SOAP Planning

Discussion in 'Emergency Medicine' started by IH8ColdWeath3r, Feb 28, 2017.

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  1. IH8ColdWeath3r

    IH8ColdWeath3r 7+ Year Member

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    Hey guys,

    let me try a modified way to ask my initial question since it did not get any responses.


    I am worried about matching into EM this year given my limited number of interviews. I know that I want to do EM. I hope that it doesn't come to me scrambling into IM and then reapplying to EM after I become IM boarded. Obviously, I would like avoid the 6 year residency route and do what I envision myself doing in half that time.


    I am really hoping to do a TY or medicine-prelim year if I do not match this year. Would you guys recommend this route and then reapplying next year?
     
    Last edited: Mar 1, 2017
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  3. EMedGrrl

    EMedGrrl 10+ Year Member

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    If you can get a prelim or TY program spot at a place with an EM residency, do an early EM rotation and get a letter/SLOE from EM faculty for your application next year, that would be ideal.
     
  4. futureemdoc91

    futureemdoc91

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    How many interviews did you have? There's always a chance so don't give up yet.
     
    Onscene likes this.
  5. EMGui2017

    EMGui2017

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    I know of a person who did a surgical prelim and is now an intern at a good EM program this year so it is possible if it comes down to it. I hope that you match though, good luck!
     
  6. IH8ColdWeath3r

    IH8ColdWeath3r 7+ Year Member

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    Is that something that I could request? like request for an early EM rotation to get a SLOE?
     
  7. IH8ColdWeath3r

    IH8ColdWeath3r 7+ Year Member

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    You think it would be better to do surgical pre-lim over IM pre-lim? I just feel like I would enjoy IM more and likely do better/be more successful due to my familiarity with medicine over surgery.
     
  8. rkmoto121

    rkmoto121 7+ Year Member

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    What about Eisenhower Medical Center in Rancho Mirage CA? They are filling their first class for next year outside the match. Idk if that is an option if you take a spot somewhere through the SOAP but it's probably worth looking into/contacting them.


    Sent from my iPhone using SDN mobile app
     
    Last edited: Mar 3, 2017
    Gomertose likes this.
  9. zyx189

    zyx189

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    There might be Summa as well this year
     
  10. Bouddha

    Bouddha 7+ Year Member

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    The problem is you may or may not know about Summa's final accreditation prior to the SOAP, so while it may be an option, I wouldn't count on this as an option.
     
  11. EMedGrrl

    EMedGrrl 10+ Year Member

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    Yes. The PDs of prelim and transitional year programs know that many of their people (who are not doing the year for an already-matched PGY2 program) need to get letters, reapply, do interviews, etc. during that PGY1 year. I would have a polite discussion with the PD about scheduling as soon as is feasible if you end up in a 1-year spot.
     
  12. BangBang22

    BangBang22

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  13. gamerEMdoc

    gamerEMdoc Associate PD; EM Clerkship Director Gold Donor

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    Getting a prelim (medicine or surgery) in a place with an EM residency is definitely your best step IMO if you are planning on re-entering the match for EM the following year. Rarely are candidates MORE desirable in the match the following year, and often they get less interviews after going unmatched, not more. But if you do well at a hospital where there is a residency, get along great with the EM residents there and they advocate for you, your chances to remain at that institution and match in EM there the following year are probably your best bet.
     
    EMedGrrl likes this.
  14. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner SDN Moderator 10+ Year Member

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    I agree. Unless there's one red flag in your app that you know about and can remove (bad letter), then a prelim year won't help you. I mean, you'll be a better intern by far, but your odds go way down. You're not going to fix bad step scores, a low GPA, or a personality disorder.
    But I will say it is pretty important that you go to a place with an EM residency if at all possible. Doing an EM elective isn't that hard during a prelim year usually. Doing an away elective is much, much harder.
     
    gamerEMdoc likes this.
  15. IH8ColdWeath3r

    IH8ColdWeath3r 7+ Year Member

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    I appreciate this advice and I have heard that it is MORE difficult as a re-applicant.
     
  16. IH8ColdWeath3r

    IH8ColdWeath3r 7+ Year Member

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    I do have a red flag, I failed the COMLEX Level 2 PE on my first attempt, passed it the second time. Honestly, I have no idea why I failed it. None, whatsoever. I have never failed a clinical rotation, OSCE, or simulated patient encounter. After my failure, my school reviewed my OSCEs and found no red flags, so they let me stay on rotations, retake the exam, and I passed. This is exactly how I explained this to the PDs at the places that I interviewed. I was trying to be truthful, because I have NO IDEA why I failed the first time since the NBOME doesn't provide a rubric/reason why the applicant failed. The PDs that I spoke with seemed like they could look past my initial failure but who knows, I'll have a better idea come Monday.

    I interviewed only at 4 programs - 3 of which I rotated at. I rotated at a program late in the cycle. I received a phenomenal end of rotation evaluation. For the sake of anonymity, I wont discuss all of the comments that were written on my eval but I was evaluated by 9 different physicians that I worked with. Their comments were anonymous but a few of them included:

    - functions well above his class and better than some of our PGY-2
    - smart, nice, skilled interpersonally, would be a great addition to the residency program
    - great evaluation of patients, history and ddx significantly above most. I would be pleasantly happy if student matched at our program
    - excellent work ethic, teachable, history and ddx well above peers
    -demonstrates advanced thought process for level of training. Excellent work ethic. Well liked by patients and staff. Helpful in ultrasound
    -needs to be ranked in top 25%

    This program promised my an interview but I never got one. The chief talked to the PD for me twice and one of the physicians who I worked with also talked to the PD on my behalf, but I was not given an interview. I actually just ran into one of the docs who wrote some of the comments on that eval and he said that he looked forward to me matching with them. I had to inform him that I didn't even get an interview. He was very surprised but wished me well and told me that I would make a great resident. I don't feel sour about this, I genuinely really liked the program and grateful for the opportunity to rotate in that department. One thing that I've taken away from this is that it will be highly unlikely that I will match (and need to plan accordingly) if I can't even get a a program that wrote such a great eval for me to even offer me an interview.

    I'm just afraid that this one failure on the PE is going to be something that nobody is going to be able to look past. This is the reason I wanted to do pre-lim because I truly believe that If I do prelim at an insitution with an EM program, that I will be able to impress the residents and faculty by doing an early, dedicated EM rotation and possibly EM as an elective. I would really appreciate any advice on how to proceed given my situation.
     
  17. gutonc

    gutonc No Meat, No Treat SDN Administrator 10+ Year Member

    Dude...this is not going to be the rate limiting step in matching for you.

    This is.
     
    sb247 likes this.
  18. IH8ColdWeath3r

    IH8ColdWeath3r 7+ Year Member

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    Not sure what you mean by how the PE is not the rate limiting step for me. I applied to a very large number of programs, over 70+ and was rejected by all but 4 of them. I believe that this was largely due to the PE because students with similar stats as me had 2-3x as many interviews as me. The last place I rotated at, which was late in the cycle (January), where I received the great eval but didn't get an interview informed me that they didn't offer me an interview because of my initial failed PE exam. They said they simply had "too man qualified applicants" without a board failure and ultimately that was the reason I was not given an interview.

    I asked them for a SLOE so that I could hopefully have an official letter that is reflective of the positive comments and hard work I did in the ED during that rotation. I am hoping that this will help me during the SOAP.
     
  19. shoal007

    shoal007 2+ Year Member

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    youre in trouble. there will be no EM SOAP spots. you need a backup plan (prelim year - med or surg or cat family or im). you might get lucky but i doubt it. I wish you the best of luck, its really a depressing time and youll come out stronger. get a good ally/advisor to help.

    Sent from my Pixel using Tapatalk
     
    IH8ColdWeath3r likes this.
  20. gamerEMdoc

    gamerEMdoc Associate PD; EM Clerkship Director Gold Donor

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    There could be spots in the soap, but I dont anticipate many. Im personally potentially worried we wont match all ours. We interviewed 90% DOs (since we were a former AOA program in the first year of ACGME match, and our applicant pool was very DO heavy). Depending on how many of those candidates matched in the AOA match (we still dont know), there is at least potentially the chance our spots wouldnt all fill. With there being other brand new programs thanks to the merger, i'm sure there are others that are in the same boat. I'm not saying there's going to be any spots in the soap, and if there are that there will be many, but there is at least potential to be some. But there is also going to be insane competition for those last few spots.
     
    IH8ColdWeath3r likes this.
  21. res1cue

    res1cue 7+ Year Member

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    Are you applying AOA, ACGME or both?
     
  22. IH8ColdWeath3r

    IH8ColdWeath3r 7+ Year Member

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    Thank you, yes my back-up plan is to do Pre-lim IM. I am in the process of writing a new personal statement to address my PE failure. Unfortunately, all my letters are EM SLOEs but the most recent one is strong and I am hoping that some programs will give me a chance. It has been a rough few couple of months, and to make matters worse, I don't have an advisor (DO school) and the one guy who used to be an EM physician resigned recently. Hoping for the best but preparing for the worst at this point.
     
    Last edited: Mar 11, 2017
  23. IH8ColdWeath3r

    IH8ColdWeath3r 7+ Year Member

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    ACGME
     
  24. Smiths11

    Smiths11 5+ Year Member

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    I didn't match. Going the prelim IM or Surg route through SOAP.

    What is the quickest way to cross reference the list of unfilled programs with places that have EM residencies, can anyone recommend?
     
  25. SalemK

    SalemK 7+ Year Member

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    +1
     
  26. EastCoastEMApplicant17

    EastCoastEMApplicant17

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    I went on 18 interviews this year, giving me a greater than 99% chance to match, and did not match this year. US MD student. Looks like I'm SOAPing into prelim surgery and preparing for EM or (more likely I guess) IM next year
     
    JBOB likes this.
  27. res1cue

    res1cue 7+ Year Member

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    Damn, sorry to hear that. That really sucks. Good luck with the SOAP
     
  28. gamerEMdoc

    gamerEMdoc Associate PD; EM Clerkship Director Gold Donor

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    18 interviews and no match? My goodness, thats insane from a statistical perspective. Sorry it happened to you.
     
  29. em2017plz

    em2017plz

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    16 interviews, with 20 invites. no match.

    Having trouble deciding between FM and reapply or surgical prelim and reapply...
     
  30. SalemK

    SalemK 7+ Year Member

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    I didn't have 16+ interviews, but I sure didn't expect today to go how it did.

    Surgical prelim > medicine prelim?
     
  31. gamerEMdoc

    gamerEMdoc Associate PD; EM Clerkship Director Gold Donor

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    Prelim year at a site with an EM residency is #1. Then Surgery>IM
     
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  32. Smiths11

    Smiths11 5+ Year Member

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    Location is important for me. I applied 50% surgical prelim, 20% IM prelim, 20% FM, 20% IM.

    There are simply more surgery prelim spots than others
     
  33. Smiths11

    Smiths11 5+ Year Member

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    Question, a lot of people said it's more difficult to match EM during prelim year than during 4th year. Why is this so? If programs interviewed you 4th year, then shouldn't the addition of Step 3 + a year of work experience benefit? I am hoping to keep in touch for the next 12 months with the places I interviewed at this year, hoping that this connection helps me score interviews next year.
     
  34. brabbit2222

    brabbit2222 2+ Year Member

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    The programs are looking for people that are the most capable of becoming excellent physicians, not the people who know the most. If every place that interviewed a person passed up on him the first year, something is probably wrong with his application/personality/there are red flags.
     
  35. Smiths11

    Smiths11 5+ Year Member

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    In my case - I don't think its my personality. It's my **** scores. All my interviews were places I did aways at. 3/4 of them straight up told me that if they saw me on paper they'd pass me up, but having seen my personality and work ethic in person, they'd be more than happy to have me. The 4th I could tell was just a courtesy interview since I rotated, and knew right away they wouldn't take me.

    Now obviously board scores will be the same next year. So not saying it will be any easier. I just don't get why it would be harder. I feel confident that I know the PD/APD at 3/4 of these programs well enough that they'd interview me again next year. In addition I'd have the EM program where I match prelim at. Coupled with Step 3 and the obvious experience + knowledge of PGY1, I am having trouble seeing why it's harder.

    Not in denial or anything, I simply don't get it.
     
  36. brabbit2222

    brabbit2222 2+ Year Member

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    I'm sorry, man, that's rough. The problem I see is that these 3 PDs, despite liking your personality and work ethic, still didn't rank you highly enough. If you can find a prelim year at a somewhat undesirable location and that's not very well known, it might be your best bet. Based on what you say, you can clearly impress people, and since that program is not going to be as competitive as some of the other places, you have a decent chance of getting in.

    Make sure there are no other factors that played a role this year, besides your scores. You don't want to miss things like silly grammar errors in your personal statement, for example. Don't give people a reason to pass up on you. I hope next year is kinder to you.
     
    Makati2008 likes this.
  37. EMedGrrl

    EMedGrrl 10+ Year Member

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    It may be a little bit harder to get interviews because of the impression @brabbit2222 mentioned that if you didn't match this year, there might be something wrong with you. The other problem is actually scheduling an EM rotation early enough to get new letters and getting time for interviews while working as a resident. That being said, if there's nothing else that you can see yourself doing happily, then it's worth a shot. I know of one occasion at my program where we re-interviewed and matched someone who hadn't matched the previous year. In that case, the extra year of experience/maturity helped. Depends on the program and what they're looking for, and the factors that caused you not to match this year.
     
  38. em2017plz

    em2017plz

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    To whoever said something about ranking in no particular order, I very purposefully ranked each program. Not sure what that has to do with anything anyway.

    Also, at what time and through what method would be best to contact programs to ask about any red flags/ways to improve your app?

    Thanks.
     
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  39. brabbit2222

    brabbit2222 2+ Year Member

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    I think next week is appropriate.
     
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  40. IH8ColdWeath3r

    IH8ColdWeath3r 7+ Year Member

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    This is good to know.
     
  41. IH8ColdWeath3r

    IH8ColdWeath3r 7+ Year Member

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    I also didn't match. I was under the impression that we could re-submit/use our SLOEs from the previous year, seeing as it would be virtually impossible to do an"away" rotation while you are a PGY-1 resident. I had a similar thing happen to you. My board scores were average 220-230s on step 1 and 2, but I failed the COMLEX PE 1 time. I got a great evaluation that stated I functioned well ahead of my class and better than some PGY-2, and several comments about needs to be ranked top 25%, excellent work ethic and interpersonal skills, would be a great addition to the residency, etc. etc. One of the attending physician that liked me even talked to the PD for me TWICE, same with the chief resident. I was not even given an interview at this place, and at the end of the rotation, they told me that it was because I failed the COMLEX PE once. (I have since passed it).

    So, moral of the story is to be really in tune with your app, understand barriers to success/matching, and try to find ways to overcome those barriers. As for me, I have no idea why I failed that exam. All I can do is be truth and inform programs that I did, how I retook it and passed, and how I have overcome that obstacle and dealt with that adversity.
     
  42. alexalex

    alexalex

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    Good luck. I saw you posted that you barely passed ck, did you withhold that info until you were done with interviews? Seems crazy that 18 programs were happy to interview knowing your scores, and then rank you low. Definitely try to contact them next week and find out if there was anything else at play so you prepare for next year and kill step 3. This sucks :/
     
  43. EastCoastEMApplicant17

    EastCoastEMApplicant17

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    Thanks for the words of support and to those who have hashed out some strategy for us. I released CK immediately per the advice of my PD; got half my interviews before half after. Will definitely contact the programs, I imagine it was just a rough year. I am a forward looking person and know that I will give EM my best shot again next year after working my hardest clinically at my prelim spot and prepare for a happy life as some form of internist should that be where things take me.
     
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  44. zyx189

    zyx189

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    First and foremost, I am sorry for any and all that did not match. I sincerely wish you the best of luck in your application and hope to see you as my future ED colleagues.

    Out of curiosity, another option I have heard is people delaying graduation for a year and reapplying the following year instead of SOAP. What are people's thought on that? Obviously you'd be giving up a year of salary and have to pay tuition for that year.
     
  45. Smiths11

    Smiths11 5+ Year Member

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    I can't imagine this to be a better strategy. What advantage does a 5th year student have over a prelim? And as you alluded to, the $100,000 price tag.
     
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  46. gamerEMdoc

    gamerEMdoc Associate PD; EM Clerkship Director Gold Donor

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    Yeah this might be the worst possible strategy Ive ever heard. Honestly, a year as an internship means a year of clinical experience of actually being a physician. And you aren't adding to debt. There is no way I'd even want to interview someone that failed to match and decided to go back and do another year of med school instead of getting actual physician experience. That just shows a striking lack of insight IMO.
     
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  47. bjs317

    bjs317 7+ Year Member

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    Congrats to those who matched! Enjoy the week, live it up with your friends. Friday will be a day you will never ever forget.

    My condolences to those who did not match. You are living through hell right now and I can imagine how awful that feels.

    Some encouragement / advice from a graduating PGY-4 who is at a "top" program that I've seen ranked #1 on multiple ROLs on the ROL thread:
    1) We have matched a surgical prelim to our program in the past 5 years.
    2) We have matched a first time Step 1 fail to our program after an audition rotation revealed they were an excellent candidate
    3) You may not want to hear it, but maybe EM is not your soulmate. It seems there has been a sizable increased in medical student interest in EM over the last number of years, which I think is secondary in some part to perceived favorable pay and work/life balance. Let me tell you, EM is not a lifestyle specialty. Dermatology and RadOnc are lifestyle specialties. Shift work sleep disorder is real, as are weekend and holiday shifts. Don't get me wrong, I think it's a way better lifestyle than most surgical specialties, IM, Peds, FM. The spread in compensation is HUGE depending on community vs academic and geographical location. Of course, money isn't everything, but it's a consideration. I'm very happy in EM. My point is, if you think you can SOAP into an alternative field such as Anesthesiology (similar to EM in that it is heavily procedural, lots of great physiology/pathology, pretty well compensated) or Radiology, you should think about this. Personally,I would favor a guaranteed categorical Anesthesia/Radiology spot rather than take my chances with a prelim Surgery (aka a year of absolute scut work and possible abuse) and a possible non-EM match again next year. There are many success stories out there, but personally, the stress wouldn't be worth it to me.
     
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  48. em2017plz

    em2017plz

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    So surg prelim>FM? How does finishing out FM residency look to EM programs vs a year of surgical prelim?

    Still at a loss what to do. Was told by surgeon that the prelim would essentially be a waste for someone not doing surgery (esp if there's no EM program there)--you do scut and when they're done using you, that's it.

    My understanding is you would also burn bridges to reapply during an FM residency, potentially lose your spot if you again go unmatched, not to mention let your fellow residents down, which I don't want to do.

    It's just difficult to not try again when your heart was set.

    Edit: for reapplication, you need new SLOEs right. Can anyone comment on how to go about that during a surgery prelim?
     
    Last edited: Mar 14, 2017
  49. racerwad

    racerwad 7+ Year Member

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    You do need new SLOEs and you must schedule time off to do an away to get them. The limited scheduling flexibility is what makes a surgical prelim somewhat less appealing than medicine.
     
  50. EMedGrrl

    EMedGrrl 10+ Year Member

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    The benefit is that you can still be a student, get some more clinical/away rotations, maybe do some research, buff your application for next year. Less preferable than doing a PGY-1 year, but more flexible for interview scheduling, and WAY preferable to doing a research year or other non-resident, non-student status.
     

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