The Journey from FM to EM – The Conclusion (?) to MonkeyMedic’s Story


2+ Year Member
Mar 20, 2016
I have been posting here for a few years now and some people have asked me for an update. Those interested in my full story can read through previous threads I started. Those who know the story can skip to the ### for the update.

As a recap, I have been seeking advice into getting into EM since my medical school days. My preclinical years were marred with an LOA and a Step 1 failure followed by a passing but mediocre score on the second attempt. Though I rebounded, in M3 and M4 including making Honors in nearly all of my EM rotations (including 3 aways), ultimately I failed to match to EM. My advisor had the foresight to recommend my simultaneous application to critical care heavy, unopposed FM programs and I matched into an unopposed FM program at a level 1 trauma center.

Over the course of my residency, I found a mentor in the Emergency Department and worked my butt off to gain experience. I was advised not to try to leave my FM residency because 1) I didn’t want to lose that spot in an excellent program and 2) the red flags were not for lack of clinical experience, it was for academic difficulties which over time would become less of an issue for PDs. Instead, I hunkered down, and developed a great relationship with the ED attendings during my rotations and even helped out with ED procedures when I was on inpatient call. I took a moonlighting gig as a hospitalist and volunteered to take the ICU shifts (open ICU) to gain more procedure and resuscitation experience. 1500 ED hours, and hundreds of procedures (over 100 intubations and central lines) later, I thought I was as well positioned as possible to make the switch.

But this is not a story with a fairy tale ending. I emailed all 170+ programs in the country to figure out which ones would be willing to accept a re-applicant. Surprisingly most programs actually responded to my email. I eliminated the ones off the list that said they either had no interest or could not due to funding issues and tried to rematch as a PGY-1. Simultaneously, I applied to every open PGY-2 position that came up. I interviewed at 2 match positions (PGY1) and 5 positions outside of the match (PGY2). One particular institution was very promising and even had ABEM evaluate my rotation list to see if I would be eligible to receive 12 months’ worth of credit for my FM training. I had more procedures and resuscitations than most of their graduating residents. Alas, I got the phone call late in May that the PD was going to have to offer the spot to a rising PGY-2 at their own academic institution who was being forced to leave their surgery residency program. It was just bad timing and luck, but my luck and timing would soon turn around.


That spring, I applied to a few EM jobs to start in the summer of 2019. Mostly rural or suburban. I had 5 offers, but the most promising one was a large hospital (trauma center) that had a great need. My luck and timing was finally turning around. They were about to lose 3 full time physicians due to medical or family issues and needed coverage quick. This group covered the trauma center and 3 affiliated rural sites. The medical director had a similar story to my own and took a chance on me. He proposed a 6-12 month trial period where I would always be in double coverage at the trauma center. After he felt he had enough time to evaluate me, I would be sent out to one of the rural sites for coverage and work my way back up the chain to eventually be able to return to the more desirable site (if I so chose, some of my partners are very happy at the rural sites).

I discussed this with my mentor, who unbeknownst to me, had been talking to his SDG to see if they could offer me a position at one of their suburban shops (all new grads in their group start double coverage for the first year). Though they only have a few non-ABEM docs remaining, and they haven’t hired any non ABEM docs in nearly a decade, he and the other senior partners knew me well and thought I might be a good fit. After all, they were the ones that trained me for the last 3 years and as a moonlighting hospitalist, I would find ways to do them some favors when on the other side of the admission. He took a look at my contract offer for the other group, and without a second thought he told me that I should take the contract. He wouldn’t be able to get anywhere close to matching the offer—it was a difference of about $100 per hour and a signing bonus difference of $25k (I was able to negotiate upwards a bit due to them being in dire straits with needing coverage being down 1 doc and soon to be down 3 docs).

So that brings us to today--I started almost exactly 13 months ago. I was “cut loose” after my 6 month time in double coverage, though I really didn’t enjoy the rural sites nearly as much as the “mothership.” Due to a bit of friction between me and my other partners over scheduling (this group usually doesn’t hire new grads, the “double coverage for 6 months” meant I didn’t work a single overnight, and the dedicated nocturnist was one of the docs needing FMLA), I was able to convince them to let me stay at the site I enjoyed more for another few months to take a bunch of nights and weekends to help make up for the fact I only took day shifts for my first 6 months. I now have enough seniority to take about 2-3 twelve hour shifts at the busier spot most months while I spend 3-4 24 hour shifts at my sleepy little ER in the middle of nowhere seeing 15-18 patients per 24 hour period.

So other than just for curiosity of the various members who have helped me out on this forum over the past 5 years, why am I posting this? I am hoping the lessons I learned will help others who are I similar situations in the future. For posterity, I think I can say with a reasonable amount of certainty:

  1. Overcoming an LOA or Step 1 failure is nearly impossible. I had great clinical scores and comments and my SLOEs were all top tier (I accidentally saw them due to a glitch in my institution’s letter system the first time I applied. The second time I applied my SLOEs were also submitted to my permanent residency file for my rotation grades meaning I could view them even though they were marked confidential/waived).
  2. I said *nearly* impossible. There are anecdotes of people doing it, but as I saw for myself, there is a lot of luck and good timing involved. Also, some of the old-timers will tell you about how they were able to switch easily but it is no longer the case. You hear people talk on there all the time about “just switch into EM” or “go do an EM residency” but the reality of the matter is that it is not as easy as it sounds.
  3. The medical education system and the Match place a lot of emphasis on preclinical years and scores, but just because you fail to get into your desired program, or in my case, desired specialty completely, does not make you a failure. I have worked on my own mental health a lot over the last few years, and coming to the realization that I am not a failure has really helped me with my mental well being.
  4. If you are persistent, you’ll eventually get lucky. My path was not what I expected, but here I am, 4 years after my initial failure, and I’m where I wanted to be.
So what are my next steps from here? Well, I’d like to work a little bit closer to home if possible. I have one contingent gig and was hoping to pick up more and eventually turn one of those into a full time job and not have to drive so far for work (I commute about 50-90 minutes depending on what rural site I am going to) but the job market kind of sucks right now. Fortunately, even though I am doing some 24 hour shifts seeing less than 10 patients all day, these are at critical access hospitals for which our pay is guaranteed and protected. I’ll probably start to search more seriously after the pandemic dies down. Unless anything major changes in my life, I think this will probably be the last major update thread I start here. But with the times we live in, who knows what will happen. My region has been shielded a bit more than others, but if pay and hour cuts hit my area too, I could be back here in a year talking about my pivot to become a hospitalist again, going to urgent care, or hanging my own shingle.

All the best,

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Chronically ambitious
15+ Year Member
Sep 19, 2004
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Congrats. I'm happy for you. Your road was not an easy one, but in a way, you now have the best of both worlds. You're working in EM, but if things go awry in terms of prospects, and right now it looks like it might, you have a very easy out, and can do all sorts of things. No 'golden handcuffs' for you!
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