How to get into Emergency Medicine?

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[BoardingDoc]

I recently graduated from undergrad and have been accepted into medical school. It's a well known fact that medical students often change the specialty they pursue, however, Emergency Medicine is something that I have been interested in for a while and I want to know how to get into an EM residency. Specifically, I want to know what EM programs look out for in an applicant and how important research and volunteering is as compared to Step 2 CK scores (since Step 1 will be p/f for me), LORs, and grades during EM and other rotations. Thank you for your help.

This is way too early to be asking this question. Come back in 1-2 years. Do well in your pre-clinical rotations. Pass step 1 (since it's evidently P/F now). Kill step 2. If you still think you want to do EM as you enter your clinical rotations, come back and pointed questions then. There is literally zero benefit to anyone, yourself included, to explore this question any further than to say "do well pre-clinically" before then.

 

[turkeyjerky]

P still equals MD, but in the future it might not guarantee you a job. Like the others said, right now the only objective should be to enjoy the next 9 months and then focus on your preclinicals.

Volunteering doesn't matter for residency. Research helps, but you can match anywhere in anything even w/o it. Aint' no retired weirdos on adcoms for residency, they want to know you can do the work.

 

[Tenk]

Study and network. That’s all you can do right now. By the end of my first year I was on good terms with both my school’s PD and ED chief.

 

[onemoretest]

I would completely agree that it is way to early to be making this decision, but I also would advise against EM. The speciality is going through a bit of a crisis right now and the simple truth is compensation is getting awfully close to many family docs who have much lower risk and better hours.

I would advise you to read this recent forum, this is a real problem that doesn't have a good solution in sight.

Trends in EM compensation (med students read this)

For those who want an honest behind scene look on what is going on in EM compensation...we have the perfect storm brewing for trouble. Consider the following PRE-COVID developments: 1) The job market nationally has consolidated over the past 20 years. The majority of clinical EM physicians now...

forums.studentdoctor.net

 

[Angry Birds]

My god, reading that was super depressing. Oh well, I guess unless I get some extremely deep love for EM, I'll find some other specialty. In this case, what are specialties that look promising and have good job market and working conditions? Is it only surgical specialties that are doing well?

The statement that EM salaries are going towards FP salaries is sensationalist, in my humble opinion.
All specialties are hurting right now, EM included. This forum tends to bring out gloom and doom views.

I also disagree that it's too early to be asking about getting into a specialty. Yes, it's true that many people change what they had initially planned, but many don't -- especially those who have worked in the ER in some capacity, either as a scribe, nurse, EMT, etc. I laughed at my friend who said he was going to be a cardiologist when he was 18 years old. Well, guess what? He's now an interventional cardiologist.

In fact, the few people who are lucky enough to know exactly what they want to do have the advantage of leaving an early paper trail of their interest, which helps them get into their specialty when the time comes. If you see someone who has EM related activities for four years of med school, yeah this will work in their favor.

Finally, I think we do a disservice to our specialty by telling med students this. It devalues our field. Instead, a more balanced assessment is called for.

 

[Angry Birds]

Thanks for this post. I do seem to get opposing views on every topic, and a lot of it probably is due to SDN's cynical perspective (which I fortunately or unfortunately subscribe to). On reddit, when I was looking up posts about this very issue on emergency physician subreddits, the physicians on there did admit to some of the same problems in EM, however, they were not nearly as bleak. I guess I have to say then that I have no idea. Everybody I read anywhere on this question will be coming into the conversation with their own experiences that have led them to a certain view.

I guess my real question now is, how is EM faring compared to other specialties, and is it hurting for the same reasons that other specialties are hurting? Lastly, knowing the answer to the previous question, what is to be done?

This has been debated on numerous other threads.

 

[ThreadStalker]

First of all, congratulations on your acceptance! Now, find a way to do as little as humanly possible for the next 9 months. The next 7-10 years will be busy beyond your belief. My advice:

1 - Work your tail off in med school. Learn as much as you can, then learn some more. That foundation of medical knowledge is going to help you in any field you go into (except maybe ortho, it's just bones). The harder you study in med school, the more doors will be open for you when you decide what to do.

2 - If your school has a home EM program, reach out to the program leadership or individual attendings and express your interest. If your school doesn't have a home program, reach out to programs nearby. They understand the spot you're in, and if they don't just move onto the next one. Find out if you can shadow in the department to gain some clinical exposure and make contacts. Find ways to be helpful when you're there.

3 - Be "that girl/guy" for your clinical teams (but not "that girl/guy") on clinical rotations. Understand that clinical medicine is about learning to apply that foundational medical knowledge in a real world environment. Help your team out: be early for signout each day, get the cup of water the patient asked for, figure out where the translator phone is kept, take the paperwork to the fax machine or the person who lords over it. Do not leave early, do not hide, do not lie, and do not worry so much when you can't differentiate hypovolemic hyponatremia from euvolemic hyponatremia (we don't care, and even IM is going to consult renal). We do everyone's job in the ED, so every rotation is educational.

4 - Don't fail Step exams, repeat years, have ethical, behavioral or professional issues, etc. These will hamstring your application to any specialty.

5 - 4th year EM rotations and your SLOEs (Student Letter Of Evaluation - I think??) will be the most critical part of your application. Then clinical grades, comments, step scores, the usual. Nobody really cares about research or volunteering unless (maybe) you do it in the EM program you match to.

Best!

 

[sylvanthus]

Become a NP or PA......kidding, or am I?

 

[The Knife & Gun Club]

When I was an M1 the EM ultrasound director paid me $100 on Amazon gift cards to let every intern do a DVT ultrasound on me for sim day.

Was like “hey, I like these people. They’re all up in my crotch but not making it weird.”

4 years later I matched at that program.

Theres legit nothing you “need” to do to match EM during years 1-2. What you should do is shadow a bunch of fields, talk to the residents and attendings about their life and if they’re happy with their choice. I wanted to do transplant surgery until I shadowed a SICU shift with the transplant team. HELL F’ing NO.

 

[onemoretest]

Thanks for this post. I do seem to get opposing views on every topic, and a lot of it probably is due to SDN's cynical perspective (which I fortunately or unfortunately subscribe to). On reddit, when I was looking up posts about this very issue on emergency physician subreddits, the physicians on there did admit to some of the same problems in EM, however, they were not nearly as bleak. I guess I have to say then that I have no idea. Everybody I read anywhere on this question will be coming into the conversation with their own experiences that have led them to a certain view.

I guess my real question now is, how is EM faring compared to other specialties, and is it hurting for the same reasons that other specialties are hurting? Lastly, knowing the answer to the previous question, what is to be done?

I am really not trying to be doom and gloom but I think it important to be told about these current problems.

To answer your problem with regard to EM and other specialties you have to look at what makes EM unique. The problem with EM is we are totally at the mercy of patients choosing to come through the door. For years we have known that a majority of patients don't need to be seen in the ER. COVID has unmasked this vulnerability. Other specialties have their own patient base and or a unique niche that only they do. Anesthesia is often compared to EM, I think they are ahead of us with rules regarding predetermined ratios and fellowship options. They also serve a niche, no other specialty is going to perform general anesthesia. They will always have cases and test there may be some fluctuation there will be cases. Payor base of the drunk being seen for the 8th time vs anesthesia doing 8 peoples knees which have already had pre authorization is also very different.

The second aspect is the over saturation, plain and simple we have seen this coming for years. COVID just move the clock forward a little it didn't cause it. Jobs in decent areas are hard to find and if you do find them they do come at significantly lower salaries than 5-10 years ago. Anesthesia has don't a much better job controlling there turn out, but even they are beginning to face some of this. This problem is rooted in the overproduction of medical students and that has lead to and 80% increase in ER residents over the past 10 years. Hospitals have realized residents are free labor that can significantly reduce the amount they have to pay for attending coverage, so they are opening these sub par programs for the pure sake of free labor with limited to no teaching.

Really not trying to burst your bubble but I see 3-5pph with some of the sites having mid level and some don't. I make 185/hr (1456hrs a year), work 2/3 my shifts as mids and nights not by my choosing. I work 2/3 of the holidays with no differential, not by my choosing. I live in a midwestern town of about 250k that wouldn't be considered desirable. I have 3% match for retirement and get my insurance through my wife.

 

[RustedFox]

You should probably look for a new job. This sounds terrible.

Truly awful numbers.

 

[Fox800]

I am really not trying to be doom and gloom but I think it important to be told about these current problems.

To answer your problem with regard to EM and other specialties you have to look at what makes EM unique. The problem with EM is we are totally at the mercy of patients choosing to come through the door. For years we have known that a majority of patients don't need to be seen in the ER. COVID has unmasked this vulnerability. Other specialties have their own patient base and or a unique niche that only they do. Anesthesia is often compared to EM, I think they are ahead of us with rules regarding predetermined ratios and fellowship options. They also serve a niche, no other specialty is going to perform general anesthesia. They will always have cases and test there may be some fluctuation there will be cases. Payor base of the drunk being seen for the 8th time vs anesthesia doing 8 peoples knees which have already had pre authorization is also very different.

The second aspect is the over saturation, plain and simple we have seen this coming for years. COVID just move the clock forward a little it didn't cause it. Jobs in decent areas are hard to find and if you do find them they do come at significantly lower salaries than 5-10 years ago. Anesthesia has don't a much better job controlling there turn out, but even they are beginning to face some of this. This problem is rooted in the overproduction of medical students and that has lead to and 80% increase in ER residents over the past 10 years. Hospitals have realized residents are free labor that can significantly reduce the amount they have to pay for attending coverage, so they are opening these sub par programs for the pure sake of free labor with limited to no teaching.

Really not trying to burst your bubble but I see 3-5pph with some of the sites having mid level and some don't. I make 185/hr (1456hrs a year), work 2/3 my shifts as mids and nights not by my choosing. I work 2/3 of the holidays with no differential, not by my choosing. I live in a midwestern town of about 250k that wouldn't be considered desirable. I have 3% match for retirement and get my insurance through my wife.

3-5 PPH in a relatively undesirable midwest area at $185/hr? You'd be making more than that, seeing fewer patients, working on the coast in California.

This may be the most underpaid job I've seen for that location and volume.

That is a r-a-w deal, amigo/amiga.

 

[BoardingDoc]

I am really not trying to be doom and gloom but I think it important to be told about these current problems.

To answer your problem with regard to EM and other specialties you have to look at what makes EM unique. The problem with EM is we are totally at the mercy of patients choosing to come through the door. For years we have known that a majority of patients don't need to be seen in the ER. COVID has unmasked this vulnerability. Other specialties have their own patient base and or a unique niche that only they do. Anesthesia is often compared to EM, I think they are ahead of us with rules regarding predetermined ratios and fellowship options. They also serve a niche, no other specialty is going to perform general anesthesia. They will always have cases and test there may be some fluctuation there will be cases. Payor base of the drunk being seen for the 8th time vs anesthesia doing 8 peoples knees which have already had pre authorization is also very different.

The second aspect is the over saturation, plain and simple we have seen this coming for years. COVID just move the clock forward a little it didn't cause it. Jobs in decent areas are hard to find and if you do find them they do come at significantly lower salaries than 5-10 years ago. Anesthesia has don't a much better job controlling there turn out, but even they are beginning to face some of this. This problem is rooted in the overproduction of medical students and that has lead to and 80% increase in ER residents over the past 10 years. Hospitals have realized residents are free labor that can significantly reduce the amount they have to pay for attending coverage, so they are opening these sub par programs for the pure sake of free labor with limited to no teaching.

Really not trying to burst your bubble but I see 3-5pph with some of the sites having mid level and some don't. I make 185/hr (1456hrs a year), work 2/3 my shifts as mids and nights not by my choosing. I work 2/3 of the holidays with no differential, not by my choosing. I live in a midwestern town of about 250k that wouldn't be considered desirable. I have 3% match for retirement and get my insurance through my wife.

This job literally makes no sense. If you said you were in NYC or SF, I would understand. Living in BFE and making that? What the hell are you doing there? Seriously, unless everyone you have ever loved and care about all live in this area, staying at that job makes absolutely zero sense. Even then, I'd be looking for a different job in the same region.

 

[Fox800]

This job literally makes no sense. If you said you were in NYC or SF, I would understand. Living in BFE and making that? What the hell are you doing there? Seriously, unless everyone you have ever loved and care about all live in this area, staying at that job makes absolutely zero sense. Even then, I'd be looking for a different job in the same region.

3+ PPH in the Midwest? That's a $325-350+/hr job, easy.

 

[emergentmd]

So much doom and gloom.

Just did a 12 hr shift last night. Saw 2 pts all before 10p. Made base 150/hr and prob another 100-150/hr in partnership distribution. Slept 7 hrs, watched 3 episodes of mandalorian, 1 hr searching for rentals to buy.

Yeah I’m lucky bc I part own my FSER.

Not all gloom/doom. Not all roses like my shift. But somewhere in the middle.

People who has it good do not posts. Only people with neg experiences posts.

Just like all of the business google reviews. Neg experiences drive someone to post 100x more than a good experience.

 

[turkeyjerky]

So much doom and gloom.

Just did a 12 hr shift last night. Saw 2 pts all before 10p. Made base 150/hr and prob another 100-150/hr in partnership distribution. Slept 7 hrs, watched 3 episodes of mandalorian, 1 hr searching for rentals to buy.

Yeah I’m lucky bc I part own my FSER.

Not all gloom/doom. Not all roses like my shift. But somewhere in the middle.

People who has it good do not posts. Only people with neg experiences posts.

Just like all of the business google reviews. Neg experiences drive someone to post 100x more than a good experience.

Yeah, must be good to be Dom right now...

 

[emergentmd]

Yeah, must be good to be Dom right now...

With any business, I may have it good right now but I could easily close up shop tomorrow. There are wayyyyyy to many uncontrollable aspect of owning a business. I know this will not last and hopefully I can retire in 2 years if this holds up.

 

[crazyozone]

I completed an EM residency. EM is a dead end job and will soon become the first specialty to continuously produce board certified physicians that can't find a job -- which is unthinkable. The American Academy of Emergency Physicians recently wrote this:

An Open Letter to the Specialty of Emergency Medicine | AAEM Resident and Student Association

The American Academy of Emergency Medicine Resident and Student Association (AAEM/RSA) is a non-profit professional association for emergency medicine residents and medical students.

www.aaemrsa.org

Basically strong wording against another group, the american college of emergency physicians which has let EM become so corporate that we are wholly controlled by CMGs. Even before covid19 hit, EM doctors were in a slow tumble in pay. Once coronavirus hit, hourly pay decreased all over the country. Many physicians have been let go, and most of the workforce has seen reduced hours. This trend will continue. Furthermore, a few CMGs own most of the jobs (staffing wise) and have been pushing higher metrics and worse working conditions in a specialty known for extreme burnout.

The CMG that I am hired through sent an email to my group of docs stating they expect a .5% rate of downgraded charts. They also have sent emails to the group about the need for increased patient satisfaction (and this is during coronavirus when everyone was dieing and families weren't allowed to be present for their loved ones' last moments). They also sent multiple emails stating they expect patients to be seen faster. So spend less time with patients while making them happier and making your notes better. They control the jobs so they control what we must do and what we get payed, and if we don't like it there is nowhere else to turn. You're lucky to even have a job. I have many friends experience the same thing at different jobs from the same or similar CMGs. I suggest you avoid the specialty at all costs

 

[cyanide12345678]

I completed an EM residency. EM is a dead end job and will soon become the first specialty to continuously produce board certified physicians that can't find a job -- which is unthinkable. The American Academy of Emergency Physicians recently wrote this:

An Open Letter to the Specialty of Emergency Medicine | AAEM Resident and Student Association

The American Academy of Emergency Medicine Resident and Student Association (AAEM/RSA) is a non-profit professional association for emergency medicine residents and medical students.

www.aaemrsa.org

Basically strong wording against another group, the american college of emergency physicians which has let EM become so corporate that we are wholly controlled by CMGs. Even before covid19 hit, EM doctors were in a slow tumble in pay. Once coronavirus hit, hourly pay decreased all over the country. Many physicians have been let go, and most of the workforce has seen reduced hours. This trend will continue. Furthermore, a few CMGs own most of the jobs (staffing wise) and have been pushing higher metrics and worse working conditions in a specialty known for extreme burnout.

The CMG that I am hired through sent an email to my group of docs stating they expect a .5% rate of downgraded charts. They also have sent emails to the group about the need for increased patient satisfaction (and this is during coronavirus when everyone was dieing and families weren't allowed to be present for their loved ones' last moments). They also sent multiple emails stating they expect patients to be seen faster. So spend less time with patients while making them happier and making your notes better. They control the jobs so they control what we must do and what we get payed, and if we don't like it there is nowhere else to turn. You're lucky to even have a job. I have many friends experience the same thing at different jobs from the same or similar CMGs. I suggest you avoid the specialty at all costs

Reviving a 1 year old thread to add another thread to the already dozen posts about the crappiness of EM 😂?