SOAP'ed into EM and now feeling lost - any advice appreciated

[penguin2018]

Long post incoming – TL;DR at the end.

So I want to start off by saying this is a very hard post for me to write. I’ve actually sat on it for a while not sure if I should even post it. I am not looking for sympathy, and while there are some things that happened out of my control, I know that the majority of my situation is due to my own short comings. I am trying to make the best of the situation I am in. I have also read SDN for a long time, but this is my first time posting, so I’m not really sure if this is the right forum. I guess I’m not a medical student anymore, but I’m not technically a resident yet either.

I recently graduated with my MD. What should be a time of celebration is, unfortunately, not. I was always a below average medical student, but everyone thought I would be OK. The match did not go the way I expected, and for a few weeks, I was pretty despondent, but now that I’ve graduated officially, the reality of the situation has hit me and I realize I need to take the reins.

###Not sure the history really matters, but I’m sure some people will want to know how I got to this point. Skip to the next ### if you don’t care

Long story short – started med school at a mid-tier public school, they had us in outpatient clinics from the get go. Really liked outpatient care and thought that’s what I wanted to do. During my second year of medical school, my mother fell ill and this resulted in a lot of me travelling back and forth out of state. This probably affected my Step 1 score, which, while passing, was below average. 3rd year went well, I liked some of my inpatient rotations too and was thinking maybe IM where I had the option of doing both. Step 2 had a lot of improvement but realistically, I was told to apply both IM and FM since I was geographically restricted as I wanted to be close to my parents. My mom may start needing more care and I wasn’t willing to miss out on the final years of my mother’s life which residency would take up most of her remaining time. (My mother is now terminal—should still have a few years left, but a decade would be stretching it.)

I was reassured by people at my school that I would likely be able to match into something primary care and in my geographical region, but looking back, I think my radius was too small and realistically, I needed a wider radius. I was considering taking some time off just to spend with family between med school and residency, but was advised that would hurt my future chances at matching and that they were sure I could match into my city of choice with the programs that are there. I probably should have looked at other nearby cities as well, and just ranked in order of distance looking back on things. After failing to match, I was faced with a tough choice—apply to SOAP at other programs some of which may be out of state, delay graduation, or look into other specialties with spots near where I wanted to be. I chose the last option and found there were EM spots in the city I wanted to be in and a few between 1-2 hours away from that city. Once again, I’m not sure I got the best advice, and there was a lot of last minute decisions and I’m not sure I made the best decision, but I SOAPed in the first round into an EM program that is in the city I wanted to be in. I’m guessing I was a pretty strong candidate from this perspective, as I had multiple first round SOAP offers. I chose based on distance.

###

So here’s the problem: I know basically nothing about EM. We were required to do 4 weeks as a 4th year, but I did mine at a community site that was known for being “easy” with little work and short hours. At this point, I will likely be doing at least a year of EM as an intern, so my first question is how do I even prepare for this?

My second question is what do I do after this year? I will save the non-EM pathway questions (such as wait for an open FM position in my area (unlikely to happen) and try to move programs after the 45 day or 60 day NRMP Match restriction, or reapply to Match next year though I’m not sure how I stay in my geographical region as a reapplicant as I hear it’s even harder and if I didn’t get in the first time…) for another post in a more appropriate forum, but I am wanting to know what options I have if I complete this residency.

I liked outpatient medicine the most but I also enjoyed inpatient medicine. I know FM docs have a pathway to practicing EM. Is there any similar such pathway for EM trained docs? Reading on this forum, it seems like there isn’t a lot of options for EM docs to transition in to the outpatient setting and the few that exist aren’t recommended (med spa, addiction medicine/pain medicine, etc).

Other than the clinical setting of the outpatient world (things I liked included the idea of having a patient panel and following them longitudinally, having a set schedule and not being inundated with patients all at once) which I obviously won’t be able to replicate, I also liked the lifestyle—not having to work evenings, nights, weekends, unless I wanted to do inpatient etc. How realistic is it to practice in an ER that has dedicated night/weekend people? I understand I’d probably have to take a pay cut as compared to those willing to work the less desirable shifts, but if I told a recruiter that I was only willing to work days, but at a lot less than the “market rate” would that be within the realm of possibility or would I be laughed out of there? Outpatient hours for outpatient pay type thing?

The only other idea I have been able to come up with is going to urgent care out of residency. I wouldn’t get the patient panel, but I would get the outpatient clinic type work, and daytime hours only. From what I can tell, a bit of a pay bump from PCP work as well. Is this even feasible or would it be just as bad of an idea as trying to be a PCP out of EM residency since I won’t have trained to be practicing that sort of medicine?

At this point I think I’m just rambling, but I’m all ears for ideas anyone has.

TL;DR:

SOAP’ed into EM due to geographical restrictions after not getting into an IM or FM spot. I really like the outpatient setting and trying to figure out how to make the best of my situation.

1. What do I need to do now to be ready for intern year given that I have basically no EM experience (rotated through an easy community site where I saw a few patients per day and then was cut loose)?

2. If I have no other options other than to stay in my EM program (I will make a separate post in another forum to discuss how to change out of EM), what options do I have after residency to at least get the lifestyle I want if I can’t get the practice environment I want?

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[BoardingDoc]

Long post incoming – TL;DR at the end.

So I want to start off by saying this is a very hard post for me to write. I’ve actually sat on it for a while not sure if I should even post it. I am not looking for sympathy, and while there are some things that happened out of my control, I know that the majority of my situation is due to my own short comings. I am trying to make the best of the situation I am in. I have also read SDN for a long time, but this is my first time posting, so I’m not really sure if this is the right forum. I guess I’m not a medical student anymore, but I’m not technically a resident yet either.

I recently graduated with my MD. What should be a time of celebration is, unfortunately, not. I was always a below average medical student, but everyone thought I would be OK. The match did not go the way I expected, and for a few weeks, I was pretty despondent, but now that I’ve graduated officially, the reality of the situation has hit me and I realize I need to take the reins.

###Not sure the history really matters, but I’m sure some people will want to know how I got to this point. Skip to the next ### if you don’t care

Long story short – started med school at a mid-tier public school, they had us in outpatient clinics from the get go. Really liked outpatient care and thought that’s what I wanted to do. During my second year of medical school, my mother fell ill and this resulted in a lot of me travelling back and forth out of state. This probably affected my Step 1 score, which, while passing, was below average. 3rd year went well, I liked some of my inpatient rotations too and was thinking maybe IM where I had the option of doing both. Step 2 had a lot of improvement but realistically, I was told to apply both IM and FM since I was geographically restricted as I wanted to be close to my parents. My mom may start needing more care and I wasn’t willing to miss out on the final years of my mother’s life which residency would take up most of her remaining time. (My mother is now terminal—should still have a few years left, but a decade would be stretching it.)

I was reassured by people at my school that I would likely be able to match into something primary care and in my geographical region, but looking back, I think my radius was too small and realistically, I needed a wider radius. I was considering taking some time off just to spend with family between med school and residency, but was advised that would hurt my future chances at matching and that they were sure I could match into my city of choice with the programs that are there. I probably should have looked at other nearby cities as well, and just ranked in order of distance looking back on things. After failing to match, I was faced with a tough choice—apply to SOAP at other programs some of which may be out of state, delay graduation, or look into other specialties with spots near where I wanted to be. I chose the last option and found there were EM spots in the city I wanted to be in and a few between 1-2 hours away from that city. Once again, I’m not sure I got the best advice, and there was a lot of last minute decisions and I’m not sure I made the best decision, but I SOAPed in the first round into an EM program that is in the city I wanted to be in. I’m guessing I was a pretty strong candidate from this perspective, as I had multiple first round SOAP offers. I chose based on distance.

###

So here’s the problem: I know basically nothing about EM. We were required to do 4 weeks as a 4th year, but I did mine at a community site that was known for being “easy” with little work and short hours. At this point, I will likely be doing at least a year of EM as an intern, so my first question is how do I even prepare for this?

My second question is what do I do after this year? I will save the non-EM pathway questions (such as wait for an open FM position in my area (unlikely to happen) and try to move programs after the 45 day or 60 day NRMP Match restriction, or reapply to Match next year though I’m not sure how I stay in my geographical region as a reapplicant as I hear it’s even harder and if I didn’t get in the first time…) for another post in a more appropriate forum, but I am wanting to know what options I have if I complete this residency.

I liked outpatient medicine the most but I also enjoyed inpatient medicine. I know FM docs have a pathway to practicing EM. Is there any similar such pathway for EM trained docs? Reading on this forum, it seems like there isn’t a lot of options for EM docs to transition in to the outpatient setting and the few that exist aren’t recommended (med spa, addiction medicine/pain medicine, etc).

Other than the clinical setting of the outpatient world (things I liked included the idea of having a patient panel and following them longitudinally, having a set schedule and not being inundated with patients all at once) which I obviously won’t be able to replicate, I also liked the lifestyle—not having to work evenings, nights, weekends, unless I wanted to do inpatient etc. How realistic is it to practice in an ER that has dedicated night/weekend people? I understand I’d probably have to take a pay cut as compared to those willing to work the less desirable shifts, but if I told a recruiter that I was only willing to work days, but at a lot less than the “market rate” would that be within the realm of possibility or would I be laughed out of there? Outpatient hours for outpatient pay type thing?

The only other idea I have been able to come up with is going to urgent care out of residency. I wouldn’t get the patient panel, but I would get the outpatient clinic type work, and daytime hours only. From what I can tell, a bit of a pay bump from PCP work as well. Is this even feasible or would it be just as bad of an idea as trying to be a PCP out of EM residency since I won’t have trained to be practicing that sort of medicine?

At this point I think I’m just rambling, but I’m all ears for ideas anyone has.

TL;DR:

SOAP’ed into EM due to geographical restrictions after not getting into an IM or FM spot. I really like the outpatient setting and trying to figure out how to make the best of my situation.

1. What do I need to do now to be ready for intern year given that I have basically no EM experience (rotated through an easy community site where I saw a few patients per day and then was cut loose)?

2. If I have no other options other than to stay in my EM program (I will make a separate post in another forum to discuss how to change out of EM), what options do I have after residency to at least get the lifestyle I want if I can’t get the practice environment I want?

1: just show up. Every intern knows basically nothing on day one. That's expected. Make a point of paying attention and learning starting on the first day you arrive.

2: Getting a job in the ED where you don't have to work nights/weekends/holidays is an unrealistic goal. To be clear, by "unrealistic" I mean "that job does not exist in emergency medicine."

If you want that lifestyle, you should plan on doing a fellowship (you mentioned pain as being undesirable. That is generally NOT true, though it certainly isn't for everyone and is also rather competitive.)

Your other option would be to take a job somewhere and simply work as few shifts as possible. The trade here is obviously money. That said, you could make over 200k (pre expenses) pretty easily working only 10 shifts of 9hrs each per month.

 

[Birdstrike]

it sounds like your heart isn’t into EM. That’s good, because EM is tough enough to do for a career when your heart is fully into it, let alone when it’s not.

My advice: Work towards getting an IM spot somewhere. Even if that means doing a full year of EM then starting over in IM (or FM) the year’s experience will put you way ahead over other incoming first year IM (or FM) residents.

Who told you Pain and addiction medicine “aren’t recommended” as if it’s established fact and not opinion? I did EM for a very difficult, turbulent decade. Now I’ve done Pain for a much more content, smooth-sailing decade. There are a lot of things about Pain that make it highly recommendable, perhaps more so than EM, for a lot of people.

 

[turkeyjerky]

Do you have an FM or IM advisor at your school you can reach out to for more personalized advice? If so, I would do that. Your best bet might be try to ingratiate yourself with the IM or FM program associated with your residency program's institution, and switch after intern year (you might even get lucky enough that one of theirs is interested in switching into EM).

If you do stick it out, you might want to look into 1) Sports Med fellowships (basically MSK primary care) or 2) Jobs at the VA (see other thread on this)

Holy ****, this is how far EM has fallen. 10 years ago, a plurality of my classes' AOA members went into EM, and now we're a backup for FM?

 

[DeadCactus]

1. The program will teach you what you need to know. Just show up with a good attitude. a willingness to learn, and put in the work their curriculum asks you to. If you want to do some pre-reading: find a review article on intubation, sepsis/pressors, reading an EKG, working up chest pain, and working up abdominal pain. That should take you a couple of hours and is more than enough. And I mean one review article or chapter for orientation to the topic, not studying for hours to try to master anything.

2. Urgent Care jobs sound like they would be a good fit for what you want but would involve some evenings. Then maybe branch out to specialty non-specific medicine that interests you. Stuff like wound care, "Men's health", flight medicine, etc. There are some fellowships that might entice you like Sport's Medicine or Hyperbaric Medicine but at that point you might also just want to consider doing a second residency in FM/IM or Occupation Medicine/Preventative Medicine.

The big question for you is whether primary care is a passion and worth pursuing even if you end up needing to sacrifice a few extra years in training or is your priority a relatively relaxed job with normal hours. If it's the former, your options all basically revolve around getting into an IM or FM training program. If it's the latter, you have more options but will need to be a bit entrepreneurial and be ready to deal with negativity from people who don't understand (or know anything about) what you're trying to do.

 

[WilcoWorld]

Holy ****, this is how far EM has fallen. 10 years ago, a plurality of my classes' AOA members went into EM, and now we're a backup for FM?

That was my first thought as well. And maybe it's true?!?


On the other hand, without knowing the OP's full story (which I wouldn't blame the OP for choosing to keep private) it's hard to know what to make of this. If they scrambled into an CMG spot in Nowheresville, FL then this may not mean much. If they scrambled into a spot in an established program in Minneapolis, Denver or Chicago...yikes!

 

[Tenk]

Don’t worry. Since Covid, outpatient medicine has gotten even lazier and we now do more outpatient medicine than ever before!

 

[Splenda88]

Do you have an FM or IM advisor at your school you can reach out to for more personalized advice? If so, I would do that. Your best bet might be try to ingratiate yourself with the IM or FM program associated with your residency program's institution, and switch after intern year (you might even get lucky enough that one of theirs is interested in switching into EM).

If you do stick it out, you might want to look into 1) Sports Med fellowships (basically MSK primary care) or 2) Jobs at the VA (see other thread on this)

Holy ****, this is how far EM has fallen. 10 years ago, a plurality of my classes' AOA members went into EM, and now we're a backup for FM?

I guess many weren't doing EM because they love EM. $300/hr was very attractive 10 yrs ago.

 

[Dr Mantis Toboggan]

Don’t worry. Since Covid, outpatient medicine has gotten even lazier and we now do more outpatient medicine than ever before!

Honest question, is pre authorization for US CT MRI etc really that hard to get?

Or are these PCPs who send non emergent patients to the ED for these scans just being lazy?

 

[VA Hopeful Dr]

Honest question, is pre authorization for US CT MRI etc really that hard to get?

Or are these PCPs who send non emergent patients to the ED for these scans just being lazy?

Yes.

Mixed bag but probably some are.

 

[Tenk]

Honest question, is pre authorization for US CT MRI etc really that hard to get?

Or are these PCPs who send non emergent patients to the ED for these scans just being lazy?

That’s not the problem. That’s been there forever.

Fever? Cough? Any symptom of being ill?

Don’t bring that **** to the office, go see the “heroes” in the emergency department and let them deal with it!!!

 

[BoardingDoc]

That’s not the problem. That’s been there forever.

Fever? Cough? Any symptom of being ill?

Don’t bring that **** to the office, go see the “heroes” in the emergency department and let them deal with it!!!

My friend has a 3 yr old daughter. She developed a fever and so they went to bring her to the pediatrician. The pediatrician's response? "If you have a fever you can not come to the office for a sick visit until you have a negative COVID PCR test result."

What the ever living f***. I told them to get a new pediatrician.

As to the nonemergent scan requests: it depends on what it is. Dvt study? Fine. CT AP for something that could potentially need treatment sooner rather than later? Sure. MRI for literally anything other than a legitimate emergency? Absolutely not.

Honestly, most of the time it's some idiot NP sending someone in for a NCHCT that is in no way indicated and I explain that 1: they don't need a boatload of ionizing radiation to their brain and 2: they should see an actual doctor next time.

 

[RustedFox]

My friend has a 3 yr old daughter. She developed a fever and so they went to bring her to the pediatrician. The pediatrician's response? "If you have a fever you can not come to the office for a sick visit until you have a negative COVID PCR test result."

What the ever living f***. I told them to get a new pediatrician.

As to the nonemergent scan requests: it depends on what it is. Dvt study? Fine. CT AP for something that could potentially need treatment sooner rather than later? Sure. MRI for literally anything other than a legitimate emergency? Absolutely not.

Honestly, most of the time it's some idiot NP sending someone in for a NCHCT that is in no way indicated and I explain that 1: they don't need a boatload of ionizing radiation to their brain and 2: they should see an actual doctor next time.

Urgent cares, too.
True story: I interviewed at a chain urgent care for a PT position about a year and a half back.
They said they'd hire me, but had concerns about "me being bored".
I made more hourly at my other sidegig, so I politely said "maybe you're right; thanks anyways".

Now, I work at the ER in the next town up the highway from that urgent care.
I get their referrals all the time, and say to myself: "Wow. Who is the windowlicker who sent this poor patient here for me to immediately discharge them?"

 

[turkeyjerky]

I guess many weren't doing EM because they love EM. $300/hr was very attractive 10 yrs ago.

Not entirely accurate. 10 years ago average yearly salary was around 250k, so my cohort was going into EM primarily b/c we saw a an attractive arena to practice diagnostic and resuscitation medicine, which was fairly well remunerated considering 3 years of training, albeit w/ a tradeoff nights/weekends/holidays in exchange for lesser total hours. While 300/hr may have been out there at the time, those getting it kept in on the hush-hush to a large part. It wasn't until a few years later when the locums craziness really started to crest.

 

[VA Hopeful Dr]

My friend has a 3 yr old daughter. She developed a fever and so they went to bring her to the pediatrician. The pediatrician's response? "If you have a fever you can not come to the office for a sick visit until you have a negative COVID PCR test result."

What the ever living f***. I told them to get a new pediatrician.

As to the nonemergent scan requests: it depends on what it is. Dvt study? Fine. CT AP for something that could potentially need treatment sooner rather than later? Sure. MRI for literally anything other than a legitimate emergency? Absolutely not.

Honestly, most of the time it's some idiot NP sending someone in for a NCHCT that is in no way indicated and I explain that 1: they don't need a boatload of ionizing radiation to their brain and 2: they should see an actual doctor next time.

At the moment the COVID thing is very location dependent. My office sees everybody in person these days. That would be how I got COVID back in January. My uncle's office 8 miles over doesn't see patients with COVID symptoms, but that's because half the doctors there are over 65 with various health issues while my office all but one of us are under age 40.

 

[Groove]

Eh, I'm having a hard time with this story. Although many things have changed over the years. FM has definitely NOT become any more competitive and looking at the Charting Outcomes for the Match, it still has the lowest USMLE scores for matched applicants compared to virtually all other specialties. You have a 90% chance of matching simply from ranking 4-5 places. 93% of the applicants who had a USMLE Step 1 score between 191 - 200...MATCHED. There were 4,662 total positions offered in the 2020 match and only 1,459 were filled. That's a massive number of open spots each and every year that go unfilled.

Anybody that can't find an open FM spot either has the absolute worst MATCH strategy on the planet along with the worst medical school advisor or there's something else going on. If you wanted FM and you sacrificed it simply because you didn't want to go very far from home....well....that's just insane. Traveling away from home to get training is just what you do during residency. Why does it matter that you'll be away from home? 3 years is over in a blink and you can go anywhere you want after that.

I'd try to swap out of EM into an open FM spot. I can't imagine it would be very hard and just pick a place where you can get decent training and quit focusing on the area/location/region. It has so little to do with anything in the long term.

 

[BoardingDoc]

At the moment the COVID thing is very location dependent. My office sees everybody in person these days. That would be how I got COVID back in January. My uncle's office 8 miles over doesn't see patients with COVID symptoms, but that's because half the doctors there are over 65 with various health issues while my office all but one of us are under age 40.

I understand that logic, but I still don't really get it in practice. Given that I have no control over who comes into the ED, I've been wearing my Envo mask for every single patient encounter for the past 2 years regardless of chief complaint. I feel like it would be trivially easy for those other groups you mentioned to simply wear a mask when seeing patients with covid sx.

At the end of the day, I find the entire idea absurd. You could agree to see everyone, take appropriate simple precautions and be fine. Alternatively, you can refuse to see patients with covid sx, presumably NOT gear up and then still have someone show up in your office, either through stupidity or deception, who has covid.

 

[BoardingDoc]

Eh, I'm having a hard time with this story. Although many things have changed over the years. FM has definitely NOT become any more competitive and looking at the Charting Outcomes for the Match, it still has the lowest USMLE scores for matched applicants compared to virtually all other specialties. You have a 90% chance of matching simply from ranking 4-5 places. 93% of the applicants who had a USMLE Step 1 score between 191 - 200...MATCHED. There were 4,662 total positions offered in the 2020 match and only 1,459 were filled. That's a massive number of open spots each and every year that go unfilled.

Anybody that can't find an open FM spot either has the absolute worst MATCH strategy on the planet along with the worst medical school advisor or there's something else going on. If you wanted FM and you sacrificed it simply because you didn't want to go very far from home....well....that's just insane. Traveling away from home to get training is just what you do during residency. Why does it matter that you'll be away from home? 3 years is over in a blink and you can go anywhere you want after that.

I'd try to swap out of EM into an open FM spot. I can't imagine it would be very hard and just pick a place where you can get decent training and quit focusing on the area/location/region. It has so little to do with anything in the long term.

I suspect you just read OP's TL;DR which leaves out some critical details.
1: They applied to a extremely narrow geographic radius, which likely explains the failure to match.
2: They then SOAPed into EM in their target city
3: The idea of not focusing on area/location/region runs counter to OPs primary desire to be able to live near his terminally ill mother while he's in residency as she may not survive past graduation.

 

[VA Hopeful Dr]

I understand that logic, but I still don't really get it in practice. Given that I have no control over who comes into the ED, I've been wearing my Envo mask for every single patient encounter for the past 2 years regardless of chief complaint. I feel like it would be trivially easy for those other groups you mentioned to simply wear a mask when seeing patients with covid sx.

At the end of the day, I find the entire idea absurd. You could agree to see everyone, take appropriate simple precautions and be fine. Alternatively, you can refuse to see patients with covid sx, presumably NOT gear up and then still have someone show up in your office, either through stupidity or deception, who has covid.

I wore my N95 every single day in January, new one every day, still got COVID. I'm not going to judge the 72 year old with Crohn's for not wanting to take a chance. That office, and other doctors that do the same, still mask up for every patient and do screening at the front desk and when rooming the patient. For the ones I know personally, they haven't seen anyone that slipped through all of that.

It's not ideal but better them do that than just retire.

 

[Groove]

I suspect you just read OP's TL;DR which leaves out some critical details.
1: They applied to a extremely narrow geographic radius, which likely explains the failure to match.
2: They then SOAPed into EM in their target city
3: The idea of not focusing on area/location/region runs counter to OPs primary desire to be able to live near his terminally ill mother while he's in residency as she may not survive past graduation.

Ah, that makes more sense. That’s what I get for blasting through at warp speed. It was a long post!

OP, sorry about your mom. Wish I had some words of wisdom for you but I don’t… Good luck.

 

[turkeyjerky]

I wore my N95 every single day in January, new one every day, still got COVID. I'm not going to judge the 72 year old with Crohn's for not wanting to take a chance. That office, and other doctors that do the same, still mask up for every patient and do screening at the front desk and when rooming the patient. For the ones I know personally, they haven't seen anyone that slipped through all of that.

It's not ideal but better them do that than just retire.

Perhaps they should come to a practice agreement w/ another physician or group to which they can refer their urgent care visits, rather than just abdicating their responsiblity for the patients. I mean, this virus has been around for two and a half years now. Can't really call it novel anymore.

 

[VA Hopeful Dr]

Perhaps they should come to a practice agreement w/ another physician or group to which they can refer their urgent care visits, rather than just abdicating their responsiblity for the patients. I mean, this virus has been around for two and a half years now. Can't really call it novel anymore.

We've got that, we have a good number of hospital owned urgent cares that see most of this stuff.

As for abdicating care, hogwash. Plenty of primary care pre-Covid had such busy schedules that they couldn't see any of their acute visits.

 

[Toomuchtuna]

There were 4,662 total positions offered in the 2020 match and only 1,459 were filled.

I'm just wondering if this is a typo, or if you are only counting US MD students? For example, in 2022, 4,470 students matched into one of the 4,935 FM positions offered (source: Match Analysis).

And according to this (Match: Which specialties place most residents through SOAP), 348 FM residents SOAPed in 2021. 348 residents out of ~4,870 FM positions in 2021 actually is a smaller percentage compared to the roughly 220 residents who SOAPed into one of the 2,900 EM positions this year...although that would still leave several hundred unfilled FM spots and (I think) 2 unfilled EM spots after SOAP. There is also a great chance my math is wrong or I am misreading your post. Cheers.

 

[TulaneUnderdog]

Meanwhile just a year ago; I applied to 40 EM programs, ranked all of them who interviewed me to the top of my list ; and still ended up sliding off the list and blindsided to IM. A year too early :/

 

[Splenda88]

Meanwhile just a year ago; I applied to 40 EM programs, ranked all of them who interviewed me to the top of my list ; and still ended up sliding off the list and blindsided to IM. A year too early :/

That might be a blessing in disguise. Go do your GI or Heme/Onc fellowship and you will get the permission to start printing $$$ while having a reasonable lifestyle.

 

[Beeftenderloin]

You never know how your interests may change and evolve over time. I failed to match into EM, SOAPed into anesthesia. I’m now finishing a fellowship in a field I absolutely love but barely knew existed as a med student.

At the time I was completely devastated. After a couple months of getting down on myself and feeling like an abject failure, I got my head right, decided to just go all in on anesthesia and see how it goes. Now half a decade later, I couldn’t imagine doing anything else with my life career-wise. Try to keep an open mind.

 

[Groove]

I'm just wondering if this is a typo, or if you are only counting US MD students? For example, in 2022, 4,470 students matched into one of the 4,935 FM positions offered (source: Match Analysis).

And according to this (Match: Which specialties place most residents through SOAP), 348 FM residents SOAPed in 2021. 348 residents out of ~4,870 FM positions in 2021 actually is a smaller percentage compared to the roughly 220 residents who SOAPed into one of the 2,900 EM positions this year...although that would still leave several hundred unfilled FM spots and (I think) 2 unfilled EM spots after SOAP. There is also a great chance my math is wrong or I am misreading your post. Cheers.

No, you're probably right. I think I was looking at Charting Outcomes for those numbers and probably misquoted but basically my point was that FM historically has a sizable amount of unfilled spots as well as IM. 2022 match had about 10% unfilled spots for FM according to this. FM definitely has the lowest USMLE scores per Charting Outcomes. So, it's generally been pretty easy to match into FM/IM if you are willing to go anywhere. That doesn't apply to the OP I suppose since I had missed the fact that he was trying to stay near his mother.

 

[Groove]

That might be a blessing in disguise. Go do your GI or Heme/Onc fellowship and you will get the permission to start printing $$$ while having a reasonable lifestyle.

This. Count your blessings. If I had to do it all over, I'd have happily chosen FM and wouldn't be on point for my major MI which will probably happen around 53.

 

[Groove]

This. Count your blessings. If I had to do it all over, I'd have happily chosen FM and wouldn't be on point for my major MI which will probably happen around 53.

Or maybe I'm just grumpy today.