SOAP Planning

[IH8ColdWeath3r]

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.

I was told by APD at University program that you did NOT need new SLOES the following year and that they could use your prior SLEOs because they understand how hard it is to do an away during a PGY-1 year.

GamERdoc brings a up a great point. The year of clinical experience and actually working in the hospital and having the autonomy to see your own patients and put in orders seems like a plus. But, if you're someone who got great EM feedback and has decent board scores on step 1 and 2, and want to do EM, and you're sitting on categorical IM interview, then what is the best option?

Perhaps additional away rotations to show that you have what it takes clinically to be successful in EM would outweight the prospect of participating in a 3 year residency that you know, in the end of the day, you won't be using because you will reapply to EM, even after 3 years.

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[GandalfTheWhite]

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.

Doesnt remaining in medical school put you in the pool of AMG instead of having to apply as an IMG, making it harder to interview and get accepted?

 

[gutonc]

Doesnt remaining in medical school put you in the pool of AMG instead of having to apply as an IMG, making it harder to interview and get accepted?

You're conflating and confusing different acronyms. An AMG is an AMG no matter how many years they take to graduate. An IMG (the I is for International, not Independent) will always be such.

But yes, as a "Graduating AMG" your app will be viewed more favorably (rightly or wrongly) than as an independent applicant.

Putting aside the money issue (which is huge, but not all that huge when compared to a career asking "you want fries with that?" with a half million worth of student loans hanging over your head), the 5th year as a student allows one to get fresh LORs, more clinical experience, do research and otherwise buff a borderline app (or create an app for a different specialty altogether), that one can't do as a prelim.

I'm not saying it's the right thing for everyone, but it shouldn't be dismissed out of hand.

 

[Anti-PD1]

Asking for a friend, goes to an Ivy medical school, good student.

He didn't match. Should he defer graduation and do a research year, or do a prelim year in IM/Surgery/TY?

 

[Lexdiamondz]

Asking for a friend, goes to an Ivy medical school, good student.

He didn't match. Should he defer graduation and do a research year, or do a prelim year in IM/Surgery/TY?

Damn, even his home program didn't take him?

 

[DokterMom]

Asking for a friend, goes to an Ivy medical school, good student.

He didn't match. Should he defer graduation and do a research year, or do a prelim year in IM/Surgery/TY?

What specialty? And why didn't he match? What were his weak areas?

 

[Anti-PD1]

Damn, even his home program didn't take him?

He only got a handful of interviews. He has decent scores. One of those failing to apply broadly situations. He had a geographic preference, which was probably not helpful.

 

[Anti-PD1]

What specialty? And why didn't he match? What were his weak areas?

For EM. I think it was not applying broadly enough. He only did 1 away rotation. No real research on his CV.

 

[DokterMom]

Not sure that a research year would help him much for EM.
SOAP does offer the opportunity to choose your geography if he's got multiple interviews. But doing more away rotations would be difficult.

IM program in a hospital with EM residency?

 

[Anti-PD1]

Not sure that a research year would help him much for EM.
SOAP does offer the opportunity to choose your geography if he's got multiple interviews. But doing more away rotations would be difficult.

IM program in a hospital with EM residency?

He has that opportunity. He's afraid of ending up stuck in IM. I imagine the stats on matching into EM after a prelim year are hard to come by.

The research year is fully funded.

Apparently there aren't any SOAP positions left.

 

[shoal007]

I can add my personal experience as i feel its helpful. I failed to match my first go around (9 interviews). I attempted transitional year programs and no acceptances. i considered im, fm, and surg prelim. I almost took a FM spot but knew i would not be happy. I ended up doing EM research for a year, published 2 papers and presented at conference. i also kept involved in ski patrol. You cannot do any medical rotations as a graduate MD due to malpractice risks. I had an updated SLOE due to my research.

I thought long and hard and applied to 3 IM programs with backup of pulm/cc. i had 15 EM interviews (5 repeat), 3 IM interviews. I was told I didnt match as i overreached and was just off the rank list. I matched at number 5. I am so glad i stuck with it.

My downfall was my slightly below average board scores and average SLOE. As an attending, I scored 90%+ on my ABEM boards and am highly regarded by staff and patients.

I interviewed and rotated with a doctor as a medical student who also didnt match the first time around. He did a surg prelim year and matched the following year. We interviewed at many of the same places. He ended up being a chief resident. You need to br motivated, work hard, stay humble and focus on your weaknesses. With these, you might have a chance at matching. Be certain however, it may not work out and please have a backup. 3Rd time applicants are pretty much a no go for many if not all fields. PM me if youd like.

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[gutonc]

He has that opportunity. He's afraid of ending up stuck in IM.

Is he/are you more afraid of being "stuck in IM" than he/you is/are of being stuck trying to pay off a quarter mil of student loans while working at Starbucks?

Beggars can't be choosers.

 

[Anti-PD1]

Is he/are you more afraid of being "stuck in IM" than he/you is/are of being stuck trying to pay off a quarter mil of student loans while working at Starbucks?

Beggars can't be choosers.

Haha, good point. It's him, I'm crazy about neurosurgery, I assure you.

I've mentioned that to him as well. I wish there were more stats for this kind of thing to help guide a decision.

 

[gutonc]

Haha, good point. It's him, I'm crazy about neurosurgery, I assure you.

I've mentioned that to him as well. I wish there were more stats for this kind of thing to help guide a decision.

The stats are...beggars can't be choosers. Get on a track to a career. It's easier to change tracks once you're on one than it is to keep trying to hop on the same track you keep getting thrown off of.

 

[racerwad]

I was told by APD at University program that you did NOT need new SLOES the following year and that they could use your prior SLEOs because they understand how hard it is to do an away during a PGY-1 year.

GamERdoc brings a up a great point. The year of clinical experience and actually working in the hospital and having the autonomy to see your own patients and put in orders seems like a plus. But, if you're someone who got great EM feedback and has decent board scores on step 1 and 2, and want to do EM, and you're sitting on categorical IM interview, then what is the best option?

Perhaps additional away rotations to show that you have what it takes clinically to be successful in EM would outweight the prospect of participating in a 3 year residency that you know, in the end of the day, you won't be using because you will reapply to EM, even after 3 years.

I have not heard of not needing new SLOEs. It seems counter-intuitive to me, although I certainly see the appeal. If it were me, I would want to do everything in my power to have a better app the next time around, not the same one with a year as a prelim somewhere. I think if you were able to get a SLOE knowing how difficult it is to get one as a prelim only speaks to your dedication and organization.

If it were me having to choose between prelim or categorical IM with the intention of someday applying EM, I'd do the prelim or research year as @shoal007 describes. I would do everything I can to make it clear to anyone who reviews my application that I am fully committed to EM. Of course, that is easy for me to say as I'm not the one who has to live with that decision.

I'm sorry you're in this spot. Good luck.

 

[IH8ColdWeath3r]

I have not heard of not needing new SLOEs. It seems counter-intuitive to me, although I certainly see the appeal. If it were me, I would want to do everything in my power to have a better app the next time around, not the same one with a year as a prelim somewhere. I think if you were able to get a SLOE knowing how difficult it is to get one as a prelim only speaks to your dedication and organization.

If it were me having to choose between prelim or categorical IM with the intention of someday applying EM, I'd do the prelim or research year as @shoal007 describes. I would do everything I can to make it clear to anyone who reviews my application that I am fully committed to EM. Of course, that is easy for me to say as I'm not the one who has to live with that decision.

I'm sorry you're in this spot. Good luck.

Great points, thank you. One question, how could one question someones dedication/intention when they are willing to go endure a 3 year residency and then apply to EM again. In that 3 years of clinical training, doesn't that resident, who has made it through one residency, and gained a lot of experience and presumably procedural skills as well, seem at least as marketable if not more marketable than your MS-IV?

If I went IM, I would try to stay involved in EM, either through EMRA or a podcast idea (with the help of an attending) that I have or both. Might try to do some EM related research as well at the affiliated EM program. Wouldn't these things, coupled with the above, give me at least a good chance of matching despite the 6 year vs 3 year route?

Also, it is hard to do pre-lim anything when the only offers made available to you are categorical IM. Isn't that a reasonable exception when someone asks why you did not do a pre-lim?

 

[Babycatsinabag]

People keep saying how expensive it is to stay an extra year in medical school, but there are some options around it. I would advice folks considering this option to talk to your admin/deans/financial aid offices. I know a couple people who were allowed to stay as MSV and who only had to pay partial tuition. Some schools will offer deals like this where you are only officially enrolled for some part of the year. On your "off" time you can do research and/or interviews and in your enrollee time you can do an away rotation and some ultrasound elective or whatever. I know you still accrue interest and that it's financially rough, but it's one more option for those who really need new SLOE or would like to apply as graduating AMG.
Doing IM with plans to do EM in the future should work, but 6 years of residency may change your mind. Maybe do that prelim year instead, kill step 3, and reapply broadly. Good luck.

 

[Tenk]

People keep saying how expensive it is to stay an extra year in medical school, but there are some options around it. I would advice folks considering this option to talk to your admin/deans/financial aid offices. I know a couple people who were allowed to stay as MSV and who only had to pay partial tuition. Some schools will offer deals like this where you are only officially enrolled for some part of the year. On your "off" time you can do research and/or interviews and in your enrollee time you can do an away rotation and some ultrasound elective or whatever. I know you still accrue interest and that it's financially rough, but it's one more option for those who really need new SLOE or would like to apply as graduating AMG.
Doing IM with plans to do EM in the future should work, but 6 years of residency may change your mind. Maybe do that prelim year instead, kill step 3, and reapply broadly. Good luck.

It's more like you lose a year of potential attending salary than anything else.

 

[racerwad]

Great points, thank you. One question, how could one question someones dedication/intention when they are willing to go endure a 3 year residency and then apply to EM again. In that 3 years of clinical training, doesn't that resident, who has made it through one residency, and gained a lot of experience and presumably procedural skills as well, seem at least as marketable if not more marketable than your MS-IV?

If I went IM, I would try to stay involved in EM, either through EMRA or a podcast idea (with the help of an attending) that I have or both. Might try to do some EM related research as well at the affiliated EM program. Wouldn't these things, coupled with the above, give me at least a good chance of matching despite the 6 year vs 3 year route?

Also, it is hard to do pre-lim anything when the only offers made available to you are categorical IM. Isn't that a reasonable exception when someone asks why you did not do a pre-lim?

I see you angle, and I don't discount it, but I'm not sure that is how I would play it - but in the end, my opinion is worth what you paid for it. Remember, no residency is looking for fully trained physicians, so I'm not sure how useful the experience gained would be. Also, most IM residencies aren't particularly procedure-heavy, so again this might be of diminishing returns. The flip-side is that you might be the only one among your IM class that is interested in procedures, so you might get a lot.

There are pros and cons to both sides and the best decision is the one that causes the least amount of ulcer growth in this stressful time.

 

[IH8ColdWeath3r]

I see you angle, and I don't discount it, but I'm not sure that is how I would play it - but in the end, my opinion is worth what you paid for it. Remember, no residency is looking for fully trained physicians, so I'm not sure how useful the experience gained would be. Also, most IM residencies aren't particularly procedure-heavy, so again this might be of diminishing returns. The flip-side is that you might be the only one among your IM class that is interested in procedures, so you might get a lot.

There are pros and cons to both sides and the best decision is the one that causes the least amount of ulcer growth in this stressful time.

I really appreciate your perspective. I will be contacting PDs at places that I interviewed and asking for their specific opinion and will present my proposed option. It will be very interesting and insightful to hear their advice.