Matching ACGME EM

[JimmyB123]

Can someone spell out to me how well one has to do in their preclinical years, clinical years, and USMLE to match ACGME EM? It sounds like it is pretty competitive but I wanted to get a picture of how competitive numerically.

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[costales]

Typically one has to get in med school first. When will you be applying for residency?

 

[Trogghunter]

Can someone spell out to me how well one has to do in their preclinical years, clinical years, and USMLE to match ACGME EM? It sounds like it is pretty competitive but I wanted to get a picture of how competitive numerically.

Its about like IM. An average preclinical student with a usmle 2 +/- 1 with at least 1sd above mean and good letters and clinical w/o red flags has a very solid shot of matching, probably academic. ER went to scramble last year. I forsee it becoming less competitive in the near future.

 

[JimmyB123]

Typically one has to get in med school first. When will you be applying for residency?

Sorry I'm just planning ahead. I have several interviews (9) and am starting to think into the future. I'll be applying in 2019.

 

[Postictal Raiden]

Its about like IM. An average preclinical student with a usmle 2 +/- 1 with at least 1sd above mean and good letters and clinical w/o red flags has a very solid shot of matching, probably academic. ER went to scramble last year. I forsee it becoming less competitive in the near future.

Why do you think that? The trend suggests otherwise. It feels like every other person I ask, he/she tells me they are planning on pursuing EM.

 

[UTsksk]

Seems like half of my class has an interest in EM

 

[Spindrift11B4]

Yeah a lot of EM interest where I am at too.

I am still learning about the residency process and what is entailed. I see this "scramble" mentioned at times, what does that mean, going to scramble?

 

[Postictal Raiden]

Yeah a lot of EM interest where I am at too.

I am still learning about the residency process and what is entailed. I see this "scramble" mentioned at times, what does that mean, going to scramble?

In short, after the main match is over, you'll always have unmatched applicants and unfilled spots. Therefore, few other mini matches take place until all positions are filled. In the AOA world, this is referred to as scrambling and in the ACGME world, it is SOAP.

Usually very competitive and desired specialties (Ortho, ENT, Derm, and surprisingly, PMR) have very little to zero positions left after the main match. I don't recall the exact number, but EM had very few left unmatched, fewer than the previous year, and significantly fewer compared to the years before that. This is an indication that the specialty is getting really hot.

I mean let's face it, short residency, high pay to hours worked ratio, good mix of medicine and procedures, greatly in demand, highly flexible, never boring, etc. No wonder most med students salivate over the idea of having a career that provides all that.

 

[BestDoctorEver]

I forsee EM to become more competitive in the next few years...

 

[hallowmann]

Yeah a lot of EM interest where I am at too.

I am still learning about the residency process and what is entailed. I see this "scramble" mentioned at times, what does that mean, going to scramble?

In short, after the main match is over, you'll always have unmatched applicants and unfilled spots. Therefore, few other mini matches take place until all positions are filled. In the AOA world, this is referred to as scrambling and in the ACGME world, it is SOAP...

To clarify this a little further: Both matches use to "scramble", meaning that when students didn't match and programs were left unfilled, basically students/schools were given a list of open programs (unfilled spots) and the students basically had to call/email/apply to any and every program hoping to secure a spot for the next year. Students were essentially at the mercy of the programs. There was no real "matching". Students applied, jobs were offered by programs, and if the students wanted to have a job for the next year, they signed the contacts.

A few years ago the NRMP (ACGME match organization) revamped their process by creating the SOAP, which is essentially a series of mini-matches where students would apply to open programs, and a match would take place in less than a day. This would repeat until most of the programs are filled over the course of 5-7 days.

The AOA still does the scramble on their side, which tends to work out because DO students who don't match ACGME, usually try to scramble into an open AOA TRI or program.

Also, this may all change depending on when the matches merge.

 

[JimmyB123]

Yeah it seems like EM is a popular option. I mean you don't see a long line of people wanting to do neurosurgery. I think EM attracts a somewhat casual personality and it isn't all that competitive either. That's why it shocks me to hear that allo EM is actually pretty darn tough to match.

 

[Dharma]

EM is more popular amongst the pre-med/pre-clinical crowd. It's NOT the lifestyle speciality many make it out to be. MUST READ:

http://forums.studentdoctor.net/threads/em-is-not-a-lifestyle-specialty.898506/

 

[Mad Jack]

Seems like half of my class has an interest in EM

Same here. Everyone and their mother wants to go into EM.

 

[Postictal Raiden]

EM is more popular amongst the pre-med/pre-clinical crowd. It's NOT the lifestyle speciality many make it out to be. MUST READ:

http://forums.studentdoctor.net/threads/em-is-not-a-lifestyle-specialty.898506/

The grass is always greener on the other side. If working an average 32hrs a week while making 250k is not a lifestyle, then I don't know what is.

 

[Mehd School]

EM is more popular amongst the pre-med/pre-clinical crowd. It's NOT the lifestyle speciality many make it out to be. MUST READ:

http://forums.studentdoctor.net/threads/em-is-not-a-lifestyle-specialty.898506/

For what it's worth, I've been in numerous ED's and older docs do get seniority. The younger docs were doing nights and the older guys had pretty cush schedules (36-48 hours weekly $250k+ working mornings and afternoons). Asking around, it isn't that uncommon to a certain extent. EM is my #1 right now.

 

[Dharma]

Food for thought.

 

[Thought Crime Spree]

For what it's worth, I've been in numerous ED's and older docs do get seniority. The younger docs were doing nights and the older guys had pretty cush schedules (36-48 hours weekly $250k+ working mornings and afternoons). Asking around, it isn't that uncommon to a certain extent. EM is my #1 right now.

The majority of community places I've been the older docs still work nights and chronic under staffing means asking for a "cush" schedule is out of the question. If your expectation is an easy lifestyle and shift schedule EM is probably going to grind you up and spit you out. Do EM because you love the work. It's not for everyone despite what a lot of med students think and it's not "cush".

 

[darklabel]

Yeah it seems like EM is a popular option. I mean you don't see a long line of people wanting to do neurosurgery. I think EM attracts a somewhat casual personality and it isn't all that competitive either. That's why it shocks me to hear that allo EM is actually pretty darn tough to match.

Neurosurgery is a pretty self-selective bunch. Scoring just decently on Step 1 pretty much stops you from even considering neurosurg because no one wants to end up without a residency or doing a Pre-lim year. Most competitive specialties are the same way.

Also EM isn't as much of a lifestyle choice as other specialties and is rather high on the physician burnout list. IM is becoming more popular choice from what I hear since for slightly less, you have the ability to sub-specialize and can still count of PSLF if it still exists since I believe most EM docs don't fall into the "working for a non-profit" clause of it.

Its about like IM. An average preclinical student with a usmle 2 +/- 1 with at least 1sd above mean and good letters and clinical w/o red flags has a very solid shot of matching, probably academic. ER went to scramble last year. I forsee it becoming less competitive in the near future.

I talked to a PD of EM and he said he received over 1k of applicants for less than 15 spots. This was AOA/ACGME certified as well. EM isn't as hard as neuro to match into, but it isn't exactly FM or IM either. Though academic IM programs are becoming more popular among med students for people wanting to subspecialize.

The grass is always greener on the other side. If working an average 32hrs a week while making 250k is not a lifestyle, then I don't know what is.

Ibn, I thought you were interested in surgery?

 

[Postictal Raiden]

Ibn, I thought you were interested in surgery?

I thought I was too. Then, med school happened, and now I'm seriously reevaluating my original plan. I just can't see myself spending most of the next 40 years of my life either studying, training or working.

Nothing is engraved in stone though; we shall see.

 

[DocEspana]

Neurosurgery is a pretty self-selective bunch. Scoring just decently on Step 1 pretty much stops you from even considering neurosurg because no one wants to end up without a residency or doing a Pre-lim year. Most competitive specialties are the same way.

Also EM isn't as much of a lifestyle choice as other specialties and is rather high on the physician burnout list.

Its actually #1 on the burnout list. But if you only measure people formally trained in ER (so not FM or IM docs who grandfathered their way in or staff middle-america shops now) you find the burnout phenomenon disappears and they are more-or-less a median specialty for burnout. Burnout seems to be MUCH more common in those trained in other specialties doing ER primarily in their practice.

Also, there is an important difference between people who burn out and retire, and people who burn out and go into another job. People who burn out in ER tend to go off and do whatever they want, since the money is in the bank already at that point and they havent burned out so much that they see no light at the end of the tunnel any longer. I forget exactly where I saw that data, but its somewhere on the ER subforum here on SDN.

Finally: per medscape, burnout or no burnout, ER physicians are near the top of all fields on doctors who would say theyd pick the same field again. It's very easy to be the contrarian and be negative just because everyone else is being positive... but in this situation ER really is that damn good *ASSUMING* you have the right personality for it and your opinion on money is "its not everything, but i like good pay per hour"

IM is becoming more popular choice from what I hear since for slightly less, you have the ability to sub-specialize and can still count of PSLF if it still exists since I believe most EM docs don't fall into the "working for a non-profit" clause of it.



I talked to a PD of EM and he said he received over 1k of applicants for less than 15 spots. This was AOA/ACGME certified as well. EM isn't as hard as neuro to match into,

Neuro is one of the easiest fields in medicine to match into (spots WAY outstrip demand). I know you didnt mean to offend, but thats pretty offensive. Unless you meant neurosurgery. That's different.

On the topic of where EM does fall? Its just slightly above average. Consider it like medicine but without as many community centers to fall back into. You'll see small hospital community IM programs everywhere "bringing down" the IM median. ER is IM with very few of those lower level programs. No one says IM at a pretty good center is easy, but its not hard either unless you're aiming major terciary center. Thats ER.

but it isn't exactly FM or IM either. Though academic IM programs are becoming more popular among med students for people wanting to subspecialize.

Ibn, I thought you were interested in surgery?

Come live life in the fast lane.

 

[W19]

I thought I was too. Then, med school happened, and now I'm seriously reevaluating my original plan. I just can't see myself spending most of the next 40 years of my life either studying, training or working.

Nothing is engraved in stone though; we shall see.

I don't blame you... Some of my classmates who were gung-ho about surgery start reevaluating their career perspective few weeks into med school. FM/EM are in the top of my list as well...

 

[darklabel]

Neuro is one of the easiest fields in medicine to match into (spots WAY outstrip demand). I know you didnt mean to offend, but thats pretty offensive. Unless you meant neurosurgery. That's different.

Sorry I meant neurosurg. .

Also Im just always wary of specialties that sound as sweet as EM does and be only mildly competitive since it seems most medical students are looking for a lifestyle friendly career.

 

[DocEspana]

Sorry I meant neurosurg. .

Also Im just always wary of specialties that sound as sweet as EM does and be only mildly competitive since it seems most medical students are looking for a lifestyle friendly career.

Most people don't have the personality for EM. They self select out despite the idealized thoughts they have during pre clinical years.

Plenty of people think too much. And they're brilliant, but their brilliant when they have time to think and would drown with the ER volume of decisions. Being good enough but decisive quickly is better than brilliant but slow. Obviously brilliant and quick takes the cake.

Many people are prestige oriented. There is no prestige in EM. You're the person sifting a pile of junk into junk to be discharged and junk to be admitted and you'll be derided by your specialists no matter what you pick for not picking what they would.

And some people just can't take the vomit, blood, pain seeking, psychogenic illness, and feces that make my day to day life so colorful.

These people will come in enamored and leave absolutely exhausted and overwhelmed, smelling a bit like urine and wondering why the medical team chewed you out for admitting that woman that might have had a stroke.

But there are those of us who put up with it all for the adrenaline and the stories that no one can beat (everyone else's best story came through our ER first.). Working 12-16 shifts a month isn't too bad either.

 

[Postictal Raiden]

I don't blame you... Some of my classmates who were gung-ho about surgery start reevaluating their career perspective few weeks into med school. FM/EM are in the top of my list as well...

Perhaps if I were younger I would be more interested in surgery and be more willing to endure its grueling residency. However, being 4-5 years older than the average age of my classmates, plus having a family to take care of, compels me to seek less time-consuming specialties, regardless of where my pure passion lies (surgery).

With that being said, I have no idea what the future hold for me, and if I have learned anything during the past 3 months of med school it would be that I should keep an open mind and to not commit to or rule out specialties any specialty.

I remember when I used to volunteer at an academic hospital that couple of med students told me that I will be changing my mind about specialties when I start med school. It's funny how true this statement is. I'm not even done with the first semester of school and I am now considering specialties I have never thought I would be interested in, not in a million years.

 

[Postictal Raiden]

Most people don't have the personality for EM. They self select out despite the idealized thoughts they have during pre clinical years.

Plenty of people think too much. And they're brilliant, but their brilliant when they have time to think and would drown with the ER volume of decisions. Being good enough but decisive quickly is better than brilliant but slow. Obviously brilliant and quick takes the cake.

Many people are prestige oriented. There is no prestige in EM. You're the person sifting a pile of junk into junk to be discharged and junk to be admitted and you'll be derided by your specialists no matter what you pick for not picking what they would.

And some people just can't take the vomit, blood, pain seeking, psychogenic illness, and feces that make my day to day life so colorful.

These people will come in enamored and leave absolutely exhausted and overwhelmed, smelling a bit like urine and wondering why the medical team chewed you out for admitting that woman that might have had a stroke.

But there are those of us who put up with it all for the adrenaline and the stories that no one can beat (everyone else's best story came through our ER first.). Working 12-16 shifts a month isn't too bad either.

Thank you for sharing these pearls with us. The contributions of fresh docs, who have not yet been jaded with the economic and political atmosphere of health care, are always welcomed.

As someone who is interested in EM(along two other specialties), I wonder if you can a little about how you think the field is going to be in the near future. With the significant increasing number of midlevel practitioners entering the field, coupled with a significant increase in the number of EM residency spots, do you think the job market is heading toward something similar to that of anesthesiology? Will the job market become so saturated so one has to work in BFE in order to earn good living?

 

[NontradCA]

EM appeals to me because you can make in an hour what most people make in a day.

 

[Postictal Raiden]

EM appeals to me because you can make in an hour what most people make in a day.

This dude made in 3 hours double of what an average American makes in a year

http://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html?_r=0

 

[DocEspana]

Thank you for sharing these pearls with us. The contributions of fresh docs, who have not yet been jaded with the economic and political atmosphere of health care, are always welcomed.

As someone who is interested in EM(along two other specialties), I wonder if you can a little about how you think the field is going to be in the near future. With the significant increasing number of midlevel practitioners entering the field, coupled with a significant increase in the number of EM residency spots, do you think the job market is heading toward something similar to that of anesthesiology? Will the job market become so saturated so one has to work in BFE in order to earn good living?

Saturated?

Hahahahaha. No.

The running joke is that the best way to interview for a community EM job (which 82% of all graduates go into) is to 1) present wrist 2) prove you have a pulse 3) sign your contract.

EM is the farthest thing in the world from saturated and the mid level providers are not going anywhere near the physicians meat and potatoes, rather their mopping up an influx of low acuity that wouldn't be coming to a hospital at all a decade ago.

 

[NontradCA]

This dude made in 3 hours double of what an average American makes in a year

http://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html?_r=0

Yea he's not pocketing that much. Not even close.

 

[DocEspana]

Saturated?

Hahahahaha. No.

The running joke is that the best way to interview for a community EM job (which 82% of all graduates go into) is to 1) present wrist 2) prove you have a pulse 3) sign your contract.

EM is the farthest thing in the world from saturated and the mid level providers are not going anywhere near the physicians meat and potatoes, rather their mopping up an influx of low acuity that wouldn't be coming to a hospital at all a decade ago.

I should add that the big controversy right now is not about the availability of jobs. The jobs are everywhere and numerous. This is because the entire center of the country is more or less devoid emergency medicine trained physicians. And every hospital wants to have their ER staffed entirely by emergency medicine trained physicians, not family medicine or internal medicine.

The big issue in emergency medicine right now is the payment structure. People are split about whether physicians should have individual contracts with each hospital, if physicians should group together into larger entities that can negotiate for better contracts, or if the physicians should jump on board with these large companies that are run by businessmen that take a lot of autonomy away from the position but pay them the most of all and streamline the whole business process down to "show up. See patients. Collect your check."

The physician run groups and the emergency "companies" are fighting tooth and nail for ground in this fight. And neither one is ideal for everyone, but hospitals are playing them off of each other hoping the cheapest one (for them) wins.

 

[Spindrift11B4]

DocEspana, I will second Ibn Alnafis MD's appreciation in you sharing your insight in this profession. I have been set on EM for a long time now, well over a decade (I'm a non-trad), and it has been a little disheartening to hear some of the persistently negative rumors/predictions that a lot of people have been throwing out there concerning EM. I keep hearing, "EM is going to be a saturated job market soon" blah, blah, blah. What you say concerning the job availability coincides with what I have seen from official sources and surveys (versus eminently informed med students and the occasional disgruntled physician), so that is good to hear from someone that is currently in the thick of it.

I first became interested in EM for the nature of the work and because I think my personality would be a good fit for it, the "lifestyle" and all of that became a secondary interest once I found out more about it. I hate to see so many people interested in the specialty just because of the perceived lifestyle. That said, I have an open mind and realize I may find another interest...but I doubt it.