MS4, recently fell in love with EM. It's too late now. I'm so lost and confused, what do I do?

[Bash Kashp]

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[The Physician Philosopher]

That ship has sailed my friend unless you can convince your home program to take you.

What specialty did you apply to?

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[surely]

Pursuing another field and had no exposure to EM until this month. I have absolutely loved my rotation and have been told by numerous attendings that my personality "fits" the field more than anything else. My rank list is due in 10 days. What do I do? I know EM never has spots to scramble into. I'm so confused. I'm also a below average applicant. Step scores are 225 and 246. Any help is appreciated. Thank you.

From your previous posts, it looks like you've applied for Psychiatry. One option would be to match into Psychiatry, but get your Psych PD on board with supporting you reapplying through ERAS for the 2019 Match. It would be extremely helpful if you got your home institution to write you a SLOE, and if you could do an Away rotation in EM during the last block of M4 to get a second SLOE. Without SLOEs, I can't imagine you'd have any chance of a successful application next year.

 

[The Physician Philosopher]

I don't know that can happen any more. I think that switching specialties is a lot harder today than it was five years ago. Particularly into a speciality that doesn't have an intern year.

That may prove really challenging.

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[HopefulEMed]

Maybe this helps: I had friends that pursued an extra degree after their 4th year of medical school while they applied to residency programs, i.e. MBA or MPP or MPH type of things. Granted, there are certain schools that would be out of the picture this late in the game, i.e. Stanford Business School or like Harvard Public Health (deadlines passed in December), but you could probably still get into a decent school that have open rolling admissions. Have you considered the London School of Economics or the London School of Tropical Hygiene or some of the schools in Europe like INSEAD? Their deadlines are typically later. Be cautious that these programs usually don't end till August...so you may have to work out a part time thing with the knowledge that you will finish during an elective block in residency. It will be hard to schedule, but doable.

It would also mean you would have to withdraw from the match entirely (someone else with better experience may want to comment on this) this year. If you decide to go to London, DM me and maybe I can be of help.

 

[Darth Doc]

There are also Emergency Psychiatry fellowships available after completing either an EM or psych residency.

 

[Gray Fox]

Pursuing another field and had no exposure to EM until this month. I have absolutely loved my rotation and have been told by numerous attendings that my personality "fits" the field more than anything else. My rank list is due in 10 days. What do I do? I know EM never has spots to scramble into. I'm so confused. I'm also a below average applicant. Step scores are 225 and 246. Any help is appreciated. Thank you.

Any way to extend graduation another year? Plenty of schools do this (including mine). It'll be hard without SLOEs. Met a few applicants going thru Match again after a med/surg prelim.

 

[KinesiologyNerd]

Emergency Psychiatry fellowships

The horror...

 

[Birdstrike]

Pursuing another field and had no exposure to EM until this month. I have absolutely loved my rotation and have been told by numerous attendings that my personality "fits" the field more than anything else. My rank list is due in 10 days. What do I do? I know EM never has spots to scramble into. I'm so confused. I'm also a below average applicant. Step scores are 225 and 246. Any help is appreciated. Thank you.

It's never 'too late' for this kind of change. If you can find a way to switch now, then great, do it. If you can't switch now, then fine. Start planning right now how to reapply for EM, to start after your intern year. At least you know you have a job the next year, and a few short months into it, you'll already be starting the process to apply for the specialty you really want. Countless people have changed specialties after 1 year or more. Hell, I did it after 11 years into my specialty choice. And if you end up having to do a year of another specialty prior to going into your final specialty, I guarantee you, you'll learn plenty of things that will benefit you in your next phase of your career. I don't know a single specialty in Medicine, that deals with live patients, that doesn't deal with a tremendous amount of psychopathology, especially EM.

It's an unfortunate reality of the medical world, that you have to make a specialty choice after only tiny fraction of the specialty exposure you really need, to make a fully informed decision.

Stick with it. You'll get there eventually.

 

[Birdstrike]

The horror...

It depends if it allows you to work 9-5 Mon-Friday, without call, or not. If so, it's far from a horror.

 

[gro2001]

Pursuing another field and had no exposure to EM until this month. I have absolutely loved my rotation and have been told by numerous attendings that my personality "fits" the field more than anything else. My rank list is due in 10 days. What do I do? I know EM never has spots to scramble into. I'm so confused. I'm also a below average applicant. Step scores are 225 and 246. Any help is appreciated. Thank you.

Depending on what your financial/personal situation is like, possibly delaying graduation might be another option? This would give you time to do a few aways, get some SLOEs under your belt, etc.

However, I would only recommend this if you are absolutely sure you definitely want to do this. There is a lot of last minute buyer's remorse around this time. There is nothing wrong with thinking there are other awesome specialties out there. Just because you think another specialty is cool, doesn't mean you have to do it for a living. It makes sense to switch tracks dramatically if you realize that you both love EM and hate psychiatry.

 

[slurpy15]

I switched residencies after internship with no problem.

 

[TrailRun]

Same basically happened to me.. I'm matching (theoretically) in a couple weeks after switching from gen surg. I never understood the extending medical school a year thing. Thats another year of loans, etc. Whereas you can stick to your original plan and match into whatever you thought you had liked. Maybe you'll realize you like it after all? Maybe not, but then you have a year of experience as a doctor (not a med student) and have made an income instead of taken out more loans. Win-win. And all my interviewers seemed receptive to having someone who could hit the ground running. Good luck!

 

[GonnaBeADoc2222]

This is the travesty of every medical school not having a required 4 week rotation during MS3. With the breadth of general medicine knowledge required in EM, required interpersonal skills, and with >50% of hospital admissions coming through the ED, this is shocking. But what is mandatory is useless memorization of the Krebs cycle, 100s of pathology slides, identification of every body structure known to man in the anatomy lab, 8 weeks of general surgery, 8 weeks of ob/gyn (um.....ok...), 4 weeks of neurology, etc, etc.

OP, you picked Psych for a reason. You might have fallen in love with the "med student" version of EM which is carrying 1-2 patients at a time, seeing traumas, fixing lacerations, etc. It's different when you're the attending and seeing 2 or more pts/hr. I like the field and it had afforded me great financial and lifestyle opportunities so far, but it definitely isn't for everyone - some days are incredibly frustrating.

Why don't you see how you like Psych and take it from there? Maybe do an EM elective during prelim year?

 

[GeneralVeers]

This is the travesty of every medical school not having a required 4 week rotation during MS3. With the breadth of general medicine knowledge required in EM, required interpersonal skills, and with >50% of hospital admissions coming through the ED, this is shocking. But what is mandatory is useless memorization of the Krebs cycle, 100s of pathology slides, identification of every body structure known to man in the anatomy lab, 8 weeks of general surgery, 8 weeks of ob/gyn (um.....ok...), 4 weeks of neurology, etc, etc.

Med schools are designed to push people into Family Medicine, which is why the mandatory FM, IM, OB/GYN, PEDS, but no mandatory EM. I remember the pressure was very strong to go into FM.

 

[CliveStaples]

Med schools are designed to push people into Family Medicine, which is why the mandatory FM, IM, OB/GYN, PEDS, but no mandatory EM. I remember the pressure was very strong to go into FM.

The times are changing; we had mandatory EM in the 3rd year curriculum at my medical school. Subsequently we had probably 5 times as many people go into EM than FM.

 

[CoolWhipp]

I feel like I'm giving primary care a lot of the times.

 

[Frazier]

Psych is a great field. I bet you end up pleased.

EM is great too... but I think you're just experiencing cold feet regarding psych.

 

[OneTwoThreeFour]

I can understand not giving mandatory EM in 3rd year: imagine it is your first rotation after step 1. You won't be of use to anyone, patient or provider. I don't think an EM rotation is conducive to learning if you don't already have a good clinical/medical foundation.

 

[GonnaBeADoc2222]

I can understand not giving mandatory EM in 3rd year: imagine it is your first rotation after step 1. You won't be of use to anyone, patient or provider. I don't think an EM rotation is conducive to learning if you don't already have a good clinical/medical foundation.

Yes, probably about as useless to the team as you are starting on any given rotation as your first one.

 

[OneTwoThreeFour]

Yes, probably about as useless to the team as you are starting on any given rotation as your first one.

Well on my EM rotation I was actually in charge of patients. Medicine/surgery etc. there was way more oversight/hand holding.

 

[Mad Jack]

I don't know that can happen any more. I think that switching specialties is a lot harder today than it was five years ago. Particularly into a speciality that doesn't have an intern year.

That may prove really challenging.

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It's actually not all that prohibitive, as 3-year EM programs would still fall within the 4-year funding window of psychiatry. It's more difficult because the match is tighter, but it's certainly not impossible if he can get his PD on board.

 

[USCDiver]

Consider scrambling into a surgical transitional year slot and reapplying next year.

 

[GonnaBeADoc2222]

Consider scrambling into a surgical transitional year slot and reapplying next year.

Seriously, don't make any snap decisions. Give psych a shot. I definitely would not take the above advice.