Bryn Mawr, medical school at the University of Rochester, and residency at the University of Wisconsin", "how about yourself?" He mumbled something about a local tech college and then said "I guess that settles that". It did🙂

The PhD at Cambridge must've felt really good to say, lol.

 

[Perfect Hair Day]

Time for a speech from Rocky Balboa



"But somewhere along the line, you changed. You stopped being you. You let people stick a finger in your face and tell you you're no good. And when things got hard, you started looking for something to blame, like a big shadow. Let me tell you something you already know. The world ain't all sunshine and rainbows. It's a very mean and nasty place and I don't care how tough you are it will beat you to your knees and keep you there permanently if you let it. You, me, or nobody is gonna hit as hard as life. But it ain't about how hard you hit. It's about how hard you can get hit and keep moving forward. How much you can take and keep moving forward. That's how winning is done! Now if you know what you're worth then go out and get what you're worth. But ya gotta be willing to take the hits, and not pointing fingers saying you ain't where you wanna be because of him, or her, or anybody! Cowards do that and that ain't you! You're better than that!"

Iconic. Was watching this the other day. Quoted it on my facebook even. Glad to see this popping up on the EM forum.