Hey man, I normally lurk SDN but I literally just registered an account because I saw your post and wanted to give you my story as it's slightly similar to yours. Honestly, it wouldn't surprise me at all if we knew each other too lol.
Our stats are nearly identical (top 20 school, 250, 260, top 25% but no AOA, several research projects but no pubs) and I wanted to do ortho for a good part of medical school. I even took a year off between third and fourth year to do dedicated ortho basic science research.
I loved ortho and I thought I was a good candidate. Towards the end of my research year it was getting clear that my efforts were not going to pay off as the project wasn't working out as I expected. I wasn't able to publish anything, and really wasn't able to get any abstracts or posters out either. The project was just too new and I would realistically need a PhD level effort to complete it or get something out of it.
Anyway, my mentor and PI (very accomplished orthopod at my institution) basically told me that my chances were pretty slim because I had this huge red flag of taking a full year off and not having anything to show for it. He actually also told me that I really didn't fit the orthopod stereotype and unfortunately ortho being an old boys club, they really care about that (I'm a short, skinny, asian guy.. pretty nerdy actually). Just like EM, ortho is looking for a "fit" and with ortho that fit tends to be tall, white, athletic, jock and I clearly wasn't it. My PI told me I should have a really good back up because I likely wasn't going to match. This was really heartbreaking.
Given other life events that happened on my research year (sick family members, sports injury of my own, and financial/money issues as I was living purely off savings since my position only offered a meager stipend), I ended up decided that ortho wasn't for me and that I should look elsewhere.
EM was the only specialty I liked next to ortho because of a variety of reasons, but it was still #2 to ortho. I figured whatever, and scheduled 3 EM subIs.
On my first subI I realized I really like EM and could see myself doing it as a career. The second subI confirmed this, and the third subI made me realize I should be really careful about "choosing" the right program because I didn't like my time at that hospital. I got honors in my first two subIs and a high pass at the third one. I had outstanding evaluations, really amazing SLOEs (from what people told me), and I was well liked at all the programs I worked at.
Anyway interviews came around, and I ended up interviewing decently given my scores and such. However, I was met with quite a bit of skeptiscism about my "commitment to EM." Almost every interviewer wanted to know how sure I was of EM, especially since my entire application screamed orthopedics. I did my best to convince them (really loved my subIs, loved taking care of patients from all walks of live with every kind of medical problem, thought EM was one of the few specialties left where you really get good at diagnosing, felt like EM was ideally poised to handle the ACA the impending changes to our healthcare system, etc etc etc).
I ended up matching at my SECOND TO LAST RANK at a program I really didn't want to go to but I pretty much put down because I'd rather match at a safety school then not match at all. It was pretty disheartening to think about all the work I had done to end up at a small unknown EM program in a state far away from where I wanted to be.
Retrospectively I guess I should be super happy and blessed that I matched at all, but holy balls man, you'd think with my application that I'd at least end up somewhere semi-desirable. EM is just too competitive now to expect anything out of the match. You're up against people who have been EMTs, went to medical school to be an EM doc, and live/eat/breath EM like there's nothing else one needs to live.
I'm still a little bitter about the whole deal, but I just want to give you a heads up especially in your situation where you're no longer a AMG senior coming out of medical school. You're "damaged goods" in the sense that you still thought you'd pursue a surgical career and now you're giving up on it to do EM, a field which is becoming really really competitive.
My only advice to you is to have an excellent story about why EM is for you and why you decided surgery isn't your thing. Your application, like mine, is going to scream ortho! ortho! ortho! and the fact that you DIDNT MATCH in ortho means that every PD under the sun is going to think that EM is your back-up rather than your "dream." That PD has 100s of kids that would love your interview spot, and all those students have wanted to do EM from day one. It's a tough game man, but you know that at somebody who didn't match ortho.
Anyway, feel free to PM me man, I feel like you and I were/are in similar boats. Good luck.
